Biomechanics of back
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| where do we find intervertebral disc | Between each vertebral pair. Exception C1-C2 and sacral vertebrae
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| where in spinal cord is missing intervertebral disc? | C1 and C2, Sacral vertebrae
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| what happen to intervertebral disc when a force is compressing to the vertebrae | it will put pressure on nucleus pulposus where it will be squeeze to reduce compression on the vertebrae body
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| Which population has higher risk of compresion fracture | Elder
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| What are the 2 component of intervertebral disc | 1) anulus fibrosus (form sclerotome)
2) nucleus pulposus (from notochord)
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| what happen to nucleus pulposus when we flex | back push the nucleus pulposus posteriorly
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| what happen to nucleus pulposus when we extend | back push the nucleus pulposus anteriorly
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| Describe facet and nucleus pulposus motion during flexion | Facet "open", Nucleus pulposus: posteriorly
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| Describe facet and nucleus pulposus motion during Extension | Facet "closed", Nucleus pulposus: anteriorly
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| Describe facet and nucleus pulposus motion during Sidebending left | Convex facet (Right side): open, Concave facet (Left side) : close, Nucleus pulposus: convexity to Left
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| Describe spinal motion during rotation to R | Transverse process is more palpable at R side
spinous process is more to the L side
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| which plane does cervical vertebral facet (C2-C7) sitting on | mostly on axial plane (horizontal)
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| what is the limitation of cervical vertebral flexion movment? | it is limited by the tension in posterior vertebral ligament
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| why cervical vertebral has limited extension movement? | It is limited by the contact of adjacent spinous process
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| does cervical vertebral has limited rotation and sidebending movement? | Yes. However, if the movement occurs all the same, the limitation is reduced
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| What special structure does cervical vertebral has to assist its motion? | Uncinate process. It insures that the vertebrae are "stay on track" and ensure the translation process (anteriorly or posteriorly)happen smoothly.
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| What happen when cervical vertebral flex or exten? | they tend to translate either posteriorly or anteriorly.
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| what plan does thoracic vertebral facet has? | Coronal plane
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| What limit the motion of throacic vertebral? | 1) the ribcage==> flexion and rotation is possible with rib movement.
2) The downwardly-oriented spinous process will limit its extension
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| What plan does lumbar facet has? | Inner Lumbar facet joint are primarily sagittal.
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| What kind of motion does lumbar has | 1) Flexion is the best.
2) Contact of facet limited extension
3) Rotation is better than extension
4) Sidebending is the allowed
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| Which throacic vertebrae has lumbar like morphology? | T11 and T12
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| That plane is lumbosacral facet? | Sagittal and cornal
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| which nerve innervate Intervertebral disc and spinal dura? | Recurrent meningeal nerve
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| Which nerve innervate facet joint and capsule | Posterior ramus from 2 adjacent level
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| cause of thoracic hyperkyphosis | 1) Compression fracture
2) osteoporosis
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| Cause of lumbar lordosis | 1) pregnancy
2) carry excessive belly fat
3) when abdominal muscle tone decrease
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| Cause of disappearance of lumbar lordosis | situation when there is a flattaning of back muscle, may due to back muscle spasm
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| cause of Scolosis | -abnoraml lateral curvature of spine
1) poor posture
2) carry excessive weight
3) short leg
4) Genetic bone pathology
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| what is the effect of ligament to vertebrae movement | The ligament limit the extend of sidebending and flexing motion of the vertebrae
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| List the ligament which connect to the vertebrae | 1) Anterior longitudinal ligament
2) posterior longitudinal ligament
3) interspinous ligament
4) supraspinous ligament
5) Intertransverse ligament
6) ligament flavum
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| Nuchal ligament and where does it connect to | -From occipital bond to T1
-ligament specific to cervical vertebrae
-extend posteriorly from cervical region and provide large surface area for cervical muscle attachment
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| Relationship of thoracic ligament and rib | the thoracic ligaments tether the vertebrae stongly to the rib
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| List 3 special ligament at the sacrum region | 1) Supraspinous ligament
2) Posterior sacrococcygeal ligament
3) Illolumbar ligament
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| Posterior sacrococcygeal ligament | it attach coccyx to sacrum and it is the place where we have epidural injection
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| Illolumbar ligament | - it connect transverse process of L4 and L5 to the illiac rest
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| How does illolumbar ligament contribute to Low back pain | It can be calcified with aging and the dysfunction result in pain. The pain can mimic muscle pain or it can radiate down to gluteal and thigh but will not radiate along dermatome
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| where is spinal nerve come out from? | Intervertebrael foramina
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| What are the structure that make up intervertebral foramina border? | iit is formed by superior and inferior vertebral notch from 2 adjacent vertebrae
-superior: pedicle
-inferior; pedicle
-anterior: vertebral body and intervertebral disc
-posterior: facet joint
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| what is the most common cause of Radiculopathy? | Herniated nucleus pulposus
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| Where is the pain from HNP usually radiate to? | dermatome.
