Anatomy of Back Muscles
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Questions and Answers

Which muscle is divided into three parts - lumborum, thoracis, and cervicis?

  • Multifidus
  • Spinalis
  • Longissimus
  • Iliocostalis (correct)

    • What is the collective name for the three intermediate intrinsic back muscles?

  • Erector spinae (correct)
  • Deep back muscles
  • Posterior muscles
  • Intrinsic muscles

    • Which muscle attaches to the mastoid process and the occipital bone of the skull?

  • Iliocostalis
  • Splenius capitis (correct)
  • Splenius cervicis
  • Longissimus

    • What is the function of the deep muscles of the back?

    <p>Control of posture</p> Signup and view all the answers

    How many layers can the deep back muscles be divided into?

    <p>Three</p> Signup and view all the answers

    Which muscle originates from the spinous processes of C7-T3/4 vertebrae?

    <p>Splenius capitis</p> Signup and view all the answers

    What is the function of the splenius capitis muscle?

    <p>Rotate head to the same side</p> Signup and view all the answers

    What is the role of the deep fascia in relation to the deep muscles of the back?

    <p>It plays a key role in their organisation</p> Signup and view all the answers

    What is the function of the spinalis muscle when it contracts bilaterally?

    <p>Extend the vertebral column and head</p> Signup and view all the answers

    Which of the following muscles is the largest of the three columns?

    <p>Longissimus muscle</p> Signup and view all the answers

    What is the collective name of the deep intrinsic muscles?

    <p>Transversospinales</p> Signup and view all the answers

    Which of the following muscles is located medially within the erector spinae?

    <p>Spinalis muscle</p> Signup and view all the answers

    What is the function of the spinalis muscle when it contracts unilaterally?

    <p>Laterally flex the vertebral column</p> Signup and view all the answers

    Which of the following muscles is the most superficial of the deep intrinsic muscles?

    <p>Semispinalis muscle</p> Signup and view all the answers

    What is the common innervation of the longissimus, spinalis, and iliocostalis muscles?

    <p>Posterior rami of the spinal nerves</p> Signup and view all the answers

    Which of the following muscles is NOT part of the deep intrinsic muscles?

    <p>Longissimus muscle</p> Signup and view all the answers

    Which muscle originates from the transverse processes of C4-T10?

    <p>Spinalis</p> Signup and view all the answers

    What is the primary action of the multifidus muscle?

    <p>Stabilizes the vertebral column</p> Signup and view all the answers

    Which muscle attaches to the spinous processes of the vertebrae?

    <p>Multifidus</p> Signup and view all the answers

    What is the primary action of the rotatores muscle?

    <p>Stabilizes the vertebral column</p> Signup and view all the answers

    Which muscle is located underneath the semispinalis muscle?

    <p>Multifidus</p> Signup and view all the answers

    What is the primary action of the interspinales muscle?

    <p>Stabilizes the vertebral column</p> Signup and view all the answers

    Which muscle originates from the transverse processes of C7-T11?

    <p>Levatores costarum</p> Signup and view all the answers

    What is the common innervation of the multifidus, rotatores, and spinalis muscles?

    <p>Posterior rami of the spinal nerves</p> Signup and view all the answers

    What is the mortality rate of patients with aortic injuries within 1 week?

    <p>70%</p> Signup and view all the answers

    What is the most common site of blunt aortic injuries?

    <p>Isthmus</p> Signup and view all the answers

    What is the primary mechanism of blunt aortic injuries?

    <p>All of the above</p> Signup and view all the answers

    What is the radiographic feature associated with thoracic aortic injury?

    <p>Loss of aortic knuckle contour</p> Signup and view all the answers

    What percentage of thoracic deaths are attributed to thoracic injury worldwide?

    <p>20-25%</p> Signup and view all the answers

    What is the management approach for penetrating cardiac injuries?

    <p>Urgent surgery</p> Signup and view all the answers

    What is a unique characteristic of the pediatric thorax that affects the mechanism of injury?

    <p>More cartilage and less bones</p> Signup and view all the answers

    What is the treatment for myocardial rupture?

    <p>Simple cardiorrhaphy</p> Signup and view all the answers

    Which type of injury is associated with shearing, tearing, and traction forces?

