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)