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| The cause of HNP | The nerve root exist intervertebral foramen is compressed by enlarged facet or by herniated root
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| HNP at Lumbar region usually affect spinal nerve at upper or lower level | LOWER, area where nerve exist is superior to where the nucleus pulposus would bulge
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| HNP at cervical region affect which part of nerve? | Since spinal nerve travel horizontally, it will affect nerve existing at same level. however, the affecting nerve is still the one below
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| at C1-C7, where does nerve exist intervertebral foramen as compared to its corresponding vertebrae | Superior to their corresponding vertebra
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| where does C8 exist the intervertebral foramen? | Between C7 and T1 since there is no C8 vertebrae
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| List 3 extrinsic back muscle and their innervation | 1) Trapezium : Accessory nerve
2) Latissmius Dorsi: Thoracodorsal nerve
3) Levator scapulae: dorsal scapular
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| What nerve innervate all the intrinsic muscle | Posterior rami
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| list categories of intrinsic muscle | Erector spinae muscle group, semispinalis captitis and cervicis, deep intrinsic muscle(rotatore, multifidi, semispinalis), minor deep intrinsic muscle (Muscle of subocciptial region, interspinalis, levator costorum, intertransveraril)
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| Erector spinae muscle group (name the muscle) and its contraction to body movement | 1) Spinalis,
2) longissimus
3) illocostalis
contract bilaterally result in extension of back while contract unilaterally result in side-bending
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| Contraction of semispinalis cervicis and capitis to body movement | contract bilaterally result in neck extension while unilaterally result in rotate toward ipsilateral side (w/ extension) of neck
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| What slightly separate semispinalis cervicis from capitis | levator scapulae
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| Name group of muscles in transversospinalis muscle | 1) rotatore (1-2 level)
2) multifidus (3-4 level) Multifidus lumborum
3) Semispinalis (5-6 level)
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| what is minor deep intrinsic muscle really for? | it is for sensing proprioception more than movement
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| name the muscle in minor deep intrinsic muscle | 1) levator costorum
2) intertransverarii
3) muscle of suboccipital region
4) interspinalis
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| Thoracolumbar fascia | complext CT structure in back
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| What is the role of thoracolumbar fascia to Latissmus dorsi | act as Aponeurosis
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| What is the role of thoracolumbar fascia to Erector spinae | act as Retinaculum, make contraction more efficient
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| What group of muscle does thoracolumbar fascia wrap around? | 1) erector spinae
2) transverosphalis
3) quadratus lumborum
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| Fascia | -arranged in several direction with no particular shape
-resist force equally in many directions and keeps structures in place with some wiggle room
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| Tendon | -arranged in one direction in a bundle, resist force strongly along the line of force as muscle pulls bone
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| Ligament | -arranged in one direction in a bundle, resist bone from another bone
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| Aponeurosis | arranged in one direction in flat sheet, broad flat tendon connecting muscle to bone
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| Retinaculum | arranged in one direction that restrain/tethers a muscle group to prevent bowstringing
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| fascia that wrap around muscle | deep or investing fascia
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| trace the pathway of Spin Tap | skin==> subcantaneous fat ==> thoracolumbar fascia ==> supraspinous ligament ==> interspinous ligament ==> dura mater ==> anarchonid mater ==> subarachonid space
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| List the muscle group of subocciptial triangle | 1)rectus capitis posterior major
2) rectus capitis posterior minor (not part of triangle)
3) oblique capitis superior
4) oblique capitis inferior
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| what is the major function of suboccipital muscle | they are extensor of head and upper cervical segment, give propriceptive input from region
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| which nerve innervate the suboccipital muscle | suboccipital nerve (posterior ramus C1)
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| Atlanto-axial joint | -superior articular facet of axis (C2) and inferior articular facet of atla (C1) are flat and smooth, den of C2 act as pivot which control rotation
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| Atlanto-occipital joint | between superior articular facet of atlas and occipital bone, major for flexion and extension
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| Den | it is tethered to occipital bone and atlas ligament while allow rotation of atlas
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| where does Myodural bridge originate from | it is a sheet of CT originate from
1) rectus capitis posterior minor, pierce of posterior atlanto-occiptal membrane and fused with dura mater
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| the clinical importance of myodural bridge | this direction connection with pain sensitive dura and posterior neck muscle make it a consideration when treating headach
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| Whiplash | a sudden violent acceleration / deceleration that may result in flexion or extension injury to the neck and CNS
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| Concussion | when the flexion and extension overpower the muscle supporting head, cerebral cortex will impact the skull
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| who are more vulnerable to cerebral trauma when shaken | babies because they have weak neck muscle, cannot support their head
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