DOCSLIB.ORG

Powerpoint Handout: Lab 1, Extrinsic Back Muscles

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Powerpoint Handout: Lab 1, Extrinsic Back Muscles PowerPoint Handout: Lab 1, Extrinsic Back Muscles Slide Title Slide Number Osteology of Scapula Slide 2 Summary of Back, Posterior Neck, and Posterior Head Dermatomes Slide 3 Back Muscle Overview Slide4 Extrinsic Back Muscles: Layers Slide 5 Trapezius and Latissimus Dorsi Slide 6 Trapezius: Continued Slide 7 Rhomboid Major, Rhomboid Minor, and Levator Scapulae Muscles Slide 8 Thoracolumbar Fascia Slide 9 Osteology of Scapula The osseous features of the scapula will be most relevant when we https://3d4medic.al/BwEkQyWz study the upper limb, but some features of the scapula are important to identify because extrinsic back muscles attach to the scapula. The learning objective for this lab includes all osseous features of the scapula, but I organize the list below by the most relevant for the extrinsic back lab. Features relevant to extrinsic back muscle • Scapular spine: attachment site for trapezius muscle (and deltoid, which will be studied later) • Acromion: attachment site for trapezius (and deltoid, which will be studied later) • Inferior angle: attachment site for latissiumus dorsi and most inferior fibers of rhomboid major m. • Superior angle: attachment site for levator scapula muscle • Medial border: attachment site for rhomboid muscles • Lateral border: relevant now for palpation purposes Features important for the upper extremity that will be studied later. • Coracoid process • Supraspinous fossa • Infraspinous fossa • Suprascapular notch • Spinoglenoid notch • Glenoid cavity (fossa). Summary of Back, Posterior Neck, and Posterior Head Dermatomes A dermatome is a region of skin on one side of the body that is innervated by sensory neurons located in one specific spinal nerve root/spinal nerve level. Note that dermatome maps always show clearly defined lines, but the reality is that there is much overlap between adjacent dermatomes. (More information on dermatomes will be presented in future sessions.) • C2, C3: posterior head • C4, C5, C6, C7: Posterior neck • C7-L5: Stripe pattern from base of neck to sacrum Back Muscle Overview Muscles of the back are organized into two major groups. 1. Extrinsic back muscles • Movement: Contraction of extrinsic back muscles results in movement of the upper limb (superficial layer) or elevation/depression of the ribs during ventilation of the lung (intermediate/deep layer). They DO NOT move the back. • Innervation: The extrinsic back muscles are innervated by branches of the ventral primary rami. The exception to this ”rule” is the trapezius muscle, which is innervated by cranial nerve XI (accessory nerve). 2. Intrinsic back muscles • Movement: Intrinsic back muscles are responsible for maintaining posture and movement of the head and vertebral column. • Innervation: The intrinsic back muscles are innervated by dorsal rami. Extrinsic Back Muscles: Layers The extrinsic back muscles are can be divided into two groups. 1. The superficial layer consists of muscles that connect the axial skeleton to the upper extremity. Because of their attachment to the upper extremity, these muscles are involved with moving the upper limb, and NOT the back. The following muscles are superficial extrinsic back muscles. • Trapezius • Latissimus dorsi • Levator scapula • Rhomboid major and minor 2. The intermediate (deep) layer of muscle attaches the vertebrae to the ribs. Due to the attachment on the ribs, these muscles play a minor role in ventilation of the lungs. Because of the minor role they play in ventilation, we place little emphasis on these muscles. These two insignificant muscles are listed below. • Serratus posterior superior • Serratus posterior inferior Trapezius and Latissimus Dorsi https://3d4medic.al/212sIdvy • The trapezius and latissimus dorsi are large, flat muscles that both have their proximal attachments on the central axis of the body, while their distal attachments extend laterally to attach to bones of the upper extremity. The axial skeleton (mainly vertebral column) becomes the anchoring point for these muscles to move the upper extremity. • Note that the trapezius is divided into 3 parts, each with its own action. See the table below. NOTE: Origins and insertions are not testable. This information is provided to help you gain a better understanding of the muscles anatomical location and to better understand a muscle’s action. MUSCLE ORIGIN INSERTION INNERVATION BLOOD SUPPLY ACTION External occipital • Superior fibers elevate scapula, upward rotation protuberance, superior Lateral 1/3 of clavicle, scapula (rotates glenoid cavity superiorly) Trapezius nuchal line, spinous acromion, spine of the Spinal accessory nerve Transverse cervical artery • Middle fibers retract scapula processes of cervical and scapula • Inferior fibers: depress scapula, upward rotation thoracic vertebrae scapula (rotates glenoid cavity superiorly) *Thoracodorsal artery, branch Spinous processes of lower Intertubercular groove on *Thoracodorsal nerve of subscapular a., which is a Latissimus dorsi thoracic and lumbar Extends, adducts and medially rotates arm (humerus) humerus branch of brachial plexus branch of 3rd part of axillary vertebrae, iliac crest, sacrum artery *These nerves and arteries will be viewed at a later time. Trapezius: Continued FUNCTIONAL ANATOMY: Trapezius Muscle Innervation The trapezius is the only muscle of the upper limb not innervated by a branch of the brachial plexus (the plexus formed by the ventral primary rami of the C5-T1 spinal nerves). The accessory nerve is considered a cranial nerve because it exits the cranial cavity through a foramen, in this case the jugular foramen. CLINICAL ANATOMY: Testing Spinal Accessory Nerve The accessory nerve passes through the lateral and posterior neck to reach the deep surface of the trapezius muscle. This course takes it in close vicinity to the internal jugular vein, the common carotid artery, and the numerous lymph nodes (deep cervical chain of lymph nodes) associated with these structures. The accessory nerve is susceptible to injury in surgical procedures involving these structures. The function of the trapezius muscle and its nerves supply is tested clinically by asking the patient to shrug his/her shoulders against resistance. Common Carotid a. Internal Jugular v. Rhomboid Major, Rhomboid Minor, and Levator Scapulae Muscles Trapezius m. Transverse Cervical Superficial Branch • The rhomboid major, rhomboid minor, and https://3d4medic.al/212sIdvy Transverse Cervical Deep Branch levator scapula are all located deep to the Rhomboid m. trapezius muscle. Thyrocervical • The rhomboid muscles are named as two Trunk separate muscles, but form one continuous sheet of muscle. • The blood supply to the rhomboids and levator scapula is supplied by the dorsal scapular artery, but note that the “dorsal Subclavian a scapular artery” can originate directly from Trapezius m. the subclavian artery, or be a deep branch of Transverse the transverse cervical artery. Thyrocervical Cervical a. Rhomboid m. Trunk Subclavian a Dorsal Scapular: (Direct Branch Subclavian) MUSCLE ORIGIN INSERTION INNERVATION BLOOD SUPPLY ACTION Dorsal scapular artery (Can be direct Spinous processes of lower Retracts and downwardly rotates Rhomboid major Dorsal scapular nerve (C5) branch of subclavian OR a deep cervical and upper thoracic Medial border of the scapula scapula (rotates glenoid cavity and minor from brachial plexus branch of transverse cervical a.) vertebrae inferiorly) ventral rami of 3-4 cervical Dorsal scapular artery (Can be direct Elevates and downwardly rotates Transverse processes of upper nerves and dorsal scapular Levator scapulae Superior angle of scapula branch of subclavian OR a deep scapula (rotates glenoid cavity cervical vertebrae nerve (C5) from brachial branch of transverse cervical a.) inferiorly) plexus Thoracolumbar Fascia The thoracolumbar fascia is a fascial complex that covers the deep muscles of the back and trunk. It is attached to the iliac crest, sacrum, rib 12, vertebrae (spinous and transverse processes), and associated intervertebral ligaments. It is thick and opaque in the lumbar region, but is thin and transparent in the thoracic region. • It forms 3 layers that surround muscles. • Posterior: When the skin is removed, only the posterior layer is visible as a thick connective tissue sheet that covers the erector spinae muscle group (an intrinsic back muscle group). Since the erector spinae muscle group is completely surrounded by thoracolumbar fascia, the posterior layer must be incised to reveal the muscle. • The middle layer separates the erector spinae group from the quadratus lumborum muscle (an abdominal muscle that forms a portion of the the posterior abdominal wall by spanning from the 12th rib to the iliac crest). • The deep layer is located along the anterior surface of the quadratus lumborum https://3d4medic.al/212sIdvy muscle. • The latissimus dorsi and serratus posterior inferior have their proximal attachment on the posterior layer of the thoracolumbar fascia. • The thoracolumbar fascia is much thicker and opaque in the lumbar region as compared to the thoracic region where it is thin and transparent. Serratus Posterior Inferior Latissimus Dorsi.
