Neck, axilla and breast Flashcards
Label the fascia of the neck
1= prevertebral fascia
2=Platysma
3=pretracheal fascia
4=Investing layer
5=Sternomastoid
6=Carotid sheath
Describe the attachments, innervation and action of the sternocleidomastoid muscle
Attachments -
Superiorly : lateral surface of mastoid process of temporal bone & nuchal line ; inferiorly: manubrium of sternum , medial third of clavicle
Innervation - spinal accessory nerve (CN XI); C2 and C3 (pain and proprioception)
Action - lateral flexion of neck , chin up and down , accessory muscle of respiration
Describe the location, innervation and function of the trapezius muscle
Location - posterior border of posterior triangle
Attachments - superiorly the nuchal ligament, occipital protuberance, spinous processes of C7-T12; inferiority the clavicle and scapula
Innervation- spinal accessory nerve (CN XI) ; C2 and C3 (pain and propioception)
Fucntion - elevate retract and rotate the scapulae
what is the clinical relevance of the scalene muscles
The brachial plexus and subclavian artery pass between the anterior and middle scalenes. The subclavian vein and phrenic nerve pass anteriorly to the anterior scalene as the muscle crosses over the first rib.
Name the 2 neck triangles and their subdivisions
Anterior triangle :
- Submental
- Submandibular
- Carotid
- muscular
Posterior triangle:
- occipital
- subclavian
What forms the superior/lateral/medial borders of the anterior triangle
Superior - mandible
Lateral - sternocleidomastoid muscle
Medial - anterior midline of neck
What anatomical landmarks are structurally significant when inserting a central venous catheter in the neck region?
catheter can be inserted either in internal jugular vein or the subclavian Veins
subclavian veins pass anterior to first rib
phrenic nerves/anterior scalene pass very close to the IJV and SCV
Muscular triangle boundaries and contents *
The muscular triangle contains some muscles and organs – the infrahyoid muscles, the pharynx, and the thyroid, parathyroid glands.
The boundaries of the muscular triangle are:
- Superiorly – hyoid bone.
- Medially – imaginary midline of the neck.
- Supero-laterally – superior belly of the omohyoid muscle.
- Infero-laterally – inferior portion of the sternocleidomastoid muscle.
More of a trapezium than a triangle
The external jugular vein passes above the
Sternocleidomastoid muscle
Submandibular triangle boundaries and contents
Boundaries :
Superiorly – body of the mandible.
Anteriorly – anterior belly of the digastric muscle.
Posteriorly – posterior belly of the digastric muscle.
Contents :
submandibular gland
facial artery and vein
submandibular lymph nodes - drains tongue mouth
salivary gland
Hypoglossal nerve (CN XII)
mylohyoid nerve
Carotid triangle contents and boundaries
Boundaries - posterior belly of digastric muscle, superior belly of omohyoid, SCM
Content:
Carotid sheath- common carotid artery, internal jugular vein, vagus nerve
Deep cervical lymph nodes
Hypoglossal nerve (CN XII)
Cervical plexus
thryoid gland
larynx/pharynx
Submental triangle boundaries and contents
Found just below chin
Boundaries : inferiorly, the hyoid bone; laterally by the right and left inferior bellies of the digastric muscles ; the apex is at the mandibular symphysis ; roof is formed by the mylohyoid bones
Content:
submental lymph nodes
anterior jugular vein ; facial artery and veins
pancoast tumour; what is it and describe the possible complications
Cancers that start in the apex of the lung and spread to : Upper ribs/nerves in upper thorax and neck/nerves near spinal cord/blood vessels supplying the upper limb
most are a non small cell cancer (squamous cell cancer arising from cells lining the airway)
can result in compression of brachial plexus or Horner syndrome
What does the prefix -omo mean?
Shoulder
What does jugular mean
Throat
Describe the hyoid bone
Not attached to another bone - suspended by muscles and ligaments
Attachments for neck and tongue muscles
Label the superior view of the atlas (C1)
Label the inferior view of the atlas
Describe the articulation between the atlas and axis articulation
The Atlantoaxial joint is composed of three synovial joints: one median atlantoaxial joint and two lateral atlantoaxial joints.
Lateral atlanto-axial joints (x2) – formed by the articulation between the inferior facets of the lateral masses of C1 and the superior facets of C2. These are plane type synovial joints.
Medial atlanto-axial joint – formed by the articulation of the dens of C2 with the articular facet of C1. This is a pivot type synovial joint.
