TSP Flashcards
1
Q
TSP - ROM
A
- Flexion - 60
- Extension - 25
- Lateral flexion - 35
- Rotation - 50
2
Q
TSP - MYOTOMES
A
- Shoulder elevation - C4, XI
- Deltoid - C5, C6 - axillary
- Brachioradialis - C5, C6 - radial
- Biceps - C5, C6 - musculocutaneous
- Triceps - C6, C7, C8, T1 - radial
- Wrist extensors - C6, C7, C8 - radial
- Wrist flexors - C6, C7 - median/ulnar
- Finger flexors - C7, C8, T1 - ulnar/median
- Interossei - C7, C8, T1 - ulnar
- Trunk rotation - T1 - T12
- Trunk lateral flexion - T1 - T12
- Trunk flexion/extension - T1 - T12
3
Q
TSP - ORTHO TESTS - TOS
A
- THORACIC OUTLET SYNDROME - Adson’s test, Roo’s test, Wright’s test
4
Q
TSP - ORTHO TESTS - NERVE COMPRESSION
A
- NERVE COMPRESSION - SLR, Slump test, Brudzinski’s test, Passive scapular adduction test
5
Q
TSP - ORTHO TESTS - TISSUE CONTRACTURE
A
- TISSUE CONTRACTURE - AROM, PROM, Chest expansion test, Rib motion test
6
Q
TSP - JOINT TYPE
A
- Gliding - zygapophyseal, costotransverse, costovertebral, sternocostal
- Fibrocartilagenous - intervertebral disc joints
7
Q
TSP - ARTICULAR SURFACES
A
- Thoracic z-joints are orientated in coronal plane
8
Q
TSP - MAIN MUSCLE ACTIONS - FLEXION
A
- FLEXION - rectus abdominis, abdominal obliques
9
Q
TSP - MAIN MUSCLE ACTIONS - EXTENSION
A
- EXTENSION - multifidi, erector spinae
10
Q
TSP - MAIN MUSCLE ACTIONS - LATERAL FLEXION
A
- LATERAL FLEXION - erector spinal, semispinalis, abdominal obliques, quadratus lumborum
11
Q
TSP - MAIN MUSCLE ACTIONS - ROTATION
A
- ROTATION - rotatores, multifidi, semispinalis, erector spinal, internal/external oblique
12
Q
TSP - MAIN MUSCLE ACTIONS - RIB ELEVATION
A
- RIB ELEVATION - erector spinae, intercostals, serratus posterior superior and inferior, levator costarum
13
Q
TSP - RESTING POSITION
A
Mid way between flexion and extension
14
Q
TSP - CLOSED PACKED POSITION
A
Full extension
15
Q
TSP - NORMAL END FEEL
A
Tissue stretch
16
Q
TSP - COUPLED MOTIONS
A
C2 - T5 segments
- Left lateral flexion coupled with left rotation
- Right lateral flexion coupled with right rotation
T6 - L5 segments
- Left lateral flexion coupled with right rotation
- Right lateral flexion coupled with left rotation
17
Q
TSP - CONDITIONS - RIB FRACTURE
A
Hx - sharp, local pain following trauma or prolonged cough
S&S - Palpable crepitus, possible oedema and/or discolouration, pain with chest motion
DDx - supraspinatus rupture, impingement syndrome, rotator cuff tear
18
Q
TSP - CONDITIONS - RIB SUBLUXATION
A
Hx - sharp local pain on near spine with inspiration
S&S - palpatory tenderness & local myospasm
DDx - joint play & passive ROM
19
Q
TSP - ORTHO TESTS - ADAM’S TEST
A
- Pt standing
- Examiner observes for rib hump when patient attempts to touch toes
20
Q
TSP - ORTHO TESTS - ADAM’S TEST - POSITIVE TEST
A
Scoliosis
- Abnormal rib hump on one side
21
Q
TSP - ORTHO TESTS - ADAM’S TEST - SN & SP
A
SN: 92
SP: 60
22
Q
TSP - ORTHO TESTS - STERNAL COMPRESSION TEST
A
- Pt supine
- Examiner applies slow gentle downward force on the sternum and observes pt for signs of discomfort
23
Q
TSP - ORTHO TEST - STERNAL COMPRESSION TEST - POSITIVE TEST
A
Rib fracture
- Lateral rib border pain
Costochondritis
- Costosternal junction pain
24
Q
TSP - ORTHO TEST - KEMP’S TEST
A
- Pt seated
