Advanced Anatomy 1, Week 1-2 Notes
Advanced Anatomy 1, Week 1-2 Notes ANAT 420
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This 14 page Class Notes was uploaded by Vivian Banh on Tuesday January 12, 2016. The Class Notes belongs to ANAT 420 at Drexel University taught by Dr. Haroian in Fall 2015. Since its upload, it has received 17 views. For similar materials see Advanced Anatomy 1 in Anatomy at Drexel University.
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Date Created: 01/12/16
1 September 22, 2015 Vertebral Column Superior inferior = vertebrae gets larger o The more inferior you go, the more weight vertebral column has to bear Sacrum is solid, forms joints with hip bone to make pelvic girdle Form anterior and posterior view, it will be a midline structure Intervertebral discs are made of fibrocartilage - serve as cushion and support between the adjacent vertebrae Posterior - Anterior View o Cervical and lumbar curve are in same direction Secondary curve imposed upon primary curve during development Cervical curve is imposed first and develops when babies can hold their head up on their own - around 3 months of age In opposite direction of primary curve Convex anteriorly and concave posteriorly Lumbar curve develops when babies can walk (9-16 months) o Thoracic and sacral curve are in same direction Part of primary curve fetal curve Primary curve is concave - anteriorly Convex - posteriorly Single curve in fetus Vertebra o Vertebral body is anterior o IV disc lies between vertebral body and bears the same shape as the body o Sitting on the body is a vertebral arch and the arch is formed by 2 features: Lamina - plate Pedicle - footlike process o 2 lamina and 2 pedicles form an arch that attaches to the body o The arch and body = vertebral foramen/vertebral canal Within the vertebral foramen is the spinal cord Spinal cord and vertebral column are not the same length Goes from IV disc to L1-L2 in an adult o Processes will help attach ligaments and muscles Spinous process attaches to the arch where the 2 lamina meet Located in the midline 2 transverse processes (in transverse plane)- attach to the arch at the point where lamina and pedicle meet Articular process involved with joints between adjacent vertebrae On each vertebra there will be 2 superior & 2 inferior articular processes An inferior of one vertebra and superior of another overlap to form a joint (bilateral) Facet Joint /Zygapophysial Joint o Classic synovial joint that accounts for movement between adjacent vertebra Flexion and extension, cumulative movement o IV discs form a joint between adjacent vertebrae o Opening on lateral side of vertebra = intervertebral foramen Paired - bilateral 2 Facet joint forms posterior boundary of the intervertebral foramen IV disc and body form the anterior boundary Superior and inferior boundaries are formed by pedicles, but the inferior vertebral notch ON the pedicle forms the superior boundary and vice versa Intervertebral foramen is important because spinal nerve exits through it. There are nervous tissues within this space. o Intervertebral disc made of fibrocartilage Annulus fibrosus is the fibrocartilage Concentric lamellae going in different directions to increase strength of collagen Fibrocartilage is the strongest due to collagen Nucleus pulposus is a gel-like cushion to help resist forces passed through vertebral column Cervical Atlas = C1 a. No body - Anterior arch instead i. Pedicle and lamina form Posterior Arch b. No spinous process o Superior articular facets of atlas articulate with occipital condyles of the occipital bone to form Atlanto-occipital Joint Flexion and extension in sagittal plane Axis = C2 o More typical cervical vertebra o Unique - Dens/Odontoid Process Projects from the body of the axis - projects form superior surface of the body Articulates with anterior arch of the Atlas Dens should have been body of the Atlas, however that piece of skeletal tissue attached to axis so that Atlas can rotate around Axis Transverse ligament Joint between dens and anterior arch of the Atlas is called the Median Atlantoaxial Joint Relative to this structure are two facet joints on either side In addition to this joint, there are 2 lateral Atlantoaxial Joint aka the facet joints Spinous process of C7 is the reason why it is called the vertebra prominens o Does NOT have bifid spinous process 3 C3-C6 are typical cervical vertebrae Typical o