Week 4 - spine non-contractile

Question 1

Extrinsic Superficial layer of back & function

Answer 1

Trapezius
Latissimus dorsi
Levator scapulae
Rhomboids

Movements
of the upper limbs

Question 2

Extrinsic Intermediate layer of back & innervation function

Answer 2

Serratus posterior superior
Serratus posterior inferior
Intercostal nerves

Associated with respiration

Question 3

Intrinsic back muscles superficial & intermediate

Answer 3

Splenius capitus + cervicis

Erector Spinae

Question 4

Overall function of intrinsic superficial and
intermediate muscles

Answer 4

• Span many vertebral layers
• Don’t even touch some vertebrae
• Responsible for angular movements
• Produce power
• Resist gravity
• Prime movers
• Can apply a compressive force to IVJs
  and facets

Question 5

Splenius Capitis & Cervicis Att., Action & NS

Answer 5

Distal (Superior)
Capitis: mastoid process, occiput
Cervicis: transverse processes C1-C3/4

Proximal (Inferior)
Capitis: lower ½ nuchal ligament, spinous
processes C7-T3/4, supraspinous ligament
Cervicis: spinous processes T3/4-T6

Action:
Unilateral: lateral flexion, ipsilateral rotation
Bilateral: neck extension

NS: posterior rami of spinal nerves

Question 6

Erector spinae muscles (medial to lateral)

Answer 6

Spinalis, longissimus, iliocostalis

Question 7

Erector Spinae (most medial) Spinalis Att., Action, NS & regions

Answer 7

Regions; capitis, cervicis, thoracis, spans several vertebral segments

Attachments:
Distal (Superior) upper thoracic spinous processes & cranium
Proximal (Inferior): supraspinous ligament, lumbar & thoracic
spinous processes

Action:
Unilateral: lateral flexion, Bilateral: back + neck extension

NS: posterior rami of spinal nerves

Question 8

Erector Spinae (middle) Longissimus Att., Action, NS & regions

Answer 8

Regions; capitis, cervicis, thoracis, spans many vertebral segments

Attachments:
Distal (Superior) ribs, mastoid process
Proximal (Inferior): broad tendon, supraspinous ligament,
sacroiliac ligaments, median sacral crest, posterior iliac crest,
lumbar & thoracic spinous processes

Action:
Unilateral: lateral flexion, Bilateral: back + neck extension

NS: posterior rami of spinal nerves

Question 9

Erector Spinae (most lateral) Iliocostalis Att., Action, NS & regions

Answer 9

Regions; cervicis, thoracis, lumborum spans many vertebral segments

Attachments:
Distal (Superior) angles of ribs, cervical thoracic processes
Proximal (Inferior): broad tendon, supraspinous ligament,
sacroiliac ligaments, median sacral crest, posterior iliac crest,
lumbar & thoracic spinous processes

Action:
Unilateral: lateral flexion, rotation
Bilateral: back + neck extension

NS: posterior rami of spinal nerves

Question 10

You get Paul from supine to sitting over the edge of the bed. He says he feels very weak and you find that you have to keep gently pushing his shoulders posteriorly.
What muscles seem to be weak in relation to what you have to do?

A. Transverse abdominus
B. Iliocostalis
C. Splenius capitus
D. Diaphragm
E. Internal intercostals

Answer 10

B. Iliocostalis is posterior and lateral on the rib cage. Which would be involved in pulling the the ribs posteriorly, therefore shoulders posterior.

Question 11

Transversospinalis muscles (deep to superficial)

Answer 11

Rotatores, multifidus, semispinalis

Question 12

Semispinalis Att., Action, NS & regions

Answer 12

Regions; capitis, cervicis (well developed), thoracis, spans 4-6 segments

Attachments:
Distal (superior): Occiput, nuchal ligament
Proximal (inferior): transverse processes of C4-T12

Action:
Unilateral: rotation of cervical region
Bilateral: extension of vertebral column

NS: posterior rami of spinal nerves

Question 13

Multifidus Att., Action, NS & regions

Answer 13

Regions; cervical, thoracic, lumbar (well developed), spans 2-4 segments

Attachments:
Distal (superior): whole length of the spinous processes of the vertebrae
Proximal (inferior)
Lumbar: posterior sacrum, PSIS, erector spinae aponeurosis, sacroiliac ligaments
Thoracic: all thoracic transverse processes
Cervical: articular processes

Action: stabilise vertebrae during local movements of vertebral column and trunk

NS: posterior rami of spinal nerves

Question 14

Rotatores Att., Action, NS & regions

Answer 14

Regions; thoracic (well developed), spans 1-2
segments

Attachments:
Distal (superior): lamina of vertebrae
Proximal (inferior): transverse process of vertebrae below

Action: stabilise vertebrae during local movements of vertebral column and trunk. Proprioceptive.

NS: posterior rami of spinal nerves

Question 15

Intrinsic - Minor deep muscles of the back names, Action, NS

Answer 15

Interspinalis & intertransversarii

Action: stabilise vertebrae (postural)

NS: posterior rami of spinal nerves

Question 16

Superficial, intermediate, deep layers of back muscle functions (and name them)

Answer 16

The superficial layer of
intrinsic back muscles
acts on the head and
neck (splenius captitis, splenius cervicus)

The intermediate layer
is responsible for global
movements of the
vertebral column (erector spinae - spinalis, longissimus, iliocostalis)

The deep layer is
responsible for local
movements and
postural support (semispinalis, multifidus, rotatores, intertransversarii, interspinalis)

Question 17

Paul has disuse atrophy from not moving whilst intubated. After getting Paul up from supine to sitting over the edge of the bed, you decide to give Paul exercises to strengthen his intrinsic deep back muscles. Which exercises do you think would be most appropriate?

