Thoracolumbar Anatomy Eric Shamus Catherine Patla Objectives

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1 1 2 Thoracolumbar Anatomy Eric Shamus Catherine Patla Objectives List the muscular and ligamentous attachments of the thoracic and lumbar spine Describe how the muscles affect the spine and upper extremity related to clinical dysfunctions. Relate normal and abnormal anatomy to clinical impairments POSTERIOR MUSCLES Trapezius Levator scapulae Teres major Rhomboid major Serratus anterior Latissimus dorsi Teres minor Rhomboid minor Serratus posterior Erector spinae ERECTOR SPINAE-SPINALIS Attachment 1 Spinous processes Attachment 2 Spinous processes six levels above ACTION Lateral flexion of spine NERVE ERECTOR SPINAE-LONGISSIMUS 8 ERECTOR SPINAE-ILIOCOSTALIS Attachment 1 Iliac crest, sacrum, lumbar vertebrae 1

2 Attachment 2 Ribs, cervical transverse processes ACTION Extends and lateral flexes spine NERVE INTERSPINALIS Attachment 1 Spinous processes Attachment 2 Spinous processes one above ACTION Extension of spine NERVE INTERTRANSVERSARII Attachment 1 Transverse processes Attachment 2 Transverse processes one above ACTION Lateral flexes spine NERVE LATISSIMUS DORSI Attachment 1 Spine T7, spinous processes and supraspinous ligaments of all lower thoracic, lumbar and sacral vertebrae, lumbar fascia, posterior third iliac crest, last four ribs (interdigitating with external oblique abdominis) and inferior angle of scapula Attachment 2 Floor of bicipital groove of humerus after spiraling around teres major ACTION Extends, adducts and medially rotates arm. Costal attachment helps with deep inspiration and forced expiration NERVE Thoracodorsal nerve (C6, 7, 8) (from posterior cord) LEVATORES COSTARUM Attachment 1 Transverse processes C7 to T11 2

3 Attachment 2 Posterior surface and angle of rib below ACTION Elevates ribs NERVE SERRATUS POSTERIOR SUPERIOR Attachment 1 Spinous processes and supraspinous ligaments of C7-T2 Attachment 2 Posterior aspect of ribs 2-5 ACTION Assists forced inspiration NERVE Anterior primary rami (T2-5) TRANSVERSOSPINALIS-MULTIFIDUS Attachment 1 Laminae of vertebra Attachment 2 Spinous processes two to three levels above ACTION Extends spine NERVE TRANSVERSOSPINALIS-ROTATORES Attachment 1 Transverse processes INSERTION Spinous processes one above Attachment 2 Rotates spine NERVE Muscles of the Low Back QUADRATUS LUMBORUM Attachment 1 Inferior border of 12th rib Attachment 2 Apices of transverse processes of L1-4, iliolumbar ligament and posterior third of iliac crest 3

4 ACTION Fixes 12th rib during respiration and lateral flexes trunk NERVE Anterior primary rami (T12-L3) Anterior Muscles Scalenes Anterior Scalenes C3-6 to the 1 st rib Middle Scalenes C2-7 to the first rib Posterior Scalenes C5-7 to the 2 nd rib Overactive with accessory breathing Muscles of Breathing Abdominal Muscles INTERNAL Obliques INTERNAL Obliques ACTION An antagonist (opponent) to the diaphragm, helping to reduce the volume of the thoracic (chest) cavity during exhalation. Limited actions in both flexion and rotation of the vertebral column. NERVE Muscular collateral branches of lower intercostal nerves EXTERNAL Obliques EXTERNAL Obliques ACTION The external oblique functions to pull the chest downwards and compress the abdominal cavity, which increases the intra-abdominal pressure. It also has limited actions in both flexion and rotation of the vertebral column. NERVE Muscular collateral branches of intercostal nerves DIAPHRAGM Attachment 1 4

5 Vertebral: medial and lateral arcuate ligaments from bodies of L1-3. Costal: inner aspect of lower six ribs. Sternal: two slips from posterior aspect of xiphoid process DIAPHRAGM DIAPHRAGM ACTION Primary muscle of respiration Inspiration and assists in raising intra-abdominal pressure NERVE Phrenic nerve (motor) (C3-5). Sensory: phrenic, intercostals (6-12) and upper two lumbar nerve roots Rectus Abdominis Attachment Pubic symphysis Attachment Xiphoid process and lower costal cartilages (5 7) superiorly Transverse abdominis Attachment Iliac crest, inguinal ligament, lumbar fascia, and cartilages of inferior six ribs Attachment Xiphoid process, linea alba, pubis Diaphragm & Iliopsoas Diaphragm interconnects with the abdominal muscles and iliopsoas to form the abdominal wall Trunk control with Lower extremity SUBCOSTALIS Attachment 1 Internal posterior aspects of lower six ribs Attachment 2 Internal aspects of ribs two to three levels below ACTION Depresses lower ribs NERVE 5

6 Muscular collateral branches of intercostal nerves VERTEBRAE 2 parts: body and the posterior arch 2 pedicles 2 superior & 2 inferior zygapophysial (facet) joints 2 laminae 2 transverse processes single spinous process 12 thoracic ANATOMICAL LANDMARKS Sternal notch T2 Spine of the scapula T3 Inferior angle of scapula T7 Nipple T4 dermatome Umbilicus T10 dermatome SPINAL MOTION Human spine can move in 3 planes Corresponding axis and motion The axis is perpendicular to the plane of motion sagittal plane flex/ext. transverse axis transverse plane rotation vertical axis coronal plane sidebend ant/post. axis THORACIC MOTION The primary motion of the thoracic spine is ROTATION facet facing - BUL vertical axis transverse plane Rotation is restricted by the attachment of the ribs VERTEBRAL MOTION All spinal and vertebral movements are described in relation to motions of their ANTERIOR and SUPERIOR surfaces Vertebral segment: a single vertebra Vertebral unit: 2 adjacent vertebrae - associated arthrodial, ligamentous, muscular, vascular, neural & lymphatic elements Thoracic and rib motion 6

7 46 Biomechanics Shoulder motion related to Spine Cervical rotation and arm elevation above 90 with external rotation Posterior rotation of ribs 2 to Functional arm movement Shoulder complex Spine Ribs Thoracic cage Diaphragm fascia connections with: Lattisimus Dorsi Quadratus lumborum Psoas Picture reference 7

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