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Anatomy of Back Muscles

  The muscles of the back can be divided into three groups – superficial, intermediate and deep: Superficial  – associated with movements of the shoulder. Intermediate  – associated with movements of the thoracic cage. Deep  – associated with movements of the vertebral column. The deep muscles develop embryologically in the back, and are thus described as  intrinsic  muscles. The superficial and intermediate muscles do not develop in the back, and are classified as  extrinsic  muscles. This article is about the anatomy of the superficial back muscles – their attachments, innervations and functions. The superficial back muscles are situated underneath the skin and superficial fascia. They originate from the vertebral column and attach to the bones of the shoulder – the clavicle, scapula and humerus. All these muscles are therefore associated with movements of the upper limb. The muscles in this group are the trapezius, latissimus dorsi, levator scapulae and the rhomboids. The trapezius
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Musculoskeletal assessment

 


Patients present with a variety of conditions, and assessments
need to be adapted to suit their needs. This section
provides a basic framework for the subjective and physical
musculoskeletal assessment of a patient.
Subjective examination

  •     Body chart
  •     Location of current symptoms
  •     Type of pain
  •     Depth, quality, intensity of symptoms
  •     Intermittent or constant
  •     Abnormal sensation (e.g. pins and needles, numbness)
  •     Relationship of symptoms
  •     Check other relevant regions

Behaviour of symptoms

  •     Aggravating factors
  •     Easing factors
  •     Severity
  •     Irritability
  •     Daily activities/functional limitations
  •     24-hour behaviour (night pain)
  •     Stage of the condition

Special questions

  •     Red flags
  •     Spinal cord or cauda equina symptoms
  •     Bilateral extremity numbness/pins and needles
  •     Dizziness or other symptoms of vertebrobasilar insufficiency
  •     (diplopia, drop attacks, dysarthria, dysphagia, nausea)

History of present condition

  •     Mechanism of injury
  •     History of each symptomatic area                                               Relationship of onset of each symptomatic area
  •     Change of each symptom since onset
  •     Recent X-rays or investigations

Past medical history

  • Relevant medical history
  • Previous episodes of present complaint
  • Previous treatment and outcome
  • General health
  • THREAD ( T hyroid disorders, H eart problems, R heumatoid
  • arthritis, E pilepsy, A sthma or other respiratory problems,
  • D iabetes)

Drug history

  • Current medication
  • Steroids
  • Anticoagulants
  • Allergies

Social and family history

  • Age and gender
  • Home and work situation
  • Dependants
  • Hobbies and activities
  • Exercise
  • Yellow flags

Physical examination
    Observation

  • Posture
  • Function
  • Gait
  • Structural abnormalities
  • Muscle bulk and tone
  • Soft tissues

Active and passive joint movements

  • Active and passive physiological movements
  • Joint effusion measurement

Muscle tests

  • Muscle strength
  • Muscle control and stability
  • Muscle length
  • Isometric muscle testing

Neurological tests

  • Integrity of the nervous system

– dermatomes
– reflexes
– myotomes

  • Mobility of the nervous system

– straight leg raise
– slump test
– slump knee bend
– passive neck flexion
– upper limb neurodynamic tests

  • Special tests (e.g. coordination)

Palpation

  • Skin and superficial soft tissue
  • Muscle and tendon
  • Nerve
  • Ligament
  • Joint
  • Bone
  • Joint integrity tests
  • Passive accessory movements

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