Unit IV Exam: Vertebral Column, Abdomen, and Perineum

spinal motions can be limited by…

pain, spinal fusions, size and compressibility of the intervertebral discs, tight joint capsule or muscle, ligament laxity, orientation of the facet joints

the vertebral column is made up of…

7 cervical vertebrae

12 thoracic vertebrae

5 lumbar vertebrae

5 fused sacral vertebrae

4 fused coccyx vertebrae

what is the importance of the curvature of the spine?

it helps to recieve the forces from gravity

discuss the curvature of the spine.

thoracic and sacral kyphosis: the spine concaves anteriorly. these are primary curves because they are present at birth.

cervical and lumbar lordosis: the spine concaves posteriorly. these are secondary curvatures as they form from infancy as we begin to hold our head, stand, and walk against gravity

what are the parts of a typical vertebrae?

vertebral arch: the collection of the pedicle, trasnverse process, lamina, and spinous process that serve as attachment points for muscles and vertebral articulations

vertebral body: weight bearing part that increases in size as the spine descends

pedicle: attaches the transverse process to the vertebral body

transverse process: a lateral extension from the union of the pedicle and lamina

lamina: connects the transverse process to the spinous process

spinous process: posterior extension from the union of the two lamina

vertebral foramen: triangular forament formed from the vertebral body and arch

what makes up the anterior spine?

vertebral body and intervertebral discs

what makes up the posterior spine?

vertebral canal: the collection of the vertebral foramina when the bodies are stacked, where the spinal cord runs through

superior articular process: articulates with the inferior articular process of the vertebrae above

inferior articular process: articulates with the superior articular process of the vertebrae below

vertebral notches: superior and inferior notches on the vertebrae above and below that form the intervertebral foramen

intervertebral foramen: formed by the vertebral notches and provide lateral openings for the spinal nerve roots and vessels to travel out from the spinal cord to the body.

what is unique about the cervical spine?

• there is no intervertebral disk between C1 and C2

• there is an addition of the transverse foramen where the vertebral arteries pass through. this helps protect them as they make their way to the groove of the posterior arch towards the forament magnum.

• the facets are diagonal (roller coaster hands) which allows for flexion/extension, and rotation combined with lateral flexion

• have uncinate processes which are superior extensions off the vertebral body that create a “cup” for the vertebral body above to sit in and create stability

• have uncovertebral joints that are formed from the articulation of the uncinate process and the intervertebral disk. with aging, our intervertebral discs degenerate and lose height causing the uncinate processes above and below to bump together. this causes fusion of the uncovertebral joints and loss of lateral flexion

what makes up the upper cervical spine?

atlas and axis

what is unique about the atlas?

• it supports the weight of our head

• it lacks a spinous process or vertebral body, so it just forms a ring

• the occipital condyles of the skull articulate with the superior articular surface of the atlas

• the anterior tubercle provides attachment for the anterior longitudinal ligament.

• the posterior tubercle provides attachment for the nuchal ligament

• has the facet for dens which sits posterior to the anterior tubercle

what is unique about the axis?

• it is the location of cervical rotation

• has a vertebral body and bifid spinous process

• the dens extends superiorly from the vertebral body and serves as a pivot for which rotation can occur around the facet for the dens on C1. the anterior surface of the dens articulates with the posterior aspect of the anterior arch of that atlas

• the superior articular facet articulates with the inferior articular surface of the atlas

• it is the strongest cervical vertebrae

what is the atlanto-occipital joint?

the articulation between the occipute and C1 where cervical flexion and extension occur without having to move the lower cervical spine

what is the atlanto-axial joint?

the articulation between the atlas (C1) and axis (C2) where 50% of all cervical rotation occurs.

what is unique about the lower cervical spine?

• made up of C3-C7

• have large triangular vertebral foramen to make room for the cervical enlargement of the spinal cord

• have narrow intervertebral foramina which put the nerve roots at risk of compression

• C3-C6 have short bifid spinous processes

• C6 is long but has a bifid spinous process

• C7 is long but does not have a bifi spinous process

what is unique about the thoracic spine?

• heart shaped bodies with costal facets on the vertebral body (super and inferior) and the transverse processes for rib articulation

• smaller vertebral foramen which means a smaller vertebral canal which supports stability

• long transverse and spinous processes. the spinous processes overlap due to their inferior angle which provides protection so theres no cracks for things to get into the vertebral canal

• facets in the frontal plane that limit flexion/extension but allow for rotation and lateral flexion

what is unique about the lumbar spine?