Load more

Recommended publications
  • Scapular Winging Is a Rare Disorder Often Caused by Neuromuscular Imbalance in the Scapulothoracic Stabilizer Muscles
    SCAPULAR WINGING Scapular winging is a rare disorder often caused by neuromuscular imbalance in the scapulothoracic stabilizer muscles. Lesions of the long thoracic nerve and spinal accessory nerves are the most common cause. Patients report diffuse neck, shoulder girdle, and upper back pain, which may be debilitating, associated with abduction and overhead activities. Accurate diagnosis and detection depend on appreciation on comprehensive physical examination. Although most cases resolve nonsurgically, surgical treatment of scapular winging has been met with success. True incidence is largely unknown because of under diagnosis. Most commonly it is categorized anatomically as medial or lateral shift of the inferior angle of the scapula. Primary winging occurs when muscular weakness disrupts the normal balance of the scapulothoracic complex. Secondary winging occurs when pathology of the shoulder joint pathology. Delay in diagnosis may lead to traction brachial plexopathy, periscapular muscle spasm, frozen shoulder, subacromial impingement, and thoracic outlet syndrome. Anatomy and Biomechanics Scapula is rotated 30° anterior on the chest wall; 20° forward in the sagittal plane; the inferior angle is tilted 3° upward. It serves as the attachment site for 17 muscles. The trapezius muscle accomplishes elevation of the scapula in the cranio-caudal axis and upward rotation. The serratus anterior and pectoralis major and minor muscles produce anterior and lateral motion, described as scapular protraction. Normal Scapulothoracic abduction: As the limb is elevated, the effect is an upward and lateral rotation of the inferior pole of scapula. Periscapular weakness resulting from overuse may manifest as scapular dysfunction (ie, winging). Serratus Anterior Muscle Origin From the first 9 ribs Insert The medial border of the scapula.
    [Show full text]
  • Thoracic Outlet and Pectoralis Minor Syndromes
    S EMINARS IN V ASCULAR S URGERY 27 (2014) 86– 117 Available online at www.sciencedirect.com www.elsevier.com/locate/semvascsurg Thoracic outlet and pectoralis minor syndromes n Richard J. Sanders, MD , and Stephen J. Annest, MD Presbyterian/St. Luke's Medical Center, 1719 Gilpin, Denver, CO 80218 article info abstract Compression of the neurovascular bundle to the upper extremity can occur above or below the clavicle; thoracic outlet syndrome (TOS) is above the clavicle and pectoralis minor syndrome is below. More than 90% of cases involve the brachial plexus, 5% involve venous obstruction, and 1% are associate with arterial obstruction. The clinical presentation, including symptoms, physical examination, pathology, etiology, and treatment differences among neurogenic, venous, and arterial TOS syndromes. This review details the diagnostic testing required to differentiate among the associated conditions and recommends appropriate medical or surgical treatment for each compression syndrome. The long- term outcomes of patients with TOS and pectoralis minor syndrome also vary and depend on duration of symptoms before initiation of physical therapy and surgical intervention. Overall, it can be expected that 480% of patients with these compression syndromes can experience functional improvement of their upper extremity; higher for arterial and venous TOS than for neurogenic compression. & 2015 Published by Elsevier Inc. 1. Introduction compression giving rise to neurogenic TOS (NTOS) and/or neurogenic PMS (NPMS). Much less common is subclavian Compression of the neurovascular bundle of the upper and axillary vein obstruction giving rise to venous TOS (VTOS) extremity can occur above or below the clavicle. Above the or venous PMS (VPMS).