- Examiner stabilises lumbar spine with one hand and supports pt shoulders with the other hand and forearm
- Pt leans away from examiner (stretch)
- Pt then flexes forward (stretch)
- Pt then back into lateral flexion and extension (compression)
25
TSP - ORTHO TEST - KEMP'S TEST - POSITIVE TEST
**Nerve root compression, radiculopathy**
- Leg pain
**Local lesion (sprain/strain, facet syndrome, meniscal entrapment)**
- Local low back pain
26
TSP - ORTHO TEST - SLUMP TEST
- Pt seated
- Pt instructed to slump forward
- Examiner extends one knee and may apply gentle overpressure
- This increases spinal flexion
27
TSP - ORTHO TEST - SLUMP TEST - POSITIVE TEST
**Nerve root tension (shooting or electrical pain) radiculopathy, disc herniation, SOL, osteophyte**
- Reproduction of symptoms
- Leg pain
**Lumbosacral sprain**
- Local lumbosacral pain
28
TSP - ORTHO TEST - SLUMP TEST - SN & SP
**SN**: 83
**SP**: 55
29
TSP - ORTHO TEST - THORACIC DISTRACTION TEST
- Pt seated
- Arms crossed over pt front
- Examiner hugs and lifts pt to distract spine
- Pt informs examiner of any specific locations of pain or relief of pain
30
TSP - ORTHO TEST - THORACIC DISTRACTION TEST - POSITIVE TEST
**Muscle, ligament or joint capsule damage**
- Increased local pain
**Decreased pressure on nerve roots, IVF encroachment**
- Decreased peripheral pain/numbness
**SN:** 40-50
**SP:** 80-100
31
TSP - ORTHO TEST - ADSON'S TEST
- Pt seated
- Examiner palpates radial pulse bilaterally
- Pt is instructed to rotate head toward affected side
- Repeat looking away from affected side (Reverse Adson’s)
32
TSP - ORTHO TEST - ADSON'S TEST - POSITIVE TEST
**Neuromuscular compression (TOS) from a cervical rib, scalene muscle brachial compression**
- Decrease/loss of pulse
33
TSP - ORTHO TEST - ADSON'S TEST - SN & SP
**SN**: 50
**SP**: 74-100
34
TSP - ORTHO TEST - EDEN'S TEST
- Pt seated
- Examiner bilaterally palpates radial pulse and pulls pt’s arms into extension
- Examiner may ask pt to roll shoulders back and take a deep breath and hold
35
TSP - ORTHO TEST - EDEN'S TEST - POSITIVE TEST
**Costoclavicular TOS**
- Diminished pulse
**Neurologic TOS**
- Arm pain, numbness, tingling
**SP**: 89-100
36
TSP - ORTHO TEST - WRIGHT'S TEST
- Pt seated or supine
- Examiner palpates radial pulse, then abducts pt arm above head
- Repeat onn opposite side (variation of test can be done by horizontally abducting the arm at 90)
37
TSP - ORTHO TEST - WRIGHT'S TEST - POSITIVE TEST
**TOS secondary to compression under pectoralis minor muscle**
- Change in radial pulse or numbness, tingling, weakness
**SP**: 38-90
38
TSP - ORTHO TEST - ROO'S TEST
- Pt seated
- Shoulders abducted 90, elbows flexed 90
- Examiner instructs pt to open and close fists 2x a second for 3 mins
39
TSP - ORTHO TEST - ROO'S TEST - POSITIVE TEST
**TOS**
- Inability to maintain action with associated numbness, tingling or weakness
40
TSP - ORTHO TEST - ROO'S TEST - SN & SP
**SN**: 82
**SP**: 100
41
TSP - SCOLIOSIS
- Apparent lateral curvature of the spine
- **Postural** – conditions outside of the spine e.g. pelvic tilt or one leg shorter than the other
**Structural** – Vertebral rotation. SPs swing round towards the concavity of the curve and the transverse processes on the convexity rotate posteriorly.
