Superficial and Deep back Flashcards
how many back layers
6
superficial 1, 2
intermediate 4
deep back 4,5,6
layer 1 of back
trapezius
latissimus dorsi
layer 2 of back
rhomboideus major
rhomboideus minor
levator scapulae
layer 3 of back
serratous posterior superior
serratous posterior inferior
layer 4 of back
erector spinae which includes:
iliocostalis
longissimus
spinalis
splenius capitis AND cervicis
layer 5 of back
Transversospinalis which includes:
semispinalis
multifidus
rotatores
intersegmental muscles
interspinales
Intertransversarii
subocciptial muscles
rectus capitis posterior major
rectus capitis posterior minor
obliquus capitis superior
obliquus capitis inferior
what 5 muscles attach the scapula to the vertebral column
trapezius latissimus dorsi levator scapulae rhomboideus minor rhomboideus major
triangle of ausculation borders
medial- trapezius
lateral- rhomboideus major
inferior- latissimus dorsi
trapezius
Origin–> external occiptial protuberance, superior nuchal line
via the nuchal ligment to the cervical/upper thoracic spinous processes to TV12
Insertion- lateral superior border of the clavicle
acromion and spine of the scapula
action of trapezius
superior fibers–> elevate scapula, assists in upward rotation of the glenoid cavity
middle fibers–> retraction of the scapula
inferior fibers–> upward rotation of glenoid cavity
innervation of trapezius
spinal accessory nerve (cranial nerv XI)
ventral rami of spinal nerves C3 to C4 (sensory)
what artery is found in the trapezius
transverse cervical artery
CN X( (spinal accessory nerve) and spinal nerves C3 and C4 form a network of nerves on the ventral surface of the trapezius known as…
subtrapezial plexus
how do you test the integrity of the spinal accessory nerve?
ask pt to shrug their shoulders against resistance
any change in strength on either side implied injury to spinal nerve (accessory) (CN XI)
latissimus dorsi (o )
o–> spinous processes T6-T12
via thoracolumbar fascia to all lumbar and sacral spinous processes
posterior one third of the crest of the ilium
outer surfaces of the ribs 9-12
inferior angle of the scapula
latissimus dorsi insertion
floor of the intertubercular groove of humerus
action of latissimus dorsi
adducts, extends, and medially rotates the humerus (swimmer doing the butterfly)
innervation of latissimus dorsi
thoracolumbar nerve
levator scapulae
Origin- transverse process of cervical vertebrae 1-4
insertion–> medial border of scapula from superior angle to root of spine
action of levator scapulae
elevates scapula
assists in downward roation of the glenoid cavity
innervation of the levator scapulae
dorsal scapular nerve (c5)
3rd and 4th cervical nerves
rhomboideus minor
superor the the rhomb. majory
origin–> spinous processes of C7 to T1
insertion–> medial border of scapula at root of scapular spine
rhomboideus minor action and innervation
action–> retracts scapula, downwardly rotaes the glenoid cavity
innervation–> dorsal scapular nerve
rhomboideus major
origin –> spinous process T2-T5
insertion–> medial border of scapula from root of spine to inferior angle
rhomboideus major action and innervation
retracts scapula, downwardly rotates glenoid cavity
innervation –> dorsal scapular nerve
what is the transverse cervical artery a branch of?
thyrocervical trunk (1st portion of the subclavian artery)
divides into superficial and deep branch
where is the superficial branch of the transverse cervical artery?
descends in company with the spinal accessory nerve on the deep surface of the trapezius
where is the deep branch of the transverse cervical artery?
run deep to the levator scapulae and the rhomboid muscles
accompanies the dorsal scapular nerve and participates in the scapular anastomosis
from what does the dorsal scapular artery arise from?
arises from the 2nd or 3rd portion of the subclavian artery and courses posteriorly between portions of the brachial plexus and neck musculature
this artery then follows the path described above by the deep branch of the transverse cervical artery
thoracodorsal artery
a branch of the subscapular artery (3rd portion of the axillary artery)
accompanies the thoracodorsal nerve on the ventral surface of the latissimus dorsi muscle
what do some texts also refer the deep branch of the transverse cervicalartery as?
descending or dorsal scapular nerve
see buck book pg 30
nerves that innervate the muscles of the upper limb and superficial back are derived from what?
ventral rami of spinal nerves associated with the brachial plexus
what innervates the superficial muscles of the back?
ventral primary rami of cervical spinal nerves
AND for the trapezius only the spinal accessory nerve which is cranial nerve XI
what innervates the intermediate muscles of the back? and what are the intermediate muscles of the back?
