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Lecture One

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Title: Lecture One


1
Lecture One
  • Superficial back

2
Bony marks
  • spine
  • supraspinous fossa
  • infraspinous fossa
  • acromion process
  • coracoid process
  • glenoid cavity

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Bony marks
  • Greater Lesser turbercle
  • Intertubercular groove
  • Lateral Medial epicondyle
  • Anatomical Surgical neck
  • Deltoid tuberosity
  • Olecranon fossa

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triangle of auscultation
  • a triangle located below the inferior angle of
    the scapula bounded by the trapezius muscle
    medially, rhomboideus major muscle superiorly and
    the latissimus dorsi muscle inferiorly its floor
    is the posterior thoracic wall, used to hear
    lungs by stethoscope

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Back muscles
  • The skin and superficial fascia of the back can
    be divided into three groups organized in layers
    superficial, intermediate, and deep. Muscles of
    the superficial and intermediate groups are
    called extrinsic back muscles because they are
    involved in respiration and movements of the
    upper extremity. Muscles of the deep group are
    called intrinsic back muscles because they are
    involved in movement and stabilization of the
    vertebral column.

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Superficial back muscles
  • trapezius and latissimus dorsi muscle

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TRAPEZIUS
  • ORIGIN
  • Upper fibers external occipital protuberance,
    medial one third of superior nuchal line,
    ligamentum nuchae, and spinous process of 7th
    cervical vertebra 
  • Middle fibers spinous processes of first to
    fifth thoracic vertebrae 
  • Lower fibers spinous processes of sixth to 12th
    thoracic vertebrae 
  • INSERTION
  • Upper fibers lateral one third of clavicle and
    acromion process of the scapula
  • Middle fibers medial margin of acromion and
    superior lip of spine of scapula 
  • Lower fibers tubercle at apex of spine of scapula

15
TRAPEZIUS
  • ACTIONWith origin fixed, adduction of the
    scapula, performed chiefly by the middle fibers
    with stabilization by the upper and lower fibers.
    Rotating of the scapula so the glenoid cavity
    faces cranially, performed chiefly by the upper
    and lower fibers with stabilization by the middle
    fibers. In addition, the upper fibers elevate and
    the lower fibers depress the scapula.With the
    insertion fixed, and acting unilaterally, the
    upper fibers extend, laterally flex, and rotate
    the head and joints of the cervical vertebrae so
    that the face turns toward the opposite side and
    acting bilaterally, the upper Trapezius extends
    the neck. The Trapezius also acts as an accessory
    muscle of respiration.
  • NERVEspinal portion of accessory nerve (XI
    cranial nerve) and ventral ramus, C2, 3, 4

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LATISSIMUS DORSI
  • ORIGIN
  • spinous processes of last six thoracic vertebrae,
    last three or four ribs, through the
    thoracolumbar fascia from the lumbar and sacral
    vertebrae and posterior one third of external lip
    of iliac crest, a slip from the inferior angle of
    the scapula
  • INSERTION
  • intertubercular groove of humerus

18
LATISSIMUS DORSI
  • ACTIONWith the origin fixed, medially rotates,
    adducts, and extends the shoulder joint. By
    continued action, depresses the shoulder girdle,
    and assists in lateral flexion of the
    trunk. With the insertion fixed, assists in
    tilting the pelvis anteriorly and laterally.
    Acting bilaterally, this muscle assists in
    hyperextending the spine and anteriorly tilting
    the pelvis, or in flexion the spine, depending
    upon its relation to the axes of motion. This
    muscle is important in ralation to movements such
    as climbing, walking with crutches, or hoisting
    the body up on parallel bars, in which the
    muscles act to lift the body toward the fixed
    arms. The strength of the latissimus dorsi is a
    factor in such forceful arm movements as
    swimming, rowing, and chopping. All adductors and
    medial rotators act in these strong movements but
    the latissimus dorsi may be of major
    importance. The latissimus dorsi may act as an
    accessory muscle for respiration
  • NERVEthoracodorsal nerve, C6, 7, 8

19
Intermediate Back Muscles
  • Levator scapulae - later, rhomboids, serratus
    anterior (deep extrinsic muscles)
  • Scapular (intrinsic shoulder) muscles (deltoid,
    supraspinatus, infraspinatus, teres major, minor
    and subcapularis)Four of these (supraspinatus,
    infraspinatus, teres minor and subscapularis) are
    referred as rotator cuff muscle
  • Serratus posterior superior Inferior (Muscles
    of thorax proper)

20
RHOMBOID MAJOR
  • ORIGINspinous processes of 2nd to 5th thoracic
    vertebrae (major)
  • INSERTIONBy fibrous attachment to medial border
    of scapula between spine and inferior angle
    (major)
  • ACTIONadduct and elevate the scapula, and rotate
    it so that glenoid cavity faces caudally
  • NERVEdorsal scapular, C4, 5

