Superficial, Deep Back, SubOccipital Triangle Flashcards
1
Q
3 sides of the scapula
A
Medial, Lateral, Superior
2
Q
Insertion/Innervation of Intermediate muscles
A
Insertion: Ribs distal to angle
Innervation: Spinal nerves, anterior rami
3
Q
Superior angle of the scapula
A
Where superior and medial borders meet
4
Q
Insertion/Innervation of Deep muscles
A
Insertion: vertebrae, skull, ribs (angle and proximal)
Innervation: Spinal nerves, posterior rami
5
Q
Glenoid fossa
A
Articulating surface of the scapula to the humerus
6
Q
Superficial fascia
A
- Immediately deep to the skin
- Contains branches of nerves/blood vessels/lymphatics
- Loose network of connective tissue
7
Q
Insertion/Innervation of superficial muscles
A
Insertion: Scapula
Innervation: Cranial nerve (XI), spinal nerves via plexus
8
Q
Rhomboid Major and Minor Action
A
Retraction and downward rotation of scapula
9
Q
Rhomboid Major: Origin, Insertion, Innervation, Arterial Supply
A
- O: Nuchal and supraspinious ligaments, spinous process of T2-5
- I: medial border of scapula, inferior to minor insertion
- In: Dorsal scapular nerve (C5 branch of brachial plexus)
- A: Dorsal scapular artery
10
Q
Serratus Posterior Inferior: Origin, Insertion, Innervation, Arterial Supply
A
- O: spinous process of T11-L2
- I: Ribs 9-12, just distal to angle of the rib
- In: anterior rami of T9-T12 (T9-T11 are intercostal nerves, T12 is subcostal nerve)
- A: Posterior intercostal arteries (branches of aorta)
11
Q
Hip-hitching
A
Ability of paraplegic to shift hips due to Lat connection to iliac crest, helps prevent bed sores
12
Q
Levator Scapulae: Origin, Insertion, Innervation, Arterial supply
A
- O: transverse process of C1-C4
- I: Superior angle of the scapula
- In: dorsal scapular nerve (C5 of brachial plexus)
- A: Dorsal scapular artery (subclavian origin) or deep branch of transverse cervical artery
13
Q
iatrogenic
A
Caused by a physician
14
Q
Rhomboid Minor: Origin, Insertion, Innervation, Arterial Supply
A
- O: Nuchal and Supraspinous ligaments, spinous process of C7-T2
- I: superior portion of the medial border of the spine
- In: Dorsal scapular nerve (C5 branch of brachial plexus)
- A: dorsal scapular artery (subclavian origin) or deep branch of transverse cervical artery
15
Q
Action of the Trapezuis
A
- Acts on the pectoral girdle
- Elevation (descending fibers)
- Depression (ascending fibers)
- Retraction (aka adduction, middle fibers)
- Upward rotation of the scapula (descending/inferior fibers)
- Extension of head/neck
16
Q
Arteries off of the Subclavian artery that go to the back
A
Thyrocervical truck → Transverse cervical artery
Bifercates!
Deep Transverse cervical branch (aka dorsal scapular artery when directly comes off of the subclavian artery): medial border of scapula
Superficial Transverse cervical branch: run deep to the trapezius
17
Q
Trapezuis: Origin, Insertion, Innervation, Arterial Supply
A
- O: Superior nuchael line, external occipital protuberance, nuchael ligament, C7-T12
- I: later 1/3 of clavicle, acromion process, spine of the scapula
- Innervation: Accessory XI
- A: Superficial branch of transverse cervical artery
18
Q
Triangle of Auscultation
A
Medial: Inferior margin of trapezius
Inferior: Superior margin of latissimus Dorsai
Lateral: medical border of scapula
Floor: 6th/7th rib and external intercostal within the 6th space
19
Q
Thoracodorsal artery pathway
A
Branches off axillary artery, through the axilla, to the deep surface of the lats
20
Q
Posterior Intercostal Arteries Pathway
A
Branches off of descending aorta, runs along the thoracic wall within the intercostal spaces
Gives rise to dorsal branch artery
21
Q
What innervated the subcutaneous tissue of the back?
