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ACD 5 & 6


1. Locate the bony prominences of the back, spines
and give their clinical significance:

a. Occipital Protuberance
● lies at the junction of the head and
● raised area on the midline of the
occipital bone where the posterior
wall meets the base of the skull

b. Vertebral Prominence
● 7th cervical vertebra
● most prominent spinous
process that can be felt in the

Superior angle of Scapula ● can be palpated opposite the first thoracic spine Inferior angle of Scapula ● palpated opposite the seventh thoracic spine .c.

d. Spine of Scapula ● palpated at level of 3rd thoracic spine .

Iliac Crest ● lie at the level of 4th lumbar spine ● used as a landmark for lumbar puncture .e.

and deep fascia of the back including its cutaneous innervation. superficial.2. . Discuss the skin.


Skin ● Thicker ● Fewer nerve endings than other parts of torso .

C7. C6.Cutaneous Innervation of the Back Posterior rami of the 31 pairs of spinal nerves ● Posterior rami of the C1. C8. L4. and L5 ○ Supplies deep muscles but not skin ● Posterior rami of C2 (Great Occipital Nerve) ○ Supplies skin of the scalp ● Posterior rami of Upper Three Lumbar Nerves ○ Skin over buttock *Emerges from intervertebral foramen *Each posterior ramus divides into medial and lateral branches .


Superficial Blood Supply Posterior branches: ● Posterior intercostal arteries ● Lumbar arteries Corresponding veins drain into: ● azygos veins ● inferior vena cava .

ARTERIAL BLOOD SUPPLY ● Posterior intercostal arteries ● Lumbar arteries VENOUS BLOOD SUPPLY ● Posterior intercostal veins ● Lumbar arteries veins .



Superficial Lymph Drainage ● Posterior group of axillary lymph nodes .

Deep Fascia of the Back (Thoracolumbar Fascia) .

Thoracolumbar Fascia (Deep Fascia of the Back) ● Between iliac crest and 12th rib ● Strong aponeurosis ● Origin of the transversus and internal obliques .

Thoracolumbar Fascia (Deep Fascia of the Back) Separated medially into three lamellae: ● Posterior lamella ○ Covers deep muscles ○ Attached to lumbar spines ● Middle lamella ○ Attached to tips lumbar transverse processes ○ Anterior to the deep muscles ○ Posterior to quadratus lumborum ● Anterior lamella ○ Attached to anterior surface of lumbar transverse processes ○ Anterior to quadratus lumborum .

3. . action with demonstration and innervation. Discuss the 3 group of the muscles of the back as to its attachments.

Superficial Muscles Trapezius Origin: ● Occipital bone ● Ligamentum nuchae ● Spine of 7th cervical vertebra ● Spines of all thoracic vertebra Insertion: ● Upper fibers into lateral third of clavicle ● Middle and lower fibers into acromion and spine of scapula Nerve: ● Spinal part of accessory nerve ● C3. C4 (sensory) Action: ● Upper fibers: elevate the scapula ● Middle fibers: pull scapula medially ● Lower fibers: pull medial border of scapula downward .

adducts. and medially rotates the arm . Superficial Muscles Latissimus dorsi Origin: ● Iliac crest ● Lumbar fascia ● Spines of lower 6 thoracic vertebrae ● Lower 3-4 ribs ● Inferior angle of the scapula Insertion: ● Floor of bicipital groove of humerus Nerve: ● Thoracodorsal nerve Action: ● Extends.


C3 and C4 .Second Layer of Superficial Muscles 1. Levator Scapula Origin: Transverse process of the upper 4 cervical vertebra Insertion: Medial border of the scapula Action: Elevates the medial border of the scapula and pulls it medially Innervation: Dorsal scapular nerve.

2. Rhomboids minor Origin: Spine of C7 Insertion: Medial border of the scapula Action: Elevates the medial border of the scapula and pulls it medially Innervation: Dorsal scapular nerve . Rhomboids major Origin: Spines of T1-T4 3.

