Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
258 Cards in this Set
- Front
- Back
|
sagittal plane
|
divides body into left and right
|
|
|
frontal/coronal plane
|
divides body into anterior and posterior
|
|
|
transverse/horizontal plane
|
divides body into superior and inferior (axial-medical imaging)
|
|
|
dorsiflexion
|
pulling foot up
|
|
|
plantar fexion
|
pushing foot down
|
|
|
retraction and protrustion
|
pull in; push out (aka jaw)
|
|
|
T3 spinous process
|
at the level of the greater tubercle of humerus
|
|
|
T7 spinous process
|
at the inferior angle of the scapula
|
|
|
L4 spin process
|
at the level of the iliac crest
|
|
|
trapezius
|
superficial, extrinsic, anterior rami, CNXI motor and C3-C4 sensory nerves; superficial branch of transverse cervical artery; attachments: clavicle, acromion, scapula spine, occipital bone; elevates lateral scapular
|
|
|
latissimus dorsi
|
attaches to intertubercular groove, thoracodorsal nerve (aka middle subscapular, C6-C8) and artery; adduct, extend, medial rotation
|
|
|
levator scapulae and rhomboids
|
dorsal scapular (C5) motor and sensory; levator= elevates, attaches to posterior tubercles of C1-C4 and superior scapula; rhomboids= adducts (retracts)
|
|
|
Serratus posterior superior and inferior
|
ventral primary rami; upper and lower intercostal nerves, proprioception, inspiratory mvmts
|
|
|
Splenius
|
bandage, unilateral- bend/rotate neck; bilateral- extend head, capitus attaches on mastoid; ligamentum nuchae and spinous processes
|
|
|
Spinalis
|
capitis (blends with semispinalis capitis), cervicis (often absent), thoracic (constant); posterior primary rami
|
|
|
Strain vs Sprain
|
strain= muscle, tendon; sprain= ligament
|
|
|
Longissimus
|
capitis, cervicis, thoracic
|
|
|
Iliocostalis
|
cervicis, thoracic, lumborum
|
|
|
Transversospinalis
|
Semispinalis (C,C,T, spans 4-6); multifidus (C, T, L, spans 2-4); rotatores (C, T, L, spans 1-2); posterior primary rami; attach: transverse processes; extend and rotate column
|
|
|
deep vertebral muscles
|
intertransversarius (C, L)=bends laterally; Interspinales (C, L)=extends/rotates column; levator costarum=trans process to rib
|
|
|
suboccipital triangle boundaries
|
roof-trapezium and semispinalis capitis; floor-atlandooccipital, atlantoaxial, rectus capitis post. minor
|
|
|
suboccipital triangle walls
|
medial=rectus capitis post. major and minor, C1 arch and C2 SP; lateral=superior oblique, C1 TP; inferior=inferior oblique, C2 SP and C1
|
|
|
suboccipital triangle contents
|
dorsal ramus of C1 (suboccipital nerve), vertebral artery; others:: dorsal ramus of C2 (greater occipital nerve), C3 (least occipital n.), occipital artery and vein, lesser occipital nerve (anterior rami of C2-C3)
|
|
|
triangle of ascultation
|
trapezius, lat dorsi, medial border of scapula, rhomboid major (floor), intercostal space 6 for listening
|
|
|
lumbar triangle
|
lat dorsi, external oblique, internal oblique (floor), Petit's hernia (inferior lumbar)
|
|
|
erector spinae
|
3 muscle groups; bilateral- extends head, unilateral- lateral bending; main extensor; attach: broad tendom, sacroiliac ligaments, spinous processes
|
|
|
conventional radiography
|
film radiography, computed radiography, digital radiography, fluoroscopy
|
|
|
cross-sectional imaging techniques
|
CT, MRI, Ultrasonography; interrogate 3D volume to produce 2D image
|
|
|
nuclear radiology
|
nuclear medicine images relfect not only biodistribution of radiopharmacuetical but the anatomic, pathologic, and artifact overlays
|
|
|
film radiography
|
screen-film system within film cassette as x-ray detector, white bones
|
|
|
computed radiography
|
