1. Presentor: Angelie Melzer
Deep Dissection of the Back
Presented by: Angelie Melzer
Presentor: Angelie Melzer

2. Superficial to Deep Dissection: Structures to Look For
PLATES: 542, 381, 544, 541, 375, 376
Nuchal Ligament
Accessory Nerve
3rd and 4th cervical nerves and dorsal scapular nerve -C5
Thoracodorsal Nerve and Artery
Posterior Axillary Fold/Intertubercular Sulcus on the Humerus
Levator Scapulae
Sternocleidomastoid
Splenus Capitus
Splenus Capitus Lateral and Medial
Masseter Muscle
Splenus Cervicis
Omohyoid Muscle
Latissimus Dorsi
Serratus posterior superior
Teres Major
Rhomboid Minor
Rhomboid Major
Supraspinatus, Infraspinatus and Teres Minor muscles (Rotator Cuff)

3. KEY: ORIGIN, INSERTION, ACTION and NERVE
O=Origin
I=Insertion
A=Action
N=Nerve
Biomechanical Actions:
Circumduction
Lateral Flexion
Rotation

4. MUSCLES OF THE NECK:

6. ORIGIN, INSERTION, ACTION and NERVE
Splenius Capitus and Cervicis
Origin: Spinous processes of C7-T4
Insertion: Mastoid process and lateral portion of superior nuchal line
Action: Rotate the head and neck to the same side, laterally flex and extend the head and neck
Nerve: Cervical
Levator Scapulae
Origin: Transverse processes of C1-4
Insertion: Medial border of scapula between superior angle and superior portion of spine of scapula
Action: Elevate and downwardly rotate the scapula, Laterally flex, rotate and extend the head and neck
Nerve: Cervical 3-4 and Dorsal Scapular C4-5
Sternocleidomastoid
Origin: Sternal Head-Top of Manubrium; Clavicular Head-Medial 1/3 of clavicle
Insertion: Mastoid process of temporal bone and lateral portion of superior nuchal line
Action: Lateraly flex head neck to same side, Rotate head and neck to opposite side and assist in elevation of the ribcage during inhalation
Nerve: C1-3

7. MUSCLES OF THE SHOULDER: Cross Sectional View

9. ORIGIN, INSERTION, ACTION and NERVE
Supraspinatus
Origin: Supraspinous fossa of scapula
Insertion: Greater Tubercle of humerus
Action: Adduct shoulder and stabilize head of humerus
Nerve: Suprascapular C4-6
Infraspinatus
Origin: Infraspinous fossa of scapula
Action: Laterally Rotate and adduct shoulder, stabilize head of humerus
Teres Minor
Origin: Upper 2/3 of lateral border of scapula
Action: Laterally Rotate and adduct shoulder, stabilize head of humerus
Nerve: Axillary C5-6
Subscapularis
Origin: Subscapular fossa of scapula
Insertion: Lesser Tubercle of humerus
Action: Medially rotate the shoulder and stabilize the head of humerus
Nerve: Upper and Lower subscapular C5-7

10. MUSCLES OF THE SPINE

11. SPINE: Erector Spinae Group
Erector Spinae: Iliocostalis Cervicis, Thoracis and Lumborum
Origin: Common tendon (cervicis, thoracis and lumborum, respectively)
Insertion: Cervical, Thoracic and Lumbar, respectively
Action: Extend and Laterally flex the vertebral column to the same side
Nerve: Spinal
Erector Spinae: Longissiumus Cervicis and Capitis
Origin: Same as above
Insertion: Transverse process of cervical vertebra and Lower nine ribs of transverse processes, respectively
Action: Same as above
Spinalis: Cervicis and Capitis
Origin: Spinous processes of the upper lumbar and lower throacic vertebrae, ligamentum nuchae and spinous processes of C7
Insertion: Spinous processes of upper thoracic and cervicals
Action: Latterally flex and Extend the vertebral column and head

12. SPINE: Transversospinalis Group
Semispinalis Capitis, Cervicis and Thoracis
Origin: Transverse processes of C4-T5
Insertion: Between superior and inferior nuchal lines
Action: Extend the vertebral column and head
Nerve: Cervical
Multifidus and Rotatores
Origin: Sacrum and transverse processes of lumbar through cervical vertebrae
Insertion: Spinous processes of lumbar vertebrae through C2
Action: Rotate and Extend vertebral column
Nerve: Spinal

