Transcript INTRODUCTION & BACK - China Medical University

REGIONAL ANATOMY
Lu Xiaoli
REGIONAL ANATOMY & OPERATIVE SURGERY
CHIAN MEDICAL UNIVERSITY
What is anatomy?
A science concerned with
the study of the structure of
biological organisms

Gross anatomy (by unaided eye )
 Regional
anatomy－by body
regions
 Systemic anatomy－by
biological systems
 Surface anatomy

Microscopic anatomy (histology)
Systemic
Anatomy
SURFACE ANATOMY

directly
palpated on
the body
surface
(underlying
bone or
muscle)

indirectly palpated
on the body surface
(surface projection
of organ)
How to learn anatomy

Observation

Memorization (≠rote memorization)

Visualization
Observation

Atlas

Specimen

Cadaver
Memorization
Terminology
 Features
 Position
 Relationship
 Blood supply
 Lymphatic drainage
 Innervations
 Relevant clinical points

Visualization

What is liver?

Where is it?

Could you visual your own liver in your
body?
liver
ANATOMICAL ORIENTATION
Anatomical
Position

erect

feet together

arms to the side

head
facing
eyes
palms of the hands forwards
Anatomical Planes of the Body

Sagittal

Coronal

Transverse
Terms of relation or position
medial (lying closer to the midline)
 lateral (lying further away from the
midline)
 posterior (dorsal) closer to the posterior
surface of the body
 anterior (ventral) closer to the anterior
surface of the body
 superior (closer to the head)
 inferior (closer to the feet)

Terms of relation or position
Superficial closer to the skin
 Deep further away from the skin
 cranial toward the head
 caudal toward the tail (feet)
 proximal closer to the origin of a
structure
 distal further away from the origin of a
structure

The ______ plane divides the body
into right and left halves.
A.
transverse
B.
sagittal
C.
coronal
D.
oblique
E.
para-sagittal
Which of the cardinal planes dividing
the body is not named for a suture of the
skull?
A.
transverse
B.
coronal
C.
Sagittal
The armpit or axilla is __________ to
the hip.
A.
superficial
B.
deep
C.
superior
D.
inferior
The "6-pack of abs" is due to the
rectus abdominis muscle, that lies within
the _______ abdominal wall.
A.
anterior
B.
posterior
C.
superior
D.
inferior
The arm is _________ to the
hand.
A.
medial
B.
lateral
C.
proximal
D.
distal
The
scapula
(shoulder
blade)
_________ to the vertebral column.
A.
anteromedial
B.
posterolateral
C.
proximal
D.
distal
is
BACK
(VERTEBRAL REGION)
Surface
Anatomy
LAYERS



Superficial layers
Deep fascia
Muscles
Superficial layers


Skin
Superficial fascia
Skin
Thick
Full of hair follicles, sweat glands & sebaceous glands
Superficial fascia
Dense, especially the Nuchal region
 Full of Fat
 Cutaneous nerve & Superficial blood
vessels

Cutaneous nerve
Greater occipital nerve
3rd occipital nerve
Spinal nerve (cutaneous
branches of dorsal rami)
Superior cluneal nerve
(cutaneous branches of
dorsal rami)
Middle cluneal nerve
(cutaneous branches of
dorsal rami)
Inferior cluneal nerve
(posterior femoral
cutaneous nerve
C2
DERMATOMES
an area of skin
which is innervated
by afferent nerve
fibers coming to a
single dorsal spinal
root.
Herpes Zoster
Infections
(Shingles)
Superficial Blood Vessels
Nuchal
Occipital artery
Superficial cervical artery
dorsal scapular artery
Posterior intercostals artery
Thoracic dorsal dorsal scapular artery
thoracodorsal artery
Lumber
Lumbar artery
Superior Cluneal artery
Sacrococcygeal
Inferior cluneal artery
Deep Fascia


Nuchal fascia: a deep investing membrane
which covers the deep muscles of the back
of the neck.
Thoracolumbar fascia: a deep investing
membrane which covers the deep muscles
of the back of the trunk.
Thoracolumbar
Fascia
a
deep investing
membrane which
covers the deep
muscles of the
back of the trunk
 3 layers in
lumbar region
Q.L
Erector spinae
MUSCLES
Superficial
group
Intermediat
e group
extrinsic back muscles
respiration and
movements of the
upper extremity
Deep
group
intrinsic back
muscles
movement and
stabilization of
the vertebral
column
Superficial Group
Trapezius
levator scapulae
Rhomboid minor
Rhomboid major
Latissimus dorsi
Triangle Of Auscultation
SUPERIOR
INFERIOR
Intermediate Group
Serratus posterior superior
Serratus posterior inferior
DEEP GROUP
Spinotransversales Muscles
Splenius Capitis
Splenius Cervicis
Erector Spine Muscles
Iliocostalis
Longissimus
Spinalis
DEEP GROUP
Transversospinales muscles
Semispinalis
Rotatores
Multifidus
Segmental back muscles
Levatores costarum
Interspinales
Intertransversarii
P59
DEEP GROUP
Suboccipital Muscles
Rectus Capitis Posterior Minor
Rectus Capitis Posterior Major
Superior Oblique
Inferior Oblique
Suboccipital Triangle





