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Cervical Spine Muscular Anatomy
Cervical and Occipital Flexors
Sternocleidomastoid
Longus Colli
Origin Lateral surface of the mastoid process of the
temporal bone
Insertion Superior anterior surface of the manubrium
sterni and medial clavicle
Action Ipsilateral lateral flexion, contralateral
rotation, flexion
Nerve Supply Accessory Nerve (11th Cranial Nerve)
Palpation
In supine, ipsilateral side flexion, contralateral rotation. Palpate between origin and
insertion. Ask client to actively raise head off bed
Origin
Upper part- anterior tubercles of transverse processes C3-5
Middle part- anterior bodies of C6-T3 Lower part- anterior bodies of T1-3
Insertion
Upper part- anterior tubercle of the atlas Middle part- anterior bodies of C2-4
Lower part- anterior transverse tubercles of C5-6
Action Flexion
Nerve Supply Anterior primary rami of C3-6
Palpation NA
Cervical Spine Muscular Anatomy
Cervical and Occipital Flexors
Scalenus Anterior
Longus Capitis
Origin Anterior tubercles of the transverse processes
of C3-6
Insertion Scalene tubercle on the inner border of the
first rib
Action Ipsilateral lateral flexion, flexion. Stabilise first rib during inspiration when upper attachment
is fixed.
Nerve Supply Anterior primary rami of C4-6
Palpation
Palpate lateral border of SCM at insertion. Increase contralateral rotation to move SCM
medially. Move just lateral with fingers. Resist ipsilateral side flexion.
Origin Anterior tubercles of the transverse process
of C3-6
Insertion Basilar aspect of the occipital bone
Action Flexion of the head on neck
Nerve Supply Anterior primary rami of C1-3
Palpation NA
Cervical Spine Muscular Anatomy
Cervical and Occipital Flexors
Rectus Capitis Anterior
Origin Anterior surface of the lateral atlas
Insertion Basilar part of the occipital bone
Action Flexion of the head on the neck
Nerve Supply Anterior primary rami of C1-2
Palpation NA
Cervical Spine Muscular Anatomy
Cervical and Occipital Extensors
Splenius Cervicis
Splenius Capitis
Origin Spinous process of T3-6
Insertion Posterior tubercles of the transverse process
of C1-4
Action Ipsilateral lateral flexion, extension, slight
ipsilateral rotation
Nerve Supply Posterior primary rami of C5-7
Palpation Supine, with contralateral rotation. Palpable
in the lamina groove of upper cervical vertebrae along with splenius capitis
Origin Lower half of ligamentum nuchae and the
spinous process of C7-T4
Insertion Posterior aspect of the mastoid process of the
temporal bone
Action Extension of the head and neck, ipsilateral
lateral flexion, ipsilateral rotation
Nerve Supply Posterior primary rami of C3-5
Palpation
Prone. Locate upper fibres of trapezius. Isolate lateral edge with cervical extension.
Palpate lateral to trapezius obliquely towards mastoid process
Cervical Spine Muscular Anatomy
Cervical and Occipital Extensors
Levator Scapulae
Trapezius
Origin Transverse process of C1-4
Insertion Medial margin of the scapula between
superior angle and spine of scapula
Action Elevation, shoulder retraction, neck
extension, ipsilateral lateral flexion, medial scapular rotation
Nerve Supply Ventral rami of C3-4
Palpation
Supine, ipsilateral cervical rotation, hand behind back. Palpate anterior to upper trapezius fibres and follow down onto
superior angle of scapulae
Origin Medial superior nuchal line, external occipital
protuberance, ligamentum nuchae and the spinous process of C7-T12
Insertion Posterior aspect of the lateral clavicle, medial acromion and the upper border of the spine
of the scapula
Action
Upper fibres- elevation, neck extension, ipsilateral lateral flexion, lateral rotation of
the scapula Middle fibres- shoulder retraction
Lower fibres- depression, lateral rotation of the scapula
Nerve Supply Accessory nerve (11th Cranial Nerve)
Palpation
Cervical Spine Muscular Anatomy
Cervical and Occipital Extensors
Rectus Capitis Posterior
Major
Rectus Capitis Posterior Minor
Origin Spinous process of the axis (C2)
Insertion Lateral aspect of the inferior nuchal line of
the occipital bone
Action Extension of the head on the neck, slight
rotation of head on neck
Nerve Supply Posterior primary rami of C1
Palpation
Supine, cradle the head with both hands. Slight upper cervical extension. Palpate
between superior nuchal line and spinous process of C2. Sub occipitals are inferior to upper trapezius and splenius capitis origins
Origin Posterior tubercle of the atlas
