Exam II: Back II

Question 1

Thoracolumbar Fascia

Answer 1

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

Question 2

Deep Muscles of the Back Group

Answer 2

1. Superficial extrinsic
2. Intermediate extrinsic
3. Spinotransversales (superficial intrinsic)
4. Erector spinae (intermediate intrinsic)
5. Transversospinal (deep intrinsic)

Question 3

Splenius capitis

Answer 3

Splenius capitis

Origin: nuchal ligament and spinous processes C7-T3
Insertion: Mastoid process and Superior nuchal line
Innervation: posterior rami of middle cervical nerves/spinal nerves
Action: draw head backward together, extending neck; individually laterally flex and rotate head to one side (same side rotation)

Question 4

Splenius cervicis

Answer 4

Splenius cervicis
Origin: Spinous processes T3-T6
Insertion: Transverse processes C1-C3
Innervation: posterior rami of lower cervical nerves/spinal nerves
Action: draw head backward together, extending neck; individually laterally flex and rotate head to one side (same side rotation)

Question 5

Iliocostalis

Answer 5

Iliocostalis: ribs
1. Lumborum
Origin: sacrum, spinous processes of lumbar and lower two thoracic vertebrae (ribs) and their supraspinous ligaments, and the iliac crest (sacrum to ribs)
Insertion: angles of the lower six or seven ribs

2. Thoracis
   Origin: angles of the lower six ribs to ribs (muscle that go from ribs to ribs)
   Insertion: angles of the upper six ribs and the transverse process of C7
3. Cervicis
   Origin: angles of ribs 3-6
   Insertion: transverse processes of C4-6

Question 6

Longissimus

Answer 6

Longissimus: transverse processes

1. Thoracis
   Origin: blends with iliocostalis in lumbar region and is attached to transverse processes of L1-5
   Insertion: transverse process of T1-12 and just lateral to the tubercles of the lower 9-10 ribs
2. Cervicis
   Origin: transverse processes of T1-5
   Insertion: transverse processes of C2-6
3. Capitis
   Origin: transverse processes of T1-5 and articular processes of lower C3-C7
   Insertion: posterior margin of the mastoid process (attach to skull)

Question 7

Spinalis

Answer 7

Spinalis: spinous processes; attaches spines to spines

1. Thoracis
   Origin: spinous processes of T10 or 11 to L2
   Insertion: spinous processes of T1-8 (varies)
2. Cervicis
   Origin: lower part of ligamentum nuchae and spinous process of C7 (sometimes T1 to T2)
   Insertion: Spinous process of C2 (axis)
3. Capitis
   Origin: usually blends with semispinalis capitis
   Insertion: with semispinalis capitis

Question 8

Spinotransversales (superficial intrinsic)

Answer 8

Splenius capitis and Splenius cervicis

Question 9

Erector spinae (intermediate intrinsic)

Answer 9

Iliocostalis (lumborum, thoracis, and cervicis)
Longissimus (thoracis, cervicis, and capitis)
Spinalis (thoracis, cervicis, and capitis)

Function: side bending

Question 10

Transversospinal (deep intrinsic)

Answer 10

Semispinalis (thoracis, cervicis, and capitis)
Multifidus
Rotatores (lumborum, thoracis, and cervicis)

Question 11

Semispinalis

Answer 11

Semispinalis: C4-T10

1. Thoracis
   Origin: transverse processes of T6 to T10
   Insertion: spinous processes of T1-4 and C6-7
2. Cervicis
   Origin: tranverse processes of T1-6
   Insertion: spinous processes of C2-5
3. Capitis
   Origin: transverse processes of T1-6/7 and C7 and articular processes of C4-6
   Insertion: medial area between the superior and inferior nuchal lines of occipital bone

Question 12

Multifidus

Answer 12

Origin: posterior sacrum, aponeurosis of erector spinae, posterior superior iliac spine, sacro-iliac ligaments, mammillary processes of lumbar vertebrae, transverse processes of thoracic vertebrae, and articular processes of lower four cervical vertebrae (C4-C7)

Insertion: base of spinous processes of all vertebrae from C2-L5

N: posterior rami of spinal nerves

A: unilateral contraction rotates to contralateral side; stabilizes vertebrae during local movements of vertebral column

Question 13

Rotatores (short and long)

Answer 13

Function: attaches transverse processes to spines and runs 1-2 segments; best developed in thoracic region