filmless eliminated chemical processing; substitutes a phosphor imaging plate; digital images transferred to PACS (pic. archiv and comm sys); looks inside for landmarks, multislice, lots of radiation
|
|
|
digital radiography
|
film and cassette free; fixed electronic detector-direct read out immediate image
|
|
|
fluoroscopy
|
continuous x-ray passes through patient onto screen; real-time radiographic visualization; interventional, active
|
|
|
Computed tomography (CT)
|
computer reconstructs image from measurment of x-ray transmission; only a single tissue parameter; density; fast, lots info, radiation
|
|
|
US (ultrasonography)
|
heardest, cheap, 0 radiation; interrogate tissue with multiple pulses, real-time images
|
|
|
CT density measurements
|
bone 400 to 1000H, soft tissue 40 to 80, fat -60 to -100, lung -400 to -600, air -1000, water 1 to 10
|
|
|
CT artifacts
|
volume averagine, beam-hardening, motion, streak (shotgun)
|
|
|
MR (magnetic resonance)
|
analyzes multiple tissue char, hydrogen (proton) density, blood flow, T1 (fat) and T2 (water); expensive, nonmotile things
|
|
|
MR pros and cons
|
good soft tissue resolution, images in any plane, absence of radiation; limited demonstration of dense bone detail, chemical shift misregistration (artifact)
|
|
|
US artifacts
|
acoustic shadowing (gallstone) and enhancement (cyst)
|
|
|
nuclear rad. function
|
inject radioisotope; PET imagine- beta particle (florine) attaches to glucose to look for meta. activity
|
|
|
primary scoliosis of thoracolumbar region
|
lateral deviation in thoracic/lumbar region; there will be compensatory curve of cervicothoracic region in other direction
|
|
|
atlas/C1
|
no body, no spinous process but does have posterior tubercle; facet joint (pivot), small transverse process and foramen; lateral mass articulates with occipital condyle
|
|
|
axis/C2
|
dens-damaged in hanging, bifid SP, transverse foramen for vertebral artery
|
|
|
transverse ligament of atlas
|
torn if dens separates (behind dens)
|
|
|
cruciate ligament
|
superior, transverse, and inferior bands; behind dens
|
|
|
cervical vertebrae
|
3-6 are bifid SP,small kidney-shaped body, 7 vertebral prominens, uncus; carotid tubercle of C6 is pressure point to control bleed from carotid
|
|
|
thoracic vertebrae
|
no trans foramen, ribs attach by facet joings, heart-shaped body, round hole; vert. notches for IV foramen; plane of articulation-frontal with bending/rotation
|
|
|
lumbar vertebrae
|
mamillary (multifidus) and accessory (longissimus) processes; kidney-shaped body, plane of articultion-sagittal with flexion/extension & lat. bending
|
|
|
sacrum
|
promontory, reduces TP and SP, superior articular facet; posteriorly- palpate cornua and median crest to find sacral hiatus; sacral foramena (ventral rami of S1-S4 and arteries)
|
|
|
IV disk
|
anulus fibrosus- longit. ligaments; nucleus pulposus-cartilaginous, elastic, posterior, absorb shock
|
|
|
facet joint
|
aka zygapophyseal joint, synovial
|
|
|
atlantoccipital joint
|
btw occipital condyle and superior articular facet of C1; has anterior and post. membranes; holes for vertebral a. and C1 nerve; flexion and extension (no rotation)
|
|
|
uncovertebral joint (of Luschka)
|
formed postnatally, assoc. with bone spurs (osteophytes), synovial, between uncinate processes, C2-C4
|
|
|
subluxation
|
atlantoaxial dislocation, may be associated with Down syndrome
|
|
|
vertebral col. ligaments
|
1. interspinjous ligament (ant.)= limits flexion, joings SPs; 2. supraspinous ligament (post.)= limits flexion, expands and forms ligamentum nuchae; 3. ligamentum flavum= limits flex., joins laminae; 4. posterior long. ligament= limit flexion, weak, direct IV disk posterolaterally, nociceptive n; 5. ant. long. ligament=- limits extension, strong, whiplash
|
|
|
movements of vert. col.