• has the largest vertebral bodies which allows them to bear weight of the body

• larger vertebral foramen to provide room for the lumbosacral enlargement.

• short and strong spinous processes

• long transverse processes

• facets in the sagittal plane that allow for good flexion and extension

what is unique about the sacrum and coccyx?

sacrum:

• wedge shaped which creates stability and transmits force to the pelvis

• 4 pairs of anterior and posterior sacral foramina that provide space for the posterior and anterior rami to go out from the spinal cord to the body.

• sacral hiatus at L5 which serves as an opening for the sacral canal

coccyx:

• Co1 is not fused but Co2 to Co4 are

• has no pedicles, laminae, or spines

what are the upper cervical ligaments and their importance?

overall,  the provide stabalization of the dens and atlanto-axial joint

alar ligaments: run diagonally and attach to the occipute and dens to limit cervical rotation

cruciform ligament: consists of the superior longitudinal band, transverse ligament of atlas, and inferior longitudinal band. It forms a cross and articulates with the posterior articular facet of the dens to support it.

if lax due to rheumatoid arthritis, down syndrome, or trauma, the joint could become losse and the dens could drift back into the canal during movement and pinch the spinal cord

what are the ligaments of the cervical spine and their importance?

posterior longitudinal ligament: runs directly behind the vertebral bodies and becomes the tectorial membrane at C2 which attaches to the occipital bone and blends into the dural matter. very thick here and helps resist excessive cervical flexion

nuchal ligament: a broad expansion of the supraspinous ligament that is attached to the spinous processes and limits cranial and cervical flexion

what is the importance of the ligamentum flavum?

• it runs the length of the spine connecting the lamina of the vertebrae above and below

• limits excessive flexion

• has elastic properties that allow it to stretch and store energy during flexion in order to assist in going back into extension

• overtime, if sedentary, it becomes thicker and takes away space from the spinal cord

what are the lumbosacral ligaments and their importance?

anterior longitudinal ligament: runs the length of the vertebral bodies anteriorly to limit extension and very thick to reinforce the discs anteriorly

supraspinous ligament: rope like, traveling the length of the spine along the spinous processes and becomes the nuchal ligament at the cervical spine. resists excessive flexion

interspinous ligament: found between the spinous processes and resists excessive flexion

posterior longitudinal ligament: runs along the posterior aspect of the vertebral bodies. its job is to provide posterior and lateral support for the intervertebral discs but it becomes narrow in this region so it doesn’t do this well. instead, this area is at risk for posterior herniations.

what are the joints of the spine?

facet joints: the articulations between the superior and inferior articular processes of the vertebral bodies to allow for gliding and sliding motion

intervertebral joints: makes a sandwhich…

1. vertebral body

2. end plate of hyaline cartilage

3. intervertebral disc

4. end plate of hyaline cartilage

5. vertebral body

what is the structure of the intervertebral disc that allows it to be a good shock absorber?

annulus fibrosus: an oblique layer of fibers that resists compression and shear force to provide stability

nucleus palposus: strong and sturdy while still being disorganized due to its water loving collagen formation. 

how does the intervertebral disc get its nutrients while being avascular?

when the spine is compressed, it creates pressure which pushes fluid out of the nucleus palposus and along with that fluid is waste. then, when the spine is decompressed, fluid and nutrients can be absorbed back into the disc.

this explains why walking helps treat disc pathologies as the spine is constantly compressed and decompressed. this also explains why when first waking up, back pain is often worse because the spine is staying decompressed so waste is not being pushed out

what are the attachements, function, and innervation of the rectus anterior capitus m?

O: base of skull, anterior to occipital condyle

I: lateral mass C1

A: head flexion

I: anterior rami C1-C2

what are the attachements, function, and innervation of the rectus lateralis capitus?

O: jugular process of occipital bone

I: transverse process of C1

A: lateral head flexion

I: anterior rami C1-C2

what are the attachements, function, and innervation of the longus capitus?

O: basilar part of occipital bone

I: transverse process of C3-C6

A: flexes head

I: anterior rami C1-C3

what are the attachements, function, and innervation of the longus colli?

O: C3-T3 vertebrae, transverse processes of C3-C5

I: C2-C4 vertebrae, transverse processes C3-C6, anterior tubercle C1

A: cervical flexion and rotation, cervical and thoracic lateral flexion

I: anterior rami C2-C8

what are the attachements, function, and innervation of the anterior scalene?

