anatomy neck and trunk
cervical protraction
Conversely, extending the head on C1 and flexing the neck (C2-C7) would be cervical protraction. Relaxed forward head posture, or looking at a computer screen through bifocals tends to accen- tuate cervical protraction. "Standing up straight" emphasizes cervical retraction.
Intervertebral Discs
Cushionlike pad composed of two parts Nucleus pulposus- Inner gelatinous nucleus that gives the disc its elasticity and compressibility Annulus fibrosus- Outer collar composed of collagen and fibrocartilage
Joint Motions
Flexion/extension/hyperextension Lateral bending Rotation Cervical protraction/retraction axial extension =cervical retraction
Transverse foramen
Holes or openings in the transverse process of the cervical vertebra through which the vertebral artery passes
internal oblique muscle
Located deep to the external oblique muscle and running at right angles to the external oblique muscle is the internal oblique muscle. It originates from the inguinal ligament, iliac crest, and thoracolumbar fascia.
Prevertebral group
Longus colli A: Flex ___neck__ Longus capitis A: Flex __head__ Rectus capitis anterior A: Flex ____head_____ Rectus capitis lateralis A: Lateally flex ___laterally bend head____
what area of the body is most often injured?
Lumbar spine because it absorbs the majority of our body weight and any weight we carry.
Sternocleidomastoid
O: Sternum and clavicle I: Mastoid process A: Bilaterally: flexes neck and hyperextends the head Unilaterally: laterally bends neck and rotates the face to the opposite side N: Spinal accessory (CN XI)
Scalenes
O: Transverse processes of cervical vertebrae I: 1st and 2nd ribs A: Bilaterally: Assist neck flexion Unilaterally: Neck lateral bending N: Lower cervical nerves
Suboccipital Group
Obliquus capitis superior Rectus capitis posterior minor A: extend the head Obliquus capitis inferior Rectus capitis posterior major A: Extension, lateral bending, rotation to the same side
Boney landmarks of skull and vertebrae
Occipital bone Occipital protuberance Nuchal line Basilar area Foramen magnum Occipital condyles Temporal bone Mastoid process
axial extension or cervical retraction
Tucking your chin in involves the head flexing on C1, as well as neck extension (C2-C7). This com- bined motion is sometimes referred to as axial extension or cervical retraction.
Cervical Vertebrae?
________________(C2) Dens projects superiorly into the anterior arch of the atlas _________ is a pivot for the rotation of the atlas
Cervical Vertebrae
_________________(C1) No body or ____________________ process Consists of anterior and posterior arches Two lateral masses Superior surfaces of lateral masses articulate with the occipital condyles
Lumbar Vertebrae?
________________________ Short, thick pedicles and laminae Flat hatchet-shaped spinous processes Location of articular facets allows for flexion and extension (______________ plane)
Thoracic Vertebrae?
_________________________________ All articulate with ribs at facets and demifacets Long spinous process (________________) Location of articular facets allows for rotation and side bending (_____________ plane)
Thoracic outlet syndrome
general term referring to compression of the neurovascular structures (brachial plexus and subclavian artery and vein) that run from the neck to the axilla. The thoracic outlet is located between the first rib, clavicle, and scalene muscles.
supraspinal ligament
extends from the seventh cervical vertebra distally to the sacrum posteriorly along the tips of the spinous processes.
facet
facet is a small, smooth, flat surface on a bone. Fac Also called costal facets, they are located superiorly and inferiorly on the sides of the bodies and on the transverse processes of thoracic vertebrae
facet joint
facet joint is the articulation between the superior articular process of the vertebra below with the inferior articular process of the vertebra above
Cervical sprains
occur when the head suddenly and violently hyperextends and then flexes. "Whiplash" is the layman's term for this condition.
Herniated disks
occur when there is a weakness or degeneration of the annulus fibrosus (outer layer). This allows a portion of the nucleus pulposus to bulge, or herniate through the annulus.
Unstable fractures, or fractures with dislocation
usually result in spinal cord injury and paralysis.
Spondylolisthesis
usually the result of a fracture, or giving way, of the defect in the pars interarticularis. The result is that one vertebra slips forward in relation to an adjacent vertebra, usually L5 slipping anterior on S1.
suboccipital muscles
are clustered together below the base of the skull and move only the head
iliocostalis muscles
are the most lateral group and primarily attach to the ribs posteriorly. Superiorly, they attach to transverse processes, and inferiorly they attach to the sacrum and ilium
Osteoporosis
meaning porous bone, is a disease in which bone is removed faster than it can be laid down. This results in a decrease in bone mass and density, making the bone more prone to fracture.
Spinal stenosis
narrowing of the vertebral canal housing the spinal cord. It is also possible to have stenosis of the intervertebral foramen through which the nerve roots pass.
Compression fractures
typically result in collapse of the anterior (body) portion of the vertebrae. They are usually caused by trauma in the lumbar region, and by osteoporosis in the thoracic region. This type of fracture does not commonly cause spinal cord damage and paralysis because the fracture is usually stable.