A
- Posterior rami of spinal nerves C4 to L3 bifurcate to form posterior cutaneous branch.
- Medial branch forms the posterior branch in mid-thoracic
- Lateral branch of rami froms posterior branch in lower-thoracic/Lumber
22
Q
Clinical test for Accessory nerve function
A
Elevation of shoulder girdle against resistance (since clavicle supports shoulder, not the trapezius)
23
Q
Plexus
A
- Anterior rami of multiple spinal nerves combined
- Cervical, brachial, lumbar, sacral
- T1 anterior ramus connects to brachial plexus
- T12 anterior ramus connects to lumbar plexus
24
Q
Thoracolumbar fascia
A
- Extensive sheet extending to sacrum and iliac crest superiorly to the neck, from the spinous process laterally to the angle of the ribs
- 3 distinct layers
- Helps with lumbar stability
- Ultrasound can show reduced mobility often associated with lower back pain
25
Cervical nerve block placement
Posterior triangle
26
Accessory nerve
* Cranial nerve XI
* Motor nerve
* Enters via foramen magnum, exits jugular foramen, crosses internal jugular vein, runs into posterior triangle of the neck
* High iatrogenic injury rate
27
Acromion
Large-flattened, anteriorly-directed process off of the lateral tip of the scapula spine
28
Deep Fascia
* Compact sheet dominated by collagen
* Surrounds or encases other structures, particularly muscle
29
Inferior angle of the scapula
Where the lateral and medial angles meet
30
Serratus Posterior Superior: Origin, Insertion, Innervation, Arterial Supply
* O: Nuchal ligament, spinous process of C7-T3
* I: ribs 2-5, Just distal to the angle of the rib
* In: Anterior rami T2-T5 (intercostal nerves)
* A: Posterior intercostal arteries (branches of aorta)
31
Latissimus Dorsi: Origin, Insertion, Innervation, Arterial Supply
* O: C7-T12 spinous processes, ribs 9-12, thoracolumbar fascia, iliac crest
* I: Floor of intertubercular sulcus on anterior humerus
* In: Thoradorsal nerve (C6-8 branch of brachial plexus)
* A: Thoradorsal artery (branch of axillary)
32
Investing fascia
Continuous with the epimysium of the muscle
33
Back muscles drain into what major veins?
Brachiochephalic or Azygous veins
34
Cause of mild scapular winging
Dorsal scapular nerve being entrapped in scalenus muscle
35
Septum
Deep fascia extending from superficial fascia to skeletal features, defining compartments
36
Thoracolumbar fascia: Shape/thickness, Area, Layers
* Covers thoracic, lumbar, and sacral regions, blending into the serrated posterior inferior, lats, transverse abdominis
* Posterior, middle, anterior layers
* Thickens inferiorly
37
Posterior Layer of Thoracolumbar fascia: Attachements, what it covers
* Attachments: spinous process of lumbar, median sacral crest, supraspinous ligaments
* Covers the erector spinae muscles
38
Middle layer of thoracolumbar fascia: Attachments, role in anatomy borders
* Attachments: transverse processes of lumbar, lower boarder of rib 12, iliac crest
* Divides the back from the posterior abdominal wall (covers posterior portion of quadratus lumborum and anterior portion of erector spinae)
39
Splenius cervicis: Origin, Insertion, Action
* O: Spinous process of T3-T6
* I: Transverse process of C1-C3
* Action: extends the head/neck, lateral flex/rotates head toward contracting muscle
40
Splenius Capitis: Origin, Insertion, Action
* O: Spinous process of C7-T4, inferior ligamentum nuchae
* I: Lateral 1/3 of superior nuchal line/mastiod process
* A: Extends head/neck, lateral flex/rotate the head towards the contracting mucsle
41
Erector Spinae: Origin, Subdivisions, Actions
* O: Common Tendon of origin (attaches to the spinous process of lumbar/lower thoracic, sacrum, iliac crests)