O: transverse processes C3-C6

I: 1st rib

A: elevate 1st rib, lateral neck flexion, neck flexion

I: anterior rami C5-C8

what are the attachements, function, and innervation of the middle scalene?

O: transverse processes C2-C7

I: 1st rib

A: elevate 1st rib, lateral neck flexion

I: anterior rami C3-C7

what are the attachements, function, and innervation of the posterior scalene?

O: transverse processes C4-C6

I: 2nd rib

A: elevate 2nd rib, lateral neck flexion, neck flexion

I: anterior rami C5-C8

what are the attachements, function, and innervation of the sternocleidomastoid?

O: anterior manubrium, medial 1/3 clavical

I: mastoid process

A: flex head, elevate thorax, rotate head

I: spinal accessory nerve (CN XI)

what are intrinsic vs extrensic muscles of the spine?

extrensic: attach to the spine and a limb

intrinsic: attach from one part of the spine to another

what are the attachements, function, and innervation of the trapezius?

O: superior nuchal line, nuchal ligament, spinous processes of thoracic vertebrae

I: scapula

A: cervical and thoracic extension, lateral flexion, contralateral rotation

I: accessory nerve (CN XI)

what are the attachements, function, and innervation of the latissimus dorsi?

O: thoracolumbar fascia, iliac crest, spinous processes T7-T12

I: bicipital groove

A: raise the trunk toward the limbs, thoracic and lumbar extension, ipsilateral trunk lateral flexion

I: thoracodorsal nerve

what are the attachements, function, and innervation of the levator scapulae?

O: transverse processes C1-C4

I: superior angle and medial border of scapula

A: cervical extension, ipsilateral rotation, lateral flexion

I: dorsal scapular nerve (C5)

what are the attachements, function, and innervation of the rhomboids?

Major:

O: spinous processes T2-T5

I: medial border below scapular spine

Minor:

O: nuchal ligament, spinous process C7-T1

I: medial border above scapular spine

A: indirectly assists with thoracic extension

I: dorsal scapular nerve (C5)

what are the attachements, function, and innervation of the serratus posterior superior?

O: nuchal ligament, spinous processes C7-T3

I: ribs 2-5

A: secondary extrensic respiratory muscle by elevating the ribs

I: intercostal nerves

what are the attachements, function, and innervation of the serratus posterior inferior?

O: spinous processes T11-L2

I: ribs 9-12

A: depress ribs to serve as secondary extrensic respiratory muscle

I: intercostal nerves

what are the attachements, function, and innervation of the splenius capitus?

O: spinous processes C7-T4

I: mastoid process

A: extend head, lateral head flexion, ipsilateral head rotation

I: dorsal rami C2-C3

what are the attachements, function, and innervation of the splenius colli?

O: spinous processes T3-T6

I: transverse processes C1-C3

A: extend head, lateral head flexion, ipsilateral head rotation

I: dorsal rami C4-C6

what is the function and innervation of the erector spinae?

A: extend and laterally flex vertebral column and head

I: dorsal rami spinal nerves

what are the main differences between the 3 erector spinae muscles?

iliocostalis:

• most lateral

• most prominant in the lumbar spine

longissimus:

• middle muscle

• most prominent in lumbothoracic spine

spinalis:

• most medial

• most prominant in cervical spine

what is unique about the deep back muscles?

they are segemental, spanning only 1 or 2 vertebral segments to provide stability and mobility

what is the function and innervation of the semispinalis cervicus and colli?

found along the cervical and thoracic spines

A: extend the neck, head, and thorax, contralteral rotation

I: dorsal rami spinal nerves

what are the attachments, function and innervation of the multifidus muscles?

found along the thoracic and lumbar spine

O: spinous processes C2-L5

I: superior articular processes C4-C7, transverse processes T1-T12, L1-L5 vertebrae, sacrum

A: stabalize the spine

I: dorsal rami spinal nerves

what is the function and innervation of the rotatores longi colli, breves colli, longi thoracis, and brevis thoracic?

found along the cervical and thoracic spines

A: stablize, extend, and rotate the cervical and thoracic spines

I: dorsal rami spinal nerves

what is the function and innervation of the levatores costarum, breves costarum, and longi costarum?

found along the thoracic spine

A: elevate the ribs

I: dorsal rami spinal nerves

what are the attachments, function and innervation of the quadratus lumborum?

