Anatomy of Back Muscles
50 Questions
0 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

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

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Related Documents

    Functional Anatomy of Spine (6).pptx
    Thoracic Trauma-.pptx

    Description

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

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser