Superficial back and scapular muscles

Levator Scapulae Function and Nerve Supply

Elevates the scapula and aids in inferior rotation of the scapula Nerve - Dorsal Scapula nerve (c4-c5)

Superficial group of back muscles

Trapezius, latissimus dorsi, rhomboids, levator scapula

Lumbar Trigone

Lies between latissimus dorsi medially, external oblique laterally, and the iliac crest inferiorly.

Infraspinatus: O, I, NS, Fx

Origin: Infraspinous Fossa Insertion: Greater Tubercle Fx: Lateral Rotation of arm and stabliziation of glenhumeral joint Nerve: Suprascapular nerve

Intermediate group of back

Serratus posterior superior, serratus posterior inferior

Palpable landmarks of back

Acromion (lateral end), Spinous process of C7 (Cervical ends) External occipital protuberance(ligamentum of nuchae starts)

Latissimus Dorsi Test

Arm is abducted to 90 and then adducted against resistance provided by the examiner. If muscle is normal, the anterior border of the muscle can be seen and palpated by posterior axillary fold.

Spine of Scapula

Attachment to trapezius and deltoid. Lateral end is acromion

Clavicle

Fulcrum, shoulders move arms Medial convexity, and lateral concavity Absorbs shock received by by upper extremity

Serratus Posterior Inferior O, I, NS, Fx

Fx: Inspiration - depresses lower three ribs Origin: Lower T and upper L vertebrae Insertion: Lower borders of three lower ribs Nerve: Ventral rami of lower T Spinal Nerves.

Humerus head

Head is separated from greater and lesser tubercles via the anatomical neck

Rhomboid Test

Individual places his or her hands posteriorly on the hips and pushes the elbows posteriorly against resistance. If the rhomboids are acting normally, they can be palpated along the medial borders of the scapulae.

Scapula (Angles and borders O & I)

Lateral angle - forms surface of shoulder joint (glenoid cavity and tubercles) Superior Angle - insertion to levator scapulae Inferior angle - attachment to serratus anterior Medial border gives insertion to rhomboids, levator scapulae, and serratus anterior.

Deltoid O, I, NS, Fx and blood

Origin: Lateral 3rd of clavice, acromion, and spine of scapula Insertion: Deltoid Tuberosity Fx: Abducts, flexes, extends, medially and laterally rotates the arm. Abduction of shoulder joint to 90 degrees (assisted by supraspinatus) Nerve: Axillary nerve Blood: Posterior Humeral Circumflex artery

Latissimus Dorsi Origin Insertion

Spinous processes of the lower 6 thoracic and lumbera, iliac crest, and the lower 2-3 costae through the thoracolumbar fascia Insertion: Intertubercular sulcus

Subscapular Muscle O, I, NS, Fx

O: Subscapular fossa I: Lesser tubercle of the humerus Fx: Medial rotation of the arm N: Upper and lower subscapular nerves (only lower goes to teres major)

Supraspinatus O, I, NS, Fx

Origin: Supraspinous fossa Insertion : Greater Tubercle (of humerous) Fx: arm abduction initiation (below 90 degrees), and stablizies glenohumeral joint Innervation: Suprascapular nerve

Function of Rhomboids and nerve supply

Retract or adduct (pulls medial border of scapula towards vertebrae) , and elevates the scapula. Dorsal Scapular Nerve

Intertubercular sulcus of Humerus

Separates greater and lesser tubercles and gives attachment to the latissimus doris, teres major and pectoralis major.

Glenoid Cavity and Supra/infraglenoid tubercle muscle attachments

Supra- long head of biceps, infra- long head of the triceps.

Function/Nerves of Latissimus Dorsi

Adducts, extends, and medially rotates the arm. Shoulder extension, shoulder adduction Nerve: Thoracodorsal Nerve (c6-c8)

Rhomboids Origin and Insertion

Lies deep to the trapezius. Origin : Spinous processes of 2nd and 5th T vertebrae. Insertion: Medial border of the scapula between trigone of the spine and the inferior angle

Mismatched Nerve and Artery

Long thoracic nerve- Lateral thoracic vessels Accessory nerves: Transverse Cervical (superficial branch) Axillary Nerve: Post humeral circumflex

Serratus Anterior O, I, NS, Fx

O: Lateral surface of upper eight ribs I: Inferior angle and medial border of the scapula N: Long thoracic nerve (runs alongside muscle surface it innervates - prone to dmg) Fx: Abducts the arm above 90 deg by pulling scapula anterior and rotating glenoid cavity upwards (comb your hair). Retracts the arm Dmg/damage causes winged scapula

Levator Scapulae (origin, insertion)

Origin - posterior tubercles of transverse processes of C1 - C6 Insertion - upper part of the medial border and superior angle of the scapula

Teres Minor O, I, NS, Fx

Origin Upper 2/3 of lateral border of scapula Insertion: Greater Tubercle of humerus Fx: Rotates arm laterally and stablizies glenohumeral joint N: Axillary Nerve

Trapezius origin/insertion

Origin of EOP, ligamentum nuchae, and processes of thoracic vertebrae Insertion: Superior fibers attach to clavicle, transverse fibers to acromion and spine of scapula, ascending fibers attach to spine of scapula

Teres Major O, I, NS, Fx

Origin: Lower third of the lateral border of scapula Insertion: Medail lip of the intertubercular sulcus Fx: Adducts and medially rotates the arm N: Lower subscapular Nerve

Serratus posterior superior O, I, NS, Fx

Respiratory Inspiratory Muscle. Origin: C7-T3, and supraspinous ligament. Insertion - 2-5 Costae (ribs) Nerve supply: Ventral rami of the upper T nerves

Triangular of auscultation

Space between trapezius superiorly, medial border of scapula laterally, and latissimus dorsi inferiorly.

Function/Nerve of Trapezius

Stabilize, rotates scapula, and depresses its medial border elevating the shoulder as in shrugging, and (secondarily) aids in abduction of the arm above 90 degrees. Nerve: Spinal Accessory Nerve (11th cranial)

Rhomboid Minor O, I, NS, Fx

Superior to Rhomboid Major. Origin is ligamentum nuchae and spinouce processes of C7-T1 Insertion is at medial border of scapula between superior angle and trigone of spine function is to retract and elevate the scapula Nerve supply is dorsal scapular nerve