Anatomy Tables - Superficial Back Topographical Anatomy of the Back

Structure/Space external occipital protuberance (N4, TG7-05) Description/Boundaries a projection on the external surface of the squamous part of the occipital bone in the midline Significance it is the attachment site of the ligamentum nuchae and the trapezius m.; its highest point is called the inion (Latin, occiput = against head; Greek, inion = back of head) it has a long, non-bifid spinous process which is prominent at the nape of the neck, hence its name (Latin, vert = to turn)

vertebra (spina) prominens (N21, TG1-01)

the seventh cervical vertebra

Viscera/Fascia
Organ/Part of Organ skin Location/Description the membranous covering of the body, also known as the cutis the outer epithelial portion of the skin including these layers (from superficial to deep): stratum corneum (or horny layer), stratum lucidum (or clear layer), stratum granulosum (or granular layer), stratum spinosum (or spiney layer), stratum germintivum (or germinative layer), stratum basale (or basal layer) (Greek, epi = on + derma = skin) blood, lymph vessels, nerves, sebaceous glands, and sweat glands occur in this layer of the skin, which lies between the epidermis and fatty (subcutaneous) layer also known as the superficial fascia, this layer lies deep to the skin and consists of loose connective tissue containing fat, cutaneous nerves, superficial veins, lymph vessles and nodes (Latin, sub = beneath + cutis = skin) a dense layer of connective tissue between the subcutaneous tissue and the muscles; surrounds the entire muscle group a dense layer of connective tissue surrounding individual muscles

epidermis

dermis

subcutaneous tissue investing (deep) fascia muscular fascia

neurovascular bundle thoracolumbar aponeurosis (fascia)

a term that describes the typical common path of a vein, artery, and nerve 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.

Bones of the Back Region

Bone occipital (N4, TG7-05) Structure Description the bone forming the posterior surface of the skull Notes it articulates superolaterally with the parietal bones through the lambdoid suture, anteroinferiorly with the temporal bone and anteriorly with the body of the sphenoid bone (Latin, occiput = against head) it is an attachment site for the ligamentum nuchae; the superior nuchal lines of the two sides meet in the midline at the external occipital protuberance; also known as: inion (Latin, occiput = against head; Greek, inion = back of head) it projects inferiorly from the junction of the petrous and squamous parts of the temporal bone; it contains the mastoid air cells that open into tympanic cavity through the mastoid antrum (Latin/Greek, mastoides = resembling a nipple) it is an attachment site for trapezius and splenius mm. (Latin, nucha = nape)

external occipital protuberance (N4, TG7-05)

a low process on the external surface of the occipital bone in the midline

mastoid process (N4,N8,N13, TG7-05, TG706)

the process located posteroinferior to the external acoustic meatus

superior nuchal line (N174, TG706)

a low ridge that runs transversely on the external surface of the squamous part of the occipital bone one of a series of irregular bones that form the spine

vertebra

a vertebra has two parts: the vertebral body and the vertebral arch; there are 33 vertebrae total: 7 cervical, 12 thoracic, 5 lumbar, 5 fused to form the sacrum, 4 coccygeal; features of a typical

vertebra include: body, pedicles, transverse processes, laminae, articular processes, spinous process spinous process (N21, TG103D, TG103E, TG105B, TG105E) vertebra prominens (N21, TG101) sacrum (N157, TG108) a posterior midline process arising from the junction of the two laminae of the vertebra the seventh cervical vertebra it projects downward and inferiorly; it is an important site of muscle attachment; spinous processes of cervical vertebra 26 are bifid

it has a long, non-bifid spinous process which is prominent at the nape of the neck, hence its name it is formed by 5 fused vertebrae; the sacrum and two os coxae bones form the pelvis. (Latin, "os sacrum" meant "Holy Bone". "Holey" bone could remind you of the sacral foramina.) there are four pairs; each transmits the dorsal primary ramus of the respective sacral spinal nerve (Latin, foramen = an aperture) the coccyx results from the fusion of the four coccygeal vertebrae; it may be a single bone or the first coccygeal vertebra may be separated from the other three; it articulates with the fifth sacral segment; coccygeal vertebrae are reduced in complexity, having no pedicles, laminae or spines. (Latin/Greek, coccyx = cuckoo's beak)

