The Trunk. Vertebral Column. Pelvis Rib Cage. Mobility Protects Spinal Cord

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1 The Trunk Vertebral Column Mobility Protects Spinal Cord Pelvis Rib Cage

2 Landmarks of the trunk

3 Vertebral Column Back View - Extended Pyramid Side View - S Shaped curve Occupies about ½ the diameter of the body Provides support for whole body

4 Vertebral Column Alignment Balance of weights Efficiency and ease of movement

5 Vertebral Column Development of curves Newborn - straight spine Lumbar 1st Curves develop in response to desire to move

6 Movement of Vertebral Column Flexion Extension Lateral Flexion Rotation ROM - determined by shape of vertebrae, thickness of disk, attachment to rib cage (thoracic)

7 Vertebral Column 4 Curvatures or Regions Cervical Thoracic Kyphosis Lumbar Lordosis Sacral

8 Vertebral Column 7 Cervical - neck, hold up head 12 Thoracic - connect to ribs 5 Lumbar - largest, lower back Sacrum - 5 fused vertebrae Coccyx fused vertebrae, tailbone *Numbered from top to bottom (ex. C1-C7)

9 Vertebral Column Analyze spinal curves Side view Shape of curves Back view Shape Muscles on Right and Left side ID C7 Roll Down Curves in Motion

10 Vertebral Structure

11 Vertebral Structure Intervertebral Foramina 3 joints Bodies connected by intervertebral disks Articular facets

12 Disks Shock absorption and movement Material in disks Annulus Fibrosus - concentric rings of fibrocartilage Nucleus Pulposus - gelatinous substance

13 Ligaments 3 ligaments extending length of vertebral column Anterior Longitudinal Ligament Posterior Longitudinal Ligament Supraspinous Ligament Other ligaments Ligamentum Flavum Interspinous Ligaments Intertransverse Ligaments

14 Ligaments

15 Vertebral Movement What happens to Disks, Bones and Ligaments in motion Flexion Extension Lateral Flexion Rotation

16 Disks/ Nucleus Bones Ligaments Flexion Compressed anteriorly nucleus moves posteriorly Arches and articular facets move apart -Anterior longitudinal ligament relaxed -Posterior ligaments stretched Extension Compressed posteriorly nucleus moves anteriorly Arches and articular facets move closer together -Anterior longitudinal ligament stretched -Posterior ligaments relaxed Lateral Flexion One side compressed Ipsilateral nucleus moves in transverse opposite direction processes and articular facets move closer together -Ipsilateral ligaments relaxed -Contralateral ligaments stretched Rotation Reduction in overall height, some compression of nucleus -All ligaments stretched Transverse and spinous processes moved apart

17 Pelvis Basin Sacrum + Coccyx + 2 innominate bones Ilium, Ischium, Pubis Greater (false) and Lesser (true) Pelvis Pelvic Inlet and Pelvic Outlet 3 joints 2 sacroiliac and pubic symphysis Receives weight from upper body and lower body

18 Landmarks (Pelvis Right Lateral View)

19 Pelvis

20 Pelvis: Landmarks Ilium Iliac Crest Anterior Superior Iliac Spine (ASIS) Anterior Inferior Iliac Spine Posterior Superior Iliac Spine External Iliac Fossa Internal Iliac Fossa Greater Sciatic Notch Arcuate Line (Iliopectineal Line)

21 Pelvis: Landmarks Ischium Ischial Spine Ischial Tuberosity Lesser Sciatic Notch Pubis Ischiopubic Ramus Pubic Tubercle Pubic Symphysis

22 Pelvis: Landmarks Acetabulum Obturator Foramen

23 Landmarks (Pelvis Right Lateral View)

24 Landmarks (Pelvis Right Medial View)

25 Sacrum 5 Fused Vertebrae Between 2 Ilia Articulates with L5

26 Sacrum Landmarks Superior Articular Process Sacral Base Sacral Promontory Anterior Sacral Foramina (Intervertebral Foramen) Transverse ridge (Intervertebral Disks) Apex Sacral Canal Articular Facet Posterior Sacral Foramina Median Sacral Crest (Spinous Process) Lateral Sacral Crest (Transverse Process) Auricular Surface

27 Coccyx 3-5 fused vertebrae Tailbone Landmarks Transverse Process Superior Cornua

28 Landmarks (Sacrum and Coccyx)

29 Landmarks (Sacrum and Coccyx)

30 Sacroiliac Joint Ilium and sacrum connect at Auricular surfaces Adduction (Nutation) Abduction (Counter-nutation) Ligaments Posterior sacroiliac ligament Sacrospinous ligament Sacrotuberous ligament

