Gross Anatomy Review 1 (from dissection on September 6, 2016)

Topics: surface anatomy-skeleton of the back, skin and superficial fascia, superficial
muscles of the back

Surface Anatomy:
● BOLD terms:
● External occipital protuberance
● Superior border of the trapezius muscle
● Spinous process of the seventh cervical vertebra (C7) (vertebra
prominens)
● Spine of the scapula (at vertebral level T3)
● Acromion of the scapula
● Medial (vertebral) border of the scapula
● Inferior angle of the scapula (at vertebral level T7)
● Spinous processes of thoracic vertebrae
● Erector spinae muscle (most noticeable in the lumbar region)
● Median furrow
● Lateral border of the latissimus dorsi muscle (posterior axillary fold)
● Iliac crest (at vertebral level L4)
● Posterior superior iliac spine
● On scapula:
● Acromion
● Spine
● Superior angle
● Medial border
● Inferior angle

Skin and Superficial Fascia:

● BOLD terms:
● Familiarize yourself with the organization of a typical spinal nerve. It is relevant
for today's learning objectives to consider the posterior (dorsal) ramus of a
spinal nerve. The posterior cutaneous branches of the posterior rami at
each thoracic level pierce the superficial back muscles (trapezius muscles and
latissimus dorsi muscles) to enter the superficial fascia and supply the skin.
● Clinical applications to consider:
● Review the branching pattern of a typical spinal nerve and understand that
cutaneous branches of the posterior rami innervate the skin of the back.
● Study a dermatome chart and become familiar with the concept of segmental
innervation.

Superficial Muscles of the Back:

● BOLD terms:
o The superficial muscles of the back:
● trapezius
 ● Superior part – attaches to the lateral one-third of the clavicle and it
elevates the scapula.
● Middle part – attaches to the acromion and spine of the scapula and
it retracts the scapula
● Inferior part – attaches near the medial end of the spine of the
scapula and it depresses the scapula
● accessory nerve (cranial nerve XI) provides motor innervation to
the trapezius muscle; the branches of nerves C3 and C4 are
sensory (proprioception)
● The superficial branch of the transverse cervical artery
accompanies the nerves.
● latissimus dorsi
● The latissimus dorsi muscle receives the thoracodorsal nerve and
artery on its anterior surface near its lateral attachment.
● rhomboid major
● The rhomboid muscles retract the scapula, rotate the scapula to
depress the glenoid cavity, and hold the scapula close to the thoracic
wall.
● dorsal scapular nerve
● dorsal scapular vessels
▪ The dorsal scapular nerve and vessels course parallel to the
medial border of the scapula.
● The dorsal scapular artery may branch directly from the subclavian
artery, or it may arise from the transverse cervical artery, in which
case it is also known as the deep branch of the transverse
cervical artery.
● rhomboid minor
● levator scapulae.
● At this stage of the dissection, the levator scapulae muscle can be
seen only near its attachment on the scapula.
● The levator scapulae muscle elevates the scapula.
● The dorsal scapular nerve and artery supply the levator scapulae
muscle. The dorsal scapular nerve and artery pass anterior (deep) to
the inferior end of the levator scapulae muscle.

● Dissection follow up:

o Review the attachments, action, innervation, and blood supply of each
muscle that you have dissected.
o Review the movements that occur between the scapula and the thoracic
wall.
o Use an illustration to observe the origin of the transverse cervical artery and
the origin of the dorsal scapular artery.
o Observe a triangle that is associated with the border of the latissimus dorsi
muscle: the triangle of auscultation
● Clinical correlation:
● The triangle of auscultation is bounded by the latissimus dorsi muscle, the
trapezius muscle, and the rhomboid major muscle. Within the triangle of
auscultation, intercostal space 6 has no overlying muscles. This area is
particularly well suited for auscultation (listening to sounds produced by thoracic
organs, particularly the lungs).
● Clinical testing for intactness of the spinal accessory nerve (Cranial Nerve XI) is
accomplished by placing your hands on both shoulders of the patient and asking
the patient to shrug his/her shoulders while you press downward and apply
moderate resistance. Normally both shoulders will equally shrug. The absence of
shrugging on one side indicates a motor denervation to the upper fibers of the
trapezius muscle