Conference 3: Posterior Triangle Flashcards
boundaries of posterior triangle of the neck
posterior border of sternocleidomastoid clavicle anterior border of the trapezius
What is this
posterior traingle of the neck
How would you test the functional integrity of each of the borders of the posterior triangle of the neck on your patient?
SCM - turn neck against some resistane on the face of the side youre turning toward (Tests side you are turning away from)
Trapezius - ask to shrug shoulder
Clavicle - palpate it
What is the scalene interval?
space between anteiror and middle scalenes; they insert at the first rib; located by finding the posterior border of SCM, which corresponds to the posterior border of the anterior scalene .
It is important because the ventral rami and trunks of the BRACHIAL PLEXUS lie within the interval. Also the sublcavian artery lies in the inerval.
What are cervical ribs and why do we care?
Cervical ribs are ribs that are not supposed to be there and are at the cervical region of the spine. Really important because they compress what is in their way. In the case presented, the cervical ribs were at the scalene interval and compressed the subclavian artery which compromised blood flow
Why assess the different pulse points along the length of an extremetiy instead of just doing it at one point?
absence or relative difference in strength of pulse can help determine location of obstruction
What nerves provide the sensory innervation to the medial arm, forearm, and hand?
Medial brachial
Medial anterachial
Ulnar (cutaneous branches) nerves
What is the segmental make-up of each nerve?
Medial brachial cutaneous (T1)
Medial antebrachial cutaneous (C8, T1)
Ulnar nerve (C8, T1)
Nerve fibers from which spinal cord segments innervate the intrinsic muscles of the hand?
C8, T1
Scalene Interval Syndrome
ANYTHING that narrows the scalene interval can cause this
- by narrowing space, can cause compression, such as of the subclevian artery
Clinical manifestation usually distal portion of upper limb
Nerve compression
- lower parts of the brachial plexus (C8, T1)
- Presents in fingers as
- tingling/burning
- diminished sensation
- weakness
Is the subclavian artery in the scalene interval?
Um yes of course
Is the subclavian vein in the scalene interval?
Absolutely not r u kidding
Where is the phrenic nerve with respect to the scalene interval?
Bonus points: what are the roots of the phrenic nerve and what does it innervate
Phrenic nerve lies anterior to the anterior scalene.
C3,4,5 (stayin alive!) diaphragm - clinically imp for referred pain
What is the consequence of a bilateral lesion of the phrenic nerves or a C4-level lesion of the spinal cord?
severe difficulty breathing; possible dependence on ventilator
