Head And Neck - Pt 6140 - Exam #3

Front 1

Cervical plexus
-Provides innervation for?
-Formed by?
-Location?
-CN XI

Back 1

-Facial muscles and cutaneous head and neck
-Anterior rami of C1-4
-Anterior to scalene medius and levator scapulae
-CN XI pierces middle of posterior border of SCM on its way to trapezius (motor function)

Front 2

Spinal cord:
1. Cervical enlargement
2. Lumbosacral enlargements
3. Ending?

Back 2

1. C5-T1 where anterior rami give rise to brachial plexus
2. L1 - S2 where anterior rami give rise to lumbar and sacral plexus
3. Ends at L2 and then becomes cauda equina

Front 3

Brachial Plexus:
-Formed by?
-Components medial to lateral

Back 3

-Anterior rami of C5-C8 to T1
-Roots (AR of C5-T1), Trunks (3 total), Divisions (Anterior/posterior), Cords (3 total), Branches (musculocutaneous, median, radial, ulnar)

Front 4

Brachial Plexus:
-Roots
-Trunks

Back 4

-Roots: Pass between scalene medius and anterior, posterior and superior to subclavian artery

-Trunks: Pass laterally over 1st rib to enter the axilla.
-Superior from C5 and C6 root
-Middle from C7 root
-Inferior from C8 and T1 root and is posterior to subclavian artery

Front 5

Brachial Plexus:
-Divisions

Back 5

-Divisions: trunks divide into anterior/posterior at level of clavicle.
-Posterior eventually give rise to peripheral nerves that innervate posterior arm/forearm
-Anterior eventually give rise to peripheral nerves that innervate anterior arm/forearm

Front 6

Brachial Plexus:
-Cords

Back 6

-named based on their relationship to axillary artery
-Most peripheral nerves arise from cords
-Lateral and medial cord innervate anterior compartment while posterior cord innervate posterior compartment

-Lateral: Anterior divisions of superior and middle trunk with contributions from C5,6,7
-Posterior: Posterior divisions of all 3 trunks with contributions from C5-T1.
-Medial: continuation of inferior trunk with contributions from C8 and T1.

Front 7

Brachial plexus: Branches
-Musculocutaneous

Back 7

Muscuolcuteanous:
-arises from lateral cord (C5-7) at lower border of pec minor, pierces coracobrachialis, passes between biceps and brachialis
-Muscular component = coracobrachialis, brachialis, biceps
-Cutaneous component = (after elbow) lateral forearm to wrist

Front 8

Brachial Plexus: Branches
-Median

Back 8

Median:
-arises from lateral and medial cord (C5-7 and C8, T1)
-Runs lateral to brachial artery, then medial to brachial artery at the cubital fossa where it continues to remain medial
-Muscular: all forearm flexors (except FCU, medial 1/2 FDP), thenar eminance (except FPB), lateral 2 lumbricals
-Cutaneous: dorsal aspect of digits, thenar eminance, palmar radial 3.5 digits

Front 9

Brachial Plexus: Branches
-Radial

Back 9

Radial:
-arises from posterior cord (C5-T1) and is largest branch
-leaves axilla posteriorly via triangular interval
-runs anteriorly between brachialis and brachioradialis
-At the lateral epicondyle, runs between 2 heads of supinator to give rise to the PIN
-Muscular: all muscles of the posterior arm and forearm
-Cutaneous: all skin on posterior arm and forearm, lower lateral arm and dorsal lateral hand

Front 10

Triangular Interval

Back 10

Medial border = long head of triceps
Lateral border = humerus
Superior border = teres major

Front 11

Brachial Plexus: Branches
-Ulnar

Back 11

Ulnar:
-arises from medial cord (C8, T1)
-runs down arm medial to brachial artery, posterior to medial epicondyle between 2 heads of the FCU
-Muscular: FCU, medial 1/2 FDP and all hand intrinsics (except thenar eminance and lateral 2 lumbricals)
-Cutaneous: palmar and dorsal medial 1.5 digits

Front 12

Brachial Plexus: Branches of the roots
-Dorsal Scapular
-Long Thoracic
-Contribution of Phrenic Nerve

Back 12

Dorsal Scapular:
-Arises from C5 root
-Pierces scalene medius to run medial to scapula
-Innervate rhomboids and sometimes levator scapulae

