GL 8 - Back, Shoulder, Scapula, and Deltoid

Occipital Protuberance

Most prominent surface of the skull posteriorly

Upper trapezius and Nuchal Ligament

The occipital protuberance serves as attachment for what 2 structures?

CV 7

Which vertebra is known as the vertebral prominence

2-7

The scapula covers which ribs

TV 2

At what level is the superior angle of the scapula located?

TV 7

At what level is the inferior angle of the scapula located?

TV 3

At what level is the spine of the scapula located?

LV 4

At what level is the iliac crest located?

Iliac crest

This structure is used as a landmark when performing a lumbar puncture

Posterior rami of T1-L3

Sensory nerve supply of the skin of the back

Posterior intercostal and lumbar arteries

Blood supply of the skin of the back

Posterior intercostal and lumbar veins

Venous drainage of the skin of the back

Above iliac crest to posterior group of axillary lymph nodes

Lymph drainage of the skin of the back

Superficial Fascia

This connective tissue structure contributes to skin movement

1 > 2

QC: Thickness of superficial fascia (1) Torso (2) Limbs

Deep Fascia

This connective tissue structure provides structural integrity, separates muscle groups, and serves as an attachment point for muscles

Thoracolumbar fascia

Deep fascia of the back located between iliac crest and rib 12 that plays a crucial role in the mechanical function and the stability of the trunk

Middle fibers of transversus and upper fibers of internal oblique

The thoracolumbar fascia gives origin to what muscles?

Middle scalene

The dorsal scapular nerve can be trapped when it passes through what muscle?

Lateral winging of scapula

Entrapment of the dorsal scapular nerve can lead to what clinical manifestation

Transverse cervical artery

What vascular structure accompanies the dorsal scapular nerve?

Trapezius, Rhomboid Major and Minor, Levator Scapulae, Latissimus dorsi

What muscles make up the superficial group of the back

Superficial and intermediate (Extrinsic back muscles)

Which group of back muscles are involved in respiration and movements of upper limbs

Deep (Intrinsic)

Which group of back muscles are involved in movement and stabilization of the vertebral column?

Superior nuchal line and External occipital protuberance

Origin of upper traps

Spinous process of CV7

Origin of middle traps

Spinous process of all thoracic vertebra

Origin of lower traps

Lateral 1/3 of clavicle and acromion

Insertion of upper traps

Spine of scapula

Insertion of middle traps

Inferior lip of scapular spine from tubercle to medial part

Insertion of lower traps

Spinal accessory, C3, and C4

Nerve supply of traps

Elevation of scapula

Action of upper traps

Pulls scapula medially

Action of middle traps

Pulls medial border of scapula downward

Action of lower traps

Spinous process of last 6 thoracic vertebra, Thoracolumbar fascia, posterior half of iliac crest, and occasionally the posterior surface of last 3 ribs

Origin of latissimus dorsi

Floor of bicipital groove of the humerus

Insertion of latissimus dorsi

Thoracodorsal nerve

Nerve supply of latissimus dorsi

Extends, adducts, and medially rotates the shoulder

Action of latissimus dorsi

Posterior tubercle of transverse process of CV1 to CV4

Origin of levator scapulae

Superior angle of scapula

Insertion of levator scapulae

Dorsal scapular, C3, and C4

Nerve supply of levator scapulae

Elevate and rotate the shoulder
Stabilize the shoulder

Action of levator scapulae

Spine of TV 1-4

Origin of rhomboid major

Vertebral border of the scapula

Insertion of rhomboid major

Dorsal Scapular nerve

Nerve supply of the rhomboids

Spine of CV7

Origin of rhomboid minor

Medial end of scapular spine

Insertion of rhomboid minor

Pull medial border of scapula upward and medially

Action of the rhomboids

Spinous process of CV7 - TV3 and aponeurosis that attaches to ligamentum nuchae

Origin of serratus posterior superior

Ribs 2-5

Insertion of serratus posterior superior

Intercostal nerves 2-5

Nerve supply of serratus posterior superior

Raises the ribs (Inspiratory muscle)

Action of serratus posterior superior

Aponeurosis attached to TV11 to LV2

Origin of serratus posterior inferior

Ribs 9-12

Insertion of serratus posterior inferior

Intercostal nerves 9-12

Nerve supply of serratus posterior inferior

Pulls ribs downward (Expiratory Muscle)

Action of serratus posterior inferior

Tendon attached to the sacrum, iliac crest, and spines of LV

Origin of the erector spinae muscles

Dorsal rami of thoracic and lumbar spinal nerves

Innervation of erector spinae muscle

Extensors of torso, neck, and head

Action of erector spinae muscles

Iliocostalis → Longissimus → Spinalis

Arrangement of erector spinae muscles from lateral to medial

Transverse process of CV4-6

Insertion of the cervical part of iliocostalis

Capitis

This is the most superior fibers of the longissimus

Mastoid process of temporal bone

Insertion of the most superior part of longissimus

Dorsal rami of spinal nerves

Innervation of the transverso-spinalis group

Extensors of the vertebra

Action of the transverso-spinalis group

Semispinalis

This is the most powerful extensor of the head and neck

TV 4-6

Attachment of lower set of semispinalis

CV 3-6

Attachment of higher set of semispinalis

Occiput

Attachment of highest set of semispinalis

Multifidus

This muscle of the transverso-spinalis group helps in the lateral flexion and rotation

Back of the sacrum

Origin of the lowest bundle of the multifidus

Transverse process of lower vertebra

Origin of the higher bundle of the multifidus

Spinous process of next higher vertebra

Insertion of the higher bundle of the multifidus

Thoracic

The rotatores is better developed in which region of the spine?

Lamina of next higher vertebra

Where does the rotatores insert?

Transverse process of higher vertebra

Origin of levatores costarum

Vertebral ends of lower rib

Insertion of levatores costarum

Elevation of corresponding ribs

Action of levatores costarum

Cervical and Lumbar

The intertransversarii and interspinalis is only found in which regions of the spine?

Extensile and stabilize

Function of intertransversarii and interspinalis

Ligamentum nuchae and Upper 4 thoracic spines

Origin of both splenius capitis and cervicis

Superior nuchal line and mastoid process

Insertion of splenius capitis

Transverse process of cervical vertebrae

Insertion of splenius cervicis

Rectus capitis posterior major, Obliquus capitis superior and inferior

What 3 muscles create the sub-occipital triangle

Sub-occipital nerve, dorsal ramus of C1, 3rd part of vertebral artery, sub-occipital venous plexus

What structures are found in the sub-occipital triangle

Inferior nuchal line of occiput

Insertion of the recti muscles of the sub-occipital triangle

Spine of axis

Origin of rectus capitis posterior major

Posterior tubercle of atlas

Origin of rectus capitis posterior minor

Transverse process of atlas

Origin of superior oblique muscle

Inferior nuchal line

Insertion of superior oblique muscle

Spine of axis

Origin of inferior oblique muscle

Transverse process of atlas

Insertion of inferior oblique muscle

Lateral 2/3 of crest of spine of scapula and acromial border to the lateral 1/3 of the clavicle

Origin of deltoid

Lateral surface of the middle of the shaft of the humerus

Insertion of deltoid

Axillary nerve

Innervation of deltoid

Shoulder flexion

Action of anterior deltoid

Shoulder abductor

Action of medial deltoid

Shoulder extension

Action of posterior deltoid

Inferior Part

This is the only part of the GH joint that isn’t reinforced by the rotator cuff muscles

Rotator cuff muscles

These muscles provide stability to the shoulder joint