The semispinalis thoracis inserts via tendinous slips into the spinous processes of C6-T4 from origins on the transverse processes of T6-T10, forming the intermediate transversospinal layer in the thoracolumbar region. Its long tendinous slips bridge 4-6 vertebral levels and contribute to thoracic extension and contralateral rotation.
Semispinalis thoracis tendinopathy is an underrecognised cause of midline thoracic and lower cervical pain, particularly at the C6-T4 spinous process insertions. It contributes to the cervicothoracic junction pain syndrome. Dry needling targeting the semispinalis thoracis at the spinous process insertions is effective for chronic midline thoracic pain. The muscle is visible on MRI as the intermediate paraspinal layer between the multifidus and the erector spinae.
Degenerative change at the upper thoracic and cervicothoracic spinous process insertions producing deep midline pain aggravated by prolonged sitting and cervicothoracic flexion.
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