Ppt 2- Fascia & Muscles Of The Back

Front 1

THORACOLUMBAR FASCIA

Back 1

•deepfascia of the back and posterior thorax skeletal muscles •extendsfrom the sacrum (median crest) to thorax •continuesinto the neck•medialattachment for many superficial and deep back muscles•Extendslaterally from spinousprocesses forming a thin covering overintrinsic musculature in thoracic region and a THICK covering over lumbar region.

Front 2

THORACIC REGION ofThoracolumbar Fascia

Back 2

Thin CT sheet;attaches

1.medially to SPs

2.laterally to rib angle

Separates extrinsic (superficial)muscles that move upper limb from intrinsic (deep) back muscles that move VC

Front 3

EXTRINSIC (SUPERFICIAL)BACK MUSCLES – 3 Layers

Back 3

•move ULs; do not move vertebral column

-allinnervated by anterior primary rami of spinal nerves or cranialnerve XI (spinal accessory) for trapezius m

Front 4

Layer 1

Back 4

Trapezius(CN XI) and LatissimusDorsi(ThoracodorsalC6-8)

Front 5

Layer 2

Back 5

LevatorScapulae, Rhomboid Minor and Major (Dorsal Scapular -C5)

Front 6

Layer 3

Back 6

SerratusPosterior Superior and Inferior (Anterior primary ramiof segmental intercostal– T2-5 and T9-11 & Subcostal nerve (T12))

Front 7

Intrinsic back muscles responsibility

Back 7

1.as agroup: responsible for backward bending and/orlateral bending and/or rotation (torsion) of VC

2.antagonistic action toanterior-lateral abdominal wall muscles and gravity

3.all innervated by posterior 1° rami of spinal nn.

4.3groups: superficial (4), intermediate (5), deep (6)

Front 8

Layer 4 Name

Back 8

Splenius Group

Front 9

Layer 4 actions

Back 9

•unilateral:laterally flex neck; rotate skull to same side

•bilateral:extend neck

Front 10

Muscles of layer 4

Back 10

Splenius Capitis

Splenius Cervicis

Front 11

Attachment of Splenius Capitis

Back 11

From Nuchal ligament and SP's of C7-T3/4 to temporal bone and occipital bone

Front 12

Attachment of Splenius Cervicis

Back 12

From Nuchal ligament and SP's of C7-T3/4 to TP's( transverse processes) of c1-c3/4

Front 13

Layer 5 name

Back 13

Erector Spinae Group

Front 14

actions of layer 5

Back 14

•unilateral:lateral flexion (bending) VC to same side as m.

- bilateral: extend VC or head

Front 15

inferior attachment of layer 5

Back 15

posterior layer of thoracolumbar fascia

Front 16

fiber direction of layer 5

Back 16

-interior-medial to superior-lateral

-but most spinals fibers essentially run vertical

Front 17

Muscles of layer 5

Back 17

•Iliocostalis:

•Longissimus

•Spinalis

Front 18

Superior attachments of layer 5

Back 18

•Iliocostalis: angle of ribs •Longissimus: TPs of vertebra and rib tubercles •Spinalis: SPs of T1-T7 and SPs of C2-C3

Front 19

Layer 6 name

Back 19

Transversospinalis Group

Front 20

Muscles of layer 6

Back 20

•deepto superficial

•rotatores(rotators)

•multifidus

•semispinalis

Front 21

attachments of layer 6 muscles

Back 21

Inferior attachments is the TP's of most vertebra and superior attachments (SP's) are

•semispinalis: 5-6segments

•multifidus: 2-4 segments

•rotatores: 1-2 segments

Front 22

semispinalis actions

Back 22

•fiberdirection = line of action of force

•moreinferior TPs are more stationary than more superior SPs or occipital bone

•unilateral: rotates VC to contralateralside of m.bilateral: extends VC or head

Front 23

multifidus actions

Back 23

local VC stabilization, rotation, and lateral flexion

Front 24

Rotatores action

Back 24

insignificant action; position and velocity sensation

Front 25

semispinalis capitis action

Back 25

causes neck extension (bilateral) or contralateral rotation (unilateral)

