The Spine and Thorax
Where is the T-12?
12th rib
Which 3 bony landmarks can help you to isolate the borders of the quadratus lumborum?
12th rib, posterior iliac crest, transverse processes of lumbar vertebrae
To avoid the thick erector spinae muscles overlying the lumbar transverse processes, it is best to slide your fingers roughly how far laterally from the spinous processes?
2 inches
Which ribs attaches to the sternum at the level of the sternal angle?
2nd
The 11th and 12th ribs lie approximately what angle on the body?
45 degrees
Transverse Abdominis
A: Compress abdominal contents O: Lateral inguinal ligament, iliac crest, and thoracolumbar fasica and internal surface of lower 6 ribs I: Abdominal aponeurosis to linea alba
Seratus Posterior Inferior
A: Depress the ribs during exhalation O: Spinous processes of T-12 to L-3 I: Posterior surface of the 9th-12th ribs
Diaphram
A: Draw down the central tendon of the diaphram, increase the volume of the thoracic cavity during inhalation O: Inner surface of lower 6 ribs, upper 2 or 3 lumbar vertebrae, inner part of xiphoid process I: Central tendon
Internal Intercostals
A: Draw the ribs inferiorly to assist with inhalation O: Inferior border of the rib above I: Superior border of the rib below
External Intercostals
A: Draw the ribs superiorly to assist with inhalation O: Inferior border of the rib above I: Superior border of the rib below
Seratus Posterior Superior
A: Elevate the ribs during inhalation O: Spinous processes of C-7 to T-3 I: Posterior surface of the 2nd-5th ribs
Interspinalis
A: Extend the vertebral column O & I: Spanning the transverse processes of vertebrae C-2 to T-3, Spanning the transverse processes of vertebrae T-12 To L-5
Semispinalis Capitis
A: Extend the vertebral column and head O: Transverse processes of C-4 to T-5 I: Between the superior and inferior nuchal lines and the occiput
Rectus Abdominis
A: Flex vertebral column, tilt pelvis posteriorly O: Pubic Crest, pubic symphysis I: Cartilage of 5th-7th ribs and xiphoid process
Erector Spinae Group
A: Laterally flex vertebral column to same side, extend the vertebral column O: Common tendon that attatched to the poterior surface of sacrum, iliac crest, spinous processes of the lumbar and last 2 thoracic vertebrae I: Various attatchments at the posterior ribs, spinous and transverse processes of thoracic and cervical vertebrae and mastoid process of temporal bone
Intertransversarii
A: Laterally flex vertebral column to the same side, extend the vertebral column O & I: Spanning the transverse processes of vertebrae C-2 to C-7, Spanning the transverse processes of vertebrae L-1 To L-5
External Oblique
A: Laterally flex vertebral column to the same side, rotate vertebral column to the opposite side, flex the vertebral column, compress abdominal contents O: External surfaces of 5th-12th ribs I: Anterior part of the iliac crest, abdominal aponeurosis to linea alba
Internal Oblique
A: Laterally flex vertebral column to the same side, rotate vertebral column to the opposite side, flex the vertebral column, compress abdominal contents O: Lateral inguinal ligament, iliac crest, and thoracolumbar fasica I: Internal surface of lower 3 ribs, abdominal aponeurosis to linea alba
Quadratus Lumborum
A: Laterally tilt the pelvis, laterally flex the vertebral column ot the same side, assist to extend the vertebral column, fix the last rib during forced inhalation and exhalation O: Posterior iliac crest I: Last rib and transverse process of 1st-4th lumbar vertebrae
Rectus capitis posterior minor
A: Rock and tilt head back into extension O: Tubercle of the posterior arch of the atlas I: Inferior nuchal line of the occiput
Oblique capitis superior
A: Rock and tilt head back into extension, laterally flex the head to the same side O: Transverse process of the atlas I: Between the nuchal lines of the occiput
Rectus capitis posterior major
A: Rock and tilt head back into extension, rotate the head to the same side O: Spinous process of the axis I: Inferior nuchal line of the occiput
Splenius Capitis
A: Rotate the head and neck to the same side, laterally flex the neck to the same side, extend the head and neck O: Inferior half of ligamentum nuchae and spinous processes of C-7 to T-4 I: Mastoid process and lateral portion of superior nuchal line
Splenius Cervicis
A: Rotate the head and neck to the same side, laterally flex the neck to the same side, extend the head and neck O: Spinous processes of T-3 to T-6 I: Transverse processes of C-1 to C-3
Oblique capitis inferior
A: Rotate the head to the same side O: Spinous process of the axis I: Transverse process of the atlas
Multifidi
A: Rotate vertebral column to opposite side, extend the vertebral column O: Sacrum and transverse processes of lumbar through cervical vertebrae I: Spinous processes of lumbar vertebrae through 2nd cervical vertebra
Rotatores
A: Rotate vertebral column to opposite side, extend the vertebral column O: Transverse processes of lumbar through cervical vertebrae I: Spinous processes of lumbar vertebrae through 2nd cervical vertebra
Which two cervical vertebrae have spinous processes that protrude further posteriorly and are more distinct than the other cervical vertebrae?
