Anatomy Practical Task Delegation

ANSWERS ARE IN ORANGE

Wai Kit in red
1. Activity 1 : Vertebral Column
(Use articulated skeletons & bone sets)
1.1. Identify the lumbar spine.
1.1.1. What is its curvature called?
1.1.2. What are the other normal curvatures of the spines?
1.1.3. Why does the Vertebral column ( spine), in old age, often acquire the C- shaped curve like that of a new born?
1.2. Identify the parts of a typical thoracic/lumbar vertebra
1.3. Identify the neural arch and its parts.
1.3.1. What projects from the neural arch?

PHEY CHIEN HELP THE TWO LENG CHAIs/ ENTAOs above and below you... =)

Ian in blue
1.4. Identify the intervertebral foramina.
Laterally, the foramen is in between two adjacent vertebra

1.4.1. What part of the neural arch forms these foramina? grays pg75
Note: there IS a slight difference between neural arch and vertebral arch
-Inferior vertebral notch on the pedicle of superior vertebrae
-Superior vertebral notch on the pedicle of inferior vertebrae
-Posteriorly, zygapophysial joint ( joint between the superior and inferior articular processes of the inferior and superior vertebra)
-Anterioly, intervertebral disc

Fig. 39-14. The neural arch and centrum (left half of figure), and the vertebral arch and body (right half). The terms centrum and neural arch refer to those parts of a vertebra ossified from primary centers. The terms vertebral arch and body are descriptive terms generally applied to adult vertebrae. The body of a vertebra includes the centrum and part of the neural arch. The vertebral arch, therefore, is less extensive than the neural arch. Note that the rib articulates with the neural arch and not with the centrum
Source's Link

1.4.2. List the contents of these foramina. grays pg75, moore pg 473
Spinal ganglion, blood vessels (artery and vein), recurrent meningeal nerve

1.4.3. What is the pars interarticularis? (moore, pg 459)
superior and inferior articular processes of the axis (C2)

1.5. What is spondylolisthesis?
Greek: spondyl = vertebrae, olisthesis= slipped
Anterior displacement of a vertebrae/vertebral column in relation to the vertebrae below
Significant in obstetrics, L5 slide anteriorly over sacrum. Thus, reducing anterior-posterior pelvic inlet which may interfere with parturition(childbirth)

1.5.1. How may it occur?
Developmental (Congenital) Spondylolisthesis
exist at birth, or may develop during childhood, but generally is not noticed until later in childhood or even in adult life.

Acquired Spondylolisthesis

Acquired spondylolisthesis can be caused in one of two ways:
i. With all of the daily stresses that are put on a spine, such as carrying heavy items and physical sports, the spine may wear out (i.e., degenerate).

Degenerative spondylolisthesis is by far the most common cause of spinal segments slipping on top of each other. Over time, aging causes changes to the tissues of the body, including the bones, joints, and ligaments that hold the vertebral column together.
If the degenerative changes progress to a point when the ligaments and joints cannot hold the proper position of the spinal column, then degenerative spondylolisthesis is the result.

ii. A single or repeated force being applied to the spine can cause a spondylolisthesis; for example, the impact of falling off a ladder and landing on your feet, or the regular impact to the spine endured by offensive linemen playing football.

Isthmic (resulting from a fracture through the pars) Spondylolisthesis
Isthmic spondylolisthesis is due to a specific bony defect in the spine called spondylolysis. Spondylolysis is a defect in a specific region called the pars interarticularis.
A pars defect is most commonly the result of repetitive microtrauma during childhood.
Some sports are thought to make children more susceptible to developing spondylolysis, including gymnastics, diving, and football.

• NOTE: Spodylolysis is not the slippage of the vertebrae

1.6. What is percutaneous vertebroplasty and is it effective?
Percutaneous = injection therefore no incision
Patient is put under sedation/light anesthesia
With X-ray guidance, pedicle is identified on anterior-posterior image
A metal cannula(tube) / needle is placed through the pedicle into vertebral body
Liquid bone cement is injected in cannula thus filling the vertebrae body
TWO functions- increase strength and prevents decrease of height
Minor side effect - heat generated might discrupt pain nerve endings.

Bert,Niva in red
2. Activity 2 : Back Muscles
(Use models & plastinated specimens)
2.1. What are the general layers of the muscles of the back?
2.1.1. Identify the components of each layer
2.1.1.1. What divides extrinsic from intrinsic muscles?

Matthias and Mitch in purple
2.1.2. What is the nerve supply to intrinsic muscles?
2.1.3. Why are most of the extrinsic muscles supplied by the brachial plexus?
2.1.4. Identify the Triangle of Auscultation

Jeevitha,Ran, Pik Yin in blue
3. Activity 3: Vertebral Joints
(Use models & software)
3.1. Identify a facet joint.
3.1.1. What type of joint is it?
3.1.2. What is the orientation of thoracic & lumbar facet joints?
3.1.3. How is this orientation related to function?
3.1.4. Identify and list the accessory ligaments of facet joints.
3.2. Identify an intervertebral disc.
3.2.1. What type of joint is this?
3.2.2. Where are they usually found?
3.2.3. What type of cartilage is involved?
3.3. What are the two major parts of the disc?
3.3.1. What is the centre of the disc a remnant of?
3.3.2. What is the only other remnant of this structure?
3.3.3. How are the shape and the thickness of a thoracic disc compare to a lumbar disc?
3.3.3.1. Why are these differences?
3.3.4. Where does a disc prolapse normally occur?
3.3.4.1. Why?
3.3.5. Which disc is most likely to prolapse?
3.3.5.1. Why?
3.3.6. Why do most young adults grow by a centimeter overnight?

We do this together! =) BUT, DEAN can try to read up since there is NO vessels task in this prac... :)

4. Activity 4 : Surface Anatomy
Palpate on yourself or on your willing and consenting peers the following:
4.1. Curvatures
4.1.1. Primary Curvatures : Sacral and thoracic
4.1.2. Secondary Curvatures: Cervical and lumbar
4.2. Spinous processes:
4.2.1. C7
4.2.2. L2
4.2.2.1. What is its significance?
4.2.3. L4 and L4-L5 IV Disc
4.2.3.1. How would you locate them?
4.2.4. S2
4.2.4.1. How would you locate it?
4.3. Sacral hiatus and the Coccyx
4.4. The posterior median furrow.
4.4.1. What muscles can be palpated on either side of it in the thoracic and lumbar regions?
4.5. Supraspinous ligament
4.6. Demonstrate the following thoracolumbar spinal movements:
4.6.1. Flexion, Extension, Lateral Flexion, Rotation


5. Activity 5 : Radiology
{Refer to radiological images in textbooks, Student resources in MUSO –MUCAS & Grants Atlas & Clinical Imaging software Radiology 2 }
Study the following :
5.1. Lumbar Spine : AP and Lateral Views
( Radiology 2 – Fracture Spine – 144. AP View Lumbar Spine; 145/146: Lateral View: Lumbar Spine)
5.2. Herniation of nucleus pulposus- median MRI
( Grants Atlas- Dynamic Human Anatomy- Clinically oriented Anatomy – 4.10)