THE BACK

Muscles Somite derived epimere becomes deep muscles. Somite derived hypomere becomes superficial muscles. Primary and secondary curvature Erect posture

Superficial Back All nerve supplies from hypomere (none from epimere) Skin of back innervated by dorsal rami of C2-C5 and T1-L3 Development of Vertebral Column

Superficial muscles: trapezius levator scapulae rhomboid minor and major latissimus dorsi serattus posterior-superior serratus posterior-inferior (Look at tables & figures in the text) Triangles and Fascia Triangle of auscultation: site where breathing can be heard best. Lumbar triangle Thoracolumbar (lumbodorsal) fascia

Deep back: Innervated by dorsal rami

Deep/Intrinsic Spinotransverse group of superficial layer: splenius capitis splenius cervicis - act to rotate head and neck and to extend head and trunk; wrap around head Damaged splenious: Ipsilateral rotation. Sacrospinalis group of intermediate layer: - Act to flex, extend and rotate vertebral column and head and include erector spinae: Iliocostalis (lateral) Longissimus (medial Spinalis (most medial) Iliocostalis has lumbar, thoracic and cervical sections. Longissimus has thoracic, cervical and capitis sections. Spinalis has thoracic part only. Transversospinalis Group of Deep Layer: Act to rotate and extend head, neck and trunk; includes: Semispinalis capitis, cervicis and thoracis, multifidus and rotators. Look and recognize all deep muscles of the back in table and figures of text.

Segmented Muscles: Interspinales: Run between adjacent spinous processes and aid in extension of vertebral column. Intertransversarii: Run between adjacent transverse processes and aid in lateral flexion.

Clinical Correlation & Motivations - Back pain - Whiplash - Weight bearing traumas

Vertebral Column 33 vertebrae: 7 cervical 12 thoracic 5 lumbar 5 fused sacral 3-5 fused coccygeal 32-34 bones total Bones are bigger in lower regions than upper regions. Primary curvatures are in thoracic and sacral regions (2 curves) - these are fetal curves; convex posterior. Secondary curvatures are in cervical and lumbar regions (2 curves) - these post-natal curves; concave post. Abnormal curvatures: Kyphosis (hunchback): Exaggerated thoracic curvature; older people often get this. Lordosis (swayback/saddle back): Accentuation of lumbar curvature; pregnantees get this. Scoliosis (Lateral deviation due to unequal growth of spinal column, erosion or asymmetric paralysis or weakness of muscles.

Typical Vertebrae Body: Functions to support weight, separated/bound by intervertebral disks, articulates with subjacent ribs. Vertebral Arch: Pedicles (laterally) and laminae (posteriorly) are paired; pedicles connect body and arch. Have 7 processes - one spinous, two transverse and four articular; also has inf. And sup. notches. Processes: Spinous process: Projects posteriorly from arch. Transverse process: Project on each side from pedicle and lamina; articulate with tubercles of ribs (1-10) in thoracic region; all ribs (except for 11 & 12 or 10 & 11) articulate with neural vertebrae. Inferior and superior articular processes articulate with each other - inf. of one to superior of next. Costal (Facets) Processes: Anterior to pedicle; articulate with heads of ribs. Inferior and superior. Mammillary Processes: Tubercles on superior articular processes of lumbar vertebrae. Foramina: Space enclosed by body and arch. Vertebral Foramina: For vertebral. Intervertebral Foramina: Between inferior and superior surfaces of pedicles; transmit spinal nerves and vessels leaving vertebral canal. Transverse Foramina: In each transverse process of cervical vertebra; transmit vertebral artery, vein and autonomic nerves.

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Intervertebral Disk: Between two vertebrae; important for absorbing shocks and for movement. Nucleus Pulposus: Of embryonic notochord in center of intervertebral disk; made of reticular and collagenous fibers embedded in mucoid; may herniate through anulus fibrosus, absorbs shock, equalizes pressure and exchanges fluids between disk and capillaries. Anulus Fibrosus: Made of concentric layers of fibrous tissue and fibrocartilage; binds column together; retains nucleus; permits movement; absorbs shock Most common direction of slipped disc:

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Regions: Atlas/First Cervical Vertebra: Supports skull, no spinous process, has anterior and posterior arches and paired transverse processes; helps form atlanto-occipital joints and atlantoaxial joints. Axis/Second Cervical Vertebra: Has dens (odontoid process) which project superiorly, articulating with anterior arch of atlas, forming pivot which atlas rotates on; cord passes behind odontoid. Seventh Cervical Vertebra: Prominens due to long spinous process; gives attachment to ligament nuchae. Extra rib would be at C7. Fifth Lumbar Vertebra: Has biggest body; has mammillary and accessory processes off transverse process. Sacrum: 5 fused vertebrae; forms posterior pelvis and gives strength and stability to it; has promontory (anterior edge of first sacral vertebrae). Ala is formed by fused transverse and costal processes. Median sacral crest formed by fused spinous processes. Sacral hiatus is formed by laminae of 5th sacral vertebra not meeting. Sacral cornu is formed by pedicles of 5th sacral vertebra; landmark for giving caudal anesthesia. Coccyx: Attachment for coccygeus and levator ani muscles. Biffets provide more aerials for muscle attachments. Ligaments: Anterior Longitudinal Ligament: Skull to sacrum on anterior surface; prevents hyperextension; on bodies. Posterior Longitudinal Ligament: Prevents hyperflexion - anterior to spinous processes; on bodies. Ligamentum Flavum: Connects laminae of two adjacent vertebrae; maintains upright posture. Intertransverse. Interspinous tissues is between spinous processes. Supraspinous is posterior to spinous processes. Ligamentum Nuchae: Between muscles posterior to neck. Vertebral Venous System: Valveless plexiform of interconnecting channels. Internal Vertebral Venous Plexus: Between wall of canal and dura mater; communicates w/basivertebral veins. External Vertebral Venous Plexus: Anterior and posterior parts. Plexuses provide pathway for malignant disease to pass from pelvis to skull; lymphs are superficial & deep. Clinical Correlation & Motivations - Intervertebral discs herniation - Cord compressions and dermatomal block - Congenital malformations - Vertebral deviations, kyplosis & scoliosis - Spondylosis - Spondiolisthesis - Spondylolysis - Spondylosyndesis
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Gross Anatomy Structures to Know

