The Extrinsic Muscles of the Back –
Anatomy of the Torso
References
Aside from the intrinsic (or primary) muscles of the back, it is particularly
the group of extrinsic (or secondary) back muscles that is of great concern
for students of medicine as well as physical therapy. This is mostly due to
the fact that this group is made up of many individual muscles, and that
there are no simple mnemonics available with regard to their origin,
insertion, function and innervation. Nevertheless, this article still tries to
classify the extrinsic back muscles into logical subgroups in order to
simplify studying them. After detailed explanations, an overview table of
the muscles and muscle subgroups is provided at the end of the article.
Picture: “Muscles That Position the Pectoral Girdle” by philschatz. License: CC
BY 4.0
The Extrinsic Muscles of the Back: Explanations
The extrinsic back muscles are also referred to as secondary back muscles.
Topographically, the muscles in this group are classed with the lateral torso wall
and the upper extremity, which is due to their location as well as their genetic
development from fetus to an adult human being.
In broad terms, the extrinsic muscles of the back are innervated by the ventral
branches of the spinal nerves and the individual cranial nerves.
In order to get an overview of this large group, it is very useful to create
subgroups. In literature, three subgroups are mentioned, which are structured
logically and relatively easy to study. They are based on location and functional
anatomy. These three subgroups are:
1. Spinoscapular and spinohumeral muscles
2. Spinocostal muscles
3. Modified intercostal muscles
Spinoscapular and Spinohumeral Muscles
Picture: “Muscles That Position the Pectoral Girdle” by Phil Schatz. License: CC BY 4.0
The group of spinoscapular and spinohumeral muscles includes back muscles
that have their osseous origin in the trunk and extend to the scapula or the
humerus. They are large structures that run along the surface, and also belong
to the musculature of the upper extremity.
They stabilize the shoulder girdle and influence how the torso functions when
the arm is fixed. Their neuronal supply is ensured through nerve branches of the
cervicobrachial plexus, which is formed by the ventral rami of the cervical spinal
nerves. Among this group are the following muscles:
Trapezius muscle
Rhomboid major muscle
Rhomboid minor muscle
Levator scapulae muscle
Latissimus dorsi muscle
Trapezius Muscle
The trapezius muscle is a large, flat, and most superficial muscle of the upper
back. It can be divided into three sections: the superior region (descending
part), the intermediate region (transverse part) and the inferior region
(ascending part). Their innervation is provided by the accessory nerve (cranial
nerve XI) and the cervical plexus (C2—C4).
Picture: “Trapezius back” by Anatomography. License: CC BY-SA 2.1 JP
Descending part
The descending part originates from the external occipital protuberance, the
superior nuchal line, the nuchal ligament and the spinous processes of
segments C2 and C3. Its insertion point is at the lateral third of the clavicle
and the acromion. This part is responsible for extension and contralateral
rotation of the head and cervical spine.
Transverse part
The transverse part has its origin at the spinous processes of C4—T1 and
inserts into the upper edge of the scapular spine and the acromion. It moves
the scapula medially.
Ascending part
The third and inferior section—the ascending part—has its origin at the spinous
processes of T5—T12 and inserts into the lower edge of the medial third of
the scapular spine. Its responsibility is the medial-caudal translation of the
scapula on the thorax.
Rhomboid Major Muscle
The large rhomboid muscle has its origin from the spinous processes of four
thoracic vertebrae (T2—T5) and inserts into the medial border of the scapula
(caudal to the scapular spine). During active innervation by the dorsal scapular
nerve from the C5 root of the brachial plexus, it acts as fixator of the scapula to
the thorax and performs a translational movement of the scapula in craniomedial
direction.
Rhomboid Major Muscle
Rhomboid Minor Muscle
The small rhomboid muscle is located caudally from its larger counterpart and
has its origin in the spinous processes of C7—T1. It inserts into the medial
border of the scapula (caudal to the spine of the scapula) and shares
innervation as well as function with the rhomboid major muscle: dorsal scapular
nerve from the C5 root of the brachial plexus; fixation and craniomedial
translation of the scapula on the thorax.
Rhomboid Minor Muscle
Levator Scapulae Muscle
This tube-like muscle originates from the transverse processes of C1—C4 and
their posterior tubercles and inserts into the superior angle of the scapula.
Aside from its primary function to elevate the scapula via the craniomedial
translation on the thorax, it can also affect dorsal extension and ipsilateral lateral
flexion of the cervical spine. It is innervated by the dorsal scapular nerve from
the C5 root of the brachial plexus and the ventral rami of cervical plexus (C3—
C4).
Latissimus Dorsi Muscle
The latissimus dorsi muscle is one of the largest back
muscles. It has a very broad area of origin and a narrow
insertion. It originates from the spinous processes of
T7—L5, the dorsal part of the sacrum, the medial
third of the iliac crest, 9th—12th rib, the
thoracolumbar fascia and, in some people, also the
inferior angle of the scapula.
