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Pile Management Card
Superficial Back

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thoracodorsal nerve
Source: posterior cord of brachial plexus

Motor: latissimus dorsi
greater occipital nerve
Source: dorsal primary ramus of spinal nerve C2 (medial br.)

Motor: posterior neck muscles

Sensory: skin of the posterior scalp
dorsal scapular nerve
Source: brachial plexus (br. of C5 ventral primary ramus)

Motor: rhomboideus major and minor mm.; levator scapulae m.

Sensory: none
dorsal primary ramus
Source: first branch off of the dorsal side of the spinal nerve

Motor: to the deep back mm.; sympathetic innervation to the skin

Sensory: cutaneous to the skin of the back

Notes: a mixed nerve containing both motor and sensory fibers
Accessory nerve
motor: to trapezius

sensory: none
transverse cervical artery
Source: thyrocervical trunk

Supplies: trapezius muscle
thoracodorsal artery
Source: subscapular

Branches: muscular

Supplies: latissimus dorsi
dorsal scapular artery
Source: subclavian a.

Branches: unnamed muscular branches

Supply to: levator scapulae m., rhomboideus major m., rhomboideus minor m.
nuchal ligament
a midline ligament that extends posteriorly from the spinous processes of cervical vertebrae and extends from the base of the skull to the 7th cervical vertebra a syndesmosis; it provides muscle attachments to the cervical spinous processes without the necessity of long spinous processes that would hinder extension of the neck
trapezius
Origin: medial third of the superior nuchal line, external occipital protuberance, ligamentum nuchae, spinous processes of vertebrae C7-T12

Insertion: lateral third of the clavicle, medial side of the acromion and the upper crest of the scapular spine

Action: elevates and depresses the scapula (depending on which part of the muscle contracts); rotates the scapula superiorly; retracts scapula

Innervation:

motor: spinal accessory (XI), proprioception: C3-C4

Artery: transverse cervical a.

Notes: named for its shape; trapezius is an example of a muscle that migrates during development from its level of origin (cervical) to its final position, pulling its nerve and artery along behind
rhomboideus minor
Origin: inferior end of the ligamentum nuchae, spines of vertebrae C7 and T1

Insertion: medial border of the scapula at the root of the spine

Action: retracts, elevates and rotates the scapula inferiorly

Innervation: dorsal scapular nerve (C5)

Artery: dorsal scapular a
rhomboid major
Origin: spines of vertebrae T2-T5

Insertion: medial border of the scapula inferior to the spine of the scapula

Action: retracts, elevates and rotates the scapula inferiorly

Innervation: dorsal scapular nerve (C5)

Artery: dorsal scapular a.
levator scapulae
Origin: transverse processes of C1-C4 vertebrae

Insertion: medial border of the scapula from the superior angle to the spine

Action: elevates the scapula

Innervation: dorsal scapular nerve (C5); the upper part of the muscle receives branches of C3 & C4

Artery: dorsal scapular a.
Latissimus dorsi
Origin: vertebral spines from T7 to the sacrum, posterior third of the iliac crest, lower 3 or 4 ribs

Insertion: medial lip of the intertubercular groove

Action: extends and rotates the arm medially, along with adduction of the arm

Innervation: thoracodorsal nerve (C7,8) from the posterior cord of the brachial plexus

Artery: thoracodorsal a.
attachments of the scapula
see Netter 407
What are the 2 articulations of the clavicle?
it articulates medially with the manubrium of the sternum and laterally with the acromion process of the scapula
What attaches to superior nuchal line?
trapezius and splenius muscles
superior nuchal line
-runs transversely on the external surface of the occipital bone
-sandwiches the external occipital protuberance
-attachment site for trapezius and splenius mm
external occipital protuberance
-a projection on the external surface of the squamous part of the occipital bone in the midline
-the attachment site of the ligamentum nuchae and the trapezius m.
-aka inion
-sandwiched by superior nuchal lines
thoracolumbar aponeurosis (fascia)
extends laterally from the spinous processes and forms a thin covering for the deep muscles in the thoracic region and a strong, thick covering for muscles in the lumbar region.
vertebra (spina) prominens
-seventh cervical vertebra
-has a long, non-bifid spinous process which is prominent at the nape of the neck, hence its name
What inserts on the external occipital protuberance?
ligamentum nuchae and the trapezius m.
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