Spine And Thorax 1

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  • 1. Spine and Thorax
  • 2. Topographical views
  • 3. Bony landmark trail
    • Trail 1. Midline Ridge
    • Explore the spinous processes of the vertebrae and the spaces between them
    • Trail 2. Crossing Paths
    • Describe surrounding bony landmarks that 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 th ribs, 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 th ribs
      • Iliocostalis cervicis: 3 rd -7 th ribs
    • Insertion
      • Iliocostalis lumborum: 6 th -12 th ribs, deep layer of thoracolumba fascia, TP of upper lumbar vertebrae
      • Iliocostalis thoracis: 1 st -6 th ribs
      • 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 subject’s 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