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Summary Thinking and Doing II
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Summary ‘Thinking and Doing II’Case 1: anatomy of the spine and spinal deformities……………………………………………………2
Case 2: osteoporosis and Rickett disease…………………………………………….…………………...26
Case 3: spinal nerves, herniation, and lower back pain……………………………………..……….47
Case 4: anatomy/vascularization of the brain, pathway systems, and stroke…………...….64
Case 5: stress response, learning theory, PTSD………………..………………………………………..86
Case 6: reward and depression…………………………………………………………………………………99
Case 7: memory and dementia…………………………………………………………….………………….114
Case 9: anatomy and pathologies of the eye………………………………………….…………………127
Case 10: pathologies of a red eye……………………………………………………….……………………152
Case 11: neck/shoulder/arm pathologies………………..………...……………………………………167
Lectures
Vertebral column and herniated discs
Osteoporosis
Neck and shoulder, from anatomy to clinic
Work and health in international perspective
Differences in the organization of health care for stroke patients
Prognostic factors
Neurobiology
Learning theory
Stress and behavior
Reward
Mental status examination
Statistics: regression analysis
Cognitive development and healthy ageing of the brain
Dementia
Biopsychosocial model and international aspects
Interactive lecture social media
Cataract and age related macular degeneration
Uveitis and glaucoma
Interactive patient lecture
Skills and practicals
Neurology: sciatica
Locomotor system: spine
Locomotor system: shoulder/neck
Eye-vision
Patientcontact CVA
Refresher course resuscitation
Macroscopy shoulder and back (dissection room)
Topography eye (dissection room)
In vivo shoulder and back
Seminar pathway systems
1
,Case 1
Learning goals:
1. Anatomy of the spine
a. Kyphosis
2. Process of sclerosis
3. Types of spine deformities
a. Scoliosis Treatment, prognosis, monitoring, diagnosis, epidemiology
4. Aging of the spine
a. Cervical spine
b. Lumbar spinal stenosis
c. Spondylolisthesis
d. Degenerative scoliosis
5. Spinal osteoarthritis
2
,Anatomy of the spine
Thieme (General anatomy of the musculoskeletal system)
The skeleton of the trunk is made up of the vertebral column, ribs, and sternum.
The spinous processes as anatomical landmarks
The spinous processes of the vertebrae appear as variable prominences beneath the skin
and provide important landmarks during the physical examination. With a few
exceptions, they are easily palpated.
- The spinous process of the 7th cervical vertebra, located at the junction of the
cervical and thoracic spine. Usually it is the most prominent of the spinous
processes, causing the 7th vertebra to be known also as the vertebra prominens.
- The spinous process of the 3rd thoracic vertebra, located on a horizontal line
connecting the scapular spines.
- The spinous process of the 7th thoracic vertebra, located at the level of the
inferior angles of the scapulae.
- The spinous process of the 12th thoracic vertebra, located slightly below the
attachment of the last rib.
- The spinous process of the 4th lumbar vertebra, located on a horizontal line
connecting the highest points of the iliac crests.
Note: the spinous processes of the thoracic vertebrae are angled downward, and so the
spinous process of the 5th thoracic vertebra, for example, is at the level of the 6th thoracic
vertebral body.
3
,4
,Regions and curvatures of the spinal column
The spinal cord of an adult is divided into 4 regions and
presents 4 characteristic curvatures in the sagittal plane.
- These curves are the result of human adaptation to
upright bipedal locomotion, acting as springs to
cushion axial loads.
The following regions and curvatures are distinguished in
the craniocaudal direction:
- Cervical spine cervical lordosis
- Thoracic spine thoracic kyphosis
- Lumbar spine lumbar lordosis
- Sacral spine sacral kyphosis
Presacral spine the cervical, thoracic, and lumbar
regions of the spinal column
The transitional areas between the different regions are of
clinical importance because they are potential sites for spinal disorders (e.g., herniated
discs).
Integration of the spinal column into the pelvic girdle
Normally the spinal column is curved and integrated into the pelvic girdle in such a way
that characteristic angles are formed between certain imaginary lines and axes.
- These angles and lines are useful in the radiographic evaluation of positional
abnormalities and deformities of the spine and
trunk.
Lumbosacral angle:
- Angle formed by the axes of the L5 and S1
vertebrae averaging 143°
Sacral angle:
- Angle between the horizontal plane and the
superior surface of the sacrum, averaging
around 30°
Pelvic inclination angle:
- Angle formed by the pelvic inlet plane with the
horizontal. It measures around 60° in upright
stance.
5
,The characteristic curvatures of the adult spine are only
partially present in the newborn and appear only during
the course of postnatal development.
- First cervical lordosis develops to balance the head
in response to the growing strength of the posterior
neck muscles.
- Lumbar lordosis develops later as the child learns to
sit, stand, and walk. The degree of lordosis increases
until the legs can be fully extended at the hips, and it
finally becomes stable during puberty.
The structure of a vertebra
All vertebrae except the atlas and axis consist of the same basic structural elements:
- A vertebral body
- A vertebral arch
- A spinous process
- Two transverse processes (called costal processes in the lumbar vertebrae)
- Four articular processes
The processes give attachment to muscles and ligaments, and the bodies of the thoracic
vertebrae have costovertebral joints. The vertebral bodies and arches enclose the
vertebral foramen, and all of the vertebral foramina constitute the vertebral (spinal)
canal.
6
, The shape and configuration of the vertebrae are closely related to the development of
the ribs and their rudiments
- Cervical vertebrae here the rudimentary rib forms a process called the
anterior tubercle. It unites with the posterior tubercle to form the transverse
foramen.
- Thoracic vertebrae because these vertebrae give attachment to the ribs, their
bodies and transverse processes bear corresponding cartilage-covered articular
surfaces (costal facets on the transverse processes, also superior and inferior
costal facets)
- Lumbar vertebrae the costal elements in the lumbar spine take the form of
‘transverse processes’, which are much larger than in the cervical spine. Because
of their size, they are also known as costal processes.
- Sacrum here the rudimentary rib forms the anterior portion of the lateral part
of the sacral vertebra. It is fused to the transverse processes.
7
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