Saint Louis University

medi Anatomy
sina
2019

Dr. Laygo | Back and Upper Extremities

Introduction to Back and Upper

Extremities

BACK
Posterior aspect of trunk inferior to neck
and superior to buttocks
Region of body to which head, neck and
limbs are attached
Components:
1. Skin and subcutaneous tissue
2. Muscles: superficial and deep layers
3. Vertebral column
4. Ribs (thoracic)
5. Spinal cord and meninges
6. Segmental nerves and vessels
7. Vertebral column and vertebral canal

Back: Topography,
Triangles

VERTEBRAL COLUMN AND VERTEBRAL

CANAL
5 Regions:
1. Cervical
2. Thoracic
3. Lumbar
4. Sacrum
5. Coccyx
Components of Vertebral Column:
1. Body
Weight-bearing portion, largest and
heaviest part
2. Arch - projection formed by:
a. 2 Pedicles
b. 2 Laminae
3. Spinous Processes
4. Articular Processes
5. Transverse Processes

Spaces

and

Superficial Anatomy:
A. Bony Landmarks
1. Acromion (scapula)
2. Spinous processes of vertebrae
(palpable)
3. Scapula (palpable)
inferior
anglesurgical
landmark,
level
of
7th
intercostal space
medial border- vertebral side
4. Iliac crest
posterior superior boundary
of pelvic cavity or pelvis
where epidural anesthesia is
performed (L4)
5. Coccyx
Tip of vertebral column
Coccygeal fracture: rectal
examination and try to push
back the dislocated coccyx

Page

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Dr. Laygo |

Back: Topography, Spaces, Triangles

Intercrestal line: imaginary

line connecting the left and
right iliac crest

B. Soft Tissue Landmarks

1. Deltoid muscle: occupies upper
part of upper arm and shoulder
joint
Anterior and posterior
portion
Nerve supply: axillary
nerve
2. Trapezius
muscle
(superior
border)
3. Latissimus
dorsi
(inferior
border)
4. Erector spinae muscle
C. Lines
1. Vertical
Midline line: imaginary line
that passes from occipital
protuberance down to cervical
ligamentum nuchae up to the
spinous process of cervical,
thoracic, sacral vertebral area
Paravertebral
line:
imaginary line that passes
through the tip of transverse
processes
parallel to vertebra
landmark:
transverse
process of vertebra
2. Horizontal
Superior/Inferior nuchal line
of occiput

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3. Angles and Triangles

a. Costovertebral angle
Angle created by the lower
most posterior part of rib
towards lumbar vertebra
Where kidneys are located
(Clinical significance: Kidney
infection)
b. Auscultation Triangle
Medial to scapula
Overlies 6th intercostal space
Significance: devoid of
muscular
or
bony
structures; area where
the
most
audible

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Back: Topography, Spaces, Triangles

thoracic cavity sound

through stethoscope is
heard
Borders
Medial: trapezius
Lateral:
rhombhoid
major
Inferior:
latissimus
dorsi

B. Lattisimus Dorsi
Originates from lower part of back
and covers wide area
O: Arise from spinous processes of
T6
to
T12,
iliac
crest,
thoracolumbar fascia and inferiorly
three ribs
Thoracolumbar (lumbar) fascia
Covers deep muscles of back
Attaches medially to spines of
vertebrae
Inferiorly to ilium (pelvic bone)
Provides
for
muscle
attachments
I:Converge into a tendon that
attaches to intertubercular sulcus
of humerus

Superficial Back Muscles

A. Trapezius
broad, flat and triangular muscle
muscles on each side form
trapezoid shape
most superficial
Origin: skull, spinous processes of
C7 to T12 and the ligamentum
nuchae
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Insertion: clavicle, acromion and

scapula spine
Nerve supply: Motor (Spinal
accessory
nerve)
CN
XI;
Proprioceptor fibers from C3 and C4
(Spinal nerves)
Action:
Upper
fibers

elevates
scapula and rotates it during
abduction of arm
Middle fibers retract scapula
Lower fibers pull scapula
inferiorly

NS: Thoracodorsal nerve

A: extends, adducts and medially
rotates upper limb

C. Levator scapulae
Small strap-like muscles which
begins in neck and descends to
attach to scapula
O: transverse processes of C1 to
C4 vertebrae
I: medial border of scapula
NS: dorsal scapular nerve
A: Elevates scapula
D. Rhomboid muscles
1. Rhomboid major

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Back: Topography, Spaces, Triangles

O: from the spinous

processes of T2 to T5 vertebrae
I: medial border of scapula,
between the scapula spine and
inferior angle
NS: Dorsal scapula nerve
A: retracts and rotates the
scapula, all elevate and adduct
2. Rhomboid minor
O: Vertebrae (C7, T1 spines)
I: Scapula (medial border)
E. Serratus Posterior, Superior and
Inferior
Innervation:
long
thoracic
nerve (a part of brachial plexus)
Goes down from cervical area
towards lateral aspect of
thoracic cage and terminates
at serratus posterior muscle
Clinical Significance: when this
nerve is damaged/cut: medial
winging of scapula (paralysis
of serratus)
1. Quadrangular space
2. Triangular space
3. Triangular interval