    [Show full text]
  • The Erector Spinae Plane Block a Novel Analgesic Technique in Thoracic Neuropathic Pain
    CHRONIC AND INTERVENTIONAL PAIN BRIEF TECHNICAL REPORT The Erector Spinae Plane Block A Novel Analgesic Technique in Thoracic Neuropathic Pain Mauricio Forero, MD, FIPP,*Sanjib D. Adhikary, MD,† Hector Lopez, MD,‡ Calvin Tsui, BMSc,§ and Ki Jinn Chin, MBBS (Hons), MMed, FRCPC|| Case 1 Abstract: Thoracic neuropathic pain is a debilitating condition that is often poorly responsive to oral and topical pharmacotherapy. The benefit A 67-year-old man, weight 116 kg and height 188 cm [body of interventional nerve block procedures is unclear due to a paucity of ev- mass index (BMI), 32.8 kg/m2] with a history of heavy smoking idence and the invasiveness of the described techniques. In this report, we and paroxysmal supraventricular tachycardia controlled on ateno- describe a novel interfascial plane block, the erector spinae plane (ESP) lol, was referred to the chronic pain clinic with a 4-month history block, and its successful application in 2 cases of severe neuropathic pain of severe left-sided chest pain. A magnetic resonance imaging (the first resulting from metastatic disease of the ribs, and the second from scan of his thorax at initial presentation had been reported as nor- malunion of multiple rib fractures). In both cases, the ESP block also pro- mal, and the working diagnosis at the time of referral was post- duced an extensive multidermatomal sensory block. Anatomical and radio- herpetic neuralgia. He reported constant burning and stabbing logical investigation in fresh cadavers indicates that its likely site of action neuropathic pain of 10/10 severity on the numerical rating score is at the dorsal and ventral rami of the thoracic spinal nerves.
    [Show full text]
  • Indications and Treatment of Myofascial Pain
    2/25/2017 Indications and Treatment of Myofascial Pain Lisa DeStefano, DO Associate Professor and Chair Department of Osteopathic Manipulative Medicine College of Osteopathic Medicine Michigan State University Common Myofascial Pain Syndromes 1 2/25/2017 2 2/25/2017 Greater Occipital Nerve Impingement Sites . 1: Origin of the third occipital nerve and proximal connection with the greater occipital nerve. 2: Greater occipital nerve as it courses inferior to the inferior oblique muscle. 3: Greater occipital nerve coursing through the semispinalis capitis muscle. 4: Greater occipital nerve exiting the aponeurosis of the trapezius muscle. 5: Greater occipital nerve traveling with the occipital artery. 6: Origin of the greater occipital nerve and relationship to the descending branch of the occipital artery. 7: Suboccipital nerve relation to the vertebral artery and the descending branch of the occipital artery and this nerves interconnection to the greater occipital nerve. 8: Relationship between the third occipital nerve and the C2‐C3 joint complex. Common Treatment Approaches • MFR • MET • Soft Tissue Release • Counterstain • HVLA Etiology of Head and Neck Myofascial Pain Syndromes • Overuse • Posture –Head over the pelvis • Posture – Scapular function • Occlusion –how the teeth control for the proper placement of the mandibular condyle. 3 2/25/2017 Stabilization of the torsobegins with spinotransverse muscle transmission of force onto the epaxial fascia or vertebral aponeurosis. 4 2/25/2017 This then transmits tension into the serratus posterior superior and inferior, which then lifts the upper four ribs and sternum and lowers the lower ribs respectively. In response a force‐ couple is generated between the serratus posterior inferior fascia, external oblique fascia, and the rectus sheath.
    [Show full text]
  • An Anatomical Illustrated Analysis of Yoga Postures Targeting the Back and Spine Through Cadaveric Study of Back Musculature Hana Fatima Panakkat1, Deborah Merrick*2
    ISSN 2563-7142 ORIGINAL ARTICLE An Anatomical Illustrated Analysis of Yoga Postures Targeting the Back and Spine Through Cadaveric Study of Back Musculature Hana Fatima Panakkat1, Deborah Merrick*2 Panakkat HF, Merrick D. An Anatomical Illustrated present the findings, unique hand-drawn illustrations Analysis of Yoga Postures Targeting the Back and were used to depict the musculature found to be Spine Through Cadaveric Study of Back Musculature. highly active with each Yoga posture, with the erector Int J Cadaver Stud Ant Var. 2020;1(1):33-38. spinae muscles appearing prominent throughout. The combined approach of using hand-drawn illustrations Abstract with cadaveric dissection to present the anatomical Back pain is a debilitating lifestyle disease that affects analysis has allowed a seamless understanding of a large proportion of the world’s population at some complex anatomical concepts alongside the nuances point in their life. Absences from work due to this of intricate gross anatomy. This study highlights the have a huge economic impact on the patient, their importance of the inclusion of cadaveric dissection employer and the healthcare providers who seek to as a pedagogical tool in medical curriculum through support their recovery. Unfortunately, back pain is exploring the anatomical basis of Yoga, also allowing often resistant to treatment and intervention, therefore the possibility of using the workings of Yoga to aid alternative therapies such as Yoga are being explored. anatomical teaching. A greater understanding of this Within the literature, five Yoga postures were may help guide personalized Yoga regimes, which may identified to be associated with reduced back pain allow alternative therapies to become integrated into in patients suffering from Chronic lower back pain.
