9.23.16 Posterior Triangle Flashcards

1
Q

What are the fascial layers of the neck?

A
  1. Investing (superficial) layer of dense connective tissue
  2. Infrahyoid fascia
  3. Pretracheal fascia
  4. Carotid sheath
  5. Prevertebral (deep cervical) fascia
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2
Q

What is the sleeve that binds all structures to the neck?

A

Investing layer of dense connective tissue

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3
Q

What is the investing fascia of the neck attached to?

A

Ligamentum nuchae and spinous process of C7 vertebrae

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4
Q

What covers the supra and infra-hyoid muscles (strap muscles)?

A

Infrahyoid fascia

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5
Q

What is the viscera surrounded with a layer of fascia including the thyroid and parathyroid glands, larynx, trachea, and esophagus?

A

Pretracheal fascia

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6
Q

What covers the carotid artery, internal jugular vein, and vagus nerve?

A

Carotid sheath

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7
Q

What covers the vertebral musculature?

A

Prevertebral (deep cervical) fascia

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8
Q

What are the boundaries of the posterior triangle (anterior, posterior, inferior)?

A

Anterior: sternocleidomastoid muscle
Posterior: trapezius
Inferior (base): Clavicle

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9
Q

What is the origin and insertion of sternocleidomastoid?

A

Sternal head origin: anterior surface of manubrium
Clavicular head origin: upper surface of medial 1/3 of clavicle
Insertion: lateral usrface of matoid process; lateral half of superior nuchal line of occipital bone

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10
Q

What innervates sternocleidomastoid?

A

Accessory nerve (CN XI)

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11
Q

What is the function of sternocleidomastoid?

A

Bilaterally - flex head, raise thorax

Unilaterally - turns face toward opposite side

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12
Q

What supplies sternocleidomastoid?

A

Sternocleidomastoid branch of superior thyroid and occipital arteries, muscular branch of suprascapular artery, occipital branch of posterior auricular artery

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13
Q

What are the three scalene muscles?

A

Anterior scalene, middle scalene, posterior scalene

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14
Q

What is the origin and insertion of anterior scalene?

A

Origin: anterior tubercles of transverse processes of C3-C6
Insertion: Scalene tubercle on 1st rib

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15
Q

What is the origin and insertion of middle scalene?

A

Origin: posterior tubercles of transverse processes of C2-C7
Insertion: Upper surface of 1st rib (behind subclavian groove)

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16
Q

What is the origin and insertion of posterior scalene?

A

Origin: posterior tubercles of transverse processes of C4-C6
Insertion: Outer surface of 2nd rib (behind attachment of serratus anterior)

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17
Q

What innervates anterior scalene?

A

Anterior rami of cervical nerves (C5-C8)

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18
Q

What innervates middle scalene?

A

Anterior rami of cervical nerves (C3-C7)

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19
Q

What innervates posterior scalene?

A

Anterior rami of lower four cervical nerves

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20
Q

What is the function of anterior scalene?

A

Elevates 1st rib, bends neck

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21
Q

What is the function of middle scalene?

A

Elevates 1st rib, bends neck

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22
Q

What is the function of posterior scalene?

A

Elevates 2nd rib, bends neck

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23
Q

What is the largest and longest of the 3 scalenes?

A

Middle scalene

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24
Q

What makes up the occipital triangle?

A

Cervical plexus (cutaneous branches and motor branches), CN XI (accessory), phrenic nerve, and transverse cervical artery

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25
Q

___ divides the posterior triangle of the neck into two smaller triangles.

A

The inferior belly of the omohyoid muscle

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26
Q

Where is the occipital triangle found?

A

Above the omohyoid muscle

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27
Q

Where is the omoclavicular triangle found?

A

Below the omohyoid muscle

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28
Q

What are the two subtriangles of the posterior triangle?

A

Occipital triangle and omoclavicular triangle

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29
Q

What is Erb’s point?

A

An area halfway along the posterior border of the sternocleidomastoid muscle that the cutaneous branches of the cervical plexus emerge from; the accessory nerve is also just deep to the investing fascia at this point.

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30
Q

What are the cutaneous branches of the cervical plexus?

A
  1. Transverse cervical nerve
  2. Great auricular nerve
  3. Lesser occipital nerve
  4. Supraclavicular nerve
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31
Q

The transverse cervical nerve branches from the ventral rami of ___ and is the cutaneous nerve to the ___.

A

C2-C3; throat

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32
Q

The greater auricular nerve branches from the ventral rami of ___ and is the cutaneous nerve to the area around the ___.

A

C2-C3; ear

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33
Q

The lesser occipital nerve branches from the ventral rami of ___ and is cutaneous to the skin near the ___.

A

C2 (and sometimes C3); mastoid process

34
Q

The supraclavicular nerve branches from the ventral rami of ___ and then splits into three branches named ___, ___, and ____. This is cutaneous to the area over the ___.

A

C3-C4; Anterior; middle; posterior; clavicle

35
Q

The motor portion of the cervical plexus lies ___ to the sensory portion and much of it can found in the ___ triangle.

A

Deep; carotid

36
Q

What are the three parts of the motor portion of the cervical plexus?

A
  1. Phrenic nerve
  2. Ansa cervicalis
  3. Ventral rami
37
Q

What are the roots of the phrenic nerve and what do they do?