Smaller than thoracic and lumbar o Distinguishing characteristics: Bifid spinous process - definitely says it’s a cervical vertebra Transverse foramen - opening within transverse process Vertebral artery enters C6 foramen Magnum (associated with occipital bone) Vertebral artery is one of the arteries responsible for bringing arterial blood to brain All cervical vertebrae have transverse foramen (C1-C7) Thoracic Primary curve T1 is similar to C7 with the vertebra prominens Typically, body is heart shaped On transverse process there is a facet for articulation with a rib On body, there are superior and inferior demifacets that articulate with prospective ribs Distinguishing characteristic: o Facet for articular part of tubercle of rib Occasionally, there will be a cervical rib or a rib associated with L1 Spinous process is long, narrow and pointed inferiorly Lumbar (5) Largest vertebrae Secondary curve When baby is learning how to stand and walk Concave posteriorly & convex anteriorly Typical lumbar vertebrae o IV disc represents shape of the vertebral bodies o Spinous process o Transverse processes o Inferior and superior articular facets o Intervertebral foramen bilaterally Distinguishing characteristics: 1. Body is kidney shaped and IV disc bears the same shape 2. Spinous process is large and blunt – shaped like a quadrangle Cervical has bifid spinous process, thoracic is long, narrow and pointed inferiorly, and lumbar has a quandrangular spinous process Sacrum Sacrum and coccyx form a primary curve (convex posteriorly & concave anteriorly) 5 fused vertebra Important to pelvic girdle Broad, superior portion is called the base Inferior portion (S5) is called the apex Articulates with coccyx Lateral to base is the Sacral Ala (wing) Associated with base, the most anterior part protrudes and this is called the Sacral promontory Midsagitally identifiable in X-ray, MRI, and CT scan 4 Relative to the base, there is an IV disc between L5 and the base of the sacrum. That’s where the last disc is. Superior articular process of sacrum forms a facet joint with inferior articular facet of L5. This is the last facet joint (between sacrum and L5) A transverse line exists between the bodies of the sacrum Position of intervertebral discs that are incorporated into the fusion of the 5 vertebrae There are openings on the anterior side – referred to the Anterior Sacral Foramina Accommodate branches of the spinal nerves Exiting the foramina are the anterior/ventral primary rami of sacral spinal nerves There is an anterior branch from the spinal nerve that exits the anterior side of the sacrum Posteriorly Median sacral crest is where the spinous process would be Sacral canal - superiorly Continuing space Continuous with vertebral foramen Sacral hiatus – inferiorly Continuing space Lateral sacral crest Posterior sacral foramina Emerging from it are posterior/dorsal primary rami of sacral spinal nerves Sacral tuberosity and auricular surface are involved in the sacroiliac joint (SI joint) Coccyx – usually formed by 3-4 bones Each vertebra gets smaller going inferiorly Ligaments Connective tissue classified as dense, regular CT made of collagen fibers 5 ligaments responsible for 1. Anterior longitudinal ligament covering the vertebral body and IV disc between Broad and wide Runs the length of vertebral column Fibers blend with annulus fibrosus fibers of IV disc 2. Posterior longitudinal ligament is much more narrow than anterior Located within vertebral foramen Between the pedicles that form the vertebral arch Note position of this ligament and its relationship to the IV disc Herniated disc o Ligamentum flavum Between lamina of adjacent vertebra Paired structures – found at regular intervals in intervertebral position o Interspinous ligament Between every spinous process o Supraspinous ligament Covers the posterior surface of the spinous process Runs the length of vertebral column 5 Movement Flexion and extension of neck with the atlantoocciptal joint Flexion and extension is in midsagittal plane Rotation of head and neck is relative to atlantoaxial joint and the atlas pivoting around the dens Facet joints also allow for rotation and cumulative effect o Cervical and trunk region Lateral flexion and extension o Flexion is moving body in coronal plane in right/left o Returning to anatomical position is extension Herniation Term applied for when something protrudes through a weakness o The