31 Pubic Symphysis Joint between 2 Pubic Bones Fibrocartilage disk Shock Absorber Surrounded by fibrous cuff and 4 ligaments Limited Mobility

32 Nutation Video

33 Sacroiliac Joint

34 Sacroiliac Joint

35 Detailed look at Lumbar Spine Shape Movement Body Flexion Disk Extension Spinous Process Lateral Flexion Transverse Process Rotation Laminae Pedicles Articular facets

36 Body Large Disk Thick Spinous Process Angled posteriorly Transverse Process Long with tubercles for muscle attachment Superior Articular Facets Concave and angled medially Inferior Articular Facets Convex and angled laterally

37 Detailed look at Lumbar Spine Movement Facilitation Flexion, Extension and Lateral Flexion Shape of articular facets Transverse process Spinous process Thickness of disks Limitation Rotation Shape of articular facets

38 Lumbosacral Joint Lumbar Spine meets Sacrum Sacral base tilted forward Body of L5 and Disk between L5 & S1 thicker anteriorly

39 Iliolumbar ligaments Transverse Process of L4 and L5 to Iliac Crest Oppose Sidebending Flexion L4 stretched and L5 relaxed Extension L5 stretched and L4 relaxed

40 Iliolumbar ligaments

41 Detailed look at Thoracic Spine Shape Movement Body Flexion Disk Extension Spinous Process Lateral Flexion Transverse Process Rotation Laminae Pedicles Articular facets

42 Body circular whole and demifacets to articulate with Ribs Disk small Spinous Process Angled inferiorly and elongated Transverse Process facets that articulate with ribs Superior Articular Facets round and flat, face back, angle up and out Inferior Articular Facets round and flat, face front, angle down and in

43 Detailed look at Thoracic Spine Movement Facilitation Flexion,Extension,Lateral Flexion and Rotation Shape and orientation of of articular facets Limitations Extension Spinous processes Small Disks Attachment to ribs *Biggest limitation - T1-T7 who connect to true ribs 8-10 false ribs connected to sternum with cartilage of rib floating ribs no anterior attachment, most mobility

44 Detailed look at Cervical Spine Shape Movement Body Flexion Disk Extension Spinous Process Lateral Flexion Transverse Process Rotation Laminae Pedicles Articular facets

45 Body Small and concave Disk Large relative to body Spinous Process C2 & C7 long C3-C7 bifurcated Transverse Process Short and broad Transverse Foramen and lateral groove Superior Articular Facets Angled back and up Inferior Articular Facets Angled front and down

46 Detailed look at Cervical Spine Movement Facilitation Flexion, extension, and rotation Small body + thick disk Shape of body Short spinous processes on C3-C6 (extension) Limitations Sidebending Rectangular shape of body Transverse Processes

47 Analyze ROM in Cervical Spine Flexion Extension Right Rotation Left Rotation Right Side Bend Left Side Bend

48 C1: Atlas Atlas Ring shaped No body or spinous process Anterior and posterior arches and lateral masses Transverse processes Transverse foramen Transverse ligament Facets Articulate with Occipital Condyles and C2 (Axis)

49 C1: Atlas

50 C2: Axis Axis Dens/Odontoid Process Represents missing body of C1 Articular facets Superior convex - Inferior facets of C1 also convex Spinous Process Relatively long

51 C2: Axis

52 Atlantoaxial Joint

53 Occipital Bone Foramen Magnum Occipital Condyles Atlanto-Occipital Joint

54 Thoracic Cage Thoracic Vertebrae Sternum Ribs

55 Sternum

56

57 Ribs

58 Ribs

59 Rib Cage Connects to Vertebrae in back - via facets on vertebral body and transverse processes Sternum in front - via costal cartilage True Ribs: 1-7 False Ribs: 8-10 Floating Ribs: 11, 12

60 Rib Movement in Respiration Inspiration/Inhalation Expiration/Exhalation Ribs elevated Ribs depressed Sternum lifts Sternum lowers Lower rib cage lifts Lower rib cage up laterally Diameter of thoracic cage increases lowers medially Diameter of thoracic cage decreases

61 Posterior Muscles of Spine Posterior Muscles of Trunk From Deep to Superficial Review Origin and Insertion Contraction brings origin and insertion closer together Direction of Muscle Fibers tells us what the muscle can do

62 Intertransverse Origin Insertion Action Transverse Process Transverse Process Sidebending *Attach posterior to intertransverse ligament

63 Interspinalis Origin Insertion Action Spinous Process Spinous Process Extension *Attach on either side of interspinous ligament

