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

2. 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

3. Thoracolumbar Fascia

4. Deep Back Muscles and Innervation

5. Rotation of Vertebrae

6. 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?

7. Spinotransversales

8. 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

9. Erector Spinae

10. ***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***

11. 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

12. Transversospinal Group

13. Transversospinal Group

14. Intersegmental Muscles
Interspinales:
Intertransversarii:

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

16. ***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***

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

18. 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

19. 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