GL 3: Posterior Triangle of the Neck Flashcards by Gianina Arzadon

T or F: The sternocleidomastoid divides the neck into right and left triangles

False. It divides the neck into anterior and posterior triangles

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What is the inferior part of the triangle of the neck?

The Clavicle

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What makes up the muscular floor?

Splenius capitis
Levator scapulae
Scalene muscles

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Triangles of the neck: What are the boundaries of the occipital triangle?

Sternocleidomastoid
Trapezius
Inferior belly of the omohyoid

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Triangles of the neck: What are the 3 major contents of the occipital triangle?

Occipital artery
Spinal accessory nerve
Brachial plexus

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Triangles of the neck: What are the boundaries of the Supraclavicular/Subclavian/Omoclavicular triangle?

Sternocleidomastoid
Inferior belly of the omohyoid
Clavicle

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Triangles of the neck: What is the major content of the occipital triangle?

Subclavian artery

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OINA of the Sternocleidomastoid

O: Manubrium sterni, clavicle (medial third)
I: Mastoid process of occipital bone
N: Spinal part of the accessory nerve
A: Extend head and flex neck; rotates the head to the opposite side

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OINA of the Trapezius

O: Occipital bone, ligamentum nuchae, and spines of C7 and all thoracic vertebre
I: Continuous insertion alone acromion and spine of the scapula and lateral third clavicle
N: CN XI (accessory nerve); C3-C4
A: Stabilizes, elevates, retracts, and rotates scapula

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OINA of the Scalenus Anterior

O: Transverse process of C3-C6
I: 1st rib
N: C4-C6
A: Elevate 1st rib during inspiration, lateral flexion and rotation of the cervical part of the vertebral column

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What is the key muscle in understanding the root of the neck?

Scalenus Anterior

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What makes up the Interscalene triangle?

Scalenus anterior
Medius muscles
1st rib from a triangular gap

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What 2 structures pass through the Interscalene triangle?

Subclavian artery

Roots of the Brachial Plexus

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What divides the subclavian artery into 3 parts?

Scalenus Anterior

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What 4 neurovascular structures are anterior to the Scalenus Anterior?

Carotid sheath and contents (CCA, IJV, CN X)
Transverse cervical artery
Suprascapular artery
Phrenic nerve

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What 4 neurovascular structures are posterior to the Scalenus Anterior?

Cervical pleura
Origin of the Brachial Plexus
2nd part of the Subclavian artery
Scalenus medius

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What 3 neurovascular structures are medial to the Scalenus Anterior?

Vertebral vessels
Sympathetic trunk
Left Thoracic duct

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What 3 neurovascular structures are lateral to the Scalenus Anterior?

Branches of the cervical plexus
Roots of the brachial plexus
3rd part of the subclavian artery

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OINA of the Scalenus Medius

O: Transverse process of the C1-C6
I: 1st rib
N: Anterior rami of cervical nerves
A: Elevation of 1st rib; lateral flexion; rotation oof the cervical part of the vertebral column

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OINA of the Scalenus Posterior

O: Transverse processes of C4-C6
I: 2nd rib
N: Anterior rami cervical nerves
A: Elevates 2nd rib; laterally flexes; rotates cervical part of the vertebral column

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OINA of the Levator Scapula

O: Transverse processes of C1-C4
I: Medial border of the scapula
N: Ventral primary rami (C3-C4); dorsal scapular nerve
A: Raises medial border of the scapula; bends neck laterally

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OINA of the Splenius Capitis

O: Ligamentum nuchae; Upper 4 thoracic spines
I: Superior nuchal line of the occipital bone
N: Dorsal primary rami of the spinal nerve
A: Bends neck laterally; elevates medial border of the scapula

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What is formed by the anterior rami of the first 4 cervical spinal nerves (C1-C4)?

Cervical Plexus

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Where is the cervical plexus formed?

In front of the origin of the Levator scapulae and Scalenus medius muscle

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What is the cervical plexus covered in and related to?

