Muscles of the Vertebral Column

MUSCLES OF THE VERTEBRAL COLUMN

Dr.Poonam Kalavadiya MPT (CardioPulmonary)

The craniocervical/upper thoracic region • 2 primary role 1. To hold the head upright against gravity 2. To infinitely position the head in space in order to optimally position the sensory organs

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POSTERIOR MUSCLES • Trapezius muscle is the most superficial of the posterior muscles • Spans from the occiput to the lower thoracic spine • Belongs predominantly to the shoulder region • Produce extension of the head and neck • Acting unilaterally,upper trapezius produce ipsilateral lateral flexion and contralateral rotation of the head and neck

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Muscles of the vertibral column

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• Levator scapula is deep to the trapezius • Runs from the root of spine of the scapula and courses superiorly,medially and anteriorly to insert on the cervical transverse process • It is scapular elevator and downward rotator when the neck is stable

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Muscles of the vertibral column

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• When the upper extremity is stabilized,produce ipsilateral lateral flexion and rotation of the cervical spine • Cervical spine is subjected to constant anterior shear forces caused by the gravity and lordotic position of the spine • Levator scapulae help resist these forces

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• Treatment for overactivity of levator scapula muscle • Conventional treatment often involves stretching this strained muscle • Porterfield and Derosa cuationed that stretching this muscle worsen the situation and cuase further irritation,because it will decrease the muscle’s ability to control the anterior shear if it is overly lengthened • So levator scapulae need the endurance and strength training

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• Slenius capitis and splenius cervicis muscle are deep to the levator scapulae • Running from the spinous processes of the cervical and thoracic spine and the ligamentum nuchae to the superior nuchal line,the mastoid process and the cervical transverse processes • Produce extension when working bilaterally and ipsilateral rotation when working unilaterally

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Muscles of the vertibral column

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• Semispinalis capitis and semispinalis cervicis are the deep to the splenius group • Produce extension of the head and neck • Run from the occiput to the cervical spinous processsemispinalis capitis • Thoracic transverse process to the cervical spinous processes-semispinalis cervicis • Porterfield and Derosa linkened the function of semispinalis group to that of the multifidus muscles in the lumber region in that they have optimal alignment and moment arm to increasing the lordosis of the cervical and lumber region,respectively

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Muscles of the vertibral column

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• Longissimus capitis and longissimus cervicis are deep and lateral to the semispinalis group • Lateral position allows them to produce ipsilateral lateral flexion when working unilaterally.

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• Suboccipital muscles are the deepest posterior muscles and consist of the rectus capitus posterior minor and major,inferior oblique and superior oblique muscles • As a group they run between occiput and C2 and produce occipital extension • Unilaterally ,they produce ipsilateral rotation and lateral flexion

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Muscles of the vertibral column

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LATERAL MUSCLES • Scalene muscles are located on the lateral aspect of the cervical spine.

• Anterior scalene muscles,runs from the first rib to the anterior tubercles of the transeverse process of C3 to C6 • Working bilaterally,flex the cervical spine and produce the anterior shear

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Muscles of the vertibral column

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• Unilaterally,will produce ipsilateral lateral flexion and contralateral rotation of the cervical spine • Middle scalene muscles run from the first rib to the anterior tubercle of the transverse process of C3 to C7 • More laterally placed than the anterior scalene.

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• The posterior scalene muscle run from the second rib to the posterior tubercles of the transeverse process of the C3 to C7 • Posterior scalene laterally flex the neck • The anterior and middle scalene muscles form a triangle through which brachial plexus and subclavian artery and vein pass • Can be the site for compression on the neurovascular structures by the anterior scalene muscle

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• Sternocleidomastoid muscle run from the sternum,distal clavical and acromion to the mastoid process • The angle of inclination is posterior,medial and superior • Acting unilaterally,will produce ipsilateral lateral flexion and contralateral rotation of the head and neck

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ANTERIOR MUSCLES • The longus capitis run from the anterior tubercle of the cervical transverse process to the occiput • The longus colli run from the thoracic vertebral bodies to the anterior tubercles of the cervical transeverse process and cranially from the anterior tubercles of the transeverse process to atlas

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Muscles of the vertibral column

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• Produce the flexion • Longus capitis and longus colli work in synergy with the trapezius to stabilize the head and neck to allow to upward rotate the scapula • Rectus capitis anterior and rectus capitis lateralis are able to produce the flexion

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CERVICAL SPONDYLOSIS

• Cervical spondylosis is a chronic degenerative condition of the cervical spine that affects the vertebral bodies and intervertebral disks of the neck (in the form of, for example, disk herniation and spur formation), as well as the contents of the spinal canal (nerve roots and/or spinal cord). the degenerative changes in the facet joints, longitudinal ligaments, and ligamentum flavum.

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DEGERATIVE DICS DISEAES • The process is thought to begin in the annulus fibrosis with changes to the structure and chemistry of the concentric layers • Over time these layers suffer a loss of water content and proteoglycan,which changes the dics’s mechanical properties,making it less resilient to stress and strain

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JOINT DEGENERATIVE DISEASE:FACET • Changes in dics stucture and function can lead to changes in the articular facets,especially hypertrophy resulting from the redirection of compressive loads from the anterior and middle colums to the posterior element

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– There also may be hypertrophy of the vertebral bodies adjacent to the degenerating disc,these bony overgrowth are known as osteophytes or the bony spurs

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• Radiation of pain from the shoulder to digit along the course of the nerve indicates nerve root compression • Paraesthesia in the form of the tingling,pins and needles may be present in the hand

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CERVICALSPONDYLOSIS WITH MYELOPATHY • Cervical spondylotic myelopathy is the most common cause of spinal cord dysfunction in older persons. The aging process results in degenerative changes in the cervical spine that, in advanced stages, can cause compression of the spinal cord.

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• Clinical Presentation of Cervical Spondylotic Myelopathy Common symptoms Clumsy or weak hands Leg weakness or stiffness Neck stiffness Pain in shoulders or arms Unsteady gait

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• Common signs Atrophy of the hand musculature Hyperreflexia Lhermitte's sign (electric shock-like sensation down the center of the back following flexion of the neck) Sensory loss

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CERVICAL RIB • Cervical Rib refers to an abnormal protrussion in the cervical region which can either be due to abnormal enlargement of the transverse process of C7 • congenital abnormality located above the normal first rib • A cervical rib is present in only about 1 in 200 (0.5%) of people • in even rarer cases, an individual may have not one but two cervical ribs.

• The presence of a cervical rib can cause a form of thoracic outlet syndrome due to compression of the brachial plexus or subclavian artery.

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• Pain and paraesthesiae may be present on ulnar aspect of the forearm and hand • Weakness of the finer movement of the hand may be present • Atrophy may be present in interossei and the muscles of the thenar and hypothenar eminence at a later stage • Absent or feeble radial pulse

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