a triangular bone that is the posterior skeletal element forming the pelvis posterior sacral foramina an opening in the posterior surface of the sacrum

coccyx (N157, TG604)

the most inferior portion of the vertebral column

pectoral formed by the scapulae and clavicles and joined to the manubrium, it girdle connects the upper limbs to the axial skeleton (N420, N421, TG2-03A) clavicle (TG2-03A) an "S" shaped bone located between the it articulates medially with the manubrium of the sternum and laterally with the acromion

sternum and the scapula

process of the scapula; it forms a strut that supports the upper limb; it is frequently fractured; it is the first bone to begin ossification during development (Latin, clavicula = little key, this term was used to refer to the catch that fastens a window as well as to keys. Curved window fasteners resemble the shape of this bone) the scapula floats in a sea of muscles, so it is difficult to fracture; it articulates with the axial skeleton through only one bone - the clavicle at the coracoclavicular and acromioclavicular joints it is an important site of muscle attachments for the intermediate layer of back muscles, including rhomboid major and minor and serratus anterior it is the attachment site for the levator scapulae m.

scapula (TG2-03A, TG2-03B)

the bone of the shoulder

medial border

the border of the scapula that runs from the superior angle to the inferior angle

superior angle the angle of the scapula formed at the union of the superior and medial borders inferior angle

the angle of the the inferior angle of the scapula scapula formed by often has a slip of origin of the the union of the latissimus dorsi attached to it medial and lateral borders a heavy ridge that runs from the medial border of the scapula to the acromion process a broad, flat process located at the lateral end of the scapular spine it supports the acromion process; it divides the posterior surface of the scapula into a supraspinatous fossa and an infraspinatous fossa it articulates with the clavicle through a synovial joint (acromioclavicular joint) (Greek, akros = point)

spine

acromion

ilium (N152,N174, N248, TG6-

fan-shaped bone one of three bones that form the that forms the os coxae: ilium, ischium, pubis lateral prominence

04) iliac crest

of the pelvis arching superior edge of the ilium that forms the rim of the "fan" attachment for abdominal wall muscles

Muscles of the Back Region - Superficial Group

Muscle latissimu s dorsi (N174, TG1-13) Origin vertebral spines from T7 to the sacrum, posterior third of the iliac crest, lower 3 or 4 ribs, sometim es from the inferior angle of the scapula transvers e processes of C1-C4 vertebrae Insertion floor of the intertuber cular groove Action extends and rotates the arm mediall y, along with adducti on of the arm Innervati on Artery Notes the inserting tendon twists so that fibers originatin g highest insert lowest (Latin, latus = broad, dorsi = back) Ima ge

thoracodor thoracod sal nerve orsal a. (C7,8) from the posterior cord of the brachial plexus

levator scapulae (N424, TG1-13)

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

elevate dorsal s the scapular scapula nerve (C5); the upper part of the muscle receives branches of C3 & C4

dorsal scapular a.

levator scapulae is named for its action (Latin, levator = to lift)

rhomboi spines of deus vertebrae major T2-T5 (N424, TG1-13)

medial border of the scapula inferior to the spine of the

retracts dorsal dorsal , scapular scapular elevate nerve (C5) a. s and rotates the scapula

named for its shape (Greek, rhomb = oblique parallelog ram)

scapula rhomboi deus minor (N424, TG1-13) inferior end of the ligament um nuchae, spines of vertebrae C7 and T1 medial border of the scapula at the root of the spine of the scapula lateral third of the clavicle, medial side of the acromion and the upper crest of the scapular spine, tubercle of the scapular spine

inferior ly retracts dorsal dorsal , scapular scapular elevate nerve (C5) a s and rotates the scapula inferior ly elevate s and depress es the scapula (depen ding on which part of the muscle contrac ts); rotates the scapula superio rly; retracts scapula motor: spinal accessory (XI), propriocep tion: C3C4 transvers e cervical a. named for its shape (Greek, rhomb = oblique parallelog ram

trapezius medial (N174, third of TG1-13) the superior nuchal line, external occipital protubera nce, ligament um nuchae, spinous processes of vertebrae C7-T12

named for its shape; trapezius is an example of a muscle that migrates during developm ent from its level of origin (cervical) to its final position, pulling its nerve and artery along behind

