Kin191 A.Ch.10. Lumbar. Thoracic. Anatomy


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  • Kin191 A.Ch.10. Lumbar. Thoracic. Anatomy

    1. 1. KIN 191A Advanced Assessment of Lower Extremity Injuries THE THORACIC AND LUMBAR SPINE ANATOMY
    2. 2. INTRODUCTION <ul><li>BONY ANATOMY </li></ul><ul><li>ARTICULATIONS </li></ul><ul><li>LIGAMENTOUS ANATOMY </li></ul><ul><li>MUSCULAR ANATOMY </li></ul><ul><li>NEUROANATOMY </li></ul>
    3. 3. <ul><li>C ervical spine (7) </li></ul><ul><ul><li>G reatest ROM </li></ul></ul><ul><ul><li>S pinal cord is the most vulnerable </li></ul></ul><ul><li>T horacic spine (12) </li></ul><ul><ul><li>G reatest protection of the spinal cord  expense of ROM because of large spinous process </li></ul></ul><ul><li>L umbar spine (5) </li></ul><ul><ul><li>An equal balance between protection of the spinal cord and available ROM </li></ul></ul><ul><li>S acrum (5) and coccyx (3~4) </li></ul><ul><ul><li>C omposed of fused bone </li></ul></ul><ul><ul><li>T o affix the spinal column to the pelvis </li></ul></ul><ul><ul><li>S erve as a site for muscle attachment </li></ul></ul>
    4. 4. Spinal Column <ul><li>The segments of the mobile spinal column </li></ul><ul><li>C ervical (n=7), thoracic (n=12), and lumbar (n=5) vertebrae </li></ul><ul><li>Discs: 23 </li></ul>
    5. 5. Bony Anatomy (Lumbar) <ul><li>Total of 5 lumbar vertebrae </li></ul><ul><li>Components </li></ul><ul><ul><li>Vertebral body </li></ul></ul><ul><ul><li>Transverse processe s </li></ul></ul><ul><ul><li>Spinous process </li></ul></ul><ul><ul><li>Neural arch </li></ul></ul><ul><ul><li>Pedicle </li></ul></ul><ul><ul><li>Lamina </li></ul></ul><ul><ul><li>Pars interarticularis </li></ul></ul><ul><ul><li>Intervertebral foramen </li></ul></ul><ul><ul><li>Facet joints (superior and inferior) </li></ul></ul>
    6. 6. Vertebral Body Transverse Processes Inferior Articular Facets Spinous Process Superior Articular Process Lamina Pedicle
    7. 7. <ul><li>Vertebral body </li></ul><ul><ul><li>Primary weight-bearing structure of spine </li></ul></ul><ul><li>Transverse processes </li></ul><ul><ul><li>Attachment site for ligaments/muscles </li></ul></ul><ul><ul><li>Long for leverage/increasing mechanical advantage </li></ul></ul><ul><li>Spinous process </li></ul><ul><ul><li>Attachment site for ligaments/muscles </li></ul></ul><ul><ul><li>Posterior projection (no inferior slant) </li></ul></ul>
    8. 8. <ul><li>The Neural Arch </li></ul><ul><ul><li>Formed by the pedicle and lamina on each side </li></ul></ul><ul><ul><ul><li>Pedicle – vertebral body to transverse process </li></ul></ul></ul><ul><ul><ul><li>Lamina – transverse process to spinous process </li></ul></ul></ul><ul><ul><li>Serves as the protective tunnel through which the spinal cord passes </li></ul></ul>Pedicle Lamina
    9. 9. <ul><li>Pars Interarticularis </li></ul><ul><ul><li>B etween the superior and inferior facets of the vertebra </li></ul></ul><ul><ul><li>A common site of stress fractures in lumbar spine </li></ul></ul><ul><li>Intervertebral Foramen </li></ul><ul><ul><li>The vertebral notch on the inferior portion of one pedicle is matched with the vertebral notch on the superior portion of the pedicle below </li></ul></ul><ul><ul><li>Nerve roots existing between the vertebrae </li></ul></ul>
    10. 10.
    11. 11. <ul><li>Facet joints (superior and inferior) </li></ul><ul><ul><li>2 sets for each vertebrae – articulation between vertebral segments </li></ul></ul><ul><ul><li>Lumbar facet orientations </li></ul></ul><ul><ul><ul><li>L1-L3 – sagittal plane </li></ul></ul></ul><ul><ul><ul><li>L4-L5 – frontal plane </li></ul></ul></ul>
    12. 12.
