4

Spine & Thorax

Topographical Views
Congratulations, you’re a vertebrate!
Congratulations, you’re biped!
Exploring the Skin and Fascia
 Bones of the Spine and Thorax

• Most mobile & accessible

• Articulate with the 12 pairs of ribs

• Help protect the internal organs

• Located between the 12th rib & posterior iliac

crest
• Designed to support the body weight of the
upper body
Bony Landmarks
Atlas (C-1)

• Atlanto-occipital joint (AOJ) – located between the

atlas & the occiput
 The AOJ allows the head to move
independently from the neck
 Flexion/Extension, Lateral flexion, Rotation

• Only vertebrae that doesn’t have a spinous process

 An
abnormal
lateral
curvature
of the
spine is
called
scoliosis
Axis (C-2)
The Atlantoaxial Joint (C1-C2):
•Allows the Atlas to move on it’s Axis (Hence
the name!)
•Flexion/Extension, Rotation
 Cervical
• Less weight bearing function
 Doesn’t need to be as stable
 Allows for more movement
• Cervical region bends anteriorly
 Forms a lordotic curve

 Extension>Flexion
 Lateral Flexion, Rotation

 Because of
lordotic curve of C-
Spine and the
FRANKENSTEIN’S
BOLTS! ligamentum
nuchae (a
ligament attaching
the spinous
processes), the
cervical spinous
processes are
actually deeper
than the thoracic &
lumbar vertebrae
Thoracic

• Makes up the Thorax of the body

• Thoracic region bends posteriorly
 Creates a kyphotic curve
Lumbar
• Defines the abdomen of the body
• Lumbar region bends anteriorly
 Forms a lordotic curve

 Why are the bodies of the lumbar vertebrae

so much bigger than the other vertebrae?

Larger than T- & C-Spine

Lumbar
• Lumbar region bends anteriorly
 Forms a lordotic curve

 Why are the bodies of the lumbar vertebrae

so much bigger than the other vertebrae?
 When you are standing, the entire weight of your trunk,
head & arms is transferred through the bodies of the
vertebrae
Lumbar
• What lies in between the vertebrae?

• What is it’s role?

Lumbar
• What lies in between the vertebrae?
 Intervertebral discs
• What is it’s role?
 Cushion the shock
Bony Landmarks
Bony Landmarks

• Ribs 1-7 = “True Ribs”

 Attach directly to the sternum
• Ribs 8-12 = “False Ribs”
 Attach indirectly to sternum by means of the
costal cartilage
 11 & 12 = “Floating Ribs”
 Do not attach to sternum or costal
cartilage at all
Bony Landmark Trails
Bony Landmark Trails

Did you know…

• When you are asleep, the
pressure is off the spine
and the discs are able to
fully restore themselves.
• You actually wake up ½”
taller than you were the
night before!
Bony Landmark Trails
Trail 1 “Midline Ridge”
Spinous Processes of the Vertebrae

• Posterior projection of the vertebrae

• Visible row of bumps that run down the center of the
back
• Attachment sites for muscles, ligaments & fascia
Trail 2 “Crossing Paths”
L-4 and Top of the Iliac Crest

 Draw a line medially from the top of the two

iliac crests and you will find the spinous
process of L-4

T-12 and the Twelfth Rib

 The 12th rib has a slender, spear-like shape &

angles inferiorly.
 3”-6” long
 Follow it medially and you will locate the
spinous process of T-12
Trail 2 “Crossing Paths”

T-7 and Inferior Angle

T-2 and Superior Angle

C-7 and Base of the Neck

 When the neck is flexed, the spinous

process of C-7 shifts superiorly but T-1
doesn’t move
Trail 3 “Nape Lane”
Spinous Processes of the Cervicals
• The spinous process of C-2 is more distinct than
the other cervical spinous processes.

When palpating the cervical vertebrae,

compression or impingement of the brachial
plexus or one of it’s nerves can create a sharp
shooting sensation.
 If this should happen, immediately release & adjust
your position posteriorly.
 ALWAYS ASK FOR FEEDBACK
Trail 3 “Nape Lane”
Transverse Processes of the Cervicals

• Located on the side of the neck

• Attachment sites for various muscles
(scalenes & levator scapulae)
• Brachial plexus exits between the
TVPs
Trail 3 “Nape Lane”
Transverse Process of C-1

• Located just distal & anterior to the

tip of the mastoid process

Cervical Lamina Groove

• Space between the spinous &

transverse processes of the vertebrae
• Pretty inaccessible thanks to our
musculature
Trail 4 “Buried Boulevard”
Transverse Processes of the Thoracic and Lumbar Vertebrae
• Shorter than TVPs of lumbar vertebrae
• Palpable deep to the erector spinae muscles
Trail 4 “Buried Boulevard”
Lamina Groove of the Thoracic Vertebrae

