4 Spine & Thorax

Topographical Views Congratulations, you’re a vertebrate! Congratulations, you’re biped!

Exploring the Skin and Fascia

Bones of the Spine and Thorax

• Most mobile & accessible

• Articulate with the 12 pairs of ribs • Help protect the internal organs

• Located between the 12th rib & posterior iliac crest • Designed to the body weight of the upper body

Bony Landmarks

Atlas (C-1) • Atlanto-occipital t (AOJ) – located between the atlas & the occiput  The AOJ allows the head to move independently from the neck  Flexion/Extension, Lateral flexion, Rotation • Only vertebrae that doesn’t have a spinous process

 An abnormal lateral curvature of the spine is called scoliosis

Axis (C-2) The Atlantoaxial t (C1-C2): •Allows the Atlas to move on it’s Axis (Hence the name!) •Flexion/Extension, Rotation

Cervical • Less weight bearing function  Doesn’t need to be as stable  Allows for more movement

• Cervical region bends anteriorly  Forms a lordotic curve  Extension>Flexion  Lateral Flexion, Rotation

FRANKENSTEIN’S BOLTS!

 Because of lordotic curve of CSpine and the ligamentum nuchae (a ligament attaching the spinous processes), the cervical spinous processes are actually deeper than the thoracic & lumbar vertebrae

Thoracic • Makes up the Thorax of the body • Thoracic region bends posteriorly  Creates a kyphotic curve

Lumbar • Defines the abdomen of the body • Lumbar region bends anteriorly  Forms a lordotic curve  Why are the bodies of the lumbar vertebrae so much bigger than the other vertebrae?

Larger than T- & C-Spine

Lumbar • Lumbar region bends anteriorly  Forms a lordotic curve  Why are the bodies of the lumbar vertebrae so much bigger than the other vertebrae? 

When you are standing, the entire weight of your trunk, head & arms is transferred through the bodies of the vertebrae

Lumbar • What lies in between the vertebrae? • What is it’s role?

Lumbar • What lies in between the vertebrae?  Intervertebral discs • What is it’s role?  Cushion the shock

Bony Landmarks

Bony Landmarks • •

Ribs 1-7 = “True Ribs”  Attach directly to the sternum Ribs 8-12 = “False Ribs”  Attach indirectly to sternum by means of the costal cartilage  11 & 12 = “Floating Ribs”  Do not attach to sternum or costal cartilage at all

Bony Landmark Trails

Bony Landmark Trails Did you know… •

•

When you are asleep, the pressure is off the spine and the discs are able to fully restore themselves. You actually wake up ½” taller than you were the night before!

Bony Landmark Trails

Trail 1 “Midline Ridge” Spinous Processes of the Vertebrae • Posterior projection of the vertebrae • Visible row of bumps that run down the center of the back • Attachment sites for muscles, ligaments & fascia

Trail 2 “Crossing Paths” L-4 and Top of the Iliac Crest

 Draw a line medially from the top of the two iliac crests and you will find the spinous process of L-4

T-12 and the Twelfth Rib

 The 12th rib has a slender, spear-like shape & angles inferiorly.  3”-6” long  Follow it medially and you will locate the spinous process of T-12

Trail 2 “Crossing Paths” T-7 and Inferior Angle T-2 and Superior Angle

C-7 and Base of the Neck  When the neck is flexed, the spinous process of C-7 shifts superiorly but T-1 doesn’t move

Trail 3 “Nape Lane” Spinous Processes of the Cervicals • The spinous process of C-2 is more distinct than the other cervical spinous processes.

When palpating the cervical vertebrae, compression or impingement of the brachial plexus or one of it’s nerves can create a sharp shooting sensation.  If this should happen, immediately release & adjust your position posteriorly.  ALWAYS ASK FOR

Trail 3 “Nape Lane” Transverse Processes of the Cervicals

• Located on the side of the neck • Attachment sites for various muscles (scalenes & levator scapulae) • Brachial plexus exits between the TVPs

Trail 3 “Nape Lane” Transverse Process of C-1 • Located just distal & anterior to the tip of the mastoid process

Cervical Lamina Groove

• Space between the spinous & transverse processes of the vertebrae • Pretty inaccessible thanks to our musculature

Trail 4 “Buried Boulevard” Transverse Processes of the Thoracic and Lumbar Vertebrae • Shorter than TVPs of lumbar vertebrae • Palpable deep to the erector spinae muscles

Trail 4 “Buried Boulevard” Lamina Groove of the Thoracic Vertebrae

• Located between the spinous & transverse processes • Gets wider & deeper as it progresses down the spine • Filled with the layers of erector spinae & transversospinalis muscles

Trail 4 “Buried Boulevard” Lamina Groove of the Lumbar Vertebrae • • •

Located between the spinous & transverse processes Lumbar region = filled with erector spinae & transversospinalis muscles Difficult to palpate directly but its borders (the spinous & transverse processes) are palpable

Trail 5 “Breastbone Ridge” Jugular Notch  Between sternal heads of the clavicles Manubrium and Sternum Xiphoid Process 1.