Demifacet
(In Latin demi means "half.") A partial, or half facet; located laterally on the superior and inferior edges of the vertebral body where ribs articulate with thoracic vertebrae. Depending on rib placement on the body, a facet or demifacet may be found on these edges.
Torticollis
(from the Latin tortus, meaning twisted and collum, meaning neck) is a deformity of the neck in which the person's head is laterally bent to one side and rotated toward the other side. It is also known as "wry" (twisted) neck
Spondylosis
(spinal osteoarthritis), is a degenerative disorder of the vertebral structure and function. It may result from bony spurs, thickening of ligaments, and a decrease in disk height due to a decrease in water content of the nucleus pulposus.
how many bones are in the skull
21
hangman's fracture
A fracture involving C2, commonly called a typically occurs when there is a forceful, sudden hyperextension of the head. Striking the head against the windshield in a motor vehicle acci- dent often provides the necessary mechanism. This is usually a stable fracture, but without proper care and handling, it could become unstable.
Dens
Also called the odontoid process; large vertical projection located anteriorly on the axis. Cervical rotation occurs through its articulation with the atlas.
C7
Also known as vertebra prominens because of its long and prominent spinous process. It resembles a thoracic vertebra and can be easily palpated with the neck in flexion.
Muscles of the Neck and Trunk list
Anterior Sternocleidomastoid Scalenes Prevertebral group Posterior Splenius capitis Splenius cervicis Suboccipital group
scoliosis
Any amount of lateral curve is a pathological condition known as scoliosis.
Bones and Landmarks of Vertebrae
Body Neural arch Vertebral foramen Pedicle Lamina Transverse process Vertebral notches Intervertebral foramen Articular process Spinous process
vertebrae
Body Neural arch Vertebral foramen Pedicle Lamina Transverse process Vertebral notches Intervertebral foramen Articular process Spinous process
Vertebral Column: Curvatures
Increase the resilience and flexibility of the spine Two posteriorly concave curvatures (lordotic) ____thoracic and sacral Two posteriorly convex curvatures (kyphotic) ____cervical and lumbar
Ligaments
Intervertebral articulations Anterior/posterior longitudinal ligaments posterior longitudinal ligament Interspinal ligament supraspinal ligament Ligamentum flavum
ligamentum nuchae (nuchal ligament)
It's very thick takes the place of the supraspinal and interspinal ligaments in the cervical region
Quadratus Lumborum
O: Iliac crest I: 12th rib & transverse processes L1-L5 A: Trunk lateral flexion N: T12-L1 nerves
Internal Oblique
O: Iliac crest & thoracolumbar fascia I: 10-12 ribs & abdominal aponeurosis A: Trunk flexion, ipsilateral bending, ipsilateral rotation N: Intercostal nerves
Transverse Abdominus
O: Iliac crest, thoracolumbar fascia & last 6 ribs I: Abdominal aponeurosis & linea alba A: Compression of abdomen N: Intercostal nerves
External Oblique
O: Lower eight ribs laterally I: Iliac crest and linea alba A: Trunk flexion, ipsilateral bending, contralateral rotation N: Intercostal nerves
Rectus Abdominus
O: Pubis I: Xiphoid process & costal cartilages of ribs 5-7 A: Trunk flexion & compression of abdomen N: Intercostal nerves
Splenius Cervicis
O: Spinous processes T3-T6 I: Transverse processes C1-C3 A: Bilaterally: Extend neck Unilaterally: Rotate & laterally flex the neck the same direction N: Middle & lower cervical nerves
Splenius Capitis
O: Spinous processes of C7-T3 I: Mastoid process A: Bilaterally: Extend head & neck Unilaterally: Rotate & laterally flex the face the same direction N: Middle & lower cervical nerves
Muscles of the Neck and Trunk (posterior)
Trunk: Anterior surface Rectus abdominus External oblique Internal oblique Transverse abdominus
Rotation
Rotation occurs in the transverse plane around a vertical axis, except between the skull and the atlas (C1). Alignment of the facet joints will greatly determine the amount of rotation and other motions possible.
transversospinalis (transverse spinal) muscle group
Rotatores spans 1 vertebra Semispinalis spans 5+ vertebrae Multifidus spans 2-4 vertebrae A: Bilaterally: Extend neck and truck Unilaterally: Rotate neck and truck opposite
rectus abdominis muscle
Spanning the anterior trunk in the midline is the rectus abdominis muscle. The two sides are separated from each other by the linea alba. The rectus abdominis muscle arises from the crest of the pubis and inserts into the costal cartilages of the fifth, sixth, and seventh ribs.
erector spinae muscles,
Spinalis muscle group Iliocostalis muscle group Longissimus muscle group A: Bilaterally: Extend neck and truck Unilaterally: Laterally flex neck and truck
Muscles of the Neck and Trunk
Trunk: Posterior surface Erector spinae muscles Transversospinalis muscles Trunk: Midline Quadratus lumborum muscle
Anterior arch
The anterior portion of C1.
