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Neck Contents Cervical Kinematics .................... 74 Thyrohyoid & Sternothyroid ....... 92 Cervical AROM ............................. 75 Sternohyoid .................................. 93 Cervical Bones ............................. 76 Omohyoid ..................................... 94 Cervical Ligaments ...................... 77 Rectus Capitis Ant. & Lateralis .. 95 Posterior Neck Muscles .............. 78 Longus Capitis ............................. 96 Anterior & Lateral Neck .............. 79 Longus Cervicis (colli) ................ 97 Trapezius (upper fibers) .............. 80 Scalene Muscle Group ................ 98 Levator Scapulae ......................... 82 Scalenus Minimus ....................... 100 Splenius Capitis & Cervicis ........ 84 Anterior Scalene .......................... 101 Suboccipital Muscles .................. 86 Middle Scalene ............................. 102 Sternocleidomastoid (SCM) ........ 88 Posterior Scalene ........................ 103 Suprahyoid Muscles .................... 90 Larynx ........................................... 104 Neck References ................................... 106 Surface anatomy Myofascial Bony Landmarks Video Demo Palpation Checklist prohealthsys.com □ Mandible & TMJ □ Clavicle/SC joint □ Semispinalis cerv./cap. □ Masseter/Parotids □ Suprasternal notch □ Suboccipitals □ Submandibular gland □ Scalenes/brachial plexus □ Facet joints / Articular pillars □ Submental gland □ SCM & mastoid □ Spinous processes (C2-C7) □ Hyoid bone □ Carotid pulse □ T1 SP & upper rib motion □ Trachea & larynx □ Upper trapezius □ . □ Thyroid gland □ Levator scapulae □ . □ Lymph nodes □ Splenius cervicis □ . Vizniak & Richer www.prohealthsys.com Neck | 73 3 - MM Neck 2014.indd 73 2014-01-04 2:02:10 AM Cervical Kinematics Joint types: Close packed position C-spine: full extension Gliding (zygapophyseal joints) TMJ: teeth clenched Pivot (atlantoaxial joint) Fibrocartilaginous (intervertebral joints) Capsular pattern of restriction C-spine: lateral flexion = rotation, extension Hinge & gliding (TMJ) TMJ: limitation of mouth opening Articular surfaces Normal end feel Atlanto-occipital joint: convex (occipital Flexion: tissue stretch condyles of occiput) on concave (superior Extension: tissue stretch articular facets of atlas) Lateral flexion: tissue stretch Rotation: tissue stretch Atlantoaxial: concave (articular facet for dens Neck on atlas) on convex (anterior facet of dens Abnormal end feel on axis) Early myospasm → muscle/ligament tear Zygapophyseal: facets are oriented 45° Late myospasm → instability Empty → ligament rupture Intervertebral discs: horizontal plane Hard → bone approximation (osteophyte) TMJ: convex (mandibular condyle & disc) on concave (mandibular fossa of temporal bone) Coupled motions Pure rotation and pure lateral flexion do not occur at Active range of motion any region in the spine below C2 Flexion .........................60° C2-T5 vertebral segments Extension ....................60° • Ipsilateral flexion & lateral flexion • Left lateral flexion coupled with left rotation Lateral Flexion ............45° • Right lateral flexion coupled with right rotation Rotation .......................80° TMJ ..............................35-50 mm opening TMJ 3 Knuckle or 3-Finger Test: (3 knuckle test) With normal TMJ ROM patient should be able to place three knuckles or Main muscle actions fingers between open teeth Flexion: sternocleidomastoid (SCM), longus coli, longus capitis, rectus capitis anterior Extension: trapezius, splenius cervicis & capitis, longissimus capitis, suboccipitals Lateral flexion: splenius capitis & cervicis, levator scapula, trapezius, longissimus capitis, scalenes, rectus capitis lateralis Rotation: SCM, longus capitis & coli, rotatores, splenius, suboccipitals Resting position C-spine: slight extension TMJ: mouth closed