What muscles attach to the nuchal ligament?

• A. Latissimus Dorsi
• B. Trapezius, Rhomboid Minor, Serratus Posterior Superior, Splenius Capitis
• C. Levator Scapulae, Scalene Muscles
• D. Semispinalis Capitis, Longissimus Capitis

Answer: (B)

The nuchal ligament is a thick, midsagittal band in the posterior neck that runs from the external occipital protuberance down to the cervical spinous processes, serving as a central anchor for several neck muscles. The muscles that attach to it include the trapezius, rhomboid minor, serratus posterior superior, and splenius capitis. The trapezius has fibers that originate near the upper nuchal line and the ligament; rhomboid minor originates in part from the nuchal ligament and C7; serratus posterior superior originates from the ligament and spinous processes of C7–T3 and inserts on ribs 2–5; and the splenius capitis originates from the ligament and from C7–T6 spinous processes to insert on the skull. Other muscles listed do not attach to the nuchal ligament, such as latissimus dorsi (thoroughly tied to the thoracolumbar fascia and humerus), levator scapulae (originates from cervical transverse processes), the scalene muscles (attach to ribs and transverse processes), and the deeper extensors semispinalis capitis and longissimus capitis (originate from transverse processes and insert on the skull rather than attaching to the ligament).