Covered in prevertebral layer of deep cervical fascia | Related to the internal jugular vein within the carotid sheath

What are the 4 sensory branches of the cervical plexus?

``` Lesser occipital (C2) Greater auricular (C2-C3) Transverse cervical (C2-C3) Supraclavicular (C3-C4) ```

What are the 3 motor (muscular) branches of the cervical plexus?

Proprioceptive (C2-C3) C3-C4 Proprioceptive (C3-C4)

What is the mixed branch of the cervical plexus?

Phrenic (C3-C5)

What is the distribution of the Lesser Occipital (C2) branch of the cervical plexus?

Supplies the back of the scalp and auricle

What is the distribution of the Greater Auricular (C2-C3) branch of the cervical plexus?

Supplies the skin over the angle of the mandible

What is the distribution of the Transverse Cervical (C2-C3) branch of the cervical plexus?

Supplies skin over the front of the neck

What is the distribution of the Supraclavicular (C3-C4) branch of the cervical plexus?

Supplies the skin over the shoulder region

These nerves are important clinically because pain may be referred along them from the phrenic nerve (gallbladder disease)

The Supraclavicular branch of the cervical plexus

What is the distribution of the proprioceptive C2-C3 motor branch of the cervical plexus?

Supplies prevertebral muscles and sternocleidomastoid

What is the distribution of the C3-C4 motor branch of the cervical plexus?

Levator scapulae

What is the distribution of the proprioceptive C3-C4 motor branch of the cervical plexus?

Trapezius

T or F: A branch from C1 joins the hypoglossal nerve

True

What forms the Ansa Cervicalis?

Descending C1 branches that leave the hypoglossal nerve | Descending C2-C3 cervical nerve

What does the Ansa Cervicalis innervate?

Infrahyoid muscles: SOS - Sternohyoid - Omohyoid - Sternothyroid

What is the distribution of the Phrenic C3-C5 mixed branch of the cervical plexus, the largest branch?

Diaphragm

What do the motor and sensory branches of the Phrenic nerve supply?

Motor: Diaphragm Sensory: Pericardium, Medistinal Parietal Pleura, Pleura and Peritoneum covering the diaphragm

What forms the Brachial Plexus?

Anterior rami of C5-C8 and T1

What are the 4 general components of the Brachial Plexus?

(In order) Roots, trunks, divisions, and cords

What forms the upper trunk of the Brachial Plexus?

Roots of the C5-C6

What forms the middle trunk of the Brachial Plexus?

Root of C7

What forms the lower trunk of the Brachial Plexus?

Roots of the C8 and T1

Where are the roots and trunks of the Brachial Plexus located?

Posterior triangle of the neck

T or F: The roots of the Brachial Plexus enter the base of the neck between the Scalenus Anterior and the Scalenus Posterior

False. The roots of the Brachial Plexus enter the base of the neck between the Scalenus Anterior and the Scalenus Medius muscles

What forms the lateral cord of the Brachial Plexus?

Anterior divisions of the upper and middle trunk

What forms the medial cord of the Brachial Plexus?

Anterior divisions of the lower trunk

What forms the posterior cord of the Brachial Plexus?

Posterior divisions of all 3 trunks (upper, middle, lower)

Where are the cords of the Brachial Plexus located?

Axilla

How are cords classified?

Based on their relationship with the 2nd part of the axillary artery

Branches of the Brachial Plexus: What are the roots and distribution of the Dorsal Scapular Nerve?

C5 | Rhomboid minor and major, Levator Scapulae muscles

Branches of the Brachial Plexus: What are the roots and distribution of the Long Thoracic nerve?

C5-C7 | Serratus muscle

Branches of the Brachial Plexus: What are the roots and distribution of the Suprascapular nerve?

C5-C6 | Supraspinatus, Infraspinatus

Branches of the Brachial Plexus: What are the roots and distribution of the Nerve to the Subclavius (Accessory Phrenic nerve)?

C5-C6 Subclavius *gives contribution to phrenic nerve

Branches of the Brachial Plexus: What are the roots and distribution of the Lateral Pectoral nerve?

C5-C7 | Pectoralis major

Branches of the Brachial Plexus: What are the roots and distribution of the Musculocutaneous nerve

C5-C7 | Coracobrachialis, Biceps Brachii, Brachialis

