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Anatomy > Deep Back and Suboccipital Triangle > Flashcards

Deep Back and Suboccipital Triangle Flashcards

1
Q

origin and insertion of deep (intrinsic) back muscles

A

within the axial skeleton

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2
Q

general function of deep back muscles

A

maintain posture and control movement of the vertebral column, particularly extension of the head and spine

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3
Q

3 main groups of deep back muscles

A
  1. superficial - splenius. In cervical region, divides into capitis/cervicis portions
  2. intermediate - erector spinae. Spanning many vertebral levels; divided into 3 longitudinal groups
  3. Deepest - transversospinales - attach transverse process of vertebrae to spinous process of more superior vertebrae. Consists of 3 groups
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4
Q

division of splenis

A

capitis and cervicis

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5
Q

division of erector spinae

A

iliocostalis, longissimus, spinalis

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6
Q

Division of transversospinales

A
  1. Semispinales - having thoracis, cervicis, and capitis portions (span 4-6 segments)
  2. multifidus
  3. rotares
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7
Q

In addition to 3 main groups of deep back muscles, what else is there

A

very deep short segmental muscles

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8
Q

Short segmental muscle components

A
  1. Interspinales - between adjacent spinous processes
  2. Intertransversarii - between adjacent transverse processes
  3. Levatores constarum - between transverse processes and rib 1 to 2 levels down
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9
Q

function of deep back muscles

A

all extensors of the spine/head. Some function in rotation or lateral flexion (side bending) of the vertebral column or head. Many of the smaller muscles likely only stabilize segmental levels and act as proprioceptors

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10
Q

describe thoracolumbar fascia in deep back

A

thicker in lumbar than thoracic and believed to have an important functional role in the mechanical stability of the low back

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11
Q

Thoracolumbar fascia in thoracic region

A
  1. lies deep to the extrinsic muscles of the back

2. attaches medially to the thoracic spinous processes and laterally to the rib angles

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12
Q

Thoracolumbar fascia in the lumbar region

A
  1. 3 layers - all of which fuse laterally with aponeuroses of lateral abdominal and superficial back musculature
  2. posterior layer has bony attachments to the lumbar spinous processes, medial sacral crest, and the superior ilium
  3. Middle layer and anterior layer attach to the lumbar transverse (costal) processes, enveloping the quadratus lumborum muscle of the posterior abdominal wall, thus the anterior layer is anterior (deep) to the quadratus lumborum. The deep back muscles are enclosed by the middle and posterior layers
  4. all 3 layers attach to the iliac crest and sacrum , closing these compartments inferiorly
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13
Q

Describe splenius capitis

A
  1. Deep to trap
  2. originates from inferior half of the ligamentum nuchae and the spinous processes of vertebrae C7-T4
  3. Fibers directed superolaterally (perp to trap)
  4. Inserts onto the mastoid process of the temporal bone and just inferior to the lateral 1/3 of the superior nuchal line
  5. laterally flexes (side bends to same side) and ipsilaterally rotates
  6. bilaterally, they extend the head and neck
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14
Q

Splenius cervicis description

A
  1. originates from spinous process of T3-T6 (overlaps capitis)
  2. inserts onto the posterior tubercles of the transverse process of C1-C4
  3. acting unilaterally, it laterally flexes and ipsilaterally rotates the neck. Bilaterally extends neck
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15
Q

Describe erector spinae muscles

A
  1. muscle fibers span 6-10 vert in vertical direction
  2. 3 muscle groups: iliocostalis, longissimus, and spinalis
  3. lowest sections of iliocostalis and longissimus have a common origin via the thoracolumbar fascia to the following: iliac crest, sacrum, sacroiliac ligaments and lumbar spinous processes
  4. Thoracolumbar fascia encloses/sheaths these muscles and the muscles attach to its inner surface
  5. Erector spinae line of pull provides a dynamic posterior shear force and a compression fore
  6. Main extensors of vertebral column
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16
Q

Describe iliocostalis

A
  1. most lateral column
  2. originates from thoracolumbar fascia
  3. inserts on rib angles C4-C6 cervical transverse processes
  4. bilateral contraction extends the vertebral column
  5. unilateral contraction laterally flexes the vertebral column
  6. This has the most effective leverage for lateral flexion of the erector spinae muscles
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17
Q

Describe Longissimus

A
  1. spans from sacrum to skill. Largest and most developed erector spinae muscles
  2. Origin: thoracolumbar and thoracic transverse processes
  3. Inserts: medial to rib angles, transverse processes (T and C) and mastoid process
  4. Bilaterally extends vertebral column
  5. Unilaterally, laterally flexes and ipsilaterally rotates the head and neck
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18
Q

Describe spinalis

A
  1. least extensive
  2. attaches between spinous processes, arching across 4-10 vertebrae
  3. also attaches to ligamentum nuchae
  4. acts to weakly extend the vertebral column
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19
Q

Describe tranversospinalis muscle group

A
  1. Deep to erector spinae
  2. Origins: mamillary process in lumbar, transverse process in thoracic, articular process in cervical
  3. fibers slant superomedially
  4. Inserts: spinous process of a more superior vertebra
  5. Unilateral contraction: lateral flexion and contralateral rotation
  6. bilateral contraction: extension
  7. stabilizers are important for proprioception and posture
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20
Q

Semispinalis muscles description

A
  1. spans upper half of vert column, with inidividual fibers spanning 4-6 vertebral segments
  2. Divided into thoracis, cervicis, and capitis
  3. all 3 portions extend the vertebral column/head
  4. unilaterally, thoracic/cervicis may weakly contralaterally rotate vertebral column/head
21
Q

semispinalis thoracis

A

long tendons

22
Q

semispinalis cervicis

A

thicker than thoracis, deep to capitis, prominent convergence onto C2 spinous process