* Divisions: Iliocostalis, Longissimus, Spinalis
* Extends the back/neck, laterally flexes the back/neck (ipsilateral contraction)
42
Illiocostalis Divisions: Origins and Insertions
* Lumborum: Common tendon of origin ►angle of lower 7 ribs
* Thoracis: Angle of lower 6 ribs ►Angle of upper 6 ribs/transverse process of C7
* Cervicis: Angle of ribs 3-6 ►Transverse process of C4-C6
* Note: Inferior muscles are more lateral than superior, origin of superior overlaps insertion of inferior
43
Longissimus Divisions: Origins ►Insertions
* Thoracis: Common tendon of origin/transverse processes of the lumbar ► transverse processes of thoracic/ ribs 2-12
* Cervicis: Transverse process of T1-T6 ► Transverse process of C2-C6
* Capitis: Transverse process of C4-T4/articular process of C4-C7 ►mastiod process
* Note: Capitis must extend laterally to meet mastiod process
44
Spinalis Divisions: Origin ► Insertion
* Thoracis: spinous process of T10-L3 ►spinous process of T2-T8
* Cervicis: spinous process of C5-T2 ► spinous process of C2-C5
* Capitis: Indistinguishable from semispinalis in most people
45
Transversospinalis Divisions, general origins/insertions, and Action
* Divisions: Semipinalis, Multifudus Rotatores
* O/I: originate from transverse process and insert onto a superior spinous process
* Action: extend the back, trunk flexion (ipsilateral contration), rotation of trunk (contralateral contraction
46
Semipinalis Divisions: Origin ► Insertions
* Thoracis: Transverse process of T6-T10 ► Spinous process of C6-T4
* Cervicis: TP of T1-T6 ► SP of C1-C5
* Capitis: TP of C7-T6 ► Articular process of C4-C6
* Note: semispinalis extend the neck and rotate the head ipsilaterally
47
Multifundus: Origin, Insertion, Action
* O: Sacrum, common tendon of origin, PSIS, mammillary processes (lumbar), TP of thoracic, articular process of lower 4 cervical
* I: Base of spinous process of a veterbrae from L5 to C2
* Stabilizer of vertebral column
* Deep to semipsinalis and are individual muscles that run up the spine
48
Rotators Divisions: general origin/insertion and action
* Longus: **2 vertebrae levels**, transverse process to spinous process 2 levels up
* Brevis: **1 vertebral level**, transverse process to spinous process 1 level up
* Proprioception organs/Stabilizes the column
49
Segmental muscles
Levatores Costarum
Intertransversarii
Interspinales
50
Lavatores costarum: divisions, general origins/insertions, action
* Oblique fibers that run laterally and inferiorly
* O: transverse processes of C7-T11
* I: near tubercle of the rib
* Bravis: crosses **1** vertebral joint
* Longus: crosses **2** vertebral joints
* Elevates the ribs
51
Intertransverssarii
Span between adjacent transverse processes
52
Interspinales
Span between adjacent spinous processes
53
Muscles of the sub occipital triangle
* Obliquus capitis: superior/inferior
* Rectus capitis: superior/inferior
54
Obliquus Capitis divisions, origin/insertion, action
* Inferior: Sp of C2 ►TP of C1, ipsilateral rotation of the head
* Superior: TP of C1 ► Occipital bone between nuchal lines, extends head/ipsilateral head bend
55
Rectus Capitis: division, origin/insertion, action
* Major: SP of C2 ►Occipital bone below inferior nuchal line, Extends head/ipsilateral rotation
* Minor: Posterior tubercle of C1 ► Occipital bone below inferior nuchal line, Contributes to extension of the head
56
Neural nerves to suboccipital triangle
* C1: Suboccipital nerve
* C2: Greater/Lesser occipital nerve
57
Arteries that serve the suboccipital triangle
* Vertebral artery (through the transverse foramina and pierces the posterior atlanto-occipital membrane)
* Occipital artery from the external carotid artery
