Back & Shoulder Region Ernest F. Talarico, Jr., Ph.D. Associate Director of Medical Education Associate Professor of Anatomy & Cell Biology Course Director,

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  • Back & Shoulder RegionErnest F. Talarico, Jr., Ph.D.Associate Director of Medical EducationAssociate Professor of Anatomy & Cell BiologyCourse Director, Human Gross Anatomy & EmbryologyIndiana University School of Medicine NorthwestGary, Indiana AY14-15Human Gross Anatomy

    Special Considerations

  • IUSM-NW AY14-15 *ObjectivesIdentify all structures in this regionUnderstand anatomical relationships in this regionTo be able to comprehend and discuss the structure of the nervous systemTo apply this knowledge to clinical situations and radiography

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  • The BackHuman Gross Anatomy

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  • IUSM-NW AY14-15 *Vertebral Column(Spine)33 vertebrae7 cervical (C)12 thoracic (T)5 lumbar (L)5 sacral (S)4 coccygeal (C0)cervicalthoraciclumbarsacralcoccygealIntervertebral disc

    Special Considerations

  • IUSM-NW AY14-15 *Vertebrae (vertebra = singular)

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  • IUSM-NW AY14-15 *Vertebrae (vertebra = singular)

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  • IUSM-NW AY14-15 *

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  • IUSM-NW AY14-15 *

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  • IUSM-NW AY14-15 *Nervous SystemSomatic Motorgeneral somatic efferent (GSE)single target organno synapsefast - myelinVisceral Motorgeneral visceral efferent2 to 3 target organs2 neuron relay from CNSslow - myelin

    Special Considerations

  • IUSM-NW AY14-15 *Spinal Nerves (31 pairs)all are mixed nerves (sensory and motor)4 fiber componentsSensoryGSA: general somatic afferentGVA: general visceral afferentMotorGSE: skeletalGVE: visceral

    Special Considerations

  • IUSM-NW AY14-15 *Typical Thoracic Spinal Nerve31 pairs of spinal nerves:8 cervical12 thoracic5 lumbar5 sacral1 coccygeal

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  • IUSM-NW AY14-15 *

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  • IUSM-NW AY14-15 *Muscles of the Back

    Superficial GroupIntermediate GroupDeep Grouptrapezius m.latissiumus dorsi m.rhomboideus major m.rhomboideus minor m.levator scapulae m.serratus posterior superior m.serratus posterior inferior m.Splenius (capitius; cervicis)Semispinalis m.Erector Spinae iliocostalis m.longissimus m.spinalis m.anchor the upper limb to the axial skeletonfunction in respirationintrinsic muscles of the dorsum (supplied by dorsal nerve rami)

    Special Considerations

  • IUSM-NW AY14-15 *Muscles of the BackSuperficial Group

    trapezius m.latissiumus dorsi m.rhomboideus major m.rhomboideus minor m.levator scapulae m.

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  • IUSM-NW AY14-15 *Muscles of the BackIntermediate Group

    serratus posterior superior m.

    serratus posterior inferior m.

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  • IUSM-NW AY14-15 *Muscles of the BackDeep Group

    Splenius (capitius; cervicis)

    Semispinalis m. (5, 13)

    Erector Spinae iliocostalis m. (11)longissimus m. (10)spinalis m. (18)

    Special Considerations

  • IUSM-NW AY14-15 *Muscles of the BackDeep Group Other intrinsic muscles

    Rotatores m. (14)Intertransverse mm. (16)

    [note: levators costarum mm.; 13)

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  • IUSM-NW AY14-15 *Spinal CordMeningesPia mater denticulate ligamentsfilum terminaleArachnoid mater (9)subarachnoid space with CSFLumbar cistern (L1 S2)Dura mater (8)Epidural spaceSubdural spaceTable #1 sacral region Table #2lower cervicalTable #3U - thoracic regionTable #4L - thoracic region Table #5lumbar regionTable #6 sacral region

    Special Considerations

  • IUSM-NW AY14-15 *L1/L2 (adult)L2/L3 (child)

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  • IUSM-NW AY14-15 *CSF & DIAGNOSIS OF NEUROLOGICAL DISORERS

    lumbar puncture (L3/L4; L4/L5)myelography and intrathecal route for medicationsneed prior CT Scan to rule out ICP

    Sample Collection (7 8 ml)

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  • IUSM-NW AY14-15 *Diagnostic AnalysisCell CountWBCs or RBCs make CSF turbidbacterial meningitis (mostly neutrophils)meningeal syphilis & fungal infections (lymphocytes)RBCs subarachnoid hemorrhage or AV malformationtraumatic tap vs. subarachnoid hemorrhageictus xanthochromia (faint yellow color)

    Differential Protein200 mg/100 ml gives CSF a yellow-orange color protein is due to vascular endothelial cell permeability (BBB breakdown)pathological conditions (hemorrhage, syphilis, meningitis, MS, Guillian-Barr Syndrome, diabetic neuropathy)

    Special Considerations

  • IUSM-NW AY14-15 *Differential GlucoseGlucose concentration is in bacterial infections

    Microorganisms

    CSF Pressuredecreased dehydration; CSF leaksspinal subarachnoid blockincreased brain edema; intracranial massacute stroke; infections, etc.

    Special Considerations

  • IUSM-NW AY14-15 *Suboccipital RegionReflect trapezius; splenius and semispinalisIdentifyRectus capitis minor m. (16)Rectus capitis major m. (18)Superior oblique m. (17)Inferior oblique m. (19)

    IdentifyGreater occipital n. (C2; 6)Suboccipital n. (C1; 5)Occipital artery (2)Vertebral artery

    Special Considerations

  • The ShoulderHuman Gross Anatomy

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  • IUSM-NW AY14-15 *Muscles of the Shoulder RegionDeltoid (axillary n.)Suprapinatus (suprascapular n.)Infraspinatus (suprascapular n.)Subscapularis (upper & lower subscapular nn.)Teres major (lower subscapular n.)Teres minor (axillary n.Latissimus dorsi (thoracodorsal n.)

    Special Considerations

  • IUSM-NW AY14-15 *Quadrangular spaceBoundariesTeres minor (4) & subcapularisTeres major (6)Long head of tricepssurgical neck of humerus (laterally)Contents (9)Axillary nervePosterior humeral circumflex artery

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  • IUSM-NW AY14-15 *Triangular spaceBoundariesTeres major (6)Long head of triceps (10)Teres minor (4)ContentsCircumflex scapular artery & vein (5)

    Special Considerations

  • IUSM-NW AY14-15 *Triangular IntervalBoundariesTeres major (6)Long head of triceps (10)Medial head of triceps (or humerus)

    ContentsRadial nerve (21)Profunda brachii artery (20)

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  • IUSM-NW AY14-15 *Triangle of Auscultation

    Boundaries

    Trapezius m.Latissimus dorsi m.Scapula

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  • IUSM-NW AY14-15 *

    NervesArteriesSuprascapular n. (C5 C6)Dorsal scapular n.Suprascapular a.Dorsal scapular a.Anastomoses around the scapula

    Special Considerations

  • IUSM-NW AY14-15 *The Shoulder JointCut and reflect the coracobrachialis m., the short head of biceps brachii m., and the long head of triceps brachiiClean the insertion of subscapularisIdentify the fibrous capsule and remove the posterior portionAttempt opening up the joint (removal of the head of the humerus may be necessary

    Special Considerations

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