Muscles of Back

Back
• Posterior axio-appendicular muscles
connect appendicular skeleton of
upper limb with axial skeleton
• Connect pectoral girdle and humerus
with vertebral column
• Clinical examination, knowledge of
structures lying –back is very
important

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Human Anatomy/Yogesh Sontakke 3
 SURFACE
LANDMARKS
Scapula
• Lies posterolateral on chest wall
• Extends vertically from 2nd to 7th rib
• Scapula – covered by muscles, only
following parts can be felt easily:
• Inferior angle: Lies – 7th rib, level
of 7th thoracic vertebra
• Medial border: Extends from T2 to
T7 vertebral level
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 SURFACE
LANDMARKS
Scapula
• Root of spine: Lies opposite – spine
of T3 vertebra
• Acromion: Can be felt at top of
shoulder
• Crest of spine: Runs downward and
medially from acromion – root of
spine

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 SURFACE
LANDMARKS
• Eighth rib
• Lies just below inferior angle of scapula
• Iliac crest
• Curved bony crest of hipbone that lies
below waist
• Anterior superior iliac spine
• Anterior end of iliac crest
• Posterior superior iliac spine
• Posterior end of iliac crest
• Can be felt in shallow dimple above
buttock, about 5 cm from median plane
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 SURFACE
LANDMARKS
• External occipital protuberance
• Bony projection – skull felt in midline
–back of head
• Nuchal furrow or groove
• Midline shallow groove extends from
external occipital protuberance –
spine of C7 vertebra

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 SURFACE
LANDMARKS
• Spines of vertebrae
• Spine of C7 vertebra can be felt –
root of neck, at lower end of nuchal
furrow
• Spine of T2 lies – superior angle of
scapula
• Spine of L4 lies – level of highest
point of iliac crest
• Spine of S2 lies – level of posterior
superior iliac spine

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 MUSCLES OF
THE BACK
• Called posterior axio-
appendicular muscles
• Connect appendicular skeleton
of upper limb –axial skeleton
• Grouped as follows
• Superficial layer
• Trapezius
• Latissimus dorsi

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 MUSCLES OF
THE BACK
• Deep layer
• Levator scapulae
• Rhomboid major
• Rhomboid minor

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 Trapezius
Muscle
• Flat triangular muscle
• Right and left trapezius muscles
together form trapezium shape
(trapezium = four-sided irregular figure,
in Greek)
• Covers back of neck and upper part of
thorax

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 Trapezius
Muscle
Origin
• Originates from
• Superior nuchal line (medial one-
third)
• External occipital protuberance
• Ligamentum nuchae
• Spine of C7 vertebra
• Spines of T1 to T12 vertebrae

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 Trapezius Muscle
Insertion
• Inserts as follows
• Upper fibers – posterior border of lateral one-
third of clavicle
• Middle fibers – medial border of acromion
process and upper lip of crest of spine of
scapula
• Lower fibers – apex of triangular area at
medial end of spine of scapula
Innervations (nerve supply)
• Supplied by
• Spinal part of spinal accessory nerve
• Proprioception by ventral primary rami of C3 14
 Trapezius Muscle
Actions
• Steadies scapula and performs following action
• Upper fibers
• Along with levator scapulae – elevation of scapula (shrugging
of shoulder)
• Middle fibers
• Along with rhomboid major and minor – retraction of scapula
• Lower fibers:
• Along with serratus anterior – rotates scapula in overhead
abduction of arm
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 Latissimus Dorsi

• Wide, thin sheet-like muscle covers wide area of back

(latissimi = wide, dorsi = back, in Latin)
• Large fan-shaped muscle connects humerus with
trunk
Origin
• Originates from
• Spines of lower six thoracic vertebrae (deep to
origin of trapezius)
• Thoracolumbar fascia
• Outer lip of iliac crest
• Lower four ribs
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•
 Latissimus Dorsi

Direction of fibers
• Fibers ascend upward and laterally
(lowest fibers almost vertical and
uppermost fibers are nearly horizontal)
• Fibers turn around inferolateral border
of teres major muscle – form posterior
axillary fold

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 Latissimus Dorsi

Insertion
• Muscle inserts in floor of
bicipital groove
(intertubercular sulcus)
Innervation
• Thoracodorsal nerve (nerve –
latissimus dorsi) (C6–C8)
• Branch of posterior cord of
brachial plexus

