Identify the following basic parts of the vertebrae and how they differ between specific Vertebrae:

A. Body

B. Pedicles

C. Laminae

D. Pars interarticularis

E. Spinous Process

F. Transverse Processes

G. Articular Processes

H. Sacral hiatus

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A. Axis has no body. Lumbar vertebrae are very large.

B.Link to the body

C. Link to the spinous process

D. Between the superior and inferior articular processes.

E.Bifid tips in Cervical

F. Have facets and demifacets in thoracic, and transverse foramen in cervical

G.Where vertebrae link and articulate

H. Indent at bottom of the saccrum where bodies of L4 and L5 should be (not shown)

1. Fibrous Joint

2. Interarticular Synovial Joint

3. Cartilaginous Joint

Supraspinous ligaments: run vertically along the spinous processes.

Interspinous ligaments: run between each spinous process.

Function: to limit ventral flexion

Fibrous joints

There are Posterior and Anterior Longitudinal ligaments. The Posterior Longitudinal ligaments make up the ventral side of the vertebral canal. The Anterior Longitudinal ligaments run along the ventral side of the body of the vertebrae.

The Longitudinal Ligaments prevent against hyperflexion of the spine.

Ligamentum Flavum = Posterior Atlanto-occipital membrane

Anterior Longitudinal Ligament = Anterior Atlanto-occipital membrane

Posterior Longitudinal Ligament = Tectorial Membrane

Where are the interarticular Synovial Joints?

In the three major regions what do these joints allow/prevent?

Interarticular Synovial Joints are located between the articular processes of the vertebrae

In the Cervical Region the horizontal orientation allows for movements in all directions, although rotation is limited

In Thoracic Region they are coronally oriented and allow for all movements (the ribs and sternum prevent all motion)

in the Lumbar region they are sagitally oriented and allow for flexion and extension (laterally as well) and rotation is limited.

Spondylolysis is a fracture of the pars interarticularis (generally a sports related injury).

Can lead to Spondylolithesis which occurs when L5 slips forward onto the body of S1.

These are the intervertebral discs which are made up of the:

1. Nucleus Pulposus - liquid-like central core made of glycoprotein

2. Annulus Fibrosis - Avascular fibrocartilage that is thickest anteriorly, and filled with nerve endings that respond to pain stimuli.

It transmits changes in compression forces.

As the nucleus in compressed water with waste is pushed out and with relaxation nutrients and water are pulled back into the nucleus.  (During sleep the discs become thicker because of the reabsorption of water)

Less water is located in older discs and therefore less nutrient waste exchange occurs.

The Annulus Fibrosis also changes with age - becoming more degenerative

When an intervertebral disc ruptures/bulges what direction will this occur most regularly?

What effect can this have on surrounding anatomical features?

Ruptures posteriolaterally (disc is thinner hear)

Because spinal nerves exit in this direction the disc can pinch the nerve. The affected nerve is the nerve that exits below the lower of the two vertebrae.

(So between L5 and S1 means the S1 nerve is affected)

Bulging Intervertebral discs

Arthritic Interarticular joints

Sore muscles and fascia

Sacroiliac joints

Metabolic problems (osteoporosis, diabetes)

A spinal nerve being pinched by a bulging disc.

You would want to check for pain that followed the dermatome for the nerve in question, as well as numbness.

Primary curvatures are permanent and established during development:

Thoracic

Sacral

Secondary curvatures are caused by pressure on the spinal chord:

Cervical

Lumbar

What are the medical names for:

1. Hunchback/Humpback

2. Inward bend of the lower back

3. Crooked back (laterally)

Who might experience these?

Humpback: Kyphosis (elderly)

Inward: Lordosis (pregnant)

Lateral: Scoliosis (females during development with poor posture)

Sacralization = L5 becomes part of sacrum

Lumbarization = S1 is not fused and is more like L6

Where do you perform a spinal tap/lumbar puncture on an adult? And why?

What will you have to puncture to reach this point?

Between L3 and L4

The spinal chord ends at L1 so between L3 and L4 you wont puncture the spinal chord but can still get CSF.

Puncture: Skin, Fascia, Skin, Erector Spinal Muscles

Interspinous ligament, Ligamentum Flavum, Dura mater and Arachnoid mater.

Note: an epidural does not require the last two be punctured.

Extrinsic or false muscles of the back arise from the hypaxial myotomes during development. These muscles migrate from the ventral side of the body and as such are served by ventral rami.

Intrinsic or true muscles of the back arise from the epaxial myotomes and are served by dorsal rami.

Superficial: trapezius, latissimus dorsi, serratus anterior

Deep: Rhomboids, levator scapulae, serratus posterior superior, serratus posterior inferior

1. Spinotransversocostal (splenius capitus & cervicis)

2. Erector Spinae (iliocostalis, longissimus, spinalis)

3. Transversospinalis (semispinalis, multifidus, rotatores)

4. Suboccipital Muscles

1. Taut Ligaments

2. Plane and Placement of Articular Facet Joints

3. Annulus Fibrosis and Intervertebral disc

4. Adequate Muscle Tone

What factors most directly influence the mobility of the spine?