|
limited by IV disk, plane of articulation
|
|
|
cervical vert. mvmts
|
horizont. orientation; thick discs; flexion, extension. lat bending, rotation
|
|
|
thoracic vert. mvmts
|
frontal orientation, thin discs, all mvmts limited, 4 sites of articulation (ribs)
|
|
|
lumbar vert. mvmts
|
sagittal orient., thick discs and body, flexion and extension, limited rotation
|
|
|
Spondylolysis
|
fracture of pars interarticularis (region btw sup and inf facets); defect lamina formation at L5
|
|
|
filum terminale
|
pia mater continum
|
|
|
epidural anesthesia and lumbar puncture
|
EA= into epidural space btw L3-L4; LP= into subarachnoid space btw L4-L5
|
|
|
Herniated disk straight leg test
|
positive if pain in lower limb when leg lifted, also if increase pain with dorsiflexion or if pain relieved when knee flexes (sciatica L4-S3)
|
|
|
paravertebral venous drainage
|
pathway for tumor cells to get to brain; post. and ant. external plexus as well as a internal plexus
|
|
|
scotty dog
|
region btw superior and inferior articulating facets; ear- sup. articular facet, collar- pars interarticularis, leg- inf. articular facet
|
|
|
stenosis
|
pressure on nerves, narrowing of vertebral foramen, IV disk bulging
|
|
|
transverse foramen
|
passage of vertebral artery and vein, vertebral flexus (sympathetic)
|
|
|
atlantoaxial joint
|
3 articulations; rotation of head, held in place by transverse ligament
|
|
|
radicular arteries
|
branches from vertebral, cervical, deep cervical, post. intercostals; follow nerves through IV foramenand form an anastomosis
|
|
|
denticulate ligament
|
supports spinal cord with IV foramen
|
|
|
cranial nerves
|
1 and 2 are direct extensions of the brain; 11 is dervied from spinal nerves C1-5; myelin by schwann cells/neurilemma
|
|
|
neuron types
|
multipolar=motor; biopolar=special sensory, interneurons; unipolar/psuedounipolar= sensory
|
|
|
motor neurons
|
located in ventral horn gray matter and intermediolateral cell column (lateral horn)
|
|
|
primary rami
|
there is a ventral (back) and dorsal (lateral and ventral sides) rami but they are both mixed because they come from a mixed spinal nerve
|
|
|
plexuses
|
from ventral primary rami; give spinal nerve a wider distribution; cervical (C1-C5), brachial (C5-T1), lumbar (L1-L4), sacral (L4-S4)
|
|
|
spinal nerve modalities
|
GSA (sensory input from surface, tendons, joints), GVA (sensory from viscera), GSE (motor to skeletal m.), GVE (motor to viscera, salivary, arrector pili, bv, sweat, autonomic)
|
|
|
Dermamyotome derivatives
|
all PNS ganglia from neural crest; spinal cord from neural tube
|
|
|
Dermatome levels
|
T4-nipple, sternal-T2, C6-C8=fingers, T10-umbilicus, L3-knee, L5-medial foot, S1-lateral foot
|
|
|
sympathetic NS
|
from T1-L3; 1st neuron=IML cell column; 2nd neuron=paravertebral (chain) or prevertebral ganglion; acetylcholernergic, acetylcholine and norepi NT
|
|
|
parasympathetic NS
|
from CN 3, 7, 9, 10 and S2-S4; cholernergic, acetylcholine NT
|
|
|
prevertebral ganglion
|
celiac, superior mesentary, and inf. mesentary ganglia; splanchnic nerves lead to this
|
|
|
rami communicans
|
white= myelinated, faster, preganglionic nerves; gray, postganglionic nerves
|
|
|
superficial reflex
|
abdominal (upper-T7-T9, lower-T10-T12); cremasteric (L1-L2); plantar reflex (scratch sole of foot, L5-S1); anal (S2-S4)
|
|
|
deep tendon reflexes
|
muscle spindles and tendon organs; biceps (C5-C6); brachioradialis (C5-7); tricep (C6-8); quadriceps (patellar tendon L2-4); anchilles tendon (S1-2)
|
|
|
blastocyst formation
|
fertilization causes mitosis of zygote to form blastomeres; solid mass of cells within zona pellucida-morula; cavity (blastocoel) develops and now is a blastocyste
|
|
|
meiosis
|
1st meiosis is before ovulation; 2nd meiosis is at fertilization
|
|
|
blastocyst
|
outer cell mass= placenta/trophoblast; inner cell mass= embryo
|
|
|
implantation factors
|
L-selectins=carb binding proteins on trophoblast initiates capture to the endometrium; integrin= expressed by trophoblast and attach via receptors on laminin mlcs in ECM of endometrium; fibronectin= migration of blastocyst into endometrium
|
|
|
placenta formation
|