Serratus Posterior Superior Origin: Lower cervical and upper thoracic spines Insertion: Upper ribs Action: Helps expand the thoracic cage during expiration Innervation: Intercostal Nerves .Intermediate Layer of the Back 1.

Superior Posterior Inferior Origin: Spines of T12-L2 Blood supply : Intercostal arteries Insertion: Last 4 ribs Action: Assists in inspiration Innervation: Intercostal nerves .2.

Deep Muscles of the Back ● Deep Muscles of the back are classified as follows ● Superficial vertically Running muscles ○ Erector Spinae ■ Ilicostalis ■ Longissimus ■ Spinalis ● Intermediate Oblique Running Muscles ○ Transversospinalis ■ Semispinalis ■ Multifudus ■ Rotatores ● Deepest Muscles ○ Interspinales ○ Intertransversarii .

Splenius Muscles ● Splenius Capitis ○ Origin: Lower part of ligamentum nuchae. upper 4 thoracic spines ○ Insertion: Superior nuchal line of occipital bone and mastoid process of temporal bone ○ Innervation: Posterior rami of spinal nerves ○ Action: bends neck laterally and elevate medial border of scapula ● Splenius Cervicis ○ Insertion: Transverse process of upper cervical vertebrae .


Discuss the deltoid and scapular muscles as to their attachment. action. .4. and neurovascular supply.

DELTOID Origin: lateral third of the clavicle. Posterior fibers: extend and laterally rotate arm Neurovascular supply: Axillary nerve (C5. Anterior fibers: flex and medially rotate arm . acromion. C6) . spine of the scapula Insertion: middle lateral surface of humerus shaft Action: abducts the arm .


C6) . capsule of shoulder joint Action: abducts arm and stabilizes shoulder joint Neurovascular supply: Suprascapular nerve (C4. C5.SUPRASPINATUS Origin: supraspinous fossa of scapula Insertion: greater tuberosity of humerus.


Origin: infraspinous fossa of the scapula

Insertion: greater tuberosity of humerus,
capsule of shoulder joint

Action: laterally rotates arm and stabilizes
shoulder joint

Neurovascular supply: Suprascapular nerve
(C4, C5, C6)

Origin: upper ⅔ of the lateral border of scapula

Insertion: greater tuberosity of humerus,
capsule of shoulder joint

Action: laterally rotates arm and stabilizes
shoulder joint

Neurovascular supply: Axillary nerve (C4, C5,

stabilizes shoulder joint Neurovascular supply: Lower subscapular nerve (C6. C7) . adducts arm.TERES MAJOR Origin: lower third of the lateral border of scapula Insertion: medial lip of bicipital groove of humerus Action: medially rotates arm.


C7) . C6. adducts arm.SUBSCAPULARIS Origin: subscapular fossa Insertion: lesser tuberosity of humerus Action: medially rotates arm. stabilizes shoulder joint Neurovascular supply: Lower and upper subscapular nerves (C5.


Discuss the axillary nerve as to its roots of origin. component fibers and areas innervated. . course.5.

Roots of Origin Arises from the posterior cord of the brachial plexus (C5.C6) .

It descends to the inferior border of the subscapularis muscle. . and then exits the axilla posteriorly via the quadrangular space with the posterior circumflex humeral artery.Course It lies posteriorly to the axillary artery and anteriorly to the subscapularis muscle.


Course As it passes through the space. . it comes into close relationship with the inferior aspect of the capsule of the shoulder joint and with the medial side of the surgical neck of the humerus.

runs anteriorly to in front of the surgical neck and ends in the deltoid Posterior division .passes along the posterior border of the deltoid and ends as upper lateral cutaneous nerve of the arm The axillary nerve also provides articular branches to the shoulder joint itself .Course It terminates by dividing into anterior and posterior branches Anterior division .

the "regimental badge" area (which is innervated by the upper lateral cutaneous nerve of the arm) . as well as the skin covering the inferior region of the deltoid muscle .Component fibers Motor functions: innervates the teres minor and the deltoid muscles Sensory functions: carries sensory information from the shoulder joint.

Deltoid . Skin covering the lower half of the deltoid muscle . Shoulder joint .Areas innervated . Teres minor .


