Quiz 2 Flashcards
Functions of the neck
-Passage way for: Respiratory system Digestive system Brachial plexus -Location parathyroid and thyroid glands
Cervical Vertebrae
- Protect cervical spinal cord
- Attachment for muscles
- Movement
Hyoid Bone
- Only bone that does not articulate with other bones
- Attachment for muscles relating to tongue and pharynx
- Level of C3
Anterior & Lateral Neck
2 major triangles: Posterior and anterior
Posterior Triangle (Boundaries)
1) Posterior Border of the SCM
2) Anterior border of the trapezius
3) Middle portion of the clavicle
Posterior Triangle (Contents)
- Spinal accessory nerve
- Cutaneous branches of the cervical plexus
- Phrenic Nerve
- Brachial plexus
Anterior triangle (Boundaries)
Anterior borders of the SCM
Mandible
Anterior triangle (Contents)
- Hyoid Bone
- Thyroid cartilage
- Cricoid cartilage
- Superior portion of the trachea
- Thyroid and parathyroid gland (C5-T1)
- Submandibular salivary gland
Thyroid Cartilage
- Component of both the larynx and pharynx
- 4th and 5th cervical vertebrae
- Adam’s apple right above them
Cricoid Cartilage
- Primary cartilage of the larynx
- C6 level
Infrahyoid Muscles
- 4 thin strap like muscles
- Steady Hyoid
Suprahyoid Muscles
- Stylohoid
- Hyoglossus
- Mylohoid
- Digastric
Scalene Triangle
- Between anterior and middle scalene
- Holds roots and trunks of brachial plexus
- Subclavian artery
Carotid sheath
- Deep to SCM
- Contains:
- internal jugular vein,
- common and internal carotid arteries,
- vagus nerve
Viscera of the neck
- Larynx (Inside trachea and Cricoid cartilage)
- Trachea (C-shaped cartilage)
- Esophagus (Behind trachea)
- Thyroid (issumiss connection between sides of thyroid)
- Parathroid
Ascending Aorta
Upward from right ventricle
Arch of the Aorta
- Starts Anteriorly about T4 level
- Braches to:
1) Brachiocephalic trunk
2) Left common carotid
3) Left subclavian
Brachiocephalic Trunk
Branches to:
1) Right common carotid
2) Right subclavian
Common Carotid
- Divides about C4
- Branches to:
1) Internal Carotid (Supplies Brain)
2) External Carotid (Face, neck, scalp)
Subclavian Artery
-Supplies lower neck and upper limb
-Branches to:
Vertebral artery
Triangle for the Vertebral Artery
Supplies: 1)Cervical Spinal Cord 2)Brain Boundaries: -Laterally= Anterior Scalene -Medially= Longus Coli -Base= Subclavian Artery -Apex= transverse process of C6
Superficial Veins
Function:
- Drain skin
- Drain into subclavian vein
Deep Veins
- Internal jugular
- Subclavian
- Brachiocephalic
Brachiocephalic Veins
- formed from the union of the internal jugular and the subclavians
- Lie directly posterior to the sternoclavicular joint
- Left vein crosses directly superior to the manubrium to join the right brachiocephalic vein forming the Superior Vena Cava
Platysma (Attachments)
Skin of anterior nack
Platysma (Innervation)
Facial Nerve
Platysma (Action)
Tightens skin of neck
Sternocliedomastoid (Attachment)
Inferior: -Manubrium -Medial 1/3 clavicle Superior -Mastoid -Lateral superior nuchal line
Sternocliedomastoid (Innervation)
- Spinal Accessory
- C2
Sternocliedomastoid (Action)
- Unilateral: tilts head to same side and rotates face to the opposite side
- Bilateral: flex head on neck or with stable head can flex head
Sternohyoid (Attachments)
Posterior manubrium and medial clavicle to body of the hyoid
Sternothyroid (Attachments)
Posterior manubrium and first costal cartilage to the Thyroid cartilage
Thyrohyoid (Attachments)
Thyroid cartilage to body and greater horn of the hyoid bone
Omohyoid (Attachments)
- Inferior belly attaches to upper border of scapula and runs to intermediate tendon
- Superior belly runs from intermediate tendon to hyoid bone
Infrahyoid Muscles (Action)
- Depresses Hyoid after it has been raised during sallowing
- Steadies, stabilizes hyoid bone during tongue movements
Infrahyoid Muscles (Innervation)
Ansa Cervicalis (C1-C3)
Longus Coli (Attachments)
- Superior oblique attaches from the anterior tubercles and transverse processes of the 3rd to 5th cervical vertebrae TO the anterior arch of the atlas
- Inferior oblique attaches from the bodies of the first 2-3 thoracic vertebrae TO the anterior tubercles of the 3rd-5th cervical vertebrae