atlanto-occipital joint
The articulation between the head and C1 (atlas). Main motion here is flexion and extension. Example: nodding your head yes
atlantoaxial joints
The articulations between the atlas and the axis are known as the atlantoaxial joints,
Atlas (C1)
The first cervical vertebra upon which the cranium rests. It is named after the Titan in Greek mythology who held up the Earth because it supports the globe of the head. The atlas is ring-shaped and has no body or spinous process.
longissimus muscle group
The intermediate muscles, the longissimus muscle group, are located lateral to the spinalis muscle group, attaching the transverse processes from the occiput to the sacrum. These muscles have a vertical line of pull lateral to the midline and, therefore, laterally bend when contracting unilaterally and extend when contracting bilaterally.
the sternocleidomastoid muscle
The largest flexor, is a long, superficial, straplike muscle originating as two heads from the medial aspect of the clavicle and superior end of the sternum
spinalis muscle group
The most medial group is the spinalis muscle group that primarily attaches the nuchal ligament and spinous processes of the cervical and thoracic vertebrae. The portion of this group that attaches to the occiput also attaches to the transverse processes of the cervical vertebrae. Located in the midline, these muscles are prime movers in trunk extension.
splenius capitis and splenius cervicis muscles
The most superficial of the neck extensors are the splenius capitis and splenius cervicis muscles. As their names imply, they attach to the head and cervical spine with the splenius capitis muscle being the more superficial of the two.
Axis (C2)
The second cervical vertebra is so named because it forms the pivot upon which the atlas (C1), supporting the head, rotates.
lateral atlantoaxial joints
The two lateral atlantoaxial joints are between articular processes of the two vertebrae
triaxial
The vertebral column as a whole is considered to be triaxial. Therefore, it has movement in all three planes. Flexion, extension, and hyperextension occur in the sagittal plane around a frontal axis.
Common Pathologies
Torticollis Scoliosis Herniated disk Osteoporosis Compression fracture
Vertebral Column
Transmits weight of trunk to lower limbs Surrounds and protects ___spinal cord Flexible curved structure containing 26 irregular bones (vertebrae) Cervical vertebrae (__7_)—vertebrae of the neck Thoracic vertebrae (_12_)—vertebrae of the thoracic cage Lumbar vertebrae (_5_)—vertebra of the lower back Sacrum—bone inferior to the lumbar vertebrae Coccyx—bottom of the vertebral column
Flat back
abnormally decreased lumbar curve.
Lordosis
abnormally increased curve of the lumbar spine. The layman's term is swayback
Kyphosis
abnormally increased thoracic curve.
lateral bending
also called side bending or lateral flexion, occurs in the frontal plane around a sagittal axis.
prevertebral muscles
anterior group of muscles. They are located deep and run along the anterior portion of the cervical vertebrae.These muscles have a role in flexing either the neck or head.
Three parts of scalene muscles
anterior scalene muscle originates on the transverse processes of C3 through C6 and inserts into the superior surface of the first rib. The middle scalene muscle originates on the transverse processes of C2 through C7 and inserts into the superior surface of the first rib also. The posterior scalene muscle, the smallest and deepest, originates from C5 through C7, and inserts into the second rib. Because they all perform the same action and are located close to each other, it is not necessary to differentiate between them.
Anklyosing spondylitis
chronic inflammation of the vertebral column and sacroiliac joints leading to fusion. It is a progressive rheumatic disease, and over time, can lead to a total loss of spinal mobility.
ligamentum flavum
connects adjacent laminae anteriorly.
median atlantoaxial joint
consists of a synovial articulation between the odontoid process (dens) of the axis and the anterior arch of the atlas anteriorly and the transverse ligament posteriorly
external oblique muscle
is a large, broad flat muscle lying superficially on the anterolateral abdomen. It originates laterally on the lower eight ribs, runs inferiorly and medially to insert into the iliac crest and, via the abdominal aponeurosis, into the linea alba at the midline.
Spondylolysis
is a vertebral defect in the pars interarticularis (the part of the lamina between the superior and inferior articular processes). This defect is most commonly seen in L5, and less commonly in L4.
Sciatica
is pain that tends to run down the posterior thigh and leg. It is caused when there is pressure on the sciatic nerve, which, in most cases, is symptomatic of an underlying pathology.
erector spinae group
postvertebral muscles located posteriorly along the vertebral column and are considered the superior portions of the deep back muscles
quadratus lumborum muscle
quadratus lumborum muscle is a deep muscle that originates from the iliac crest and runs superiorly to insert into the last rib and transverse processes of all lumbar vertebrae
The posterior longitudinal ligament
runs along the vertebral bodies posteriorly inside the vertebral foramen. Its purpose is to prevent excessive flexion. It is thick superiorly where it helps support the skull.
interspinal ligament
runs between successive spinous processes
anterior longitudinal ligament
runs down the vertebral column on the anterior surface of the bodies and tends to prevent excessive hyperextension. It is thin superiorly and thick inferiorly where it fuses to the sacrum.
transverse abdominis muscle
the deepest of the abdominal muscles is the trans- verse abdominis muscle lying deep to the internal oblique muscle.