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Title: Anatomy of the Neck
Description: Anatomy of the neck, including bones, joints, and clinical aspects that pertain to injuries of the neck. The study guide goes into the muscles, neurovasculature, and lymphatics of the lateral cervical region, posterior cervical region, and the anterior cervical region, as well as the root neck. The study guide goes into the glands, cartilage, and structures of the anterior and posterior neck.
Description: Anatomy of the neck, including bones, joints, and clinical aspects that pertain to injuries of the neck. The study guide goes into the muscles, neurovasculature, and lymphatics of the lateral cervical region, posterior cervical region, and the anterior cervical region, as well as the root neck. The study guide goes into the glands, cartilage, and structures of the anterior and posterior neck.
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The Neck
Overview
• Transitional area between base of cranium and
clavicles
...
• Many important and vulnerable structures are
crowded into a small area
...
• Superior Thoracic Aperature: highway
Neck divided into regions: lateral, anterior, posterior
and other SCM
Superficial: Platysma (thin, sheet like muscle,
fascial expression, tightens neck, muscles, and
fascia)
Atypical Cervical Vertebrae
• CA, chapter 4, chapter 8, p
...
• Superior articular facets support the occipital
condyles
...
• C2 (axis)- strongest cervical vertebra
• Tooth-like dens (odontoid process) extends
superiorly from body for rotation of cranium and C1
...
o Most superior one you can feel
Craniovertebral Joints- 2 sets (not specific questions, just sense of how it is set up)
• Atlanto-occipital joints- C1 (atlas) and occipital condyles
...
Permits
flexion/extension and sideways tilting of head
...
Gliding synovial joints
...
o All three working together: rotation of head (cranium and C1 rotate on C2)
...
468 for visual of connective tissues (apical lig
...
long
...
- tectorial
membrane, anterior long
...
- anterior membrane, ligamentum flavum- posterior membrane
...
o Suspended in anterior neck at C3 level; between mandible and thyroid cartilage
...
get stuck; potential damage to cord
• Fracture/dislocation of atlas: occur with vertical forces compressing the lateral masses,
fracturing the ant
...
arches (Jefferson burst fracture)
...
o Jefferson: diving into a pool, can bi in a car crash, whenever you directly land on
your head
o Transverse ligament fractures: everything starts moving around
• Fracture/dislocation of C2 vertebral arch: common cervical vertebrae injury
...
• Fracture of dens also common, resulting from horizontal blow to the head or osteopenia
(bone gets thin and fractures)
...
At the base of the SCM lies the lesser supraclavicular fossa
...
o SCM- Produces extension of
the neck (chin skyward)
...
Chin thrust(bilateral)
...
• Arteries of Lateral Region
o Thyrocervical trunk- branch of
the subclavian artery which further branches to
suprascapular artery, ascending cervical artery, and
inferior thyroid artery
...
o Cervicodorsal trunk- bifurcates to superficial
cervical artery and dorsal scapular artery
...
o Subclavian artery- 3 parts (medial, posterior, and
lateral to anterior scalene), supplies blood to upper
limb, crosses over the first rib posterior to the
subclavian vein and anterior scalene
...
• Veins of the Lateral Region:
o External jugular vein- arises from union of the
posterior retromandibular vein and posterior auricular vein, crosses the
SCM obliquely deep to platysma, joining the subclavian vein in the
inferior lateral cerv, region
...
o Subclavian vein: drains the upper limb, passes through the inferior
lateral cerv
...
§ EJV receives and drains the cervicodorsal, suprascapular, and
anterior jugular veins
...
o Brachial plexus (important)- roots appear between anterior and middle
scalenes, 3 trunksà pass between 1st rib, clavicle, and superior border
of scapula (cervico-axillary canal) à entering axilla
...
§ Lesser occipital nerve:
cutaneous C2à supplies neck
and scalp skin; posterosuperior
to the auricle
§ Great auricular nerve:
cutaneous C2 and C3à
supplies parotid gland, mastoid
process, both surfaces of the
auricle, and skin from angle of
mandible to mastoid process
(surrounding the ear)
§ Transverse cervical nerve:
cutaneous C2 and C3 à
supplies the skin covering the
anterior cervical region in 2
branches
§ Supraclavicular nerves: cutaneous C3 and C4 crosses the
clavicle à supply the skin over the shoulder
o Phrenic nerves- mixed, primarily C4 (with some fibers form C3 and
C5), provides sole motor supply to diaphragm and sensory fibers to
central part only (not the region closest to rib cage), as well as
supplies the pericardium and mediastinal pleura
§ Passes into the thorax posterior to subclavian vein and
anterior to the subclavian artery
o Erb’s point located in lateral cervical region
§ 4 branches of cervical plexus emerge from behind the
muscleà point of weakness/vulnerabliilty when doing
injections
§ lies of posterior aspect of SCM, be careful here
§ Autonomic response with SCM because of Erb’s point
(tearing, blurred vision, sweating, changes in hearing,
dizziness)
• Lymph Nodes of Lateral Region
o Superficial cervical lymph nodes- drain lymph from the
superficial tissues, lie along the EJV, superficial to SCM, and
drain into the deep cervical nodes along the IJV
...