Rectus Capitis
Posterior Major
Superior Rectus
Oblique
Inferior Rectus
Oblique
Vertebral Artery
Suboccipital N
(Dorsal Ramus Of
CⅠ)
Superior Lumbar Triangle
(Triangle Of Grynfeltt-Lesshaft )
twelfth rib
 Serratus
posterior inferior
 Erector spinae
 internal oblique

Inferior Lumbar Triangle
(Petit's Lumbar Triangle)



External
Abdominal
Oblique
Latissimus Dorsi
Iliac Crest
Deep Arteries
Nuchal Region
Thoracic Region
Lumber Region
Sacrococcygeal
Region
Occipital Artery
Superficial Cervical Artery
Dorsal Scapular Artery
Vertebral Artery
Posterior Intercostals Artery
Dorsal Scapular Artery
Thoracodorsal Artery
Lumbar Artery
Subcostal Artery
Superior Cluneal Artery
Inferior Cluneal Artery
DEEP VEINS
Nuchal
Vertebral vein
Internal jugular vein
Subclavian vein
Posterior Intercostals vein – azygos vein
Thoracic
Subclavian vein
Axillary vein
Lumber
Lumbar vein – inferior vena cava
Sacroco
ccygeal
Internal iliac vein
Vertebral
Artery
Atlas
Vertebral Veins
Deep Nervers

Dorsal rami of spinal nerve

Accessory nerve

Thoracodorsal nerve

Dorsal scapular nerve
Dorsal Rami of Spinal Nerve
Accessory Nerve
Transient
postoperative
paralysis of
spinal
accessory
nerve
Thoracodorsal
Nerve
Dorsal Scapular Nerve
VERTEBRAL CANAL
CONSTRUCTION

Anterior Wall:




Posterior Wall:




Vertebral Column
Posterior Border Of
Intervertebral Disc
Posterior Longitudinal
Ligament
Lamina
Ligament Flava;
Zygapophysial Joints
Bilateral Wall:


Pedicle
Intervertebral Foramina
CONTENTS
Spinal Cord
Meninges
Spinal Nerve Root
Cauda Equina
Blood Vessels
Nerves
Lymphatic Vessels
Connective Tissues
SPINAL CORD

31 spinal cord segments
8 cervical segments
 12 thoracic segments
 5 lumbar segments
 5 sacral segments
 1 coccygeal segment


Two enlargements
Cervical enlargement (C4-T1)
 Lumbosacral enlargement (L2-S3)

MENINGES
Spinal dura mater
Spinal arachnoid mater
Spinal pia mater
MENINGES
Denticulate
Ligament