1. Disc height:Vertebrae Height (the thicker the disc the more motion allowed)

2. Muscle Tone 

3. Ligament Tautness

4. Plane of Articulation of Synovial Joints

Lumbar - ileolumbar

Sacral - lateral sacral

Internal plexus - in vertebral canal

External plexus - located anteriorly and posteriorly to the vertebral canal

1. The Shoulder - attached to trunk
2. Proximal Segment (Brachium, Stylopodium)-Between Shoulder and Elbow
3. Intermediate Segment (Antebrachium, Zygopodium) - Between Elbow and Wrist
4. Distal Segment and Hand - Distal to wrist

Preaxial (Superior) = Lateral

Postaxial (Inferior)= Medial

What type of joints are the following joints of the upper limb?

1. Glenohumeral
2. Elbow Joint
3. Proximal and Distal Radioulnar Joints
4. Wrist
5. Digits
6. Metacarpophalangeal joint
7. Thumb/Pollex

1. Ball and Socket
2. Hinge
3. Pivot
4. Condyloid
5. Hinge
6. Condyloid
7. Saddle

Clavicle: attachment site for muscle. Transmits weight and force from the limb to the trunk (shock absorber)

Scapula: muscle attachment, protraction and retraction of the arm (slides on the trunk)

Together these bones protect nerves passing from the neck to the axilla.

Divides the limb into anterior (flexor, adductors, medial rotators) and posterior (extensor, abductors, lateral rotators) compartments.

Difference in pressure within the compartments may cause compartment syndrome.

Can act as a wick for infection

May entrap nerves

What muscles make up the Rotator Cuff?

Which is most often torn

Supraspinatus, Infraspinatus, Subscapularis, and Teres Minor

Supraspinatus

What are the main arteries in the following segments of the upper limb?

1. Proximal
2. Intermediate
3. Distal

1. Proximal: Subclavian becomes the Axillary which becomes the brachial
2. Radial and Ulnar
3. Superficial and Deep Palmar Arches which branch into Common palmar digital arteries

What are the veins that run through the following segments of the upper arm?

1. Proximal
2. Intermediate
3. Distal

1. Proximal: Subclavian (Preaxillary) becomes the Basilic (Post axillary), and the Cephalic
2. Intermediate: Subclavian and Basilic
3. Distal: Basilic Vein and Cephalic

Superficial lymphatic vessels run along the various veins (cephalic and basilic and their small branches)

Deep lymphatic vessels run along arteries

Drains are located at the elbow (trochlear) which drain into axillary nodes which in turn drain into the subclavian nodes/ducts.

Infected = Enlarged and painful

Neoplastic = hard, enlarged, and not painful

Collateral Circulation

Made possible by anastomoses

What four things are needed for a functional hand?

What is the ultimate function of the upper extremity?

1. Stability - Bones & Ligaments
2. Viability - Veins & Arteries
3. Sensibility - Nerves
4. Mobility - Muscles

To put the hand in desired place

What are the two main arteries of the arm?

Which provides blood to the superficial palmar arch?

Which provides blood to the deep palmar arch?

Radial (thumb side) - Deep palmar arch

Ulnar (Pinky) - superficial palmar arch

Which nerve(s) innervate the thenar muscles?

The Hypothenar muscles?

Thenar = thumb = Median

Hypothenar = pinky= Ulnar

Intrinsic = Wrist and hand

Extrinsic = Forearm

Anconeus

Supinator

Brachioradialis

extensor carpi radialis longus

extensor carpi radialis brevis

extensor carpi ulnaris

Extensor digitorum

Extensor digiti minimi

Extensor indici

extensor pollicus longus

extensor pollicus brevis

abductor pollicus longus

1. palmaris longus
2. flexor carpi radialis
3. flexor carpi ulnaris
4. pronator teres
5. flexor digitorum superficiale
6. flexor digitorum profundus
7. flexor pollicus longus

1. Median Nerve
2. Flexor Pollicus Longus
3. Flexor Digitorum Superficialus
4. Flexor Digitorum Profundus

abductor minimi

flexor digiti minimi

Opponens

Dorsal abduct

Ventral Adduct

1. Fibrous (suture of the skull)
2. Fibrocartilagenous (epiphysis, intervertebral)
3. Synovial

Hyaline cartilage

Synovium (1 cell layer thick - produce synovial fluid)

Capsule

Sternoclavicular

Acromio-clavicular

Acromio-humeral

acromioclavicular ligament

coracoclavicular ligament

1. Acromioclavicular ligament is stretched
2. Acromioclavicular ligament is broken but coracoclavicular ligament is attached
3. Both are separated

Glenohumeral fossa with glenohumeral labrum

Muscles

Ligaments

Humeral-ulnar

Humeral-radial

Radio-ulnar

Subluxation of the radius from the radial annular ligament.

Fixed by pronating/supinating arm