    <p>Acceleration-deceleration injury</p> Signup and view all the answers

    What is the treatment for traumatic VSD?

    <p>Closure for the bigger ones</p> Signup and view all the answers

    What is the primary goal of initial evaluation in thoracic trauma patients?

    <p>Prompt identification of life-threatening injuries</p> Signup and view all the answers

    What is the management approach for myocardial contusion?

    <p>Admit to HCU/ICU for monitoring</p> Signup and view all the answers

    What is the primary survey in the ATLS protocol?

    <p>Airway-breathing-circulation</p> Signup and view all the answers

    What is the characteristic of a flail chest?

    <p>Two rib fractures in two segments</p> Signup and view all the answers

    What is the management approach for a simple pneumothorax?

    <p>Supportive care</p> Signup and view all the answers

    What is the characteristic of a sternal fracture?

    <p>Transverse fracture in the midportion</p> Signup and view all the answers

    What is the surgical approach for proximal tracheal injuries?

    <p>Cervical collar incision</p> Signup and view all the answers

    What is the primary presenting symptom of a foreign body in the esophagus?

    <p>Dysphagia</p> Signup and view all the answers

    What is the management of an acute foreign body in the airway?

    <p>Urgent bronchoscopy with bronchotomy</p> Signup and view all the answers

    What is a common complication of esophageal injuries?

    <p>Mediastinal contamination</p> Signup and view all the answers

    What is the investigation of choice for diagnosing esophageal injuries?

    <p>Combination of clinical suspicion, CXR, water soluble contrast swallow, and oesophogram</p> Signup and view all the answers

    What is the surgical approach for lower esophageal injuries?

    <p>LPLT 6th ICS</p> Signup and view all the answers

    What is the indication for surgical repair in tracheobronchial tree injuries?

    <p>All of the above</p> Signup and view all the answers

    What is the common presentation of diaphragmatic injuries?

    <p>With or without signs of bowel obstruction</p> Signup and view all the answers

    What is the management of chronic foreign body in the esophagus?

    <p>Oesophagoscopy with mediastinal drainage</p> Signup and view all the answers

    What is the common site of diaphragmatic injuries?

    <p>Left diaphragm</p> Signup and view all the answers

    Study Notes

    Back Muscles

    • The back muscles can be categorized into three layers: superficial, intermediate, and deep.

    Superficial Muscles

    • The superficial muscles are also known as the spinotransversales.
    • There are two muscles in this group: splenius capitis and splenius cervicis.
    • They are associated with movements of the head and neck.
    • Located on the posterolateral aspect of the neck, covering the deeper neck muscles.

    Splenius Capitis

    • Originates from the lower aspect of the ligamentum nuchae and the spinous processes of C7-T3/4 vertebrae.
    • Fibers ascend, attaching to the mastoid process and the occipital bone of the skull.
    • Innervated by posterior rami of spinal nerves C3 and C4.
    • Actions: Rotate head to the same side.

    Splenius Cervicis

    • Originates from the spinous processes of T3-T6 vertebrae.
    • Fibers ascend, attaching to the transverse processes of C1-3/4.

    Intermediate Muscles

    • There are three intermediate intrinsic back muscles: iliocostalis, longissimus, and spinalis.
    • Together, these muscles form a column known as the erector spinae.
    • The erector spinae is situated posterolaterally to the spinal column, between the vertebral spinous processes and the costal angle of the ribs.

    Iliocostalis

    • Located laterally within the erector spinae.
    • Associated with the ribs.
    • Can be divided into three parts: lumborum, thoracis, and cervicis.

    Longissimus

    • Situated between the iliocostalis and spinalis.
    • Largest of the three columns.
    • Can be divided into three parts: thoracic, cervicis, and capitis.
    • Attachments: Arises from the common tendinous origin and attaches to the lower ribs, the transverse processes of C2-T12, and the mastoid process of the skull.
    • Innervation: Posterior rami of the spinal nerves.
    • Actions: Acts unilaterally to laterally flex the vertebral column, and acts bilaterally to extend the vertebral column and head.

