anatomy, physical examination and imaging of …...understand: dermatomes, * slr test,...
TRANSCRIPT
Anatomy, Physical Examination
and Imaging of Thoracic
and Lumbosacral Spine
NGUYỄN THÀNH NHÂN
LEARNING OBJECTIVES
Understand:
* Basic anatomy of the spine
* Thoracic and Lumbar spine anatomy
Understand basic imaging of X ray, CT Scan and MRI
Identify and assess functions of the structures in clinical aspect:
* Identify structures: inspection, palpation
* Assess: Thoracic - Lumbar spine movements
Understand: dermatomes, * SLR test, Bragard’s test, Neri’s test, …
CONTENT
Basic anatomy of the spine
Thoracic - Lumbosacral spine anatomy
Imaging of Thoracic - Lumbar spine
Physical examination of Thoracic and Lumbar spine
Anatomy
Basic anatomy of the spine
- The vertebral column consists of 33
vertebrae,
- 5 segments: cervical, thoracic,
lumbar, sacral, and coccygeal.
- There are 7 cervical, 12 thoracic, 5
lumbar, 5 sacral, and 4
coccygeal vertebrae.
- The two major exceptions are C1
(atlas) and C2 (axis)
- Atlantoaxial joint - cervical rotation
Anatomy
Basic anatomy of the spine
[1]
Anatomy
Basic anatomy of the spine
[1]
Anatomy
Basic anatomy of the spine
- The spinal cord
- Conus medullaris: L1 - L2
- There are 8 cervical, 12 thoracic, 5
lumbar, and 5 sacral pairs, and 1
coccygeal pair of spinal nerves.
- The sacral spinal nerves
make up the cauda equina
The neural anatomy is such that the spinal cord resides within
the bony canal between C1 and L1 and/or L2. The filum
terminale extends from the conus and attaches to the coccyx.[1]
Anatomy
Basic neurology of the spine
- Gray matter
+ Spinal neurons (lower motor
neurons),
+ Interneurons
- White matter
+ The axons of LMN
+ Afferent sensory neuron axons
+ 4 funiculi: L lateral, R lateral, ventral,
dorsal
Cross section of the spinal cord delineating
white and gray matter and four funiculi. [1]
Anatomy
Basic neurology of the spine
- White matter
Cross section of the spinal cord delineating
white and gray matter and four funiculi.
+ Within the white matter are tracts
of ascending and descending axons
segregated into pathways of function
[1]
Anatomy
Basic neurology of the spine
- White matter
Cross section of the spinal cord delineating
white and gray matter and four funiculi.
+ The lateral spinothalamic tract: pain
and temperature sensation. (crosses)
+ The dorsal column pathway:
vibration sensation, two-point touch,
conscious proprioception
+ The lateral corticospinal tract:
voluntary motor function. [1]
Lumbosacral Spine
Lumbar vertebrae are characterized by massive bodies and robust spinous and transverse processes.Their articular facets are oriented somewhat parasagittally, which is thought to contribute the largerange of anteroposterior bending possible between lumbar vertebrae. Lumbar vertebrae alsocontain small mammillary and accessory processes on their bodies. These bony protuberances aresites of attachment of deep lumbosacral muscles.
Lumbar Spine Anatomy
[2]
Drawing of 2 lumbar segments viewed from anoblique angle. The outline of the facets andthe pars interarticularis has the appearance ofthe "neck" of a Scottie dog.
Lumbar Spine Anatomy
[2]
IMAGING
AP VIEW LATERAL VIEW OBLIQUE VIEW
Adult Lumbar Spine - AP View [3]
Adult Lumbar Spine - Lateral View [3]
Adult Lumbar Spine - Lumbosacral L5S1 View [3]
Adult Lumbar Spine - Oblique View [3]
Spondylolisthesis L4-L5
EXTENSION VIEW FLEXION VIEW
CT Scan
Sagittal
CT: L4 compression fracture
T2W T1W STIRT2W
MRI
Thoracic Spine X-ray: AP projection. 1, Left
ventricle. 2, Gas in stomach. 3, Right
hemidiaphragm. 4, Posterior rib. 5,Clavicle.
Thoracic Spine X-ray: AP projection. 1, Gas in Colon (Splenic
flexure). 2, Gas in stomach. 3, Left hemidiaphragm. 4, Posterior
rib. 5, Pedicle. 6, Spinous process. 7, Transverse process.