- Vertical portion attaches from the bodies of the upper 3 thoracic and lower 3 cervical vertebrae TO the bodies of the 2nd to 4th cervical vertebrae
Longus Coli (Action)
- Bilateral: Flex neck
- Unilateral: Lateral flexion and rotation to the ipsalateral side
Longus Coli (Innervation)
Branches of the cervical plexus
Longus Capitis (Attachments)
C3-C6 to the base of the skull
Longus Capitis (Action)
- Bilateral: Flex head on the neck at the atlantooccipital joint
- Unilateral: involves the rotation of the head on the neck to the ipsilateral side at the atlantoaxial joint
Longus Capitis (Innervation)
Branches of the cervical plexus
Rectus Capitis Anterior (Attachments)
Atlas TO area anterior to occipital condyles
Rectus Capitis Lateralis (Attachments)
Transverse process of atlas TO the jugular process of the occipital bone
Rectus Capitis Anterior/ Lateralis (Action)
- Stabilizes the skull on the cervical vertebrae
- Assist in flexion of the neck and of head on neck
Rectus Capitis Anterior/ Lateralis (Innervation)
Branches of the cervical plexus
Anterior Scalene (Attachments)
Transverse processes of C3- C6 TO the first rib via common tendon
Middle Scalene (Attachments)
Transverse processes of C2-C6 TO the frist rib via the common tendon posterior to the anterior scalene
Posterior Scalene (Attachments)
Transverse processes of C6-C7 to the 2nd rib via the common rib
Scalene Muscles (Actions)
- Bilateral: Elevate the 1st rib during forced inspiration with trunk stable they flex the neck
- Unilateral: Ipsilateral lateral flexion
Scalene Muscles (Innervation)
Segmentally via branches from cervical and brachial plexus
Cervical Nerve Plexus (Components)
- Ventral Rami of C1-C4
- Ventral Rami of C1 is ONLY motor
Cervical Plexus (Sensory Branches)
- Lesser Occipital (C2)
- Greater Auricular (C2,3) Ear
- Transverse Cervical (C2,3) Anterior neck
- Supraclavicular (C3,4) Above clavicular
Cervical Plexus (Mixed Branches)
-Phrenic Nerve (C3,4,5)
~Motor to diaphragm
~ Sensory from diaphragm and mediastinal pleura
~Sensory from pericardium
Cervical Plexus (Motor)
-Ansa Cervicalis (C1,2,3)
~Motor to infrahyoid
-Branches to scalene and prevertebral muscles
Cervical Plexus (Dermatomes)
- Skin covering: the mastoid process, lateral and anterior neck, top of shoulders
- Parietal Pleura and parietal pericardium
Reffered somatic pain
- Pain feels like musculoskeletal system but comes from elsewhere
- Ex: Shoulder pain originating in the from the pericardium
Sympathetic
heart, smooth muscle, and glands by secretion of norepineoherine
Parasympathetic
heart, smooth muscle, glands by secretion of acetylcholine
Preganglionic neurons cell body
Are in gray matter of thoracic and upper lumbar regions of the spinal cord (T1-L2)
Postganglionic neurons cell body
Are in the paravertebral ganglia
White Ramus
- Preganglion sympathetic axon
- White Rami connects the paravertebral ganglia
- T1-L2
Grey Ramus
- axon of postganglionic sypathetic neurons
- Connects all paravertebral ganglia in the neck, thorax, abdomen, and pelvis to ventral rami
- Full length
Pathways of Preganglionic Sympathetic Axons
1) Synapse with a cell body of a postganglionic neuron w/in the paravertebral ganglion as they enter
2) Ascend or descend w/in the sympathetic chain to synapse in a paravertebral ganglion either superior or inferior to the one they entered
3) Pass through the paravertebral ganglion without synapsing and leave going to the abdomen becoming the splanchnic nerve
Pathways of Postganglionic Sympathetic Axons
1) Can enter a grey ramus and be conveyed to and distributed with a ventral ramus. Eventually go to: sweat glands, erector pili muscles, and cutaneous blood vessels involved in temp. regulation
2) Some go from the paravertebral chain to the heart and lungs forming sympathetic components of the cardiac and pulmonary pexi
3) In the Superior Cervical Paravertebral Ganglion are distributed with branches of the carotid arteries to cutaneous structures forming the Carotid plexus
Paravertebral ganglia in the neck
1) Superior Cervical
2) Middle Cervical
3) Inferior Cervical
Stellate Ganglion