Lumborum
Origin: transverse processes of lumbar vertebrae
Insertion: spinous processes of lumbar vertebrae

Thoracis
Origin: transverse processes of thoracis vertebrae
Insertion: spinous processes of thoracic vertebrae

Cervicis
Origin: articular processes of cervical vertebrae
Insertion: spinous processes of cervical vertebrae

A: may function as organs of proprioception, stabilize vertebrae and help with extension

Question 14

Rotation of Vertebrae

Answer 14

Whole point rotate vertebral column:

1. Transversospinalis: semispinalis (thoracis, cervicis, capitis), multifidus, rotatores (lumborum, thoracis, and cervicis)
2. Spinotransversalis: splenius capitis and splenius cervicis (both individually rotate the head to one side while also turning the vertebrae to the same side)

Muscle cannot act on same level from spinous to transverse process

• Contracts and pull transverse
• Rotate vertebral body to same side

Muscle from transverse process to spinous process- move vertebral body in contralateral rotation (opposite side)

Question 15

Segmental Back Muscles

Answer 15

Postural muscles/assist with posture
ALL are innervated by dorsal rami
1. Interspinales- between spinous processes
2. Intertranversarii- between transverse processes
in the thoracic region are modified to form the levator costarum

Accessory Respiratory Muscles:
Levatores costarum
Origin: Transverse processes of C7-T11
Insertion: Rib below origin
Action: Elevate ribs

Question 16

Suboccipital Muscles

Answer 16

Muscles give you a headache
Deep to all muscle we have talked about: Trapezius, Splenius capitus, Semisplenalis, etc.
Suboccipital muscles include: rectus capitis posterior major and minor and obliquus capitis superior and inferior

Question 17

Rectus capitis posterior major and minor

Answer 17

Rectus capitis posterior major
Origin: spinous process of C2
Insertion: lateral portion of occipital bone below inferior nuchal line
Innervation: posterior ramus of C1
Function: extension of head; rotation of face to same side as muscle

Rectus capitis posterior minor
Origin: spinous tubercle of C1
Insertion: medial portion of occipital bone below inferior nuchal line
Innervation: posterior ramus of C1
Function: extension of head

Question 18

Obliquus capitis superior and inferior

Answer 18

Obliquus capitis superior
Origin: transverse process of C1
Insertion: occipital bone between superior and inferior nuchal lines
Innervation: posterior ramus of C1
Function: extension of head and bends it to the same side

Obliquus capitis inferior
Origin: spinous process of C2
Insertion: transverse process of C1
Innervation: posterior ramus of C1
Function: rotation of face to same side

Question 19

Suboccipital Triangle

Answer 19

Obliguus capitis inferior: transverse process of C1 to C2; inferior border
Obliguus capitis superior: C1 to inferior nuclei; lateral border
Rectus capitis posterior major: spinous process of C2 up to skull; medial border
Retus capitis posterior minor: C1 up to inferior nuclei

Question 20

Spinal Cord: General Information

Answer 20

Part of the CNS
Occupies the vertebral canal and segmented
In infants the spinal cord extends into the sacrum
In adults the cord extends from the cranial border of the atlas to L2
Level of termination is slightly more superior in flexion
Cervical enlargement: C5-T1
Lumbosacral enlargement: L1-S3
Tapers to conus medullaris (L2)- end of spinal cord
Cauda Equina (dorsal and ventral roots exiting)- nerve roots
Filum terminale (extension of spinal cord to coccyx)- anchors
31 pairs of spinal nerves: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal

Question 21

External and Internal Surfaces of the Spinal Cord

Answer 21

External surface:
Anterior median fissure
Posterior median sulcus
Posterolateral sulcus

Internal surface:
Central canal (contains CSF)
White matter (spinal cord tract/info coming and going)
Gray matter (where cell bodies/synapses are)

Question 22

Myotomes: Rhomboids and Latissimus Dorsi

Answer 22

Latissimus Dorsi: C6-8

Rhomboids: C5 and C6

Question 23

Dura Mater

Answer 23

Thick/dense inelastic membrane
Attached around the foramen magnum and bodies of 2nd & 3rd cervical vertebrae
Tubular extensions enclose roots of the spinal nerves
End of dural sac is S2, but terminal cord like extension, filum terminals extern extends to the coccyx