    [Show full text]
  • Scapular Dyskinesis
    Scapular Dyskinesis Presented by: Scott Sevinsky MSPT Presented by: Scott Sevinsky SPT 1 What is Scapular Dyskinesis? Alteration in the normal static or dynamic position or motion of the scapula during coupled scapulohumeral movements. Other names given to this catch-all phrase include: “floating scapula” and “lateral scapular slide”.1, 2 1 Alterations in scapular position and motion occur in 68 – 100% of patients with shoulder injuries. Scapular Dyskinesis Classification System 1, 3 Pattern Definitions Inferior angle At rest, the inferior medial scapular border may be prominent dorsally. During arm motion, the inferior (type I) angle tilts dorsally and the acromion tilts ventrally over the top of the thorax. The axis of the rotation is in the horizontal plane. Medial border At rest, the entire medial border may be prominent dorsally. During arm motion, the medial scapular (type II) border tilts dorsally off the thorax. The axis of the rotation is vertical in the frontal plane. Superior border At rest, the superior border of the scapula may be elevated and the scapula can also be anteriorly (type III) displaced. During arm motion, a shoulder shrug initiates movement without significant winging of the scapula occurring. The axis of this motion occurs in the sagittal plane. Symmetric At rest, the position of both scapula are relatively symmetrical, taking into account that the dominant scapulohumeral arm may be slightly lower. During arm motion, the scapulae rotate symmetrically upward such that the (type IV) inferior angles translate laterally away from the midline and the scapular medial border remains flush against the thoracic wall. The reverse occurs during lowering of the arm.
    [Show full text]
  • Erector Spinae Plane Block Versus Retrolaminar Block a Magnetic Resonance Imaging and Anatomical Study
    Regional Anesthesia & Pain Medicine: first published as 10.1097/AAP.0000000000000798 on 1 October 2018. Downloaded from REGIONAL ANESTHESIA AND ACUTE PAIN BRIEF TECHNICAL REPORT Erector Spinae Plane Block Versus Retrolaminar Block A Magnetic Resonance Imaging and Anatomical Study Sanjib Das Adhikary, MD,* Stephanie Bernard, MD,† Hector Lopez, MD,‡ and Ki Jinn Chin, FRCPC§ As with the ESP block, it has been postulated that the clinical ef- Background and Objectives: The erector spinae plane (ESP) and fects of the retrolaminar block may be explained by spread of lo- retrolaminar blocks are ultrasound-guided techniques for thoracoabdominal cal anesthetic into the paravertebral space,6 but this mechanism wall analgesia involving injection into the musculofascial plane between has never been systematically investigated. However, there are the paraspinal back muscles and underlying thoracic vertebrae. The ESP significant anatomical and technical differences between the 2 block targets the tips of the transverse processes, whereas the retrolaminar techniques: the retrolaminar block targets the lamina instead of block targets the laminae. We investigated if there were differences in the transverse process, and thus the injection point is more medial injectate spread between the 2 techniques that would have implications and deeper. The muscle layer over the lamina and adjacent to the for their clinical effect. spinous processes is thicker, being composed of the spinalis portion Methods: The blocks were performed in 3 fresh cadavers. The ESP and of the erector spinae muscle group as well as the transversospinalis retrolaminar blocks were performed on opposite sides of each cadaver at muscle group, which comprises the multifidus, rotatores, semis- the T5 vertebral level.