O: 12th rib, transerve process L1-L4

I: iliac crest

A: extend and laterally flex lumbar spine

I: anterior rami T12-L1

where is the suboccipital triangle found?

deep to the trapezius, semispinalis capitus, and  splenius capitus; running from the base of the occipute to C2

what makes up the subocciptal triangle?

obliquus capitus inferior: attaches to spinous process of C2 and the transverse process of C1 to form the inferior border

rectus capitus posterior major: runs from spinous process of C2 to the occipute to from the superior medial border

obliquus capitus superior: runs from the transverse process of C1 to the occiput to form the superior lateral border

what is found in the occipital triangle and what is its importance?

• it is a powerful head extensor and rotator

• suboccipital nerve runs through it and greater occipital nerve runs over it and under the semispinalis and splenius capitus. also the vertebral artery runs through it.

• bc of the small space and nerves running through here, it is often a site of headaches

what is the referral pattern of the C2-C3 facet joint?

posterior head and base of skull

what is the referral pattern of the C3-C4 facet joint?

posterior base of skull and neck

what is the referral pattern of the C4-C5 facet joint?

neck and posterior triangle

what is the referral pattern of the C5-C6 facet joint?

lower neck, upper back extending lateral from shoulder

what is the referral pattern of the C6-C7 facet joint?

upper back, extending lateral to shoulder and scapular region

what is the referral pattern of the L1-L5 facet joint?

lumbar region extending lateral flank

what is the referral pattern of the L2-S1 facet joint?

lower lumbar and gluteal region, lateral thigh

what is the referral pattern of the L3-S1 facet joint?

posterior thigh, anterior thigh, and groin

what is the dermatome and myotome linked to C2 nerve root?

dermatome: suboccipital

myotome: upper cervical extension

what is the dermatome and myotome linked to C3 nerve root?

dermatome: subclavicular fossa

myotome: cervical lateral flexion

what is the dermatome and myotome linked to C4 nerve root?

dermatome: upper trapezius

myotome: spapular elevation

what is the dermatome, myotome, and DTR linked to C5 nerve root?

dermatome: lateral antecubital fossa

myotome: shoulder abduction

DTR: biceps, brachioradialis

what is the dermatome, myotome, and DTR linked to C6 nerve root?

dermatome: thumb

myotome: elbow flexion, wrist extension

DTR: biceps, brachoradialis, triceps

what is the dermatome, myotome, and DTR linked to C7 nerve root?

dermatome: 3rd digit

myotome: elbow extension, wrist flexion

DTR: triceps

what is the dermatome and myotome linked to C8 nerve root?

dermatome: 5th digit

myotome: thumb extension, finger flexion

what is the dermatome and myotome linked to T1 nerve root?

dermatome: medial anatecubital fossa

myotome: finger abduction

what is the dermatome and myotome linked to L1 nerve root?

dermatome: upper anterior thigh

myotome: hip flexion

what is the dermatome, myotome, and DTR linked to L2 nerve root?

dermatome: mid anterior thigh

myotome: hip flexion

DTR: patellar

what is the dermatome, myotome, and DTR linked to L3 nerve root?

dermatome: medial femoral condyle

myotome: knee extension

DTR: patellar

what is the dermatome, myotome, and DTR linked to L4 nerve root?

dermatome: medial malleolus

myotome: dorsiflexion

DTR: patellar

what is the dermatome and myotome linked to L5 nerve root?

dermatome: dorsum of great toe

myotome: great toe extension

what is the dermatome, myotome, and DTR linked to S1 nerve root?

dermatome: lateral malleolus or heel

myotome: plantarflexion

DTR: achilles

what is the dermatome, myotome, and DTR linked to S2 nerve root?

dermatome: popliteal fossa

myotome: toe flexion

DTR: achilles

what causes referred pain and discrimination of touch?

each vertebar has 4 facet joints— right superior and inferior, left superior and inferior. therefore, the nerve must divid to go between both to get to the spinal cord. this means the same segment goes to 2 different roots. for example, L4/L5 facet gives info to L4 and L5 nerve roots

what are osteophytes and what can be caused from them?

osteophytes are boy growth of the articular processes of the facet joint that can impinge the nerve root. this can only be treated with surgery

what is intracapsular swelling and what can it cause?

the articular cartilage becomes degenerated along with synovial inflamation or capsular swelling that results in referred pain and pinches the nerve root. this should get better with treatment by reducing inflammation

what is disc protrusion vs disc herniation?

protrusion: bubble, expansion, or deformity of the disc as a result of a weak or partial tear of the annulus fibrosus

herniation: complete tear of the annulus fibrosus allowing the nucleus pulposus to come out posteriorly or laterally into the spinal canal. this can impinge on the nerve root or cauda equina

what makes up the superior border of the bony frame for the abdominal can?