Question 24

Arachnoid Mater

Answer 24

Delicate membrane
Not attached to dura mater
Spider web like
Ends at S2
Avascular- gets nutrients from CSF

Question 25

Pia Mater

Answer 25

Vascular membrane Denticulate ligaments- connect spinal cord to dura mater Filum terminlae internum Directly adherent to the spinal cord

Question 26

Multiple Spaces Between Meninges

Answer 26

Epidural space Between vertebrae and dura Contains epidural fat, internal vertebral venous plexus Between ligamentum flavum and dura mater ``` Subdural space Between dura and arachnoid Contains only serous fluid Potential space Ends at S2 ``` Subarachnoid space Between arachnoid and pia Contains CSF, blood vessels, and connective tissue Ends at S2

Question 27

Lumbar Cistern

Answer 27

The lumbar cistern is a space (subarachnoid) below the spinal cord that contains CSF Spinal cord ends at L2 Dural sac ends at S2 Forms lumbar cistern- sample CSF enlargement of the subarachnoid space between the conus medullaris of spinal cord (about vertebral level L2) and inferior end of subarachnoid space and dura mater (about vertebral level S2); occupied by the posterior and anterior roots constituting the cauda equina, the terminal filum, and cerebrospinal fluid; site for lumbar puncture and spinal anesthesia

Question 28

Epidural

Answer 28

Pregnant women before birth Layers the needle passes through: skin, subcutaneous fat, supraspinous ligament, interspinous ligament, ligamentum flavum, then in epidural space Inject needle into the epidural space just past the ligamentum flavum Anesthesia injected into the sacral hiatus

Question 29

Blood Supply to the Spinal Cord

Answer 29

Vertebral artery: anterior spinal artery and posterior spinal arteries Segmental arteries: anterior radicular, posterior radicular, segmental medullary arteries Longitudinal artery: anterior and 2 posterior arteries coming from vertebral artery and run the entire length of the spinal cord and connected to feeder arteries Aorta with feeder arteries that branch off Radicular arteries coming off rootlets

Question 30

Venous Drainage

Answer 30

1. Spinal Cord: intervertebral veins, spinal veins, and internal venous plexus Two main veins instead of 3: anterior and posterior and drain back into intervertebral veins From there they drain from internal vertebral plexus in epidural space (blue) 1. Vertebral Column: external Spinal Venous Plexus and Basivertebral Veins Take path of least resistance Basivertebral veins also drain vertebral bodies Can move anteriorly or posteriorly These veins are valveless so they go to where there is least resistance Azygos veins- vein running up the right side of the thoracic vertebral column draining itself towards the superior vena cavae

Question 31

Iliocostalis, Longissimus, and Spinalis: Moore's

Answer 31

O: Arises by broad tendon from posterior part of iliac crest, posterior surface of sacrum, sacro-iliac ligaments, sacral and inferior lumbar spinous processes, and supraspinous ligament I: Iliocostalis- fibers run superiorly to angles of lower ribs and cervical transverse processes Longissimus- fibers run superiorly to ribs between tubercles and angles to transverse processes in thoracic and cervical regions and to mastoid process of temporal bone Spinalis- run superiorly to spinous processes in upper thoracic region and to cranium N: posterior rami of spinal nerves A: acting bilaterally, extend vertebral column and head as back is flexed, control movement by gradually lengthening their fibers; acting unilaterally, laterally flex vertebral column

Question 32

Semispinalis: Innervation and Action

Answer 32

Innervation: posterior rami of spinal nerves Action: extends head, thoracic, and cervical regions of vertebral column and rotates them contralaterally

Question 33

Interspinales

Answer 33

O: Superior surfaces of spinous processes of cervical and lumbar vertebrae I: Inferior surface of spinous processes of vertebrae superior to vertebrae of origin N: Posterior rami of spinal nerves A: Aid in extension and rotation of vertebral column

Question 34

Intertransversarii

Answer 34

O: Transverse processes of cervical and lumbar vertebrae I: Transverse processes of adjacent vertebrae N: Posterior and Anterior rami of spinal nerves A: Aid in lateral flexion of vertebral column; acting bilaterally, stabilizes vertebral column

Question 35

Levatores costarum

Answer 35

O: Tips of transverse processes of C7 and T1-T11 I: Pass inferolaterally and insert on rib between its tubercle and angle N: Posterior rami of C8-T11 spinal nerves A: Elevate ribs, assisting respiration; assist with lateral flexion of vertebral column