Term
| The posterior triangle is bounded by the ___________ anteriorly, the __________ posterior, and the _________ inferiorly. |
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Definition
The POST. TRIANGLE IS BOUNDED BY the sternocleidomastoid (SCM) anteriorly, the trapezius posteriorly and the middle third of the clavicle inferiorly.
(The apex of the triangle is superior and the base inferior (formed by clavicle)) |
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Term
What is the fixed (non-movable) end of a muscle when it contracts?
What is the movable end of a muscle when it contracts? |
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Definition
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Term
| What is the origin and insertion of the sternocleidomastoid muscle? |
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Definition
1. Origin: Sternal head --- manubrium
Clavicular head --- medial 1/3 of clavicle
2. Insertion: Mastoid process and lateral ½ of superior nuchal line |
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Term
| What are the functions of the sternocleidomastoid muscle anterolateral and lateral view? |
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Definition
anterolateral: Lateral flexion (tilts head toward shoulder on same side) and rotation
lateral: Flexion of CV when person is supine (can elevate sternum and clavicle-forced inspiration) |
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Term
What is a contraction of the cervical muscles that produces twisting of the neck and slanting of the head?
Occasionally the _______ is injured when an infant’s head is pulled too much during a difficult birth, tearing its fibers |
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Definition
Torticullis
sternocleidomastoid muscle |
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Term
| Surgical release of the SCM from its inferior attachments to the_______ and ______ may be necessary to enable the person to hold and rotate the head normally in torticollis |
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Definition
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Term
| What is the origin and insertion of the trapezius muscle? |
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Definition
Origin: Superior nuchal line, ext. occipital protuberance, lig. nuchae, spines of C7 – T12
Insertion: Lateral 1/3 of clavicle, acromion, spine of scapula |
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Term
What do the superior fibers of the trapezius muscle do?
inferior fibers?
Middle fibers?
Superior and inferior fibers? |
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Definition
elevation of scapula (sup. fibers)
depression of scapula (inf. fibers)
retraction of scapula (middle fibers)
superior rotation of glenoid fossa of scapula (sup. + inferior fibers) |
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Term
| What is essential in order to elevate the arm vertically above the head? |
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Definition
| Superior rotation of the glenoid fossa |
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Term
| In addition to an innervation by XI, the SCM & trapezius are innervated by the ___________. (2-4) |
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Definition
| ventral rami of cervical nn |
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Term
| What muscle and fascia make up the roof of the posterior triangle? |
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Definition
| platysma m. and the investing layer of cervical fascia. |
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Term
| What (5) muscles make up the floor of the posterior triangle? |
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Definition
| splenius capitis, levator scapulae, and the posterior, middle, and anterior scalene muscles |
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Term
| The muscles of the floor are covered with the ________________ |
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Definition
| prevertebral layer of deep cervical fascia |
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Term
| What are the origins and insertions of the anterior, middle, and posterior scalene muscles? |
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Definition
Ant. scalene m.
O – ant. tubercles of transverse processes of C3 – C6
I - scalene tubercle and ridge of rib 1
Middle scalene m.
O - post. tubercles of transverse processes of C2 – C7
I - broad attachment to upper surface of rib 1
Posterior scalene m. (only incompletely separated from the middle scalene m.)
O – post. tubercles of transverse processes of C5 – C7
I - lateral surface of rib 2 |
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Term
Bilateral action of longus colli and scalene mm., as well as SCM, produce ________ of neck.
Bilateral action of the scalene mm. can also elevate ________ |
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Definition
flexion
ribs 1-2 (inspiration) |
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Term
| Unilateral action of intertransverse and scalene mm. (as well as other mm. not shown) produce __________ of neck. |
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Definition
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Term
| Prevertebral and scalene mm. innervated by ________ of cervical nerves. |
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Definition
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Term
True or False:
Only the inferior belly of omohyoid m. lies in the posterior triangle |
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Definition
True
(superior belly in anterior triangle) |
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Term
XI originates from neurons in spinal cord segments _______.
The axons of these neurons leave the cord, join together and ascend as a single nerve through the __________.
XI then exits the skull through the _________ and passes (anteroinferiorly, anteriorsuperiorly, posteroinferiorly, posterosuperiorly). |
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Definition
C1-C5
foramen magnum
jugular foramen
posteroinferiorly |
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Term
| Accessory Nerve (XI) supplies what 2 muscles? What cervical spinal nerves (#) also send branches to these 2 muscles? |
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Definition
sternocleidomastoid trapezius (efferent)
C2, C3, and C4 (afferent and efferent) |
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Term
| Efferent fibers in XI are considered (SVE, GVE, GSE)? |
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Definition
| SVE (to skeletal muscles derived from the pharyngeal arches) |
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Term
What are the following brachial plexus sections in relationship to the clavicle?
