BACK

MUSCLES OF THE BACK

for movements of the upper extremity and along the vertebral column
category:
o by layers:
superficial- move the proximal part of the upper extremity and pectoral girdle
intermediate
deep- for movements of the vertebral column (torso and partly head and neck)
fascicular bundles overlap
o by attachments
o by function
Lumbo-dorsal Fascia
aponeurosis
strong fibrous sheet over the lumbar area
serves as origin for several muscles and as reinforcing layer on the posterior abdominal wall
protects the more posterior organs in the abdominal cavity
I. Superficial Muscles

Muscle Origin Insertion Action Innervation
Superior fibers - slightly twisted in aterolateral
direction to insert along the
lateral 3rds of the clavicle
and along borders of the
bundle
- inclines obliquely
downwards and laterally to
insert as separate slips to the
posterior surfaces of the 2
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Middle fibers
- thickest
From the superior nuchal
line, tip of the spinous
processes of the spinal
vertebrae and
ligamentum nuchae
- crest of the spine of the
scapula
- normal tone of the muscle
maintains the position of the
shoulders

- voluntary contraction:
a. shrugging/ elevation of
shoulders
b. tilting and supero-medial
rotation of the scapula
when the upper limb is
moved forwards and/or
upwards to increase the
length of its reach (result of
coordinated pull of superior
and inferior fibers, aided by
pull of other muscles
attached to its medial
border)
c. anchoring effect on the
Spinal accessory
nerve and twigs
from C3 and C4
Gross Anatomy Reviewer University of Santo Tomas Faculty of Medicine and Surgery 2007 Section D4

Inferior fibers tips of the spinous
processes of all the
thoracic vertebrae
- inferior lip of the scapular
spine from the tubercle of
the crest to its medial
border
scapula (result of
simultaneous pull of all the
muscles attached to the
scapula; for more effective,
strong leverage in moving
the humerus)
Latissimus Dorsi
-large, flat, broad
- lies at the lower
back, same plane as
the trapezius
-tips of the spinous
process of last 6 thoracic
vertebra and lumbo-
dorsal fascia
- posterior half of iliac
crest and posterior
surfaces of last 3 ribs
- floor of the bicipital groove
of the humerus
- adduct, extend and medially
rotate the humerus
-thoraco-dorsal
branch of the
posterior cord of
brachial plexus

Triangle of Auscultation
small intermuscular area at the middle of the back
borders:
o inferior: superior border of latissimus dorsi
o lateral: inferior end of vertebral border of the scapula
o medial: sloping inferior border of the trapezius

II. Second Layer of Muscles
Muscle Origin Insertion Action Innervation
Levator Scapula
- thick, fleshy
Posterior tubercles of
transverse processes of
CV 1-4
superior angle of the
scapula
Pulls the scapula supero-
medially (Upward
retraction or medial
rotation)
Innervations of muscle
Rhomboids Minor
- flat, slender
- more superior than
Rhomboids Major
Spine of the 7
th
cervical Narrow smooth triangular
base or medial end of
scapular spine
Pulls the scapula supero-
medially (Upward
retraction or medial
rotation)
Dorso-scapular nerve
(C5-6)
-courses vertically
downwards on the
anterior surface of the
rhomboids close to their
insertion
-arise directly from
subclavian artery
- accompanied by
transverse cervical artery
Rhomboids Major
- flat, wider, inferior
belly

Spines of TV 1-4 Along the rest of the
vertebral border of the
scapula down to the
inferior angle
- parallel fibers slant
downwards and laterally
Pulls the scapula supero-
medially (Upward
retraction or medial
rotation)
Dorso-scapular nerve
(C5-6)
Serratus Posterior
Superior
- composed of thin
fibers at the upper
back
Thin aponeurosis
attached to the
ligamentum nucha (CV
7- TV 3 spines)

Superior Belly



Expands the thoracic cage
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Inferior Belly



Spines of TV 11- LV 12
Last four ribs
- fibers directed obliquely
upwards and laterally
Prevents the lower ribs from
being pulled inwards by
the contraction of the
diaphragm during deep
inspiration