-inferior cervical fused with first thoracic
Cervical paravertebral cell bodies
- Found in the grey matter of the upper 4 thoracic segments
- Axons leave the spinal cord with ventral roots to pass into the white rami connected to the upper 4 thoracic segments
- They can synapse there or go up to the cervical sympathetic chain
Postganglionic sympathetic axons of the Middle and Inferior cervical ganglion
- Pass through grey ramus associated w/ this ganglion and are distributed to the skin of the upper limb via brachial plexus
- Do not enter grey ramus but go directly to join the cardiac or pulmonary plexi
Postganglionic sympathetic axons of the superior cervical ganglion
- Pass through the grey ramus directly associated with this ganglion to be distributed to the skin of the neck via the cervical plexus
- Go to Carotid Plexus
- Go straight to cardiac or pulmonary plexi
Carotid Plexus
-Postganglionic sympathetic axons derived from cell bodies in the superior cervical ganglion
-Distributed with branches of the carotid arteries to:
~Skin of face and scalp
~Dilator of pulp muscles
Horner’s Syndrome Symptoms
- Dropping of upper eye lid
- Constricted pupil due to inability to dilate
- Loss of sweating to the affected side of the face
- Loss vasoconstriction so redness on the affected side
Horner’s Syndrome Causes
- Lesion involving the superior cervical sympathetic chain
- Dilation of the carotid sinus may cause a region of the superior cervical ganglion
- Aneurysm of the carotid arteries
- Brachial or cervical Plexus nerve blocks
- Pressure on the sympathetic trunk
Axilla (Anterior Boundaries)
- Pectoralis Major muscle
- Clavicle
- Pectoralis Minor and subclavian muscles
Axilla (Posterior Boundaries)
- Teres major and Latissimus Dorsi
- Scapula
- Subscapularis
Axilla (Medial Wall)
- Ribs and intercostal muscles
- Serratus anterior
Axilla (Lateral Wall)
- Floor of the bicipital groove of the humerus
- Long head of the biceps and coracobrachialis
Axilla (Apex/Cervicoaxillary Canal- thoracic outlet)
- Root of neck
- Superior border of the scapula
- Clavicle
- First rin
Axilla (Base)
-Skin, fascia and hair
Axilla (Contents)
- Brachial plexus
- Axillary artery and vein
Anterior Axillary Fold
Lower border of the pectoralis major
Posterior Axillary Fold
lower borders of the Teres major and the latissimus dorsi
Sternoclavicular Joint
- Medial end of clavicle with sternum
- Largely passive movements
- Only articulation between the axial and appendicular skeletons
Sternoclavicular Joint (Movements)
- Depression of medial end of clavicle when scapula is elevated
- Elevation of medial end of clavicle when scapula is depressed
- Pronation or having the medial end of the clavicle moves anteriorly on the manubrium as the scapula is depressed
- Slight rotation along the axis of the clavicle
Acromioclavicular joint
- Between the clavicle and the acromion of the scapula
- Static stability to the upper limb
Glenohumeral Joint
- Most moveable joint in the body
- Greatest range of motion
- Full range of motion is needed to move the hand fully
Glenohumeral Joint (Movements)
- Flexion
- Extension
- Abduction
- Adduction
- Inward rotation
- Medial rotation
Scapulothoracic Joint
- Scapula and thoracic wall
- Not a true joint
- Muscles stabilize scapula
- Muscles actively move the scapula
- Very mobile bone
- Mobility increases range of motion of shoulder
Scapulothoracic Joint (Movements)
- Elevation of the scapula occurs when the superior border moves superiorly
- Depression occurs when the upper border is returned to normal or below normal level
- Protraction is abducting the scapula from the midline
- Retraction is adducting the scapula back to the midline
- Upward rotation occurs when the glenoid cavity moves upward
- Downward rotation occurs when the glenoid cavity moves downward
Rotator Cuff Muscles
- Supraspinatous
- Infraspinatous
- Teres Minor
- Subscapularis
Combined action of the Trapezius and Rhomiboids
Retract and elevate scapula
Combined action of Serratus anterior and Pectoralis Minor
Protract the scapula
Combined action of Trapezius and Serratus Anterior
Upward Rotation of the Scapula
What muscle initiates abduction of the humerous?
