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Quadratus Lumborum Woodburne
The four sided muscle lies adjacent to the transverse processes of the lumbar vertebrae
and is broader below than above
1. it arises from
a. the iliolumbar ligament and
b. from 5cm of the posterior part of the iliac crest
2. it inserts
a. into the lower border of the last rib for about half its length
b. into the upper four lubar trasverse processes
3. it lies anterior to the lateral margin of the erector spinae muscle and is separated
from it by the anterior layer of the thoracolumbar fascia
a. the medial part of the muscle is anterior to the lumbar transverse processes
and is overlapped by the more anterior psoas muscle.
4. The transversalis fascia covers the anterior surface
a. At the posterolateral border of the muscle this fascia fuses with the
anterior layer of the thoracolumbar fascia
b. At the medial border the fascia attaches to the lumbar transverse processes
c. The thoracolumbar fascia is on the posterior side of the this muscle
5. Nerves pass under the surface of the muscle but under the transversalis fascia
a. Subcostal
b. Iliohypogastric
c. Ilioinguinal
The transversalis fascia
1. fuses with the thoracolumbar fascia at the posterolateral border of the muscle
2. At the medial border of the muscle it attaches to the lumbar transverse processes
Between the transversalis fascia and the muscle these nerves pss lateralward into the
abdominal wall:
1. Subcostal
2. Iliohypogastric
3. ilioInguinal
One of my questions is could the TOP block actually be a block of the quadratus
lumborum because local injected in it or under the thoracolumbar fascia could
1. get on the other side to affect the nerves
2. or migrate to the lumbar nerves and block the lumbar plexus
The iliolumbar ligament. The lower border is attached to the