Superficial and Deep Muscles of Back

Thoracolumbar fascia 3 main functions

- load transfer between attachments - elastic support (weight-lifters belt) - retinaculum for deep spine muscles

Levator scapulae insertion

Scapula, superior angle

Suboccipital region includes (2)

1. Rectus capitis posterior major & minor 2. Obliquus capitus superior & inferior

To make the triangle of auscultation show on patient subcutaneously, what can you ask the patient to do?

Ask patients to fold arms over chest wall & bend over - the triangle becomes subcutaneous

In a motor accident, the axis of a young man was crushed, which of the muscles of the suboccipital region was spared ? A. Rectus capitis posterior major B. Splenius cervicis C. Oblique capitis inferior D. Oblique capitis superior

B

Extrinsic Back Muscles innervated by

The ventral (or anterior) primary rami of spinal nerves

levator scapulae action

a: elevate & rotate scapula

action of spinalis muscles

bilaterally extends the head and neck, half: cervical rotation to same side and lateral flexion

"True" intrinsic back muscles innervated by

dorsal (or posterior) primary rami of spinal nerves

Lesser occipital n (arises from? vertebrae? supplies to what?)

from cervical plexus C2-3 supplies skin of posterior surface of auricle & adjacent portion of scalp posterior to auricle

latissiumus dorsi wraps over ________ _________ of ____________

inferior angle of scapula

external occipital protuberance aka ________

inion

Accessory nerve X1 innervates ______ and ____________ muscles you can check this with what actions

innervates trapezius and sternocleidomastoid muscles -have individual shrug their shoulders and turn their head/neck

Kinesiology (position) monitors:

interspinalis, levator costae (transverse process to rib), intertransversarii

latissimus dorsi attaches at _____________________ __________ of ___________

intertubercular groove of humerus

Name the "broad muscle of the back"

latissimus dorsi

name 3 "other" deep muscles and 2 functions

levator costarum, intertransversarii, interspinales, posture, proprioceptive transducers

Name the muscles of layer 2 (superficial)

levator scapulae, rhomboid minor, rhomboid major

Ligamentum nuchae (nuchal ligament); found in the __________, works as an intermuscular _________, located from _____________ to ____, limits ________

nape, septum, occiput, C7, flexion

Boundaries of suboccipital triangle & contents

obliquus capitis inferior obliquus capitis superior rectus capitis posterior major Contents: vertebral artery, C1

name the 2 superficial muscles

trapezius, latissiumus dorsi

Intrinsic Back muscles characteristics: aka _________ back muscles; originate and insert on the ________; anti______; protection of deep ____________; maintain _____________; extend from ______ to ________; enclosed by deep _______ of the back

true, spine, gravity, ligaments, posture, skull, sacrum, fascia

Suboccipital region nerve

N: Suboccipital nerve (posterior ramus C1)

Anterior vertebral muscles nerve

N: cervical spinal nerves (ventral rami)

Splenius capitis nerve

N: dorsal primary rami of spinal nerves

Rhomboid minor & major nerve

N: dorsal scapular (C4-5)

Serratus Posterior Inferior Nerve

N: intercostals ( T9-12)

Serratus Posterior Superior Nerve

N: intercostals (T2-5)

Latissimus dorsi: describe nerve, artery and action

N: thoracodorsal nerve Artery: thoracodorsal artery Action: extend, adduct, medially rotate arm; "swimming muscle"

Transversospinalis origin & insertion

O & I: between spinous processes and transverse processes and skull (semispinalis capitis)

Anterior vertebral muscles origin and insertion

O & I: skull, cervical vertebrae, ribs

Suboccipital region orgin and insertion

O & i: Skull, C1, C2

Rhomboid minor & major origin

O: Spinous processes, C7-T5, nuchal ligament

Serratus Posterior Inferior: origin and insertion

O: Spinous processes, T11-L2 I: Lower ribs, 9-12

Levator scapulae origin

O: cervical transverse processes of C1-4

Trapezius (origin, insertion)

O: external occipital protuberance, nuchal ligament, spinous processes of C7-T12 I: clavicle, acromion, spine

Splenius capitis origin

O: lower half of nuchal ligament, spinous processes of C7-T3

Erector spinae origin

O: sacrum, iliac crest

Splenius cervices (o, i, n)

O: spinous processes of T3-T6 I: Transverse processes of C1-C3 N: dorsal primary rami of spinal nerves

latissimus dorsi origin and insertion

O: spinous processes of T7-L5, thoracolumbar fascia/aponeurosis, iliac crest, spinous tubercles of sacrum, ribs 10-12 I: intertubercular groove of humerus

Serratus Posterior Superior: origin and insertion

O: spinous processes, C7-T3 I: upper ribs, 2-5

the plane that is located on the high points of the iliac crest and crosses L4 spinous process is the _____________ plane

supracristal

"Colli" = "Scalene" =

"Colli" = collar, neck "Scalene" = bent, unequal

"Rectus" = "Oblique" =

"Rectus" = "straight" "Oblique" = "angled"

Injury to Dorsal Scapular Nerve produces

"Rhomboid winging of scapula"

"Erector"; "Spinalis"

"straighten" "next to spine"

Iliocostalis has 3 parts

1. lumborum 2. thoracis 3. cervices

Longissimus has 3 parts

1. thoracis 2. cervices 3. capitis

Clinical importance of triangle of auscultation; how to make it become subcutaneous