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 Latissimus Dorsi
Actions
• Helps – swimming, rowing,
climbing, and pulling
• Movements require adduction,
extension, and medial rotation of
shoulder
• Violent expiration: coughing and
sneezing
• Climbing on rope: this action,
humeral attachment (proximal
attachment of the muscle) – fixed
and trunk moves upward
• Pectoralis major muscle also helps –
climbing
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 Latissimus Dorsi

Clinical testing
• Ask to adduct abducted
arm (at 90°) against
resistance
• Accentuates posterior
axillary fold or contracted
muscle can be felt in
posterior axillary fold

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Human Anatomy/Yogesh Sontakke 21
22
 Clinical
Integration
• Musculocutaneous flap for breast reconstruction
• Case of carcinoma of breast, breast reconstruction
surgery – required after mastectomy (removal of
breast)
• Musculocutaneous flap of latissimus dorsi with
thoracodorsal nerve and thoracodorsal artery
(branch of subscapular artery) and venae
comitantes may be used for breast reconstruction

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 Clinical
Integration
• Cardiac support
• Patients with low cardiac output but not suitable for
heart transplant, latissimus dorsi is wrapped
around the heart and this muscle is stimulated
electrically using pacemaker along with heart
• Procedure is called cardiomyoplasty

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 Clinical
Integration
• Injury to thoracodorsal nerve
• May occur during mastectomy as axillary tail
reaches up to nerve
• Results in paralysis of latissimus dorsi muscle and
inability – raise trunk during climbing
• Latissimus dorsi – useful in breast reconstruction
surgeries and for filling back defects

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 Deep Posterior Axio-appendicular Muscles

Deep posterior axio-

appendicular muscles are
• Levator scapulae
• Rhomboid major
• Rhomboid minor
• Levator Scapulae
• Strap-like muscle situated –
back of neck
• Elevates the scapula, called
levator scapulae
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 Deep Posterior Axio-appendicular Muscles

Origin
• Originates from
• Transverse processes of
C1–C4 vertebrae
Direction of fibers
• Runs obliquely downward
and laterally

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 Deep Posterior Axio-appendicular Muscles

Insertion
• Inserts on
• Superior angle of scapula
• Posterior surface of medial border of scapula (between
superior angle and root of the spine)
Innervations (nerve supply)
• Innervated by
• Dorsal scapular nerve (C5)
• Branches from C3 and C4 nerves
Action
• Elevates and steadies scapula
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 Rhomboid
Minor
Small rhomboid-shape lies under cover
of trapezius
Origin
• Originates from
• Lowest part of ligamentum nuchae
• Spine of C7 and T1 vertebrae
• Supraspinous ligament intervening
between C7 and T1 vertebrae
Direction
• Muscle fibers run downward and
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 Rhomboid
Minor
Insertion
• Inserts on medial border of
scapula on triangular area –
root of spine
Innervation
• Dorsal scapular nerve (C5)
Action
• Retracts scapula 30
 Rhomboid Major
Quadrilateral sheet of muscle lies
deep – trapezius and inferior –
rhomboid minor
Origin
• Originates from spines of T2 – T5
vertebra.
Insertion
• Inserts on posterior aspects of
medial border of scapula below
root of spine
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 Rhomboid Major
Innervation
• Dorsal scapular nerve (C5)
Actions
• Rhomboid minor and major,
and middle fibers of trapezius
retract scapula
• Rhomboids steady scapula
with help of serratus anterior
muscle

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POST TEST - Muscles of
the Back
1. Which muscle is the most
superficial in the back?
• A) Trapezius
• B) Latissimus dorsi
• C) Rhomboid major
• D) Serratus posterior
2. Which muscle aids in shrugging
the shoulders?
• A) Levator scapulae
• B) Trapezius
• C) Latissimus dorsi
• D) Serratus anterior
3. The rhomboid muscles are located
between which two structures?
• A) Spine and scapula
• B) Scapula and clavicle
• C) Spine and ribs
• D) Scapula and humerus
4. The thoracolumbar fascia is
associated with which muscle?
• A) Latissimus dorsi
• B) Trapezius
• C) Rhomboid minor
• D) Levator scapulae
5. Which muscle connects the
scapula to the vertebral column?
• A) Rhomboid major
• B) Serratus anterior
• C) Latissimus dorsi
• D) Pectoralis minor
Thank you………….

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