A

C3-C4-C5; innervate the diaphragm (3-4-5 keeps the diaphragm alive)

38
Q

The phrenic nerve sits on top of the ___ muscle.

A

Anterior scalene

39
Q

What are the roots of ansa cervicalis?

A

C1-C2-C3

40
Q

What are the two limbs (roots) of the ansa cervicalis?

A
  1. C1 ventral ramus

2. C2 and C3 rami

41
Q

What does the C1 ventral ramus do?

A

Provides separate motor innervation to the thyrohyoid and geniohyoid muscles

42
Q

What forms the superior root of the ansa cervicalis?

A

C1 ventral ramus

43
Q

What do C2 and C3 rami do?

A

Innervates sternohyoid, sternothyroid, and omohyoid muscles

44
Q

What forms the inferior root of the ansa cervicalis?

A

C2 and C3 rami

45
Q

What does the ventral rami do?

A

Innervates the rectus capitis lateralis, rectus capitis anterior, longus capitis, longus colli, levator scapulae, and scalene muscles

46
Q

What are the contents of the supraclavicular triangle?

A
  1. Lower portion of brachial plexus
  2. Subclavian artery and vein
  3. Branches of the subclavian artery
  4. Termination of external jugular vein
47
Q

What are the branches of the subclavian artery?

A

V: veterbral artery
I: internal thoracic artery
T: thyrocervical trunk (inferior thyroid artery, transverse cervical artery, suprascapular artery, ascending cervical artery)
C: costocervical trunk (supreme intercostal artery, deep cervical artery)
D: dorsal scapular artery

48
Q

Where does the vertebral artery go to?

A

Brain via transverse foramina and foramen magnum

49
Q

Where does the internal thoracic artery go to?

A

Posterior aspect of anterior chest wall

50
Q

What are the 4 parts of the thyrocervical trunk?

A
  1. Inferior thyroid artery
  2. Transverse cervical artery
  3. Suprascapular artery
  4. Ascending cervical artery
51
Q

Where does the inferior thyroid artery go to?

A

Thyroid and larynx

52
Q

Where does the transverse cervical artery go to?

A

Scalene and posterior triangle muscles, brachial plexus

53
Q

Where does the suprascapular artery go to?

A

Area above the scapula and rhomboids

54
Q

Where does the ascending cervical artery go?

A

Area around scalenes and anterior tubercles; spinal cord (?)

55
Q

What are the two parts of the costocervical trunk?

A
  1. Supreme intercostal artery

2. Deep cervical artery

56
Q

Where does the supreme intercostal artery go to?

A

First and second intercostal spaces

57
Q

Where does the deep cervical artery go to?

A

Prevertebral and deep next structures

58
Q

Branches off of the third segment are aberrant forms of the ___ (which normally arises elsewhere) and the ___ (which is frequently absent)

A

Suprascapular; dorsal scapular artery

59
Q

What runs behind the clavicle and in front of the anterior scalene?

A

Subclavian vein

60
Q

What runs between the anterior and middle scalene muscles?

A

Subclavian artery and brachial plexus

61
Q

What runs in front of (on top of) anterior scalene?

A

Phrenic nerve

62
Q

What run in front of the anterior scalene?

A

Transverse cervical artery and suprascapular artery

63
Q

What (if it exists) normally runs behind (deep to) the anterior scalene?

A

Dorsal scapular artery

64
Q

Draw the cervical plexus.

A

See Powerpoint

65
Q

What is the origin and insertion of subclavius?

A

Origin: upper border of 1st rib and its cartilage
Insertion: inferior surface of middle third of clavicle

66
Q

What innervates subclavius?

A

Nerve to subclavius

67
Q

What is the function of subclavius?

A

Anchors and depresses clavicle

68
Q

What supplies subsclavius?

A

Clavicular branch of thoraco-acromial artery

69
Q

What is the origin and insertion of longus capitis?

A

Origin: anterior tubercles of transverse processes of C3-C6
Insertion: inferior surface of basilar part of occipital bone

70
Q

What innervates longus capitisi?

A

Ventral rami of cervical nerves (C1-C4)

71
Q

What is the function of longus capitis?

A

Flexes and assists in rotating cervical vertebrae and head

72
Q

What supplies longus capitis?

A

Ascending cervical branch of inferior thyroid artery, ascending pharyngeal artery, muscular branches of vertebral artery

73
Q

What is the origin and insertion of splenius cervicis?

A

Origin: spinous process of T3-T6
Insertion: transverse processes (C1-C3)

74
Q

What innervates splenius cervicis?

A

Dorsal rami of lower cervical nerves

75
Q

What is the function of splenius cervicis?

A

Bilaterally: extend neck
Unilaterally: laterally bends (flexes) and rotates neck toward same side

76
Q

What supplies splenius cervicus?

A

Descending branch of occipital artery, deep cervical artery

77
Q

What is the origin and insertion of omohyoid?

A

Origin of inferior belly: from upper border of scapula and suprascapular ligament, ending in tendon under sternocleidomastoid bone
Origin of superior belly: from this tendon
Insertion of inferior belly: to intermediate tendon
Insertion fo superior belly: to body of hyoid bone

78
Q

What innervates omohyoid?

A

Ansa cervicalis

79
Q

What is the function of omohyoid?

A

Steadies hyoid bone and depresses hyoid

80
Q

What supplies omohyoid?

A

Hyoid branch of lingual artery, sternocleidomastoid branch of superior thyroid artery