Insertion Medial aspect of the inferior nuchal line of
the occipital bone
Action Extension of the head on the neck
Nerve Supply Posterior primary rami of C1
Palpation
Supine, cradle the head with both hands. Slight upper cervical extension. Palpate
between superior nuchal line and spinous process of C2. Sub occipitals are inferior to upper trapezius and splenius capitis origins
Cervical Spine Muscular Anatomy
Cervical and Occipital Extensors
Superior Oblique
Inferior Oblique
Origin Transverse process of the atlas (C1)
Insertion In-between the superior and inferior aspect
of the nuchal line of the occipital bone
Action Extension of the head on the neck
Nerve Supply Posterior primary rami of C1
Palpation
Supine, cradle the head with both hands. Slight upper cervical extension. Palpate
between superior nuchal line and spinous process of C2. Sub occipitals are inferior to upper trapezius and splenius capitis origins
Origin Spinous process of the axis (C2)
Insertion Posterior aspect of the transverse process of
the atlas (C1)
Action Extension, ipsilateral rotation
Nerve Supply Posterior primary rami of C1
Palpation
Supine, cradle the head with both hands. Slight upper cervical extension. Palpate
between superior nuchal line and spinous process of C2. Sub occipitals are inferior to upper trapezius and splenius capitis origins
Cervical Spine Muscular Anatomy
Cervical and Occipital Lateral Flexors
Scalenus Medius
Scalenus Posterior
Origin Transverse process of C1-2 and the posterior
tubercles of C3-7
Insertion Lateral aspect of the 1st rib behind the
subclavian artery groove
Action Ipsilateral lateral flexion, stabilising first rib
during respiration when upper attachment is fixed
Nerve Supply Anterior primary rami of C3-8
Palpation Palpate posterolateral to scalenus anterior. Caution: Avoid brachial plexus and subclavian
artery
Origin Posterior tubercles of the transverse process
of C4-6
Insertion Outer surface of the 2nd rib posteriorly
Action Ipsilateral lateral flexion
Nerve Supply Anterior primary rami of C6-8
Palpation Palpate posterolateral to scalenus medius
Cervical Spine Muscular Anatomy
Cervical and Occipital Rotators
Semispinals Cervicis
Multifidus
Origin Transverse processes of T1-6
Insertion Spinous processes of C2-6
Action Cervical extension and cervical contralateral
rotation
Nerve Supply Posterior primary rami of adjacent spinal
nerves
Palpation N/A
Origin
Back of sacrum and fascia covering erector spinae, mammillary processes of lumbar
vertebrae, transverse processes of thoracic vertebrae and articular processes of C4-7
Insertion Spines of all vertebrae from L5 to Axis (C2)
Action Ipsilateral rotation, extension and ipsilateral lateral flexion. Stabilising acting as extensible
ligaments.
Nerve Supply Posterior primary rami of adjacent nerves
Palpation N/A
Thoracic Spine Muscular Anatomy
Scapulae Retraction
Rhomboid Major
Rhomboid Minor
Origin Spinous processes of T2 to T5 and
supraspinous ligament between them
Insertion Medial border of scapula between base of
spine and inferior angle
Action Scapulae retraction, medial scapula rotation
Nerve Supply Dorsal Scapular Nerve
Palpation
Side lying, with arm hanging over edge of bed to abduct scapula. Palpate obliquely
downwards and lateral from spinous process to medial scapula border
Origin Spinous process of C7 to T1 and supraspinous
ligament between them
Insertion Upper medial border of scapula at base of
spine of scapula
Action Scapulae retraction, medial scapula rotation
Nerve Supply Dorsal Scapula Nerve
Palpation
Side lying, with arm hanging over edge of bed to abduct scapule. Palpate obliquely
downwards and lateral from spinous process to medial scapula border
Cervical Musculature
Cervical and Occipital Flexion
Sternocleidomastoid
Longus Colli
Longus Capitis
Scalenus Anterior
Rectus Capitis Anterior (Head Only)
Cervical and Occipital Lateral Flexion
Scalenus Anterior
Scalenus Medius
Scalenus Posterior
Levator Scapulae
Sternocleidomastoid
Trapezius
Splenius Capitis
Erector Spinae
Spenius Cervicis
Cervical and Occipital Extension
Levator Scapulae
Splenius Cervicis
Splenius Capitis
Trapezius
Erector Spinae
Rectus Capitis Posterior Major (Head Only)
Rectus Capitis Posterior Minor (Head Only)
Superior Oblique (Head Only)
Inferior Oblique
Cervical and Occipital Rotation
Semispinalis Cervicis
Multifidus
Scalenus Anterior
Splenius Cervicis
Splenius Capitis
Sternocleidomastoid
Inferior Oblique (Head Only)
Rectus Capitis Posterior Major (Head Only)