Cervical Spine Muscles

Question 1

Platysma:
Superficial layer of Cervical Spine Muscles:

O: fascia covering the superior portion of the pectoralis major and deltoid
I: lower border of the mandible, the posterior fibres blending with the muscles about the angle and lower part of the mouth
A: retracts and depresses the angle of the mouth
N: VII Facial Nerve, Cervical Branch

Question 2

Superficial layer of Cervical Spine Muscles:
Sternocleidomastoid:
O: medial or sternal head: cranial part of manubrium
O: lateral or clavicular head: medial 1/3 of clavicle
I: lateral surface of mastoid process, lateral half of superior nuchal line of occipital bone
A: bilateral: extension, flexion
A: unilateral: contralateral rotation, and lateral flexion
N: Accessory Nerve (CN XI) & Cervical 1, 2

Answer 2

Sternocleidomastoid Anterior Neck Flexors:
Patient: supine with elbows bent, hands beside head, resting on table
Fixation: firm downward pressure on thorax
Test: anterolateral neck flexion
Pressure: against the temporal region of the head in an obliquely posterior direction

Question 3

Superficial layer of Cervical Spine Muscles (Spine Musculature layer1):
Trapezius:

• Trapezius Upper fibres:
  O: external occipital protuberance (EOP), medial 1/3 of superior nuchal line, ligamentum nuchae & spinous process of C7
  I: lateral 1/3 of clavicle & acromion process of scapula
• Trapezius Middle fibres
  O: spinous processes of T1-T5
  I: medial margin of the acromion
• Trapezius Lower fibres
  O: spinous processes of T6 – T12
  I: Tubercle of the apex of the spine of the scapula

A: adduction, rotation, elevation & depression of the scapula. Unilateral: lateral flexion and contralateral rotation of the cervical spine. Bilateral: extension of the cervical spine.

N: CN XI – Accessory Nerve and ventral ramus from C2, C3, C4

Answer 3

• Trapezius Upper Fibres:

Patient: sitting
Fixation: none
Test: elevate the acromial end of the clavicle and scapula, posterolateral extension of the neck, bringing the occiput towards the elevated shoulder with the face turned in the opposite direction.
Pressure: against the shoulder, in the direction of the depression and against the head.

• Trapezius Middle:

Patient: prone, shoulder in 90 degrees of abduction and in lateral rotation
Fixation: one hand on the opposite scapular area to prevent trunk rotation
Test: adduction of the scapula with upward rotation and without elevation of the shoulder girdle
Pressure: against the forearm in a downward direction towards the table

• Trapezius Lower:

Patient: prone
Fixation: examiner places one hand below the scapula on the opposite side
Test: adduction and depression of the scapula with lateral rotation of the inferior angle, line up the arm with the lower fibres
Pressure: against the forearm in a downward direction toward the table.

Question 4

Levator Scapulae :
Superficial layer of Cervical Spine Muscles (Spine Musculature layer 1):

O: transverse processes of C1 to C4

I: medial border of the scapula, between superior angle and root of the spine

A: elevates the scapula and assists in rotation to place the glenoid cavity facing caudally. Bilateral: extension cervical spine. Unilateral: lateral flexion, and ipsilateral rotation of the cervical spine.

N: Cervical C3, C4 and Dorsal Scapular nerve (C4, C5)

Answer 4

Question 5

Semispinalis Capitis (layer 6)= spinalis capitis (layer 5)

O: transverse processes of C7-T6, vertebra and articular process of C4-C6
I: occipital bone between superior and inferior nuchal lines
A: Bilaterally: extension of head & neck
Unilaterally: contralateral rotation of head
N: spinal nerve (dorsal rami)

Answer 5

Muscle Testing: Posterolateral Neck Extensors: Semispinalis Capitis & Cervicis/ Splenius Capitis & Cervicis/ Cervical Erector Spinae:
Patient: prone, elbows bent, hands overhead
Fixation: none
Test: posterolateral neck extension, with face turned toward the side being tested
Pressure: against the posterolateral aspect of the head in an anterolateral direction