weakness is annulus fibrosus o Can be congenital, developmental o Typical direction of herniation of nucleus pulposus is in the posterolateral direction o Posterior longitudinal ligament adds additional resistance o Thus, instead of nucleus pupolsus going directly posteriorly, it’s going to one side or the other and ends up in intervertebral foramen (where spinal nerve and branches are located) o When you herniate a disc, pressure is put on the nerve elements within intervertebral foramen symptoms depending on level of herniation and which axons are compressed (sensory or motor neurons innervating muscles) Disorders of Vertebral Column Scoliosis – lateral deviation (right/left) in thoracic region o Can occur in multiple levels Kyphosis o Hunch back o Thoracic curve exaggerated – concave anteriorly and convex posteriorly o Compromises breathing and heart function when severe Lordosis o Lumbar curve exaggerated – concave posteriorly and convex anteriorly o Develops with weight gain o Common in early pregnancy, typically resolves itself after birth It’s not uncommon for a combination of these disorders to be present in early age September 25, 2015 Muscles of the Back Superficial Muscles Located on the back but have nothing to do with movement of vertebral column – this group of muscles involved with moving Pectoral Girdle Pectoral Girdle o Clavicle o Scapula Some muscles will act on shoulder joint Trapezius - most superficial muscle o Located on posterior surface of neck, shoulder, & portions of trunk o Relative to this, there’s a midline origin that extends from base of skull to T12 spinous process o In cervical region, there’s a thickening of connective tissue, called the Ligamentum Nuchae o This muscle originates from the ligamentum nuchae, which is attached to spinous processes of the cervical vertebrae, and also takes origin with all of spinous processes of thoracic vertebrae o Some origin from base of skull as well o Insertion of Trapezius = pectoral girdle o Muscle fibers are not in the same plane 3 different planes Descending/superior part o Goes anteriorly, inserts into lateral portion of clavicle Intermediate o Goes lateral parts of scapular spine Inferior/ascending o Medial aspects of scapular spine These 3 parts can work together or individually o If all 3 parts are working, action is: Pectoral girdle elevates Scapular retraction (Adduction) With the scapula only, retraction and adduction are the same thing Pulls scapula towards midline o This is why we call traps the Attention Muscle When scapula rotates via contraction of trapezius, inferior angle of scapula rotates laterally. On the left side, scapula will be rotating clockwise. On the right side, rotation is counterclockwise. Rotation is required for complete abduction of upper extremity. o Inferior trapezius overlaps superior Latissimus Dorsi o Innervated by cranial nerve 11 – spinal component of the spinal accessory nerve CN XI o Slide 3 – Trapezius reflected Yellow going through it is the spinal accessory nerve CN XI Sometimes it branches out into fine nerves distributed through the muscle so not as apparent Latissimus Dorsi o Large, flat tendon-like structure = Thoracolumbar fascia Fascia arising from thoracic and lumbar spinous processes T7 and below Broad, flat tendon Parallel structures Tendon is made of collagen this fascia is made of collagen, strong and no elasticity o Thoracolumbar fascia has 2 layers Deep layer – attached to transverse process Superficial layer – attached to spinous process Between the 2 layers are intrinsic back muscles Deep muscles Move vertebral column o Muscle fibers are in the superior, lateral direction o Origin – superficial layer of thoracolumbar fascia o Inserts on proximal humerus o Muscle crosses shoulder joint, scapula & humerus o Takes origin from vertebral column & superior aspects of hip bone such as iliac crest o Act on shoulder joint: Extend – move humerus posteriorly in sagittal plane Adduct – bring humerus toward trunk Medial rotate (internal) o Does not move vertebral column o Innervated by branches of brachial plexus Thoracodorsal nerve (nerve to latissimus dorsi) Triangle of Auscultation o Trapezius is medial boundary o Medial edge of scapula is lateral boundary o Superior border of latissimus dorsi is inferior boundary o May be used to listen to lungs – pt asked to cross arms and bend forward which opens up the triangle One way you can distinguish muscles