Gross Anatomy: Deep Back 27 on concepts, 25 questions on back

Thoracolumbar Fascia The thoracolumbar fascia: surrounds the deep muscles of the back superiorly, continuous with deep fascia of the neck “deep” to serratus posterior muscles medially, attaches to the spines of the vertebrae laterally, attaches to the transverse processes inferiorly, attaches to lower border of 12th rib and iliac crest The thoracolumbar fascia covers the deep back muscles. Any time fascia crosses bone, it attaches to it. So it is attached to the spines of the vertebrae and the transverse processes

Thoracolumbar Fascia

Deep Back Muscles and Innervation

Rotation of Vertebrae

Spinotransversales Splenius Cervicis: Attachments: Splenius Capitis: What is the action of these muscles? Innervation? Patient of yours has tightness in left splenius capitus. How do you “stretch” the muscle?

Spinotransversales

What is the collective action of both erector spinae acting together? Spinalis- attached to just spinous processes (red) thoracis cervicis capitis Longissimus- begins at sacrum and attaches to transverse processes (blue) some go to mastoid on skull Iliocostalis- arises from iliac crest. Second attachment is two ribs and goes up ribs. Connects to cervical transverse processes lumborum 3 subdivisions as shown here. We don’t have to worry about the subdivions From outside to inside: I Love Spaghetti They only do extension What is the collective action of both erector spinae acting together? A. Extension B. Flexion C. Rotation D. Side bending

Erector Spinae

***This is an example of Type 1 Somatic Dysfunction*** A 35-year-old male presents with the main complaint of upper back discomfort. Physical exam reveals that T3 – T8 vertebra are SL [side-bent left] and RR [rotated right]. How can you tell? What muscle is most likely responsible for this finding? ***This is an example of Type 1 Somatic Dysfunction***

Transversospinal Group Rotatores-shortest muscles. Span only 1-2 segments. Extend the entire vertebral column and are most developed in the thoracic region. Start on a transverse process and go up to the spinous process above it. Probably for proprioception. Multifidus- 2 to 4 segments. Goes up entire column but best developed in lumbar region Semispinalis- 3 to 5 segments. In thoracic and cervical. Also capitis. Some go to skull Starts on transverse processes and runs up and medial towards spines Yellow is showing erector spinae Transversospinal group are in red All cause some rotation of the vertebral column

Transversospinal Group

Transversospinal Group

Intersegmental Muscles Interspinales: Intertransversarii:

Intersegmental Muscles Intertransversarii: in the thoracic region intertransversarii are modified to form the levator costarum

***This is an example of Type 2 Somatic Dysfunction*** A 47-year-old male presents with the main complaint of lower back pain. Physical exam reveals that L1 – L2 vertebra are SL [side-bent left] and RL [rotated left]. What muscle is most likely responsible for this finding? ***This is an example of Type 2 Somatic Dysfunction***

Suboccipital Muscles situated deep to semispinalis capitis Rectus capitis posterior major Rectus capitis posterior minor Obliquus capitis inferior Obliquus capitis superior

A 25-year-old female presents with the chief complaint of tightness in her neck and pain in the area indicated to the left. What nerve is most likely affected? A. C1, posterior ramus B. C2, posterior ramus C. C1 spinal nerve D. C1, anterior ramus E. C2, anterior ramus

Contents of the Suboccipital Triangle Note the greater occipital nerve and the suboccipital nerve If that muscle is abnormal or contracted it can cause pain due to that nerve