III. Deep Muscles of the Back

Gross Anatomy Reviewer University of Santo Tomas Faculty of Medicine and Surgery 2007 Section D4




Muscle Origin Insertion Action Innervation
A. Those that extend from the midline attachments laterally towards their insertions
Splenius Cervicis Ligemantum nuchae
and spines of CV 6
and CV 7
Transverse processes
of CV 1-3
Extend the head and
neck; help SCM
muscle to flex the
head and neck
ipsilaterally
Dorsal rami of
the cervical
spinal nerves
Splenius Capitis Ligemantum nuchae
and spines of CV 6
and CV 7
Mastoid process and
adjacent part of the
occipital bone
Extends the head and
neck; helps SCM
muscle to flex the
head and neck
ipsilaterally
Dorsal rami of
the cervical
spinal nerves
B. Those that are longitudinally positioned parallel to the vertebral column
Erector Spinae (Sacrospinales)
- muscular bundles are shaped like two strong pillars at the lower back at each side of the spinal column
- palpable as rounded columns separated by a vertical furrow along the midline
-separate into 3 fascicles at dorsal surface of thoracic cage
Iliocostalis
lumborum

Iliocostalis thoracis
a. Ilio-costales
Group
-most lateral
-3 overlapping
fascicles at the
dorsal surfaces of
ribs, extending to
the neck
Iliocostalis cervicis Transverse processes
of CV 4-6
Longissimus
thoracis

Longissimus cervicis
b. Longissimus
Group
- middle bundles
disposed at back
of ribs
Longissimus capitis Mastoid process
Spinalis thoracis
Spinales cervicis
c. Spinales Group
-most slender,
median bundle
Spinalis capitis
Broad strong tendon
attached to the
sacrum, iliac crest
and spines of lumbar
vertebrae

- primary extensors of
torso, neck and head
- antagonist to the
pull of the antero-
lateral muscles of the
abdominal wall which
flex the torso forwards
- maintain erect
position of the body
(strained in incorrect
postures, cause of
chronic back pain)
Dorsal rami of
thoracic and
lumbar spines
C. Transvero-spinalis group-deepest muscles close the vertebrae, slightly inclined from lateral to medial
Semispinalis
-small slips of muscle fasciculi
Transverse processes
of the thoracic
vertebra
- those from lower set
attach to TV 4-6
- those from higher
thoracic vertebra
reach up top the CV
3-6
- highest attached
insert to the occiput
between the nuchal
lines, beneath insertion
of splenius
Extensors of
vertebrae, most
powerful extensor of
head and neck
Dorsal rami of
spinal nerves
Multifidus
- deep, short
- thicker at lumbar region
- lowest bundles
back of the sacrum
- higher bundles
transverse processes
of the lower vertebra
Spinous process of the
next higher vertebra
Extensors of
vertebrae, lateral
flexion
Dorsal rami of
spinal nerves
Gross Anatomy Reviewer University of Santo Tomas Faculty of Medicine and Surgery 2007 Section D4

Rotatores
- better developed in thoracic region
- deep to the multifidus
Transverse processes Lamina of the next
higher vertebra
Extensors of
vertebrae, lateral
rotation
Dorsal rami of
spinal nerves
D. Vertebro-costal and Intervertebral group
Levatores Costarum
- 12 pairs of small, short muscular strips
Transverse processes
of a higher vertebra
Vertebral ends of the
lower ribs
Help to elevate the
corresponding rib to
help in enlargement
of thoracic cage
during respiration

Intervtransversarii
- in cervical and lumbar vertebrae
Transverse processes
Interspinales
- in cervical and lumbar vertebrae

Spinous processes
Stabilizing and
extensile functions

E. Sub-occipital group- 4 short, small and deep muscles; forms the boundaries of a small sub-occipital triangle
Rectus Capitis
Posterior Major
Spine of the axis Inferior nuchal line of
the occiput
Recti Muscles
- medial border of
sub-occipital
triangle
Rectus Capitis
Posterior Minor
Posterior tubercle of
the atlas
Inferior nuchal line of
the occiput

