Superficial, Deep Back, SubOccipital Triangle Flashcards Preview

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Flashcards in Superficial, Deep Back, SubOccipital Triangle Deck (57):

3 sides of the scapula

Medial, Lateral, Superior


Insertion/Innervation of Intermediate muscles

Insertion: Ribs distal to angle

Innervation: Spinal nerves, anterior rami


Superior angle of the scapula

Where superior and medial borders meet


Insertion/Innervation of Deep muscles

Insertion: vertebrae, skull, ribs (angle and proximal)

Innervation: Spinal nerves, posterior rami


Glenoid fossa

Articulating surface of the scapula to the humerus


Superficial fascia

  • Immediately deep to the skin
  • Contains branches of nerves/blood vessels/lymphatics
  • Loose network of connective tissue


Insertion/Innervation of superficial muscles

Insertion: Scapula

Innervation: Cranial nerve (XI), spinal nerves via plexus


Rhomboid Major and Minor Action

Retraction and downward rotation of scapula


Rhomboid Major: Origin, Insertion, Innervation, Arterial Supply

  • O: Nuchal and supraspinious ligaments, spinous process of T2-5
  • I: medial border of scapula, inferior to minor insertion
  • In: Dorsal scapular nerve (C5 branch of brachial plexus)
  • A: Dorsal scapular artery


Serratus Posterior Inferior: Origin, Insertion, Innervation, Arterial Supply

  • O: spinous process of T11-L2
  • I: Ribs 9-12, just distal to angle of the rib
  • In: anterior rami of T9-T12 (T9-T11 are intercostal nerves, T12 is subcostal nerve)
  • A: Posterior intercostal arteries (branches of aorta)



Ability of paraplegic to shift hips due to Lat connection to iliac crest, helps prevent bed sores


Levator Scapulae: Origin, Insertion, Innervation, Arterial supply

  • O: transverse process of C1-C4
  • I: Superior angle of the scapula
  • In: dorsal scapular nerve (C5 of brachial plexus)
  • A: Dorsal scapular artery (subclavian origin) or deep branch of transverse cervical artery



Caused by a physician


Rhomboid Minor: Origin, Insertion, Innervation, Arterial Supply

  • O: Nuchal and Supraspinous ligaments, spinous process of C7-T2
  • I: superior portion of the medial border of the spine
  • In: Dorsal scapular nerve (C5 branch of brachial plexus)
  • A: dorsal scapular artery (subclavian origin) or deep branch of transverse cervical artery


Action of the Trapezuis

  • Acts on the pectoral girdle
    • Elevation (descending fibers)
    • Depression (ascending fibers)
    • Retraction (aka adduction, middle fibers)
    • Upward rotation of the scapula (descending/inferior fibers)
    • Extension of head/neck


Arteries off of the Subclavian artery that go to the back

Thyrocervical truck → Transverse cervical artery


Deep Transverse cervical branch (aka dorsal scapular artery when directly comes off of the subclavian artery): medial border of scapula

Superficial Transverse cervical branch: run deep to the trapezius


Trapezuis: Origin, Insertion, Innervation, Arterial Supply

  • O: Superior nuchael line, external occipital protuberance, nuchael ligament, C7-T12
  • I: later 1/3 of clavicle, acromion process, spine of the scapula
  • Innervation: Accessory XI
  • A: Superficial branch of transverse cervical artery


Triangle of Auscultation

Medial: Inferior margin of trapezius

Inferior: Superior margin of latissimus Dorsai

Lateral: medical border of scapula

Floor: 6th/7th rib and external intercostal within the 6th space


Thoracodorsal artery pathway

Branches off axillary artery, through the axilla, to the deep surface of the lats


Posterior Intercostal Arteries Pathway

Branches off of descending aorta, runs along the thoracic wall within the intercostal spaces


Gives rise to dorsal branch artery


What innervated the subcutaneous tissue of the back?