    13. 13. Intervertebral Disc <ul><li>Dual purposes </li></ul><ul><ul><li>Shock absorption (longitudinal and rotational) </li></ul></ul><ul><ul><li>Increase available ROM </li></ul></ul><ul><li>Components </li></ul><ul><ul><li>Annulus (ring) fibrosus – tough/dense outer layer </li></ul></ul><ul><ul><li>Nucleus (cell)pulposus – flexible inner layer </li></ul></ul><ul><ul><li>“ J elly doughnut” </li></ul></ul>
    14. 14.
    15. 15. <ul><li>23 intervertebral discs are found along the spinal column </li></ul><ul><li>No disc between </li></ul><ul><ul><li>C0-C1 (the skull and the first cervical vertebrae) </li></ul></ul><ul><ul><li>C1-C2 </li></ul></ul><ul><li>Individual disc are referenced by the vertebrae between which they are found </li></ul><ul><ul><li>The disc located between the fourth and fifth lumbar vertebrae is known as the L4-L5 intervertebral disc </li></ul></ul>
    16. 16. <ul><li>Permanent dehydration </li></ul><ul><ul><li>Occurs through the aging process </li></ul></ul><ul><ul><li>Until the age of approximately 40 years, the disc is fully hydrated  after this age dehydration begins </li></ul></ul><ul><ul><li>By age 60 years, the disc have reached their maximum state of dehydration </li></ul></ul><ul><ul><ul><li>Decreasing ROM </li></ul></ul></ul><ul><ul><ul><li>A slight narrowing of the intervertebral foramen </li></ul></ul></ul>
    17. 17. Nucleus Pulposus <ul><li>Elastic/gelatinous substance – 60-70 % of H 2 0 content </li></ul><ul><li>Deformable but resistant to compression </li></ul><ul><li>Affects of bipedal ambulation and aging </li></ul>
    18. 18. Bony Anatomy (Thoracic) <ul><li>Vertebral bodies </li></ul><ul><ul><li>Smaller in thickness and diameter than lumbar vertebral bodies </li></ul></ul>
    19. 19. <ul><li>Spinous processes </li></ul><ul><ul><li>Project inferiorly to limit extension ROM </li></ul></ul><ul><ul><li>Continue to serve as muscular and ligamentous attachment sites </li></ul></ul><ul><li>Transverse processes </li></ul><ul><ul><li>Thicker to allow for formation of costotransverse joints on ribs 1-10 </li></ul></ul><ul><ul><li>Ribs 11-12 are “floating” so no articulation with transverse processes </li></ul></ul>
    20. 20. <ul><li>Costovertebral joints </li></ul><ul><ul><li>Articulation between each rib and thoracic spine vertebral bodies </li></ul></ul><ul><ul><li>For T1 and T10-12, articulation with 1 rib on each side (1 facet in middle) </li></ul></ul><ul><ul><li>For T2-T9, articulation with 2 ribs on each side at inferior and superior costal facets </li></ul></ul>
    21. 21. <ul><li>Ribs </li></ul><ul><ul><li>True ribs (1-7) articulate with sternum through own costal cartilages </li></ul></ul><ul><ul><li>False ribs (8-10) articulate with sternum through conjoined costal cartilage </li></ul></ul><ul><ul><li>Floating ribs (11-12) have no anterior articulation </li></ul></ul><ul><li>Sternum </li></ul><ul><ul><li>Manubrium (superior) </li></ul></ul><ul><ul><li>Body </li></ul></ul><ul><ul><li>Xiphoid process (inferiorly) </li></ul></ul>
    22. 22.
    23. 23. A RTICULATIONS <ul><li>Synovial joints (joint capsule) </li></ul><ul><ul><li>Superior and inferior facet joints </li></ul></ul><ul><li>Cartilaginous joints </li></ul><ul><ul><li>Intervertebral disc and superior/inferior vertebral bodies </li></ul></ul><ul><li>Each segment has relatively little individual mobility, but in combination allow for significant trunk/spine ROM </li></ul>
    24. 24. Ligamentous Anatomy <ul><li>Anterior longitudinal ligament </li></ul><ul><ul><li>Broad/thick, attaches to anterior aspect of vertebral bodies and intervertebral discs </li></ul></ul><ul><ul><li>Limits spine extension (thinnest in lumbar area) </li></ul></ul><ul><li>Posterior longitudinal ligament </li></ul><ul><ul><li>Thins distally, lines anterior portion of vertebral foramen, limited intervertebral disc attachment </li></ul></ul><ul><ul><li>Limits spine flexion </li></ul></ul>
    25. 25. Ligamentous Anatomy <ul><li>Supraspinous ligament </li></ul><ul><ul><li>Attaches tips of spinous processes together </li></ul></ul><ul><li>Interspinous ligaments </li></ul><ul><ul><li>Fills space between adjacent spinous processes </li></ul></ul><ul><ul><li>Limit spine flexion and rotation </li></ul></ul><ul><li>Ligamentum flavum </li></ul><ul><ul><li>Connect laminae of adjacent vertebrae </li></ul></ul><ul><ul><li>Reinforces facet joints </li></ul></ul>
    26. 26.