Most cases have no obvious cause, some due to bony anomalies or connective tissue disorders
- Most commonly begins in young people aged 10-18 - condition of development
- Degenerative scoliosis - occurs later in life due to weakened structures
- Idiopathic scoliosis - 80% of all cases, cause unknown - not linked to bad posture, exercise or diet etc
- A possible obvious spinal deviation from midline, may be more apparent with P in flexion
- Rib hump in thoracic curves
- Asymmetrical prominence of one hip
- Excessive kyphosis or lordosis
42
TSP - SCOLIOSIS - RISK FACTORS
- the bones in the spine not forming properly in the womb – this is called congenital scoliosis and is present from birth
- an underlying nerve or muscle condition, such as cerebral palsy or muscular dystrophy – this is called neuromuscular scoliosis
- wear and tear of the spine with age – this is called degenerative scoliosis, which affects older adults
43
TSP - SPONDYLOLISTHESIS
- Vertebral displacement, forward slip of the vertebra
- When normal mechanism of laminae and facets constituting a locking mechanism to keep each vertebra from moving forwards from the one below fails
44
TSP - SPONDYLOLISTHESIS - CAUSES
- Usually always between L4 and 5 or between L5 and the sacrum, due to:
- Dysplasia of lumbar sacral facet joints – 20% of cases
- Separation or stress fracture through neural arch – 50%
- Osteoarthritic degeneration of facet joints causing them to loose normal stability – 25%
- Destructive conditions such as fracture, tb and neoplasia – 5%
45
TSP - SPONDYLOLISTHESIS - POPULATION AFFECTED
- Women 3x more likely
- Dysplastic spondylolisthesis seen in children
- Lytic spondylolisthesis – most common and seen in adults
- Degenerative spondylolisthesis – occurs in Ps over 40 with long standing backache due to facet joint arthritis
46
TSP - SPONDYLOLISTHESIS - CLINICAL PRESENTATION
- Intermittent back ache usual presenting symptom
- Pain may be worse during exercise
- A step can often be felt when running fingers down spine
47
TSP - THORACIC OUTLET SYNDROME
- A group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) are compressed. This can cause shoulder and neck pain and numbness in your fingers. A diagnosis of exclusion
- Can be arterial, venous or neurogenic.
48
TSP - INTERCOSTAL NEURALGIA
- Any painful condition of the intercostal nerves
- Presents as a band like pain wrapping across the chest in the dermatomal distribution.
49
TSP - TIETZE SYNDROME
- Inflammation of the cartilage of one or more of the upper ribs (costochondral junction), specifically where the ribs attach to the sternum.
50
TSP - PRECORDICAL CATCH SYNDROME
- Chest pain that occurs when nerves in the front of the chest are squeezed or aggravated.
51
TSP - HERPES ZOSTER
- Viral infection that occurs with reactivation of the varicella-zoster virus (Chicken-pox).
Shingles
- Most commonly have a rash in one or two adjacent dermatomes
- Not usually along P’s midline
- Painful, itchy, can be described as tingly
52
TSP - COSTOVERTEBRAL JOINT SYNDROME
- Joints between the vertebrae in the upper back and the ribs are called the costovertebral joints
- Trunk and rib cage are rotated. This can overstretch the structures supporting the joint resulting in a costovertebral joint sprain.
- Pain made worse by deep breathing, coughing, or rotation movements
- Aching often felt between shoulder blades, towards one side of the Tspine
53
TSP - ACUTE PANCREITIS
- Sudden inflammation of the pancreas gland that begins in the cells in the pancreas that produce digestive enzymes.
54
TSP - POST HERPATIC NEURALGIA
- Pain in a dermatomal distribution which persists for three months or more after either onset or healing of the shingles rash.
