60 THE SUPERIOR EXTREMITY 



band which runs parallel to the upper border of the major 

 rhomboid. It springs from the lower part of the ligamentum 

 nuchae, the spine of the seventh cervical vertebra, and frequently 

 also from the spine of the first thoracic vertebras. It is 

 inserted into the vertebral margin of the scapula opposite 

 the triangular surface at the flattened apex of its spine 

 (Fig. 38, p. 83). It is entirely covered by the trapezius. 



The rhomboideus major arises from the upper four or five 

 thoracic spines, and the corresponding parts of the supraspinous 

 ligaments. Its fibres run obliquely downwards and laterally, 

 and end in a tendinous arch, which is attached to the 

 vertebral margin of the scapula, from the inferior angle to 

 the apex of the spine. The main attachment of the fibrous 

 arch is to the inferior angle, but it is bound to the vertebral 

 border from that point to the spine by fairly firm areolar 

 tissue (Fig. 38, p. 83). The greater part of the rhomboideus 

 major is covered by the trapezius ; only a small portion near 

 the inferior angle of the scapula lies immediately subjacent 

 to the deep fascia. 



M. Levator Scapulas. The levator scapulae is an elon- 

 gated muscle which arises by four, more or less tendinous, 

 slips from the posterior tubercles of the transverse processes 

 of the upper four cervical vertebrae. It passes downwards 

 and backwards to be inserted into the vertebral margin of 

 the scapula, from the medial angle to the spine. It is supplied 

 by branches from the third and fourth cervical nerves. 



Dissection. Clean the levator scapulae, taking care not to 

 injure the nerves which supply it. The muscle belongs partly to 

 the dissector of the head and neck and partly to the dissector of 

 the superior extremity. When both of them have studied its 

 attachment and nerve-supply, the muscle must be divided at 

 the middle of its length. The lower half is then to be turned 

 downwards and laterally to its insertion, and the dorsalis scapulas 

 nerve and the descending branch of the transverse cervical 

 artery, which lie deep to the muscle, are to be preserved and 

 followed to the upper margin of the rhomboideus minor. 



Next cut through the rhomboids, from above downwards, 

 midway between the scapula and the spines of the vertebrae ; 

 remember that they are very thin, and take care not to injure the 

 serratus posterior superior, which is immediately subjacent to 

 them. Turn the medial part of each muscle towards the vertebral 

 spine and verify its attachment. Turn the lateral parts towards 

 the scapula and follow the dorsalis scapulae nerve and the 

 descending branch of the transverse cervical artery to their 

 terminations. The nerve gives branches to the levator scapulae 

 and to both the rhomboid muscles, and the artery not only supplies 

 the rhomboids but also the adjacent muscles on the scapula. 