64

65

66 Transversospinalis Rotatores Most Deep Span 1 vertebral level Multifidus Superficial to Rotatores Span 2-4 vertebral levels Semispinalis Most superficial Span 4-6 vertebral levels

67 Transversospinalis Actions: Bilateral Contraction - Extension Unilateral Contraction - Sidebending or Contralateral Rotation Main Purpose: keep the trunk erect

68 Transversospinalis Origin Insertion Rotatores Transverse Process Lamina Multifidus Transverse Process Spinous Process Semispinalis Transverse Process Spinous Process

69

70 Deep neck muscles Origin Rectus Capitus Posterior Arch Posterior Minor C1 Insertion Action Inferior Bilateral: Occipital Ridge Extension Unilateral: Sidebending -Rotation (Ipsilateral)

71 Deep neck muscles Origin Insertion Action Rectus Capitus Spinous Process Inferior Bilateral: Posterior Major of C2 Occipital Ridge Extension lateral to minor Unilateral: Sidebending Rotation (Ipsilateral)

72 Deep neck muscles Origin Insertion Action Obliquus Capitis Transverse Occiput lateral to Bilateral: Superior Process C1 Rectus Capitis Extension Posterior Major Unilateral: Sidebending -Rotation (Contralateral)

73 Deep neck muscles cont. Origin Insertion Obliquus Capitis Spinous Process Transverse Inferior of C2 Process of C1 Action Extension, Sidebending Rotation

74

75 Intermediate Back and Neck Muscles Erector Spinae Splenius Capitis and Cervicis Levator Scapulae Rhomboids Serratus Posterior Latissimus Dorsi Trapezius

76 Erector Spinae Iliocostalis Cervicis, Thoracis, Lumborum Longissimus Capitis, Cervicis, Thoracis Spinalis Spinalis Capitis, Semispinalis capitis, Thoracis

77 Erector Spinae Iliocostalis Origin Insertion Lumborum: Iliac Crest via Lumbar Fascia L: Lower Ribs Thoracis: Lower T: Upper 6 Ribs 6 Ribs Cervicis: Upper C: Transverse 6 Ribs Processes of Lower Cervicals

78 Erector Spinae Action Iliocostalis -Spinal Extension -Assists in Lateral Flexion of Spine -Assists in Rotation

79 Longissimus Origin Thoracis: -Lumbar Transverse Processes Cervicis: Transverse Processes of Upper Thoracic Vertebrae Capitis: Transverse Processes of Upper Thoracics and Lower Cervicals Insertion Thoracis: -Thoracic Transverse Processes & Posterior Ribs 9 and 10 Cervicis: Transverse Processes of lower cervical vertebrae Capitis: -Mastoid Process

80 Longissimus Action -Spinal Extension -Assists in Lateral Flexion of Spine -Assists in Rotation of Spine Capitis: -Assists in Extension of Head -Assists in Lateral Flexion of Head

81 Origin Spinalis Insertion Thoracis: Thoracis: -Spinous Processes of -Spinous T1-T10 Processes of T11-L2 Capitis: Capitis and -Spinous Processes of Semispinalis: Lower Cervicals and Occiput Upper Thoracics Semispinalis Capitis: -Transverse Processes of Lower Cervicals and Upper Thoracics

82 Spinalis Region Action Thoracis -Spinal Extension Bilateral: Capitis And -Extend Head Semispinalis Capitis -Straighten out Cervical Spine Unilateral: -Assist in Lateral Flexion of head and neck -Assist in Rotation of head and neck

83

84 Splenius Capitis and Cervicis Origin Insertion Capitis Nuchal Mastoid Ligament and Process and Spinous Occipital Process of Bone lower C and upper T Action Bilateral: Extend Head and Cervical Spine Unilateral: Sidebending Cervicis Spinous Transverse -Ipsilateral Process of T5- Process of Rotation T7 C1-C3

85

86 Levator Scapulae Origin Insertion Levator Transverse Medial Scapulae Processes of Scapula C1-C4 Action When Scapula Fixed Reinforces splenius cervicis

87

88 Serratus Posterior Origin Insertion Action Superior Spinous Ribs 1-5 Processes of C7-T3 Elevates Ribs aids inspiration (inhale) Inferior Spinous Ribs 9-12 Processes of T12-L2 Depresses Ribs aids expiration (exhale)

89

90 Rhomboids Action Rhomboids When scapula is fixed pull vertebrae laterally

91

92 Latissimus Dorsi Action Latissimus Dorsi -Structural integrity of trunk -Extends thoracolumbar spine

93

94 Trapezius Action Trapezius When shoulder is fixed Bilateral: Extends neck Unilateral (Superior): Ipsilateral sidebending -Contralateral rotation