syncytiotrophoblast= amorphous multinucleate erodes into endometrium and maternal bv; cytotrophoblast= mononucleated; extraembryonic mesodern adds to inner surface to become 3rd layer
|
|
|
bilaminar germ disc (hypo and epi blast)
|
hypoblast= give rise to exocoelomic (Heuser's) mem and forms primary yolk sac; epiblast= gives rise to 3 germ layers and extraembryonic mesoderm
|
|
|
bilaminar germ disc
|
amnioblasts=from epiblast, form amniotic mem; extraembryonic mesoderm= from yolk sac and epiblast, fills blastocyst cavity; chorionic cavity= divides into splanchnopleuric and somotopleuric extraembryo. mem. except at connecting stalk
|
|
|
primitive streak
|
at caudal end within the epiblast; cells move through streak to replace hypoblast and form endoderm and intraembryonic mesodern
|
|
|
primitive node
|
cells move through this to form prechordal plate, notochord, paraxial mesodern
|
|
|
gastrulation
|
in 3rd week; form primitive streak, germ layers, allantois; all formed by epiblast
|
|
|
notochord
|
prechordal plate= cluster of mesodermal cells that cause forebrain in ectoderm; prenotochordal cells= form notochord; neurenteric canal= brins amniotic and yolk sacs together
|
|
|
teratomas
|
remnants of primitive streak persist and cause tumors- sacrococcygeal teratomas; also from primordial germ cells that don't go to gonads
|
|
|
mesoderm fate map
|
intraembryonic= primitive node and streak; prechordal plate= cranial portion of node; notochord= cranial portion of node; paraxial= node and cranial primitive streak; intermediate= mid-primitive streak; lateral plate= caudal prim streak; extraembryonic= most caudal prim streak
|
|
|
body axes
|
anterior visceral endoderm= transcription factors for head formation; nodal= prim streak; BMP-4 and fibroblastic growth factor (FGF)= ventralize mesoderm; noggin/chordin/follistatin= prim node, antagonize BMP for dorsalization
|
|
|
Brachyury (T) gene
|
regulates dorsal mesoderm in caudal region; absence causes sirenomelia (caudal dysgenesis; mermaid)
|
|
|
body axes cont.
|
hepatic nuclear factor (HNF-3B)= forebrain and midbrain differentiation; FGF-8= exp. of nodal and lefty2 genes and upreg of PITX for left side; Lefty1= prevents left side going right; SHH= supresses left side from the right, from notochord; Snail=downreg of genes det. right side
|
|
|
amniotic sac
|
growth gets rid of chorionic cavity; amniotic fluid by diffusion then fetal urine; body folds and compresses yolk sac against connecting stalk (umbilical)
|
|
|
poly and oligohydramnios
|
poly= too much fluid; anencephalia, GI atresia, diabetes; oligo= too little, renal atresia, hypoplasia, polycystic kidneys
|
|
|
amniotic fluid
|
symmetrical growth, prevents amnion adherence, maintains temp, prevents trauma, allow mvmt, fluid wedge and parturition (dilate cervix), estimate maturity
|
|
|
yolk sac
|
limited role in metabolism; disappears or become Meckel's diverticulum; site of hematopoiesis and serum protein; primordial germ cell differentiation
|
|
|
allantois
|
from wall of yolk sac; induction of vitelline and umblilical vessels; persists as urachus (medial umbilical ligament) from bladder to abdominal wall
|
|
|
end of 3rd week
|
3 germ layers and 3 fetal membranes
|
|
|
secondary/definitive yolk sac
|
endodermal cells from hypoblast replace primary yolk sac
|
|
|
ectoderm
|
CNS, PNS and ganglia, sensory epi, epi of skin (sweat and mammary glands), pituitary gland, tooth enamel
|
|
|
mesoderm
|
CT, muscle, blood, lymph, vessel walls, kidney, gonads, suprarenal gland cortex, spleen
|
|
|
endoderm
|
lining of gut and assoc organs, lining of resp, lining of bladder, thyroid, parathyroids, lining of auditory and tympanic cavity
|
|
|
bone window
|
could be brain, soft tissue, etc
|
|
|
cervical and thoracic SP
|
C7- directed inferolaterally; T1- directed superolaterally
|
|
|
articular "pillars"
|
formed by articulation btw sup and inf articular processes
|
|
|
prevertebral soft tissue "shelf"
|
at C4/5 where esophagus begins
|
|
|
T2 weighted
|
Water, shows CSF brightly, hyrdated disk
|
|
|
T1 weighted
|
Fat, bright in vertebrae b/c of marrow
|
|
|
lateral sagittal MRI
|
can see neural foramen (big in lumbar v.)
