4.1 Flashcards by Brooke Glaser

Label surface anatomy neck muscles

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Bones of the neck

C1-C7
Hyoid
Manubrium
Clavicles

C1 is just inferior to the mastoid process.
The 1st rib traverses the neck region.

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Superficial Cervical Fascia

Includes the platysma
Contains arteries, nerves, veins, and adipose tissue

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Deep Cervical Fascia

Investing (red)
- deep to subcutaneous skin layer
- surround the entire neck

Pretracheal (blue)
- anterior hyoid –> inferior
- muscular and visceral

Carotid sheath (green)
- communicates with cranium and mediastinum

Prevertebral (orange)
- vertebral column
* retropharyngeal space just anterior

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Boundaries of the anterior triangle

Anterior: median line of the neck
Posterior: anterior border of sternocleidomastoid
Superior: inferior border of mandible
Inferior: superior sternum
Roof: platysma
Floor: pharynx, larynx, thyroid gland

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Contents of anterior triangle

Hyoid bone
- forms superior border of larynx
- located at C3
- important for pharynx and larynx movements

4 suprahyoid mm
- mylohyoid
- geniohyoid
- stylohyoid
- digastric

4 infrahyoid mm
- sternohyoid
- omohyoid
- thyrohyoid
- sternothyroid

Arteries
- common carotid bifurcates
- carotid sinus contains carotid body; a chemoreceptor for O2

Veins
- internal jugular that empties into subclavian

Nerves
- CN XII enters tongue
- CN IX (glossopharyngeal)
- CN X (vagus)

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Lateral triangle boundaries

Anterior: posterior border of sternocleidomastoid
Posterior: anterior border of trapezius
Superior: merging of sternocleidomastoid and trapezius
Inferior: clavicle
Roof: platysma
Floor: muscles covered by prevertebral layer

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Contents of lateral triangle

Floor overlies deep mm of the neck

Arteries
- thyrocervical trunk and branches
- subclavian artery traveling to arm

Veins
- external jugular

Nerves
- CN XI, spinal accessory to trapezius (motor)
- multiple sensory nerves
- Erb’s point
- ansa cervicalis (cervical plexus)
* nerve loop formed from C1-C3
* motor innnervation to neck muscles

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Prevertebral muscles

Lie directly posterior to retropharyngeal space on anterior surface of vertebrae

Anterior mm:
- rectus capitis
- longus capitis
- longus coli

Lateral mm:
- scalene mm
- anatomical variation - an extra rib can be found at C7 and can predispose thoracic outlet syndrome

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Root of the neck

Junction between neck, thorax, and upper limb
Inferior boundary: superior thoracic aperture
- manubrium, T1, 1st rib

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Contents of the root of the neck

Prevertebral muscles
Phrenic, vagus, and recurrent layngeal nn.
Brachial plexus
Sympathetic trunk
Carotid sheath and contents
Subclavian vessels and branches
Apex of lungs
Trachea/ esophagus

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Outlet syndrome

Group of entrapment syndromes of the brachial plexus and/or axillary artery and vein as they pass from trunk to axilla
Common sites:
* interscalene triangle - between anterior and middle scalene mm
* costoclavicular space - between 1st rib and clavicle
* intrapectoral space - under pectoralis minor tendon and coracoid process

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Viscera of the neck (3 layers)

Organized into 3 layers from anterior to posterior:
1. endocrine layer - thyroid and parathyroid glands
- hormone producing layer
2. respiratory layer - larynx and trachea
3. alimentary layer - pharynx and esophagus

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Viscera of the neck: superficial to deep

Laryngeal prominence: thyroid cartilage
- thyroid gland overlies the trachea
Trachea
Esophagus

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Label the regions of the thorax

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Internal structures with external landmarks: jugular notch, sternal angle, aortic arch

Jugular notch: T2-T3
Sternal angle T4-T5
Aortic arch: T4

Bones of the anterior chest wall

Sternum
- manubrium
- body
- xiphoid process
12 pairs of ribs
- true (vertebrocostal) ribs (1-7)
- false (vertebrochondral) ribs (8-10)
- floating ribs (11-12)
12 thoracic vertebrae
Costal cartilages
Intercostal spaces

Bones of the posterior chest wall

12 pairs of ribs
- true (vertebrocostal) ribs (1-7)
- false (vertebrochondral) ribs (8-10)
- floating ribs (11-12)
12 thoracic vertebrae

Superior thoracic aperture

Bound by T1, rib 1, and manubrium
Thoracic outlet syndrome

Inferior thoracic aperture

Bound by T12 and ribs 11-12
Anterolaterally: cartilage of ribs 7-10
- xiphisternal joint
- diaphragm

Label the parts of the rib

Label the joints of the rib

What are the cavities of the trunk?

Thoracic and abdominopelvic

Pleural cavity

Contains multiple cavities lined with connective tissue which forms separate compartments.
Serous membrane surrounding the lungs
- Visceral layer: clings to lung surface
- Parietal layer: lines cavity walls
- Pleural cavity: potential space between layers with serous fluid

The visceral layer is continuous with the parietal layer.

External interacostals

11 muscles Costal tubercles --> costochondral junction - does NOT extend to sternum Attachments - Superior: lower border of superior rib - Inferior: upper border of inferior rib - External intercostal membrane Inferomedial fiber direction (hands in pockets) Action: elevates ribs during inspiration; stabilizes chest wall - N: intercostal nn. - A: intercostal aa.

Internal intercostals

11 muscles, perpendicular to externals Sternum --> costal angle - does NOT extend to vertebrae Attachments - superior: lower border of superior rib - inferior: upper border of inferior rib Action: depresses ribs during expiration; stabilizes chest wall N: intercostal nn. A: intercostal aa.

Innermost intercostals

Deeper parts of internal intercostals Doesn't extend to sternum or vertebra (only lateral wall) Separated from internals by intercostal artery, vein, and nerve

Diaphragm

Primary muscle for breathing Dome shaped, flat muscle Separates thoracic and abdominal cavities Contractile fibers insert into central tendon

Structures of the diaphragm

Right and left dome Central tendon Right and left crus

Foramina in the diaphragm

Vena caval hiatus (inferior vena cava: T8 Esophageal hiatus: T10 Aortic hiatus: T12

Arteries and nerves of the diaphragm

Arteries - superior surface: branches of the internal thoracic artery - abdominal surface: right and left inferior phrenic Nerve: phrenic nerve C3-C5

Chest wall movement

1. Contraction of diaphragm 2. Anterior rib movement: pendulum swinging anterior to posterior 3. Transverse movement: lateral

Intercostal neurovasculature

Arteries, nerves, and veins travel between the ribs. - protected by the rib acting as a roof - within the costal groove Located in the place between internal intercostal and innermost intercostal and the costal groove.

Motor and sensory innervation of the chest wall

Intercostal nerves: ventral rami of spinal nerves T1-T11 Subcostal nerve (because no more ribs): ventral ramus of T12

Arteries of the thorax

Subclavian artery branch: internal thoracic artery Segmental arteries from thoracic aorta: posterior intercostal

Neurovasculature of the anterior chest wall

Subclavian artery: internal thoracic artery - anterior intercostal arteries 1-6 - anterior intercostal arteries 7-9 form the musculophrenic artery - distal internal thoracic becomes the superior epigastric artery - descends into rectus abdominis

Neurovasculature of posterior chest wall

Thoracic aorta - posterior intercostal arteries 3-11