Discuss the rotator cuff muscles and its significance .6.

Rotator Cuff Muscles ● SITS muscles ● Composed of the following: ○ Suprasinatus ○ Infrasinatus ○ Teres Minor ○ Subscapularis ● Rotator cuff (tendons of the muscles) ● Surrounds the shoulder joint Harrison. L. Avoid Shoulder Injury by Strengthening the Rotator .d. Retrieved from https://breakingmuscle.). (n..

Rotator Cuff Muscles ● Significance: ○ Acts in coordination in holding the humerus head in the glenoid fossa ○ Provides stability to the shoulder joint.aafp. The Painful Shoulder.html coracoid process . L. especially in abducted position ● Tendinitis/ Rotator Cuff Tear ○ Injury: affects the supraspinatus tendon when the upper arm is raised due to the humerus in close contact with the joint produced by the acromion and Kibuk. (2000). Retrieved from

Draw the boundaries of the sub-occipital triangle and discuss its clinical significance .

Sub-occipital triangle •Medially: Rectus • posterior capitis major •Laterally: Oblique capitis superior and Oblique capitis inferior .

Clinical significance •Vertebral artery *Arteriosclerosis – hardening of arteries •Reduced blood supply to brain • The posterior cranial fossa is approached by neurosurgeons to remove the brain tumor by clearing the sub occipital muscles and removing the exposed bone .

Draw the boundaries of the Triangle of Auscultation and discuss its clinical significance. .7B.

Triangle of Auscultation Medial: ● Inferior fibers of the trapezius Lateral: ● Medial border of the scapula Inferior: ● Superior border of latissimus dorsi .

Triangle of Auscultation Superficial structures ● Serratus anterior ● Rhomboid major ● Lateral portion of erector spinae Deep structures ● 6-7th intercostal space ● Lungs .

Triangle of Auscultation Clinical Significance ● Posterior thoracic wall is closer to the skin surface ● Site where breath sounds can be easily heard ● Rate and rhythm of the heart can also be heard .

. Draw the boundaries of the Lumbar Triangle.7c. What’s its clinical significance.

Inferior Lumbar Triangle Inferior: Iliac Crest Medial: Inferior border of latissimus dorsi Lateral: Posterior border of the external oblique muscles Floor: Internal oblique muscle and transversus abdominis muscle .

Superior Lumbar Triangle Medial: Quadratus lumborum Lateral: Internal oblique muscle Superior: 12th rib Floor: Transversalis fascia Roof: External abdominal oblique muscle .

Clinical Significance of Lumbar Triangle ● Site of pus accumulation ● Lumbar Hernia .

Discuss the quadrangular and triangular spaces and their contents.8. .

Posterior Circumflex Humeral Artery . triceps brachii Lateral: Surgical neck of humerus Contents: Axillary Nerve. Quadrangular Space Superior: Subscapularis Inferior: Teres major Medial: Long head.8a.

8b. Triangular space Boundaries ● Superior: Teres minor ● Inferior: Teres major ● Lateral: Long head of triceps brachii Contains circumflex scapular artery .

Illustrate the circumscapular anastomosis and its clinical significance .9.


Discuss the shoulder girdle as to its articulating bones and joints .10.

Shoulder Girdle Consists of the clavicle and Scapula Articulation: Acromioclavicular joint .


Clavicle Lies horizontally across the root of the neck beneath the skin Articulation Medial: Sternum and 1st costal cartilage Lateral: Acromion Process Sternoclavicular joint and Acromioclavicular joint .




Scapula Lies on the posterior chest wall between the 2nd and 7th rib Posterior: Spine of the scapula Lateral: Acromion which articulates with the clavicle Superolateral: Glenoid cavity or fossa. .articulates with the head of the humerus at the shoulder joint Coracoid process provides attachment for muscles and ligaments.


Glenoid Cavity and Coracoid Process .

Anterior: Subscapular fossa Medial: Suprascapular notch The spine divides the posterior surface into supraspinous fossa and infraspinous fossa Inferior angle can be palpated easily at the level of 7th rib and the spine of 7th thoracic vertebra .