Question 6

Semispinalis Cervicis (layer 6) :
O: transverse processes of T1-T5-6
I: spinous process of C2-C5
A: Bilateral: extension of vertebral column
Unilateral: contralateral rotation of head and cervical/upper thoracic spine
N: spinal nerve (dorsal rami)

Answer 6

Muscle Testing: Posterolateral Neck Extensors: Semispinalis Capitis & Cervicis/ Splenius Capitis & Cervicis/ Cervical Erector Spinae
Patient: prone, elbows bent, hands overhead
Fixation: none
Test: posterolateral neck extension, with face turned toward the side being tested
Pressure: against the posterolateral aspect of the head in an anterolateral direction

Question 7

Multifidus Cervicis (layer 6):
O: transverse processes of C4-7
I: spinous processes 2-4 segments above origin
A: Bilateral: extension of vertebral column
Unilateral: contralateral rotation of the vertebral column
N: spinal nerve (dorsal rami)

Question 8

Rotatores Cervicis (layer 6):
O: transverse processes of cervical vertebrae
I: Brevis: base of spinous process of one segment above
I: Longus: base of spinous process of two segments above
A: unilateral: contralateral rotation
bilateral: extension of the spine
N: spinal nerve (dorsal rami)

Question 9

Spinalis Cervicis (layer 5):
O: spinous processes (SP) of C7
(sometimes T1, T2), nuchal ligament
I: spinous processes (SP) of C2
(sometimes C3, C4)
A: extension of the vertebral column in the upper cervical area
N: spinal nerve (dorsal rami)

Answer 9

Muscle Testing: Posterolateral Neck Extensors: Semispinalis Capitis & Cervicis/ Splenius Capitis & Cervicis/ Cervical Erector Spinae
Patient: prone, elbows bent, hands overhead
Fixation: none
Test: posterolateral neck extension, with face turned toward the side being tested
Pressure: against the posterolateral aspect of the head in an anterolateral direction

Question 10

Longissimus Capitis (layer 5):
O: transverse processes of T1 -T4 and articular processes of C5-C7
I: Mastoid process
A: Bilateral: extension of head and vertebral column
A: Unilateral: lateral flexion, and ipsilateral rotation of the cervical spine
N: spinal nerve (dorsal rami)

Answer 10

Muscle Testing: Posterolateral Neck Extensors: Semispinalis Capitis & Cervicis/ Splenius Capitis & Cervicis/ Cervical Erector Spinae
Patient: prone, elbows bent, hands overhead
Fixation: none
Test: posterolateral neck extension, with face turned toward the side being tested
Pressure: against the posterolateral aspect of the head in an anterolateral direction

Question 11

Longissimus Cervicis (layer 5):
O: via tendons transverse processes of T1-T5
I: via tendons into the posterior tubercle on the transverse processes of C2-C6
A: Bilaterally: extension of the cervical vertebral column
A: Unilaterally: lateral flexion of vertebral column in the cervical region
N: spinal nerve (dorsal rami)

Answer 11

Muscle Testing: Posterolateral Neck Extensors: Semispinalis Capitis & Cervicis/ Splenius Capitis & Cervicis/ Cervical Erector Spinae
Patient: prone, elbows bent, hands overhead
Fixation: none
Test: posterolateral neck extension, with face turned toward the side being tested
Pressure: against the posterolateral aspect of the head in an anterolateral direction

Question 12

Iliocostalis Cervicis (layer 5):
O: angle of ribs 3-6
I: posterior tubercles of transverse processes of C4-C6
A: Bilaterally: extension of vertebral column in upper thoracic and lower cervical areas
A: Unilaterally: Lateral flexion of the upper thoracic and lower cervical areas of the vertebral column
N: spinal nerve (dorsal rami)