    Spinalis

    • Located medially within the erector spinae.
    • Smallest of the three muscle columns.
    • Can be divided into the thoracic, cervicis, and capitis.
    • Attachments: Arises from the common tendinous origin, and attaches to the spinous processes of C2, T1-T8, and the occipital bone of the skull.
    • Innervation: Posterior rami of the spinal nerves.
    • Actions: Acts unilaterally to laterally flex the vertebral column, and acts bilaterally to extend the vertebral column and head.

    Deep Intrinsic Muscles

    • Located underneath the erector spinae.
    • Known collectively as the transversospinales.
    • Three major muscles in this group: semispinalis, multifidus, and rotatores.

    Semispinalis

    • Most superficial of the deep intrinsic muscles.
    • Can be divided by its superior attachments into thoracic, cervicis, and capitis.
    • Attachments: Originates from the transverse processes of C4-T10.
    • Fibers ascend 4-6 vertebral segments, attaching to the spinous processes of C2-T4 and the occipital bone of the skull.
    • Innervation: Posterior rami of the spinal nerves.
    • Actions: Extends and contralaterally rotates the head and vertebral column.

    Multifidus

    • Located underneath the semispinalis muscle.
    • Best developed in the lumbar area.
    • Attachments: Has a broad origin – arises from the sacrum, posterior iliac spine, common tendinous origin of the erector spinae, mamillary processes of lumbar vertebrae, transverse processes of T1-T3, and articular processes of C4-C7.
    • Fibers ascend 2-4 vertebral segments, attaching to the spinous processes of the vertebrae.
    • Innervation: Posterior rami of the spinal nerves.
    • Actions: Stabilizes the vertebral column.

    Rotatores

    • Most prominent in the thoracic region.
    • Attachments: Originates from the vertebral transverse processes.
    • Fibers ascend, and attach to the lamina and spinous processes of the immediately superior vertebrae.
    • Innervation: Posterior rami of the spinal nerves.
    • Actions: Stabilizes the vertebral column and has a proprioceptive function.

    Minor Deep Intrinsic Muscles

    • Interspinales: Spans between adjacent spinous processes, and acts to stabilize the vertebral column.
    • Intertranversari: Spans between adjacent transverse processes, and acts to stabilize the vertebral column.
    • Levatores costarum: Originates from the transverse processes of C7-T11, and attaches to the rib immediately below, and acts to elevate the ribs.

    Tracheobronchial Tree Injuries

    • Can be conservative or surgical, depending on the severity of the injury
    • Surgical approach is based on the location and extension of the injury
      • Cervical collar incision for proximal trachea
      • Right postero-lateral thoracotomy for lower trachea, carina, and proximal right main bronchus
      • Left postero-lateral thoracotomy for distal left main bronchus

    Foreign Body in the Airway

    • Management depends on the severity of the injury
      • Acute: Urgent bronchoscopy with or without bronchotomy
      • Chronic: Bronchoscopy with precaution, with or without lung resection

    Esophagus Injuries

    • Rare, but can occur due to blunt or penetrating trauma
    • Cervical esophageal injuries are the most common
    • Symptoms include:
      • Pneumothorax (left)
      • Hemorrhage without rib fractures
      • Lower sternum or epigastric pain (severe blunt trauma)
      • Particulate matter in the ICD
      • Penetrating injury that has crossed the mediastinum
      • Odynophagia
      • Dysphagia
      • Surgical emphysema
      • Mediastinitis
    • Investigations:
      • Combination of clinical suspicion, CXR, water-soluble contrast swallow, and oesophagoscopy
    • Management:
      • Timing: 24 hours, debride and drainage, surgical repair or resection with delayed reconstruction
      • Approach: Right postero-lateral thoracotomy (RPLT) for upper esophagus, left postero-lateral thoracotomy (LPLT) for lower esophagus

    Complications of Esophagus Injuries

    • Mediastinal contamination
    • Abscess formation
    • Empyema thoracis

    Foreign Body in the Esophagus

    • Types: bone, meat, battery, coin
    • Clinical presentation:
      • Acute: dysphagia, choking, hematemesis
      • Chronic: hemoptysis, coughing when feeding
    • Management:
      • Oesophagoscopy with or without mediastinal drainage and repair