- Supraspinatous
- Without it no abduction
What muscle is required to bring the arm to should er level?
-Deltoid
What muscles complete abduction?
- Deltoid
- Trapezius
- Serratus Anterior
Scapulohumeral Rhythm
- 2 degrees of movement of humerus to 1 degree of movement of scapula
- Humerus moves 120 degrees and scapula move 60 degrees allowing a 180 degrees of total movement
Axillary Artery
- Continuation of subclavian after the first rib
- 3 parts with 6 total branches
- 1 branch from the first part, 2 from the second, and 3 from the third
Brachial Artery
-Continuation of Axillary Artery after the inferior border of Teres MAJOR
Axillary Artery Branches
-Part 1: Superior thoracic
-Part 2:
~Thoracoacrominal Trunk
~Lateral Thoracic
-Part 3:
~Posterior humeral circumflex
~Anterior humeral circumflex
~Subscapular
Thoracoacrominal Trunk
Four branches:
- Clavicular
- Acromion
- Pectoral
- Deltoid
Subscapular Artery Branches
- Circumflex scapular
- Thoracodorsal
Subclavian Branches
- Suprascapular
- Transverse cervical
Suprascapular Artery
Passes over the transverse scapular ligament to the supraspinous fossa then pass through the greater scapula notch to the infraspinous fossa to join the subscapular artery
Triangle of Ausculation (Boundaries)
- Borders: Latissimus Dorsi, Lower Trapezius, Rhomboid or scapula
- Floor: 6 and 7 ribs & intercostals
- Roofs: Fascia & skin
Triangle of Ausculation (Purpose)
-Listening to thorax
Triangular Space (Boundaries)
- Teres Minor
- Teres Major
- Long head of triceps
Triangular Space (Contents)
-Circumflex scapular artery
Quadrangular Space (Boundaries)
- Teres Minor
- Teres Major
- Long head of Triceps
- Shaft of the Humerus
Quadrangular Space (Contents)
- Axillary Nerve
- Posterior humeral circumflex artery
Triangular Interval (Boundaries)
- Teres Major
- Long Head of the Triceps
- Shaft of the Humerus
Trianguler Interval (Contents)
- Radial Nerve
- Profunda/ deep brachial artery
Trapezius (Attachments)
- Proximal: Medial superior nuchal line, external occipital protuberance, ligamentum nuchae, and spinous processes of C7 to T12
- Distal: Lateral 1/3 of the clavicle, the acromion, spine of the scapula
Trapezius (Innervation)
- Spinal Accessory
- Sensory C3 and C4
Superior Portion of the Trapezius (Action)
-Elevates shoulder girdle
Inferior Portion of the Trapezius (Action)
-Depresses shoulder girdle
Middle Portion of the Trapezius (Action)
-Retracts shoulder girdle (assisted by other portions)
Superior and Inferior Portion of the Trapezius (Action)
-Work together to upwardly rotate the scapula
Latissimus Dorsi (Attachments)
- Proximal: Spinous process of T6-L5, sacrum, iliac crest lower 3 or 4 ribs and thoracodorsal fascia
- Distal: Floor of the bicipital groove
Latissimus Dorsi (Innervation)
-Thoracodorsal (C5)
Latissimus Dorsi (Action)
- Extend the shoulder
- Adduct the shoulder
- Medial/ internally rotate the shoulder
Levator Scapulae (Attachments)
- Proximal: Transverse processes of C1- C3
- Distal: Upper medial border of the scapula above the root
Levator Scapulae (Innervation)
- Dorsal scapula
- C3 and C4
Levator Scapulae (Action)
-Elevate and downwardly rotate the scapula
Rhomboid Major and Minor (Attachments)
- Proximal: Ligamentum Nuchae, spinous processes of C7 to T5
- Distal: Medial border of the scapula from the root of the spine to the inferior angle (Minor is to the root of the spine)
Rhomboid Major and Minor (Innervation)
-Dorsal scapular (C5)
Rhomboid Major and Minor (Action)
