Dalley, 10th Edition

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Overview of Back and Vertebral Column

Spine of scapula

C7 (vertebra prominens) Spinous processes of vertebrae:

Acromion

Trapezius

Trapezius

Greater tubercle of humerus

2

T3

Teres major

Inferior angle of scapula Spine of scapula

Site of inferior angle of scapula

T7

Posterior median furrow overlying spinous processes of vertebrae

Latissimus dorsi

Latissimus dorsi

Level of diaphragm

7th rib

T9

T10

Erector spinae

Palpable features of back Angles of ribs

Dimple overlying posterior superior iliac spine (PSIS)

Iliac crest

Thoracodorsal fascia

L2

Gluteal muscles

Gluteal muscles

Tip of 12th rib

(C) Posterior view

L4

Iliac crest

Back muscles

S2

Superficial extrinsic Intermediate extrinsic

Erector spinae (intermediate intrinsic) Transversospinales (deep intrinsic)

Posterior superior iliac spine

Body of vertebra

(E) Posterior view

Rib

Angle of rib

FIGURE 2.1. Anatomy of back. C. Surface anatomy of back. In lean individuals with well-developed musculature, extrinsic back muscles serving the upper limb are apparent. D. Layered arrangement of extrinsic and intrinsic muscles of back. Intrinsic back muscles lie medial to the angles of the ribs. E. Skeleton of back. A central column of vertebrae and intervertebral discs anked by the posterior portions of ribs comprise the axial skeleton of the back. Features normally palpable are highlighted in green . Although located in the back, scapulae are parts of the superior appendicular skeleton. ( continued )

Serratus posterior inferior

Latissimus dorsi

Thoracic spinous process

Trapezius

(D) Schematic transverse section

TABLE 2.1. RELATIONSHIPS OF PALPABLE LANDMARKS OF BACK TO SIGNIFICANT DEEP STRUCTURES Palpable Landmark Spinous Process Signi cant Deep Structure (Approximations)

Vertebra prominens Copyright © 2027 Wolters Kluwer. Unauthorized reproduction of the article is prohibited. C7 Apex of lungs, thyroid isthmus

T3

Formation of superior vena cava

Spine of scapula

T4

T4–T5 IV disc; transverse thoracic plane (intersects: sternal angle, aortic arch, bifurcation of trachea, arch of azygos vein)

Inferior angle of scapula T7

Level of nipple on anterior thoracic wall

T9–T10

Central tendon of diaphragm; base of lungs

Tips of 12th rib

L2

Inferior end of spinal cord

Iliac crest

L4

Bifurcation of aorta; commonly lumbar puncture performed between laminae of 4th and 5th lumbar vertebrae

Dimple overlying posterior superior iliac spine (PSIS)

S2

Inferior extent of dural sac/subarachnoid space