Objectives 1.1 Back, spinal cord, scapular region

Osteology

Scapula:

  • Scapular spine
  • Acromion process
  • Coracoid process
  • Glenoid fossa
  • Supraspinous fossa
  • Infraspinous fossa
  • Subscapular fossa
  • Superior, medial, and lateral borders
  • Superior and inferior angles
  • Suprascapular notch

Ilium:

  • Iliac crest
  • Posterior superior iliac spine

Occipital bone:

  • External occipital protuberance

Vertebral column (33 vertebrae total):

  • 7 cervical
  • 12 thoracic
  • 5 lumbar
  • 5 sacral (fused)
  • 4 coccygeal (fused)

Identify the following features on all vertebrae:

  • Body
  • Vertebral foramen
  • Vertebral arch
  • Lamina
  • Transverse process
  • Spinous process (note differences between cervical, thoracic, and lumbar)
  • Superior articular process
  • Inferior articular process
  • Intervertebral foramen

Identify the following features of the cervical vertebrae:

  • Transverse foramina
  • Atlas (C1 vertebra)
    • Posterior arch
    • Groove for vertebral artery
  • Axis (C2 vertebra)
    • Dens
  • Vertebra prominens (C7 vertebra)

Identify the following features of the thoracic vertebrae:

  • Thoracic vertebrae
  • Costal facets – transverse and demi-facets

Identify the following features of the sacrum:

  • Sacrum
  • Sacral hiatus
  • Posterior (dorsal) sacral foramina

Muscles

  • Trapezius muscle (three parts: descending, transverse, ascending fibers)
  • Latissimus dorsi muscle
  • Rhomboid minor muscle
  • Rhomboid major muscle
  • Levator scapulae muscle
  • Serratus posterior superior muscle
  • Serratus posterior inferior muscle
  • Erector spinae group
  • Deltoid muscle
  • Teres major m.
  • Long head of triceps brachii muscle
  • Lateral head of triceps brachii muscle

FOUR (4) rotator cuff muscles:

  • Supraspinatus m.
  • Infraspinatus m.
  • Teres minor m.
  • Subscapularis m.

Anatomical spaces (understand and define the borders and content(s) of the following):

  • Quadrangular space
  • Triangular space
  • Triangular interval

Arteries

  • Transverse cervical artery
  • Dorsal scapular artery
  • Thoracodorsal artery
  • Suprascapular artery
  • Posterior circumflex humeral artery and vein
  • Deep artery of arm (profunda brachii/deep brachial artery)
  • Understand the arteries that contribute to scapular anastomosis

Nerves

  • Spinal accessory nerve (CN IX)
  • Thoracodorsal nerve
  • Dorsal scapular nerve
  • Axillary nerve
  • Radial nerve
  • Suprascapular nerve
  • Spinal nerves

Spinal cord:

  • Cervical enlargement of spinal cord
  • Lumbar enlargement of spinal cord
  • Conus medullaris
  • Cauda equina
  • Filum terminale
  • Posterior (dorsal) roots and anterior (ventral) roots (be able to distinguish, specify fiber types inside each).
  • Spinal nerve
  • Spinal ganglion (dorsal root ganglion)
  • Posterior (dorsal) ramus and anterior (ventral) ramus (ramus = singular; rami = plural)

Meninges:

  • Meninges of spinal cord
  • Dura mater
  • Dural sac
  • Epidural (extradural) space
    • Anterior internal vertebral venous plexus (know location relative to vertebra)
    • Anterior and posterior external vertebral venous plexus (know location relative to vertebra)
  • Arachnoid mater
  • Subarachnoid space
  • Pia mater
  • Denticulate ligaments

Ligaments

  • Ligamentum flavum
  • Anterior longitudinal ligament
  • Posterior longitudinal ligament

Clinical Correlates

  1. Muscle and nerve function, result of damage.
  2. For each of the following muscles (trapezius, latissimus dorsi, rhomboid major, rhomboid minor, levator scapulae), know their innervations and be able to answer the following questions:
    • Which muscle is affected if a specific nerve is damaged?
    • Paralysis of a specific muscle indicates a lesion of which nerve?
    • What functional deficit (loss or weakness of what action?) and movement(s) are affected
  3. Movements of vertebral column
  4. Dislocation/fracture of cervical vertebrae, structures at risk of injury
  5. Jefferson fracture
  6. Hangman’s fracture
  7. Lumbar stenosis
  8. Caudal epidural anesthetic injection
  9. Lumbar puncture (spinal tap)
  10. Abnormal vertebral curvatures
  11. Scoliosis
  12. Excessive lordosis
  13. Excessive kyphosis
  14. Anomalies of vertebrae:
  15. Spina bifida occulta
  16. Spina bifida cystica
  17. Herniated disc: signs and symptoms, nerve affected based on location of hernia
  18. Vertebral venous plexus: implications in cancer metastasis
  19. Rotator cuff muscles: injury & symptoms
  20. Painful arc syndrome
  21.  Arterial anastomoses around scapula