THORACIC SPINE
Thoracic Spine X-ray: Lateral view. 1, Right
hemidiaphragm. 2, Left
hemidiaphragm. 3, Vertebral body. 4, Rib.
Thoracic Spine X-ray: Lateral view. 1,Posterior
rib. 2, Vertebral body. 3, Intervertebral discal space.
THORACIC SPINE
Physical Examination Of Thoracic Spine
Visual Examination
Physical Examination Of Thoracic Spine
Visual Examination
Physical Examination Of Thoracic Spine
Palpation
Physical Examination Of Thoracic Spine
Percussion
Physical Examination Of Thoracic Spine
MovementsActive Movements
Physical Examination Of Thoracic Spine
MovementsActive Movements
Physical Examination Of Thoracic Spine
MovementsActive Movements
Physical Examination Of Thoracic Spine
MovementsActive Movements
Physical Examination Of Thoracic Spine
Neurologic Evaluation of the Thoracic Spine
Physical Examination Of Thoracic Spine
Physical Examination Of Thoracic Spine
Physical Examination Of Thoracic Spine
Physical Examination Of Thoracic Spine
Inspection
When the patient enters the room
▪ He or she is distressed?
▪ Is the patient leaning to one side?
▪ Is the patient able to walk,
▪ Is the gait normal?
▪ The pelvis?
▪ The patient is limited in any motion,
▪ Note the extent of any pain.
Physical Examination Of Lumbosacral Spine
[1]
Inspection
Once the patient is undressed,
▪ Look for signs of trauma, blisters, scars, discoloration,
redness, contusions, lumps, bumps, fat pads, and
other marks.
▪ Hairy patches or café au lait spots
▪ Look for a lateral curvature, or scoliosis
Physical Examination Of Lumbosacral Spine
[1]
Palpation
Posterior Lumbar, Sacral, and Coccygeal Spine
▪ Sit on a stool behind the
standing patient. Place
your thumbs on the
midline of the patient’s
back at the level of the
iliac crest. This should be
the junction between L4
and L5.
Physical Examination Of Lumbosacral Spine
[1]
Palpation
C7
D7
D12
L4-L5
Palpation
Posterior Lumbar, Sacral, and Coccygeal Spine
Physical Examination Of Lumbosacral Spine
[1]
Palpation
Paraspinal Muscles
▪ Detect tenderness, spasm, muscular defect, and
asymmetries.
Physical Examination Of Lumbosacral Spine
[1]
Palpation
Anterior Lumbar, Sacral, and Coccygeal Spine
Physical Examination Of Lumbosacral Spine
[1]
Movements
Active Movements
Physical Examination Of Lumbosacral Spine
Forward Bending
Forward Bending Test
[1]
Movements
Active Movements
Physical Examination Of Lumbosacral Spine
Backward Bending
[1]
Movements
Active Movements
Physical Examination Of Lumbosacral Spine
Side Bending
[1]
Movements
Active Movements
Physical Examination Of Lumbosacral Spine
Trunk Rotation
[1]
Movements
Passive Movements
Physical Examination Of Lumbosacral Spine
Rotation
[1]
Movements
Resisted Movements
Physical Examination Of Lumbosacral Spine
Rotation
[1]
Movements
Resisted Movements
Physical Examination Of Lumbosacral Spine
Flexion
[1]
Movements
Resisted Movements
Physical Examination Of Lumbosacral Spine
Side Bending
[1]
Tests
Physical Examination Of Lumbosacral Spine
Straight Leg Raise (Lasègue)
[1]
Tests
Physical Examination Of Lumbosacral Spine
Bragard’s Test – Neri’s Test
[1]
Tests
Physical Examination Of Lumbosacral Spine
Neurologic Evaluation of the Lumbar Spine
[1]
Tests
Physical Examination Of Lumbosacral Spine
Neurologic Evaluation of the Lumbar Spine
[1]
KEY MUSCLES - MYOTOME
KEY MUSCLES - MYOTOME
References
1. Todd J.Albert, Alexander R. Vaccaro. Physical Examinatiom of the Spine 2th edition. Thieme Medical Publishers, 2017.
2. Stephen Kishner, Maxim Moradian, Jan K Morello. Lumbar Spine Anatomy. Update: Aug 12 2015. emedicine.Medscape.com
3. Wiki – Radiography.net