PT 656 Gross and Applied Anatomy I - Slippery Rock University - PDF

**SLIPPERY ROCK UNIVERSITY** **SCHOOL OF PHYSICAL THERAPY** **PT 656 - GROSS AND APPLIED ANATOMY I** **OBJECTIVES \-- SUPERFICIAL BACK** By the completion of this subject, the student should be able to 1\. Describe the extents of the deep fascia of the superficial back with special regard to th...

**SLIPPERY ROCK UNIVERSITY** **SCHOOL OF PHYSICAL THERAPY** **PT 656 - GROSS AND APPLIED ANATOMY I** **OBJECTIVES \-- SUPERFICIAL BACK** By the completion of this subject, the student should be able to 1\. Describe the extents of the deep fascia of the superficial back with special regard to the ligamentum nuchae and thoracolumbar fascia. 2\. Discuss the cutaneous innervation of the superficial back and shoulder 3\. Discuss the musculature of the superficial back, giving attachments, actions, and neurovascular supply. Identify the root values of appropriate nerves and describe ramifications of nerve lesions on the muscles. 4\. Explain the various bursae associated with the superficial back and shoulder. 5\. Trace the course of the neurovascular structures associated with superficial back and shoulder muscles. 6\. Discuss the musculature of the shoulder, giving attachments, actions, and neurovascular supply. Identify the root values of appropriate nerves and describe ramifications of nerve lesions on the muscles. 7\. Describe the \"scapulothoracic joint\" and its importance to shoulder motion. **Superficial back** I. surface anatomy \- vertebral furrow \- vertebral prominens \- superior and inferior angles of scapula \- trapezius m. \- latissimus dorsi m. \- posterior axillary fold \- acromion process \- acromioclavicular joint \- spine of scapula II\. superficial back fasciae A. ligamentum nuchae \- white fibrous tissue and elastic tissue sheet extending from the eop to C7 spinous process \- provides attachment for trapezius m. B. thoracolumbar fascia \- strong fibrous sheet \-- a local thickening of the deep fascia of the back \- found over the thoracic, lumbar, and sacral regions \- provides attachment for the latissimus dorsi m. C. deep fascia of the superficial back \- dense fibrous tissue layer \- attached superiorly to the occipital bone, ligamentum nuchae, spinous processes below C7, scapular spine, acromion process, and iliac crest \- continuous with axillary fascia and deep cervical fascia III\. cutaneous innervation \- dorsal rami (except for C1) \- medial branch \- these supply skin above midthoracic level \- lateral branch \- these supply skin below midthoracic level \- ventral rami \- lateral cutaneous branches of intercostal nerves IV\. superficial back muscles A Introduction 1\. Specific movements a\. [upward rotation of the scapula]: rotating the glenoid fossa superiorly b\. [downward rotation of the scapula]: rotating the glenoid fossa inferiorly c\. [retraction of the scapula (scapular adduction)]: drawing the scapula posteriorly 2\. Other functions a\. serve to connect the upper limb to the vertebral column b\. create \"scapulothoracic joint\" d\. cervical posture muscles 3\. Muscles a\. trapezius m. O: external occipital protuberance and superior nuchal line, ligamentum nuchae, spinous process of C7, and spinous processes of all Th vb I: upper fibers: posterior border of the lateral 1/3 of the clavicle middle fibers: acromion process and lateral spine of scapula lower fibers: spine of scapula F: upper fibers: elevate the shoulder, assist lower fibers in upward rotation of the scapula, extend neck and skull middle fibers: retraction of scapula ("squaring the shoulders), assist deltoid/supraspinatus mm. in abduction of the arm \- important in assisting latissimus dorsi m. and deltoid m. in extension of the shoulder lower fibers: depression of scapula, assist upper fibers in upward rotation of the scapula, assist middle fibers in scapular retraction N: **spinal accessory n. (CN XI)** and ventral rami of C3 and C4 A: transverse cervical a. b\. latissimus dorsi m. O: spinous processes of T6-T12 thoracolumbar fascia, posterior iliac crest, and lower ribs (var: inferior angle of scapula) I: floor of the intertubercular groove and crest of lesser tubercle \- as this tendon passes ventral to the teres major m., a bursa occurs F: shoulder extension, medial rotation of shoulder, shoulder adduction N: thoracodorsal n. (**C6**, **C7** and C8) A: thoracodorsal a. c\. levator scapulae m. O: transverse processes of C1-C4 I: vertebral border and superior angle of scapula F: elevates scapula, assists in downward rotation of scapula, lateral flexion of neck and extension of neck N: **dorsal scapular n. (C5)**, C3 and C4 A: dorsal scapular a and transverse cervical a. d\. rhomboid minor m. O: ligamentum nuchae and spinous processes of C7 and T1 I: vertebral border of scapula F: downward rotation of scapula, scapular retraction, assists serratus anterior m. in holding scapula in place against body wall N: dorsal scapular n. A: dorsal scapular and transverse cervical aa. e\. rhomboid major m. O: spinous processes of T2-T5 I: vertebral border of scapula F, N, & A: as rhomboid major m. f\. serratus anterior m. O: ribs I-VIII I: vertebral border of scapula N: long thoracic n. (C5-C7) A: lateral thoracic a. F: protracts the scapula, keeps scapula firmly to chest wall V. arteries A. transverse cervical a. \- branch of the subclavian a. \- courses posteriorly toward the trapezius m. \- travels deep to this muscle, being joined by CN XI \- continues deep to the levator scapulae and rhomboid mm. along vertebral border of scapula B. dorsal scapular a. \-- variably present \- branch of the subclavian a. \- frequently absent, replaced by the transverse cervical a. \- if present, found lateral to the levator scapulae m. C. thoracodorsal a. \- branch of the axillary a. \- enters the medial border of the latissimus dorsi m. along with the n. VII\. nerves A. spinal accessory n. \-- efferent \- exits cranium via jugular foramen \- enters sternocleidomastoid m. and passes through its posterior border to enter the deep surface of the trapezius m. B. dorsal scapular n. \- C5, from brachial plexus \- approaches levator scapulae m. anteriorly, disappearing deep to the muscle \- runs deep to the levator scapulae and rhomboid mm., along the vertebral border of the scapula C. thoracodorsal n. \- C6, C7 and C8, from brachial plexus \- accompanies thoracodorsal a. VIII\. spaces \- triangle of auscultation \- lumbar triangle \- borders: external abdominal oblique m. (lateral), latissimus dorsi m. (medial), and iliac crest (inferior)