    Diaphragmatic Injuries

    • Often occult, easily missed, especially on the left side
    • Marker of severe thoracoabdominal trauma
    • Causes:
      • Blunt trauma
      • Penetrating trauma (stab or iatrogenic)
    • Clinical features:
      • With or without signs of bowel obstruction, drainage of peritoneal content via chest drain
      • NGT in the chest (CXR)
      • Herniation of GIT
      • Acute, delayed, common left
    • Investigations:
      • CXR: elevated hemidiaphragm, hemo-pneumothorax
      • Swallow and follow through
      • Contrast-enhanced CT scan
    • Management:
      • Surgical repair: thoracotomy, thoraco-abdominal incision, or laparotomy, laparoscopy

    Cardiac Injuries

    • Penetrating:
      • Myocardial contusion, transient arrhythmias
      • Valve injuries
      • IVS rupture
    • Blunt:
      • Myocardial contusion, patchy areas of muscle necrosis, hemorrhagic infiltrate, rupture of small vessels
      • Hemorrhage into the interstitium and around the muscle fibers
    • Investigations:
      • Admit to HCU/ICU for monitoring
      • ECG, cardiac enzymes
      • Treat dysarrhythmias and heart failure
      • Formal ECHO/TEE
    • Management:
      • Elective or urgent surgery
      • Myocardial rupture: simple cardiorrhaphy, pledgetted suture
      • Mitral valve: repair or replacement
      • Tricuspid valve: repair
      • IVS: traumatic VSD, closure for larger ones, bypass or not

    Surgery

    • Elective or urgent
    • Myocardial rupture: simple cardiorrhaphy, pledgetted suture
    • Mitral valve: repair or replacement
    • Tricuspid valve: repair
    • IVS: traumatic VSD, closure for larger ones, bypass or not

    Great Vessel Injuries

    • Aorta is the most commonly injured in severe blunt or penetrating trauma
    • 85-95% mortality
    • Typically, patients survive the initial injury insult
    • Mortality rates:
      • 30% within 6 hours
      • 50% within 24 hours
      • 70% within 1 week

    Blunt Aortic Injuries

    • Mechanisms:
      • Acceleration-deceleration
      • Production of shearing forces
      • Direct luminal compression - fixation points
    • Site: isthmus, near ligamentum arteriosum
    • Clinical features:
      • Death on the scene - rapid exsanguination
      • Expanding thoracic inlet hematoma, bruit, hypotension, pulse deficit

    Aortic Disruption

    • Radiographic features associated with thoracic aortic injury:
      • Loss of aortic knuckle contour
      • Widened mediastinum
      • Obliteration of aorto-pulmonary window
      • 1st/2nd rib fracture
      • Depression of the right main bronchus
      • Deviated NGT and tracheal displacement to the right
      • Widened paratracheal stripe
      • Left massive hemithorax
      • Left pleural cap

    Management

    • Medical: endovascular stents
    • Surgical: open surgical procedures

    Thoracic Trauma

    • Accounts for 20-25% of thoracic deaths worldwide
    • Male vs female
    • Age
    • Blunt, penetrating, transfixing

    Mechanism of Injury

      1. Penetrating:
      • High velocity - gunshots
      • Low velocity - stab wounds
      1. Blunt:
      • Direct:
        • Assault and blast
      • Indirect:
        • Falls, MVA (acceleration-deceleration injuries, crush injuries, and shearing forces)
      1. Transfixing

    Special Factors

    • Pediatric thorax: more cartilage, absorbs forces
    • Geriatric thorax: calcification and osteoporosis, more fractures

    Initial Evaluation

    • Goal: prompt identification of life-threatening injuries
    • Pathology:
      • Airway obstruction
      • Loss of oxygenation or ventilation
      • Hypovolaemia
      • Obstructive shock
      • Ventilation-perfusion mismatch
    • Physiological causes of death:
      • Tissue hypoxia
      • Hypercarbia
      • Metabolic acidosis

    Traumatic Rib Fractures

    • Other bony fractures of the chest wall
      • Sternal fractures:
        • Up to 4%
        • Transverse, in the upper or midportions
        • Associated injuries: myocardium
        • Cf: point of tenderness, swelling, and deformity

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    Description

    This quiz covers the origin, innervation, and actions of the muscles of the back, including the longissimus muscle.

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