Anatomy of the Back & Suboccipital Region | Gross HSB B ▪ Latissimus dorsi

Year 1 – Sem 2 – Midterms – Week 1 (Bea, M.D.)

• Origin – iliac crest, spine of T7-T12
Important structures (a checklist) • Insertion – floor of the bicipital groove of the humerus
✓ Boundaries of the back • Nerve supply – thoracodorsal nerve (from the posterior cord of the brachial
✓ Thoracolumbar fascia plexus)
✓ Superficial muscles of the back • Action – medial rotation & adduction
✓ Intermediate muscles of the back ▪ Levator scapulae
✓ Deep muscles of the back • Origin – transverse process of C1-C4
✓ Suboccipital region
• Insertion – medial border of the scapula (upper part)
✓ Vertebral column
• Nerve supply – dorsal scapular nerve (from C5 part of the brachial plexus)
Overview
▪ Boundaries of the back region • Action – elevates the scapula
o Superior border – external occipital protuberance ▪ Rhomboid minor
o Lateral border – acromion process • Origin – ligamentum nuchae
o Inferior border – iliac crest & tip of the coccyx • Insertion – medial border of the scapula
▪ Thoracolumbar (dorsolumbar) fascia • Nerve supply – dorsal scapular nerve (from C5 part of the brachial plexus)
o Importance – structure which covers the deep muscles of the back & also the • Action – retracts & rotates the scapula
muscles of the posterior abdominal wall ▪ Rhomboid major
o Location – lower part of the back • Origin – spinous process of T2-T5
o Lumbar part of the fascia – located between the iliac crest & the 12th rib • Insertion – medial border of the scapula
o Three layers or lamellae of the thoracolumbar fascia • Nerve supply – dorsal scapular nerve (from C5 part of the brachial plexus)
• Action – retracts & rotates the scapula
❖ Intermuscular spaces of the back
• Triangle of auscultation
o Importance – area where breath sounds are most easily heard with a
stethoscope due to the lack of overlapping muscles
o Boundaries of the triangle of auscultation
▪ Trapezius (medially)
1) Posterior layer ▪ Latissimus dorsi
• Function – covers the deep muscles of the back (attached to the spine) ▪ Medial border of the scapula
2) Middle layer • Lumbar triangle of Petit
• Location – anterior to the deep muscle of the back & posterior to the o Importance – common site for lumbar herniation
quadratus lumborum o Boundaries of the lumbar triangle of Petit
3) Anterior layer ▪ Latissimus dorsi
• Function – forms the anterior covering of the quadratus lumborum ▪ External oblique muscle
Blood supply of the back ▪ Iliac crest
▪ Description – due to the extensive nature of the back, each region will have their own 2) Intermediate muscle group
corresponding blood supplies ▪ Description – muscles which assist in forceful or labored respiration due to
▪ Cervical region (neck) attachment to the ribs
o Occipital artery ▪ Serratus posterior superior
▪ Description – branch of the external carotid artery • Location – immediately underneath the rhomboids
o Vertebral artery • Origin – lower cervical & upper thoracic spines
▪ Description – branch of the subclavian artery • Insertion – upper ribs
o Deep cervical artery • Nerve supply – intercostal nerves
▪ Description – branch of the costocervical trunk • Action – raises the ribs (during forceful inspiration)
▪ Thoracic region ▪ Serratus posterior inferior
o Corresponding posterior intercostal arteries • Origin – lower thoracic & upper lumbar spines
▪ Description – direct branches of the thoracic/descending aorta • Insertion – lower ribs
▪ Lumbar region
• Nerve supply – intercostal nerves
o Subcostal arteries
• Action – depresses the ribs (during forceful expiratory)
o Lumbar arteries
▪ Levatores costarum
▪ Description – direct branches of the abdominal aorta
▪ Sacral region • Origin – tip of the transverse processes of C7-T11 vertebrae
o Iliolumbar artery & lateral sacral artery • Insertion – angle of the rib below
▪ Description – direct branches of the posterior division of the internal iliac artery • Nerve supply – posterior rami of the thoracic spinal nerves
Venous drainage of the back • Action – raises the ribs (during forceful inspiration)
▪ External vertebral venous plexus • Note: Innervated by the posterior rami of the thoracic spinal nerve but it is not