Divisions
Roots and trunks
Cords and terminal branches |
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Definition
divisions-postclavicular
roots and trunks - supraclavicular (lie within the post. triangle)
cords and terminal branches infraclavicular in position |
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Term
| For anesthesia of upper limb, the anesthetic agent is injected (superior or inferior) to the midpoint of the clavicle. |
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Definition
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Term
| What are the (5) parts of the Brachial Plexus (innervates the upper limb)? |
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Definition
Roots, Trunks, Divisions, Cords and Branches
" Roger Travis Drinks Cold Beer" |
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Term
| The "roots" of the brachial plexus are formed by the ___________ of ______ (vertebrae). |
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Definition
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Term
| The ventral rami of ____ and ____ join to form the superior trunk, the ventral ramus of _____ continues as the middle trunk and the ventral rami of _____ and ____ join to form the inferior trunk. |
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Definition
| The "roots" of the plexus are formed by the VENTRAL RAMI of C5-T1. The ventral rami of C5 & C6 join to form the sup. trunk, the ventral ramus of C7 continues as the middle trunk and the ventral rami of C8 & T1 join to form the inf. trunk |
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Term
| The (anterior or posterior) divisions of all three brachial plexus trunks unite to for the (______) cord; the (anterior or posterior) divisions of the superior and middle trunks unite to form the (_______) cord; the (posterior or anterior) division of the inferior trunk continues as the ______ cord. |
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Definition
| The posterior divisions of all three trunks unite to form the posterior cord; the anterior divisions of the superior and midde trunks unite to form the lateral cord; the anterior division of the inferior trunk continues as the medial cord |
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Term
| The ___________ is the ventral rami of cervical nerves 1-4. |
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Definition
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Term
What are the cutaneous nerves (branches of the cervical plexus) that appear at the posterior border of the SCM that radiate in the following directions?
to skin of upper chest and shoulder
to skin of ant. triangle
to skin of ear and parotid region
to skin of ear and scalp |
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Definition
supraclavicular nn. (to skin of upper chest and shoulder)
transverse cervical n. (to skin of ant. triangle)
great auricular n. (to skin of ear and parotid region)
lesser occipital n. (to skin of ear and scalp) |
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Term
| All of the cervical plexus nerves contain fibers from ________ (vertebrae) EXCEPT the ______ nerve |
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Definition
| All of these nerves contain fibers from C2 & C3 except the supraclavicular nn. (C3&C4). |
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Term
Regional anesthesia of the skin of the neck can be accomplished by a __________.
The main site of injection is just superior to the midpoint of the post. border of the SCM. This is known as the _________________ (________) |
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Definition
Regional anesthesia of the skin of the neck can be accomplished by a CERVICAL PLEXUS BLOCK.
The main site of injection is just superior to the midpoint of the post. border of the SCM. This is known as the NERVE POINT OF THE NECK (ERB’S POINT). |
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Term
The __________ artery has 3 parts based on its relationship to the anterior scalene muscle.
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Definition
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Term
| Only the 3rd part of the subclavian artery lies in the _________; after cross the first rib it becomes the ________ artery (to the upper limb) |
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Definition
posterior triangle
axillary artery |
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Term
| The transverse cervical artery and the supra scapular artery are also contents of the ________ triangle. They arise from the _________ (1st pt. of subclavian a.) and course across the __________ |
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Definition
| The transverse cervical a. and the suprascapular a. are also contents of the posterior triangle. They arise from the thyrocervical trunk (1st pt. of subclavian a.) and course across the anterior scalene m. |
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Term
| What vein serves as an "internal barometer"? (When venous pressure is in the normal range, it is usually visible above the clavicle, when venous pressure rises it is prominent through its course) |
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Definition
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Term
| Observation of the external jugular vein during physical exam may give diagnostic sign of what 4 things? |
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Definition
heart failure
SVC obstruction
enlarged supraclavicular lymph nodes
increased intrathoracic pressure. |
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Term
What happens when the external jugular vein is severed where it pierces the roof of the posterior triangle?
What side of the heart does this affect?
What should you do to prevent this? |
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Definition
its lumen is held open by the investing layer of deep cervical fascia, and the negative intrathoracic pressure will suck air into the vein.