• Located between the spinous & transverse

processes
• Gets wider & deeper as it progresses down the
spine
• Filled with the layers of erector spinae &
transversospinalis muscles
Trail 4 “Buried Boulevard”
Lamina Groove of the Lumbar Vertebrae
• Located between the spinous & transverse processes
• Lumbar region = filled with erector spinae & transversospinalis
muscles
• Difficult to palpate directly but its borders (the spinous &
transverse processes) are palpable
Trail 5 “Breastbone Ridge”
Jugular Notch  Between sternal heads of the clavicles
Manubrium and Sternum
Xiphoid Process
1. Manubrium
• Superior portion of
the sternum
• Articulates with
clavicles, 1st & 2nd ribs
2. Sternum
• “Breastbone”

3. Xiphoid process
• Attachment site for
the abdominal
aponeurosis (A.K.A.,
Rectus Sheath)
 Large sheet of
connective tissue
 Attachment site
for INT/EXT
Obliques &
Transverse
Abdominus
• Easy to break
• 1” in length
Trail 6 “One Bumpy Road”
Ribs and Costal Cartilage

• The ribs
articulate
posteriorly with
the thoracic
vertebrae
(Costovertebral
joints) & then
curve around the
thorax to the
anterior chest.
 Easily
accessible to the
sides
• Costal cartilage
attaches the ribs
to the sternum
Trail 6 “One Bumpy Road”
First Rib
• Difficult to isolate along the anterior thorax
• Lies directly beneath the clavicle & then curves quickly to the back
• Can be accessed in the posterior triangle of the neck
• Formed by the clavicle & the sternocleidomastoid and trapezius muscles
Trail 6 “One Bumpy Road”
Eleventh and Twelfth Ribs

• “Floating Ribs”
 Do not attach to the costal
cartilage
• Can palpate the lateral aspects
Muscles of the Spine and Thorax

• Create movement
of the vertebral
column & rib cage
• Difficult to isolate
a particular
portion of muscle

Sections of the Spine:

1. Erector Spinae  Most Superficial

Group
2. Transversospnalis
Group
3. (2) Splenii
4. (8) Suboccipitals
 Deepest
  `
Erector Spinae  `
Muscles
• Extend from the tip `
of the spinous
process to the
body of the rib
Muscles of the Spine and Thorax

• Muscles responsible for

good posture

 How do we analyze
posture?
 What about a person
whom sits at a desk all
day?
Muscles of the Spine and Thorax

• Cross-Section view of the muscles of

the spine

 Transversospinalis muscles (rotatores,

mutifidi & semispinalis) are located
within the lamina groove
 Erector Sponae muscles (spinalis,
longissimus & iliocostalis) extend from
the tip of the spinous process to the
body of the rib
Muscle Layers of the Posterior Neck
Muscle Layers of the Posterior Neck
Muscle Layer of the Posterior Neck
Cross Section of the Neck
Cross Section of the Thorax
Cross Section of the Thorax
Synergists – Muscles Working Together
Vertebral Column
Vertebral Column
Vertebral Column
Ribs/Thorax
Erector Spinae Group
Spinalis
Longissimus
Iliocostalis

• Runs from the sacrum to the • Smallest

occiput along the posterior aspect • Lies
of the vertebral column closest
• Dense, layered arrangement of to spine
muscles that can be difficult to (in
visualize (think of a Poplar tree) lamina
groove)

• Deep to the thoracolumbar

aponeurosis (Lumbar region)
• Deep to trapezius, rhomboids,
serratus posterior superior &
inferior (T- & C-Spine)
Erector Spinae Group

 Help maintain an upright

posture
 Help return to anatomical
position when you are finished
tying your shoes
 Picking up a heavy suitcase
Erector Spinae Group
Erector Spinae Group
1. Partner prone. Lay both hands along either side of the lumbar
vertebrae. Locate the region of the lower erectors by asking your
partner to alternately raise & lower their feet slightly. The erectors do
not raise the feet, but they will contract in order to stabilize the pelvis.
2. As your partner maintains this contraction, palpate inferiorly onto the
sacrum and then superiorly along the thoracic vertebrae. Ask your
partner to extend their spine & neck slightly in order to contract the
erectors in the thoracic region.
3. Follow the ropy fibers of the erectors between the scapulae and along
the back of the neck. These fibers are smallest in the cervical region &
are primarily situated lateral to the lamina groove.
Transversospinalis Group
Multifidi
• Deep to the erector spinae muscle group
Rotatores  Rotate your torso to put on a seat belt
Semispinalis Capitis  Heaving dirt off a shovel

 Difficult to
isolate the
individual bellies
but as a group,
their mass can
be felt along the
lamina groove of
the T- & C-spine
Transversospinalis Group

• Multifidi are directly accessible in the lumbar

spine
 Only muscle fibers that lie across the
posterior surface of the sacrum
• Rotatores lie deep to the multifidi
Transversospinalis Group

