ANATOMY OF THE BACK

BACK
• The back forms the axis
(central line) of the
human body
• consists of the:
– vertebral column,
– spinal cord,
– supporting muscles, and
– associated tissues (skin,
connective tissues,
vasculature, and nerves).
BACK……
• The back forms the axis (central line) of the
human body
• consists of the:
– vertebral column,
– spinal cord,
– supporting muscles, and
– associated tissues (skin, connective tissues,
vasculature, and nerves).
• Functionally, the back is involved in three
primary tasks:
– Support.
– Protection.
– Movements
• SURFACE ANATOMY
• The Landmarks include the following:
• Vertebrae prominense:
• Scapula.
• Iliac crest.
• Posterior superior iliac spines.
SURFACE ANATOMY….
VERTEBRAL COLLUMN
• VERTEBRAL COLLUMN………

• Viewed from the lateral aspect one can identify the following:

• Cervical curvature (cervical lordosis): this curvature is acquired

secondarily when the infant can support the weight of its own head

• Thoracic curvature (thoracic kyphosis): a primary curvature present

in the fetus (imagine the spine in the “fetal position”)

• Lumbar curvature (lumbar lordosis): this curvature is acquired

secondarily when the infant assumes an upright posture and supports

its weight

• Sacral curvature: a primary curvature present in the fetus

Common Abnormal Curvatures of the Spine

• Scoliosis is abnormal lateral curvature of the spine, which

also includes an abnormal rotation of one vertebra upon
the other.
• It can present as accentuated lateral and rotational curve
of thoracic or lumbar spine

• Can be due to genetic, trauma, idiopathic causes and

occurs in adolescent girls more than boys
kyphosis
Hunchback,
accentuated
flexion of
thoracic spine.
It can be due to
poor posture,
osteoporosis
Lordosis (swayback)
accentuated extension
of lumbar spine,
weakened trunk
muscles.
Can be seen in late
pregnancy, obesity
• MUSCLES OF THE BACK

• The muscles of the back are

divided into two major groups:
● Extrinsic back muscles are
concerned with movements of
the upper limb and with
respiration.
● Intrinsic back muscles are
concerned with movements of
the spine and the maintenance
of posture.
MUSCLES OF THE
BACK…..
Complex but divisible into
3 groups (in layers) with
different functions:
A. SUPERFICIAL
LAYER -move upper
extremity (arm)
B. INTERMEDIATE
LAYER- Respiratory
muscles (insert to ribs)
C. DEEP LAYER – move
trunk and back
• TRAPEZIUS
• Origin
• Occipital bone(external occipital
protuberunce), superior nuchal line,
ligamentum nuchae, spine of seventh
cervical vertebra, spines of all thoracic
vertebrae and their supraspinous ligament
Insertion
• Upper fibers into lateral third of
clavicle; middle and lower fibers into
acromion and spine of scapula
Nerve Supply
• Spinal part of accessory nerve (motor)
and C3 and 4 (sensory)
• XI cranial nerve (spinal part)
Action
• Upper fibers elevate and upwardly
rotate the scapula, extend the neck.
• middle fibers adduct(retracts) the
scapula.
• lower fibers depress and help upper
fibers in rotating scapula.
• Latissimus dorsi
• Origin
• Iliac crest, lumbar fascia, spines of
lower six thoracic vertebrae(T7-T12),
lower three or four ribs, and inferior
angle of scapula
Insertion
• Floor of bicipital groove of humerus
Nerve Supply
• Thoracodorsal nerve(C6, 7, 8)
Action
• Extends, adducts, and medially
rotates the arm
• Its called the climbing muscle
• Raising of the trunk above the arm
Important :As it winds around lower
border of teres major it forms
posterior fold of axilla its lateral
border forms a boundary of lumbar
triangle
• Levator scapulae
• Origin
Transverse processes of first
fourth cervical vertebrae
Insertion
Medial border of scapula
Nerve supply
C3 and 4 and dorsal scapular
nerve
Action
Raises medial border of scapula
Important : Part of floor of
Posterior triangle
• Rhomboid minor and Major
• Origin
(MInor)Ligamentum nuchae
and spines of seventh cervical
and
first thoracic vertebrae
(Major)T2-T5 spines
Insertion
Medial border of scapula
Nerve supply
• Dorsal scapular nerve C4,5
Action
• Raises medial border of
scapula upward and medially
THORACOLUMBA
R (LUMBAR)
FASCIA –
- covers deep
muscles
of back.
- attaches medially
to spines of
vertebrae
- inferiorly to ilium
(pelvic bone)
- Provides for
muscle
attachments
TRIANGLE OF
AUSCULTATION –
Medial to scapula
Boundaries
Inferior - Lat. Dorsi
Superior - Trapezius
Lateral – Rhomboid Major
overlies 6th intercostal
space;
floor has no
large muscles- good
place for listening with
stethoscope
The lumber triangle:
Triangle of Petit
• Is formed by the
posterior free border of
the external oblique
muscles
• The superior border of
the iliac crest and the
lateral border of the
latismus drsi.
• It floor is formed by
internal oblique
abdominal muscle
• It may be site of an
abdominal hernia or
where pus may emerge
from the abdominal
Intermediate Group- associated with Respiration