ventral primary rami of thoracic spinal nerves
(intercostal nerves)
serratous posterior superior and inferior
what is the primary function of the deep muscles of the back?
extend, sidebend, and rotate the spine
what are the muscles groups of the deep muscles of the back?
splenius erector spinae (no rotation) transversospinal group intersegmental muscles muscles of the subocciptial triangle
serratous posterior superior (intermediate)
origin–> nuchal ligament and spinous processes of CV7-TV3
Insertion–> posterior surface of ribs 2-5 lateral to the angle
action of serratous posterior superior
elevates ribs during inspiration
innervation of serratous posterior superior
intercostal nerves T1-T4
origin of serratous posterior inferior
spinous process TV11-LV2 via thoracolumbar fascia
insertion of serratous posterior inferior
posterior surface of ribs 9-12 lateral to the angle
SAME INSERTION AS latissimus dorsi
action of serratous posterior inferior
depresses lower four ribs allowing diaphragm to act during inspiration (stabilizes the diaphragm)
innervation of the serratous posterior inferior
intercostal nerves T9-T11 AND subcostal nerve (underneath last rib)
fascia
continuous layer extending from skull to the sacrum
possesses regionally named divisions
- nuchal
- throacolumbar fascia (thorax and lumbar regions)
superficial lamina (fascia) attachments
attachaed medially to the nuchal ligament, supraspinal ligament, tips of all spinous processes, median crest of the sacrum
deep (anterior) (fascia) lamina attachment
attached medially to the base of the skull below the superior nuchal line, to the tips of cervical and lumbar transverse processes and in the thoracic region to the angles of the ribs
NOTE about fascia
laterally the two layers of the nuchal fascia blend to become continuous with the prevertebral fascia
laterally the anterior and posterior laminae of the thoracolumbar fascia blend with the fascias of the anterolateral abdominal musculature
splenius capitis et cervicis origin
spinous process of CV7 - TV6
insertion of splenius capitis
lateral portion of the superior nuchal line and mastoid process
insertion of splenius cervicis
posterior tubercles of transverse processes of CV1 to CV3
action of capitis splenius
extends head
rotates and side bends the head and neck to the same side
action of cervicis splenius
extends and rotates neck to the same side
also binds deeper musculature
innervation of splenius capitis and cervicis
dorsal rami of C2-C5
erector spinae muscle group
occupies vertebral costal groove
extends the full length of the vertebral column
inferiorly it attaches via a strong aponeurotic tendon to the iliac crest, sacrum, lumbar spinous process and supraspinal ligament
***primarily an EXTENSORS and side bender of the spine AND POSTURAL Muscles NOT FOR ROTATION
iliocostalis divisions
lumborum
thoracis
cervicis
part of erector spinae muscle
origin of iliocostalis
crest of ilium and sacrum
posterior surface of ribs at angle
insertion of ilocostalis
angle of ribs
transverse processes lower cervical vertebrae
proximal attachment versus distal attachment
proximal–> usually the origin
distal –> usually the insertion
innervation of ilocostalis AND spinalis
dorsal rami of spinal nerves from vertebral segments covered by muscle
division of longissimus
thoracis, cervicis, capitis
origin of longissimus
transverse process below
insertion of longissimus
transverse process above
capitis portion inserts on mastoid process deep to splenius and sternocleidomastoid muscles
action of longissimus
extends vertebral column
lateral flexion to same side
capitis portion*** extends skull and rotates it to the same side
origin of spinalis
part of erector spinae muscles
divided into thoracis, cervicis, capitis
***the capitis portion is usually blended/fused with a deeper muscle, the semispinalis capitis
origin—>spinous process below
insertion of spinalis
spinous processes above
action of spinalis
extends vertebral column, lateral flexion to same side
capitis portion extends the skull
general movements of transversospinal group (5th layer) if acting on one side
rotate vertebrae above to opposite side
side bend the vertebral column to the same side
general movements of transversospinal group (5th layer) if acting with both sides
extends the vertebral column
origins of transversospinal groups
on transverse process below
insertions of transversospinal groups
on spinous process one to six segments above depending on specific subdivision
innervation of transversospinal groups
dorsal rami of spinal nerves of vertebral segments covered by muscle
divisions of transversospinal group
semispinalis– subdivision spanning 4-6 vertebrae
multifidus- subdivisions spanning 2-4 vertebrae
rotatores-subdivisions spanning 1-2 vertebrae
semispinalis thoracis
continuous with semispinalis cervicis
semispinalis cerviscis
ends at spinous process of CV2 (first bifid spinous process)
semispinalis capitis
largest muscle of the posterior neck
extends from mid thoracic and lower cervical vertebrae to the skull
covers semispinalis cervicis
multifidus
extends the length of the vertebral column from sacrum to CV2
most well developed in lumbar area
***important in extension and minimal rotatory component
semispinalis general info
extends one half of vertebral column from lower thoracic to upper cervical levels
rotatores
each subdivision spans one to two vertebrae
note on movement of rotatores and multifidus
since these span fewer vertebral segments compared to semispinalis they function more as stabilizers between individual vertebral segments than as prime movers
intersegmental deep back muscles 6th layer general info
lcoated deep to transversospinal muscles
consists of short muscles that span one vertebral segment
stabilizers***
high concentration of stretch receptors allow them to feedback on postural spinal muscles
innervated by dorsal rami of regional spinal nerves EXCEPT for levatores costarum
interspinales
paired muscles (left and right) that span adjacent spinous processes of cervical and lumbar vertebrae
local adjustors*** constantly keeping spine straight b/c they are filled with proprioceptor fibers
intertransversarii
paired muscles (anterior and posterior)
span adjacent transverse processes of cervical and lumbar vertebrae
what is the anterior portion of the intertransversarri innervated by ?
