The rotatores thoracis attach by short tendons from the transverse process of one thoracic vertebra to the base of the spinous process of the vertebra one or two levels above. As the deepest transversospinal muscles, their tendons are the most precisely positioned spinal stabilisers, contributing to fine intersegmental control rather than gross movement.
The rotatores thoracis tendons are rarely the primary site of pathology but contribute to thoracic multisegmental pain syndromes. Their short lever arm makes them proprioceptive sensors rather than prime movers. Deep paraspinal trigger points at the thoracic level often involve the rotatores tendinous insertions. Needle fenestration and injections targeting these tendons require fluoroscopic or ultrasound guidance due to their deep location.
Traction injury to the rotatores tendons from sudden unguarded thoracic rotation producing deep midline thoracic pain localised to one or two segments, managed with manual therapy and rotational mobility exercises.
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