- Caused by herpes zoster-induced peripheral and central neuronal damage
55
TSP - AROM - FLEXION - MUSCLES ACTIVATED
**Eccentric** contraction of erector spinae
56
TSP - AROM - FLEXION - TISSUES STRETCHED
Erector spinae
Supraspinous & interspinous ligaments
Posterior IVD
Posterior facet joint capsule
Intercostal muscles
57
TSP - AROM - FLEXION - TISSUES COMPRESSED
Anterior thoracic structure
Anterior longitudinal ligament
Anterior IVD
Lungs
Heart
Aorta
Abdominal contents
58
TSP - AROM - EXTENSION - MUSCLES ACTIVATED
**Concentric** contraction of erector spinae
**Eccentric** contraction of rectus abdominis and abdominal obliques
59
TSP - AROM - EXTENSION - TISSUES STRETCHED
Rectus abdominis
Anterior longitudinal ligament
Aorta
Lungs
Anterior intercostal muscles
60
TSP - AROM - EXTENSION - TISSUES COMPRESSED
Erector spinae
Supraspinous & interspinous ligaments
Posterior IVD & IVF
Z-joint capsule
Posterior intercostal muscles
61
TSP - AROM - SIDE BENDING - MUSCLES ACTIVATED
**Eccentric** contraction of **contralateral** erector spinae
Transversospinalis
62
TSP - AROM - SIDE BENDING - TISSUES STRETCHED
**Contralateral** erector spinae
Transversospinalis
Intercostal muscles
Contralateral IVD & IVF
Z-joints
63
TSP - AROM - SIDE BENDING - TISSUES COMPRESSED
**Ipsilateral** erector spinae
Transversospinalis
Intercostal muscles
Contralateral IVD & IVF
64
TSP - AROM - ROTATION - MUSCLES ACTIVATED
**Contralateral** external oblique and transverso-spinalis
**Ipsilateral** internal oblique
65
TSP - AROM - ROTATION - TISSUES STRETCHED
**Ipsilateral** external oblique and transversosoinalis
**Contralateral** internal oblique
66
TSP - AROM - ROTATION - TISSUES COMPRESSED
Abdominal contents
Ipsilateral intervertebral foramen
67
TSP - POSTERIOR TRUNK SUPERFICIAL MUSCLES
Trapezius
Deltoid
Infraspinatus
Teres minor and major
Latissimus dorsi
Rhomboid minor
Rhomboid major
Serratus posterior superior
Serratus posterior inferior
Intercostal muscles
68
TSP - POSTERIOR TRUNK DEEP MUSCLES
Iliocostalis
Longissimus
Spinalis
Multifidi
Levator costarum
69
PECTORALIS MINOR - ORIGIN
Ribs 3-5
70
PECTORALIS MINOR - INSERTION
Coracoid process of scapula (medial aspect)
71
PECTORALIS MINOR - ACTION
Stabilises scapula for arm movements
Depresses and downwardly rotates scapula
72
PECTORALIS MINOR - INNERVATION
Medial pectoral nerve (C8, T1)
73
PECTORALIS MINOR - TRIGGER POINT REFERRAL
Pain is most prominent over the anterior deltoid but may extend over the subclavicular area
Pain may radiate down the ulnar side, elbow, forearm and hypothenar
74
PECTORALIS MINOR - STRETCH
Shoulders extended with scapulas fully retracted
Stick out chest
75
PECTORALIS MINOR - STRENGTHEN
Push up
Weighted fly
76
RECTUS ABDOMINIS - ORIGIN
Pubic crest
Pubic symphysis
77
RECTUS ABDOMINIS - INSERTION
Costal cartilage of ribs 5-7
Xiphoid process
78
RECTUS ABDOMINIS - ACTION
Flexion of trunk
Posterior pelvic tilt
79
RECTUS ABDOMINIS - INNERVATION
Intercostal nerves (T5-T12)
80
RECTUS ABDOMINIS - TRIGGER POINT REFERRAL
Bilaterally horizontally across the back