- Retraction, downward rotation, some elevation of the scapula
- Fixes the scapula against the trunk
Serratus Anterior (Attachments)
- Proximal: Outer surface of ribs 1-8
- Distal: Anterior surface of the medial border of the scapula
Serratis Anterior (Innervation)
Long thoracic nerve
Serratis Anterior (Action)
- Protraction of the shoulder girdle
- Holds scapula against the thoracic wall
- Upwardly rotates the scapula
Deltoid (Attachments)
- Proximal: Lateral 1/3, acromion, and crest of spine of the scapula
- Distal: Deltoid tuberosity of the humerous
Deltoid (Innervation)
Axillary nerve
Anterior Portion of the Deltoid (Action)
-Flexes, medial rotates, and horizontally abducts the arm
Middle portion of the Deltoid (Action)
-Abducts arm
Posterior portion of the Deltoid (Action)
-Extends, laterally rotates, and horizontally abducts the arm
Anterior and Posterior Portions of the Deltoid (Action)
-Work together to abduct with the middle portion
Teres Major (Attachments)
- Proximal: Inferior angle of scapula, dorsal scapula near the angle
- Distal: Medial lip of the bicipital groove
Teres Major (Innervation)
Lower subscapular
Teres Major (Action)
- Adduction and medial rotation of the arm
- Extends the arm when its flexed
- Stabilizes during abduction
Supraspinatus (Attachments)
- Proximal: Medial Supraspinous fossa of the scapula
- Distal: Superior facet of the greater tubercle
Supraspinatus (Innervation)
Suprascapular nerve
Supraspinatus (Action)
- Starts abduction of the humerous
- Stabilize arm
- Prevent downward displacement of the humerous
Infraspinatus (Attachments)
- Proximal: Infraspinous fossa of scapula
- Distal: Middle facet Greater tubercle of the humerous
Infraspinatus (Innervation)
Suprascapular
Infraspinatus (Action)
- Lateral rotation of the arm
- hold head of humerus in glenoid fossa
Teres Minor (Attachments)
- Proximal: Upper 2/3s of the scapula
- Distal: Lowest facet of the greater tubercle of the humerous
- SUPERIOR to teres major
Teres minor (Nerve)
Axillary
Teres Minor (Action)
- Lateral rotation
- Abduction of arm
- Hold head of humerus in glenoid fossa
Subscapularis (Attachments)
- Proximal: Medial subscapular fossa
- Distal: LESSER tubercle of the humerus
Subscapularis (Innervation)
Upper and Lower subscapular
Pectoralis Major (Attachments)
- Proximal: Medial 1/2 of clavicle, the sternum, costal cartilage of ribs 2-6
- Distal: Lateral lip of the bicipital groove
Pectoralis Major (Innervation)
Lateral and medial Pectoral nerves
Subscapularis (Action)
- Medial rotation of the humerous
- Holds head of humerus in glenoid fossa
Pectoralis Major (Action)
-Adduction
-Medial Rotation
-Horizontal adduction of the shoulder
Clavicular portion:
-Flexion of shoulder
Sternal Portion:
-Extension of shoulder from a flexed position
Pectoralis Minor (Attachments)
- Proximal: Ribs 3, 4, 5
- Distal: Coracoid process
Pectoralis Minor (Innervation)
Medial pectoralis nerve
Pectoralis Minor (Action)
- Stabilizes scapula
- Draws it forward and downward (Tips)
Deltoid (Myotome)
C5
Biceps Brachii (Myotome)
C6
Extensor Carpi Radialis Longus (Myotome)
C6
Flexor Carpi Radialis (Myotome)
C7
Triceps Brachii (Myotome)
C7
Extensor Digitorum (Myotome)
C7
Flexor Digitorum Superficialis (Myotome)
C8
Flexor Digitorum Profundus (Myotome)
C8
Interossei
T1
Extrinsic Shoulder Muscles
- Trapezius
- Latissimus dorsi
- Levator scapulae
- Rhomboids
- Serratus Anterior
Intrinsic Shoulder Muscles
- Deltoid
- Teres Major
- Teres Minor
- Supraspinatis
- Infraspinatis
- Teres Minor
- Subscapularis