SUPERFICIAL

DISSECTION OF
THE BACK;
SCAPULAR &
DELTOID REGIONS
Back of a woman with major palpable bony landmarks indicated
Back of a man indicating position of vertebral spinous processes and
associated structures
B – Prominent C VII and C – Ligamentum nuchae
T1 vertebral spinous accentuated with flexed neck.
processes The ligament passes along
spinous processes of C1 to C7
Prominence of spinous process of C 7
(also known as “vertebra prominens”)
 Extrinsic muscles of the back
Muscles of the back:
Are grouped into:
• Extrinsic muscles of the back
and
• Intrinsic muscles of the back
(muscle proper of the back – to be
covered with Head & Neck)

Extrinsic muscles are further

grouped into:
• Superficial:
trapezius
latissimus dorsi

• Intermediate:
levator scapula
rhomboid minor
rhomboid major
 Superficial group of the extrinsic back muscles
Trapezius:
• Is a superficially-lying triangular-
shaped muscle – considering only one
side (Right & left muscles together are
diamond-shaped, thus the name -
trapezius!) trapezius C7 – T12
• Trapezius attaches UL to trunk

Origin: external occipital protuberance,

middle 1/3rd of superior nuchal line,
ligamentum nuchae, spinous processes
of C7-T12
Insertion: spine & acromion of scapula,
lateral 1/3rd of clavicle

Nerve supply: Spinal accessory nerve

Action:
upper fibers – elevate scapula
middle fibers – retract scapula
lower fibers – depress scapula
 Innervation and blood supply of trapezius

Nerve supply to trapezius

is by spinal part of
accessory nerve (cranial
nerve XI)
Spinal part of

Arterial supply is by
superficial branch of
transverse cervical
Artery

The nerve and vessels lie

on the deep surface of the
muscle
 Lesion of spinal accessory nerve

Spinal accessory nerve supplies

2 muscles, sternocleidomastoid &
trapezius
If the nerve is injured after it
supplies sternocleidomastoid
muscle, only trapezius is
paralyzed

Paralysis of trapezius results in:

• weakness to retract and
elevate the shoulder
• Drooping of the shoulder
• Atrophy (wasting) of trapezius
muscle Drooping of the left shoulder and wastin
of the trapezius muscle following divisio
of the spinal accessory nerve.
 Latissimus dorsi muscle
(L- meaning “widest of back”)
• Is a fan-shaped muscle that attaches
humerus to the back

Origin:
• Spinous processes of T7-T12 vertebrae,
thoracolumbar fascia, iliac crest, ribs 8-12
Insertion:
• Floor of intertubercular groove

Nerve supply:
• Thoracodorsal nerve with root value of
C6 to C8 (branch of posterior cord of
brachial plexus)

Action:
• Extend, adduct & medially rotate humerus
• Raises body towards arm during climbing’
thus also known as the climbing muscle
Thoracodorsal nerve to latissimus dorsi
Details of the superficial extrinsic muscles of the
back

Spinal root of
 Triangle of Auscultation
• Is a triangular space on the back that is bounded
by latissimus dorsi inferiorly, medial border of
scapula superolaterally and trapezius
superomedially

• It provides a clear place to listen to the breathing

sounds of posterior segments of the lungs with a
stethoscope during examination (auscultation)

• The auscultatory triangle enlarges by folding the

arms across the chest when the trunk is flexed,
and the 6th intercostal spaces (I.C.S.) between 6th &
7th ribs become subcutaneous
 Triangle of auscultation

The triangle is bounded by:

• laterally - medial border of
scapula
• medially - Lateral border of
trapezius
• inferiorly - Superior border of Triangle of
auscultation
latissimus dorsi
 Intermediate group of the extrinsic back muscles

Intermediate group includes:

• levator scapula
• rhomboid minor
• rhomboid major
 Levator scapulae muscles

Levator scapulae muscle lies deep to

sternocleidomastoid muscle
(superior 1/3rd ) and deep to trapezius
(inferior 1/3rd )

Origin:
Posterior tubercle of transverse process
of C1-C4 vertebrae

Insertion:
Superior aspect of medial border of
Scapula

Nerve supply:
Dorsal scapular nerve (C5)
(branch of root of brachial plexus)

Action:
Elevates scapula
Rotates scapula & tilts glenoid cavity
inferiorly
 Rhomboid major and minor muscles
• Named after their shapes
• Attach scapula to the axial
skeleton
• Lie deep to trapezius
• May be difficult to separate the
two muscles
• Rhomboid minor lies superiorly and
is smaller but thicker than rhomboid
major

Origin: Rhomboid minor C7

• Minor: nuchal ligament & spinous
• process of C7 & T1
• Major: spinous process of T2-T5 Rhomboid major

Insertion:
• Minor: medial border of scapula
above root of spinous process
• Major: medial border of scapula
below root of spinous process

Nerve supply: Dorsal scapular N

Action: retract scapula & rotate it to
depress glenoid cavity inferiorly
 Extrinsic Intermediate muscles of the back

Muscle proximal Distal Nerve supply action

attachment attachment
 Innervation and blood supply of the rhomboid muscles

Nerve supply to the

rhomboid muscles:
• Dorsal scapular nerve
(branch of root of brachial
plexus, from C5)

• Arterial supply is from

superficial branch of
transverse cervical artery
 Scapulohumeral (Intrinsic shoulder)
muscles

A group of six muscles that attach scapula to humerus includes:

• Deltoid
• Teres major
• Teres minor
• Supraspinatus
• Infraspinatus
• Subscapularis

This group of muscles acts on the glenohumeral (shoulder) joint

• Name derived from Greek word, Deltoid muscle
Delta, Δ
• It is a thick, powerful muscle that
gives the rounded contour to the
shoulder

• Anterior and posterior parts of the

muscle are unipennate; these steady
the muscle during abduction of the
arm and assist pectoralis major and
latissimus dorsi muscles respectively
during flexion and extension of the
arm like in walking

• Middle part is multipennate and

major abductor of the arm
(after abduction is initiated by
supraspinatus muscle!!) and is a
stabilizer of the shoulder joint
 Deltoid muscle con’t…..