    [Show full text]
  • Anatomy, Shoulder and Upper Limb, Shoulder Muscles
    Eovaldi BJ, Varacallo M. Anatomy, Shoulder and Upper Limb, Shoulder Muscles. [Updated 2018 Dec 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534836/ Anatomy, Shoulder and Upper Limb, Shoulder Muscles Authors Benjamin J. Eovaldi1; Matthew Varacallo2. Affilations 1 University of Tennessee HSC 2 Department of Orthopaedic Surgery, University of Kentucky School of Medicine Last Update: December 3, 2018. Introduction The shoulder joint (glenohumeral joint) is a ball and socket joint with the most extensive range of motion in the human body. The muscles of the shoulder dynamically function in performing a wide range of motion, specifically the rotator cuff muscles which function to move the shoulder and arm as well as provide structural integrity to the shoulder joint. The different movements of the shoulder are: abduction, adduction, flexion, extension, internal rotation, and external rotation.[1] The central bony structure of the shoulder is the scapula. All the muscles of the shoulder joint interact with the scapula. At the lateral aspect of the scapula is the articular surface of the glenohumeral joint, the glenoid cavity. The glenoid cavity is peripherally surrounded and reinforced by the glenoid labrum, shoulder joint capsule, supporting ligaments, and the myotendinous attachments of the rotator cuff muscles. The muscles of the shoulder play a critical role in providing stability to the shoulder joint. The primary muscle group that supports the shoulder joint is the rotator cuff muscles. The four rotator cuff muscles include:[2] • Supraspinatus • Infraspinatus • Teres minor • Subscapularis. Structure and Function The upper extremity is attached to the appendicular skeleton by way of the sternoclavicular joint.
    [Show full text]
  • Effect of Latissimus Dorsi Muscle Strengthening in Mechanical Low Back Pain
    International Journal of Science and Research (IJSR) ISSN: 2319-7064 ResearchGate Impact Factor (2018): 0.28 | SJIF (2019): 7.583 Effect of Latissimus Dorsi Muscle Strengthening in Mechanical Low Back Pain 1 2 Vishakha Vishwakarma , Dr. P. R. Suresh 1, 2PCPS & RC, People’s University, Bhopal (M.P.), India Abstract: Mechanical low back pain (MLBP) is one of the most common musculoskeletal pain syndromes, affecting up to 80% of people at some point during their lifetime. Sources of back pain are numerous, usually sought in as lesion of disc or facet joints at L4- L5 and L5-S1 levels. Studies have shown that 40% of all back pain is of thoracolumbar origin. The term meachnical low back pain also gives reassurance that there is no damage to the nerves or spinal pathology. The clinical presentation of mechanical low back pain usually the ages 18-55 years is in the lumbo sacral region. A study was conducted to evaluate the designed to check the effectiveness of Conventional Exercises alone in Mechanical low back pain and along with the latissimus dorsi muscle strengthening, data was collected from People’s hospital, Bhopal (age group-30-45 yr both male and female randomly) Keywords: Visual analog scale, Assessment chart, Treatment table, Data collection sheets, Essential stationery materials, Computer, SPSS Software etc. 1. Introduction Back pain is a primary to seek medical advice considering 80% of people suffering from back pain. Mechanical low back pain is defined as a result of minor intervertebral dysfunction and referred pain in the low back The latissimus dorsi is a large, flat muscle on the back that and hip region, and can often be confused with the other stretches to the sides, behind the arm, and is partly covered pathologies that may cause these symptoms.18 by the trapezius on the back near the midline, the word latissimus dorsi comes from Latin and its means, broadest muscle of the back dorsum means back.
    [Show full text]
  • Lumbar Muscle Function and Dysfunction in Low Back Pain - Markku Kankaanpää
    PHYSIOLOGY AND MAINTENANCE – Vol. IV - Lumbar Muscle Function and Dysfunction in Low Back Pain - Markku Kankaanpää LUMBAR MUSCLE FUNCTION AND DYSFUNCTION IN LOW BACK PAIN Markku Kankaanpää Department of Physical Medicine and Rehabilitation, Kuopio University Hospital, and Department of Physiology, University of Kuopio, Finland Keywords: Low back pain, trunk muscles, muscle coordination, dysfunction, biomechanics, deconditioning syndrome. Contents 1. Anatomy and Function of the Trunk Extensor and Flexor Muscles 1.1. Functional Properties of Lumbar Spine 1.2. Anatomy of Lumbar and Abdominal Muscles 1.3. Control Properties of Lumbar and Abdominal Muscles 2. Epidemiological Aspects of LBP 2.1. Physical Risk Factors of LBP 3. Structural and Pathophysiological Aspects in LBP 4. Lumbar Muscle Dysfunction in LBP 4.1. Loss of Strength 4.2. Excessive Lumbar Muscle Fatigue 4.3. Loss of Co-ordination and Muscle Control 4.4. Active Rehabilitation and Back Extensor Muscle Functional Assessment Glossary Bibliography Biographical Sketch Summary Low back pain is one of the most common health problems. The reason for back pain is most often unknown. Some of the models that help in explaining the origin of low back pain are introduced. The lumbar structure and muscle functions and dysfunctions in relation to low back pain are reviewed. Complex central and peripheral elements control the biomechanics of the lumbar spine and ensure optimal spinal loading in normal everyday life situations.UNESCO Low back pain leads to acute – and EOLSS chronic changes in paraspinal muscles and their control mechanisms. Acute changes are observed as impaired reflexive functions of paraspinal muscles. Pain in spinal structures results from reflexive activities that protect the spine from excessiveSAMPLE and harmful loading.