    27. 27. <ul><li>A: Ligamentum flavum </li></ul><ul><li>B: Interspinous ligament </li></ul><ul><li>C: Supraspinous ligament </li></ul>
    28. 28. MUSCULAR ANATOMY <ul><li>Extrinsic muscles </li></ul><ul><ul><li>Rectus abdominus </li></ul></ul><ul><ul><ul><li>Responsible primarily for trunk flexion </li></ul></ul></ul><ul><ul><li>Internal/external obliques (pocket muscle) </li></ul></ul><ul><ul><ul><li>Responsible for lateral bending and/or spine rotation </li></ul></ul></ul><ul><ul><li>Transvers e abdominus </li></ul></ul><ul><ul><ul><li>Trunk stabilization </li></ul></ul></ul><ul><ul><li>Latissimus dorsi </li></ul></ul><ul><ul><ul><li>Trunk stabilization via thoracolumbar fascia </li></ul></ul></ul>
    29. 29. Abdominal Muscles
    30. 30. <ul><li>Intrinsic muscles </li></ul><ul><ul><li>Quadratus lumborum – pelvis to transverse processes </li></ul></ul><ul><ul><li>Erector spinae muscles (lumborum categorization) – pelvis/sacrum and spinous processes to transverse processes) </li></ul></ul><ul><ul><ul><li>Iliocostalis – most lateral </li></ul></ul></ul><ul><ul><ul><ul><li>Lumborum/Thoracis/Cervicis </li></ul></ul></ul></ul><ul><ul><ul><li>Longissimus – intermediate </li></ul></ul></ul><ul><ul><ul><ul><li>Thoracis/Cervicis/Capitis </li></ul></ul></ul></ul><ul><ul><ul><li>Spinalis – medial </li></ul></ul></ul><ul><ul><ul><ul><li>Thoracis/Cervicis/Capitis </li></ul></ul></ul></ul>
    31. 31. <ul><ul><li>Transversospinal muscles – transverse process to spinous process </li></ul></ul><ul><ul><ul><li>Multifidus </li></ul></ul></ul><ul><ul><ul><li>Rotatores </li></ul></ul></ul><ul><ul><ul><li>Semispinalis </li></ul></ul></ul><ul><ul><ul><ul><li>Thracis/Cervicis/Capitis </li></ul></ul></ul></ul>
    32. 32.
    33. 33. Muscular Anatomy <ul><li>Extrinsic muscles – indirect effect on spinal column </li></ul><ul><ul><li>Latissimus dorsi </li></ul></ul><ul><ul><ul><li>Spine extension and stabilization via fascia </li></ul></ul></ul><ul><ul><li>Rhomboid major and minor </li></ul></ul><ul><ul><ul><li>Stabilization of thoracic spine and scapular adduction </li></ul></ul></ul><ul><ul><li>Trapezius (middle and lower fibers) </li></ul></ul><ul><ul><ul><li>Stabilization of thoracic spine </li></ul></ul></ul><ul><li>Will be covered in KIN 191B </li></ul>
    34. 34. NEUROANATOMY <ul><li>Lumbar plexus </li></ul><ul><li>Sacral plexus </li></ul><ul><li>Nerve roots named for spinal segment superior to corresponding nerve root level </li></ul><ul><ul><li>L4 nerve root exits spinal column below 4 th lumbar vertebrae </li></ul></ul>
    35. 35. Lumbar Plexus <ul><li>Primarily arises from L2, L3, L4 nerve roots </li></ul><ul><li>Posterior (dorsal) branches combine to form femoral nerve </li></ul><ul><ul><li>Femoral nerve – posterior division of L2-L4 </li></ul></ul><ul><li>Anterior (ventral) branches combine to form obturator nerve </li></ul><ul><ul><li>Obturator nerve – anterior division of L2-L4 </li></ul></ul>
    36. 36. Lumbar Plexus
    37. 37. Sacral Plexus <ul><li>Primarily arises from anterior branches of L4 and L5 as well as S1 through S3 </li></ul><ul><li>Anterior (ventral) branches of L4-S3 combine to form tibial nerve </li></ul><ul><ul><li>Tibial nerve – anterior division of L4-S3 </li></ul></ul><ul><li>Posterior (dorsal) branches of L4-S2 combine to form common peroneal nerve </li></ul><ul><ul><li>Common peroneal nerve – posterior division of L4-S2 </li></ul></ul>
    38. 38. Sacral Plexus
    39. 39. Sacral Plexus