o Location – outside the vertebral column an intrinsic muscle; it is only innervated by the posterior rami due to its deep
▪ Internal vertebral venous plexus location (beside the iliocostalis)
o Location – inside the vertebral column o Hence, by action & insertion it is part of the intermediate but by innervation
Nerve supply of the back it is similar to the deep muscles (still classified as intermediate back
▪ Posterior rami of the 31 pairs of spinal nerves muscle)
o Importance – innervates the intrinsic (deep) muscles of the back 3) Deep (intrinsic) muscle group
▪ Also, it is sensory to the skin of the back as well ▪ Description – muscles which are concerned with the posture & movement of
o Formation of the posterior rami vertebral column
1) Nerve roots (dorsal & ventral) exit the spinal column → immediately forms a ▪ Generally, for intrinsic muscles the more superficial the muscles are;
single nerve trunk • the longer the muscle fibers
2) Nerve trunk → immediately splits into an anterior & posterior rami • the more vertical the muscle
• Posterior ramus – innervates the intrinsic (deep) muscles of the back • the more gross movement of the muscle
• Anterior ramus – innervates the anterior muscles of the chest & abdomen ▪ Further subdivided into three groups
Muscles of the back a) Superficial intrinsic muscle group (superficial deep)
▪ Three major divisions of the muscles of the back o Splenius muscles (spinotransversales)
1) Superficial (extrinsic) muscle group ▪ Location – underneath the trapezius muscle
▪ Description – muscles which are inserted to the bones of the upper extremities ▪ Description – muscle fibers are oriented obliquely
▪ Trapezius ▪ Splenius capitis
• Shape – diamond-shaped muscle • Origin – ligamentum nuchae & spine of C7
• Description – extensive site of origin & insertion • Insertion – mastoid process of the temporal bone
• Divisions – three muscle fibers (upper, middle, & lower) ▪ Splenius cervicis
o Origin – external occipital protuberance, nuchal ligament, & spinous • Origin – T1-T7 thoracic spines
process of the C7-T12 • Insertion – transverse processes of C1-C4 (upper four cervical)
o Insertion – lateral third of clavicle & spine of scapula and acromion ▪ Nerve supply – posterior rami of the cervical spine
o Nerve supply – accessory cranial nerve (CN 11) ▪ Action of the splenius muscles
o Action of the trapezius • Two muscles contract on both sides → extension of the neck
▪ Upper & middle muscle fibers – pulls the scapula upward • Only one muscle contracts on one side → lateral flexion & rotation of
▪ Lower muscle fiber – pulls the scapula downward the neck
 o Erector spinae (sacrospinalis)
▪ Note: Also known as sacrospinalis, since the muscles originate from the
sacrum and insert above
▪ Description – considered as paravertebral muscles since they are found
beside the vertebral column (at the concavity between the spine & rib)
▪ Arrangement (lateral-to-medial) – iliocostalis, longissimus, and spinalis
▪ Iliocostalis
• Three regions of the iliocostalis
o Iliocostalis lumborum – iliac crest → inferior angles of ribs 7-12
o Iliocostalis thoracic – angles of ribs 7-12 → angles of ribs 1-6
o Iliocostalis cervicis – ribs 3 to 6 → transverse p. of C7
• Action – extension & lateral flexion of the back
▪ Longissimus
• Three regions of the longissimus
o Longissimus thoracis
▪ Description – largest region of the longissimus
▪ Extent – from transverse p. of lumbar vertebrae to
transverse p. of thoracic vertebrae & lower 9-10 ribs
o Longissimus cervicis
▪ Extent – from T1-T5 to C2 to C6
o Longissimus capitis
▪ Extent – from C4-T5 to the mastoid process
• Action of longissimus
o Longissimus thoracis & cervicis – extension & lateral flexion of the
back
o Longissimus capitis – extension of the head & turning to the same
side
▪ Spinalis
• Three regions of the spinalis
o Spinalis thoracis – from T11-L2 to upper thoracic vertebrae
o Spinalis cervicis – from ligament nuchae to spine of axis (may be
absent)
o Spinalis capitis – fibers usually blend with semispinalis capitis
• Action – extends the vertebral column
