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HEALTH SCIENCES 365 Chapter 12 – The Trunk & Spinal Column Bones of the Trunk, Spinal Column, and Rib Cage Vertebral Column General Structures 1. Body 2. Pedicle 3. Transverse Processes 4. Articular Processes 5. Lamina 6. Spinous Process 7. Vertebral Foreman 8. Intervertebral Foreman Neural Arch Cervical (7) 1. Bifed Spinous Process 2. Transverse Foreman 3. Atlas (Articular Fossa) 4. Axis (Odontoic Process) Thoracic (12) 1. Superior & Inferior Costal Facets 2. Transverse Costal Facet Lumbar (5) Sacral (5) 1. Median Sacral Crest 2. Sacral Canal 3. Sacral Foramen 4. Sacral Hiatus 5. Superior Articular Facet 6. Superior Sacral Notch Coccyx (4) Sternum Manubrium Clavicular Notch Jugular Notch Sternal Angle Body of Sternum Costal Notches Transverse Ridge Xiphoid Process Ribs True (7) False (3) Floating (2) Head Neck - Articulating facet Tubercle - Articular part - Nonarticular part Superior Border Inferior Border Costal Groove Shaft Costal Angle Joints & Range of Motion of the Vertebral Column Atlantooccipital (condyloidial) Occiptial condyles of skull sitting on the articular fossa of the atlas Approx. 15° flexion/extension Atlantoaxial (trochoid) Rotation of atlas (C1) around the fingerlike process (odontoid process - dens) of the axis (C2) during rotation of the head 75° rotation, 14° extension, 24° lateral flexion Vertebral Facet Joints (articulation between the superior & inferior articular processes) Intervertebral Disks Acts as cushions and shock absorbers and produces the natural curves of the spines Annulus Fibrosus Nucleus Pulposus Intervertebral Discs and Movement - During bending - During compression loads - Nutrient supply Ligaments Ligamentum Nuchae Connects spinous processes, runs from external occipital protuberance to C7 Supraspinal Connects tips of spinous process from C7 to sacrum Ligamentum Flavum Connects lamina from adjacent vertebrae from axis to sacrum Interspinal Connects inner surface of spinous processes of adjacent vertebrae Intertransverse Connects transverse processes of adjacent vertebrae Anterior Longitudinal Connects adjacent vertebral bodies, runs from axis to sacrum on anterior aspect Posterior Longitudinal Connects adjacent vertebral bodies, runs from axis to sacrum on posterior aspect Movements & Range of Motion (ROM) Cervical Region: Flexion 45°, Extension 45°, Lateral Flexion 45°, Rotation 60° Lumbar Region: Flexion 20° 30°, Extension 20° to 30°, Lateral Flexion 35°, Rotation 45° Selected Major Muscles of the Spine Sternocleidomastoid O. Manubrium Anteriosuperior surface of medial clavicle I. Mastoid process A. ________________________________________________________ ________________________________________________________ N. Spinal Accessory Splenius Cervicis O. Spinous processes of T3-T6 I. Transverse processes of C1-C3 A. ________________________________________________________ ________________________________________________________ N. Cervical nerves 4-8 Splenius Capitis O. Lower half of ligamentum nuchae, spinous processes C7-T3 I. Mastoid process and occipital bone A. ________________________________________________________ ________________________________________________________ N. Cervical nerves 4-8 Erector Spinae: Spinalis O. Ligamentum nuchae, spinous process C-7, spinous process T11-12, spinous process L1-2. I. Spinous process C2, spinous process T5-12, occipital bone A. ________________________________________________________ ________________________________________________________ N. Spinal nerves Erector Spinae: Longissimus O. Posterior/medial iliac crest, thoracolumbar aponeurosis, transverse processes L1-5, transverse processes T1-5, articular processes C5-7 I. Spinous processes C2-6, transverse processes T1-12, lower 9 ribs, mastoid process A. ________________________________________________________ ________________________________________________________ N. Spinal nerves Erector Spinae: Iliocostalis O. Posterior/medial iliac crest, thoracolumbar aponeurosis, posterior ribs 3-12 I. Posterior ribs 1-12, transverse processes C4-7 A. ________________________________________________________ ________________________________________________________ N. Spinal nerves Quadratus Lumborum O. Posterior inner lip of iliac crest I. Medial inferior surface of 12th rib, transverse processes of L1-4 A. ________________________________________________________ ________________________________________________________ N. T12, L1 nerves Muscles of the Abdominal Wall Rectus Abdominis O. Pubic crest, pubic symphysis I. Styloid process, cartilage of 5th, 6th, 7th ribs A. ________________________________________________________ ________________________________________________________ N. Intercostals T7-T12 External Oblique O. External surfaces of 5th -12th ribs (dovetailing the Serratus Anterior) I. Anterior half of iliac crest, Inguinal ligament, pubic crest, fascia of Rectus Abdominus A. ________________________________________________________ ________________________________________________________ N. Intercostal nerves T8-T12, Iliohypogastic, ilioinguinal nerve Internal Oblique O. Inner lip anterior half of iliac crest, upper half of inguinal ligament, lumbar fascia I. Inferior borders of 10th -12th ribs, linea alba A. ________________________________________________________ ________________________________________________________ N. Intercostal nerves T8-T12, Iliohypogastic, ilioinguinal nerve Transverse Abdominis O. Inner rim of the iliac crest, inner surfaces of ribs 7th – 12th, upper half of inguinal ligament, lumbar fascia I. Linea alba, pubic crest, iliopectinal line A. ________________________________________________________ ________________________________________________________ N. Intercostal nerves T7-T12, Iliohypogastic, ilioinguinal nerve Tendinous Connective Tissue Associated with the Abdominals – connecting or supporting the abdominal arrangement of muscles in lieu of bony attachments. Linea Alba: __________________________________________________________ Linea Semilunaris: ____________________________________________________ _____________________________________________________________________ Tendinous Inscriptions: ________________________________________________ _____________________________________________________________________ Functions of the Abdominal Wall Protection ____________________________ Support of Viscera _____________________ Elimination ___________________________ Forced Expiration ______________________ Stabilization of Trunk and Pelvis __________ Trunk Movement ______________________ Parturation ___________________________ Abdominal Considerations Causes for weakness of the abdominal wall Developmental Pathological Abdominal Ptosis: _____________________ Beever’s Sign: ________________________ Kinesiology of the Abdominal Muscles: List in order the importance or degree of involvement of the abdominals in the following activities. _____ Straight leg raises (unilateral) _____ Sit-ups _____ Pull-ups _____ Ambulation _____ Straight leg raises (bilateral) _____ Push-ups _____ Curl-ups Lordosis – Excessive anterior curvature of the lumbar spine (Anterior Pelvic Tilt) Relationship of ASIS to PSIS Causes Considerations 1. Congenital deformity 1. More common in tall ectomorphs 2. Poor body mechanics 2. More common in child and adolescents 3. Muscle imbalance (disuse or disease) 3. Asymptomatic unless due to trauma 4. Overtraining in certain sports 4. Relationship to low back pain 5. Compensatory deformity to a kyphosis ______________________________ or other deformities of foot, knee, or hip 5. Changes in intervertebral body distance ________________________________ ______________________________ 6. Bony changes uncommon Loose/Weak Muscles/Ligament a. _______________________________ b. _______________________________ c. ________________________ ligament How Strengthen (isolate)? Tight/Inflexible Muscles/Ligaments a. _______________________________ b. _______________________________ c. ________________________ ligament How Stretch (isolate)? Pelvic Roll Scoliosis – Lateral deviation(s)/curve(s) of the spine Causes Considerations 1. Known: (20%) Hemivertebrae, 1. Most common in adolescence 10-18 Congenital spinal deformities, neuron2. Onset, typically during puberty muscular problems, leg length difference 3. Affects 2% women, .5% men cerebral palsey, muscular dystrophy 4. Usually asymptomatic 2. Unknown: Idiopathic (80%) Classification: Simple “C” Classification: Compound “S” Signs of Scoliosis Adam’s Forward Bend Test 1. Unilateral problems 1. Asymmetry of erector spinae 2. Rotation of trunk (one shoulder forward) 2. Rotation of vertebrae with rib 3. Contour of trunk (waistline), skin folds Angulation (Razor back sign) 4. Distance from arm to thorax 3. Level of fingertips 5. Asymmetry of scapula 4. Trunk contour 6. Deviations of spinous processes 7. Chest flatness on side of convexity