• All Origin- Vertebra; All Insert- Ribs

– Levator costarum
– Seratus posterior superior
– Seratus posterior superior
Levator es costarum

• Origin:
• Vertebrae- Transverse
process of C7,T1-T11
• Insertion:
• Ribs
• Action:
• Raise ribs in
inspiration
• Innervation:
• Dorsal rami of
thoracic spinal
nerves.
SERRATUS POSTERIOR
SUPERIOR -
Origin: Vertebrae cervical and
upper
thoracic spines)
Insert: Ribs
Action: Raise ribs in inspiration
SERRATUS POSTERIOR
INFERIOR -
Origin: Vertebrae lumbar and
lower thoracic spines;
Insert: Ribs
Action: Lower ribs in expiration
Innervation: both muscles by
Intercostal Nerves
 DEEP GROUP OF BACK MUSCLES

• Divisible into 3 subgroups:

– Splenius,
– Erector Spinae,
– Transversospinalis
• NB;
• all extend trunk of neck when act bilaterally
• all located dorsal to vertebral column
• all innervated by dorsal rami of spinal nerves
 DEEP GROUP OF BACK MUSCLES
• Divisible into 3 subgroups:
– Splenius,
– Erector Spinae,
– Transversospinalis-deep
to Erector Spinae
NB;
• all extend trunk of neck
when act bilaterally
• all located dorsal to
vertebral column
• all innervated by dorsal rami
of spinal nerves
1.SPLENIUS CAPITIS AND SPLENIUS CERVICIS

• located deep to trapezius;

• both muscles have same
origin, different insertions
• Origin: Vertebrae (Spines of
T1- T4)
• Insert:
• Splenius Capitis- Skull
(Occipital, Temporal bones)
• Splenius Cervicis- Vertebrae
(Transverse processes C2, C3)
• Action: Extend neck and head;
rotate in unilateral action
 2. ERECTOR SPINAE-

• Three columns of muscle

lying in parallel.
– SPINALIS- most medial
– LONGISSIMUS-
intermediate
– ILIOCOSTALIS- lateral
 3. TRANSVERSOSPINALIS GROUP
•  is the deep layer of the intrinsic muscles.
• The groups are
– rotatores,
– multifidus, and
– semispinalis.
• ALL: Origin: transverse processes
• Insert: spines of vertebrae above
• are grouped by length of the fascicles, as well as region
covered
• Act: Extend trunk in bilateral action, rotate unilaterally
• Note: Orientation of muscle fibers: transversospinalis are
angled up and in toward spines; erector spinae are parallel to
vertebral column
 TRANSVERSOSPINALIS GROUP….
• rotatores thoracis muscle
– eleven pairs of small quadrilateral muscles, each segment
containing a rotator brevis and rotator longus
– first pair is between T1 and T2, and the last is between T11
and T12. The first or last pair can sometimes be absent.
• rotator brevis muscle
– origin: the upper, posterior part of the inferior transverse
process
– insertion: lower border and lateral surface of the superior
lamina
• rotator longus muscle
– origin: inferior transverse process
– insertion: base of the superior spinous process two levels
above 
• TRANSVERSOSPINALIS GROUP….
• Multifidus
• The multifidus muscle extends from the cervical to the sacral
levels, lying lateral to the spinous processes and covering the
laminae of the underlying vertebrae from cervical to upper
lumbar levels, then expanding to encompass the sacrum at the
lumbosacral levels. The fascicles span two to five segments. 
• origin: posterior sacrum, posterior superior iliac spine,
aponeurosis of the erector spinae, sacroiliac ligament,
mammillary processes of the lumbar vertebrae, transverse
processes of T1-3, articular processes of C4-C7
• insertion: fibers pass upwards and medially to insert along the
length of the spinous process.
• TRANSVERSOSPINALIS GROUP….
• semispinalis capitis muscle
– lies superficial to the semispinalis cervicis muscle and
deep to the splenius caopitis and cervicis and trapezius;
sometimes a small portion of the muscle remains
exposed as part of the posterior triangle of the neck
– origin: there is variation between texts but in general, the
semispinalis capitis muscle starts from superior articular
processes C4 or C5 to C7 and the tips of the transverse
processes of C7 or T1 to T6 or T7 
– insertion: medial part between superior and inferior
nuchal lines of the occiput
 TRANSVERSOSPINALIS GROUP….