Answer 12

Muscle Testing: Posterolateral Neck Extensors: Semispinalis Capitis & Cervicis/ Splenius Capitis & Cervicis/ Cervical Erector Spinae
Patient: prone, elbows bent, hands overhead
Fixation: none
Test: posterolateral neck extension, with face turned toward the side being tested
Pressure: against the posterolateral aspect of the head in an anterolateral direction

Question 13

Anterior Scalenes:
O: anterior tubercles of transverse processes of C3-C6
I: scalene tubercle and the cranial crest on the on 1st rib
A: flexion & lateral flexion of neck; elevation of 1st rib; contralateral rotation
N: cervical spinal ventral rami of C5 – C8

Answer 13

Question 14

Middle Scalene:
O: posterior tubercles of transverse processes of C2-C7
I: 1st rib, cranial surface between tubercle and subclavian groove
A: lateral flexion of neck, elevation of 1st rib, contralateral rotation
N: cervical spinal ventral rami C3-C7

Answer 14

Question 15

Posterior Scalenes:
O: 2-3 tendons on posterior tubercles on transverse processes of C4-C6
I: outer surface of 2nd rib behind serratus anterior
A: lateral flexion of neck, elevation of 2nd rib, contralateral rotation
N: cervical spinal ventral rami C6-C8

Answer 15

Question 16

Splenius Capitis (layer 4):
O: nuchal ligament, SPs of C7-T3
I: mastoid process of temporal bone, lateral 1/3 of superior nuchal line on occipital bone
A: unilateral: ipsilateral rotation & lateral flexion of head & neck
A: bilateral: extension of head & neck
N: cervical spinal nerves (dorsal rami)

Answer 16

Muscle Testing: Posterolateral Neck Extensors: Semispinalis Capitis & Cervicis/ Splenius Capitis & Cervicis/ Cervical Erector Spinae
Patient: prone, elbows bent, hands overhead
Fixation: none
Test: posterolateral neck extension, with face turned toward the side being tested
Pressure: against the posterolateral aspect of the head in an anterolateral direction

Question 17

Suboccipital Muscles:
Rectus Capitis Posterior Major:
O: spinous process of axis (C2)
I: lateral portion of the inferior nuchal line of occipital bone
A: Extends and rotates head to the same side
N: suboccipital nerve

Question 18

Splenius Cervicis (layer 4):
O: spinous processes of T3-T6
I: posterior tubercles of transverse processes of C1-C3
A: unilateral: ipsilateral rotation & lateral flexion of neck
A: bilateral: extension of neck
N: cervical spinal nerves (dorsal rami)

Answer 18

Muscle Testing: Posterolateral Neck Extensors: Semispinalis Capitis & Cervicis/ Splenius Capitis & Cervicis/ Cervical Erector Spinae
Patient: prone, elbows bent, hands overhead
Fixation: none
Test: posterolateral neck extension, with face turned toward the side being tested
Pressure: against the posterolateral aspect of the head in an anterolateral direction

Question 19

Suboccipital Muscles:
Rectus Capitis Posterior Minor:
O: posterior tubercle of C1 (atlas)
I: medial portion of inferior nuchal line of the occipital bone
A: extension of head
N: suboccipital nerve

Question 20

Suboccipital Muscles:
Obliquus Capitis Superior:
O: transverse process (TP) of C1 (atlas)
I: occipital bone (between superior & inferior nuchal lines)
A: Extends and laterally flexes head
N: suboccipital nerve

Question 21

Suboccipital Muscles:
Obliquus Capitis Inferior:
O: spinous process of C2 (axis)
I: transverse process of C1 (atlas)
A: ipsilateral rotation of head
N: suboccipital nerve

Question 22

Suboccipital Muscles:
Interspinales Cervicis:
O: Superior surface of SPs of vertebra
I: Inferior surface of SPs of adjacent vertebrae (above)
A: Extension of vertebral column
N: dorsal rami of spinal nerves

Question 23

Suboccipital Muscles:
Intertransversarius Cervicis:
O: transverse process of vertebra below
I: transverse process of adjacent vertebra above
A: Lateral Flexion of vertebral column
N: dorsal rami of spinal nerves