anterior: inferior aspect of false rib

posterior: T12

roof: diaphragm

what makes up the inferior border of the bony frame for the abdominal can?

anterior: ASIS and AIIS

posterior: lumbar spine

lateral: iliac crest

what is the importance of the abdominal can?

these muscles work together to produce coordinated movement to provide stability for functional movements and support viscera

what is the roof of the abdominal can and its attachments, action, and innervation?

diaphragm

O: xihpoid process, costal cartilage ribs 7-12, L1-L3 vertebrae

I: central tendon

A: descends during inspiration

I: phrenic nerve (C3, C4, C5)

what makes up the anterior wall of the abdominal can?

external oblique, internal oblique, transverse abdominis, rectus abdominis

what are the attachements, function, and innervation of the external oblique?

O: ribs 5-12

I: linea alba, pubic tubercle, iliac crest

A: flex and rotate trunk

I: anterior rami spinal nerves

what are the attachements, function, and innervation of the internal oblique?

O: thoracolumbar fascia, iliac crest

I: ribs 10-12, linia alba, pubic crest

A: flex and rotate trunk

I: anterior rami spinal nerves

what are the attachements, function, and innervation of the transverse abdominis?

O: costal cartilage ribs 7-12

I: thoracolumbar fascia, iliac crest

A: compress and support abdominal viscera

I: anterior rami T7-L1

what are the attachements, function, and innervation of the rectus abdominis?

O: pubic crest, pubic symphesis

I: costal cartilage ribs 5-7, xiphoid process

A: flex trunk, compress viscera

I: anterior rami T7-T12

what muscles make up the posterior wall of the abdominal can?

latissiums dorsi, erector spinae, quadratus lumborum, mutifidus, psoas major, psoas minor, iliacus

what are the attachements, function, and innervation of the psoas major?

O: anterior lateral T12-L5, transverse processes L1-L5

I: lesser trochanter

A: trunk flexion and lateral flexion

I: ventral rami L1, L2

what are the attachements, function, and innervation of the psoas minor?

O: anterior lateral T12-L1

I: ilipectineal emminence

A: flex pelvis on vertebral column

I: ventral rami L1, L2

what are the attachements, function, and innervation of the iliacus?

O: superior 2/3 iliac fossa, iliac crest, anterior SI ligament

I: lesser trochanter via tendon of psoas major

A: indirectly causes anterior pelvic tilt which promotes lumbar extension

I: femoral nerve

what muscles make up the floor of the abdominal can?

piriformis, obterator internus, coccygeus, levator ani

what are the attachements, function, and innervation of the piriformis?

O: anterior sacrum
I; greater trochanter

A: stabalize SI joint, support lumbar posture

I: nerve to the piriformis

what are the attachements, function, and innervation of the obterator internus?

O: pelvic aspect obterator membrane, pelvic bones

I: greater trochanger

A: external rotation, hip abduction when flexed

I: nerve to obterator internus

what are the attachements, function, and innervation of the coccygeus?

O: ischial spine

I: inferior sacrum, coccyx

A: supports viscera

I: nerve to coccygeus

what are the attachements, function, and innervation of the levator ani?

O: body of pubis, ischial spine

I: perineal body, coccyx, walls of prostate or vagina

A: supporst pelvic viscera, elevates pelvic floor

I: nerve to levator ani, perineal nerve

what forms the superficial abdominal wall?

external obliques: have a fiber direction goind medially and inferiorly which matches the fiber direction of the serratus anterior and external intercostals

rectus sheath: covers the rectus abdominus and is formed anteriorly by the tendinous part of the external obliques

linea alba: the thickening of the rectus sheath that serves as an anterior point of attachment for the abdominal muscles. rapid weight gain or organ dysfunction can weaken the linea alba due to increased presure and separate it, known as diastesis recti

what forms the intermediate abdominal wall?

internal obliques: the superior and medial fibers run superiorly while the inferior fibers run horizontally

rectus sheath: here the tendinous part of the internal obliques is contributing to the anterior and posterior part of the sheath

rectus abdominis: running vertically with tendinous intersections that tether and stabalize the muscle

what forms the deep abdominal wall?

transverse abdominis: runs horizontally and contributes to the posterior aspect of the rectus sheath above the arcuate line

arcuate line: the height of the iliac crest. above the line, there is both an anterior and posterior rectus sheath. below the line there is only an anterior rectus sheath. while this is important for wllowing vessels to get to reproductive organs, it means this area is weaker which increases risk for hernias