Gross Anatomy:
Deep 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
Thoracolumbar Fascia
Deep Back Muscles and Innervation
Rotation of Vertebrae
SpinotransversalesSplenius Cervicis:Attachments:
Splenius Capitis:Attachments:
What is the action of these muscles?Innervation?
Patient of yours has tightness in left splenius capitus. How do you “stretch” the muscle?
Spinotransversales
Erector SpinaeSpinalis- attached to just spinous processes
(red)thoraciscerviciscapitis
Longissimus- begins at sacrum and attaches to transverse processes (blue) some go to mastoid on skullthoraciscerviciscapitis
Iliocostalis- arises from iliac crest. Second attachment is two ribs and goes up ribs. Connects to cervical transverse processeslumborumthoraciscervicis
What is the collective action of both erector spinae acting together?
A. ExtensionB. FlexionC. RotationD. Side bending
Erector Spinae
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
Transversospinal Group
Transversospinal Group
Intersegmental Muscles
Interspinales:
Intertransversarii:
Intersegmental MusclesIntertransversarii: in the thoracic region
intertransversarii are modified to form the levator costarum
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 ramusB. C2, posterior ramusC. C1 spinal nerveD. C1, anterior ramusE. C2, anterior ramus
Contents of the Suboccipital Triangle