o Important clinical region
• Muscles of Posterior Region
o Superficial extrinsic- trapezius
o Superficial intrinsic- splenius cervicis and capitis
o Intermediate intrinsic- erector spinae (in this region on spine: semispinalis capitus)
o Deep intrinsic- transversospinalis and minor deep layer
o Small muscles with high density of spindles thought to be primarily proprioceptive, producing fine postural
correction- not a lot of force, just changing the posture of the neck and spine in small notions
Transversospinalis: extends spine; lateral flex to the same side; rotates to same side
• Suboccipital Triangle
o Formed by
suboccipital
muscles
...
o Vertebral arteries- cervival part passing
through transverse foramina of C1-C6
...
• Nerves of
Posterior Region
o Suboccipital
nerve (C1)lies in the
suboccipital
triangle
...
o Lesser occipital (C2-C3)- cutaneous supply of
posterolateral neck and scalp posterior to ear
...
§ Carotid triangle (know carotid triangle)- vascular area bounded by
anterior border of SCM, superior belly of omohyoid, and posterior belly
of digastric
...
Contains bifurcation of carotid artery, carotid sinus, and carotid body
...
As a
group, constitute the floor of the mouth, allowing tongue function, elevating
the hyoid and larynx with swallowing and tone production
...
§ As a group:
• Originates away from hyoid and inserts on the hyoid
• Actions: depressing or fixing the hyoid for phonation
and swallowing
o Exception: thyrohyoid raise hyoid during
swallowing
o Platysma- depresses and wrinkles skin of lower face and mouth,
tenses skin of neck, aids depression of the mandible
...
§ Right common carotid: begins at the bifurcation of
brachiocephalic trunk
§ Left common carotid: begins at the arch of the aorta
...
§ External carotid arteries: pass to area between the neck of
the mandible and auricle of the ear, then bifurcates into maxillary and superficial temporal arteries
• Supplies most external cranial structures
...
o Occipital artery: passes through the occipital groove in temporal bone, dividing into numerous
branches in posterior scalp
...
o Superior thyroid artery: supplies thyroid gland, infrahyoids, SCM, and branches off superior
laryngeal artery to larynx
...
o Facial artery:
branches off the
ascending palatine
and tonsillar artery
§ Supplies the
submandibular
gland, branches
off the
submental
artery, enters
the face at middle of inferior
border of mandible
...
§ From superior bulb: descends in the carotid
sheath, leaving the anterior region by passing
deep to the SCM
...
o Multiple tributaries- inferior petrosal sinus, facial,
lingual, pharyngeal, superior and middle thyroid,
• Nerves of Anterior Region
o Transverse cervical nerve- covered with cervical plexus
...
o Branches of the glossopharyngeal (CNIX) and vagus
(CN X)
...
Located posterior to the cervical viscera and anterolateral to cervical
vertebral column
...
§ Viscera: thyroid gland, parathyroid gland, esophagus, trachea
• Muscles of Deep Neck
o Anterior prevertebral muscles (CA, table 8
...
o Lateral prevertebral muscles (CA, table 8
...
o Scalene and SCM form the floor of the lateral section
§ Scalenes originate on the cervical spine and insert on the ribs
§ Anterior and Middle Scalenes insert on 1st rib; Posterior scalene inserts on 2nd rib
Myofascial pain: tight bands
Treatment: needle directly into the
balled area
Neck pain is a huge issue
Commonly due to mechanical
issues, secondly due to
degeneration (metabolic)
Thoracic outlet syndrome: Upper
Limb symptoms à question this
diagnosis!
•
Clinical
Syndrome
o
Usually either
chronic pain or acute
repetitive
history
...
§ If present for long period of time à more muscles involved à
harder to pinpoint
o Palpation/examination reveals tightness/banding of individual
muscle fibers with classic tender trigger points and referral pattern
...
Some ROM dysfunction may be present if muscle crosses
articulation
...
• Treatment
o Injection with 0
...
Goal is to elicit LTRspinal reflex resulting in sudden contraction in the fibers of the taut
band
...
Followed by vapocoolant spray and stretch and heat packs (forces
lots of blood in muscle)
...
Bounded
by superior thoracic aperture (1st pair ribs,
manubrium, body of T1)
...
Arteries in Root of Neck
• Brachiocephalic trunk- largest branch of aorta,
divides into right common carotid and right
subclavian arteries
...