• semispinalis cervicis muscle

– fascicles cover the cervical and thoracic multifidus
muscles
– origin: T1-T5 or T6 transverse processes 
– insertion: spinous process of C2-C5
• semispinalis thoracis muscle
– thin, fleshy fascicles with long tendons at either end;
covers the thoracic multifidus muscle
– origin: T6-T10 transverse processes 
– insertion: C6-T4 spinous processes 
• Deltoid
• Origin
Lateral third clavicle(Anterior) Lateral
border of acromion(middle) Spine of
scapula(posterior)
Insertion
Middle of lateral surface of shaft of
humerus to deltoid tuberosity
Nerve supply
Axillary nerve C5, 6
Action
Anterior fibers flex and medially rotate
arm
Middle fibers Abducts arm;
Posterior fibers extend and laterally rotate
arm Abduction from 15-90 degrees
• Applied anatomy
Intramuscular injections are
given into the deltoid . They
should be given in the lower half
of the muscle to avoid injury to
axillary nerve.
In subacromial bursitis pressure
over the deltoid below the
acromion with the arm by the side
causes pain. However when the
arm is abducted pressure over the
same point causes no pain because
the bursa disappearsunder the
acromion. This is referred to as
Dawbarn’s sign.
• Supraspinatus
• Origin
Supraspinous fossa of
scapula
Insertion
Greater tuberosity of
humerus; capsule of
shoulder joint
Nerve supply
Suprascapular nerve C4, 5, 6
Action
Abducts arm and stabilizes
shoulder joint Initiation of
abduction 0-15
degree
• Infraspinatus
• Origin
• Infraspinatus Infraspinous
fossa of scapula
Insertion
Greater tuberosity of
humerus; capsule of
shoulder joint
Nerve supply
Suprascapular nerve C4, 5,
6
Action
Laterally rotates arm and
stabilizes shoulder joint
• Teres minor
Origin
Upper two thirds of
lateral border of scapula
Insertion
Greater tuberosity of
humerus; capsule of
shoulder joint
Nerve supply
Axillary nerve (C4), C5,
6
Action
Laterally rotates arm and
stabilizes shoulder joint
• Teres major
Origin
Lower third of lateral border
ofscapula
Insertion
Medial lip of bicipital groove
ofhumerus
Nerve supply
Lower subscapular nerve
C6,7
Action
Medially rotates and adducts
arm and stabilizes shoulder
joint
Important : Considered
continuation of
subscapularis
• Subscapularis
Origin
Subscapular fossa
Insertion
Lesser tuberosity of
humerus
Nerve supply
Upper and lower
subscapular nerves C5, 6, 7
Action
Medially rotates arm and
stabilizes shoulder joint
Important: Multipennate
Arterial Anastomosis Around the Shoulder Joint

• Scapular anastomoses is
an anastomoses between
the first part of
subclavian and third
part of axillary artery.
• This anastomosis
occur at two different
site :
1. Around the body
2. Around the acromial
process
• Branches from the
subclavian artery
1. The suprascapular artery
is a branch of thyrocervical
trunk of subclavian artery.
Supplies the supraspinous and
infraspinous fossae, and their
contents .
2. Deep branch of transverse
cervical artery supplies the
rhomboidei and the medial
border of the scapula, running
deep to levator scapulae.
• Branch from the axillary
artery
3. The circumflex scapular
artery, a branch of the
subscapular artery which arises
from the third part of axillary
artery

• Applied aspect
•It provides a collateral
circulation through which blood
can flow to the limb in case of
blockage of distal part of
subclavian artery or proximal
part of axillary artery.