LE anatomy week 1

Three parts of aorta in order

1. Ascending aorta

2. Arch of the aorta

3. Descending aorta

Orientation and components of Aortic arch

Curves left, posterior, and downward

• Brachiocephalic trunk

  • R Subclavian + R common carotid

• L common carotid

• L subclavian

Arterial Circulation of LE

Abdominal aorta —> R + L common iliac arteries

R+L external and R+L internal iliac arteries

R+L external iliac arteries —> femoral arteries

Femoral artery —> Popliteal artery

Popliteal artery —> posterior + anterior tibial artery

Anterior tibial —> dorsalis pedis artery

arteries of the gluteal region (internal iliac)

Obturator artery

Internal pudendal artery

Superior gluteal artery

Inferior gluteal artery

Example of RUQ

Liver

Example of LUQ

spleen

Example of RLQ

Appendix

Example of LLQ

intestines

Orientation of thoracic vertebrae

90 degree facet joint orientation

What is the rule of 3

T1-T3 SPs are even with TPs

T4-T6 SPs are one half level below TPs of same level

T7-T9 SPs are one full level below TPs of same level

T10-T12 transition back to even.

Thoracic coastal facets

T2-T9 have ½ facets; share head of rib with adjacent vertebrae

Other T vertebrae have complete facets for head of rib

Rib motion during inhalation

Pump handle

• superior, anterior movement of sternum

• in sagittal plane

Bucket handle

• elevation of lateral shafts of ribs

• in frontal plane

Defect of pars interarticularis

Spondylolisis and sponylolisthesis

Additional processes of lumbar spine

mamillary process

accessory process

Laminectomy

Effective in reducing pain, but causes eventual pain through structural/vertebral instability

can be avoided through exercise (increased muscular support)

What is the site for lumbar fusion

Pedicles

What makes L5 unique

anterior body taller than posterior body- encourages lordosis

smaller spinous process

facets angled different to protect L5 from slipping anteriorly

properties of ligamentum flavum

yellow; a lot of elastic fibers

from foramina to foramina

hypertrophy of this can cause slackening in extension to compress SC

pars interarticularis

forced/explosive extension can cause fracture

also sidebend and rotation can do this

fracture of pars interarticularis

spondylolysis or spondylolisthesis

difference between spondylolisis and spondylolisthesis

spondylolysis: unilaterally

Spondylolisthesis: bilateral fracture; vertebrae can slide

L5 most common site (its load and shape)

Grade 1 (1-25%), Grade 2(25-50%), or Grade 3)(50%+)

Typical vertebral movement

Gapening of facet on same side as rotation

upglide and opening in flexion

what happens to faramen in stinosis

foramen becomes 8 shaped

L5 on MRI

disc is brighter because more fluid in nuclei

where does cauda equina start

L1-L2 typically

What view to look at spondys at pars interarticularis?

Oblique view

Ligaments of the spine

PLL: ANT to body, POST to SC: Tense in flexion

ALL:just POST. to Abd. aorta: slacked in flexion

LF: along midline, gap at midline:slacked in extension

Also interspinalis ligaments, supraspinous ligaments, and intertransverse ligaments (sidebend/rotation limiter)

Components of sacrum

ANT surface: inf. lat. angle as broad attachment

POST surface: sup. articular facets-help to prevent post. slide of L5

SI articular surface: rough-no movement

Hypo/hypermobility at si is painful|pregnant women experience hypermobility

Sacral ala (wings)

why is SI joint not torn/injured

Not synovial; no movement, supported by many ligaments

prehistoric tail

coccyx

Vertebral movement in flexion

ALL: relaxed

Discs: compressed anteriorly

PLL: Stretched

LF: Stretched

Inter+Supra spinal L: Stretched

upglide of superior articular processes on inferior

Scoliosis

Frontal plane curvature

structurally irreversible, functionally reversable

Cobb angle determines severity of curvature

Thoracic convexity R, Lumbar convexity L

10-24=mild

25-39=moderate

40+=severe

curvature changes occur most in puberty

Associated with other conditions

Scheuermann’s kyphosis/disease

kyphotic deformity in thoracic

congenital or aquired

peak below T7

sagittal plane curvature

does flexion worsen compressive symptoms

Yes

sacralization

L5 fused to sacrum

Lumbarization

S1 becomes like a L6; it’s not fused to sacrum