b) Intermediate intrinsic muscle group (intermediate deep)
o Transversospinalis
▪ Description – fibers are oblique due to originating from the transverse
process of the vertebra to the spinous process of another vertebra
▪ Semispinalis
• Three regions of the semispinalis
o Semispinalis thoracis
▪ Origin – transverse process of T6-T10
▪ Insertion – spine of C6-T4
o Semispinalis cervicis
▪ Origin – transverse process of T1-T16
▪ Insertion – spine of C2-C5
o Semispinalis capitis – from transverse p. of C7-T7 to occipital bone
• Nerve supply of semispinalis – posterior rami of the thoracic &
cervical spinal nerves
• Action of semispinalis
o Semispinalis thoracis & cervicis – extension of the cervical and
thoracic region & rotation to the opposite side
o Semispinalis capitis – extension of the head & turns the face to the
opposite side
▪ Multifidus
Suboccipital region
▪ Description – below the external occipital protuberance
▪ Suboccipital triangle
o Location – found underneath the semispinalis capitis
o Note: Not a microscopic structure; it can be distinguished grossly
o Boundaries of the suboccipital triangle
▪ Superomedially – rectus capitis posterior major
▪ Superolaterally – obliquus capitis superior
▪ Inferolaterally – obliquus capitis inferior
o Importance of the suboccipital triangle
▪ Contains the vertebral artery, suboccipital nerve, and occipital membrane
▪ Note: You may feel for the arch of the atlas if you insert your finger inside the
suboccipital triangle
o Muscles of the suboccipital region
▪ Importance – some of these muscles serve as the borders/boundaries of the
suboccipital triangle
▪ Rectus capitis posterior major
• Description – median side of the suboccipital triangle
• Origin – spinous process of the axis (C2)
• Insertion – lateral ½ of the inferior nuchal line
• Nerve supply – suboccipital nerve
• Action – extends the head & rotates the face on the same side
▪ Rectus capitis posterior minor
• Origin – tubercle on posterior arch of the atlas (C1)
• Insertion – medial part of the inferior nuchal line
• Nerve supply – suboccipital nerve
• Action – extends the head
▪ Obliquus capitis inferior
• Description – inferior side of the suboccipital triangle
• Note: It is a muscle with a ‘capitis’ name but does not attach to the skull
• Origin – axis (lamina)
• Insertion – atlas (transverse process)
• Nerve supply – suboccipital nerve
• Action – rotates the face towards the same side
▪ Obliquus capitis superior
• Description – superior side of the suboccipital triangle
• Origin – upper surface of C1/atlas (transverse process)
• Insertion – occipital bone between superior & inferior nuchal lines
• Nerve supply – suboccipital nerve
• Action – flexes the head backwards & towards the same side
“I would still ‘do it again’ despite all the difficulty of training and roadblocks to just practice medicine. Truly is worth it!”
James A. Bowden, M.D.

• Origins – muscle fibers begin from the sacrum, aponeuroses of the AngeloBautista

erector spinae muscle, the transverse processes of the thoracic &

lower four cervical vertebrae
• Insertion – to the spine of the vertebra above the origin
• Action – rotates the vertebra slightly towards the opposite side
▪ Rotatores
• Description – fully-developed in the thoracic region but shorter
compared to the multifidus muscle
• Origin – transverse process of one vertebra
• Insertion – lamina of the vertebra above it (between the spine &
transverse process of the vertebra)
• Two types of rotatores muscles
o Rotatores brevis – inserts to the lamina of the vertebra immediately
above it
o Rotatores longus – inserts to the lamina of the vertebra two steps
above
c) Deep intrinsic muscle group (deep deep wtf?)
o Description – short-paired muscles seen most distinctly at the cervical
region of the back
o AKA. segmental muscle group
o Interspinales
▪ Description – attached to the apices of the contiguous spine (from spine
of one vertebrae to the spine of its adjacent vertebra)
o Intertransversarii
▪ Description – attached to the transverse processes of the contiguous
spine (from transverse process of one vertebra to the transverse
process of its adjacent vertebra)
o Function – proprioception