Manubrium • •

2.

Sternum •

3.

Superior portion of the sternum Articulates with clavicles, 1st & 2nd ribs “Breastbone”

Xiphoid process •

Attachment site for the abdominal aponeurosis (A.K.A., Rectus Sheath)  

• •

Large sheet of connective tissue Attachment site for INT/EXT Obliques & Transverse Abdominus

Easy to break 1” in length

Trail 6 “One Bumpy Road” Ribs and Costal Cartilage • The ribs articulate posteriorly with the thoracic vertebrae (Costovertebral ts) & then curve around the thorax to the anterior chest.  Easily accessible to the sides

• Costal cartilage attaches the ribs to the sternum

Trail 6 “One Bumpy Road” First Rib • •

Difficult to isolate along the anterior thorax • Lies directly beneath the clavicle & then curves quickly to the back Can be accessed in the posterior triangle of the neck • Formed by the clavicle & the sternocleidomastoid and trapezius muscles

Trail 6 “One Bumpy Road” Eleventh and Twelfth Ribs

• •

“Floating Ribs”  Do not attach to the costal cartilage Can palpate the lateral aspects

Muscles of the Spine and Thorax • Create movement of the vertebral column & rib cage • Difficult to isolate a particular portion of muscle

Sections of the Spine: 1.

2. 3. 4.

Erector Spinae Group Transversospnalis Group (2) Splenii (8) Suboccipitals 

Deepest

 Most Superficial

Erector Spinae Muscles •

 `  `

Extend from the tip of the spinous process to the body of the rib

`

Muscles of the Spine and Thorax

•

Muscles responsible for good posture

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How do we analyze posture? What about a person whom sits at a desk all day?



Muscles of the Spine and Thorax •

Cross-Section view of the muscles of the spine

 Transversospinalis muscles (rotatores, mutifidi & semispinalis) are located within the lamina groove  Erector Sponae muscles (spinalis, longissimus & iliocostalis) extend from the tip of the spinous process to the body of the rib

Muscle Layers of the Posterior Neck

Muscle Layers of the Posterior Neck

Muscle Layer of the Posterior Neck

Cross Section of the Neck

Cross Section of the Thorax

Cross Section of the Thorax

Synergists – Muscles Working Together Vertebral Column

Vertebral Column

Vertebral Column

Ribs/Thorax

Erector Spinae Group Spinalis Longissimus Iliocostalis

• Runs from the sacrum to the occiput along the posterior aspect of the vertebral column • Dense, layered arrangement of muscles that can be difficult to visualize (think of a Poplar tree) • Deep to the thoracolumbar aponeurosis (Lumbar region) • Deep to trapezius, rhomboids, serratus posterior superior & inferior (T- & C-Spine)

• •

Smallest Lies closest to spine (in lamina groove)

Erector Spinae Group

 Help maintain an upright posture  Help return to anatomical position when you are finished tying your shoes  Picking up a heavy suitcase

Erector Spinae Group

Erector Spinae Group 1.

2.

3.

Partner prone. Lay both hands along either side of the lumbar vertebrae. Locate the region of the lower erectors by asking your partner to alternately raise & lower their feet slightly. The erectors do not raise the feet, but they will contract in order to stabilize the pelvis. As your partner maintains this contraction, palpate inferiorly onto the sacrum and then superiorly along the thoracic vertebrae. Ask your partner to extend their spine & neck slightly in order to contract the erectors in the thoracic region. Follow the ropy fibers of the erectors between the scapulae and along the back of the neck. These fibers are smallest in the cervical region & are primarily situated lateral to the lamina groove.