anterior innervated by ventral rami
what is the posterior intransversarri divided into and what innervates each part?
divided into medial and lateral portions
medial innervated by dorsal rami
lateral innervated by ventral rami
what is the lateral muscle group (of the 6th layer) that is located in the thoracic region only
the lateral posterior intertransversarri which are called the LEVATOR COSTARUM
levator costarum general info
extend from transverse processes ABOVE to ribs (medial to angle) one and two segments BELOW
function of levator cost arum??
elevate ribs during inspiration
what innervates the levator costarum?
innervated by corresponding VENTRAL RAMI of spinal nerves
location of subocciptial triangle
deep to semispinalis capitis
function of subocciptial triangle
extend the skull and rotate the skull and atlas to the same side
innervation of suboccipital muscles
dorsal ramus of cervical nerve C1 (suboccipital nerve)
rectus capitis posterior major
origin spinous process of CV2
insertion inferior nuchal line and occipital bone below
action of rectus capitis posterior major (x3)
extension and lateral flexion of the skull
minimal rotation to the same side
rectus capitis posterior minor
more medial than the rectus capitis posterior major
origin–> posterior tubercle of atlas
insertion of rectis capitis posterior minor
medial portion of inferior nuchal line and occipital bone between inferior nuchal line and foramen magnum
may also attach to dura between CV1 and occiput
obliquus capitis inferior
origin –> spinous process of CV2
insertion–> transverse proces of atlas
***only muscle that turns the head but does not attach to the head
action of obliquus capitis inferior
rotates skull and atlas on odontoid process to the same side
obliquus capitis superior
origin–> transverse process of atlas
insertion–> occipital bone between super and inferior nuchal lines
action of obliquus capitis superior
extends and sidebends the skull to the same side
lateral superior border of the suboccipital triangle
obliquus capitis superior
lateral inferior border of the suboccipital triangle
obliquus capitis inferior
medial border of the suboccipital triangle
rectus capitis posterior major
roof and floor of the suboccipital triangle
roof–> semispinalis capitis
floor–> posterior atlantooccipital membrane and the posterior arch of the atlas
vertebral artery
traverses the transverse cervical foramen of atlas and turns medially along the groove in the posterior arch of the atlas and pierces the posterior atlantoccipital membrane to gain the foramen magnum
suboccipital nerve (C1-dorsal ramus)
pierces the atlantoocciptal (posterior) membrane between the posterior arch of the atlas and the vertebral artery
passes through the sub occ triangle and distributes to all sub occ muscles
greater occiptial nerve (C2-dorsal ramus)
emerges from beneath the obliquus capitis inferior
turns upward to cross that muscle and the subocc triangle and pierces the semispinalis capitis and trapezius
innervates the posterior scalp as far forward as the vertex of the skull
what is the cause of tension headaches?
passage of the greater occipital nerve through the substance of the semispinalis capitis places the nerve in a position where after prolonged extension of the neck CONTINUED TRACTION of the nerve results in the headache
vessels of deep back usually are what ?
dorsal branches of specific arteries
how is venous return accomplished in the deep back ?
venae comitantes of the arterial supply
tributaries to occipital, ascending cervical, vertebral, posterior intercostal, lumbar, iliolumbar, lateral sacral veins, most of which have continuity with the vertebral venous plexus
