Superficial and Deep Back musculature Flashcards
What can the high mobility of the upper limb be attributed to
having only one bony attachment to the torso- the sternoclavicular articulation
What muscles attach the scapula to the vertebral column
Trapezius, Latissimus Dorsi, Levator Scapulae, Rhomboideus Minor and Major
What is the origin and insertion of Trapezius m
Origin- along midline posteriorly from occipital protuberance and sup nuchal line and all spinous processes till TV12
Insertion- Lateral superior border of clavicle, acromion and spine of the scapula
What are the actions of trapezius m
Superior- elevate scapula and assist in upward rotation of glenoid fossa
Middle fibers- retract the scapula(tense)
Inferior- upward rotation of the glenoid fossa
What innervates trapezius
CN XI spinal accessory- motor
Ventral rami of spinal nerves C3 and C4 (sensory)
What is in the subtrapezial plexus
CN XI and spinal nerves C3 and C4 network
How do we test the integrity of spinal accessory
Asking the patient to shrug his/her shoulders against resistance- any disparity on either side implies injury to CN XI
What is the origin of latissimus dorsi m
ORigin- spinous processes T6-T12 via thoracolumbar fascia to all lumbar ans sacral processes, posterior 1/3 crest of ilium and outer surfaces of 9-12 and inferior angle of scapula
What is the insertion of latissimus dorsi m
floor of the inter tubercular (bicipital) groove of humerus
What is the action of latissimus dorsi m
adducts, extends and medially rotates the humerus
What is the innervation for latissimus dorsi m
Thoracodorsal nerve
What is the origin and insertion for Levator Scapulae m
origin- transverse processes of cervical vertebrae 1-4
Insertion- Medial border of scapula from superior angle to root of spine
Action of levator scapulae m
elevates scapula and assists in downward rotation of glenoid fossa
What innervates legator scapulae m
Dorsal scapular nerve C5, third and 4th cervical nerve
What is the origin and insertion of rhomboid minor
Origin- spinous processes C7 and T1
Insertion- medial border of scapula at root of spine
What is the action of rhomboid minor
retracts scapula, and downwardly rotates glenoid fossa
What is the innervation to rhomboid minor
dorsal scapular nerve
What is the insertion and origin of rhomboid major?
origin- spinous processes T2-T5
insertion- medial border of scapula from root of spine to inferior angle
What is the action of rhomboid major
retracts scapula, downwardly rotates glenoid cavity
What innervates the rhomboid major
dorsal scap nerve
What is the triangle of auscultation
located superficial to posterior 6th intercostal space, devoid of overlying muscle
What are the borders for the triangle of auscultation
Medial- trapezius
lateral rhomboid major
inferior- latissimus dorsi
What vessels are found in superficial back
Transverse cervical artery
Dorsal Scapular
Thoracodorsal
Describe transverse cervical a
passes posteriorly within posterior triangle of neck and slips deep to trapezius
splits in 50% cases to superficial and deep
Where does the superficial branch of transverse cervical a go?
descends with CN XI on deep surface of trapezius
is aided by dorsal branches of posterior intercostal aa
Where does the deep branch of transverse cervical a go?
runs deep to the levator scapulae and rhomboid mm, runs with dorsal scap nerve
Describe dorsal scapular artery
present in approx 50%. arises from 2nd or 3rd portion of subclavian artery and courses posteriorly. follows path of deep transverse cervical a
Describe the thoracodorsal artery
branch of sub scapular artery (3rd portion of axillary a)
accompanies thoracodorsal nerve on ventral surface of latissimus dorsi m
excluding trapezius, what nerves innervate mm of upper limb and superficial back
derived from ventral rami of spinal nerves assoc with brachial plexus
What are the muscles from the intermediate layer of the back
Serratus posterior superior and inferior
What is the origin and insertion of serratus posterior superior
origin- nuchal ligament and spinous processes Cv7-TV3
insertion- posterior surface of ribs 2-5 lateral to angle
What is the action os serratus posterior superior
elevates ribs during inspiration
What nerves innervate serratus posterior superior
intercostal nerves T1-T4
What is the origin and insertion of serratus posterior inferior
origin- spinous process TV11-LV2 via thoracolumbar fascia
insertion- posterior surface of ribs 9-12 lateral to angle
what is the action of serratus posterior inferior
depresses lower 4 ribs to allow diaphragm to act during inspiration
What is the inntervation of serratus posterior inferior
intercostal nn T9-T11 and subcostal n (T12)
What are the divisons of the deep back fascia
nuchal- cervical region
thorabolumbar- thorax and lumbar regions
What are the attachments of the back fascia
superficial- medially to nuchal lig, supraspinal lig and tips of cervical and lumbar transverse processes, angles of ribs in thorax
deep- medially to base of skull and tups of cervical and lumbar transverse processes and angles of ribs in thorax
Laterally, what does the anterior and posterior laminae of thoracolumbar fascia become
fuse with fascia of anterolateral abdominal musculature
Laterally, what does the nuchal fascia become
blends with the prevertebral fascia
What are the deep back muscles
Splenius Capitis et cervicis
Erector Spinae mm
Transversospinal group
Intersegmental deep back muscles
What is the origin of splenius capitis
spinous processes CV7-TV6
What are the insertions of the spelnius captiis et cervicis
Capitis- lateral portion of the superior nuchal line and mastoid process
Cervicis- posterior tubercles of transverse processes of CV1 to CV3
What are the actions of Splenius capitis
extend the head, rotate and side bend the head an neck to the same side