|
|
|
scotty dog
|
in oblique section; shows pars interarticularis
|
|
|
block BMP4
|
form neural plate in middle of ectoderm
|
|
|
Pax 3 and 7
|
bipolar sensory neurons, from neural crest
|
|
|
Shh signaling
|
from notochord, form floor plane, invagination of nueral plant into embryo
|
|
|
Pax 6
|
determines motor portion of CNS, by Shh
|
|
|
Somites
|
from paraxial mesoderm, 3 a day, leaves cranial and caudal neuropore, cranial closes first
|
|
|
folding of cranial end of neural tube
|
cephalic and cervical flexure and then pontine flexure
|
|
|
NS cells
|
neural epithelium= oligodendrocytes, astrocytes, ependymal cells of ventricles; mesodern= microglial cells; neural crest= schwann cell, ganglia, meninges, melanocytes, pharyngeal arches
|
|
|
mantle and marginal layer
|
mantle= nuerons/gray matter; marginal= white matter
|
|
|
alar and basal plate
|
alar= dorsal horn; basal= ventral horn
|
|
|
epimeric and hypomeric
|
muscles; epimeric=dorsally; hypomeric= ventrally
|
|
|
spinal cord levels
|
8 weeks (whole canal); 24 weeks (S1/S2); newborn (L3/L4); adult (L1/L2)
|
|
|
spina bifita
|
occulta= no closing of vertebral arch, hairs; cystica= herniation of meninges and/or brain (meningocele, meningomyelocele); apera=neural plate didn't form, no Shh
|
|
|
Arnold-Chiari Malformation
|
aka myeloschisis, can cause hydroencephalis; brain (cerebral tonsils) pulled through foramen magnum
|
|
|
hydrocelphalus
|
aqueductal stenosis or tethering of nueral tube derivates
|
|
|
cranium bifidum
|
herniation at the level of the skull; meningocele; meningoencephalocele; meningohydroencephalocele (meninges, brain, CSF fluid)
|
|
|
exencephaly
|
cranial neural tube doesn't close, results in anencephaly
|
|
|
craniorachischisis
|
skull failed to form
|
|
|
pituitary gland
|
oralectoderm and neuralectoderm; Rathke's Pouch-adenohypophysis(anterior), pars tuberalis, pars intermedia; Infundibulum- stalk, pars nervosa
|
|
|
rhombomeres
|
molecular signaling from occipital somites; motor nuclei develop within (C5, 6, 7, 9, 10, 12)
|
|
|
ectodermal placodes
|
form from surface ectoderm and then are populated by neural crest that form neurons; nasal, otic, epibranchial (ganglia to CN 5, 7, 9, 10 that supply pharyngeal arches)
|
|
|
proencephalon
|
forms telencephalon (cerebral hemisphere, lateral ventricles) and diencephalon (thalmus, third ventricle)
|
|
|
mesencephalon
|
forms midbrain, aqueduct, CN 3 and 4
|
|
|
rhombencephalon
|
forms metencephalon (pons, cerebellum, upper fourth ventricle) and myelencephalon (medulla, lower fourth ventricle)
|
|
|
intraembryonic cavity
|
formed from splitting of lateral ectoderm
|
|
|
mesoderms in embryo
|
splanchnic=around yolk sac, form gut tube; somatic= form body cavity, CT
|
|
|
somite
|
from paraxial mesoderm; sclerotome-migrate to nueral tuve and notochord, form mesenchyme, form vertebrae; dermamyotome- skin and muscles (4 occip. 8 cerv. 12 thor. 5 lumb. 5 sacral 8-10 coccy)
|
|
|
membranous neurocranium
|
mesenchyme to osteoblasts; intermembraneous ossification
|
|
|
cartilaginous neurocranium (chondrocranium)
|
sphenoid and ethmoid (prechoral, neural crest); parachordal cartilage, occip sclerotomes (chordal, paraxial mesoderm); wings of sphenoid, temporal bone (mesenchymal
|
|
|
neural crest contribution
|
to head from cranial end of neural tube; frontal, face bones, hyoids
|
|
|
paraxial mes. contribution
|
parietal, back of skull
|
|
|
visceral cranium
|
bones of face, hearing, first 2 pharyngeal arches (1-maxilla, zygomatic, squamous temporal, malleus, incus, mandible; 2-styloid, hyoid, stapes)
|
|
|
craniosynostosis
|
early closing of sutures; scaphocephaly= sagittal, brain moves ant and post; acrocephaly= coronal; plagiocephaly= coronal and lamboid on 1 side
|
|
|
forming limbs
|
upreg FGF10 to create limbs; BMP-4 form AER (apical ectodermal ridge and FGF8 (division) and FGF4 (keeps it going) work
|
|
|
craniocaudal limb form.
|
ZPA (zone of polarizing avtivity) has Shh expression (retinoic acid) that make correct order of digits; BMP-4 causes cell death btw digits
|
|
|
dorsoventral limb form.
