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