GROSS ANATOMY - ANAT 6010

Unit 1 - Back and Thorax, G01: Back

👨‍🏫 Dr. Weyrich 📅 University of Utah School of Medicine 📄 4페이지

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글자크기

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요약

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📑 목차

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1 1) Skin of the Back

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2 2) Back Muscles - Superficial Layer

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3 3) Deep Back Muscles

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4 4) Suboccipital Region

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5 Exercises

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1) Skin of the Back

Anatomical Landmarks

Students should be able to identify basic anatomical landmarks of the back including external occipital protuberance, C7 vertebra, angles of the scapula, medial margin of the scapula, spine of the scapula, iliac crest, and boundaries of the trapezius, latissimus dorsi, and erector spinae muscles.

Posterior view of back showing surface anatomy with labeled landmarks

Dermatome map showing segmental distribution from C2 to S5, Co

💡 핵심 개념

Identify basic anatomical landmarks of the back
External occipital protuberance
C7 vertebra
Angles of the scapula
Medial margin of the scapula
Spine of the scapula
Iliac crest
Boundaries of trapezius, latissimus dorsi, and erector spinae muscles

Vertebral Levels of Bony Landmarks

Identify the vertebral level of the following bony landmarks: Root of the spine of the scapula at T3, Inferior angle of the scapula at T7, and Iliac crest at L5.

💡 핵심 개념

Root of the Spine of the scapula - T3
Inferior angle of the scapula - T7
Iliac crest - L5

Segmental Cutaneous Innervation and Vascular Supply

Understand the segmental cutaneous innervation (dorsal rami) and vascular supply (posterior intercostal branches) to the back.

💡 핵심 개념

Segmental cutaneous innervation via dorsal rami
Vascular supply via posterior intercostal branches

2) Back Muscles - Superficial Layer

Superficial Back Muscles Overview

Identify and describe specific attachments, actions, innervation, vascularization, and relations of superficial back muscles including Trapezius, Latissimus dorsi, Levator scapulae, Rhomboid major, and Rhomboid minor.

Posterior view of superficial back muscles showing trapezius, latissimus dorsi, and other superficial muscles

💡 핵심 개념

Study specific attachments, actions, innervation, and vascularization
Focus on superficial back muscles (See table)

Trapezius Muscle - Detailed Innervation

Motor innervation via Spinal accessory nerve (CN XI) which arises from upper segments of the spinal cord, ascends through the foramen magnum to enter the cranial cavity, then exits through the jugular foramen, descends through the posterior triangle of the neck to the sternocleidomastoid and trapezius. Accessory nerve syndromes can occur as it crosses the posterior triangle of the neck resulting in a medial winged scapula, droopy shoulder, or the inability to raise shoulder or arm above the head. Sensory innervation through C3 and C4 spinal nerves for proprioception.

💡 핵심 개념

Motor: Spinal accessory nerve (CN XI)
Sensory: Proprioception through C3 and C4 spinal nerves
Accessory nerve syndromes: medial winged scapula, droopy shoulder, inability to raise shoulder/arm above head

Table of Superficial Back Muscles

Comprehensive table showing muscle characteristics of superficial back muscles.

📊 Table of Superficial Back Muscles

Muscle	Proximal Attachment	Distal Attachment	Action	Innervation	Vascularization
Trapezius	Occipital bone, nuchal ligament, C7-T12 vertebrae	Clavicle, acromion and spine of scapula	Elevates, retracts, depresses, and rotates scapula	Spinal root of accessory n. (CN XI) cervical nn (C3-C4)	Superficial branch of the transverse cervical artery
Latissimus dorsi	T7 sacrum, thoracolumbar fascia, iliac crest and inferior 3 ribs	Intertubercular groove of humerus	Extends, adducts, and medially rotates humerus	Thoracodorsal n. (C6-C8)	Thoracodorsal artery
Levator scapulae	Transverse processes of C1-C4 vertebrae	Superior angle of the scapula	Elevates and rotates the scapula; inclines the neck to the same side of contraction	Cervical nn. (C3-C4) and dorsal scapular n. (C5)	Transverse cervical artery, Transverse cervical artery
Rhomboid major	Spinous processes of T2-T5 vertebrae	Medial margin of scapula	Retract and rotate scapula	Dorsal scapular n. (C4-C5)
Rhomboid minor	Spinous processes of C7-T1

💡 핵심 개념

Memorize attachments, actions, innervation, and vascularization
Pay special attention to clinical correlations

3) Deep Back Muscles

Deep Back Muscles Anatomy

Identify and describe general attachments, actions, segmental innervation, and relations of the deep back muscles including splenius capitis and cervicis, erector spinae, and transversospinalis muscles.