    [Show full text]
  • The Anatomy and Function of the Equine Thoracolumbar Longissimus Dorsi Muscle
    Aus dem Veterinärwissenschaftlichen Department der Tierärztlichen Fakultät der Ludwig-Maximilians-Universität München Lehrstuhl für Anatomie, Histologie und Embryologie Vorstand: Prof. Dr. Dr. Fred Sinowatz Arbeit angefertigt unter der Leitung von Dr. Renate Weller, PhD, MRCVS The Anatomy and Function of the equine thoracolumbar Longissimus dorsi muscle Inaugural-Dissertation zur Erlangung der tiermedizinischen Doktorwürde der Tierärztlichen Fakultät der Ludwig-Maximilians-Universität München Vorgelegt von Christina Carla Annette von Scheven aus Düsseldorf München 2010 2 Gedruckt mit der Genehmigung der Tierärztlichen Fakultät der Ludwig-Maximilians-Universität München Dekan: Univ.-Prof. Dr. Joachim Braun Berichterstatter: Priv.-Doz. Dr. Johann Maierl Korreferentin: Priv.-Doz. Dr. Bettina Wollanke Tag der Promotion: 24. Juli 2010 3 Für meine Familie 4 Table of Contents I. Introduction................................................................................................................ 8 II. Literature review...................................................................................................... 10 II.1 Macroscopic anatomy ............................................................................................. 10 II.1.1 Comparative evolution of the body axis ............................................................ 10 II.1.2 Axis of the equine body ..................................................................................... 12 II.1.2.1 Vertebral column of the horse....................................................................
    [Show full text]
  • Quadratus Lumborum Blocks
    REGIONAL ANAESTHESIA Tutorial433 Quadratus Lumborum Blocks Ro´ isı´ n Nee†1, John McDonnell2 1Regional Fellow, Galway University Hospital, Galway, Ireland 2Consultant Anaesthetist, Galway University Hospital, Galway, Ireland Edited by: Dr. Su Cheen Ng, University College Hospital London, UK Dr. Gillian Foxall, Consultant Anaesthetist, Royal Surrey County Hospital, Guildford, UK †Corresponding author e-mail: [email protected] Published 29 September 2020 KEY POINTS Quadratus lumborum blocks (QLB) are a variation on transversus abdominis plane (TAP) blocks. Four different approaches to ultrasound-guided QLB have been described. QLB can be used to provide adjuvant analgesia for abdominal, orthopaedic, gynaecological and urological surgery. They can be performed in the lateral or supine position with a wedge under the patient’s hip. The shamrock sign of the psoas, erector spinae and the quadratus lumborum muscles around the transverse process on ultrasound allows identification of the needle insertion point. INTRODUCTION Dr. Rafa Blanco first described quadratus lumborum blocks (QLBs) in 20071 as a ‘‘no pops’’ transversus abdominis plane (TAP) block. It has been proposed as a more consistent method of accomplishing somatic as well as visceral analgesia of the abdomen than the TAP block and may provide an extended sensory blockade between T4 and L1. It can be used as an adjuvant technique for analgesia but does not provide adequate blockade to be used for anaesthesia. The QLB was developed to address the fact that as ultrasound imaging for regional anaesthesia has become more widespread, the tendency has been to move the injection point of the TAP block more anterior on the abdominal wall as compared with the original landmark technique, which is at the Triangle of Petit.
    [Show full text]