• Located along the thoracic & cervical vertebrae and

ultimately reaches the cranium
• Form the “speed bumps” easily seen on the
posterior neck when the neck is extended against
some resistance
Transversospinalis Group
1. Partner prone. Locate the spinous
processes of the lumbar vertebrae.
Slide your fingers laterally off the
spinous processes, sinking between
them and the erector spinae fibers.
2. Pushing the erectors laterally out of
the way, explore deeply for the dense,
diagonal fibers of the multifidi.
Progress inferiorly to the sacrum,
rolling your fingers in a
perpendicular direction to the
multifidi fibers.
3. Move superiorly, exploring the
lamina groove of the thoracic &
cervical areas. Then turn your
partner supine & palpate the cervical
region
Transversospinalis Group
Splenius Capitis and Cervicis
Splenius Capitis and Cervicis

• Located along the upper back & posterior neck

• Run obliquely
Splenius Capitis

1. Partner prone. Locate the upper fibers of the

trapezius.
2. Isolate the lateral edge of the trapezius by having
your partner extend his head slightly.
3. Ask your partner to relax. Palpate just lateral to
the trapezius for the splenius capitis’ oblique
fibers, following them up to the mastoid process &
inferiorly through the trapezius

Both Splenii Muscles

1. Partner supine with thte head
rotated 45° away from the side you
are palpating. Cradle the head with
one hand while the other one locates
the lamina groove of the upper
cervical & thoracic vertebrae.
2. Passively extend the neck slightly to
shorten the tissue & palpate through
the overlying trapezius fibers.
Suboccipitals
Suboccipitals
Suboccipitals
Suboccipitals
• The deepest muscles of the upper posterior
neck.
• Stabilize the axis & atlas
• Create intrinsic movements
• Rocking & tilting the head
Quadratus Lumborum
Quadratus Lumborum

• The deepest muscle of the abdomen

 An abdominal muscle located on the posterior surface of the thorax
• Lateral edge is accessible from the side of the torso
Quadratus Lumborum
When do you use your QL?
1. Hiking up your hip to walk over something
2. Raising yourself up from a side lying position (lateral flexion)
3. Salsa, tango or ballroom dancing
Abdominals
Rectus Abdominis
External Oblique
Internal Oblique
Transverse Abdominis

• Provide support & protection for your internal organs

Abdominals
Abdominals
Abdominals
Abdominals
 What is the Linea Alba?
• No, it’s not Jessica’s Sister
Abdominals
 What is the Linea Alba?
• No, it’s not Jessica’s Sister

“White Line” composed of mostly collagen connective

tissue
Rectus Abdominis
1. Partner supine with knees flexed. Locate the Xiphoid
process & the ribs just lateral to the Xiphoid. Also,
locate the pubic crest.
2. Place your hand between these landmarks & ask
your partner to alternately flex & relax their trunk
slightly. (“Do a small sit-up”)
3. Explore the entire length of the rectus & sculpt
between its rectangular muscle bellies.

External Oblique (left side)

1. Partner supine with knees flexed. Lay
your hand on the left side of the abdomen
& lower ribs. Ask your partner to raise
their left shoulder toward their right hip
(rotating their trunk).
2. Palpate across the superficial fibers of the
external oblique, noting their diagonal
direction.
3. With the trunk still rotated, follow the
fibers superiorly to where they
interdigitate with the serratus anterior,
then inferiorly to the abdominal
aponeurosis and, finally, laterally to the
iliac crest
Diaphragm
Diaphragm

• An involuntary contraction of the diaphragm will cause air to rush into the lungs & the vocal cords
to snap shut. The audible result is a hiccup!

 The heart’s pericardium is

also attached to the central
tendon, so the heart will ride
up & down when you breathe
Diaphragm

• The primary muscle of respiration.

• Separates the upper & lower thoracic
cavities.
• Inspiration (inhalation) = muscle fibers
contract & pull the central tendon
inferiorly
• Exhalation = muscle fibers relax,
releasing the central tendon & allowing
the lungs to deflate
Intercostals  The meat on your spare ribs
Serratus Posterior Superior and Inferior
Serratus Posterior Superior

Serratus Posterior Inferior

Intertraversarii
Interspinalis
Other Structures of the Spine and Thorax
Ligamentum Nuchae

• Helps stabilize the head & neck

• Attachment site for trapezius & splenius capitis
Supraspinous Ligament
• Attaches to the spinous
processes of the T- & C-
Spine

Abdominal Aorta

• Chief artery for carrying

blood to the abdominal
organs & lower
appendages
Thoracolumbar Aponeurosis

• A broad, flat tendon stretching

across the thorax & lumbar
regions
• Anchor for latissimus dorsi &
erector spinae group
Craniovertebral Joints
Atlantooccipital and Atlantoaxial Joints
Craniovertebral Joints
Atlantooccipital and Atlantoaxial Joints

Text
Intervertebral Joints
Intervertebral Joints
Costovertebral Joints
Text
Sternocostal Joints
Blank slide

Text