from each other is from the direction of muscle fibers Medial aspect insertion – 3 muscles that arise from the vertebral column o Levator scapulae – arise from some cervical (transverse processes) vertebrae and inserts on medial border of scapula superior to scapular spine Elevates scapula o Rhomboid minor Inserts into scapula where the spine is located Origin from vertebral column but action on scapula Innervated by brachial plexus o Rhomboid major Inserts inferior to spine on medial border Function of major and minor are the same Origin of rhomboids come from spinous processes of inferior cervical and upper thoracic regions Insertion on medial border of scapula When they contract, they retract (adduct) scapula – goes toward midline Innervated by brachial plexus Deep to traps and lats o Accessory respiratory muscles Serratus posterior superior – elevates ribs Inspiration Deep to rhomboids Origin – spinous processes of vertebrae Insertion – upper & lower ribs respectively Attaches to superficial layer of thoracolumbar fascia Serratus posterior inferior – depress ribs Expiration Deep to lattisimus dorsi These are difficult to see, especially in leaner, older adults – may have become connective tissue Deep Muscles Transversospinalis o Semispinalis – deep to splenius Directed vertically Origin – lateral parts of vertebrae Insertion – medial posterior aspect of skull R + L together = extension of head/neck One muscle = rotation to contralateral side Splenius – more superficial o Muscle fibers are obliquely oriented o Origin – spinous processes of cervical and some thoracic o Insertion – lateral side of skull o R + L splenius work together = extension of head/neck o One muscle = rotate or lateral flex to ipsilateral (same) side Erector spinae – holds vertebral column erect o Extend, hyperextend vertebral column o Ipsilateral rotation of trunk o Spinalis (medial) Runs adjacent to spine o Longissimus Extends from sacrum/hip into cervical region Insertion – medial parts of ribs o Iliocostalis (lateral) From ilium, sacrum to ribs cervical area Innervation o Deep muscles innervated by dorsal primary rami of spinal nerves Innervate skin and deep muscles Sensory and motor September 26, 2015 Spinal Cord Not same length as vertebral column, it’s shorter Cylindrical structure Does not have same diameter or circumference throughout Continuation of medulla oblongata superiorly Inferiorly, cord is cone-shaped - called conus medullaris o Ends at IV disc L1-2 in adult o Full term newborn - ends at IV disc L1-3 Swelling in neck region called cervical enlargement o Gives rise to brachial plexus Innervates upper extremities o Large due to number of motor neurons and sensory areas of spinal cord concerned with innervating skin and muscles of upper extremities o Also large due to the hands – neurons that innervate muscles and skin Thoracic region is significantly smaller in diameter because the area is not as sensitive Lumbar enlargement/lumbosacral enlargement o Associated with innervation of lower extremities Cauda equina o Come from lumbar and sacral levels of spinal cord o Sensory & motor axons Dorsal/ventral roots of spinal nerves o Not spinal nerves o Lumbar cistern – enlargement of subarachnoid space (has CSF) Cauda equina located in lumbar cistern and bathes CSF Inferior to conus medullaris o Dura sac extends to S2 of vertebral column Inferior end of dural and arachnoid sacs at S2 Dura mater = “Tough Mother” o Collagen o No elastic qualities, doesn’t stretch o Outer external meningeal layer (CT coverings) Arachnoid o Spider web-like membrane o More delicate than dura o Close to dura, very little space between dura and arachnoid o Not fused together o Dura + arachnoid = dura/arachnoid sac that extends to S2 Pia Mater – “Soft Mother” o Directly on surface of spinal cord o Applied to surface of CNS o Gives rise: Filum Terminale Continuation of conus, continues down and leaves end of dura/arachnoid sac at S2 As filum terminale pierces the dura, the arachnoid an dura will contribute to the coccygeal ligament o Coccygeal ligament receives contribution from dura & arachnoid o Leaves the sacral hiatus Denticulate Ligaments Tooth-like structure that arises from surface of cord as pia Extends laterally to attach to dura/arachnoid sac “spot weld” is attachment to arachnoid dura These 2 are designed to stabilize cord within subarachnoid space Epidural space: between dura + bone of vertebral canal (external to dura) o Real space … fat + venous plexus present o Epidural nerve block Must be injected external to dura, can be given anywhere o Epidural Hematoma (accumulation of blood) Subdural space: between dura + arachnoid o Potential space o Subdural Hematoma Subarachnoid space: between arachnoid + pia mater o Real space … CSF o Lumbar cistern – contains filum terminale and cauda equina o Enlarged inferior to conus medullaris which is the lumbar cistern Spinal Tap/Lumbar spinal puncture o Adult: IV disc between L3-4 o Newborn: IV disc between L4-5 o Puncture dura and go into lumbar cistern o Numbs cauda equina, blocks sacra and lumbar peripheral nerves (anesthesia) o Sample CSF o Injection of drug that doesn’t cross BBB Myelogram – inject contrast into lumbar cistern o Needle used is large and makes a hole in dura o CSF can leak out of subarachnoid space causing headaches due to pressure changes o Blood Patch – withdraw 20cc blood, inject blood into epidural space Blood coagulates and forms a patch around the hole in dura Transsacral epidural anesthesia goes through foramina of the sacrum Caudal epidural anesthesia goes through sacral hiatus Spinal Nerve White Matter – myelinated axons o Dorsal funiculus o Lateral funiculus o Ventral funiculus o Located in periphery o Funiculus is a term that refers to a bundle o 2 way traffic here – to and away from brain Gray Matter o Soma (cell body), dendrites, unmyelinated axons o Dorsal horn - sensory General sensation: 1. Pain 2. Temperature 3. Tactile discrimination (fine touch) 4. Vibratory sense 5. Proprioception (muscle sense) - comes from muscle spindles (stretch/length receptors) and golgi tendon organs (tension receptors in muscle tendons) o Ventral horn – motor Spinal nerve has a sensory and motor component, hence it is mixed o All spinal nerves are mixed EXCEPT C1 motor only Dorsal/Ventral Primary Rami o First branch o C1 will have primary rami but they will only be motor o All spinal nerves will have dorsal & ventral primary rami that are mixed o Dorsal is smaller, ventral larger – directly related to the tissues that they innervate o Dorsal Innervates deep muscles of back Erector spinae Sensory component – general sensation Innervate skin on dorsal aspect of head, neck and trunk Emerge at regular intervals to innervate muscle and skin in region that they emerge o Segmental in appearance Cutaneous branches must pass through superficial muscles of back to get to skin o Ventral Innervate everything else in body except what is covered by the cranial nerves Motor innervation Superficial muscles of back o Latissimus dorsi o Rhomboids o Levator scapulae o Serratus posterior Muscles associated with lateral & anterior aspect of trunk o Intercostal, Rectus abdominus, Obliques All of muscles associated with upper & lower extremity regardless of what side they are located on o Hamstrings, triceps Muscles in neck o Except sternocleidomastoid Sensory innervation All of skin of body except dorsum of back and whatever’s covered by cranial nerves o All of upper & lower extremities o Skin on lateral & anterior side of neck and trunk Cervical region has 8 pairs of nerves o Nerves come out superior to vertebra o C8 comes out inferior to C7 vertebra Thoracic region has 12 pairs of nerves o Nerve comes out inferior to vertebra Lumbar – 5 pairs nerves Sacral – 5 pairs of nerves Coccygeal nerve 31 pairs of nerves altogether st Through 1 trimester, cord/vertebral column are same length After 1 trimester is when differential growth occurs between cord & vertebral column Spinal Dermatome o Region of skin innervated by both dorsal and ventral primary rami – innervated by one particular spinal nerve o Ex.T6 dermatome will be posterior portion innervated by dorsal primary ramus, lateral & anterior part of dermatome innervated by ventral primary ramus T6 is innervated by T5-7, you must damage all 3 to damage the whole dermatome o 3 spinal nerves innervate 1 dermatome – there is an overlap o No C1 dermatome – no sensory neurons o Trigeminal nerve dermatome (CN5) Peripheral Plexus o Not present in thoracic region o Origin: ventral primary rami o o Brachial Plexus C5-7 (3 spinal levels) goes into musculocutaneous nerve Innervates biceps Injure nerve peripherally = paralyze biceps If only C7 is injured, biceps will be weaker Most muscles in body are innervated by more than one spinal level
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