Posterior view showing deep back muscles with superficial layers removed

Posterior view showing erector spinae and transversospinalis muscle groups

💡 핵심 개념

Splenius capitis and cervicis
Erector spinae muscles
Transversospinalis muscles
General attachments, actions, and segmental innervation
See table for detailed information

4) Suboccipital Region

Suboccipital Triangle - Boundaries and Contents

Identify and describe the boundaries and contents of the suboccipital triangle. Boundaries include rectus capitis posterior major, obliquus capitis superior, and obliquus capitis inferior muscles. Contents include suboccipital nerve (posterior ramus of C1) and vertebral artery.

Detailed anatomical diagram of suboccipital region showing suboccipital triangle, nerves, and arteries

💡 핵심 개념

Boundaries: rectus capitis posterior major, obliquus capitis superior, obliquus capitis inferior muscles
Contents: suboccipital nerve (posterior ramus of C1) and vertebral artery

Suboccipital Muscles

Identify and describe the general attachments, functions, innervation, and vascularization of the suboccipital muscles: rectus capitis posterior major, rectus capitis posterior minor, obliquus capitis superior, and obliquus capitis inferior.

💡 핵심 개념

Rectus capitis posterior major
Rectus capitis posterior minor
Obliquus capitis superior
Obliquus capitis inferior
See table for detailed attachments, functions, innervation, and vascularization

Exercises

🎯 연습문제

1. Identify and locate all basic anatomical landmarks of the back on cadaver

주요 해부학적 랜드마크:

1. External occipital protuberance - 후두골 뒤쪽 돌출부
2. C7 vertebra (vertebra prominens) - 목을 굽혔을 때 가장 튀어나온 척추
3. Spine of scapula - 견갑골의 극
4. Medial margin of scapula - 견갑골 내측연
5. Inferior angle of scapula - 견갑골 하각
6. Iliac crest - 장골능

🎯 연습문제

2. Determine vertebral levels of bony landmarks: T3, T7, L5

척추 레벨과 해부학적 랜드마크:

- T3: Root of the spine of scapula (견갑골 극의 뿌리)
- T7: Inferior angle of scapula (견갑골 하각)
- L5: Iliac crest (장골능)

임상적으로 요추천자(lumbar puncture) 위치 확인에 사용

🎯 연습문제

3. Trace the pathway of the spinal accessory nerve (CN XI)

Spinal Accessory Nerve (CN XI) 경로:

1. 척수 상부 분절에서 기원
2. Foramen magnum을 통해 두개강으로 상행
3. Jugular foramen을 통해 두개강 탈출
4. 경부 후삼각(posterior triangle)을 하행
5. Sternocleidomastoid와 Trapezius 지배

운동기능: 어깨 올리기, 머리 회전

🎯 연습문제

4. Identify all superficial back muscles and their attachments

표재성 등 근육:

1. Trapezius
- 기시: 후두골, 항인대, C7-T12
- 정지: 쇄골, 견봉, 견갑극

2. Latissimus dorsi
- 기시: T7-천골, 장골능, 하위 3늑골
- 정지: 상완골 결절간구

3. Levator scapulae
- 기시: C1-C4 횡돌기
- 정지: 견갑골 상각

4. Rhomboid major/minor
- 기시: T2-T5/C7-T1 극돌기
- 정지: 견갑골 내측연

🎯 연습문제

5. Demonstrate actions of trapezius, latissimus dorsi, and levator scapulae

Trapezius 작용:
- 상부섬유: 견갑골 거상
- 중부섬유: 견갑골 후인
- 하부섬유: 견갑골 하강
- 상방회전

Latissimus dorsi 작용:
- 상완골 신전, 내전, 내회전
- '수영 근육'

Levator scapulae 작용:
- 견갑골 거상
- 동측으로 경부 측굴

🎯 연습문제

6. Identify boundaries and contents of suboccipital triangle

후두하삼각 경계:

- 상내측: Rectus capitis posterior major
- 상외측: Obliquus capitis superior
- 하외측: Obliquus capitis inferior

내용물:
1. Suboccipital nerve (C1 후지) - 후두하근 운동지배
2. Vertebral artery - 뇌로 가는 혈액 공급

🎯 연습문제

7. Locate suboccipital nerve and vertebral artery in suboccipital region

Suboccipital nerve (C1 posterior ramus):
- 후두하삼각 내에 위치
- 순수 운동신경
- 후두하근 4개 지배

Vertebral artery:
- C6 횡돌기 구멍으로 진입
- C1-C2 사이에서 후방으로 만곡
- 후두하삼각 바닥을 지남
- Foramen magnum을 통해 두개강 진입
- 반대측과 합쳐져 basilar artery 형성

🎯 연습문제

8. Understand clinical significance of accessory nerve syndromes

Accessory Nerve Syndrome 임상적 의의:

손상 원인:
- 경부 후삼각 수술
- 림프절 생검
- 외상

증상:
1. Medial winged scapula - 견갑골 내측익상
2. Droopy shoulder - 어깨 처짐
3. 팔/어깨를 머리 위로 들기 불가
4. 어깨 외전 장애

감별: Long thoracic nerve 손상 시 lateral winging 발생