Block One

Dry
Lab
Spine, Rib
s , B ac k
M u sc l es
Curvatures of the Spine
0 Primary Curvatures
0 Thoracic and Sacral
0 From an embryo to an adult
these curvatures remain
concave

0 Secondary Curvatures
0 Cervical and Lumbar
0 As a baby learns to lift their
head, the cervical curvature
Red = Cervical Curvature
develops.
Blue = Thoracic Curvature
0 As the child learns to walk, Purple = Lumbar
the lumbar curvature Green = Sacral
develops.
0 These become convex.
 Injuries to the Spine
0 Whiplash May rupture the Anterior
Longitudinal Ligament (ALL). Common injury
when car is rear ended, causing forceful
extension.
0 C1-C3 acts as the whip
0 C4 acts as the fulcrum
0 C5-C7 acts as the handle
 Injuries to the Spine
0 Hangmans Fracture pedicles of the axis
(C2) break.

Pedicle
 Injuries to the Spine
0 Jefferson Fracture
arches of the atlas (C1)
break. There is no
anchor point for the
transverse ligament of
the atlas. Occurs when
someone lands straight
on their head (ex: diving
in a pool too shallow)
0 On X-ray, you may see
atlas overhang axis.
Intervertebral Disc (IVD)
Herniation
0 From the 9 oclock to 3 oclock Annulus
position the Anterior Fibrosus
Longitudinal Ligament (ALL) is
protecting the IVD.
0 At the 6 oclock position the
Posterior Longitudinal Ligament
is protecting the IVD.
0 The 5 oclock and 7 oclock
position are the only areas not
protected and this is where the
nucleus pulposus is most likely
to herniate.
0 Annulus Fibrosus is the tough
outer capsule of the nucleus
pulposus.
 Spinal Tap
0 Layers pierced while performing a
spinal tap
1. Skin
2. Supraspinous ligament
3. Interspinous ligament
4. Ligamentum Flavum
5. Dura Mater
6. Arachnoid Mater
0 Subarachnoid space is where
Cerebral Spinal Fluid (CSF) is
located.
0 Epidural Space is where women
who are in labor receive their
epidurals.
0 Usually done between L3/L4 or
L4/L5.
 Thoracic Vertebrae Rib
Facets
0 Thoracic Vertebrae 1
(T1) has one set of full
facets and a pair of
hemi(demi) facets.
0 T2-T8 are typical and
have two pairs of
hemi(demi) facets.
0 T9 is atypical with one
pair of hemi(demi)
facets.
0 T10-T12 each have a pair
of full facets.
 Rib Articulation
0 The ribs articulate
typically with two
vertebrae and one
transverse process.
0 The number of the rib
(example rib 7) correlates
to the transverse process
of the vertebra it
articulates with (T7).
0 True ribs = 1-7
0 False ribs = 8-12
0 Floating ribs = 11-12
 Cervical and Lumbar
Vertebrae
0 C1-C6 all have 0 L1-L5 all have
transverse foramen Mamillary processes
where the Vertebral located on the
Artery and Vein superior articular
passes through (C7 processes and
only receives Accessory processes
vertebral vein). on the transverse
processes.
 Thoracocentesis
0 Usually done at mid-
axillary line in
between ribs 8 and 9.
Can be done between
ribs 9 and 10 (as
shown in diagram).
0 Want to insert needle
as low in the
intercostal space as
possible as to avoid
the Intercostal Nerve.
 Stab Wounds
0 Straight In:
0 Air can move in and out with each inspiration and
expiration.
0 No air trapping.
0 At an Angle:
0 With each inspiration air moves into the thoracic cavity
but as expiration occurs, the skin acts as a flap and
closes, not allowing for air to leave.
0 Each inspiration increases the amount of air trapped in
the thoracic cavity and will push the medistinum away
from the affected side (Problem!!!!)
0 Immediate treatment needed.
 Flail Chest
0 One or more ribs is broken in two places.
0 Upon inspiration the region with broken rib(s)
will sink while the rib cage expands.
(Paradoxical movement)
0 This is dangerous because the lungs can be
punctured.
 Anterior Chest Wall
0 Rotters Nodes: A way breast cancer can
metastasize by bypassing the axillary nodes.
0 Majority of breast lymph drains to axillas
pectoral/anterior nodes.
0 $$Million Dollar Space$$
0 Aka retromammary space
0 Location for artificial breast placement
0 Behind the Pectoralis Major or between the Pectoralis
Major and the fat pad
0 Dermatomes to know
0 T4 = Nipple Line
0 T10 = Umbiliqus
 Suboccipital Triangle
0 Borders:
0 Obliquus Capitis Inferior
0 Obliquus Capitis Superior
0 Rectus Capitis Posterior
Major
0 Contents:
0 Vertebral Artery
0 Suboccipital Nerve (rami of
C1)
0 Take note of the anchor
points of these muscles.
The atlas(C1) and axis(C2)
are both involved.
Inferior nuchal line
OC
RCPMinor S

Greater Occipital
OCI
Nerve (C2, RCPMajor
sensory)
 Extrinsic and Intrinsic
Muscles of the Back
0 Extrinsic: 0 Intrinsic:
0 Know what is provided
in the notes for the
course of the exam.
0 Origins and insertions:
try to simplify it. Dont
memorize the
paragraphs they have
provided.
0 Arterial, nerve supply
and action are very
important.
0 Know the groups in
which each muscle
belongs to.
0 Dont need to know
the origin and
insertions here. What
is in the notes is what
will be tested on.
0 Nerve supply is Dorsal
Primary Rami.
 Auscultation Triangle
0 When a patient crosses
their arms in front of
them and bends forward,
this exposes the lung.
0 Auscultation of the lung
can be done here.
0 Borders:
0 Medial border of scapula
0 Lateral border of
Trapezius Muscle
0 Superior border of
Latissimus Dorsi Muscle
 Lumbar Triangle
0 Site of a lumbar
hernia
0 Boders:
0 Superior ridge of
Iliac Crest
0 Lateral border of
Latissimus Dorsi
Muscle
0 Lateral border of
External Oblique
Muscle