|
LMXI and Wnt7a cause dorsalization; ventral caused by blocking Wnt
|
|
|
bones in limb
|
HOX genes 9-13 expression causes differentiation; 9-scapula, +10-humerous, +11-forearm, +12-wrist, +13-digits
|
|
|
limb deformities
|
amelia (limb absence), meromelia (partial absence), polydactyly (too many digits), ectrodactyly (missing digit), syndactyly (fusion of digits)
|
|
|
vertebrae formation
|
sclerotome cells attain intersegmental position; spinal nerve is above vertebrae; mesenchyme contain intersegmental arteries
|
|
|
formation of transverse foramina
|
CERVICALLY= costal processes fuse with transverse processes
|
|
|
ribs and sternum formation
|
ribs from mesenchymal; true- first 7 with sternum; false- last five; sternum from sternal bars in mmesenchyme of mesoderm; endochondral ossification bones
|
|
|
muscle formation
|
paraxial mesoderm- skeletal; splanchnic mesoderm- smooth and cardiac;
|
|
|
lower boundary of neck
|
superior thoracic aperature=T1, manubrium, 1st ribs (not clavicle)
|
|
|
external occip. protuberance
|
attachment of nuchal ligament
|
|
|
hyoid
|
floating, suspended by suprahyoid m., at level of C3
|
|
|
thryoid cartilage
|
thyroid notch, 2 quadrilateral laminae, lengthens vocal cords
|
|
|
cricoid cartilage
|
at C6, wide part- lamina, on posterior
|
|
|
superficial investing layer of deep fascia
|
splits to enclose SCM, trap, parotid gland, omohyoid, anterior and posterior of sternum (suprasternal space for ant. jugular vein), continuous with ligamentum nuchae
|
|
|
pretracheal fascia
|
wraps around back to viscera, forms buccopharyngeal in posterior
|
|
|
prevertebral fascia
|
scalenes, intrinsic, transverse processes
|
|
|
cervicoaxillary shealth
|
prevertebral fascia enveloping brachial plexus and axillary vessels
|
|
|
Sibson's fascia
|
at cervicothoracic aperature, prevertebral fasica over lung to form diaphragm
|
|
|
retropharyngeal space
|
infection place, between prevertebral and buccopharyngeal, air in space from injury to pharynx
|
|
|
pretracheal space
|
in front, thyroid cart to sup. mediastinum
|
|
|
triangles of neck
|
anterior triangle, posterior triangle (lateral cervical triangle)-bound by SCM, clavicle, trap.
|
|
|
SCM
|
innervated by CN X1, ventral rami C2-C4, makes lesser supraclavicular fossa (end of internal jugular), bilaterally- chin to chest, protude chin; unilaterally- rotate ear to shoulder
|
|
|
Torticollis "wry neck"
|
lesion of accessory nerve, pulls head forwards or ear on shoulder
|
|
|
roof of posterior cervical triangle
|
superficial deep fascia, pierced by cutaneous nerves of cervical plexus, external jugular vein
|
|
|
floor of post. cervical triangle
|
prevertebral fascia, semispinalis capitus, splenius capitis, levator scapulae, 3 scalenes, brachial plexus, omohyoid
|
|
|
levator scapulae
|
inn. by C3, C4, and dorsal scapular n. (C5); accessory nerve lies on top of it
|
|
|
scalenes
|
posterior= 2nd rib, C5-8 ventral rami; middle= 1st rib, C3-8 ventral rami; anterior=C4-6 ventral rami; flex neck, head forward, to one side, inspiration
|
|
|
veins of posterior cervical triangle
|
external jugular vein emptying into subclavian vein (drains upper limb); subclavian and internal jugular make up brachiocephalic
|
|
|
Accessory nerve and cervical plexus
|
Accessory nerve:: cranial root-attaches to vagus in medula; spinal root- C1-5, innervates SCM and trap.
|
|
|
CN X1 damage
|
commonly damaged iatrogenically (lymph node biopsies); cannot abduct above horizontal, shoulder dropped
|
|
|
Sensory of cervical plexus
|
C2-C4; lesser occipital nerve C2 some C3- skin behind ear; great auricular n. C2&3- ear, jaw, parotid; transverse cervical C2&3- anterior neck; supraclavicular C3&4- over clavicle, shoulder, upper thoracic (3 branches)
|
|
|
Erb's point
|
where sensory components of cervical plexus originate, not assoc w/ CNX1
|
|
|
brachial plexus
|
are ventral rami, roots of brachial plexus are C5-A1 (merge into trunks), between middle and anterior scalene
|
|
|
dorsal scapular nerve
|
C5, from middle scalene; inn. rhomboids and levator scapulae
|
|
|
long thoracic nerve
|
C5, C6, 42% C7; from middle scalene, inn serratus anterior
|
|
|
phrenic nerve
|
C3-C5, from on anterior scalene, from cervical plexus, innervates diaphragm, may have accessory from C5 (on top of brachial plexus)
|
|
|
nerve to subclavius
|
C5-C6
|
|
|
suprascapular n
|
to supra/infraspinatus by going under transverse scapular ligament
|
|
|
arteries of posterior triangle
|
subclavian a.; thryrocervical branch (transverse cervical a and suprascapular artery); occipital artery
|
|
|
suprascapular a
|
supplies supra/infraspinatus, SCM, subclavius
|
|
|
transverse cervical a
|
deep branch or dorsal scapular artery (from thyrocervical trunk or 3rd part of subclavian a)
|
|
|
aortic arch
|
left subclavian, left common carotid, brachiocephalic trunk on right (branches into right subclavian and right common carotid)
|
|
|
branches from subclavian artery part 1
|
vertebral a; thyrocervical trunk; internal thoracic a.
