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C7
Vertebrae prominens
T1-T2
Superior angle of the scapula
T7
Inferior angle of the scapula
L4
Iliac crest
Extrinsic muscles
Superficial group (trapezius, latissimus dorsi, rhomboid major, rhomboid minor, levator scapulae) and intermediate group (serratus posterior superior and serratus posterior inferior)
Superficial group of the extrinsic muscles
Controls upper limb movements since it connects upper limbs to the trunk
Layer 1 of the superficial group
Trapezius and latissimus dorsi
Layer 2 of the superficial group
Rhomboid major, rhomboid minor, levator scapulae
Insertion of Trapezius
Upper fibers to lateral third of posterior border of clavicle; lower to medial acromion and superior lip of spine of scapula to deltoid tubercle
Origin of Trapezius
Medial third superior nuchal line, ligament nuchae, spinous processes and supraspinous ligaments to T12
Action of Trapezius
Laterally rotates, elevates and retracts scapula. If scapula is fixed, extends and laterally flexes neck
Innervation of Trapezius
Spinal accessory cranial nerve 11 - CN XI
Supply of Trapezius
Transverse cervical artery
Insertion of Latissimus Dorsi
Floor of bicipital groove of humerus after spiraling around teres major
Origin of Latissimus Dorsi
Spine T7, spinous processes and supraspinous ligaments of all lower thoracic, lumbar and sacral vertebrae, lumbar fascia, posterior third iliac crest, last four ribs (interdigitating with external oblique abdominis) and inferior angle of scapula
Action of Latissimus Dorsi
Extends, adducts and medially rotates arm. Costal attachment helps with deep inspiration and forced expiration; also plays a role in the expiratory efforts as in coughing and sneezing
Innervation of Latissimus Dorsi
Thoracodorsal nerve
Supply of Latissimus Dorsi
Thoracodorsal artery
Intermediate group of the extrinsic muscles
Associated with the thoracic wall, and control respiratory movement
Insertion of Rhomboid major
Lower half of posteromedial border of scapula, from angle to upper part of triangular area at base of scapular spine
Origin of Rhomboid major
Spines of T2-T5 and supraspinous ligaments
Action of Rhomboid major
Retracts scapula. Rotates scapula to rest position
Innervation of Rhomboid major
Dorsal scapular nerve
Supply of Rhomboid major
Dorsal scapular artery
Insertion of Rhomboid minor
Small area of posteromedial border of scapula at level of spine, below levator scapulae
Origin of Rhomboid minor
Lower ligamentum nuchea, spines of C7 and T1
Action of Rhomboid minor
Retracts scapula. Rotates lower scapula back to rest position
Innervation of Rhomboid minor
Dorsal scapular nerve
Supply of Rhomboid minor
Dorsal scapular artery
Insertion of Serratus posterior superior
Posterior aspect of ribs 2-5
Origin of Serratus posterior superior
Spinous processes and supraspinous ligaments of C7-T2
Action of Serratus posterior superior
Assists forced inspiration
Innervation of Serratus posterior superior
Anterior primary rami
Supply of Serratus posterior superior
Posterior intercostal arteries
Triangle of auscultation
Trapezius and Latissimus Dorsi
Insertion of Serratus posterior inferior
Posterior aspect of ribs 9-12
Origin of Serratus posterior inferior
Spinous processes and supraspinous ligaments of T11-L2
Action of Serratus posterior inferior
Assists forced expiration
Innervation of Serratus posterior inferior
Anterior primary rami
Supply of Serratus posterior inferior
Posterior intercostal arteries
Intrinsic muscles
Superficial layer (splenius capitis and splenius cervicis), intermediate layer (erector spinae), deep layer (semispinalis, multifidus, rotatores)
Origin of Splenius capitis
Lower ligament nuchae, spinous processes and supraspinous ligaments T1-3
Insertion of Splenius capitis
Lateral occiput between superior and inferior nuchal lines
Action of Splenius capitis
Extends and rotates cervical spine
Innervation of Splenius capitis
Posterior primary rami of C3, 4
Supply of Splenius capitis
Deep cervical artery and the posterior intercostal arteries
Origin of Splenius cervicis
Spinous processes and supraspinous ligaments of T3-6
Insertion of Splenius cervicis
Posterior tubercles of transverse processes of C1-3
Action of Splenius cervicis
Extends and rotates cervica spine
Innervation of Splenius cervicis
Posterior primary rami of C5, 6
Supply of Splenius cervicis
Deep cervical artery and the posterior intercostal arteries
Origin of Erector spinae
Posterior sacrum, iliac crest,
sacrospinous ligament, supraspinous
ligament, spinous processes of lower
lumbar and sacral vertebrae
Insertion of Erector spinae
Iliocostalis : angles of lower ribs, cervical transverse processes Longissimus: between tubercles and angles of ribs, transverse processes of thoracic and cervical vertebrae, mastoid process Spinalis: spinous processes of upper thoracic and midcervical vertebrae
Action of Erector spinae
Extends and laterally bends vertebral column and head
Innervation of Erector spinae
Dorsal rami of each region
Supply of Erector spinae
Cervical portions: occipital, deep cervical, and vertebral arteries Thoracic portions: dorsal branches of posterior intercostal, subcostal, and lumbar arteries Sacral portions: dorsal branches of lateral sacral arteries
Origin of Serratus anterior
Eight digitations from the upper 8 ribs
Insertion of Serratus anterior
Into the ventral aspect of the medial border of the scapula