23
Q

semispinalis capitis

A

deep to splenius, inserts on skull between superior and inferior nuchal lines

24
Q

describe multifidus

A
  1. each fascicle spans 2-4 verterbral segments
  2. robust in lumbar region where it lies deep to the erector spinae muscles.
  3. originates from sacrum, PSIS, mammillary process, transverse process
  4. inserts on spinous process of vertebra 2-4 segments above its site of origin
  5. bilaterally extends (Stabilizer)
  6. unilaterally, lateral flexion and weak contralateral rotation of vertebral column
25
Q

Describe rotatores

A
  1. Deepest of transversospinalis group
  2. found throughout the sacrum to C2, thickest in thoracic region
  3. each fascicle spans 1 (rotares brevis) or 2 (rotares longus) vertebral segments
  4. originates from transverse processes, mamillary processes, and articular processes in cervical regions
  5. inserts onto the base of more superior spinous processes
  6. might extend the vertebral column and rotate it contralaterally more likely a stabilizer and does proprioception
26
Q

transversospinalis muscle group contains

A

semispinalis, mutlifidus, and rotares

27
Q

Short segmental muscle group

A
  1. Interspinales
  2. Intertransversarii
  3. Levatores costarum
28
Q

Interspinales description

A

short muscle that blends with the interspinous ligament, attaching near the tips of adjacent spinous processes - likely to aid in stabilizing adjacent vert.

29
Q

Intertransversarii description

A
  1. short muscle that attaches to the transverse process of adjacent vertebrae - aid in stabilizing adj vert
30
Q

levatores costarum

A
  1. originates from transverse processes of vertebrae C7-T11
  2. Fibers pass inferolaterally to insert on rib one level below (lc brevis) or 2 levels below (lc longus) site of origin
  3. May elevate the ribs, assisting with inpspiration, likely act in stabilization/proprioception
31
Q

intrinsic muscles and overlying skin are segmentally innervated by

A

dorsal rami of spinal nerves EXCEPT for intertransversarii (may receive ventral rami)

32
Q

motor fibers innervate what

A

effectors (contractile elements in muscles, sweat glands in skin)

33
Q

sensory fibers do what

A

carry signals from sense organs (skin, propropceptors)

34
Q

what do muscular branches of nerves have

A

motor and sensory fibers

35
Q

what do cutaneous branches of nerves have

A

motor and sensory fibers

36
Q

what is the innervation from T6 to the skull

A

the cutanous sensation passes primarily through medial branches

37
Q

what is the innervation inferior to T6

A

lateral branches contribute to cutaneous sensation

38
Q

what innervates the intrinsic muscles

A

both medial and lateral branches

39
Q

Dorsal rami innervation

A

to deep back and supply dermatome sensation to the posterior back, sensation to the posterior vertebral ligaments, and apophyseal joints

40
Q

Describe the blood supply of the deep back

A
  1. Back muscles and overlying skin receive their blood supply in segemental arrangement
  2. In cervical region, blood is supplied via the vertebral artery, deep cervical artery, occipital artery, and deep branch of the transverse cervical artery
  3. in thoracic region, posterior intercostal arteries are involved
  4. in lumbar region, dorsal branches of lumbar arteries supply the muscles and skin
41
Q

Describe the suboccipital region and triangle

A
  1. pyramidal shape space located deep to the semispinales muscles, bilaterally
  2. posterior arch of C1 and posterior atlanto-occipital membrane form the floor
  3. contains 4 paired muscles attaching to combos of C1 C2 and inferior nuchal lines of occiput
  4. triangle is bounded by the first 3 muscles below (OCI, OCS, RCMj)
    a. Superomedial boundary is the inferolateral margin of the RCP major
    b. Superolateral boundary is the inferomedial margin of the OCS
    c. Inferolateral boundary is the superior margin of the obliquus inferior
42
Q

Describe Obliquus Capitis Inferior

A
  1. originates from spine of C2
  2. Inserts onto the transverse process of C1
  3. Ipsilateral rotation of head/neck at atlantoaxial joint
43
Q

describe Obliquus capitis superior

A
  1. originates from the transverse process of C1
  2. inserts between the superior and inferior nuchal lines, laterally
  3. extension of head at atlanto-occipital joint (AO)
44
Q

describe rectus capitis posterior major

A
  1. originates from the spine of C2
  2. inserts on inferior nuchal line, intermediately
  3. extends (AO jt) and ipsilaterally rotates (AA jt) the head
45
Q

Rectus capitis posterior minor description

A
  1. medial and slightly deeper than major
  2. originates from posterior tubercle of C1
  3. inserts on inferior nuchal line, medially
  4. aids in extension of head (AO jt)
46
Q

what does the suboccipital triangle contain

A

the location of important nerves and vessels

47
Q

Suboccipital nerve

A
  1. dorsal ramus of C1 spinal nerve
  2. passes superior to the posterior arch of C1 and inferior to the vertebral artery
  3. innervates all 4 of the suboccipital muscles
48
Q

Vertebral artery

A
  1. branch of the subclavian artery
  2. passes superiorly through the transverse foramina of C6 up to C1
  3. After penetrating the transverse formaen of C1, the artery turns medially and lies in a groove on the superior surface of the posterior arch of C1, eventually enters the skull
49
Q

Greater occipital nerve

A
  1. not within triangle but just inferior
  2. medial branch of the dorsal ramus of C2 spinal nerve
  3. emerges between the posterior arch of C1 and lamina of C2
  4. passes just inferior to the obliquus capitis inferior
  5. ascends deep to the semispinalis capitis which is pierces before penetrating the trapezius near this muscles attachment to the skull
  6. helps supply cutaneous sensation to the posterior scalp

Anatomy (4 decks)

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