|
|
|
vertebral a
|
ascends and enters transverse foramen of C6, turns medially on posterior arch of C1, turns superiorly into foramen magnum, vertebral arteries combine and form basilar artery (from aortic arch in 1.2%)
|
|
|
thyrocervical trunk
|
interior thyroid a, ascending cervical a, transverse cervical a, suprascapular a
|
|
|
ascending cervical a
|
ascends on anterior scalene; supplies anterior scalene, longus capitis, spinal cord, and meninges
|
|
|
branches from subclavian artery part 2
|
usually only one branch: costocervical (branch into deep cervical a. and highest intercostal a.)
|
|
|
deep cervical a.
|
supples prevertebral m., epaxial m, anastamoses in suboccipital triangle
|
|
|
branches of subclavian a part 3
|
usually no branches; occasionally suprascapular or dorsal scapular
|
|
|
neurologic thoracic outlet syndrome
|
compression of brachial plexus; occurs with cervical rib, weight-lifting, or slumping
|
|
|
thyroid ima artery
|
from aortic arch or brachiocephalic trunk, ascends anterior to trachea, 10%
|
|
|
carotid sheath
|
deep fascial layer; common carotid a, internal jugular vein, vagus nerve, deep cervical lymph nodes, superior ramus of ansa cervicalis
|
|
|
carotid sinus
|
dilation at point to bifurcation of common carotid into external and internal (C3/C4); baroreceptors senses bp changes
|
|
|
carotid body
|
at bifurcation of carotids; chemoreceptor senses changes in O2 and CO2
|
|
|
branches of external carotid
|
superior thyroid a, ascending pharyngeal a, lingual, facial, occipital, posterior auricular, maxillary, superficial temporal
|
|
|
superior thyroid artery
|
deep to infrahyoid muscles; descends to give off superior laryngeal a.
|
|
|
lingual
|
deep to hypoglossal n and hyoglossus m; lies on middle pharyngeal constrictor m and arches to hyoid bone
|
|
|
fascial
|
deep to digastric and stylohyoid and submandibular gland
|
|
|
ascending pharyngeal a
|
branches to pharynx, prevertebral m, middle ear, meninges
|
|
|
internal jugular vein
|
united with subclavian to from brachiocephalic vein; tributaries: facial, lingual, pharyngeal, superior, 2 middle thyroid (occipital?) [inferior thyroid goes into brachiocephalic]
|
|
|
cervical pleura
|
lung into superior thoracic aperature and into supraclavicular fossae; "cupula"
|
|
|
thoracic duct
|
left side only, lymph from lower parts of body, empties into left brachiocephalic vein
|
|
|
right lymphatic drainage
|
variable; 3 separate connections to veins: right jugular trunk, right subclavian trunk, right bronchomediastinal trunk
|
|
|
deep cervical nodes
|
prelaryngeal, pretracheal, paratracheal flow to inferior deep cervical nodes and passes to supraclavicular nodes (also: submental, submandibular, upper/middle/lower lateral jugular)
|
|
|
cervical sentinal nodes
|
cancer spreading to these nodes and enlarges them
|
|
|
external jugular vein
|
from retromandiubular and posterior auricular veins
|
|
|
muscles of anterior triangle
|
suprahyoid (digastric, stylohyoid, mylohyoid, geniohyoid) and infrahyoid (omohyoid, sternohyoid, thyrohyoid, sternothyroid)
|
|
|
infrahyoid muscles
|
depress hyoid, "strap muscles" because develop in long. sheet, "rectus cervicis"; innervated by C1/2/3 ansa cervicalis n
|
|
|
digastric
|
mastoid notch, depresses mandible, facial n and CN V3
|
|
|
stylohyoid
|
facial nerve
|
|
|
mylohyoid
|
depresses mandible, CN V3
|
|
|
geniohyoid
|
inn by C1 (coursing with hypoglossal n); found uner mylohyoid
|
|
|
cricoidthyroid
|
not an infrahyoid muscle; of the larynx, speech