Action of Serratus anterior
Superior external rotation of the scapula; draws from the scapula internally and forwards; lowers the arm from a raised position; elevates ribs; boxer’s muscle
Innervation of Serratus anterior
Long thoracic nerve and the brachial plexus (C5-C7)
Supply of Serratus anterior
Lateral thoracic artery
Origin of Semispinalis
Transverse processes of C4–T12
Insertion of Semispinalis
Spinous processes of cervical and thoracic regions
Action of Semispinalis
Cervical portions: occipital, deep
cervical, and vertebral arteries
Thoracic portions: dorsal branches
of posterior intercostal arteries
Innervation of Semispinalis
Dorsal rami of spinal nerves
Supply of Semispinalis
Extends head, neck, and thorax and rotates them to opposite side
Origin of Multifidus
Sacrum, ilium, transverse processes
of T1–T12, and articular processes of
C4–C7
Insertion of Multifidus
Spinous processes of vertebrae
above, spanning two to four
segments
Action of Multifidus
Stabilizes spine
Innervation of Multifidus
Dorsal rami of each region
Supply of Multifidus
Cervical portions: occipital, deep cervical, and vertebral arteries Thoracic portions: dorsal branches of posterior intercostal, subcostal, and lumbar arteries Sacral portions: dorsal branches of lateral sacral arteries
Origin of Rotatores
Transverse processes of cervical,
thoracic, and lumbar regions
Insertion of Rotatores
Lamina and transverse process of
spine above, spanning one or two
segments
Action of Rotatores
Stabilizes, extends, and rotates spine
Innervation of Rotatores
Dorsal rami of spinal nerves
Supply of Rotatores
Dorsal branches of segmental arteries
The spinal root of the accessory nerve (CN XI) supplies…
The trapezius and the sternomastoid. It is the only motor supply for these two muscles.
How does the trapezius with the Serratus anterior rotate the scapula?
It rotates the scapula upwards from 90-180 degrees, raising the limb above the head; abduction above 90 degrees
Levator scapulae, rhomboid major and rhomboid minor
All take origin from the vertebral column, insert into the scapula, and are supplied by the dorsal scapular nerve
Winging of the scapula
Damage to the long thoracic nerve
A typical vertebra has the following:
Body, vertebral arch, articular processes, intervertebral foramen, lamina, pedicle, transverse processes, spinous process, and vertebral foramen
Body of the vertebra
The weight-bearing portion of a vertebra that tends to increase in size as one descends down the spine
Articular processes
Two superior and two inferior facets for articulation with adjacent vertebrae
Intervertebral foramen
The opening formed by the vertebral notches that is traversed by spinal nerve roots and associated vessels
Lamina
Paired portions of the vertebral arch that connect the transverse processes to the spinous processes
Pedicle
Part of the vertebral arch that attaches the transverse processes to the body
Transverse processes
Lateral extensions from the union of the pedicle and the lamina
Spinous process
A projection that extends posteriorly by the union of two lamina
Vertebral foramen
a foramen formed from the vertebral arch and body that contains the spinal cord and its meningeal coverings
Cervical vertebrae
Small in size, have a transverse foramen to transmit the vertebral vessels
C1
Atlas, has no vertebral body or spinous process
C2
Axis, has a dens (which is the body of the atlas)
Atlanto-occipital joint
Allows the head to nod up and down, Yes-Yes joint (flexion and extension)
Atlanto-axial joint
Allows the head to rotate side to side, No-No joint (rotation)
Suboccipital muscles
Lie deep to the trapezius & sternomastoid, the splenius capitis, and the semispinalis capitis. Consists of two recti and two obliquus muscles, all of which are innervated by the suboccipital nerve (dorsal ramus of C1 - motor only)
Occipital artery
Branch of the external carotid artery
Vertebral artery
Branch of the subclavian artery
2 structures within the floor of the suboccipital triangle
Vertebral artery and tthe suboccipital nerve, purely moto
2 structures within the roof of the suboccipital triangle
Occipital artery and the greater occipital nerve, purely sensory
Origin of the Rectus major
Spine of axis
Insertion of the Rectus major
Inferior nuchal line
Action of the Rectus major
Extends and rotates head to same side
Innervation of the Rectus major
Suboccipital nerve
Supply of the Rectus major
Vertebral artery, descending branch of occipital artery
Origin of the Rectus minor
Tubercle of posterior arch of atlas
Insertion of the Rectus minor
Median inferior nuchal line
Action of the Rectus minor
Extends head
Innervation of the Rectus minor
Suboccipital nerve
Supply of the Rectus minor
Vertebral artery, descending branch of occipital artery
Origin of the Inferior oblique
Spine of axis
Insertion of the Inferior oblique
Transverse process of atlas
Action of the Inferior oblique
Rotates atlas to turn face to same side
Innervation of the Inferior oblique
Suboccipital nerve
Supply of the Inferior oblique
Vertebral artery, descending branch of occipital artery
Origin of the Superior oblique
Transverse process of atlas
Insertion of the Superior oblique
Occipital bone
Action of the Superior oblique
Extends and bends head laterally
Innervation of the Superior oblique
Suboccipital nerve
Supply of the Superior oblique
Vertebral artery, descending branch of occipital artery