Joints and Ligaments

Joint or ligament nuchal ligament (N21, TG1-09) Description 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 Notes 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 (Latin, nucha = nape)

Blood Vessels of the Back

Artery dorsal scapular (N33,N427, N429,N430,N477, TG2-09) Source subclavian a., 3rd part Branches unnamed muscular branches Supply to levator scapulae m., rhomboideus major m., rhomboideus minor m. Notes dorsal scapular a. anastomoses with the suprascapular a. and the subscapular a. to form the scapular anastomosis; dorsal scapular a is a branch of the transverse cervical a. in ~30% of cases

thoracodorsal (N429, TG1-13)

subscapular

muscular

latissimus dorsi trapezius muscle and surrounding tissues transverse cervical a. gives rise to the dorsal scapular a. ~30% of the time

transverse cervical thyrocervical unnamed (N33,N177,N427, trunk muscular TG1-13) branches, possibly the dorsal scapular a.

Nerves of the Back

Nerve accessory n. (N177, TG793C) Source cranial root: medulla nucleus ambigu us; spinal root: spinal nucleus of the upper cervical spinal cord Branch es no named branche s Motor Sensory Notes also known as: CN XI, 11th cranial nerve; spinal root enters cranial cavity by passing through the foramen magnum; exits skull by passing through the jugular foramen; accessory n. is motor only; the subtrapezial plexus of nerves receives proprioceptive

GSE: none sternocleidomas toid and trapezius mm.

fibers: for the sternocleidomas toid m. from the ventral primary rami of spinal nn. C2 and C3 for trapezius via ventral primary rami of C3 and C4 dorsal primary ramus (N258, TG112) first branch off of the dorsal side of the spinal nerve brachial plexus (br. of C5 ventral primary ramus) dorsal primary ramus of spinal nerve C2 (medial br.) formed at the point where the dorsal and ventral rootlets meet; it ends where numero us to the deep back mm.; sympathetic innervation to the skin general sense (touch, pressure, pain, heat, cold, etc.) to the skin of the back a mixed nerve containing both motor and sensory fibers (Latin, ramus = branch)

dorsal scapular n. (N33,N427,N4 29, N430,N477, TG2-09) occipital n., greater (N178, TG116)

no named branche s

rhomboideus none major and minor mm.; levator scapulae m.

dorsal scapular n. passes through the scalenus medius m.

no posterior neck named muscles branche s

skin of the posterior surface of the scalp

muscles innervated by this nerve develop from epimeres in the embryo

spinal n. (N258, TG112)

dorsal primary ramus; ventral primary ramus

to skeletal mm.; some levels carry preganglionic sympathetic axons (T1-L2)

general sense (touch, pressure, pain, heat, cold, etc.) from the entire surface of the neck, trunk and extremities

located at the intervertebral foramen; there are 31 pairs of spinal nerves - 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal

the dorsal and ventral primary rami diverge

; visceral pain (via the white ramus communic ans and the sympatheti c nervous system) latissimus dorsi

thoracodorsal (middle subscapular) (N429, TG113)

posterio r cord of brachial plexus

Clinical Terms
Term triangle of auscultation (N424, TG1-13) lumbar triangle (Petit's triangle)/hernia (N174, TG1-13) Definition a triangular gap formed by the superior horizontal border of the latissimus dorsi, the medial border of the scapula, and the inferolateral border of the trapezius; this is a good place to examine posterior segments of the lungs with a stethoscope bordered medially by the latissimus dorsi, laterally by the external abdominal oblique, and inferiorly by the iliac crest, this point is vulnerable to abdominal (lumbar) hernia. The definition of a hernia is the protrusion of a portion of an organ or tissue through an abnormal opening. The excellent editorial assistance of Dr. Pat Tank, UAMS is gratefully acknowledged.

The material presented in these tables is contained in the book: MedCharts Anatomy by Thomas R. Gest & Jaye Schlesinger Published by ILOC, Inc., New York Copyright 1995, unauthorized use prohibited.

Copyright 2000 The University of Michigan. Unauthorized use prohibited.

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