Question 24

Deep Anterior Cervical Muscles:
Rectus Capitis Anterior:
O: root of transverse process, lateral mass of atlas C1
I: base of occipital bone anterior to foramen magnum
A: bilaterally: flexion of head ( atlanto –occiput joint)
unilaterally: ipsilateral rotation of the head
N: cervical spinal nerves (ventral rami C1-C2)
NOTE: this muscle is too deep to be palpated

Question 25

Deep Anterior Cervical Muscles: Rectus Capitis Lateralis O: superior surface of the transverse process of the atlas (C1) I: inferior surface of the jugular process of the occipital bone A: lateral flexion of head (atlanto occiput joint) N: cervical spinal ventral rami C1, C2

Question 26

Deep Anterior Cervical Muscles: Longus Capitis: O: anterior tubercles of transverse processes of C3-C6 I: interior surface of basilar part of occipital bone A: bilaterally: flexion of head & neck unilaterally: ipsilateral rotation of cervical vertebrae and head N: cervical spinal ventral rami C1-C4

Question 27

Deep Anterior Cervical Muscles: Longus Colli: O: surface of anterior vertebral bodies of C5-T3, anterior tubercles of transverse processes of C3-C5 I: surface of anterior vertebral bodies of C2-C4, anterior tubercles of transverse processes of C5-C6, tubercle of anterior arch of C1 A: flexion & lateral flexion of neck, ipsilateral rotation of neck N: cervical spinal ventral rami C2-C7

Question 28

Suprahyoid Muscles: Digastric(cut into 2) Muscle O: anterior belly: inferior border of mandible posterior belly: mastoid process I: intermediate tendon to body and cornu of hyoid bone A: anterior belly: assists in depressing the mandible posterior belly: elevates and pulls the hyoid bone posteriorly N: anterior belly: Cranial Nerve V (Trigeminal Nerve) posterior belly: Cranial Nerve VII (Facial Nerve)

Question 29

Suprahyoid Muscles: Stylohyoid Muscle O: styloid process of the temporal bone I: body of the hyoid A: elevates and pulls the hyoid bone posteriorly N: Cranial Nerve VII (Facial Nerve)

Question 30

Suprahyoid Muscles: Geniohyoid: O: median ridge of the mandible I: body of hyoid bone A: elevates the hyoid bone and the tongue, depresses the mandible N: Ansa Cervicalis (C1, C2)

Question 31

Suprahyoid Muscles: Mylohyoid: O: mylohyoid line of the mandible I: body of hyoid bone and median raphe(ligament) A: elevates the hyoid bone and tongue, depresses the mandible N: Cranial Nerve V (trigeminal)

Question 32

Infrahyoid Muscles: Sternohyoid: O: manubrium & medial clavicle (posterior aspect of both) I: body of hyoid bone (inferior border) A: depresses hyoid N: ansa cervicalis (C1, C2, C3)

Question 33

Infrahyoid Muscles: Omohyoid: O: superior belly: hyoid bone (lateral to sternohyoid) inferior belly: superior scapular border (medial to the suprascapular notch) I: clavicle (both bellies meet & are held loosely to the clavicle by a pulley tendon) A: depresses and stabilizes hyoid bone N: ansa cervicalis (C1, C2, C3)

Question 34

Infrahyoid Muscles: Thyrohyoid: O: thyroid cartilage (oblique line) I: greater horn of hyoid bone A: depression of hyoid bone, depression of larynx; elevation of thyroid cartilage N: Ansa Cervicalis, C1 spinal nerve (via CN XII)

Question 35

Infrahyoid Muscles: Sternothyroid: (doesn’t attach to hyoid bone ) O: manubrium of sternum (posterior aspect), 1st costal cartilage I: oblique line of thyroid cartilage A: depression of thyroid cartilage N: ansa cervicalis (C1, C2, C3)