Lecture One

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Lecture One

• Superficial back

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Bony marks

• spine
• supraspinous fossa
• infraspinous fossa
• acromion process
• coracoid process
• glenoid cavity

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Bony marks

• Greater Lesser turbercle
• Intertubercular groove
• Lateral Medial epicondyle
• Anatomical Surgical neck
• Deltoid tuberosity
• Olecranon fossa

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triangle of auscultation

• a triangle located below the inferior angle of
  the scapula bounded by the trapezius muscle
  medially, rhomboideus major muscle superiorly and
  the latissimus dorsi muscle inferiorly its floor
  is the posterior thoracic wall, used to hear
  lungs by stethoscope

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Back muscles

• The skin and superficial fascia of the back can
  be divided into three groups organized in layers
  superficial, intermediate, and deep. Muscles of
  the superficial and intermediate groups are
  called extrinsic back muscles because they are
  involved in respiration and movements of the
  upper extremity. Muscles of the deep group are
  called intrinsic back muscles because they are
  involved in movement and stabilization of the
  vertebral column.

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Superficial back muscles

• trapezius and latissimus dorsi muscle

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TRAPEZIUS

• ORIGIN
• Upper fibers external occipital protuberance,
  medial one third of superior nuchal line,
  ligamentum nuchae, and spinous process of 7th
  cervical vertebra 
• Middle fibers spinous processes of first to
  fifth thoracic vertebrae 
• Lower fibers spinous processes of sixth to 12th
  thoracic vertebrae 
• INSERTION
• Upper fibers lateral one third of clavicle and
  acromion process of the scapula
• Middle fibers medial margin of acromion and
  superior lip of spine of scapula 
• Lower fibers tubercle at apex of spine of scapula

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TRAPEZIUS

• ACTIONWith origin fixed, adduction of the
  scapula, performed chiefly by the middle fibers
  with stabilization by the upper and lower fibers.
  Rotating of the scapula so the glenoid cavity
  faces cranially, performed chiefly by the upper
  and lower fibers with stabilization by the middle
  fibers. In addition, the upper fibers elevate and
  the lower fibers depress the scapula.With the
  insertion fixed, and acting unilaterally, the
  upper fibers extend, laterally flex, and rotate
  the head and joints of the cervical vertebrae so
  that the face turns toward the opposite side and
  acting bilaterally, the upper Trapezius extends
  the neck. The Trapezius also acts as an accessory
  muscle of respiration.
• NERVEspinal portion of accessory nerve (XI
  cranial nerve) and ventral ramus, C2, 3, 4

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LATISSIMUS DORSI

• ORIGIN
• spinous processes of last six thoracic vertebrae,
  last three or four ribs, through the
  thoracolumbar fascia from the lumbar and sacral
  vertebrae and posterior one third of external lip
  of iliac crest, a slip from the inferior angle of
  the scapula
• INSERTION
• intertubercular groove of humerus

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LATISSIMUS DORSI

• ACTIONWith the origin fixed, medially rotates,
  adducts, and extends the shoulder joint. By
  continued action, depresses the shoulder girdle,
  and assists in lateral flexion of the
  trunk. With the insertion fixed, assists in
  tilting the pelvis anteriorly and laterally.
  Acting bilaterally, this muscle assists in
  hyperextending the spine and anteriorly tilting
  the pelvis, or in flexion the spine, depending
  upon its relation to the axes of motion. This
  muscle is important in ralation to movements such
  as climbing, walking with crutches, or hoisting
  the body up on parallel bars, in which the
  muscles act to lift the body toward the fixed
  arms. The strength of the latissimus dorsi is a
  factor in such forceful arm movements as
  swimming, rowing, and chopping. All adductors and
  medial rotators act in these strong movements but
  the latissimus dorsi may be of major
  importance. The latissimus dorsi may act as an
  accessory muscle for respiration
• NERVEthoracodorsal nerve, C6, 7, 8

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Intermediate Back Muscles

• Levator scapulae - later, rhomboids, serratus
  anterior (deep extrinsic muscles)
• Scapular (intrinsic shoulder) muscles (deltoid,
  supraspinatus, infraspinatus, teres major, minor
  and subcapularis)Four of these (supraspinatus,
  infraspinatus, teres minor and subscapularis) are
  referred as rotator cuff muscle
• Serratus posterior superior Inferior (Muscles
  of thorax proper)

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RHOMBOID MAJOR

• ORIGINspinous processes of 2nd to 5th thoracic
  vertebrae (major)
• INSERTIONBy fibrous attachment to medial border
  of scapula between spine and inferior angle
  (major)
• ACTIONadduct and elevate the scapula, and rotate
  it so that glenoid cavity faces caudally
• NERVEdorsal scapular, C4, 5