Long Thoracic
-innervates serratus anterior

Front 13

Brachial Plexus: Branches of the trunks
-Suprascapular
-Subclavian

Back 13

-Comes off of superior trunk

Suprascapular: Supraspinatus and infraspinatus
Subclavian: Subclavius muscle

Front 14

Brachial Plexus: Branches of the cords
-Lateral cord
-Medial cord
-Posterior cord

Back 14

Lateral cord
-Lateral pectoral: Pectoralis major

Medial cord
-Medial antebrachial: cutaneous innervation of medial forearm
-Medial brachial: cutaneous innervation of medial arm
-Medial pectoral: muscular innervation of pec major and minor

Posterior cord
-Lower subscapular: subscapularis and teres major
-Thoracodorsal: latissimus dorsi
-Upper subscapular: subscapularis

Front 15

Brachial Plexus: Axillary nerve

Back 15

-arises from posterior cord
-passes through quadrilateral space
-splits into anterior and posterior components
-anterior innervates deltoids
-posterior innervates teres minor

Front 16

Temporalis
-attachment, action, innvervation

Back 16

-Lateral skull - coranoid process of the mandible
-elevate and retract mandile, powerful biting and chewing
-mandibular branch of trigeminal nerve

Front 17

Masseter
-Attachment, action, innervation

Back 17

-zygomatic arch - lateral surface of the mandibular ramus
-elevate mandible, powerful biting and chewing
-mandibular branch of the trigeminal nerve

Front 18

Medial Pterygoid
-Attachment, action, innervation

Back 18

-Medial surface of the lateral pterygoid plate - medial surface of the angle of the mandible
-bilaterally elevates mandible
-unilaterally produces contralateral deviation of the mandible (side to side chewing)
-mandibular branch of the trigeminal nerve

Front 19

Cervical flexion/extension AROM

Back 19

Flexion:
-initiated and ended with lower C/S (C4-7)
-CV (OA and AA) and middle C/S (C2-4) mostly during middle ROM
-terminal flexion = CV moves into extension

Extension:
-similar
-CV reaches max extension at end range

Front 20

Scalene Anterior
-Attachments, action, innervation

Back 20

-Anterior tubercles of C3-6 - scalene tubercle of the first rib
-bilateral flexor, fixes first rib during diaphragm action and active during quiet respiration
-unilateral ipsilateral side flex and contralateral rotator
-VR C4-6

Front 21

Scalene Medius
-Attachments, action, innervation

Back 21

-PT of the TP's C2-7 - upper border of rib 1
-unilateral ipsilateral side flexor
-fixes 1st rib during diaphragm action and active during quiet respiration
-pierced by dorsal scapular nerve and is separated from scalene anterior by subclavian artery
-VR C4-6

Front 22

Scalene posterior
-attachments, action, innervation

Back 22

-Posterior tubercles of C4-6 - outer aspect of rib 2
-fixes 2nd rib and stabilize scapula, ipsilateral side flexor
-VR C5-7

Front 23

Sternocleidomastoid
-Attachment
-Action
-Innervation

Back 23

-Mastoid process to SH: SC Joint and CH: medial 1/3 clavicle
-Bilaterally: flexes upper C/S, extends lower C/S, whiplash, gaze and spatial orientation, works with UFT to stabilize head during chewing and talking
-Unilaterally: contralateral rotator, ipsilateral side flexor
-CN XI

Front 24

RCP +

Back 24

-SP of C2 - lateral nuchal line
-extension
-DR of C1

Front 25

RCP -

Back 25

-posterior tubercle of C1 - medial nuchal line
-extension
-DR of C1

Front 26

Inferior oblique

Back 26

-SP of C2 - TP of C1
-ipsilateral rotator
-DR of C1

Front 27

Superior oblique

Back 27

-TP of C1 - lateral nuchal line
-extension and ipsilateral side flexor
-DR of C1

Front 28

Suboccipitals

Back 28

-connect occiput to the atlas and axis
-extension of OA and AA joints
-50% of C/S transverse plane rotation occurs at the AA join
-33% of C/S saggital plane flexion occurs at OA joint
-mechanoreceptor density = posture and sensory information
-primarily slow twitch muscles