What are the actions of splenius cervicis
extend and rotate neck to same side, also bind to deeper musculature
What nerves innervate splenius capitis et cervicis
dorsal rami of C2-C5
Primarily the erector spinae m group has what function
extensor and side bender of the spine
Describe the origin and insertion of iliocostalis
origin- crest of ilium and sacrum, posterior surface of ribs at angle
insertion- angle of ribs, traverse processes of lower cervical vertebrae
Action of iliocostalis
extends vertebral column, laterally flexes(side beds) same side
Nerve innervation of iliocostalis
dorsal rami of spinal nerves from vertebral segments covered by muscle
What is the origin and insertion of longissimus
Origin- transverse processes beloe
Insertion- transverse processes aboce, capitis portion inserts on mastoid process deep to splenius and sternocleidomastoid m
What is the action of longissimus
Extends vertebral column, lateral flexion to same side, capitis portion extends skull and rotates it to same side
What is the innervation of longissimus
dorsal rami os spinal nerves from vertebral segments covered by mm
What is the origin and insertion of spinalis
origin- spinous processes below
insertion- spinous processes above
What are the actions of spinalis m
Extends vertebral column, lateral flexion to same side; capitis portion extends skull
What innervates the spinalis m
dorsal rami of spinal nerves from vertebral segments covered by muscle
What are the transversospinal muscles
Semispinalis
Multifidus
Rotatores
Describe the divisions of semispinalis
semispinalis thoracis- continuous with with semispinalis cervicis
semispinalis cervicis- ends at spinous provess of CV2
semispinalis capitis- largest post neck, extends mid-thoracic and lower CV to skull, covers semispinalis cervicis
What portion of the erector spinae mm fuses medially with semispinalis capitis
spinalis capitis
Describe multifidus mm
extends length of vertebral column from sacrum to CV2, each subdivision spanning 2-4 vertebrae
Where are the multifidus mm most developed
lumbar region
what is the function of multifidus mm
extension, minimal rotatory component
how are the rotatores mm different than multifidus
spans 1-2 vertebrae instead of 2-4
What is the main function of rotatores and multifidus
stabilizers between vertebral segments than as prime movers
What are the intersegmental deep back muscles
interspinales and intertransversarii and levator costarum
Describe the interspinales mm
paired mm (left & right) between spinous processes of cervical and lumbar vertebrae
Describe intertransversarri
paired (anterior and posterior) mm between transverse processes of cervical and lumbar vertebrae
What division of intertransversarri are innervated by ventral rami
anterior mm and the lateral portion of posterior
What innervates medial portion of posterior intertransversarri
dorsal rami
What is the name of the lateral posterior intertrasnversarri in the thoracic region
levator costarum mm
Where is the insertion of the levator costorum mm and its function
insert on ribs 1-2 segments below on superior surface function is to elevate the ribs during inspiration
What innervates the levator costorum mm
ventral rami of spinal nerves
Where is the suboccipital triangle located
deep to semispinalis capitis
What innervates ALL sub occipital mm
dorsal ramus of cervical spinal nerve C1 (suboccipital nerve)
What muscles are in the sub occipital triangle area
Rectus capitis posterior major and minor
obliquus capitis inferior and superior
Origin and insertion of rectus capitis posterior major
origin- spinous process of C2 axis
inserts- inferior nuchal line and occipital bone
action of rectus capitis posterior major
extension and lateral flexion of the skull; minimal rotation to same side
Origin and insertion of rectus capitis posterior minor
origin- posterior tubercle of C1 atlas
inserts- medial portion of the inferior nuchal line- may attach to dura between CV1 and occiput
What is the action of rectus capitis posterior minor
extension and some lateral flexion of the skull
What rectus capitis posterior mm can maybe be attributed with dural headache
rectus capitis posterior minor because of possible attachment to dura
what is the origin and insertion of obliquus capitis inferior
origin- spinous process of CV2
inserts- transverse process of atlas
Action of obliquus capitis inferior
rotates skull and atlas on odontoid process(dens) to same side
Origin and insertion of obliquus capitis superior
origin- transverse process of atlas
insertion- occipital bone between superior and nuchal lines
Action of obliquus capitis superior
extends and side beds the skull to same side
5 boundaries of suboccipital triangle
lateral superior- obliquus capitis superior
lateral inferior- obliquus capitis inferior
medial- rectus capitis posterior major
roof- semispinalis capitis
floor- posterior atlanto-occipital membrane and posterior arch of atlas CV1
Where does vertebral artery pass through in subocciptal area
turns along its groove on the posterior arch of the atlas and pierces the posterior atlantooccipital membrane to enter foramen magnum
Where does the sub occipital nerve pass through
pierces posterior atlanooccippital membrane between posterior arch of atlas CV1 and vertebral a.
Where does the greater occipital nerve pass through
emerges from beneath the obliquus capitis inferior and turns upward to cross the muscle and the triangle.
Pierces semispinalis capitis and trapezius to innervate posterior scalp as far as the vertex of skull
Describe the veins of the deep back
venae commitantes.(occipital, ascending cervical, vertebral, posterior intercostal, lumbar, iliolumbar, and lateral sacral vv) final common path of venous drainage for deep back as well as spinal cord and vertebral column