with teeth not in contact 74 | Muscle Manual www.prohealthsys.com Vizniak & Richer 3 - MM Neck 2014.indd 74 2014-01-04 2:02:10 AM Cervical AROM Introduction statement: “Try and move as far as possible, if any of the actions or movements are painful please let me know, do not do any action you feel will cause you further injury.” Flexion (50º-70º) Muscles Activated: sternocleidomastoid (SCM), longus cervicis, longus capitis, rectus capitis anterior; eccentric contraction of upper trapezius, splenius, semispinalis, longissimus capitis Tissue Stretched: trapezius, splenius cervicis & capitis, longissimus capitis, suboccipitals, nuchal ligament, interspinous ligament, posterior IVD, posterior facet joint capsule Flexion Tissue Compressed: anterior neck muscles, trachea, esophagus, carotid arteries Neck Extension (50º-70º) Muscles Activated: trapezius (upper), splenius cervicis & capitis, longissimus capitis, suboccipitals Tissue Stretched: anterior neck muscles, anterior longitudinal ligament, anterior IVD, trachea, esophagus, carotid arteries Tissue Compressed: posterior neck muscles, posterior intervertebral discs, facet (z-joints) joints, vertebral arteries Extension Lateral Flexion (45º-60º) Muscles Activated: ipsilateral: trapezius (upper), splenius cervicis & capitis, longissimus capitis, levator scapulae, suboccipitals Tissue Stretched: contralateral: trapezius (upper), longissimus capitis, SCM, lateral IVD, carotid artery, z-joints Tissue Compressed: ipsilateral: trapezius (upper), longissimus capitis, SCM, lateral IVD, carotid artery, Lateral Flexion z-joints Rotation (80º-90º) Muscles Activated: ipsilateral: splenius cervicis & capitis, suboccipitals; contralateral: SCM Tissue Stretched: contralateral: splenius cervicis & capitis, suboccipitals; ipsilateral: SCM Tissue Compressed: ipsilateral: splenius cervicis & capitis, suboccipitals; contralateral: SCM Rotation Vizniak & Richer www.prohealthsys.com Neck | 75 3 - MM Neck 2014.indd 75 2014-01-04 2:02:11 AM Cervical Bones posterior view lateral view anterior view C1 C2 C3 C4 C5 Articular pillar C6 C7 Neck T1 C1 - Atlas 1. Posterior tubercle (no spinous process) 2 3 2. Posterior arch 3. Anterior arch 1 4 4. Anterior tubercle 8 5. Lateral mass (no vertebral body) 7 10 6. Transverse process 10 5 9 6 7. Transverse foramen 8. Articular facet for dens 9. Articular process (superior & inferior) 10. Superior articular facet C2 - Axis 1. Dens (odontoid process) 3 4 2. Spinous process (bifid) 5 2 3. Lamina 4. Transverse process 1 6 5. Superior articular facet 10 7 6. Body 5 8 7. Pedicle 8. Transverse foramen 9. Inferior articular facet 9 10. Facet for anterior arch of C1 Typical Cervical Vertebra 3 4 1. Spinous process (bifid) 2 2. Lamina 1 10 5 3. Transverse process 4. Transverse foramen 6 5. Body 6. 9 Pedicle 7 7. Superior articular facet 8 8. Inferior articular process 9. Uncinate process (uncus) 10. Vertebral canal (spinal cord) 76 | Muscle Manual www.prohealthsys.com Vizniak & Richer 3 - MM Neck 2014.indd 76 2014-01-04 2:02:11 AM Cervical Ligaments posterior view lateral view anterior view 1 5 2 6 3 7 4 Neck 1. Posterior atlanto-occipital membrane posterior view with vertebral 2. Posterior atlantoaxial membrane lamina & SPs removed 3. Capsular ligaments (zygapophyseal) 4. Nuchal ligament 5. Anterior atlanto-occipital membrane 6. Anterior atlantoaxial membrane 8 7. Anterior longitudinal ligament 8. Tectorial membrane 9 9. Posterior longitudinal ligament 10 10. Alar ligaments 11. Cruciform / cruciate ligament 12. Apical ligament C1-C2 Articulation (lateral view) 11 9 12 Vizniak & Richer www.prohealthsys.com Neck | 77 3 - MM Neck 2014.indd 77 2014-01-04 2:02:11 AM Posterior Neck Muscles 1. Occipitalis Superficial 2. Trapezius (upper fibers) 3. Splenius capitis 1 4. Splenius cervicis 5. Levator scapulae 6. Rhomboid minor 7. Spinalis capitis 8. 