1. Spine and Thorax

2. Topographical views 3. Bony landmark trail

Trail 1. Midline Ridge

Explore thespinous processesof the vertebrae andthe spaces between them

Trail 2. Crossing Paths

Describe surroundingbony landmarksthat intersect with specific spinous processes

4. Bony landmark trail Trail 3. Cervical vertebrae Trail 4. Thoracic and Lumbar vertebrae 5. Bony landmark trail

Trail 5. sternum

Trail 6. Ribs, rib cage and costal cartilage

6. Muscles of the spine and thorax Superficial muscles of the back 7. Muscles of the spine and thorax Intermediate muscles of the back Deep muscles of the back 8. Muscles of the spine and thorax Schematic cross section view of the muscles of the spine 9. Muscle layers of the post. neck 10. Erector spinae group

Spinalis

Longissimus

Iliocostalis

• As a group, easily palpated along the entire length of the back and neck

11. Spinalis cervicis

Action

• Bilateral contraction extends the cervical and thoracic spine

• Unilateral contraction bends the cervical and thoracic spine to the same side

Origin

• SP of the T1-T2 and C5-C7 vertebrae

Insertion

• SP of the C2-C5 vertebrae

Innervation

• Dorsal rami of the spinal nerve

12. Spinalis thoracis

Action

• Bilateral contraction extends the cervical and thoracic spine

• Unilateral contraction bends the cervical and thoracic spine to the same side

Origin

• Lateral surface of the SP of the T10-T12 and L1-L3 vertebrae

Insertion

• Lateral surface of the spinous processes of the T2-T8 vertebra

Innervation

• Dorsal rami of the spinal nerve

13. Longissimus muscle

4.Longissimus thoracis

5.Longissimus cervicis

6.Longissimus capitis

14. Longissimus thoracis

Action

• Bilateral contraction extends the spine, unilateral contraction bends the spine laterally to the spine

Origin

• Sacrum, iliac crest(common tendon of origin with iliocostalis), SP of lumbar vertebrae, TP of lower thoracic vertebrae

Insertion

• 2 nd -12 thribs, costal processes of lumbar vertebrae, TP of thoracic vertebrae

Innervation

• Lateral branches of dorsal rami of spinal nerve

15. Longissimus Cervicis

Action

• Bilateral contraction extends the spine, unilateral contraction bends the spine laterally to the spine

Origin

• TP of T1-T6 vertebrae

Insertion

• TP of C2-C5 vertebrae

Innervation

• Lateral branches of dorsal rami of spinal nerve

16. Longissimus capitis

Action

• Bilateral contraction extends the head, unilateral contraction flexes and rotates the head to the same side

Origin

• TP of T1-T3 vertebrae and TP and articular process of C4-C7 vertebrae

Insertion

• Mastoid process of occipital bone

Innervation

• Lateral branches of dorsal rami of spinal nerve

17. Iliocostalis muscle

1.Iliocostalis lumborum

2.Iliocostalis thoracis

3.Iliocostalis cervicis

Action

• Entire muscle; bilateral contraction extends the spine, unilateral contraction bends the spine laterally to the same side

18. Iliocostalis muscle

Origin

• Iliocostalis lumborum: sacrum, iliac crest, thoracolumbar fascia

• Iliocostalis thoracis: 7 th -12 thribs

• Iliocostalis cervicis: 3 rd -7 thribs

Insertion

• Iliocostalis lumborum: 6 th -12 thribs, deep layer of thoracolumba fascia, TP of upper lumbar vertebrae

• Iliocostalis thoracis: 1 st -6 thribs

• Iliocostalis cervicis: TP of C4-C6 vertebrae

Innervation

• Lateral branches of dorsal rami of C8-L1

19. Erector spinae group

• Prone position

• Locate the region of lower erectors by asking to alternatively raise and lower feet slightly (contract in order to stabilize the pelvis)

20. Erector spinae group

• Palpate inferiorly onto the sacrum and then superiorly along the thoracic vertebrae

• Ask the patient to extend his spine and neck slightly in order to contract the erectors in the thoracic region

21. Erector spinae group

• Follow the ropy fibers of the erectors between the scapulae and along the back of the neck

22. Test for back extensors 23. Test for back extensors

Patient:Prone

Fixation:Hip extensors must give fixation of the pelvis to the thigh. The examiner stabilizes the legs firmly on the table

Test:Trunk extension to the subjects full range of motion

24. Back extensors

Strong back extensor and strong hip extensor

Strong back extensor and weak or paralyzed hip extensor

Weak or paralyzed back extensor and strong hip extensor