Fundamentals-1 Superficial and Deep Back

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Fundamentals-1 Superficial and Deep Back
2012-01-10 17:34:24

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  1. Extrinsic vs Intrinsic
    • Extrinsic:
    • superficial and intermediate layers of the back
    • attaches the axial skeleton to the appendicular skeleton
    • moves the arm and helps in breathing
    • nerve innervation-anterior rami/CN XI

    • Intrinsic:
    • Deep layers of the back
    • Connects axial to axial (vertebrae to vertebrae)
    • moves the vertebral columb and maintains posture
    • innervation-posterior rami

    The intrinsic muscles are the only muscles the posterior rami innervate
  2. Trapezius muscle:

    • attaches to spinous process of C7-T12
    • external occipital protruberance

    lateral clavical, acromion, and spina scapula

    innervation- spinal acessory

    • Descending- elevates scapula
    • Asending-depresses scapula
    • Middle-retracts scapula
    • Des and Asen-superiorly rotates scapula
  3. Latissimus dorsi

    • points of attachment:
    • spinous process (inferior thoracic)
    • thoracolumbnar fascia
    • iliac crest
    • floor of intertubercular sulcus of the humerus

    innervation: thoracodorsal nerve (C6,C7,C8)

    • Action:
    • Extends, adducts and medially rotates humerus
  4. Levator scapulae


    • medial border, superior to spine of scapula
    • the transverse processes of C1-C4

    • innervation:
    • Dorsal scapular nerve (C5)

    • Action:
    • Elevates the scapula
    • inferiorly rotates scapula ( makes the glenoid cavity point down)
  5. Rhomboid major and minor

    • Attachments: major:
    • spinous processes of T2-T5
    • medial border of scapula inferior to the spine

    • Minor: Nuchal ligament
    • spinous process of C7-T1
    • midial border of the scapula at the level of the spine

    • innervation:
    • Dorsal scapular nerve (C4,C5)

    • Action:
    • Retracts scapula
    • inferiorly rotates scapula (glenoid cavity points inferiorly)
  6. If a patient walks into your office and cannot shrug his shoulders against rsistance what muscle is having a problem, what nerve?
    • muscle: trapezius
    • nerve: spinal accessory (CN11)
  7. What is a sign of paralysis of the latissimus dorsi
    • Difficulty raising trunk to arm
    • Cannot pull trunk to arms when arms are in a fixed position
  8. Describe the boundries of the triangle of auscultation?
    less muscles between skin and lungs

    • Superiorly and medially, by the inferior portion of the Trapezius
    • Inferiorly, by the Latissimus dorsi
    • Laterally by the medial border of the Scapula
  9. what are the muscles of the extrinsic back? what are they intervated by?
    • Serratus posterior superior
    • Serratus posterior inferior

    innervated by the anterior rami
  10. Serratus posterior superior

    • Attachments:
    • superior- nuchal ligament
    • spinous process of C7-T3
    • inferior- ribs 2-4

    innervation: anterior rami-intercostal nerves

    • action:
    • proprioception and elevates ribs, now its thought that its action is to monitor the ribs movement during breathing
  11. Serratus posterior inferior

    • Attachments:
    • spinous processes of T11-L2
    • Ribs 8-12

    • innervation
    • Anterior rami through intercostal nerves

    • action:
    • proprioception and depression of ribs. monitors the movement of ribs during breathing
  12. what are the muscles of the deep back? what are they innervated by?
    • Splenius
    • Erector spinae
    • Transversospinalis

    innervated by the posterior rami of spinal nerves
  13. Splenius

    • Attachments:
    • Nuchal ligament
    • spinous process C7-T4
    • mastoid process
    • superior nuchal line of occipital bone
    • transverse process C1-C-4

    innervation is the posterior rami of spinal nerves

    • actions
    • unilateral- laterally flexes neck
    • rotates head ipsilaterally
    • bilateral- extends head and neck
  14. Errector spinae

    • Lateral to medial:
    • Iliocostalis, Longissimus, Spinalis

    • Attachments:
    • posterior iliac crest
    • posterior sacrum
    • inferior spinous processes of the lumbar spine

    • Iliocostalis attachment- cervical transverse process
    • angles of lower ribs

    • longissimus- posterior ribs
    • thoracic and cervical spinous processes
    • mastoid process

    spinalis- thoracic and cervical spinous processes

    • action of the errector spinae:
    • unilateral- laterally flexvertebral columb
    • bilateral- extend the vertebral columb and neck
    • Transversospinalis group includes:
    • semispinalis- attach to transverse spinous
    • Mulifidus- conects the transverse processes to the spinous processes
    • Rotatores- most deep of the spinal muscles

    innervation: posterior rami

    action- extension and lateral rotation btween the adjacent vertebrae in the cervical and thoracic vertebral columb

    functions to stabalize the vertebral columb
  15. What are the borders of the suboccipital triangle?
    superolateral border- obliquus capitis superior

    inferior border- obliquus capitis inferior

    superomedial border- rectus capitis posterior major
  16. what is the significance of the suboccipital triangle?
    Can locate the suboccipital nerve (C1) and the vertebral artery(on the groove of C1 Vertebrae) in the triangle.
  17. Rectus capitus posterior major

    makes up the superiomedial border of the suboccipital triangle

    • origin: C2 spinous process
    • Insertion: inferior nucal line of the occipital bone

    innervation: suboccipital nerve

    • action:
    • unilateral- rotates head ipsilateral
    • bilateral-extends head
  18. Rectus capitus posterior minor

    • origin: poterior tuberacle of the C1
    • Insertion: inferior nuchal line

    Innervation: suboccipital nerve

    • action:
    • unilateral: rotates head ipsilateral
    • bilateral: extension of the head
  19. Obliquus capitus inferior

    • origin: C2 spinous process
    • insersion C1 transverse process

    Innervation- suboccipital nerve

    action- rotates head side to side
  20. Obliquus Capitus superior

    • Attachment:
    • origin- at the C1 transverse process
    • insertion- occipital bone btw superior and inferior nucal lines

    innervation: posterior rami

    action: extend the head
  21. what are the signs of paralysis of the trapizius.
    Drooped shoulder, cant elevate shoulder
  22. What is the difference between a back strain and a back sprian?
    • Strain-- when the muscle fibers are injured
    • streching or microtears of the fibers
    • How--rapid/extensive/strong movements
    • heavy lifting
    • poor conditioning
    • muscles usually effected- errector spinae

    • Sprain-- when the ligament is injured
    • usually accompanys a bone fracture or dislocation of joint
    • how?-excessive/strong/rapid movement
    • whiplash/neck hyperextension
    • ligament usually effected- anterior longitudinal ligament
  23. what is the site that is best to hear breath sounds?
    The triangle of auscultation which is made up of 3 muscles/bones

    • 1. the superiomedial--trapezius
    • 2. the inferior is the latissimus dorsi
    • 3. the lateral is the medial border of the scapula
  24. What muscles rotate the head contralaterally?
    • Sternocladomastiod
    • semispinalis capitis
  25. what muscles rotate the head ipsilaterally?
    • rectus capitus posterior major and minor
    • Obliquus capitus inferior
    • longissimus capitis
    • splenius capitis