Transversospinalis Group Multifidi Rotatores Semispinalis Capitis

• Deep to the erector spinae muscle group  Rotate your torso to put on a seat belt  Heaving dirt off a shovel

 Difficult to isolate the individual bellies but as a group, their mass can be felt along the lamina groove of the T- & C-spine

Transversospinalis Group

• Multifidi are directly accessible in the lumbar spine  Only muscle fibers that lie across the posterior surface of the sacrum • Rotatores lie deep to the multifidi

Transversospinalis Group

• •

Located along the thoracic & cervical vertebrae and ultimately reaches the cranium Form the “speed bumps” easily seen on the posterior neck when the neck is extended against some resistance

Transversospinalis Group 1. Partner prone. Locate the spinous processes of the lumbar vertebrae. Slide your fingers laterally off the spinous processes, sinking between them and the erector spinae fibers. 2. Pushing the erectors laterally out of the way, explore deeply for the dense, diagonal fibers of the multifidi. Progress inferiorly to the sacrum, rolling your fingers in a perpendicular direction to the multifidi fibers. 3. Move superiorly, exploring the lamina groove of the thoracic & cervical areas. Then turn your partner supine & palpate the cervical region

Transversospinalis Group

Splenius Capitis and Cervicis

Splenius Capitis and Cervicis • •

Located along the upper back & posterior neck Run obliquely

Splenius Capitis 1. Partner prone. Locate the upper fibers of the trapezius. 2. Isolate the lateral edge of the trapezius by having your partner extend his head slightly. 3. Ask your partner to relax. Palpate just lateral to the trapezius for the splenius capitis’ oblique fibers, following them up to the mastoid process & inferiorly through the trapezius

Both Splenii Muscles 1. Partner supine with thte head rotated 45° away from the side you are palpating. Cradle the head with one hand while the other one locates the lamina groove of the upper cervical & thoracic vertebrae. 2. ively extend the neck slightly to shorten the tissue & palpate through the overlying trapezius fibers.

Suboccipitals

Suboccipitals

Suboccipitals

Suboccipitals • The deepest muscles of the upper posterior neck. • Stabilize the axis & atlas • Create intrinsic movements • Rocking & tilting the head

Quadratus Lumborum

Quadratus Lumborum • The deepest muscle of the abdomen 

An abdominal muscle located on the posterior surface of the thorax

• Lateral edge is accessible from the side of the torso

Quadratus Lumborum When do you use your QL? 1. 2. 3.

Hiking up your hip to walk over something Raising yourself up from a side lying position (lateral flexion) Salsa, tango or ballroom dancing

Abdominals Rectus Abdominis External Oblique Internal Oblique Transverse Abdominis •

Provide & protection for your internal organs

Abdominals

Abdominals

Abdominals

Abdominals  What is the Linea Alba? • No, it’s not Jessica’s Sister

Abdominals  What is the Linea Alba? • No, it’s not Jessica’s Sister “White Line” composed of mostly collagen connective tissue

Rectus Abdominis 1. Partner supine with knees flexed. Locate the Xiphoid process & the ribs just lateral to the Xiphoid. Also, locate the pubic crest. 2. Place your hand between these landmarks & ask your partner to alternately flex & relax their trunk slightly. (“Do a small sit-up”) 3. Explore the entire length of the rectus & sculpt between its rectangular muscle bellies.

External Oblique (left side) 1. Partner supine with knees flexed. Lay your hand on the left side of the abdomen & lower ribs. Ask your partner to raise their left shoulder toward their right hip (rotating their trunk). 2. Palpate across the superficial fibers of the external oblique, noting their diagonal direction. 3. With the trunk still rotated, follow the fibers superiorly to where they interdigitate with the serratus anterior, then inferiorly to the abdominal aponeurosis and, finally, laterally to the iliac crest

Diaphragm

Diaphragm •

An involuntary contraction of the diaphragm will cause air to rush into the lungs & the vocal cords to snap shut. The audible result is a hiccup!

 The heart’s pericardium is also attached to the central tendon, so the heart will ride up & down when you breathe

Diaphragm • The primary muscle of respiration. • Separates the upper & lower thoracic cavities. • Inspiration (inhalation) = muscle fibers contract & pull the central tendon inferiorly • Exhalation = muscle fibers relax, releasing the central tendon & allowing the lungs to deflate

Intercostals

 The meat on your spare ribs

Serratus Posterior Superior and Inferior

Serratus Posterior Superior

Serratus Posterior Inferior

Intertraversarii

Interspinalis

Other Structures of the Spine and Thorax Ligamentum Nuchae • •

Helps stabilize the head & neck Attachment site for trapezius & splenius capitis

Supraspinous Ligament • Attaches to the spinous processes of the T- & CSpine

Abdominal Aorta

• Chief artery for carrying blood to the abdominal organs & lower appendages

Thoracolumbar Aponeurosis

• A broad, flat tendon stretching across the thorax & lumbar regions • Anchor for latissimus dorsi & erector spinae group

Craniovertebral ts Atlantooccipital and Atlantoaxial ts

Craniovertebral ts Atlantooccipital and Atlantoaxial ts Text

Intervertebral ts

Intervertebral ts

Costovertebral ts Text

Sternocostal ts

Blank slide Text