General Landmarks: Vertebral Column: 7 cervical, 12 thoracic, 5 lumbar and 5 (fused) sacral vertebrae and the coccyx. Scapula: Spine, acromion, superor and inferior angles, vertebral border. Iliac crest: Posterior superior iliac spine. Lumbar and thoracic vertebra: Pedicles (roots) and laminae (two flat plates), transverse process (junction) and articular processes; spinous process. Intervertebral disc. Intervertebral foramen. Cervical vertebrae: Transverse process, foramen transversarium, spinous processes. Atlas: No spinous process. First Thoracic Spine (part of axis). Vertebral foramen. Vertebral canal. Occipital bone: External occipital protuberance and nuchal lines. Mastoid process. Primary and secondary curvatures. Back:
Structure Trapezius Levator scapulae Rhomboid minor Rhomboid major Latissimus dorsi of auscultation Lumbar triangle Thoracolumbar fascia Serratus posterior sup. Serratus posterior inf. Splenius captis Splenius cervicis Transversospinalis: (1) Semispinalis captitis (2) Multifidus (3) Rotators Erector spinae/Scrspnls: (1) Iliocostalis (2) Longissimus (3) Spinalis Longissimus capitis Rectus capitis post. Mj. Rectus capitis post. Mn. Obliquus capitis sup. Obliquus capitis inf. Action Add. rot, ele, depr, scap. Elevates scapula. Adducts scapula. Adducts scapula. Add, ext. rot arm med. Boundaries: Latissimus Boundaries: Latissimus Covers deep back musc. Elevates ribs. Depresses ribs. Rot, ext head and neck. Rot, ext head and neck. Rot, ext head, nck, trnk. Small slips of muscles Rot, ext hd, nck, trnk. Flex, ext, rot coll & hd. Flex, ext, rot coll & hd. Flex, ext, rot coll & hd. Same as longissimus. Ext, rot, flex head lat. Ext, rot, flex head laterally. Ext, rot, flex head lat. Ext, rot head laterally. Origin Ext occ, sup nuchal Line, ligamentum nuchae, C7-T12. Trans process C1-C4. Spines of C7-T1. Spines of T2-T5. T5-T12, thoracodorsal fascia, iliac c, ribs 9-12. Dorsi, trapezius, rhomboid Dorsi, external oblique ------------------------------Ligamentum nuchae, supraspinal lig, C7-T3. Supraspin lig, T11-L3. Spinous processes. Spinous processes. ------------------------------Upper thoracic trans. On all levels of ver. ------------------------------Ilium, ribs and spines. Sacrum, ilium, ribs, spin. Sacrum, ilium, ribs, spin. See above. Spine of axis. Posterior tubercle: atlas. Trans process of atlas. Spine of axis. Insertion Spine of scapula acromion and lateral third of clavicle. Med border of scapula. Root of spine of scap. Med border of scap. Floor of bicipital groove of humerus. major and vertebral And iliac crest. -------------------------------Upper border of ribs T2-5. Lower bord of ribs 2-5. Sup nucal line, mastoid. Trans of upper Cs. ------------------------------Occipital bone. ------------------------------------------------------------Ribs and cervical trans. Mastoid, ribs, trans. Spinous processes. Mastoid process. Lateral inferior nuchal. Occ. Below inf. nuchal. Occ. Above inf. Nuchal. Trans process of atlas. Innervation Spinal accessory +nerve; C3-C4. Dorsal scap C3-C4. Dorsal scap. C5. Dorsal scapular. Thoracodorsal. Border of scapula. -----------------------------Intercostal T1-T4. Intercostal T9-T12. Dorsal rami. Dorsal rami. -----------------------------C1-T10. ----------------------------------------------------------Dorsal rami. Dorsal rami. Dorsal rami. Doral rami. Suboccipital. Suboccipital. Suboccipital. Suboccipital.

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References: Clinical Anatomy, Richard S. Snell, 6th Ed. Clinically Oriented Anatomy, Keith L. Moore, 4th Ed. Regional Atlas of the Human Body, Clemente, 4th Ed. Guide to Physical Examination & History Taking, Lynn S. Bickley, 7th Ed.

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