Branches of the Brachial Plexus: What are the roots and distribution of the Upper Subscapular nerve?

C5-C6 | Subscapularis

Branches of the Brachial Plexus: What are the roots and distribution of the Lower Subscapular nerve?

C5-C6 | Subscapularis, Teres major

Branches of the Brachial Plexus: What are the roots and distribution of the Axillary nerve?

C5-C6 | Deltoid, Teres minor

Branches of the Brachial Plexus: What are the roots and distribution of the Thoracodorsal nerve?

C6-C8 | Latissimus dorsi

Branches of the Brachial Plexus: What are the roots and distribution of the Radial nerve?

C5-C8 and T1 | Triceps, Anconeus, part of the Brachialis, forearm, hand and finger muscles

Branches of the Brachial Plexus: What are the roots and distribution of the Medial Pectoral nerve?

C8 and T1 | Pectoralis major and minor

Branches of the Brachial Plexus: What are the roots and distribution of the Medial Cutaneous nerve?

C8 and T1 | Skin of the medial side of the arm

Branches of the Brachial Plexus: What are the roots and distribution of the Medial Cutaneous nerve of forearm?

C8 and T1 | Skin of medial side of forearm

Branches of the Brachial Plexus: What are the roots and distribution of the Ulnar nerve?

C8 and T1 | Hand and finger muscles

Branches of the Brachial Plexus: What are the roots and distribution of the Lateral root of the Median nerve?

C5-C7 | Forearm, hand and finger muscles

Branches of the Brachial Plexus: What are the roots and distribution of the Medial root of Median nerve?

C5-C8 and T1 | Forearm, hand and finger muscles

What are the 2 sources that form and course the Spinal Accessory nerve?

Cranial root and Spinal root

Where does the Cranial Root of the Spinal Accessory nerve originate?

Medulla Oblongata

Where does the Spinal Root of the Spinal Accessory nerve emerge from?

Nerve cells in the Anterior Gray Horn of the upper 5 Cervical Spinal nerves

What is the order of the formation and course of the Spinal Accessory nerve? 1. The roots separate with the Cranial Root joining the Vagus nerve, which supplies the Soft Palate, Pharynx, and Larynx 2. Spinal Accessory nerve leaves the skill via the Jugular Foramen 3. From the spinal cord, the Spinal nerves travel upwards towards the location of the Cranial Roots 4. The Spinal Root ends up supplying the Sternocleidomastoid and Trapezius 5. The Spinal and Cranial Roots unite at the Posterior Cranial Fossa 6. As the Spinal nerves go up, it enters the Foramen Magnum

3 - 6 - 5 - 2 - 1 - 4

Where are the 5 locations of the Sympathetic Ganglia in the neck?

Based on the skull to the neck of the 1st rib Behind interior and common carotid arteries Medial to the Vagus Embedded in deep fascia Between carotid sheath and prevertebral layer

Name the 3 ganglia of the sympathetic trunk

Superior cervical ganglion Middle cervical ganglion Inferior cervical ganglion

Where is the Superior cervical ganglion located?

Below the skull

Where is the Middle cervical ganglion located?

Level of the cricoid cartilage

Where is the Inferior cervical ganglion located?

Near the transverse process of the 7th Cervical vertebra or the 1st Thoracic vertebra

T or F: the Inferior cervical ganglion usually joins the ganglia of the 1st Thoracic Vertebra to form the Stellate Ganglion

True

Branches of the Superior Cervical Ganglion: Where is the Internal Carotid nerve located?

NOTE: They are postganglionic fibers | Accompanies ICA

Branches of the Superior Cervical Ganglion: Where is the Gray Rami Communicantes located?

To the upper 4 rami of cervical nerves

Branches of the Superior Cervical Ganglion: Where are the Arterial branches located?

To the common and external carotid arteries

Branches of the Superior Cervical Ganglion: Where are the Cranial Nerve branches located?

Joins the CN IX, CN X, and CN XII

Branches of the Superior Cervical Ganglion: Where are the Pharyngeal branches located?

Unites with the glossopharyngeal and vagus nerves

Branches of the Superior Cervical Ganglion: Where is the Superior Cardiac branch located?

Descends in the neck; ends in the Cardiac Plexus

What are the 6 branches of the Superior Cervical Ganglion?