Pain may be described as heartburn, indigestion or nausea
81
RECTUS ABDOMINIS - STRETCH
Standing or kneeling and extend back
OR
Lying flat on stomach and extend spine
82
RECTUS ABDOMINIS - STRENGTHEN
Sit up (knee bent)
Crunch
83
EXTERNAL ABDOMINAL OBLIQUE - ORIGIN
Anterior 1/2 of iliac crest
Inguinal ligament
Pubic tubercle/crest
Rectus sheath
84
EXTERNAL ABDOMINAL OBLIQUE - INSERTION
Inferior border of ribs 6-12
85
EXTERNAL ABDOMINAL OBLIQUE - ACTION
Flexion, lateral flexion and contralateral rotation of trunk
Posterior pelvic tilt
86
EXTERNAL ABDOMINAL OBLIQUE - INNERVATION
Intercostal nerves (T7-T12)
87
EXTERNAL ABDOMINAL OBLIQUE - TRIGGER POINT REFERRAL
Upper chest or diagonally across abdomen
Local area or down to groin, possibly into testicles
88
EXTERNAL ABDOMINAL OBLIQUE - STRETCH
Lying supine, bend knees and rotate legs to contralateral side
89
EXTERNAL ABDOMINAL OBLIQUE - STRENGTHEN
Sit up or crunch with rotation
Bicycles
Side bending
90
INTERNAL ABDOMINAL OBLIQUE - ORIGIN
Iliac crest
Inguinal ligament
Thoracolumbar fascia
91
INTERNAL ABDOMINAL OBLIQUE - INSERTION
Ribs 10-12
Rectus sheath
92
INTERNAL ABDOMINAL OBLIQUE - ACTION
Flexion, lateral flexion and ipsilateral rotation of trunk
Posterior tilt of pelvis
93
INTERNAL ABDOMINAL OBLIQUE - INNERVATION
Intercostal nerves (T7-L1)
94
INTERNAL ABDOMINAL OBLIQUE - TRIGGER POINT REFERRAL
Lower chest or diagonally over abdomen
Refer over the local area or down the groin, possibly into the genital region
95
INTERNAL ABDOMINAL OBLIQUE - STRETCH
Standing, laterally flex and rotate trunk to opposite side
96
INTERNAL ABDOMINAL OBLIQUE - STRENGTHEN
Sit up or crunch with rotation
Bicycles
Side bending
97
MIDDLE TRAPEZIUS - ORIGIN
SPs of C7-T5
98
LOWER TRAPEZIUS - ORIGIN
SPs T5-T12
99
MIDDLE AND LOWER TRAPEZIUS - INSERTION
Lateral 1/3 of clavicle
Acromion
Spine of scapula
100
MIDDLE AND LOWER TRAPEZIUS - ACTION
Elevation and retraction (adduction) of scapula
**Unilateral** - lateral flexion of head
**Bilateral** - extension of head
101
MIDDLE AND LOWER TRAPEZIUS - INNERVATION
Spinal accessory (CN XI)
Ventral rami of C2-C4
102
MIDDLE AND LOWER TRAPEZIUS - TRIGGER POINTS REFERRAL
Just above the superior border of the scapula
Just inferior to the inferior angle of the scapula
103
MIDDLE AND LOWER TRAPEZIUS - STRETCH
Flex Tsp and abduct arm to 120, protract scapula and apply gentle traction on arm
104
MIDDLE AND LOWER TRAPEZIUS - STRENGTHEN
Posterior fly
105
LATISSIMUS DORSI - ORIGIN
SPs T7-L5
Thoracolumbar fascia
Iliac crest
Posterior sacrum
Ribs 9-12
106
LATISSIMUS DORSI - INSERTION
Bicipital groove of humerus
107
LATISSIMUS DORSI - ACTION
Adduction, medial rotation and extension of shoulder
108
LATISSIMUS DORSI - INNERVATION
Thoracodorsal nerve (C6-C8)
109
LATISSIMUS DORSI - TRIGGER POINT REFERRAL
Axillary region along the posterior axillary fold
Inferior angle of scapula and the lower to mid Tsp
110
LATISSIMUS DORSI - STRETCH
Abduct and externally rotate shoulders above head against wall or door, pull body inferiorly
111
LATISSIMUS DORSI - STRENGTHEN
Chin up
Pull over
Seated rows
Swimming breast stroke
