1. Superficial muscles of the back
Kaan Yücel M.D., Ph.D
18.December.2011 Tuesday

2. MUSCLES OF THE BACK Extrinsic back muscles Superficial group
Movements of the upper limb
Intermediate group
Attached to the ribs
May serve as a respiratory function.
Intrinsic (deep) back muscles
Act on the vertebral column
Its movements
Maintain posture

3. SUPERFICIAL GROUP OF BACK MUSCLES
Immediately deep to the skin and superficial fascia.
Connected with the shoulder girdle.
Attach the superior part of the appendicular skeleton (clavicle, scapula, and humerus) to the axial skeleton (skull, ribs, and vertebral column).

4. SUPERFICIAL GROUP OF BACK MUSCLES
Produce and control limb movements.
Trapezius
Latissimus dorsi
Rhomboid major
Rhomboid minor
Levator scapulae

5. trapezium (G. irregular four-sided figure)
TRAPEZIUS
Covers posterior aspect of neck & superior half of trunk
trapezium (G. irregular four-sided figure)

6. TRAPEZIUS
muscle's origin: base of triangle situated along vertebral column
muscle's insertion: apex pointing toward tip of shoulder
Occipital bone
Scapula
Vertebral column

7. TRAPEZIUS attaches the pectoral girdle to cranium & vertebral column
assists in suspending the upper limb.

8. TRAPEZIUS Descending (superior) fibers elevate the scapula
(e.g., when squaring the shoulders).
Middle fibers
retract the scapula
(i.e., pull it posteriorly).
Ascending (inferior) fibers depress the scapula and
lower the shoulder.

9. from the skull and upper portion of the vertebral column
TRAPEZIUS
Superior fibers of trapezius
from the skull and upper portion of the vertebral column
descend to attach to
lateral 1/3 clavicle & acromion of scapula.

10. TRAPEZIUS
Lateral 1/3
C7 to T12
Spine of scapula

11. TRAPEZIUS Superior and inferior fibers work together
to rotate the lateral aspect of the scapula upward, which needs to occur when raising the upper limb above the head.

12. TRAPEZIUS
Descending and ascending trapezius fibers act together in rotating the scapula on the thoracic wall in different directions.

13. TRAPEZIUS
The trapezius also braces the shoulders by pulling the scapulae posteriorly and superiorly, fixing them in position on the thoracic wall with tonic contraction; consequently, weakness of this muscle causes drooping of the shoulders.

14. TRAPEZIUS Motor innervation of trapezius accessory nerve [XI]
descends from the neck onto the deep surface of the muscle.
Proprioceptive fibers from trapezius pass in the branches of the cervical plexus and enter the spinal cord at spinal cord levels C3 &C4.

15. LATTISIUMUS DORSI Begins in the lower portion of the back
L. widest of back
Begins in the lower portion of the back
Tapers as it ascends to a narrow tendon that attaches to the humerus anteriorly.

16. Posterior axillary fold
LATTISIUMUS DORSI
Posterior axillary fold

17. LATTISIUMUS DORSI Spinous processes of T7 to L5 Sacrum Iliac crest
Ribs 10 to 12
Floor of intertubercular sulcus of humerus

18. LATTISIUMUS DORSI Passes from the trunk to the humerus.
Acts directly on the glenohumeral joint.
Acts indirectly on the pectoral girdle.

19. can also depress the shoulder, preventing its upward movement
LATTISIUMUS DORSI
Extend
Adduct humerus (arm,upper limb)
Medially rotate
Apley scratch test.
can also depress the shoulder, preventing its upward movement

20. powerful adductor of the humerus
LATTISIUMUS DORSI
In combination with pectoralis major
powerful adductor of the humerus
plays a major role in
downward rotation of the scapula in association with this movement.

21. LATTISIUMUS DORSI
also useful in restoring the upper limb from abduction superior to the shoulder; important in climbing.