It inserts into the crest of lesser tubercle of the
humerus and acts on the torso and the upper arm. It
has humeral functions as extensor, adductor, and
Latissimus Dorsi Muscle
internal rotator.
Furthermore, with regard to expiration and active coughing, it functions as
auxiliary respiratory muscle. Moreover, it can pull the entire shoulder girdle in a
dorsal as well as caudal direction. In functional anatomy, it is, therefore, often
classified as part of the shoulder girdle musculature. Its neuronal supply is
provided by the thoracodorsal nerve (C6—C8).
Spinocostal Muscles
The spinocostal muscles are located in the middle layer between the extrinsic
musculature of the extremities and the intrinsic back musculature.
Picture: “Intercostal Muscles” by Phil Schatz. License: CC BY 4.0
They extend from the spinous processes of the vertebral bodies to the dorsal rib
sections and act as auxiliary respiratory muscles of inspiration. They are
innervated via the intercostal nerves, which originate in the ventral rami of the
thoracic segments. They are also classed with the lateral torso wall or—
especially in the older medical literature—the primary thorax wall muscles. This
group includes two muscles:
The serratus posterior superior muscle
The serratus posterior inferior muscle
Serratus Posterior Superior Muscle
The serratus posterior superior muscle originates in the spinous processes of
lower two cervical and upper two thoracic vertebrae C6—T2 and inserts into
the costal angle of ribs 2—5. It is innervated by the ventral rami of the spinal
nerves (T1—T4) and elevates the ribs, which makes it a synergist muscle of
inspiration.
Serratus Posterior Inferior Muscle
Originating from the spinous processes of lower two thoracic and upper two
lumbar vertebrae T11—L2, the serratus posterior inferior muscle inserts into
the lower edge of the 9th—12th rib. With active innervation by the ventral rami
of the spinal nerves (T9—T12), serratus posterior inferior muscle depresses
the ribs, which makes it a synergist muscle of expiration.
The Modified Intercostal Musculature
The modified intercostal musculature is a morphological extension of the intrinsic
back musculature in the deeper layers. It serves as a connection between the rib
homologs of two consecutive segments in the extra-thoracic area of the spinal
column. Its movement function, however, is very limited and therefore cannot be
compared with other skeletal muscles. What the intercostal muscles are to the
thoracic spine, the following muscles are to the lumbar spine and the cervical
spine:
Lateral lumbar intertransversarii muscles
Anterior cervical intertransversarii muscles
Rectus capitis lateralis muscle
The intertransversaii muscles, as the name indicates, are present between
adjacent transverse processes of vertebrae. These muscles are innervated by
the ventral rami of spinal nerves and help in the lateral flexion of the spine.
Picture: “Posterior and Lateral Views of the Neck” by Phil Schatz. License: CC BY 4.0
The Lateral Lumbar Intertransversarii Muscles
The lateral lumbar intertransversarii muscles originate from the costal
processes of all lumbar vertebrae and insert into the costal processes of the
adjacent lumbar vertebrae. With active innervation by the lumbar plexus
(ventral rami L1—L4), they act as a lateral flexor of the lumbar spine.
The Anterior Cervical Intertransversarii Muscles
These muscles originate from the transverse processes of all cervical
vertebrae and insert into the transverse processes of the adjacent cervical
vertebrae. They are innervated by the cervical plexus (ventral rami of C2—
C6) and are lateral flexors of the cervical spine.
Rectus Capitis Lateralis Muscle
Originating from the transverse process of atlas (C1 vertebra), the rectus
capitis lateralis muscle inserts into the basilar part of the occipital bone, lateral
to the occipital condyle. It flexes the head laterally whenever it is actively
innervated by the cervical plexus (ventral ramus C1).
Table: Overview of the Extrinsic Muscles of the Back
Muscle Group Muscles
trapezius muscle
rhomboid major muscle
Spinoscapular and spinohumeral
rhomboid minor muscle
musculature
levator scapulae muscle
latissimus dorsi muscle
serratus posterior superior
Spinocostal musculature muscle
serratus posterior inferior muscle
lateral lumbar intertransversarii
Modified intercostal musculature anterior cervical intertransversarii
rectus capitis lateralis muscle
You can learn everything about the intrinsic back musculature in a separate
article.
Review Questions
Solutions can be found below the references.
1. In how many muscle groups can the extrinsic back musculature be
subdivided?
1. 1
2. 2
3. 3
4. 4
5. 5
2. Which of the muscles listed below does not belong to the spinoscapular
and spinohumeral group?
1. Trapezius muscle
2. Levator scapulae muscle
3. Rhomboid major muscle
4. Rhomboid minor muscle
5. Deltoid muscle
3. Which of the functions listed below is executed by the modified
intercostal musculature?
1. Flexion
2. Extension
3. Lateral flexion
4. Rotation
5. Stabilization