112
RHOMBOID MINOR - ORIGIN
SPs C7 & T1
Supraspinous ligament
113
RHOMBOID MINOR - INSERTION
Medial border of scapula
114
RHOMBOID MAJOR - ORIGIN
SPs T2-T5
Supraspinous ligament
115
RHOMBOID MAJOR - INSERTION
Medial border of scapula
116
RHOMBOID MINOR AND MAJOR - ACTION
Retraction (adduction) of the scapula
Elevation and downward rotation of the scapula
117
RHOMBOID MINOR AND MAJOR - INNERVATION
Dorsal scapular nerve (C4-C5)
118
RHOMBOID MINOR AND MAJOR - TRIGGER POINT REFERRAL
Referral begins along the vertebral border of the spine between the scapula and the paraspinal muscles
Extends over the supraspinatous portion of the scapula
119
RHOMBOID MINOR AND MAJOR - STRETCH
Cross arms in front of body and 'walk' hands out laterally
120
RHOMBOID MINOR AND MAJOR - STRENGTHEN
Seated row
Bent over row
Resisted shoulder extension retraction (pull shoulder blades together and hold)
121
SERRATUS POSTERIOR SUPERIOR - ORIGIN
SPs of C7-T3
122
SERRATUS POSTERIOR SUPERIOR - INSERTION
Ribs 2-5 (superior external border)
123
SERRATUS POSTERIOR SUPERIOR - ACTION
Elevation of ribs
124
SERRATUS POSTERIOR SUPERIOR - INNERVATION
Intercostal and sub costal nerves
125
SERRATUS POSTERIOR INFERIOR - ORIGIN
SPs of T11-L3
126
SERRATUS POSTERIOR INFERIOR - INSERTION
Ribs 9-12 (inferior external border)
127
SERRATUS POSTERIOR INFERIOR - ACTION
Depression of ribs 9-12
128
SERRATUS POSTERIOR INFERIOR - INNERVATION
Intercostal and sub costal nerves
129
ERECTOR SPINAE GROUP - ORIGIN
Board tendon from the iliac crest
Posterior surface of the sacrum
Lumbar spines
130
ERECTOR SPINAE GROUP - INSERTION
Angle of ribs
Cervical transverse processes
Mastoid process
131
ERECTOR SPINAE GROUP - ACTION
**Bilateral** - Extension of vertebral column and head
**Unilateral** - Lateral flexion of the spine
132
ERECTOR SPINAE GROUP - INNERVATION
Spinal nerve dorsal rami
133
ERECTOR SPINAE GROUP - TRIGGER POINT REFERRAL
Pain gradually radiates directly outward from their location
Tsp may project laterally across the back of the chest
Lsp may refer pain to the buttock and SI region
134
ERECTOR SPINAE GROUP - STRETCH
'Cat stretch' on all fours arch back
Lying supine, flex back and bring knees back over head
135
ERECTOR SPINAE GROUP - STRENGTHEN
Plank
Back extensions
Dead lift
136
ERECTOR SPINAE - ILIOCOSTALIS THORACIS - ORIGIN
Angle of ribs 8-12
137
ERECTOR SPINAE - ILIOCOSTALIS THORACIS - INSERTION
Angle of ribs 1-7
138
ERECTOR SPINAE - ILIOCOSTALIS - ACTION
**Bilateral** - extension spine and head, eccentric stabilisation during trunk flexion
**Unilateral** - lateral flexion of spine
139
ERECTOR SPINAE - ILIOCOSTALIS - INNERVATION
Spinal nerve (dorsal rami)
140
ERECTOR SPINAE - LONGISSIMUS CERVICIS - ORIGIN
TPs of T1-5
141
ERECTOR SPINAE - LONGISSIMUS CERVICIS - INSERTION
TPs of C2-C6
142
ERECTOR SPINAE - LONGISSIMUS - ACTION
**Bilateral** - extension spine and head eccentric stabilisation during trunk flexion
**Unilateral** - lateral flexion of spine
143
ERECTOR SPINAE - LONGISSIMUS - INNERVATION
Spinal nerve (dorsal rami)
144
ERECTOR SPINAE - SPINALIS THORACIS - ORIGIN