C-2, C-7
Iliocostalis
O: Common tendon, posterior surface of ribs 1-12 I: Transverse processes of lumbar vertebrae 1-3 and posterior surface of ribs 6-12, posterior surface of ribs 1-6, transverse processes of lower cervicals
Longissimus
O: Common tendon, transverse processes of thoracic vertebrae I: Lower 9 ribs and transverse processes of thoracic vertebrae, transverse processes of cervical vertebrae, mastoid process of temporal bone
Spinalis
O: Spinous process of the upper lumbar and lower thoracic vertebrae, ligamentum nuchae, spinous process of C-7 I: Spinous processes of upper thoracic, spinous processes of cervicals except C-1
Name the abdominals
Rectus Abdominis, External Oblique, Internal Oblique, Transverse Abdominis
Name the Suboccipitals
Rectus capitis posterior major/minor, oblique capitis superior/inferior
Depression of Ribs
Synergists: Internal intercostals, serratus posterior inferior Antagonist: External intercostals
Extension of Spine
Synergists: Semispinalis capitis, spinalis, iliocotalis, interspinalis, intertransversarii Antagonists: Retus abdominis
Rotation of Spine (to the right)
Synergists: external oblique (left side), internal oblique (right side) Antagonists: multifidi (right side)
In which 3 directions are the ribs ideally designed to move?
anterior/posterior, lateral, superior
Where is the C-7?
base of the neck
Name 2 factors that might affect the position of the scapula?
body type, muscular contraction
Which section of the vertebral column is capable of the most movement?
cervical
The first rib is deep to which bone along the anterior thorax?
clavicle
What is the structure that extends off the ribs and attaches to the sternum?
costal cartilage
What is the primary muscle in respiration?
diaphragm
As you palpate medially toward the spine, you may lose contact with the 12th rib because it is deep to which muscle group?
erector spinae group
The thoracic vertebrae are located deep to the _____ muscles and superficial to the _______.
erector spinae, cpnnecting aspects of the ribs
You are palpating lateral to the edge of the rectus abdominis and the fibers you feel are superficial and running at an angle. Which muscle is this?
external oblique
The ligamentum nuchae spans between which 2 bony landmarks?
external occipital protuberance, spinous process of C-7
To feel the ligamentum nuchae change extension underneath your fingers, what 2 passive movements can you perform at the head?
flexion and extension
What two movements at the spine could you ask your partner to perform to feel the movement of the spinous processes?
flexion, extension
Where is the T-7?
inferior angle of the scapula
Which muscles are located between the ribs?
intercostals
As a group, the transverospinalis muscles can be easily located along the ________ of the thoracic and lumbar vertebrae.
lamina grooves
Whicch edge of the quadratus lumborum is accessible from the side of the torso?
lateral edge
What action could you ask your partner to perform to feel the quadratus lumborum contract?
laterally tilt the hip
The thoracolumbar aponeurosis serves as an attachment site for which 2 muscles?
latissimus dorsi, any branches of the erector spinae group
Name the 2 large muscles through which you would have to palpate to access various portions of the intercostals.
latissimus dorsi, pec major, external oblique
Rotating the head to the left demands the contraction of which splenius capitis, left or right?