|
|
|
hypoglossal nerve (CN X11)
|
extrinsic and intrinsic m of tongue
|
|
|
prevertebral muscles
|
longus colli/capitis; rectus capitis anterior/lateralis; scalene muscles; flex neck and head; ventral primary rami; in vertebral fascia
|
|
|
longus colli
|
anterior tubercles of C5/6 to bodies T1/2/3; bodies C5-T3 to C2-4; TP C3-5 to anterior arch of C1
|
|
|
longus capitis
|
anterior tubercles C3-6 to occipital bone
|
|
|
rectus capitis anterior
|
lateral mass of atlas to skull
|
|
|
rectus capitis lateralis
|
TP of atlas into occipital bone
|
|
|
scalenes
|
supplied by ascending cervical artery; anterior C4-C6; middle C3-C8; posterior C5-8
|
|
|
thyroid gland
|
two lateral lobes and isthmus; pyramidal lobe in 50% from thyroglossal duct; in pretracheal fascia;
|
|
|
thyroid veins
|
superior and middle (to internal jugular) and inferior (to brachiocephalic)
|
|
|
recurrent laryngeal n
|
branch of vagus n, talking, control muscles of larynx, not bilaterally sym
|
|
|
parathyroid glands
|
supplied by inferior thyroid artery or from anastomosis; drained by thryoid plexus of veins; superior-midpoint, at cricoid cart
|
|
|
tracheostomy
|
cricothyrotomy (in children, higher left brachiocephalic vein), high, or low
|
|
|
esophagus
|
begins at inferior of cricoid cartilage; btw trachea and ant long ligament; contacts right cervical pleua and left subclavian a; covered by vagus n.; supplied by inferior thyroid a. and v.
|
|
|
cervical plexus general
|
ventral primary rami C1-4 (C5 contributes to phrenic); ansa cervicalis (motor); contributes to spinal accessory
|
|
|
cervical plexus sensory
|
C2-4; middle posterior border of SCM-Erb's point; lesser occipital, great auricular, transverse cervical, supraclavicular
|
|
|
ansa cervicalis
|
motor; supples infrahyoids and geniohyoid; superior (C1/2, within carotid sheath) and inferior (C2/3)
|
|
|
phrenic nerve
|
C3-5; on anterior scalene, motor and sensory to diaphragm
|
|
|
cervical propioception
|
C2-4 from trapezius and SCM
|
|
|
rectus capitis lateralis/anterior innervation
|
C1-2 loop
|
|
|
longus capitis/colli innervation
|
capitis: C1-2 loop; colli: C2-4
|
|
|
levator scapulae innervation
|
C3-C4
|
|
|
brachial plexus
|
accessory phrenic n (C5); nerve to subclavius (C5-6); suprascapular (C5-6)
|
|
|
branches of vagus nerve
|
superior laryngeal, pharyngeal, meningeal, auricular, carotid, cardiac, recurrent laryngeal
|
|
|
superior laryngeal n
|
internal-sensory to larynx; external-motor to cricothyroid
|
|
|
recurrent laryngeal n
|
loops around rt subclavian a. and lt aortic arch, posterior to thryoid, ascend to larynx; supply intrinsic larynx muscles
|
|
|
glossopharyngeal nerve (IX)
|
branches: muscular, pharyngeal, carotid sinus, tympanic, lesser petrosal n
|
|
|
muscular branch of CN IX
|
innervates stylopharyngeus m
|
|
|
lesser petrosal n
|
extension of tympanic n., synapses in otic ganglion, parasym. to parotid gland
|
|
|
cervical sympathetic trunk
|
posterior to carotid sheath, lies on prevertebral fascia; splits into ansa subclavia
|
|
|
superior cervical ganglion
|
C1-4; CN9,10,12; internal/external carotids; pharyngeal plexus
|
|
|
middle cervical ganglion
|
branches to C5/6, at level of cricoid cartilage
|
|
|
cervicothoracic ganglion
|
inferior cervical and first thoracic ganglia; form vertebral plexus
|
|
|
Horner's syndrome
|
damage to cervical sym trunk; pupillary constriction, ptosis of upper eyelid, sinking of eye, vasodilation (redness), no sweating (anhidrosis), hypopigmentation of iris (in congentital cases)
|
