Uddin Back Lecture

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<![CDATA[ THE BACK Dr. Mukarram Uddin Department of Anatomy Ross University School of Medicine]]>

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<![CDATA[ Objectives: 1. Understand various fasciae. 2. Have good understanding of nerves innervating back muscles. 3. In general, know muscle origin and insertion and their function. 4. Know the blood supply, venous drainage, and lymphatic drainage. 5. Knowledge of suboccipital , auscultation, and lumbar triangles.]]>

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<![CDATA[ BACK -It comprises the posterior aspect of the trunk (body) -It is inferior to the neck and superior to the hips. -It is the part of the body to which the head, neck and limbs are attached.]]>

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<![CDATA[ Back: Skin Superficial fascia---subcutaneous tissue that wraps deep structure of the body -Outer connective tissue layer containing nerves, superficial veins & smaller arteries -An inner layer of smooth membrane. Deep fascia---- dense, organized connective tissue layer, surrounds muscle Muscles Vertebral column Ribs (bones) Spinal cord and its coverings (meninges) (Thigh Cross-section)]]>

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<![CDATA[ 1. Superficial group of muscles (extrinsic#): -Trapezius -Innervation: Spinal accessory (CN XI) -Function: elevates, depresses, retracts and rotates the scapula -Latissimus dorsi Innervation:Thoracodorsal nerve Function:extends, adducts, and medially rotates humerus -Levator scapulae -Innervation: Dorsal scapular nerve -Function: elevates and rotates scaplua Rhomboid major & minor -Inervation: Dorsal scapular nerve -Function: retracts and rotate scapula # Insert on an area but originate from different area]]>

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<![CDATA[ 2. Intermediate group of muscles (extrinsic) -Serratus posterior superior: -Innervation: intercostal nerve -Function: assist in respiration -Serratus posterior inferior: -Innervation; intercostal nerve -Function: assist in respiration ]]>

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<![CDATA[ 3. Deep group of muscles (intrinsic*) -Are innervated by posterior rami -Act to maintain posture & control movements of vertebral column Superficial layer: -splenius capitis & cervicis Intermediate layer: -Erector spinae: -Iliocostalis -longissimus -spinalis *originate and insert in the same area ]]>

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<![CDATA[ C. Deep layer: -Semispinalis* -Multifidus* -Rotators* *Transversospinalis]]>

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<![CDATA[ Cross section at the lumbar level -Arrangement of back muscles]]>

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<![CDATA[ Blood Vessels of the Back: -Arteries supplying the back: Circumflex scapular Intercostal and lumbar 3 and 4 Lumbar Intercostal Deep branch of transverse cervical/ dorsal scapular 1 2 3 4 5 6]]>

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<![CDATA[ Veins of the Back: -Drainage by complicated plexuses located all along the vertebral column. -External vertebral venous plexus: -Internal vertebral venous plexus (epidural): Clinical relevance: -In vertebral venous plexus blood can return to heart from abdomen or pelvis via superior vena cava. -Tumor cells from prostatic cancer can spread to vertebral column -Epidural plexus can spread cancer to the brain]]>

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<![CDATA[ Lymphatic Drainage of the Back: -The lymphatic vessels follow the veins. -Lymphatic vessels from the skin of the neck drain into the cervical nodes. -Those from the trunk above the iliac crest drain into the axillary lymph nodes. -Those from the below the level of iliac crest drain into the superficial inguinal lymph nodes.]]>

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<![CDATA[ AUSCULTATION TRIANGLE: -Inferiorly, latissimus dorsi muscle -Superiorly, trapezius -Laterally, medial border of the scapula Clinical relevance: - Respiratory sounds can be heard clearly with a stethoscope in this location LUMBAR TRIANGLE: -Inferiorly, iliac crest (bony) -Laterally, internal abdominal oblique muscle -Medially, latissimus dorsi muscle Clinical relevance: -Site of abdominal hernia ]]>

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<![CDATA[ Suboccipital Triangle: - Boundaries: Superomedial– Rectus capitus major, Superolateral– Superior oblique, Inferolateral– Inferior oblique Floor: Posterior atlanto-occipital membrane, and posterior arch of vertebra C1 Roof: Semispinalis capitis Contents: Vertebral artery and suboccipital nerve (C1) Other structures: Greater occipital nerve (C2), Occipital artery]]>

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