A venous air embolism produced in this way will fill the right side of he heart w/ froth, which nearly stops blood flow through it, resulting in dyspnea and cyanosis
The application of firm pressure to the severed EJV until it can be sutured will prevent this. |
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Term
| The interscalene triangle may become too narrow due to the presence of a _____________. |
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Definition
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Term
| A cervical rib can compress the _________ leading to ischemia (reduced blood supply) to the upper limb. How often are cervical ribs found in humans? |
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Definition
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Term
| The cervical rib can elevate the _____________ with consequent compression of the nerve fibers leading to pain, paresthesia and muscular weakness. |
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Definition
| lower trunk of the brachial plexus |
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Term
| Compression of the subclavian a. and/or brachial plexus in the interscalene triangle by the cervical rib is termed ____________. |
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Definition
| Anterior scalene syndrome |
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Term
| What is the KEY muscle in the root of the neck with regard to important relationships. |
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Definition
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Term
| What nerve can be blocked with anesthetic or surgically crushed on anterior surface of ant. scalene m. to achieve paralysis of hemidiaphragm |
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Definition
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Term
| What vessel is is often the point of entry to the venous system (for central line placement). Central lines are inserted to administer nutritional fluids and medications, and to measure central venous pressure |
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Definition
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Term
| In an infraclavicular subclavian v. approach , the thumb of one hand is placed on the ____________ and the index finger in the ________. The needle punctures the skin (superior or inferior) to the thumb and is advanced (medially or distally) toward the tip of the index finger until the tip enters the_________, posterior to the sternoclavicular joint. |
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Definition
| In an infraclavicular subclavian v. approach , the thumb of one hand is placed on the middle part of the clavicle and the index finger in the jugular notch. The needle punctures the skin inferior to the thumb and is advanced medially toward the tip of the index finger until the tip enters the right venous angle, posterior to the sternoclavicular joint. |
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Term
If the needle is not inserted carefully in the subclavian vein puncture, what may it puncture?
If possible, (right or left) subclavian vein puncture is desirable in order to avoid damage to the _________. |
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Definition
pleura and lung, causing pneumothorax; subclavian artery
right; thoracic duct |
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Term
| What are the 3 layers of the deep cervical fascia? |
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Definition
Investing layer (most superficial)
Prevertebral layer (covers prevertebral muscles)
Visceral layer (2 layers form a tubular sleeve around the cervical viscera) |
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Term
Which deep cervical fascia layer is the most superficial; It forms a "tubular sleeve" or "investment" around the neck.
It splits to enclose what 2 muscles?
between these muscles it is a single layer that contributes to the (roof or floor) of the post. triangle. |
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Definition
Investing layer
Sternocleidomastoid muscle and trapezius
roof of the posterior triangle |
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Term
The pre vertebral layer of the deep cervical fascia continues laterally and posteriorly to cover what 2 muscles?
Does it contribute to the (roof or floor) of the posterior triangle? |
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Definition
scalene and levator scapulae muscles
floor of the posterior triangle |
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Term
Identify the 2 components of the visceral based on what they do.
1) forms a sheath for the thyroid glen
2) connects the two lobes of the thyroid gland and covers the posterior surface of the esophagus
What do these 2 components form together? |
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Definition
1) pretracheal
2)buccopharyngeal
Together, these two components form a tubular sleeve around the cervical viscera (trachea, esophagus, thyroid gland). |
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Term
| The carotid sheath is a fascial structure in the neck enclosing what 3 structures medially, laterally, and posteriorly? |
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Definition
| the common (or internal) carotid a. (medially), the internal jugular v. (laterally) and the vagus n. (posteriorly) |
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Term
What is the space that is clinically important BECAUSE IT PROVIDES A ROUTE FOR THE SPREAD OF INFECTION (Infectious material (eg, from an abscessed tooth) can enter the space and pass inferiorly into the chest.)
What are the boundaries? |
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Definition
Retropharyngeal space
buccopharyngeal fascia (anterior), prevertebral fascia (posterior) and carotid sheath (lateral |
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Term
What is the vertical extent of the retropharyngeal space?
The retropharyngeal space is filled with __________to allow pharynx and esophagus to expand when swallowing. |
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Definition
base of the skull to the posterior mediastinum (area of chest post. to heart and pericardium)
loose areolar tissue |
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Term
| What two arteries derive from the thyrocervical trunk (from 1st part of the subclavian artery) |
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Definition
| transverse cervical a. and suprascapular a. |
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