2 Semispinalis capitis 9. Longissimus capitis Neck 3 4 5 6 7 8 9 Deep 10 11 lateral view 10 13 11 12 12 Suboccipital muscles* 10. Rectus capitis posterior minor* 13 14 11. Rectus capitis posterior major* 12. Obliquus capitis inferior* 13. Obliquus capitis superior* 14. Interspinalis 78 | Muscle Manual www.prohealthsys.com Vizniak & Richer 3 - MM Neck 2014.indd 78 2014-01-04 2:02:12 AM Anterior & Lateral Muscles Superficial 1 2 3 Neck 7 2 4 8 12 16 9 10 8 10 9 11 5 6 1. Platysma 2. Sternocleidomastoid 3. Trapezius 4. Omohyoid 5. Sternohyoid 6. Sternothyroid 7. Thyrohyoid 8. Middle scalene 13 9. Posterior scalene 14 10. Anterior scalene 11. Scalenus minimus 15 12. Levator scapulae 16 13. Rectus capitis lateralis 14. Rectus capitis anterior 15. Longus capitis 16. Longus cervicis Deep Lines indicate muscle attachments to the base of the skull How to check the integrity of your deep neck flexors: lying supine, flex neck with chin tucked to ~45°, hold for 30 seconds (no hands) - Can you do this without shaking or dropping your head? Vizniak & Richer www.prohealthsys.com Neck | 79 3 - MM Neck 2014.indd 79 2014-01-04 2:02:13 AM Trapezius (upper fibers) upper: EOP, nuchal line & nuchal ligament O middle: SPs of C7-T5 lower: SPs T5-T12 I 1 lateral /3 of clavicle, acromion, spine of scapula elevation & retraction (adduction) of scapula upward rotation of scapula A unilateral: lateral flexion of head bilateral: extension of head stabilization of scapula for arm movements Neck N spinal accessory (CN XI), ventral rami of C2-C4 B transverse cervical & dorsal scapular arteries S levator scapulae Clinical Notes • Anatomical variation: clavicular insertion may extend to middle of clavicle, or blend with posterior edge of SCM; attachments to thoracic vertebrae are sometimes reduced (up to as high as T7); often separations between the cervical & thoracic portions
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  • An Unusual Case of Axillary Arch Bridging Across the Anterior and Posterior Axillary Folds in the Distal Part of Axilla

    An Unusual Case of Axillary Arch Bridging Across the Anterior and Posterior Axillary Folds in the Distal Part of Axilla

    eISSN 1308-4038 International Journal of Anatomical Variations (2011) 4: 128–130 Case Report An unusual case of axillary arch bridging across the anterior and posterior axillary folds in the distal part of axilla Published online June 28th, 2011 © http://www.ijav.org Mohandas RAO KG ABSTRACT Somayaji SN Axillary arch is an additional muscle slip extending usually from the latissimus dorsi in the posterior fold of the axilla, to Narendra PAMIDI the pectoralis major or other neighboring muscles and bones. In the present case presence of such unusual axillary arch Surekha D SHETTY innervated by the fine twigs of musculocutaneous nerve has been reported. During routine dissection of axilla region in one of the upper limbs, the occurrence of axillary arch was observed. The muscle fibers were posteriorly continuous with the belly of latissimus dorsi and anteriorly were merging with fleshy fibers of pectoralis major on its deeper surface. The fibers of the axillary arch were innervated by fine twigs from the musculocutaneous nerve. Position of the axillary arch and its critical relationship with neurovascular bundle has been discussed. Further, a detailed literature review was Department of Anatomy, Melaka Manipal Medical College, Manipal University, Manipal, INDIA. done and the surgical and clinical importance of the case was discussed. © IJAV. 2011; 4: 128–130. Dr. Mohandas Rao KG Associate Professor of Anatomy Melaka Manipal Medical College (Manipal Campus) Manipal University Manipal, 576 104, INDIA. +91 984 4380839 [email protected] Received September 30th, 2010; accepted June 14th, 2011 Key words [axillary arch] [musculocutaneous nerve] [axilla] [latissimus dorsi] [pectoralis major] Introduction the belly of latissimus dorsi just proximal to its insertion.