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Extrinsic Back Muscles Intrinsic Back Muscles

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Extrinsic Back Muscles Intrinsic Back Muscles BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) Reg Anesth Pain Med Table 1. Muscles of the back Muscle name Attachments Nerve supply Extrinsic back muscles Trapezius Descending part: extends between superior nuchal Accessory nerve (11th line of occiput to lateral third of clavicle cranial nerve) Transverse part: extends between spinous processes of C1-T3 to acromion and spine of scapula Ascending part: extends between spinous processes of T4-T12 to spine of scapula Levator scapulae Extends between the C1-C4 transverse processes Ventral rami of C3 and C4, to the medial border of the scapula and dorsal scapular nerve (branch of C5 ventral ramus) Serratus posterior Extends between the C7-T3 spinous processes and Branches of 2nd – 5th superior 2nd – 5th ribs intercostal nerves Rhomboid minor Extends between the C7-T1 spinous processes to Dorsal scapular nerve (C4- the spine of the scapula C5) Rhomboid major Extends between T2-T5 spinous processes to the Dorsal scapular nerve (C4- medial border of the scapula C5) Latissimus dorsi Broad origin from T7-T12 spinous processes, Thoracodorsal nerve (C6- thoracolumbar fascia, posterior iliac crest, 9th – 12th C8) ribs, and inferior angle of scapula. Inserts onto the proximal humerus. Serratus posterior Extends between the T11-L2 spinous processes and Branches of 9th – 12th inferior the 9th - 12th ribs intercostal nerves Intrinsic back muscles Splenius capitis Extend between the spinous processes of C7-T3 Lateral branches of dorsal and cervicis (capitis) and T3-T6 (cervicis), to the occiput and rami of cervical spinal mastoid process (capitis) and the C1-2 transverse nerves. processes (cervicis). Erector spinae muscles Spinalis cervicis Extend between spinous processes of the cervical Intermediate and lateral and thoracis and thoracic vertebrae across 3-8 levels. Does not branches of dorsal rami of extend into lumbar spine. cervical and thoracic spinal nerves. Longissimus Thoracis: extends between the transverse processe Intermediate and lateral cervicis and of L1-L5 vertebra, sacrum and posterior iliac crest branches of dorsal rami of thoracis Chin KJ, et al. Reg Anesth Pain Med 2021; 46:581–599. doi: 10.1136/rapm-2021-102506 BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) Reg Anesth Pain Med to the transverse processes of T6-12 vertebrae and cervical, thoracic and corresponding ribs lumbar spinal nerves. Cervicis: extends between transverse processes of C4-T5 to the transverse processes of C2-C6 and the mastoid process Iliocostalis Cervicis: extends between the angle of 3rd – 6th ribs Lateral branches of dorsal cervicis, thoracis, to the transverse processes of C4-C6 vertebrae rami of cervical, thoracic and lumborum and lumbar spinal nerves. Thoracis: extends between the angle of 7th - 12th ribs to the angle of 1st-6th ribs and the C7 transverse process. Lumborum: extends between sacrum, iliac crest and thoracolumbar fascia to the angle of 5th-12th ribs, L1-L4 transverse processes and adjacent thoracolumbar fascia. Transversospinalis muscles Rotatores breves Connects the transverse processes of thoracic Medial branches of dorsal and longi vertebrae to the spinous processes of vertebrae 1- rami of spinal nerves. 2 levels above. Multifidus Connects articular, transverse and mammillary Medial branches of dorsal cervicis, thoracis, processes of each vertebra, to the spinous rami of cervical, thoracic, and lumborum processes of vertebrae 2-5 levels above. and lumbar spinal nerves. Semispinalis Connects transverse processes of cervical and Medial branches of dorsal capitis, cervicis, thoracic vertebra to the spinous processes of rami of cervical, thoracic, and thoracis vertebrae 5-6 levels above. and lumbar spinal nerves. Deepest layer Interspinales Connects adjacent spinous processes. The thoracic Medial branches of dorsal cervicis, thoracis, component can be absent or rudimentary. rami of cervical, thoracic, and lumborum and lumbar spinal nerves. Intertransversarii Connects adjacent transverse processes. Usually Medial branches of dorsal colli and absent in the thoracic region. rami of cervical and lumbar lumborum spinal nerves. Levatores Connects each transverse process to the rib below. Medial branches of dorsal costarum rami of cervical and lumbar spinal nerves. Chin KJ, et al. Reg Anesth Pain Med 2021; 46:581–599. doi: 10.1136/rapm-2021-102506.
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