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RHOMBOID MINOR
  • ORIGINligamentum nuchae, spinous processes of
    7th cervical and 1st thoracic vertebrae (minor)
  • INSERTION medial border at root of spine of
    scapula (minor)
  • ACTIONadduct and elevate the scapula, and rotate
    it so that glenoid cavity faces caudally
  • NERVEdorsal scapular, C4, 5

23
Serratus anterior (the boxers muscle)
  • ORIGINouter surface and superior borders of
    upper eight or nine ribs
  • INSERTIONcostal surface of medial border of
    scapula
  • ACTIONWith the origin fixed, abducts the
    scapula, rotates the inferior angle laterally and
    the glenoid cavity cranially, and holds the
    medial border of the scapula firmly against the
    rib cage. In addiction, the lower fibers may
    depress the scapula, and the upper fibers may
    elevate it slightly. Starting from a position
    with the humerus fixed in flexion and the hands
    against a wall, the serratus acts to displace the
    thorax posteriorly as the effort is made to push
    the body away from the wall. Another example of
    this type of action is in a properly executed
    push-up.With the scapula stabilized in addition
    by the rhomboids, thereby fixing the insertion,
    the serratus may act in forced inspiration
  • NERVELong thoracic, C5, 6, 7, 8 (winging the
    scapula if damaged)

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DELTOID
  • ORIGIN
  • anterior fibers anterior border, superior
    surface, lateral one third of claviclemiddle
    fibers lateral margin and superior surface of
    acromion
  • posterior fibers inferior lip and superior
    border of spine of scapula
  • INSERTION
  • deltoid tuberosity of humerus
  • ACTIONAbduction of the shoulder joint, performed
    chiefly by the middle fibers with stabilization
    by the anterior and posterior fibers. In
    addition, the anterior fibers flex and, in the
    supine position, medially rotate the shoulder
    joint the posterior fibers extend and, in the
    prone position, laterally rotate. 
  • NERVEaxillary nerve, C5, 6

27
TERES MAJOR
  • ORIGINdorsal surface of inferior angle and lower
    third of lateral border of scapula
  • INSERTIONthe crest of the lesser tubercle of
    humerus
  • ACTIONMedially rotates, adducts, and extends the
    shoulder
  • NERVELower Subscapular Nerve C 5, 6, 7

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TERES MINOR
  • ORIGINUpper two thirds, dorsal surface of
    lateral border of scapular
  • INSERTIONthe lowest facet of the greater
    tubercle of the humerus, and shoulder joint
    capsule
  • ACTIONLaterally rotates shoulder joint, and
    stabilizes head of humerus in the glenoid cavity
    during movement of this joint
  • NERVEAxillary nerve, C5, 6

30
INFRASPINATUS
  • ORIGINmedial two thirds of infraspinatus fossa
    of scapula
  • INSERTIONthe middle facet of the greater
    tubercle of the humerus, and shoulder joint
    capsule
  • ACTIONLateral rotates shoulder joint and
    stabilizes head of humerus in the glenoid cavity
    during movement of this joint
  • NERVEsuprascapular nerve, C(4), 5, 6 

31
SUPRASPINATUS
  • ORIGINmedial two thirds of supraspinous fossa of
    scapula
  • INSERTIONsuperior facet of greater tubercle of
    humerus, and shoulder joint capsule
  • ACTIONAbducts the shoulder joint, and stabilizes
    head of humerus in the glenoid cavity during
    movement of this joint
  • NERVESuprascapular nerve, C 4, 5, 6

32
SUBSCAPULARIS
  • ORIGINSubscapular fossa of scapula
  • INSERTIONlesser tubercle of humerus and shoulder
    joint capsule
  • ACTIONmedially rotates shoulder joint, and
    stabilizes the head of the humerus in the glenoid
    cavity during movements of this joint
  • NERVEupper and lower subscapular nerve, C5, 6, 7

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SERRATUS POSTERIOR SUPERIOR
  • ORIGINligamentum nuchea in the neck, spinous
    processes of C7, and T1 to T3
  • INSERTIONsuperior borders of second to forth
    ribs
  • ACTIONelevate first four ribs, aid respiration
    by increasing diameter of the thorax
  • NERVEintercostal nerve

35
SERRATUS POSTERIOR INFERIOR
  • ORIGINspinous processes of the last two thoracic
    and first two lumbar
  • INSERTIONinferior borders of the inferior three
    or fourth ribs
  • ACTIONdepress inferior ribs, preventing them
    from being pulled up by diaphragm
  • NERVEintercostal nerve

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Rotator Cuff Tear
  • Cause
  • Over use, aging (middle aged man)
  • Symptoms
  • Pain, unable to raise arm
  • Treatment
  • Conservative
  • Surgical
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