SPs of T10-L2
145
ERECTOR SPINAE - SPINALIS THORACIS - INSERTION
SPs of T3-T9
146
ERECTOR SPINAE - SPINALIS - ACTION
**Bilateral** - extension of spine and head, eccentric stabilisation during trunk flexion
**Unilateral** - lateral flexion of spine
147
ERECTOR SPINAE - SPINALIS - INNERVATION
Spinal nerve (dorsal rami)
148
TRANSVERSOSPINALIS GROUP - SEMISPINALIS THORACIS - ORIGIN
TPs of T6-T12
149
TRANSVERSOSPINALIS GROUP - SEMISPINALIS THORACIS - INSERTION
SPs of C6-T4
150
TRANSVERSOSPINALIS GROUP - SEMISPINALIS - ACTION
**Bilateral** - extension of head and neck
**Unilateral** - controls lateral flexion to side opposite contraction; maintains head posture
151
TRANSVERSOSPINALIS GROUP - SEMISPINALIS - INNERVENTION
Spinal nerve (dorsal rami)
152
TRANSVERSOSPINALIS GROUP - MULTIFIDI THORACIS - ORIGIN
TP of T1-T12
153
TRANSVERSOSPINALIS GROUP - MULTIFIDI THORACIS - INSERTION
SPs of all vertebrae extending from L5-C2
154
TRANSVERSOSPINALIS GROUP - MULTIFIDI - ACTION
**Bilateral** - extension of vertebral column (trunk and neck)
**Unilateral** - rotate vertebral bodies to opposite side; control lateral flexion to side opposite contraction
155
TRANSVERSOSPINALIS GROUP - MULTIFIDI - INNERVATION
Spinal nerve (dorsal rami)
156
TRANSVERSOSPINALIS GROUP - ROTATORES - ORIGIN
TPs of C4-L5
157
TRANSVERSOSPINALIS GROUP - ROTATORES - INSERTION
SPs (base and lamina 1-2 segments above origin
158
TRANSVERSOSPINALIS GROUP - ROTATORES - ACTION
**Unilateral** - rotation to opposite side
**Bilateral** - extension; stabilise vertebrae and are involved with proprioception
159
TRANSVERSOSPINALIS GROUP - ROTATORES - INNERVATION
Spinal nerve (dorsal rami)
160
INTERSPINALIS - ORIGIN
SP of vertebra below
161
INTERSPINALIS - INTERVENTION
SP of vertebra above
162
INTERSPINALIS - ACTION
Extension of neck and trunk
163
INTERSPINALIS - INNERVATION
Dorsal rami of spinal nerves
164
INTERTRANSVERSARIUS - ORIGIN
TP of vertebra below
165
INTERTRANSVERSARIUS - INSERTION
TP of vertebra above
166
INTERTRANSVERSARIUS - ACTION
Lateral flexion of neck and trunk
167
INTERTRANSVERSARIUS - INNERVATION
Dorsal rami of spinal nerves
168
LEVATOR COSTARUM - ORIGIN
TPs C7-T11 (posterior lateral tip)
169
LEVATOR COSTARUM - INSERTION
Ribs 1-12 (below the TP)
170
LEVATOR COSTARUM - ACTION
Elevation of ribs (inspiration)
171
LEVATOR COSTARUM - INNERVATION
Dorsal rami of spinal nerves
172
INTERCOSTAL MUSCLES
External intercostal
Internal intercostal
Innermost intercostal
Subcostalis
Transversus thoracis (sternocostalis)
173
DIAPHRAGM - ORIGIN
**Vertebral** - crura from bodies of L1-L2 on the left and L1-L3 on the right
**Costal part** - medial and lateral arcuate ligaments, innermost aspect of lower 6 ribs
**Sternal** - 2 slips from posterior aspect of xiphoid
174
DIAPHRAGM - INSERTION
Central tendon of diaphragm
175
DIAPHRAGM - ACTION
Inspiration
Assists in raising intra-abdominal pressure
176
DIAPHRAGM - INNERVATION
Phrenic nerve (C3, **C4**, C5)
177
DIAPHRAGM - TRIGGER POINT REFERRAL
Near the central dome of the diaphragm can refer to the upper border of the ipsilateral shoulder