  • Posterior rami of spinal nerves C4 to L3 bifurcate to form posterior cutaneous branch.
  • Medial branch forms the posterior branch in mid-thoracic
  • Lateral branch of rami froms posterior branch in lower-thoracic/Lumber


Clinical test for Accessory nerve function

Elevation of shoulder girdle against resistance (since clavicle supports shoulder, not the trapezius)



  • Anterior rami of multiple spinal nerves combined
  • Cervical, brachial, lumbar, sacral
  • T1 anterior ramus connects to brachial plexus
  • T12 anterior ramus connects to lumbar plexus


Thoracolumbar fascia

  • Extensive sheet extending to sacrum and iliac crest superiorly to the neck, from the spinous process laterally to the angle of the ribs
  • 3 distinct layers
  • Helps with lumbar stability
  • Ultrasound can show reduced mobility often associated with lower back pain


Cervical nerve block placement

Posterior triangle


Accessory nerve

  • Cranial nerve XI
  • Motor nerve 
  • Enters via foramen magnum, exits jugular foramen, crosses internal jugular vein, runs into posterior triangle of the neck
  • High iatrogenic injury rate



Large-flattened, anteriorly-directed process off of the lateral tip of the scapula spine


Deep Fascia

  • Compact sheet dominated by collagen
  • Surrounds or encases other structures, particularly muscle


Inferior angle of the scapula

Where the lateral and medial angles meet


Serratus Posterior Superior: Origin, Insertion, Innervation, Arterial Supply

  • O: Nuchal ligament, spinous process of C7-T3
  • I: ribs 2-5, Just distal to the angle of the rib
  • In: Anterior rami T2-T5 (intercostal nerves)
  • A: Posterior intercostal arteries (branches of aorta)


Latissimus Dorsi: Origin, Insertion, Innervation, Arterial Supply

  • O: C7-T12 spinous processes, ribs 9-12, thoracolumbar fascia, iliac crest
  • I: Floor of intertubercular sulcus on anterior humerus
  • In: Thoradorsal nerve (C6-8 branch of brachial plexus)
  • A: Thoradorsal artery (branch of axillary)


Investing fascia

Continuous with the epimysium of the muscle


Back muscles drain into what major veins?

Brachiochephalic or Azygous veins


Cause of mild scapular winging

Dorsal scapular nerve being entrapped in scalenus muscle



Deep fascia extending from superficial fascia to skeletal features, defining compartments


Thoracolumbar fascia: Shape/thickness, Area, Layers

  • Covers thoracic, lumbar, and sacral regions, blending into the serrated posterior inferior, lats, transverse abdominis
  • Posterior, middle, anterior layers
  • Thickens inferiorly


Posterior Layer of Thoracolumbar fascia: Attachements, what it covers

  • Attachments: spinous process of lumbar, median sacral crest, supraspinous ligaments
  • Covers the erector spinae muscles


Middle layer of thoracolumbar fascia: Attachments, role in anatomy borders

  • Attachments: transverse processes of lumbar, lower boarder of rib 12, iliac crest
  • Divides the back from the posterior abdominal wall (covers posterior portion of quadratus lumborum and anterior portion of erector spinae)


Splenius cervicis: Origin, Insertion, Action

  • O: Spinous process of T3-T6
  • I: Transverse process of C1-C3
  • Action: extends the head/neck, lateral flex/rotates head toward contracting muscle


Splenius Capitis: Origin, Insertion, Action

  • O: Spinous process of C7-T4, inferior ligamentum nuchae
  • I: Lateral 1/3 of superior nuchal line/mastiod process
  • A: Extends head/neck, lateral flex/rotate the head towards the contracting mucsle


Erector Spinae: Origin, Subdivisions, Actions

  • O: Common Tendon of origin (attaches to the spinous process of lumbar/lower thoracic, sacrum, iliac crests)
  • Divisions: Iliocostalis, Longissimus, Spinalis
  • Extends the back/neck, laterally flexes the back/neck (ipsilateral contraction)