Front 26

Other deep back muscles

Back 26

Interspinales and Intertransversarii

Front 27

interspinales action

Back 27

extends spine and is the muscular fascicule between adjacent spinous processes

Front 28

intertransversarii action

Back 28

lateral flexion of the spine and is found between adjacent transverse processes

Front 29

Anterior and lateral vertebral muscle group

Back 29

Scalenes(anterior, middle, and posterior)

longus capitis

longus colli

rectus captious anterior

rectus captious lateralis

Front 30

Scalene muscle group

Back 30

1.fixesribs 1 & 2 during forced inspiration →

2. allowsExternal Intercostals to better elevate ribs

Front 31

Subcostal Muscles

Back 31

denticalaction and innervation as innermost intercostal mm.; but slightly differentattachments: lie in same curved plane as innermost intercostal muscles on internal surface ofangle of ribs but spread over 1-2 intercostal spaces contract during forcedexpiration along with innermost intercostal mm. and the interosseous internal intercostal mm.; best seen in gross lab spreadacross anterior surface around angle of ribs

Front 32

Transverse Thoracic muscles

Back 32

spanbetween posterior lower sternum and internal surfaces of costal cartilages 2-6;believed to have proprioceptive role and weakly depress the ribsduring expiration

Front 33

Anterior scalenes

Back 33

a.arisesfrom the anterior tubercles of C3-C5 transverse processes and descendslaterally to the scalene tubercle on rib 1

b.elevatesthe first rib, ipsilaterallybends the neck and contralaterally rotates

c.innervatedby C4-C6 primary rami

d.importantrelationship: phrenicnerve, subclavian veinrun on it’s anterior surface, subclavian artery & roots of the brachialplexus pass posterior and the cupula of the lung extends up behind the muscle

Front 34

middle scalenes

Back 34

1.justbehind the brachial plexus & subclavian artery

a.longestof the scalenes& also attaches to rib 1 to elevate it

Front 35

Posterior scalene

Back 35

usuallydifficult to distinguish from the middle scalene but it attaches to rib 2

Front 36

lavatories costarum muscles

Back 36

believed to have proprioceptive rolland weakly elevate the ribs during inspiration

innervated by lateral divisions of the dorsal rami( not by the intercostal nerve

Front 37

suboccipital triangle

Back 37

Rectus capitis

obliques captifs interior (OCI)

obliques captifs superior (OCS)

Front 38

suboccipital triange information

Back 38

Suboccipitalmuscles

A.Deepto semispinalisgroup

1.Rectuscapitisposterior major & minor – run from the spinous process of C2 (posterior tubercleof C1 for Mi) to the inferior nuchal line above

2.Obliquus capitisinferior – C2 spinous

process to C1 transverse process

3.Obliquus capitissuperior – C1 spinous

process to inferior nuchal line

B.Suboccipitaltriangle

1.Boundariesof the triangle are RCP major, OCI and OCS

2.Floorof the triangle is the posterior atlanto-occipital membrane

3.Contentsof the triangle

a.Vertebralartery – moving from lateral to medial and perforates the posterior atlantooccipitalmembrane to enter the foramen magnum to supply the brain & spinal cord

b.Suboccipitalnerve (C1) – exits from the triangle to innervate the suboccipitalmuscles

4.Relatedstructures

a.Greateroccipital nerve (C2) –crosses the triangle from inferior to superior, piercesthe semispinalis capitis& trapezius(supplies those muscles & the semispinalis cervicis) tosupply the posterior aspect of the scalp

b.Occipitalartery - crosses the lateral corner of the triangle and runs with the greateroccipital nerve.

Front 39

Myodural Bridge 1

Back 39

Aconnective tissue link between the spinal dura mater and the Rectus CapitusPosterior Major, Rectus Capitus Minor, and even the Obliquus CapitusInferior.

Front 40

Myodural Bridge 2

Back 40

Theseattachments extend from the muscles to the spinal dura through the Atlanto-occipitalspace and the Atlanto-axialspaces posteriorly.

Front 41

Myodural Bridge 3

Back 41

Theclinical significance of this structure is linked to tension headache andmigraine headache pain as well as its role in the proprioceptive apparatus ofthe upper cervical spine.