Fascia, Muscles and triangles of neck, TOS compression sites Flashcards
What is the Superficial Cervical Fascia?
Thin layer of subcutaneous connective tissue, fatty connective tissue between skin and investing layer of cervical fascia
Contains nerves, blood and lymphatic vessels, superficial lymph nodes, fat and platysma muscle
What ae the Investing Layer of Deep Cervical Fascia?
SCM and Trapezius within the investing layer of deep cervical fascia. These muscles are derived from the same embryonic sheet of muscle and are innervated by the same name (CN XI).
Superiorly the investing layer attaches to:
Superior nuchal lines of occipital bone
Mastoid Process
Zygomatic arches
Inferior border of mandible
Spinous processes of cervical vertebra and nuchal ligament.
The stylomandibular ligament is a thickened modification of this fascial layer.
What are the classifications of thoracic outlet syndrome?
Costoclavicular syndrome
Cervical rib syndrome
Scalenus anticus syndrome
Hyperabduction syndrome
What are the symptoms of thoracic outlet syndrome?
In General the symptoms consist of:
Pain in the fingers, hand, forearm, arm, and shoulder
Paresthesia in the C8 and T1 nerve distribution.
Numbness most frequently in the fingers,
Arm(s) feel heavy
Numbness, coldness, weakness, discoloration due to intermittent compression of the subclavian artery
What is thoracic outlet syndrome?
Compression of the neurovascular bundle (NVB) – (including: subclavian artery, subclavian vein, brachial plexus) in its course through the thoracic outlet in the neck (Scalenus antricus & medius and inferiorly by the first rib).
Spaces of potential compression
IVF (roots only)
Inter-scalene triangle
Costoclavicular space
Axilla
Contributing factors
Dynamic ROM of shoulder joint involves changes in relation of regional structures, may compress or impinge NVB
Static vigorous work or exercise increases muscle bulk and decreases space for NVB
Decrease in muscle tone may lead to traction on NVB
Congenital factors including cervical rib, bony prominence on 1st rib fascial band, abnormal insertion of middle scalene on 1st rib.
What is Scalenus-anticus syndrome?
Tightness or hypertrophy of the anterior or middle scalene muscle(s). This can compromise the interscalene triangle
Contributing factors: forward head carriage, ergonomics, sleep posture, etc
Anatomical variations in the interscalene triangle -subclavian artery passes through the anterior scalene along with part or all of the brachial plexus
Can result from a mass such as Pancoast tumor
What is the diagnosis procedure of Scalenus-anticus syndrome?
Adsons test
Attempt to tense the ant and med scalene muscles and decrease the interscalene triangle to increase the compression on the NVB
What is Cervical Rib Syndrome?
Anatomical variations in the interscalene triangle
Cervical rib or its fibrous extension, Elongated TVP of C7
Subclavian artery passes through the anterior scalene along with part or all the brachial plexus
Upright posture causes traction especially on the lower cords of the brachial plexus and the subclavian vessel over the 1st rib
Poor posture (sagging or drooping of the shoulders)
What is the diagnosis procedure of Cervical Rib syndrome?
Adsons test
Attempt to tense the ant and med scalene muscles and decrease the interscalene triangle to increase the compression on the NVB
Reverse Adsons Test
Decreased interscalene triangle by drawing the mid scalene anteriorly
Hypertonic/hypertrophied middle scalene or cervical rib
What is Costoclavicular syndrome ?
Pressure is exerted on the NVB by backward and downward thrust of the shoulders, this narrows the space between the clavicle and the 1st rib. First noticed in soldiers who carried heavy backpacks.
What are the predisposing factors to Costoclavicular syndrome?
Predisposing factors
Fractures of the clavicle
Cervicodorsal scoliosis
Abnormalities of the 1st rib
Hypertrophied subclavius
What is the diagnostic and treatment of Costoclavicular syndrome?
Costoclavicular Test (aka Military Test)
Treatment
Normalise biomechanics of the clavicle and 1st rib, SMT
What is Ptosis?
is the medical name for the drooping of the upper eyelid, which can happen in one or both eyes.
What is the Anatomy/Neuroanatomy behind Ptosis?
The superior eye lid lifts under coordinated control of muscles, levator palpebrae superioris (innervated by CNIII) and the superior tarsal muscle (innervated by the sympathetic nervous system). Ptosis can occur due to dysfunction of the muscles that raise the eyelid or their nerve supply.
What are the Causes of ptosis (Acquired) (Congenital ptosis exists)?
Aponeurotic - Disinsertion/dehiscence of levator aponeurosis
Myogenic - Oculopharyngeal dystrophy, myotonic dytrophy
Neurogenic - CN111 Palsy. Horners syndrome
Neuromyogenic - Myasthenia gravis. botox induced
Mechanical - Lid Tumours
Pseudo-ptosis - Dermatochalasis, anopthalmos, hypotropia
What is Myasthenia gravis?
Myasthenia gravis is anautoimmune diseasewhich results fromantibodiesthat block or destroynicotinic acetylcholine receptorsat theneuromuscular junction.
What is Hyperabduction syndrome?
NVB compression symptoms in the upper extremities following prolonged hyperabduction of the arm and shoulder
Predisposing factors
Sleeping, occupational painters &decorators
Two sites of compression
Beneath pectoralis minor and under coracoid process
Between clavicle and 1st rib - Retroclavicular space
What are the contents of the carotid triangle?
Common carotid artery
Carotid sinus (baroreceptor)
Carotid body (chemoreceptor)
Carotid sheath and its contents
What are the boundaries of the carotid triangle?
Lateral: Anterior border of the SCM
Medial: Superior belly of the omohyoid
Superior: Posterior belly of digastric
What are the contents of the submental triangle?
Submental lymph nodes
Small veins that unite to form the anterior jugular vein
What are the boundaries of the submental triangle?
Boundaries:
Superior: Chin
Inferior: Body of the hyoid bone
Lateral: Right and left anterior bellies of the digastric muscles
Floor: Two mylohyoid muscles which meet in a median fibrous raphe
What is the carotid sheath?
Extends from the base of the skull to the root of the neck and communicates with the mediastinum of the thorax inferiorly and the cranial cavity superiorly
What are the contents of the carotid sheath?
Common carotid artery
Internal carotid artery
Internal jugular vein
Vagus nerve (CN10)
Deep cervical lymph nodes
Carotid sinus nerve
Sympathetic nerve fibres (Carotid periarterial plexuses)
What are the boundaries of Posterior Cervical Triangle?
Anterior: SCM
Posterior: Trapezius
Inferior: Clavicle
Roof: Skin and subcutaneous tissue containing the platysma
Floor: Prevertebral fascia overlying the splenius capitis, levator scapulae, middle scalene and the posterior scalene