Illiocostalis Divisions: Origins and Insertions

  • Lumborum: Common tendon of origin ►angle of lower 7 ribs
  • Thoracis: Angle of lower 6 ribs ►Angle of upper 6 ribs/transverse process of C7
  • Cervicis: Angle of ribs 3-6 ►Transverse process of C4-C6
  • Note: Inferior muscles are more lateral than superior, origin of superior overlaps insertion of inferior


Longissimus Divisions: Origins ►Insertions

  • Thoracis: Common tendon of origin/transverse processes of the lumbar ► transverse processes of thoracic/ ribs 2-12
  • Cervicis: Transverse process of T1-T6 ► Transverse process of C2-C6 
  • Capitis: Transverse process of C4-T4/articular process of C4-C7 ►mastiod process
  • Note: Capitis must extend laterally to meet mastiod process


Spinalis Divisions: Origin ► Insertion

  • Thoracis: spinous process of T10-L3 ►spinous process of T2-T8
  • Cervicis: spinous process of C5-T2 ► spinous process of C2-C5
  • Capitis: Indistinguishable from semispinalis in most people


Transversospinalis Divisions, general origins/insertions, and Action

  • Divisions: Semipinalis, Multifudus Rotatores
  • O/I: originate from transverse process and insert onto a superior spinous process
  • Action: extend the back, trunk flexion (ipsilateral contration), rotation of trunk (contralateral contraction


Semipinalis Divisions: Origin ► Insertions

  • Thoracis: Transverse process of T6-T10 ► Spinous process of C6-T4
  • Cervicis: TP of T1-T6 ► SP of C1-C5
  • Capitis: TP of C7-T6 ► Articular process of C4-C6
  • Note: semispinalis extend the neck and rotate the head ipsilaterally


Multifundus: Origin, Insertion, Action

  • O: Sacrum, common tendon of origin, PSIS, mammillary processes (lumbar), TP of thoracic, articular process of lower 4 cervical
  • I: Base of spinous process of a veterbrae from L5 to C2
  • Stabilizer of vertebral column
  • Deep to semipsinalis and are individual muscles that run up the spine


Rotators Divisions: general origin/insertion and action

  • Longus: 2 vertebrae levels, transverse process to spinous process 2 levels up
  • Brevis: 1 vertebral level, transverse process to spinous process 1 level up
  • Proprioception organs/Stabilizes the column


Segmental muscles

Levatores Costarum




Lavatores costarum: divisions, general origins/insertions, action

  • Oblique fibers that run laterally and inferiorly
  • O: transverse processes of C7-T11
  • I: near tubercle of the rib
  • Bravis: crosses vertebral joint
  • Longus: crosses 2 vertebral joints
  • Elevates the ribs



Span between adjacent transverse processes



Span between adjacent spinous processes


Muscles of the sub occipital triangle

  • Obliquus capitis: superior/inferior
  • Rectus capitis: superior/inferior


Obliquus Capitis divisions, origin/insertion, action

  • Inferior: Sp of C2 ►TP of C1, ipsilateral rotation of the head
  • Superior: TP of C1 ► Occipital bone between nuchal lines, extends head/ipsilateral head bend


Rectus Capitis: division, origin/insertion, action

  • Major: SP of C2 ►Occipital bone below inferior nuchal line, Extends head/ipsilateral rotation
  • Minor: Posterior tubercle of C1 ► Occipital bone below inferior nuchal line, Contributes to extension of the head


Neural nerves to suboccipital triangle

  • C1: Suboccipital nerve
  • C2: Greater/Lesser occipital nerve


Arteries that serve the suboccipital triangle

  • Vertebral artery (through the transverse foramina and pierces the posterior atlanto-occipital membrane)
  • Occipital artery from the external carotid artery