1. Gross Anatomy 2: Superficial Back Kulesza

2. Readings: Snell, Clinical Anatomy by Regions (8 th edition) The Superficial Part of the Back and the Scapular Region: p. 454 –458; table 9-2 Page 63; table 2-1 [serratus posterior muscles] Objectives: 1.Identify the superficial landmarks associated with the back. 2.Describe the structure, function and support of the superficial muscles of the back (arterial supply, venous drainage and innervation). 3.Identify the borders and functional significance of the triangle of auscultation and the lumbar triangle.

3. Superficial Landmarks Median Vertebral Furrow Erector Spinae External occipital protuberance Spinous Processes, vertebra prominens (C7) Cervical border of trapezius Acromion Deltoid Scapula and its spine Posterior axillary fold Iliac crest

4. Dermatomes

5. Sternoclavicular and Scapulothoracic Articulations

6. An 18-year-old male presents following a mountain biking accident. History reveals he was thrown from the bike and landed on the side of his head (he was wearing a helmet). Physical exam reveals a fracture clavicle. On a follow-up visit, the fracture has healed but he has weakness in shrugging his shoulder and in retracting the scapula. Physical exam reveals atrophy of the trapezius. What nerve was most likely damaged in the accident? ---Spinal accessory nerve

7. Trapezius Proximal attachment: superior nuccal ligament Distal attachment: Action: Innervation: CN XI (& contributions from CN’s II, III, IV) Latissimus Dorsi Proximal attachment: Distal attachment: Action: Innervation:

8. Trapezius & Latissimus Dorsi

10. Innervation of the Trapezius

12. 2nd Layer of Superficial Back Muscles

13. Levator Scapulae Proximal attachment: Distal attachment: Action: Innervation: Rhomboids Proximal attachment: Distal attachment: Action: Innervation:

14. Superficial Back Triangles Triangle of Auscultation: Lumbar Triangle: Inferior Lumbar Hernia (Petit’s Hernia) Superior Lumbar Hernia (Grynfeltt’s Hernia)

15. Intermediate Back Muscles *respiratory muscles* Serratus Posterior Superior: Proximal attachment: Distal attachment: Action: Innervation: Serratus Posterior Inferior: Proximal attachment: Distal attachment: Action: Innervation:

16. Common Variations of the Transverse/Superficial Cervical Artery