Lateral view of shoulder girdle

Proximal attachment:
Spine of scapula, acromion
& lateral 1/3rd of clavicle

Distal attachment:
Deltoid tuberosity of
humerus

Nerve supply:
Axillary nerve
Left deltoid wasting, secondary to axillary nerve damage after
dislocation of the shoulder joint
Injury to the axillary nerve – rounded contour of
the shoulder disappears due to atrophy of
deltoid, which gives flattened appearance to the
shoulder
 Sensory loss in injury to axillary nerve

Area of
anesthesia (red)

Loss of sensation on lateral side of the proximal part of the arm due to
injury of the superior lateral cutaneous nerve of the arm, a branch of
axillary nerve
 Teres Major muscle

Teres major muscle is a thick

rounded muscle
Origin:
dorsal surface of the inferior angle of
the scapula
Insertion:
medial lip of the intertubercular
groove of the humerus inferior angle of
the scapula

Nerve supply:
Lower subscapular nerve (C6 & C7)

Action:
•adducts and medially rotates arm
•stabilizes the head of the
humerus in its glenoid cavity
 Rotator Cuff Muscles
The four muscles that form the rotator cuff
muscles are:
• Supraspinatus
• Infraspinatus On dorsal surface
• Teres minor
• Subscapularis (on costal surface)
(SITS for short)
As a group, they form a musculotendinous
cuff around the shoulder joint
Their tendons fuse with the capsule of the
shoulder joint re-enforcing it and protecting
and stabilizing the joint during arm
movement
The only muscle that is NOT a rotator is the
supraspinatus
Teres minor and infraspinatus are lateral
rotators of the arm while subscapularis is a
medial rotator of the arm
 Muscles of the scapular region

Deltoid lateral 1/3 rd of clavicle,
acromion & spine of scapula
deltoid tuberosity of axillary N (C5 anterior part: flexes & medially
humerus & C6 rotates arm;
middle part: abducts arm
posterior part: extends &
laterally rotates arm

Subscapularis subscapular fossa lesser tubercle of humerus upper & lower medially rotates & adducts
subscapular nerves arm; helps to hold humeral
(C5, C6 & C7) head in glenoid cavity
Position of the rotator cuff muscles
 Supraspinatus muscle
Lies in the supraspinous fossa of scapula
Its tendon is separated from the
coracoacromial ligament, acromion and
deltoid by the subacromial bursa, a
serous sac b/n tendon & bone, or b/n
tendon & tendon

Proximal attachment: supraspinous fossa

Distal attachment: superior facet on
greater tubercle of humerus

Nerve supply: suprascapular nerve (C4,

C5 & C6 – from superior trunk of
brachial plexus)

Action: -Initiates abduction (1st 15⁰) of

the shoulder joint
-strengthens shoulder with rotator
cuff muscles
 Infraspinatus muscle
Lies deep to trapezius and deltoid in
the medial 3/4th of the infraspinous
fossa of the scapula

Proximal attachment: infraspinous

fossa

Distal attachment: middle facet on the

greater tubercle of the
humerus
Nerve supply: suprascapular nerve
(C5 & C6)

Action: lateral rotator of arm; stabilizes

humeral head in glenoid cavity of
the shoulder joint
 Teres minor

Lies deep to the deltoid

May not be clearly separated from the
infraspinatus muscle

Proximal attachment:
lateral border of scapula
Distal attachment:
I inferior facet on greater tubercle
of humerus
Nerve supply: Axillary N (C5 &C6)
Action:
-Lateral rotator of arm;
-strengthens and protects
shoulder joint
 Subscapularis muscle
A thick triangular muscle that lies on Anterior aspect of scapula
subscapular fossa of the costal Subscapularis muscle
surface of scapula
Crosses glenohumeral joint anteriorly
Also forms part of the posterior wall of
the axilla
Proximal attachment:
subscapular fossa
Distal attachment:
lesser tubercle of humerus
Nerve supply: upper and lower
subscapular nerves (C5, C6
and C7)
Action: Medial rotator and adductor of
humerus;
-holds humeral head in the
glenoid cavity stabilizingthe joint
during movement
A full-thickness tear of the rotator cuff produces failure of
abduction due to instability of the glenohumeral (shoulder) joint.
The shoulder is characteristically hunched up. There is wasting
of the infraspinatus and supraspinatus.
 Inter-muscular spaces of the scapula

Quadriangular space:
Boundaries:
• Superior – subscapularis and
teres minor
• Inferior – teres major
• Medial – long head of triceps
• Lateral – humerus

(Upper) triangular space:

boundaries:
• Superior – teres minor
• Inferior – teres major
• Lateral – long head of triceps
Structures passing through muscular spaces
of the scapula
Structures passing through the
quadriangular space:
• Axillary nerve
• Posterior circumflex humeral A & V

Structures passing through

the (upper) triangular space:
• Circumflex scapular vessels
(branch of subscapular A)
(branch of
subscapular A)

of humerus

Intermuscular spaces – Quadrangular and triangular

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