Author: Dr Peter de Souza
Last modified: 17 December 2020


Okay so this is a tutorial on the extrinsic muscles of the back. The extrinsic muscles of the back are those muscles which are superficial and are responsible for movements at the shoulder and upper limb.

These are different to the intrinsic muscles of the back which are deep, and which are responsible for controlling posture and movement of the spine and head.


The extrinsic muscles of the back are the trapezius, the latissimus dorsi, the rhomboid major and minor, and the levator scapulae.


Just working superficially to deep I'll just show you these muscles. I'll start with the trapezius, which is this muscle here which you probably all know - big trapezium shaped muscle, which is why it's called the trapezius. And it basically extends from the external occipital protuberance here, all the way down to the lowest thoracic vertebra T12 - the spine of T12. And laterally it inserts along the spine of the scapula and posteriorly on the distal end of the clavicle, which you can't quite see, but it inserts just at the back of the clavicle here, and also on the acromion of the scapula.


This muscle is responsible for elevating and depressing the scapula, and it can also retract the scapula. It's innervated by the accessory nerve, which is the eleventh cranial nerve and it receives sensory innervation from the ventral rami of C3 and C4. All the extrinsic muscles are innervated by the ventral rami, as opposed to the dorsal rami, because these muscles insert onto the...insert onto the upper limbs, whereas the intrinsic muscles, which are primarily innervated by the posterior rami, are deeper and are just responsible for attaching to, and controlling the posture and movement of the spine.


That’s the trapezius, this huge muscle here, I’ll just get rid of that. The next muscle is the latissimus dorsi, and it's called that because in Latin, "latissimus" means "the broadest", and "dorsi" means "back", so it's basically the "broadest muscle of the back".


This muscle inserts into the humerus in between the insertion points of the pec major and...what's this one...the teres major, and for that reason it's often referred to as the "lady between two majors", so it inserts in the intertubercular groove of the humerus, in between the teres major and the pectoralis major.


This huge muscle, the latissimus dorsi adducts the arm, extends, and internally rotates the humerus. It's innervated by spinal nerves C6, 7 and 8.


Moving on, just underneath the trapezius, which I've removed here, we now have, we can now see the rhomboid muscles.  This is the rhomboid minor here...zoom in a bit the rhomboid minor and the rhomboid major. These just lie deep to the trapezius muscle, and as you can see here they insert onto, or sorry, they originate on the spines of the vertebra.


The rhomboid minor here originates on the spine of C7 and T1, and inserts onto the medial border of the scapula. And the rhomboid major originates on the spinous processes of T2 to T5 and inserts medially on the scapula. These muscles basically keep the scapula pressed against the thoracic wall and they can retract the scapula when the trapezius is contracted. They act as antagonists to the trapezius muscle. They are both innervated by the dorsal scapula nerve, which comes of C3, spinal nerves C3 and C4. These are the rhomboids.

The last extrinsic muscle of the back is the levator scapulae, or well, collectively the levator scapulae.


I'll just get rid of the rhomboids, so had a good look at those, and underneath them you can see the levator scapulae.


It’s this muscle here. And as you can tell by the name, this muscle elevates the scapula, so levator is Latin I guess, for lifting, lifter, or something like that, so it elevates the scapula.


We can see here, just at its origin, it's covered by the sternocleidomastoid and the splenius capitis.


Okay so if we zoom in, you can see exactly where it originates on the transverse process of the first vertebra, and then if we follow the path down, we can see that it inserts on the superior angle of the scapula and the adjacent medial border.


That’s the levator scapulae and it's innervated by branches of C4 and C5, and it elevates the scapula.


Just to recap, the extrinsic muscles, you've got the trapezius, the latissimus dorsi, the rhomboid major, the rhomboid minor, and the levator scapulae, so these two muscles here.