Average 21 pairs
Attach pia mater
to the arachnoid
and dura maters
Provide stability
for the spinal cord
SPACES
Epidural space
Subdural space
Subarachnoid space
Mesothelial
Septum
Epidural Anesthesia
L4
Epidural Venous Plexus
Lumbar Cistern
LUMBAR PUNCTURE
Cisterna Magna
(Cerebellomedullary
Cistern)
SPINAL NERVE ROOTS
Relationship
with intervertebral
foramen & disc
OPERATING DECOMPRESSION
Segmental
Artery
VEINS
Segments of Spinal Cord
Spinal Cord
Vertebra
C1-4
C1-4
C5-8, T1-4
Cn-1
T5-8
Tn-2
T9-12
Tn-3
L1-5
T10-11
S1-5, Coccygeal
T12, L1
DISTRIBUTION
C1-C4
C3-C5
C5-T1
T2-T12
L1-L4
L4-S1
S2-S4
head and neck.
diaphragm (chest and breathing)
shoulders, arms and hands
chest and abdomen
(excluding internal organs)
abdomen (excluding internal organs),
buttocks, genitals, and upper legs
legs
genitals and muscles of the perineum
A motorcyclist lost control of his bike
after hitting a wet spot on the pavement.
He hit a curb and was catapulted several
feet, landing on the point of his right
shoulder and the right side of his head and
neck, severely stretching his neck. He was
taken to the emergency room with
abrasions, lacerations and multiple injuries
to both fleshy and bony tissues. Given this
scenario, answer the following:
For the integument to bleed or for
tissue fluid to ooze from the abrasions,
what layers must be damaged?
A.
epidermis and dermis
B.
epidermis and superficial fascia
C.
epidermis and deep fascia
D.
dermis and superficial fascia
E.
dermis and deep fascia
Sutures (stitches) would be placed in
which tough layer of the skin in order to
sew up the lacerations?
A.Epidermis
B.Deep fascia
C. Dermis
D.Subcutaneous tissue
E.Superficial fascia
After initial examination, the patient is
sent to radiology. Radiographs reveal that
the portion of the scapula forming the tip
or point of the shoulder has been fractured.
This bone is the:
A.
Acromion
B.
Angle
C.
Coracoid
D.
glenoid
E.
spine
Elevation of the tip of the patient's
right shoulder was still possible indicating
that which of the following nerves was
intact?
A.
accessory
B.
axillary
C.
dorsal scapular
D.
suprascapular
E.
thoracodorsal
Panniculus adiposus refers to an
abundance of fat in the:
A.
Deep fascia
B.
Muscular fascia
C.
Skin
D.
Subcutaneous tissue
E.
Neurovascular bundles
In order to make an intramuscular
injection, the needle must pass through
several layers of tissue to reach the
muscle. Choose the the correct order of
tissues the needle would pass through
from superficial to deep.
A. Epidermis, dermis, investing fascia,
subcutaneous tissue, muscle
B.
Epidermis, dermis, subcutaneous tissue,
investing fascia, muscle
C.
Epidermis, investing fascia, dermis,
subcutaneous tissue, muscle
D.
Epidermis, subcutaneous tissue, investing
fascia, dermis, muscle
E.
Epidermis, subcutaneous tissue, dermis,
investing fascia, muscle
From
your
observations
while
removing the skin from the cadaver, in
which area did you find the skin to be the
thickest?
A.
Anterior surface of the forearm
B.
Anterior surface of the chest
C.
Medial surface of the arm
D.
Posterior surface of the forearm
E.
Posterior surface of the neck and scalp
Nerves enter and exit the spinal cord
through the:
A.
Vertebral foramina
B.
Intervertebral foramina
C.
Superior vertebral foramina
D.
Pedicles
E.
Laminae
Loss of function, paralysis, of which
muscle would result in drooping or sagging
of the shoulder?
A.
Erector spinae
B.
Latissimus dorsi
C.
Levator scapulae
D.
Rhomboideus major
E.
Trapezius
A football player suffers a herniated
(ruptured) intervertebral disk in his neck.
The disk compresses the spinal nerve
exiting through the intevertebral foramen
between the 5th and 6th cervical vertebrae.
Which spinal nerve is affected?
A. C
4
B. C
5
C. C
6
D. C 7
E. C
8
A man has a herniated intervertebral
disk between the fourth and fifth lumbar
vertebrae. If this disk compresses the
spinal nerve in the intervertebral foramen
immediately posterior to this disk, which
spinal nerve would be affected?
A.
B.
C.
D.
E.
L3
L4
L5
S1
S2
Both the dural sac and the
subarachnoid space end at which
vertebral level?
A.
L4
B.
L5
C.
S2
D.
S1
E.
S4
It is decided to image the spinal cord
and spinal nerve rootlets by doing a
myelogram (injection of a radio-opaque dye
into the subarachnoid space followed by a
radiograph). In order to inject the dye
without injury to the spinal cord, the
injection is usually done below what
vertebral level?
A. L1
B. L2
C. L3
D. L4
E. L5
As the spinal needle in the above
question is being inserted, which ligament
would it pass through on its way to the
subarachnoid space?
A.
Anterior longitudinal
B.
Dentate
C.
Ligamentum nuchae
D.
Posterior longitudinal
E.
Supraspinous
The spinal cord is segmented like the
vertebral column, but in contrast to the
vertebrae, there are only _____ cord
segments
A.
28
B.
29
C.
30
D.
31
E.
32
A patient is suspected of having
bacterial meningitis. A lumbar puncture is
performed to remove cerebrospinal fluid
(CSF) for analysis. If done properly, the
needle used for the tap would penetrate
all layers except:
A.
B.
C.
D.
E.
Arachnoid mater
Epidural fat
Dura mater
Pia mater
Supraspinous ligament
A patient is suspected of having
bacterial meningitis. As part of the
diagnostic procedure, a lumbar puncture is
to be performed. The attending physician
asks you where she should insert the spinal
needle to withdraw CSF. You answer, "just
below the spine of the 4th lumbar
vertebra." What reference point would you
use to identify the spine?
A.
B.
C.
D.
E.
Crest of the ilium
Ischial tuberosity
Pubic symphysis
Umbilicus
Xiphoid process
REVIEW
Introduction
What is anatomy?
Anatomical
Orientation
Surface anatomy
Back
Layers
Superficial layers
Deep fascia
Muscles
Deep arteries & veins
Vertebral canal
Anatomical position
Anatomical planes
Anatomical terms
Construction
Contents
Meninges & spaces
Spinal nerve roots
Blood supply
Segments