Borders
Lateral: surgical neck of the
humerus
Medial: triceps brachii (long head)
Superior: teres minor
Inferior: teres major
Clinical Significance
The contents can be compressed
or damaged due to spaceoccupying lesions or disruption in
the anatomy due to trauma.
Symptoms: axillary nerve related
weakness of the deltoid muscle in
the case of any significant mass
lesions
2. Triangular space
Contents
circumflex scapular vessel artery
and vein: branch of subscapular
artery
Borders
Superior: teres minor
Inferior: teres major
Lateral: long head of triceps
3. *Triangular interval
Contents
radial nerve
deep brachial artery/
brachii artery

profunda

Intermediate Back Muscles

1.

Quadrangular
space
Contents

Axillary nerve (nerve supply to

deltoid)
posterior
humeral
circumflex
vessels: artery and vein

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Muscle

Origin

Inserti
on

Action

Nerve

1. Levato
res
costar
um

Vertebra
e:
Transver
se
process
es of C7,
T1-11
Vertebra
e:
Spines
of the
cervical
and
upper

Ribs:
inferior
to
origin

Raise
ribs in
inspirati
on

Dorsal
rami of
thoracic
spinal
nerves

Ribs

Raise
ribs in
inspirati
on

Intercos
tal
nerves

2. Serrat
us
posteri
or
superi
or

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Dr. Laygo |

Back: Topography, Spaces, Triangles

thoracic
vertebra

3. Serrat
us
posteri
or
inferio
r

Vertebra
e:
Spines
of
lumbar
and
thoracic

Ribs

Lower
ribs in
expirati
on

Intercos
tal
nerves

Located deep to trapezius; both

muscles
have
same
origin,
different insertions
O: Vertebrae (spines of T1-T4)
I: Splenius capitis - Skull (occipital,
temporal bones)
: Splenius cervicis vertebrae
(transverse processes C2, C3)
A: extend neck and head; rotate in
unilateral action

2. Erector spinae (Sacrospinalis)

Long muscles of the back
Elongated group of muscles which
extends upward from the dorsum
of the sacrum and the posterior
part of the iliac crest
Chief extensors

3 columns of muscle lying in

parallel
a) Spinalis most medial
O: Spinous processes
I: Spinous processes
b) Longissimus intermediate
O: transverse processes
I: transverse processes
c) Iliocostalis lateral
O: ilium and ribs
I:
ribs
and
transverse
processes above

Splenius

Erector
spinae

Transversospinalis
(deep to
erector
spiane)

1. Act to extend trunk

when act bilaterally
2. Located dorsal to
vertebral column
3. NS: Dorsal primary rami
of spinal nerves

1. Splenius
cervicis
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capitis

and

Splenius

Capitis = Head
Cervicis = neck
Thoracis = thorax and
vertebrae
Lumborum
=
lumbar
vertebrae

Single muscles:
Iliocostalis cervicis
Iliocostalis thoracis
Iliocostalis lumborum
*Spinalis, Longissimus, Iliocostalis
NS: Posterior rami of spinal nerves
ACTION:
Acting bilaterally: Extend
vertebral column and head; as
back is flexed; control

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Dr. Laygo |

Back: Topography, Spaces, Triangles

movement via eccentric

contraction
Acting unilaterally: Laterally
flex vertebral column

3. Transversospinalis
O: transverse processes
I: spines of vertebrae above
A: extend trunk in bilateral action,
rotate unilaterally
Parts differ in how many vertebrae
they extend across:
a. Semispinalis 5 or 6
b. Multifidus 3 or 4
c. Rotatores 1 or 2

ERECTOR
(Sacrospinalis)

2. Rotatores Longi (long) / Breves (short)

Stabilizes vertebrae during
local movements and assist
with local extensions and
rotary movemnets of vertebral
columns, may function as
organ of propioception
3. Interspinales: muscle connecting
spinous processes
4. Inter-transversarii: muscle that
connects transverse process

SPINAE

A. SUPERFICIAL LAYER
1. Occipito cervical area:
splenius capitis: near to occipital bone
Splenius cervicis (attached to cervical
vertebra)
2. Thoracic-Lumbar-Sacral
Spinalis capitis
Spinalis cervicis
3. Longissimus, Capitis
Cervicis
Thoracis
4. Ilio-costalis
Cervicis
Thoracis
Lumborum (insert to pelvic crest)
B. INTERMEDIATE LAYER
Extends hgead and thoracic and
cervical regions of vertebral column
and rotates them contralaterally
1. Semispinalis capitis
2. Seminspinalis Cervicis
3. Semispinalis Thoracis
C. DEEP LAYER
1. Multifidus
Maybe found in cervical,
thoracic, lumbar, sacral area
Stabilizes vertebrae during
local movements
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CENTER OF GRAVITY

(standing up) total body mass

concentration at 1 inch anterior to S2
vertebra
Weight-bearing area

LINE OF GRAVITY
1) Along frontal plane
2) Along sagittal plane
From coronal suture to anterior
to ankle