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RHOMBOID MINOR

• ORIGINligamentum nuchae, spinous processes of
  7th cervical and 1st thoracic vertebrae (minor)
• INSERTION medial border at root of spine of
  scapula (minor)
• ACTIONadduct and elevate the scapula, and rotate
  it so that glenoid cavity faces caudally
• NERVEdorsal scapular, C4, 5

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Serratus anterior (the boxers muscle)

• ORIGINouter surface and superior borders of
  upper eight or nine ribs
• INSERTIONcostal surface of medial border of
  scapula
• ACTIONWith the origin fixed, abducts the
  scapula, rotates the inferior angle laterally and
  the glenoid cavity cranially, and holds the
  medial border of the scapula firmly against the
  rib cage. In addiction, the lower fibers may
  depress the scapula, and the upper fibers may
  elevate it slightly. Starting from a position
  with the humerus fixed in flexion and the hands
  against a wall, the serratus acts to displace the
  thorax posteriorly as the effort is made to push
  the body away from the wall. Another example of
  this type of action is in a properly executed
  push-up.With the scapula stabilized in addition
  by the rhomboids, thereby fixing the insertion,
  the serratus may act in forced inspiration
• NERVELong thoracic, C5, 6, 7, 8 (winging the
  scapula if damaged)

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DELTOID

• ORIGIN
• anterior fibers anterior border, superior
  surface, lateral one third of claviclemiddle
  fibers lateral margin and superior surface of
  acromion
• posterior fibers inferior lip and superior
  border of spine of scapula
• INSERTION
• deltoid tuberosity of humerus
• ACTIONAbduction of the shoulder joint, performed
  chiefly by the middle fibers with stabilization
  by the anterior and posterior fibers. In
  addition, the anterior fibers flex and, in the
  supine position, medially rotate the shoulder
  joint the posterior fibers extend and, in the
  prone position, laterally rotate. 
• NERVEaxillary nerve, C5, 6

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TERES MAJOR

• ORIGINdorsal surface of inferior angle and lower
  third of lateral border of scapula
• INSERTIONthe crest of the lesser tubercle of
  humerus
• ACTIONMedially rotates, adducts, and extends the
  shoulder
• NERVELower Subscapular Nerve C 5, 6, 7

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TERES MINOR

• ORIGINUpper two thirds, dorsal surface of
  lateral border of scapular
• INSERTIONthe lowest facet of the greater
  tubercle of the humerus, and shoulder joint
  capsule
• ACTIONLaterally rotates shoulder joint, and
  stabilizes head of humerus in the glenoid cavity
  during movement of this joint
• NERVEAxillary nerve, C5, 6

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INFRASPINATUS

• ORIGINmedial two thirds of infraspinatus fossa
  of scapula
• INSERTIONthe middle facet of the greater
  tubercle of the humerus, and shoulder joint
  capsule
• ACTIONLateral rotates shoulder joint and
  stabilizes head of humerus in the glenoid cavity
  during movement of this joint
• NERVEsuprascapular nerve, C(4), 5, 6 

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SUPRASPINATUS

• ORIGINmedial two thirds of supraspinous fossa of
  scapula
• INSERTIONsuperior facet of greater tubercle of
  humerus, and shoulder joint capsule
• ACTIONAbducts the shoulder joint, and stabilizes
  head of humerus in the glenoid cavity during
  movement of this joint
• NERVESuprascapular nerve, C 4, 5, 6

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SUBSCAPULARIS

• ORIGINSubscapular fossa of scapula
• INSERTIONlesser tubercle of humerus and shoulder
  joint capsule
• ACTIONmedially rotates shoulder joint, and
  stabilizes the head of the humerus in the glenoid
  cavity during movements of this joint
• NERVEupper and lower subscapular nerve, C5, 6, 7

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SERRATUS POSTERIOR SUPERIOR

• ORIGINligamentum nuchea in the neck, spinous
  processes of C7, and T1 to T3
• INSERTIONsuperior borders of second to forth
  ribs
• ACTIONelevate first four ribs, aid respiration
  by increasing diameter of the thorax
• NERVEintercostal nerve

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SERRATUS POSTERIOR INFERIOR

• ORIGINspinous processes of the last two thoracic
  and first two lumbar
• INSERTIONinferior borders of the inferior three
  or fourth ribs
• ACTIONdepress inferior ribs, preventing them
  from being pulled up by diaphragm
• NERVEintercostal nerve

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Rotator Cuff Tear

• Cause
• Over use, aging (middle aged man)
• Symptoms
• Pain, unable to raise arm
• Treatment
• Conservative
• Surgical