22. LATTISIUMUS DORSI In conjunction with pectoralis major,
raises the trunk to the arm,
performing chin-ups or climbing a tree

23. LATTISIUMUS DORSI
Innervation: thoracodorsal nerve

24. Levator scapulae Superior 1/3 deep to sternocleidomastoid
Inferior 1/3 deep to trapezius

25. Levator scapulae
Upper portion medial border of scapula superior to root of spine of scapula

26. Levator scapulae

27. Levator scapulae
acts with the descending part of the trapezius to elevate the scapula, or fix it!
resists forces that would depress it, as when carrying a load.

28. Levator scapulae With rhomboids & pectoralis minor,
rotates the scapula,
depressing the glenoid cavity
rotating the lateral aspect of scapula inferiorly

29. Levator scapulae
Acting bilaterally (also with the trapezius), the levators extend the neck.
Acting unilaterally, may contribute to lateral flexion of the neck
toward the side of the active muscle.

30. rhomboID MAJOR RHOMBOID MINOR
Deep to trapezius, inferior to levator scapulae
Broad parallel bands
Pass inferolaterally from vertebrae to medial border of scapulae

31. RHOMBOID MINOR Lower portion of ligamentum nuchae
Spinous processes of C7 and T1
Medial border of scapula at the spine of scapula

32. RHOMBOID major Spinous processes of T3 to T5
Medial border of scapula between spine & inferior angle

36. RHOMBOID major et mInor
Retract (adduct) and elevate scapula
Assist serratus anterior in holding the scapula against the thoracic wall and fixing the scapula during movements of the upper limb.

37. Innervation: dorsal scapular nerve branch of brachial plexus
C4 & C5

38. INTERMEDIATE GROUP
OF BACK MUSCLES

39. Serratus posterIor SUPERIOR SERRATUS POSTERIOR INFERIOR
Deep to the muscles in the superficial group
Related to the movements of the thoracic cage
Superficial respiratory muscles
More likely proprioceptive rather than motor in function .

40. Serratus posterior superior lies deep to the rhomboids
Serratus posterior inferior lies deep to the latissimus dorsi .

41. Serratus posterIor SUPERIOR SERRATUS POSTERIOR INFERIOR
attached to the vertebral column and associated structures medially
Either descend (fibers of serratus posterior superior) or Ascend (fibers of serratus posterior inferior)
to attach to the ribs.
These two muscles therefore elevate and depress the ribs .

42. Serratus posterIor SUPERIOR SERRATUS POSTERIOR INFERIOR.
Lower portion of ligamentum nuchae
Spinous processes of C7 to T3
Supraspinous ligaments
Upper border of ribs 2 to 5
just lateral to their angles
Spinous processes of T11 to L3
Supraspinous ligaments
Lower border of ribs 9 to 12 just lateral to their angles

43. Serratus posterIor SUPERIOR SERRATUS POSTERIOR INFERIOR
first four intercostal spinel nerves .
last four intercostal spinel nerves

44. Testing the superficial muscles of the back
TRAPEZIUS
fxn of spinal accessory nerve [CN XI]
person attempts to raise the shoulders as the examiner presses down on them

45. Testing the superficial muscles of the back fxn of thoracodorsal nerve
LATISSIMUS DORSI
fxn of thoracodorsal nerve
arm is abducted 90° and then adducted against resistance provided by the examiner

46. Testing the superficial muscles of the back RHOMBOIDS
fxn of dorsal scapular nerve
hands placed posteriorly on the hips
elbow pushed posteriorly against resistance provided by the examiner.
If the rhomboids are acting normally, they can be palpated along the medial borders of the scapulae; because they lie deep to the trapezius, they are unlikely to be visible during testing.

47. Auscultatory Triangle
latissimus dorsi
trapezius
medial border of scapula

48. Stiff Neck Levator scapulae
levator scapula which connects the neck and shoulder.
most usual complaint
pain when trying to turn the head to the side where it hurts, often turning the body instead of the neck to look behind.
It is often associated with a headache but not always.
The most common causes for developing this kind of stiff neck are; turning the head to one side while typing, long phone calls without a headset, sleeping without proper pillow support with the neck tilted or rotated, sitting in a chair with armrests too high and exposure of the neck to a cold draft. There are other causes basically from shortening of this muscle as illustrated with using a cane that is too long.
Activities such as vigorous tennis, swimming the crawl stroke and watching a tennis match rotating the head back and forth can also cause a stiff neck.