The transverse ligament joins the axis and atlas
Allows the rotation of the neck left and right
What are the 3 main features of most cervical vertebrae
Triangular vertebral foramen.
Bifid spinous process – this is where the spinous process splits into two distally.
Transverse foramina – holes in the transverse processes. They give passage to the vertebral artery, vein and sympathetic nerves.
label these three structures; indicate the point of entry for an emergency cricothyroidotomy
1 = hyoid bone 2= thyroid cartilage 3= cricoid cartilage
Identify the coloured structures
Define anterior, posterior and primary ramus
The anterior/ventral ramus innervates the skin and muscle on the anterior aspect of the trunk, while the posterior/dorsal ramus innervates the post-vertebral muscles and the skin of the back
The roots of the brachial plexus are the anterior ramii
Label the structures in the root of the neck
Phrenic nerve anterior to anterior scalene
Subclavian artery posterior to anterior scalene
Contents of the vertebral artery triangle
Carries the vertebral artery and phrenic nerve
Borders of the axilla
Identify the muscles here
Contents of axilla
Brachial plexus
Axillary arteries, veins and lymph nodes
Bicep and corachobrachialis tendons
What is the most common direction in which dislocation occurs?
Which nerve is in most danger when the shoulder joint is dislocated ?
Anterior dislocation
Axillary nerve
The axillary artery passes under and over which muscles ?
Under the pec minor
Over the teres major
Identify the axillary artery and vein
The subclavian vein branches into the ____ ____ and the _____ _____
Cephalic vein and axillary vein
Label the breast
The lobules are the milk glands that produce milk
the lactiferous ducts transfer the milk from the lobules to the nipple
suspensory ligaments attach the breast to the dermis and pectoral fascia as well as separating the secretory lobules of the breast
What vessels will supply and drain the breast tissue
Superior thoracic artery
Internal mammary artery
Acromiothoracic artery
Ancillary artery
Thoracodorsal artery
Axillary vein
Lateral thoracic vein
Internal mammary vein
Posterior triangle boundaries, roof and floor
Sternocleidomastoid muscle
Trapezius
Clavicle
Roof - deep investing fascia
Floor - prevertebral fascia
Contents of posterior triangle
Cervical plexus/brachial plexus/subclavian artery (found between mid scalene muscle and the anterior scalene muscle)
External jugular vein
Floor - omohyoid muscle , transverse cervical and suprascapular arteries, spinal accessory nerve (CN XI), the 3 scalene muscles , splenius capitis, levator scapulae,
Omohyoid muscle
in the posterior triangle region
split into two bellies by a tendon.
The inferior belly crosses the posterior triangle, travelling in an supero-medial direction, and splitting the triangle into two (occipital triangle and supraclavicular triangle).
The muscle then crosses underneath the SCM to enter the anterior triangle of the neck.
Label the suprahyoid and infrahyoid muscles of the neck
Where does the subclavian artery become the axillary artery?
Once it passes below the clavicle it becomes the axillary artery
Veins of the neck
SVC —> R and L brachiocephalic veins
R and L brachiocephalic veins —> L/R subclavian vein +L/R internal jugular vein
Great arteries of neck
Seen at C7
What are fascia
Strand or sheets of fibrous connective tissue that wrap around the organs to form compartments
Contents of superficial fascia
Outermost layer of fascia
Subcutaneous tissue , platysma tissue and cutaneous vein,artery and nerve
Location/contents/boundaries of the deep investing fascia
Just below superficial fascia
Encircles the neck
Envelops the traps/SCM
Forms the rood of the posterior triangle
Pierced by cutaneous branches of cervical plexus and EJV
Boundaries :
Anteriorly - mandible, hyoid, sternum
Posteriorly - occipital, nuchal ligament, traps
Location/contents of pretracheal fascia
Forms visceral compartment - contains trachea, thyroid, recurrent laryngeal nerve, oesophagus, parathyroid gland
summarise the branches of the brachial plexus and the muscles they innervate
define the terms anterior (ventral) and posterior (dorsal) primary ramus
A primary ramus is a branch of a spinal nerve
summarise the brachial plexus
remember to drink cold beer
groups of ventral rami
Cervical plexus (C1-C5) supplies head & neck
Brachial plexus (C5-T1) supplies upper limb
Nerves of the trunk (T1-L1) supply trunk
Lumbosacral plexus (L1-S3) supplies trunk & lower limb
Sacrococcygeal plexus (S3-S5) supplies pelvis & lower trunk
location of cervical plexus
located in posterior triangle of neck halfway up SCM, and within prevertebral fascia ; derived from cervical rami C1-C4
Label the cervical spine
Nerves of cervical plexus
Name the nerves of the cervical plexus innervating each of the highlighted areas and the vertebral origin
Label this diagram of the superficial fascia
Platysma - attachments, innervation and actions
Attachments - superiorly : inferior border mandible, skin and subcutaneous tissue of lower face. Inferiorly : fascia covering superior parts of pec major and deltoid
Innervation - cervical branch off the facial nerve (CN VII)
Actions - draws corners of mouth inferiorly and widens in expression of sadness and fright
label the structures within the neck at level of C7
label the infra hyoid muscles
label the clavicle; describe the superior and inferior surfaces
superior surface is mostly subcutaneous ; inferior surface - attachment of subclavius muscle and site of important ligaments attaching it to the coracoid process
label the mandible
label the hyoid bone
Label the arteries of the neck
Identify the structures X and Y of the brachial plexus
Identify the muscles of the posterior wall
Boundaries of delta pectoral triangle
Clavicle
Deltoid
Clavicular head of deltopectoral triangle
The deltopectoral triangle is a palpable hollow area
Lymph vessels drain into the
Venous system
What causes Horner syndrome and what are the symptoms?