Superior Oblique Transverse process of
the atlas
Inferior nuchal line of
the occiput
Oblique Muscles
- lateral boundaries
of sub-occipital
triangle
Inferior Oblique Spine of the axis Transverse process of
the atlas



Sub-occipital Triangle

Borders:
o Medial: Recti muscles
o Lateral: Oblique muscles
Significance
o vertebral artery lies deep in the triangle after emerging from the transverse foramen of the atlas to make its way to the
foramen magnum
o dorsal ramus of spinal nerve C1 passes through the triangle to supply surrounding muscles
anterior ramus emerges from the triangle to participate in cervical plexus
o sub-occipital plexus- covers the triangle superficially
may become congested due to inadequate drainage , stress or strain
may press on the nerve (sub-occipital headache)
























Gross Anatomy Reviewer University of Santo Tomas Faculty of Medicine and Surgery 2007 Section D4

SHOULDER AND SCAPULAR MUSCLE

Rotator Cuff Muscle
Covers the shoulder joint
Holds the head of the humerus
in glenoid fossa
Provides stability to the joint,
especially in abducted
position
4 groups of muscle
o Subscapularis
o Teres Minor
o Supraspinatus
o Infraspinatus

Deltoid
Well developed muscle
forms rounded bulky mass on
shoulder

Muscle Origin Insertion Action Innervation
Deltoid Crescent shaped

Lateral 2/ 3 of the
spine of scapula

Acromial border to
the lateral third of
clavicle

Lateral surface of the
middle shaft of the
humerus

Producing deltoid
tuberosity
Principal Abductors (arm)
o Acromial fibers
o Up to 90% angle

Weaker Clavicular fibers
o Medial rotation
o Flexion of arm

Posterior fibers
o Help in extension of
arm
Axillary or circumflex
nerve (C5, 6)

Supra and Infra-Spinatus Muscle
Nerve penetrates into supraspinous fossa through the suprascapular notch
Nerve is accompanied by the subscapular vessels

Muscle Origin Insertion Action Innervation
Supra-Spinatus muscle



Infra-Spinatus muscle



Scapular fossae



Scapular fossae
Top of the greater
tubercle of the humerus


Posterior adjacent part
Abductor of arm
o Helps the deltoid


Helps in lateral extension
Suprascapular nerve
(C4, 5, 6)


Suprascapular nerve
(c4 ,5, 6)


Teres Minor
Smaller and higher
fibers


Teres Major
Bulkier


Subscapularis Muscle
(thick and wide)




Axillary (lateral) border
of scapula



Axillary (lateral) border
of scapula


Scapular fossa

Posterior aspect of the
greater tuburcle below
infraspinatus


Crest of the lesser
tuburcle



Lesser tubercle of the
humerus

Adduction
External (lateral) rotation of
the arm






Pirincipal Adductors and
medial rotation of humerus

Helps in forward flexion

Circumplex nerve








Upper and lower
scapular of posterior
brachial plexus

Summary of Actions of Back, Deltoid and Scapular
Actions Muscle Direction
Pincipal elevators of the shoulder Trapezius
Levator scapula
Rhomboids

Rotators of scapula Trapezius
Serratus anterior
Levator scapula
Rhomboids
Upwards and laterally

Downwards medially
Medial Rotractors of scapula Trapezius
Rhomboid

Abductors (protractors) Serratus anterior
Pectoralis minor
Reaching out in front
Abductors of arm only Deltoid
Suprascapularis

Adductors of the arm (and lateral rotators) Infraspinatus
Latissimus dorsi
Subscapularis
Teres muscle

Flexor and medial rotators Acromial fibers of the deltoid
Muscles in the arm

Extensor Posterior fibers of deltoid
Latissimus dorsi


Gross Anatomy Reviewer University of Santo Tomas Faculty of Medicine and Surgery 2007 Section D4