A= Provide Paul with simple touch toes and stand up
exercises
B= Take Paul to the gym and get him to do weighted
extension exercises
C= Prescribe Paul with sit ups
D= Get Paul to gradually increase his walking distance
E= Teach Paul diaphragmatic breathing exercises

Answer 17

D. Intrinsic deep muscles are involved in postural support for the vertebrae. Walking is a good way to focus on engaging these muscles.

Question 18

Quadratus Lumborum Att., Action & function, NS

Answer 18

Attachments:
Distal (superior): lower border of 12th rib &
lumbar transverse processes L1 to L4
Proximal (inferior): transverse process of L5
& posterior iliac crest

Action & Function: lateral flexion of spine &
fixator of 12th rib during respiration (lateral pelvic tilt also)

NS: anterior rami of spinal nerves T12-L3/L4

Question 19

Neck muscles superficial

Answer 19

Platysma (don’t need to know)
Sternocleido-mastoid

Question 20

STERNOCLEIDOMASTOID Att., Action & function, NS

Answer 20

Attachments
Superior: mastoid process and
occiput
Inferior: anterior-superior
sternum (manubrium) and medial
1/3 of clavicle

NS: accessory nerve

Action & Function:
Unilateral: neck lateral flexion and contralateral rotation
Bilateral:
Neck extension in upright
position; neck flexion in supine;
accessory muscle of inspiration

Question 21

Torticollis

Answer 21

A contraction or shortening of the sternocleidomastoid

Many different types of torticollis, but can develop in utero due to the baby’s sustained head position

Question 22

Prevertebral anterior muscles (4) & action

Answer 22

Rectus capitis
anterior
Rectus capitus
lateralis
Longus capitis (to head)
Longus colli (collar)

Action & function - flection of head and neck “yes”

Question 23

Prevertebral lateral muscles

Answer 23

Scalene posterior
Scalene middle
Scalene anterior

Question 24

ANTERIOR SCALENE att., action & function, NS

Answer 24

Anterior to the brachial plexus, posterior to SCM and clavicle

Attachments
Superior: transverse processes of C3-C6
Inferior: 1st rib

Action & Function: flex head; accessory
muscle of inspiration

Innervation: anterior rami of cervical spinal nerves

Question 25

Middle scalene Att., Action & function, NS

Answer 25

Largest and strongest scalene

Attachments
Superior: transverse processes of C2-C7
Inferior: 1st rib

Action & Function: side flexion; accessory
muscle of inspiration

Innervation: anterior rami of cervical spinal nerves

Question 26

Posterior scalene Att., Action & function, NS

Answer 26

Smallest and deepest scalene

Attachments
Superior: transverse processes of C5-C7
Inferior: second rib

Action & Function: side flexion; accessory
muscle of inspiration

Innervation: anterior rami of cervical spinal
nerves

Question 27

Suboccipital deep muscles (posterior)

Answer 27

Rectus capitis posterior major
Rectus capitis posterior minor
Obliquus capitis superior
Obliquus capitis inferior

Question 28

Rectus capitis posterior minor

Answer 28

Attachments*:
Superior: Medial occiput
Inferior: atlas (C1) tubercle on the posterior arch

Action: extension of head on atlas

NS: posterior rami of spinal nerve C1

Question 29

Rectus capitis posterior major

Answer 29

Attachments:
Distal: Lateral occiput
Proximal: axis (C2) spinous process

Action:
Bilateral: extension of head
Unilateral: ipsilateral rotation of head

NS: posterior rami of spinal nerve C1

Question 30

Obliquus capitis superior

Answer 30

Attachments:
Superior: Occiput
Inferior: transverse process of atlas (C1)

Action: extends head

NS: posterior rami of spinal nerve C1

Question 31

Obliquus capitis inferior

Answer 31

Attachments:
Superior : transverse process of atlas (C1)
Inferior: axis (C2) spinous process

Action: “no”
Unilateral: turns head ipsilaterally
Bilateral: extends atlas on axis

NS: posterior rami of spinal nerve C1

Question 32

How do the the neck and intrinsic back muscles help with head and eye control?

Answer 32

They work in synergy to produce movements on the atlanto-occipital (C0-1) joints to position the head for functional movements & vision/eyesight.

Continual fine adjustments to
contraction level and length to
achieve a balanced head posture

Question 33

Paul indicates that he has right sided middle back pain. You want to brainstorm all the possible structures it could be. What could the contractile tissue be that is causing pain?

Answer 33

Erector spinae, QL, deep intrinsic muscles, deep minor muscles, Latissimus dorsi, transverse abdominis

Question 34

Paul indicates that he has right sided middle back pain. You want to brainstorm all the possible structures it could be. What could the non-contractile tissue be that is causing pain?

Answer 34

costotransverse joint, costovertebral joint, vertebral facet joint, erector spinae aponeurosis, thoracolumbar fascia, lower ribs, kidneys, vertebral ligaments (mainly transverse)