6th & 7th ribs, and 7th intercostal space overlying the apex of lower lobe of lung; ask pt to fold arms over chest wall and bend forward

"Splenion" from splenius cervicis

= Bandage

"Caput"

= Head

Serratus Posterior Inferior Action

A: depress lower ribs (widen chest for inspiration)

Serratus Posterior Superior Action

A: elevate upper ribs (widen chest for inspiration)

Erector spinae action AND nerve

A: extend ("erect") spine, bend laterally if contract one side N: dorsal rami of spinal nerves

Suboccipital region action

A: extension ("yes") and rotation ("no") of head & neck

Anterior vertebral muscles action

A: flexion ("yes") and rotation ("no") of head & neck, lateral bending, elevate ribs

Rhomboid minor & major action; what they are known as

A: retract & rotate scapula hold to wall; "pushup muscles"

Transversospinalis action

A: stabilize vertebral column if all contract, or rotate or lateral bending of vertebrae if only 1 segment contracts

boundaries of triangle of auscultation

Boundaries: trapezius/latissimus dorsi mm & vertebral (medial) border of scapula

Spinal accessory nerve is accompanied by what artery and vein?

By transverse cervical artery and vein (neurovascular bundle)

hyoid bone at ____, thyroid cartilage at _____-____, first cricoid ring (cartilage around trachea) at _____

C3, C4-5, C6

What nerve is the dorsal scapular nerve

C5

Clinical diagnosis of accessory nerve dysfunction

Characteristic downward and lateral displacement of scapula, w narrowing of inferior scapulohumeral angle and loss of function, w pain commonly present

Transversospinalis nerve

DORSAL RAMI of spinal nerves

. A CT image of the neck of a man in ER showed a fracture of the transverse process of the atlas. Which of the following muscles of the suboccipital region is involved? A. Rectus capitis posterior major B. Rectus capitus posterior minor C. Oblique capitis inferior D. Oblique capitis superior E. Both C and D

E

Erector spinae insertion

I: Spinous processes (spinalis), transverse processes and skull (longissimus), ribs (iliocostalis)

Splenius capitis insertion

I: mastoid process and occipital bone

Rhomboid minor & major insertion

I: scapula, medial border

T6/T7

Inferior angle of scapula

Lumbar triangle (triangle of Petit) base/floor: what muscle?

Internal oblique muscle

"True" Intrinsic back muscles vs. extrinsic

Intrinsic: originate from and insert on bones of axial skeleton Extrinsic: originate from axial skeleton but insert on bones of pectoral girdle or upper limb

Umbilicus at L_?

L3

Level of iliac crests L_?

L4

Lumbar triangle boundaries; aka

Latissimus dorsi/external oblique, & iliac crest; Triangle of Petit

Muscles of back arranged into 6 layers:

Layers 1 & 2 are superficial Layer 3 is intermediate Layer 4 to 6 are deep

Levator scapulae nerve

N: C3, dorsal scapular (C4-5)

Lumbar triangle (triangle of Petit) clinical importance (hint it's rare)

Lumbar (petits) hernia (rare)

Trapezius (Nerve, action)

N: Spinal accessory nerve (CNX1; motor); proprioceptive afferent info. via C3-4 spinal nerves A: upper fibers: elevate scapula, laterally flex neck, rotate face away -Middle: adduct (retract) -Lower: depress scapula

Spinal accessory nerve supplies what?

Supplies trapezius

______ is the first blade-like spinous process

T12

xiphoid process of sternum is at the level of T_?

T9

Spinalis has 3 parts:

Thoracis Cervices Capitis - not semispinalis capitis

the dimple on your back is the ________________ _____________ _______ _________

posterior superior iliac spine

Name the anterior vertebral muscles

rectus capitis anterior & lateralis, longus colli & capitis, scalenes

there is _____________ innervation of skin by _________ branches of nerves piercing through superficial muscles

segmental

Name the muscles of layer 6 and the name of this deep muscle group

semispinalis, multifidus, rotatores, transversospinalis

Name the muscles of later 3 (intermediate)

serratus posterior superior and inferior

Spinal accessory nerves (CN X1) supply what type of fibers to the sternocleidomastoid and trapezius muscles; arise as rootlets from sides of spinal cord in C__-C__; accessory to the ________ _______ which joins the _________ nerve; ascend to cranial cavity via _________ ___________ and exit through _________ ___________

somatic motor fibers, C1-C5, cranial root, vagus, foramen magnum, jugular foramina

Name the muscles of layer 5 (and name of entire muscle group)

spinalis, longissimus, iliocostalis, erector spinae

rectus capitus post major & oblique capitis inferior attach at _______ of ________; rectus capitus posterior minor at ___________ _________ of _________; oblique capits superior and oblique capitus inferior at _____________ process of _______

spine of axis, tubercle of atlas, process of atlas

splenius muscles make up what muscle group (of intrinsic muscles)

spinotransversales

True back muscles are subdivided into 4 groups: name the layers

spinotransversales, erector spinae, transversospinalis, intersegmental muscles

Name the muscles of layer 4 (deep muscles)

splenius capitis, splenius cervicis

Extrinsic muscles are the ______________ which produce movement of the _________ __________ and _______________ layer which produces __________ and __________ of rib cage (attaches to rib cage and verteral column)

superficial, upper limbs, intermediate, elevation, depression

T2 (where)

superior angle of scapula

C7 spinous process aka

vertebral prominens