Superficial muscles of the back

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 • Movementsof the upperlimb • Intermediate group • Attached to the ribs • May serve as a respiratory function. • Intrinsic (deep) back muscles • Act on the vertebralcolumn • Itsmovements • Maintainposture

3. SUPERFICIAL GROUP OF BACK MUSCLES Immediatelydeep to the skin and superficial fascia. Connectedwith the shoulder girdle. Attachthe 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 Produceand control limb movements. Trapezius Latissimusdorsi Rhomboid major Rhomboid minor Levator scapulae

5. TRAPEZIUS Coversposterioraspect of neck & superiorhalf of trunk trapezium (G. irregularfour-sidedfigure)

6. TRAPEZIUS muscle'sorigin: base of triangle situated along vertebral column muscle'sinsertion: apexpointingtoward tip of shoulder Occipital bone Scapula Vertebralcolumn

7. TRAPEZIUS attachesthepectoralgirdle tocranium & vertebralcolumn assistsin suspendingtheupperlimb.

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. TRAPEZIUS • Superiorfibers of trapezius • fromtheskullandupperportion of thevertebralcolumn • descendtoattachto • lateral 1/3 clavicle & acromion of scapula.

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

11. TRAPEZIUS • Superiorandinferiorfibersworktogether • torotatethelateralaspect of thescapulaupward, whichneedstooccurwhenraisingtheupperlimbabovethehead.

12. TRAPEZIUS • Descendingandascendingtrapeziusfibersacttogether in rotatingthescapula on thethoracicwall in differentdirections.

13. TRAPEZIUS Thetrapeziusalsobracestheshouldersbypullingthescapulaeposteriorlyandsuperiorly, fixingthem in position on thethoracicwallwithtoniccontraction; consequently, weakness of thismusclecausesdrooping of theshoulders.

14. TRAPEZIUS • Motor innervation of trapeziusaccessorynerve [XI] • descendsfromtheneckontothedeepsurface of themuscle. • Proprioceptivefibersfromtrapeziuspass in thebranches of thecervicalplexusandenterthespinalcord at spinalcordlevels C3 &C4.

15. LATTISIUMUS DORSI L. widest of back Beginsin thelowerportion of theback Tapers as it ascendsto a narrowtendonthatattachestothehumerusanteriorly.

16. LATTISIUMUS DORSI Posterioraxillaryfold

17. LATTISIUMUS DORSI

18. LATTISIUMUS DORSI • Passesfromthetrunktothehumerus. • Actsdirectly on theglenohumeraljoint. • Actsindirectlyon thepectoralgirdle.

19. LATTISIUMUS DORSI Extend Adducthumerus (arm,upperlimb) Mediallyrotate Apley scratch test. can alsodepresstheshoulder, preventingitsupwardmovement

20. LATTISIUMUS DORSI • Incombinationwithpectoralismajor • powerfuladductor of thehumerus • playsa major role in • downwardrotation of thescapula in associationwiththismovement.

21. LATTISIUMUS DORSI • alsouseful in restoringtheupperlimbfromabductionsuperiortotheshoulder; importantin climbing.

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

23. LATTISIUMUS DORSI Innervation: thoracodorsalnerve

24. Levatorscapulae Superior 1/3 deeptosternocleidomastoid Inferior 1/3 deeptotrapezius

25. Levatorscapulae Upper portion medial border of scapulasuperiortoroot of spine of scapula

26. Levatorscapulae

27. Levatorscapulae actswiththedescendingpart of thetrapeziustoelevatethescapula, orfixit! resistsforcesthatwoulddepress it, as whencarrying a load.

28. Levatorscapulae • Withrhomboids & pectoralisminor, • rotatesthescapula, • depressingtheglenoidcavity • rotatingthelateralaspect of scapulainferiorly

29. Levatorscapulae • Actingbilaterally(alsowiththetrapezius), thelevatorsextendtheneck. • Actingunilaterally, maycontributetolateralflexion of theneck • towardtheside of theactivemuscle.

30. rhomboID MAJOR • RHOMBOID MINOR Deeptotrapezius, inferiortolevatorscapulae Broadparallelbands Passinferolaterallyfromvertebraetomedialborder of scapulae

31. RHOMBOID MINOR • Lower portion of ligamentumnuchae • 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 • Assistserratusanteriorin holding thescapulaagainstthethoracicwallandfixingthescapuladuringmovements of theupperlimb.

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

38. INTERMEDIATE GROUP OF BACK MUSCLES

39. SerratusposterIor SUPERIOR SERRATUS POSTERIOR INFERIOR Deeptothemuscles in thesuperficialgroup Relatedtothemovements of thethoraciccage Superficialrespiratorymuscles Morelikelyproprioceptiveratherthan motor in function .

40. Serratusposteriorsuperiorliesdeeptotherhomboids Serratusposteriorinferiorliesdeeptothelatissimusdorsi .

41. SerratusposterIor SUPERIOR SERRATUS POSTERIOR INFERIOR • attachedtothevertebralcolumnandassociatedstructuresmedially • Eitherdescend (fibers of serratusposteriorsuperior) orAscend (fibers of serratusposteriorinferior) • toattachtotheribs. • Thesetwomusclesthereforeelevateanddepresstheribs .

42. SerratusposterIor SUPERIOR SERRATUS POSTERIOR INFERIOR . • Lower portion of ligamentumnuchae • Spinous processes of C7 to T3 • Supraspinousligaments • 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. SerratusposterIor SUPERIOR SERRATUS POSTERIOR INFERIOR • firstfourintercostalspinelnerves . • lastfourintercostalspinelnerves

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 LATISSIMUS DORSI fxn of thoracodorsalnerve 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 placedposteriorly 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 latissimusdorsi trapezius medial border of scapula

48. Levator scapulae Stiff Neck levatorscapula 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.