Download Deep structure of the back of neck and trunk

Deep structure of the back of
neck and trunk
• Vertebral column
(vertebrae, disc, ligaments)
•Muscle of the back
(superficial/ deep)
• Suboccipital region
龔秀妮 2017
Occipital bone
Superior nuchal line
O
External occipital protuberance
Inferior nuchal line
Occipital condyle
Curvature of vertebral column
Lordosis
Kyphosis
Lordosis
Kyphosis
Excessive kyphosis
Vertebral
fora men
Vertebra
Body
articular facet
Pedicle
Lamina
articular facet
Spinous process
Intervertebral
fora men
Joints between adjacent vertebra
Joints of vertebral bodies: IV disc, ligaments
• Joints of vertebral arches (facet joints)
• Cranio-vertebral joints
• Costovertebral joints; Sacroiliac joints
•
Intervertebral
di s c
Intervertebral
fora men
Fa cet joint
Intervertebral disc :
Anulus fibrosus + Nucleus pulposus
Anulus
fibrosus
• Concentric lamellae of fibrocartilage
• Fibers cross each other obliquely
• Thinning posteriorly (incomplete : cervical
spine)
• Outer third :sensory innervation
Nucleus pulposus
• Semifluid nature
• Shock absorber
• Position: between center and posterior aspect
Intervertebral disc protrusion
Zygapophysial joint (Facet joint)
• Articular process
• Prevent anterior slippage
Spondylolysis
腰椎峽部裂 椎骨脫離
fracture of the bones connecting articular processes
*
Spondylolisthesis: dislocation of adjacent vertebrae
椎弓根骨折
Movement of intervertebral joint
• Interaction: Abdominal wall
muscle and back muscles
• Static/ postural
• Controlled relaxation
C1, Atalas
C2, Axis
Craniovertebral joint
• Atlanto-occipital joint
- occipital condyles
- “Yes”
• Atlanto-axial joint
- Transverse ligament
- “No”
Fracture of Dens
Nuchal ligament
• Thickened fibroelastic tissue
• external occipital protuberance - spinous
process of cervical spines
Muscles of the back
• Extrinsic (superficial and intermediate)
- upper Limb movement
- Respiratory movement
- anterior rami of spinal nerves.(except: CNXI)
• Intrinsic (deep)
- Act on vertebral column/ maintain posture, produce movement
- Posterior rami of spinal nerves
- Deep fascia; thoracolumbar fascia
Thoracolumbar fascia (post.layer)
Extrinsic muscles
Levator scapular
(superficial)
Trapezius
Vertebral column
Rhomboids
(cut)
Pectoral girdle
Humerus
Latissimus dorsi
Serratus posterior superior
Serratus posterior inferior
(Intermediate)
Auscultation triangle
Lumbar triangle
Lumbar
triangle
Thoracolumbar fascia:
Intrinsic back muscles: Superficial
Spinotransversales m.-Splenius (bandage)
-Midline
superolateral
-S. capitis: mastoid process, superior nuchal line
-S. cervicis: transverse process, C1~3
-Pull the head posteriorly; turn face / the same side
Spl enius capitis
Spl enius cervi cis
T3
Intrinsic back muscles:
Intermediate layers
Splenius
• Erector spinae muscles
- Chief extensor of vertebra
- Largest m. in intrinsic m.
- “long muscles” of the back
- Covered by TL facia
- Origin: broad tendon
- 3 columns:
1) Spinalis (small)
2) Longissimus (big)
3) Iliocostalis (lumborum, throacic, cervicis))
Serratus.P.S
1)
2)
S.P.I
3)
Erector spinae
*
1.Spinalis
- spinous proc. spinous proc.
- thoracis, cervicis, and capitis#
Serratus posterior ms.
#
2.Longissimus
- sacrum transverse proc./angle
- L.capitis * mastoid p.
- L.cervicis
- thoracis, cervical, and capitis
3.Iliocostalis
-Iliac crest ribs; transverse process of
C4,5,6
-lumborum, thoracis, and cervicis
Erector spinae muscles
• Iliocostalis (lumborum, throacic, cervicis)
(C4-6)
(上6)
(下6)
Broa d
tendon
Intrinsic back muscles: Deep layers
• Transversospinales muscle group
- Transverse processes to “superior” spinous processes
- Rotate body to opposite side
1) Semispinalis: 4-6 segments
2) Multifidus: 2-4 segments
3) Rotatores: 1-2 segments
Semispinalis – thoracis, cervicis, capitis
C4-T12
Semispinalis capitis
• Powerful muscle
• deep to splenius
• Insert on occipital bone
• Pull the head posteriorly and
the chin the same side
(different from other
transversospinales)
Multifidus
Short, triangular
Thickest , lumbar region
Rotatores
deepest
Thoracic region
SP
TP
Multifidus
present throughout the vertebral column
Segmental muscles
• Levatores costarum
- C7-T11 rib
- Elevate the ribs
• Interspinales
- between spinous process
• Intertransversarii
- between transverse process
intertransversarii
multifidus
rotators
Transverse process
interspinales
Spinous process
Suboccipital triangle
Sub-occipital nerve
Vertebral artery
Boundary:
• Rectus capitis posterior major
• Obliquus capitis superior
• Obliquus capitis inferior
Transverse proc. of Atlas (C1)
*
* Spinous process of C2 (Axis)
Vertebral artery
Suboccipital region:
arteries
•
Foramen of transverse proc. of C2
•
Medial course
foramen magnum
occipital artery
3
2
Greater occipital
nerve
(C2).
3
1
2
Occipital artery
•
Between O. capitis sup. and splenius
• Pierce trapezius and supply the scalp
1. Trapezius; 2. Splenius capitis; 3. Semispinalis capitis
Suboccipital region: nerves
Grea ter occipital n.
Suboccipital nerve (C1)
• Between vertebral a. and
arch of atlas
• Innervate the 4 muscles of
triangle
s uboccipital n.
Vertebral a.
Greater occipital nerve (C2)
•
Medial branch of dorsal ramus, C2
• Superficial to muscles of
triangle
• Sensory nerve to the scalp
Cutaneous nerves of the back
Each of these nerves are accompanied by similar
branches of arteries and veins
Dorsal ramus
Dorsal ramus of
cervical spinal
nerve
Lateral branch
Medial branch
Branches from
cervical plexus
Greater occipital nerve (dorsal ramus of C2)
Superior gluteal nerves (dorsal ramus of L1,2,3)