Lesion of a sympathetic trunk in the neck
- Pupillary constriction resulting from paralysis of the dilator pupillae muscle.
- Ptosis (drooping of the superior eyelid), resulting from paralysis of the smooth (tarsal) muscle intermingled with striated muscle of the levator palpebrae superioris.
- Sinking in of the eyeball (enophthalmos), possibly caused by paralysis of smooth (orbitalis) muscle in the floor of the orbit.
- Vasodilation and absence of sweating on the face and neck (anhydrosis), caused by a lack of sympathetic (vasoconstrictive) nerve supply to the blood vessels and sweat glands.
Pressure on the brachial plecuts can cause specific symptoms ; describe them
Severe pain in the shoulder or scapula
pain in the arm or weakness of the hand in the affected side
The shoulder joint is formed by articulation between the ____ ____ with the ____ ____
what type of joint is it and what kind of cartilage covers it?
Humeral head ; glenoid fossa (of scapula)
synovial joint; covered by hyaline cartilage
Why should special attention be given to the parathyroid glands during a thyroidectomy
parathyroid glands are situated behind the lateral lobes of thyroid
high risk of being damaged/removed during surgery
as parathyroid responsible for increase [Ca2+], remove results in hypocalcaemia
hypocalcaemia symptoms ; tetanus, muscle cramps, tingling of fingers/toes/mouth
Which nerve are close to the (a) superior thyroid artery and the (b) inferior thyroid artery and why Is this clinically relevant
A) external laryngeal nerve
b) recurrent laryngeal nerve
important to not damage during thyroid surgery as this can cause problems with speech and Swallowing
describe carotid sinus hypersensitivity
Exaggerated response to carotid sinus baroreceptor stimulation = HR/BP dangerously fall = fainting and falls (particularly dangerous in older patients)
often in people with atheroscleoris
Where on the axillary artery must a blockage occurs for the anastomosis to maintain an uncompromising supply of blood to the rest of the upper limb?
Between 1st part of the subclavian artery and 3rd part of axillary artery
Define anastomosis
Communication between neighbouring vessels via branching pre-capillaries
Label the axial projection of the shoulder joint
Damage to the C5/6 roots of brachial plexus
symptoms
Loss of lateral rotation of shoulder
loss of abduction and elbow flexion
reduced ability to extend wrist
sensory loss at thumb and index
symptoms of damage to C8/T1
Loss of finger extension
finger and thumb flexion
sensory loss of ring/little finger
Horner syndrome may occur - drooping of eyelid/absence of sweat in cheek/excess pupil constriction/posterior displacement of eye
Which root and trunks of the brachial plexus will be most likely to be affected by a Pancoasts tumour?
C5/6 in early disease = arm and shoulder pain
C8/T1 in late disease = horners syndrome
some people are born with an extra rib above the first rib called the cervical rib
Describe the possible complications
Thoracic outlet syndrome via compression of C8/T1
The lateral chord forms branches off into
Lateral pectoral nerve
musculocutaneus nerve
lateral root of median nerve
The posterior chord branches off into
Superior subscapular nerve,
thoracodorsal nerve
inferior subscapulnar
axillary nerve
radial nerve
the medial chord branches off into
Medial pectoral
medial cutaneous nerves of arm and forearm
medial root of median nerve
ulnar nerve