Reach an apex while
passing posterior to anterior scalene, and changes
name to axillary artery when at level of 1st rib
...
§ Cranial part of vertebral artery supplies
the medulla, spinal cord, parts of
cerebellum, dura of posterior cranial
fossa
...
o Thyrocervical trunk- most important branch is
inferior thyroid artery
o Costocervical trunk- divides into superior intercostal
and deep cervical arteries, supplying first two
intercostal spaces and posterior deep cervical muscles
...
• Subclavian veins begin at lateral border of 1st rib and
terminate with union at IJV
...
Site where thoracic
duct (L) and right lymphatic trunk (R) drain collected lymph
into venous circulation
...
Right passes anterior to subclavian and posterior
to brachiocephalic, into the thorax
...
o Recurrent laryngeal nerve- arises from the
vagus to supply the trachea, esophagus,
and all intrinsic muscles of larynx except
cricothyroid
...
• Sympathetic trunks, CA, fig 8
...
Read on your own,
including the clinical aspects
...
o Respiratory- larynx and trachea
...
Neck: Endocrine Layer- Thyroid Gland
• Thyroid gland- largest endocrine gland, located
anteriorly at level of C5-T1, consisting of right and left
lobes connected by this isthmus
...
• Arterial supply:
o Superior thyroid arteries- from external carotids to
anterosuperior gland
...
• Venous supply:
o Thyroid plexus consisting of superior, middle,
and inferior thyroid veins draining into IJV and
brachiocephalic veins
...
Fibers are
vasomotor
...
Neck: Endocrine Layer- Parathyroid Glands
• Parathyroid glands- small, flattened, oval glands lie on medial half of
the posterior surface of each thyroid lobe
...
• Inferior parathyroids usually near the inferior poles of thyroid, but may
vary in location
...
• Larynx- organ of voice production and airway maitenence, composed of
nine cartilages, connective tissues, and the vocal folds
...
Connects the inferior oropharynx with trachea
...
32:
o Three single (thyroid, cricoid, epiglottic) and three paired (arytenoid, corniculate, cuneiform)
...
Fused anteriorly to form laryngeal prominence, superior and inferior
thyroid notch
...
o Inferior horns articulate with lateral cricoid at cricothyroid joints, providing
rotation and gliding of thyroid cartilage (changes length of vocal folds)
...
Thicker and stronger than the thyroid, only
complete ring of cartilage surrounding the airway
...
o Attached to first tracheal ring by cricotracheal
ligament
...
o Corniculate and cuneiform- small nodules in posterior part of ary-epiglottic
fold
...
Forms
the superior part of the anterior wall and superior margin of the laryngeal inlet
...
Attached to the hyoid by the hyo-epiglottic
ligament
...
o Vestibular fold- superior to vocal fold, formed from
quadrangular membrane and vestibular ligament
...
o Vocal ligaments (vocal folds)- extend from the
laminae of thyroid cartilage to the vocal processes
of the arytenoid cartilages
...
Muscles of Larynx
• Extrinsic- previously discussed
...
o Everything but cricothyroid
(superior laryngeal) supplied by
recurrent laryngeal nerve (branch
of CN X)
...
sternal
angle or T4-T5 IV disc
...
• Alimentary Layer
Pharynx-: superior portion of alimentary system, posterior to nasal
and oral cavities
...
Pharynx is continuous with
the esophagus
...
o Oropharynx- extends from the soft palate to superior epiglottis, bounded by
soft palate, base of tongue, digestive function (deglutition)
...
o Laryngopharynx- extends from the superior epiglottis to the inferior border
of the cricoid cartilage, where it narrows and becomes continuous with the
esophagus
...
Risk for foreign body and aspiration
with inefficient swallow
...
Most alimentary tract composed of smooth muscle
...
o Primarily constrict walls of pharynx, elevate pharynx and
larynx during swallowing and speaking
...
Consists of
striated muscle in upper third, mixture of smooth and striated in the
middle, and smooth muscle in the lower third
...
• Attached to the trachea with loose connective tissue
Title: Anatomy of the Neck
Description: Anatomy of the neck, including bones, joints, and clinical aspects that pertain to injuries of the neck. The study guide goes into the muscles, neurovasculature, and lymphatics of the lateral cervical region, posterior cervical region, and the anterior cervical region, as well as the root neck. The study guide goes into the glands, cartilage, and structures of the anterior and posterior neck.
Description: Anatomy of the neck, including bones, joints, and clinical aspects that pertain to injuries of the neck. The study guide goes into the muscles, neurovasculature, and lymphatics of the lateral cervical region, posterior cervical region, and the anterior cervical region, as well as the root neck. The study guide goes into the glands, cartilage, and structures of the anterior and posterior neck.