left
Passive flexion of the spine would _____ the iliocostalis.
lengthen
Passive roation of the head and neck to the opposite side would ________ the splenius capitis.
lengthen
Passive rotation of the head to the opposite side would _______ the oblique capitis inferior.
lengthen
Passive rotation of the spine to the same side would _______ the multifidi.
lengthen
Passive rotation of the vertebral column to the opposite side would ______ the internal oblique.
lengthen
Passive rotation of the vertebral column to the same side would ________ external oblique.
lengthen
Which band of connective tissue lies superficial to the cervical spinous processes?
ligamentum nuchae
Your partner is supine and you passively rotate the head 45 degrees away from you. This position places the cervical transverse processes in a line running between which 2 bony landmarks?
mastoid process, center of shaft of clavicle
The abdominal aorta is located where in relationship to the psoas major?
medial
Name the muscles in the Transverospinalis Group
multifidi, rotatores, semispinalis capitis
When is it best to move your fingers as you curl them underneath the rib cage to feel the diaphragm?
only as your partner exhales
To contract the lower fibers of the erector spinae group in a prone position, you could ask your partner to perform what action?
raise and lower his feet slightly
Which abdominal muscke runs vertically from the rib cage to the pubic crest?
rectus abdominis
Rotating your trunk to the right would engage your left or right internal oblique muscle?
right
To distinguish the trapezius fibers from the splenius capitis fibers, you could ask your partner to perform what action?
rotate his head slightly toward the side you are palpating
Ranges of motion for the spine and thorax
rotation of spine, flexion/extension of spine, lateral flexion of spine, depression/elevation of ribs
Exploring just posterior to the clavicle, through which muscle group must you palpate to access the first rib?
scalenes
Unlike the long, vertical erector fibers, the branches of the transversospinalis group consist of many __________ fibers.
short, diagonal
Compression of the abdominal contents would _______ the transverse abdominis.
shorten
Drawing the ventral part of the ribs upward would ______ the external intercostals.
shorten
Increasing the volume of the thoracic cavity would _____ the diaphragm fibers.
shorten
Passive extension of the head and neck would ______ the splenius capitus.
shorten
Passive lateral flexion of the head and neck would ________ the splenius cervicis.
shorten
Passive lateral flexion of the spine to the same side would _________ the longissimus.
shorten
Passive rotation of the head of the same side would ________ the rectus capitis posterior major.
shorten
Passive rotation of the spine to the opposite side would ______ the rotarores.
shorten
What action could you ask your partner to perform to feel the first rib move?
slow, deep breath into upper chest
The most medial branch of the erector spinae group is the ______, while the most lateral is the ______.
spinalis, iliocostalis
Name the muscles in the Erector Spinae Group
spinalis, longissimus, iliocostalis
The lamina groove is located between which 2 bony landmarks of the vertebrae?
spinous and transverse processes
What 2 bony landmarks and one region can be helpful to isolate the location of the suboccipitals?
spinous process of C-2, TVP's of C-1, the space between the superior nuchal line of the occiput and C-2
The visible row of bumps down the center of the back are the ________.
spinous processes
Many of the cervical transverse processes are deep to which neck muscle?
sternocleidomastoid
The thorax is composed of which two structures?
sternum and rib cage
Where is the T-2?
superior angle of the scapula
What superficial ligament can be felt between the spinous processes of the thoracic and lumbar vertebrae?
supraspinous
When the diaphragm muscle fibers contract, what connective tissue structure is pulled inferiorly?
the central tendon
Although the entire rib cage is deep to the muscle tissue, which portion is easily accessible?
the sides of the trunk
How can the upper fibers of the trapezius be helpful in locating the suboccipitals?
the trap's lateral edge is the same width as the suboccipitals
In the lumbar region, the erectors lie deep to what connective tissue structure?
thoracolombar aponeurosis
Where is the L-4?
top of the iliac crest
When exploring between the scapulae, can you name two muscles through which you will have to palpate to access the deeper erector spinae fibers?
trapezius, rhomboids or serratus posterior superior
The splenius capitis is a deep muscle except on the lateral side of the neck where it is superficial between which 2 muscles?
trapezius, sternocleidomastoid