Posterior muscles of the neck Dr Muhammad Mustafa

+ Posterior muscles of the neck Dr. Muhammad Mustafa yousafzai

+ Different goups of muscles of back n Superficial n Inter mediate n Spinotransversales n Erector spinae n Transversospinales n Segmental back muscles n Suboccipital muscles

+ trapezius n O: superior nuchl line, external occipital protruberance, ligamentum nuchae and spinous process of C 7 to T 12. n I; lateral one third of clavical , acromian and spine of scapula. n N; motor – accessory nerve 11 n A; rotates the scapula while hoizontal abduction of humerus, upper fibres elevate, middle fibres adduct, lower fibres depress the scapula

+ Levator scapulae n O; n I; transverse process of C 1 to C 4 , upper portion and medial border of scapula n N; C 3 -4, and dorsal scapular nerve C 4 C 5 n A; elevates the scapula

+ Intermediate group of muscles n Serratus posterior superior: n O: lower portion of ligamentum nuchae, spinous process of C 7 T 3 and supraspinatous ligament n i: upper border of ribs 2 nd to 5 th just lateral to their angles n N: anterior rami of upper thoracis nerves T 2 -5 n A: elevates the ribs 2 -5

+ Spinotransversale muscles n Splenius capitis n O: arises on the ligamentum nuchae and spinous processes of C 7 to T 3 n I: attaches under the lateral part of the superior nuchal line of the occiput and on the mastoid process of the temporal bone. n N: posterior rami middle cervical nerves n Splenius cervicis arises on the spinous processes of T 3 to T 6 and attach on the posterior tubercles of the transverse process C 1 to T 3. n N; posterior rami lower cervical nerves.

+ n Splenius capitis and splenius cervicis lie deep to sternocleidomastoid, trapezius and the rhomboids and superficial to the segmental muscles, interspinales, intertransversarii and transversospinalis. n Nerve supply: Cervical spinal nerves. Actions: Splenius capitis and splenius cervicis contracting bilaterally extend the head and neck, contracting unilaterally they sidebend and slightly ipsilaterally rotate the head and neck.

+ Erector spinae n Iliocostalis cervicis arises on the superior border of the angles of ribs 3 to 6. It attaches on the posterior tubercles of the transverse process of C 4 to C 6. n Longissimus cervicis arises on the transverse processes of T 1 to T 5 medial to longissimus thoracis and attaches to the posterior tubercles of the transverse processes of C 2 to C 6.

+ n Spinalis cervicis arises on the spinous processes of C 7 to T 2 and the ligamentum nuchae. It attaches on the spinous processes of C 2 to C 4. It exhibits variation in its attachments and may be absent. n Cervical spinous processes may be bifid. C 2 and C 7 (vertebra prominens) are easily palpable. C 6 is usually palpable but disappears in extension. Articular pillars and facet joints are at finger width spacings.

+ Transversospinales n Semispinalis thoracis arises on the transverse processes of T 6 to T 10 and attaches on the spinous processes of C 6 to T 4. More tendon in form. n Semispinalis cervicis arises on the transverse processes of T 1 to T 6 and attaches on the spinous processes of C 2 to C 5. More muscular especially the fibres that attach on the axis. n.

+ n Semispinalis capitis arises on the transverse processes of C 7 to T 6 and the articular processes of C 4 to C 6 (sometimes C 7 & T 1) and attaches either side of the mid-sagittal line between the superior and inferior nuchal lines on the occiput. n Nerve supply: Dorsal rami of cervical and thoracic nerves. Action: Extension of the head and cervical spine

+ n Multifidus arise on the sacrum (S 4), aponeurosis of the erector spinae, posterior superior iliac spine, posterior sacro-iliac ligament, mamillary processes of L 1 to L 5, transverse processes of T 1 to T 12 and articular processes of C 4 to C 7. The muscle attaches along the length of a spinous process one to four vetebral segments above. n Nerve supply: Dorsal rami of the spinal nerves. n Rotatores are the deepest muscles. They arise on cervical, thoracic and lumbar transverse processes and attach on the lamina and base of the spinous process of the vertebra above. Nerve supply: Dorsal rami of the spinal nerves.

+ Segmental back muscles n Interspinales run from one spinous process to the spinous process above. They are present between C 2 and T 3, and between T 11 and L 5. They are more distinct in the cervical spine. Sometimes they occur between L 5 and the sacrum. n Nerve supply: Dorsal rami of the spinal nerves.

+ n Intertransversarii run from a transverse process to the transverse process above. They are present between C 1 and T 1, and between T 10 and the sacrum. In the cervical and lumbar, pairs of muscles lie either side of the spine. n Nerve supply: Dorsal and ventral rami of the spinal nerves.

+ ROTATORES n The rotatores (rotatores spinae) muscles lie beneath the multifidus and are present in all spinal regions but most prominent in thethoracic region; they are eleven in number on either side. n O; from the superior and posterior part of the transverse process. n I; inserted into the lower border and lateral surface of the lamina of the vertebra above, the fibers extending as far as the root of the spinous process. n N; POSTERIOR RAMI

+ Suboccipital muscles n Rectus capitus posterior major: n O: spinous process of axis n I: lateral portion of occipital bone below inferior nuchal line n N: posterior ramus of C 1 , same for all suboccipital muscles n A: extension of head and rotation of head towards the same side

+ n Rectus capitis posterior minor: n O: posterior tubercle of atlas n i: medial portion of occipital bone below inferior nuchal line n A: extension of head

+ n Obliquus capitis superior: n O: transverse proces of atlas n I: occipital bone between superior and inferior nuchal line n A: extension of head and rotation towards the same side

+ n Obliqqus capitus inferior: n O: spinous process of axis n I: transverse process of atlas n A: rotation of face towards the same side

+ S S K TH N A