95

96 Anterior Neck Muscles Longus Colli Rectus Capitis Longus Capitis Scalenus Sternocleidomastoid

97 Longus Colli Origin Insertion Action Longitudinal Bodies of C2- Bodies of C4- Bilateral: T3 C7 Flexes head and Oblique Anterior Arch Transverse straightens Superior C1 Processes of cervical spine C3-C6 Unilateral: Oblique Bodies of T1- Transverse Assists in Inferior T3 Processes of Sidebending C5-C7

98 Longus Colli

99 Rectus Capitis Origin Insertion Action Lateralis Occipital Transverse Bone Process of Atlas Flexion of head and sidebending Anterior Occipital Anterior Bone Atlas Flexion of head, sidebending and rotation

100 Longus Capitis Origin Longus Capitis Insertion Action Transverse Occiput processes of C3-C6 Bilateral: Flexion of head and straighten cervical spine Unilateral: Lateral Flexion of head

101 Scalenus Origin Anterior Medius Posterior Insertion Action Transverse Anterior Part Unilateral (3): processes of Rib 1 Sidebending of C3-C6 Unilateral (A&M): Transverse Anterior Part Contralateral processes of Rib 1 Rotation of C2-C7 Bilateral (A&M): Increase Transverse Lateral curvature of processes surface of Rib Cervical Spine, of C4-C6 2 (3): Assist in Inspiration when cervical spine fixed

102 Sternocleidomastoid Origin Insertion Action Sternum and Clavicle Mastoid Process Skull Fixed: Elevates Sternum and Clavicle assisting in inspiration Unilateral: Ipsilateral sidebending and contralateral rotation Bilateral: Extension of head

103

104 Muscles of Respiration Diaphragm Internal Intercostals External Intercostals Levatores Costarum Transversus Thoracis Scaleni Sternocleidomastoid Posterior Serratus Abdominal Wall

105 Intercostals

106 Levator Costarum Origin Insertion Action Transverse processes of Thoracic vertebrae 1 or 2 ribs below -Elevation of ribs -Assists with rotation of spine

107

108 Transversus Thoracis Origin Insertion Inner surface of Costal sternum and cartilage of xiphoid process ribs 2-6 Action Depresses Ribs assisting with exhalation

109

110 Diaphragm Primary muscle of respiration Origins Sternal: xiphoid process Costal: Deep surfaces of Ribs 7-12 Vertebral: Right Crus bodies of L1-L3 Left Crus Bodies of L1-L2 Insertion: Central Tendon Inspiration Diaphragm Contracts and moves inferiorly Expiration Diaphragm Relaxes and moves superiorly

111

112

113

114 Psoas Major Origin Insertion Action Bodies, Disks, Lesser trochanter Bilateral: Straighten the Transverse Lumbar Spine Processes of T12Unilateral: L5 Sidebending Flexion Rotation (contralateral)

115

116 Quadratus Lumborum Origin Insertion Action Posterior Iliac Rib 12 Sidebending Crest Transverse processes of L1-L5

117

118 Abdominal Wall Cylindrical Fascial Sheath From Spine to Linea Alba (midline) Joins top of pelvis to bottom of rib cage Back and sides 3 layers of muscle: Transversus, Internal and External Obliques Front and center 1 layer of muscle: Rectus

119 Transversus Abdominis Deepest layer Compresses abdomen Attachments Back: Lumbar Vertebrae Sides: Iliac Crest and Inner surface of Ribs 6-12 Front: Inguinal ligament and deepest part of aponeurosis

120 Internal Oblique Front View A Shape Actions: Sidebending, Ipsilateral Rotation, Compresses Abdomen, Assists in Flexion of trunk Attachments Back: Thoracolumbar Fascia Side: Ribs 9-12, Iliac Crest Front: Inguinal ligament, and aponeurosis

121 External Oblique Front View: V shape Action: Sidebending, Contralateral Rotation, Compression of Abdomen, Assists in Flexion of trunk Attachments Front: External surface of ribs 5-12, inguinal ligament, Joins aponeurosis

122 Rectus Abdominis Inside Abdominal Sheath Action: Flexes trunk Attachments Lower: Pubic Crest and Symphysis Upper: Xiphoid Process and costal cartilage of Ribs 5-7

123

124 Pelvic Floor Several layers of muscles and fascia that connect pubic bones, ischial tuberosities, and sacrum Supports weight of pelvic organs Provides sphincters for rectum, bladder and vagina Pelvic Diaphragm Urogenital Diaphragm

125

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