13. MUSCLES OF THE BACK: Cross Sectional View

14. ORIGIN, INSERTION, ACTION and NERVE
Rhomboid Minor and Major Muscles
Origin: Spinous processes of T2-5 and C7-T1, respectively
Insertion: Medial border of scapula across spine of scapula
Action: Adduct, elevate and downwardly rotate scapula
Nerve: Dorsal Scapular C4-5
Quadratus Lumborum
Origin: Posterior Iliac Crest
Insertion: Last rib and transverse processes of L1-4
Action: Laterally tilt pelvis, laterally flex to same side and extend vertebral column
Nerve: Lumbar Plexus T12-L3

15. Arteries, Veins, Nerves and Lymph Nodes
Accessory Nerve (Lies inferior on the trapezius muscle)
Arteries and Veins
Laterally:
External Jugular Vein
Internal Jugular Vein
Lateral cutaneous branches of Ventral Rami-Intercostal Nerves of Ribs
Posteriorly:
Occipital Artery and Vein
Great Auricular Nerve
Posterior Cutnaeous Branches of Dorsal Rami (C4-T6)
Posterior Cutaneous Branches of Ventral Rami (T7-12)
Subclavian artery and vein
Superficial cervical artery and vein (descending branch)
Iliohypogastric Nerve (just superior to the Iliac Crest)

17. LYMPH NODES:
Occipital
Mastoid
Sternocleidomastoid
External Jugular
Inferior Deep Lateral Cervical
Thoracic Duct
Transverse Cervical Chain
Supraclavicular
Jugular Trunk
Subclavian Trunk and Node

18. Dissection Techniques
This week:
Latissimus Dorsi: Identify the Thoracodorsal Nerve and Artery along the deep surface of the muscle. Locate the serratus posterior inferior, separate the Lats from it. Also locate the Teres Major muscle and follow it to the point of insertion for both the Lats and Teres Major on the intertubercular sulcus at the posterior axillary fold. Separate the two muscles from eachother. Locate T9 and the beginning of the Thoracolumbar Fascia. Make an arcing cut from the medial to the lateral border (just above the iliac crest) separating the Latissimus Dorsi from the Fascia.
Rhomboids Major and Minor: ID the two muscles and separate them from underlying tissue. ID the dorsal scapular nerve and transverse cervical artery. Sever the rhomboids from the vertebral column and reflect laterally.
Serratus Posterior Superior and Inferior: ID both portions along the spine at C7-T3 and T11-L3 respectively. Sever them both at their attachments on the vertebral column. Reflect them laterally to expose the thoracolumbar fascia.
Thoracolumbar Fascia: The posterior layer is a thick aponeurosis that covers the erector spinae. A vertical incision will be made from the 12th rib to the iliac crest, cutting medially to the midline and laterally to the border of the erector spinae muscles. A vertical cut will be made along the line fo fusionto expose the underlying Quadratus Lumborum muscle.

19. UPCOMING DISSECTIONS Quadratus Lumborum Splenius Capitis and Cervicis
Levator Scapulae
Erector Spinae
Spinalis: Cervicis and Capitis
Transversospinalis: Semispinalis Capitis, Cervicis and Thoracis
Multifidus
Rotatores
Interspinous and Intertransverse

20. BIBLIOGRAPHY
Biel, Andrew. Trail Guide to the Body, 4th Edition. Boulder, CO: Books of Discovery
Clemente, Carmine D. Anatomy: A Regional Atlas of the Human Body, 6th Edition. Los Angeles: Lippincott, Williams and Wilkins, , 38, 40, 44-45, 47, 53, 55, 65,
Clemente, Carmine D. Anatomy Dissector, 3rd Edition. Los Angeles: Lippincott, Williams and Wilkins, 2011.
Netter, Frank. Atlas of Human Anatomy, 3rd Edition. New Jersey: Novartis ,
Semenow, Bluhm and Oliver. . Rapid Review: Anatomy Reference Guide, 3rd Edition. Skokie, IL: Lippincott, Williams and Wilkins, ,