``` Internal Carotid nerve Gray Rami Communicantes Arterial branches Cranial Nerve branches Pharyngeal branches Superior Cardiac branch ```

Branches of the Middle Cervical Ganglion: Where is the Gray Rami Communicantes located?

To the anterior rami of the 5th and 6th cervical nerves

Branches of the Middle Cervical Ganglion: Where are the Thyroid branches located?

Passes along the Inferior Thyroid artery to the Thyroid gland

Branches of the Middle Cervical Ganglion: Where is the Middle Cardiac branch located?

Descends in the neck, ends in the cardiac plexus

What are the 3 branches of the Middle Cervical Ganglion?

Gray Rami Communicantes Thyroid branches Middle Cardiac branch

Branches of the Inferior Cervical Ganglion: Where is the Stellate Ganglion located?

Fused inferior cervical with the 1st Thoracic ganglion

Branches of the Inferior Cervical Ganglion: Where is the Gray Rami Communicantes located?

To the anterior rami of the 7th and 8th cervical nerve

Branches of the Inferior Cervical Ganglion: Where are the Arterial branches located?

To the subclavian and vertebral arteries

Branches of the Inferior Cervical Ganglion: Where is the Inferior Cardiac branch located?

Descends to join the cardiac plexus

What are the 4 branches of the Inferior Cervical Ganglion?

Stellate Ganglio Gray Rami Communicantes Arterial branches Inferior Cardiac branch

Where are the commencement and termination of the Subclavian Artery?

Commencement: - R: Sternoclavicular junction - Origin: Brachiocephalic trunk - L: Manubrium Sterni - Origin: Arch of the aorta Termination: Outer border of the 1st rib (eventually becomes the axillary artery)

Where are the commencement and termination of the Subclavian Vein?

Commencement: Outer border of the 1st rib (from Axillary Vein) Termination: Sternoclavicular junction (forms the Brachiocephalic Vein with the IJV)

T or F: The commencement and termination of the Subclavian Vein is just the reverse of the commencement and termination of the Subclavian Artery

True

How many parts of the branches of the Subclavian Artery does the Scalenus muscle divide? What are they?

3 part: - Medial part - Posterior part - Lateral part

Where is the 1st (medial) part of the branches of the Subclavian Artery located?

Extends from the origin of the Subclavian Artery to the medial border of the Scalenus Anterior

Where is the 3rd (lateral) part of the branches of the Subclavian Artery located?

Extends from the lateral border of the Scalenus Anterior across the posterior triangle to the lateral border of the 1st rib Continues to the Axillary Artery No branching

1st (Medial) Part of the branches of the Subclavian Artery: what is the path of the Internal Thoracic (Mammary)?

Descends into the thorax behind the 1st costal cartilage and in front of the pleura

1st (Medial) Part of the branches of the Subclavian Artery: what are the 2 terminal branches of the Internal Thoracic (Mammary)?

Superior Epigastric artery | Musculophrenic artery

Internal Thoracic (Mammary): what does the Superior Epigastric artery supply?

Anterior abdomen

Internal Thoracic (Mammary): what does the Musculophrenic artery supply?

7th-9th intercostal spaces | Diaphragm

1st (Medial) Part of the branches of the Subclavian Artery: What is the path of the Vertebral artery?

Ascends in the neck through the foramina in the transverse processes of the upper 6 cervical vertebrae Ascends into the skull through the foramen magnum

Vertebral Artery: What is formed at the anterior surface of the medulla oblongata at the level of the lower border of the pons?

Basilar Artery

What are the 3 structures that the Basilar artery gives branches to?

Pons Cerebellum Internal ear

What structure does the Basilar Artery help form?

Circle of Willis

Vertebral Artery: What curves laterally and backward around the midbrain?

Posterior cerebral artery

What 3 structures make up the Thyrocervical Trunk?

Inferior Thyroid Artery Superficial Cervical Artery Suprascapular Artery

What is the Inferior Thyroid artery closely related to?

Recurrent Laryngeal Nerve

What 2 structures does the Inferior Thyroid artery give branches to?

Thyroid gland | Inferior Parathyroid gland

Where does the Superficial Cervical artery cross?

Brachial Plexus

What does the Suprascapular artery follow?

The Suprascapular nerve onto the back of the scapula

2nd (Posterior) Part of the branches of the Subclavian Artery: what structure runs backward over the dome of the pleura?

Costocervical trunk

What are the 2 terminal branches of the Costocervical trunk?

Superior Intercostal artery | Deep Cervical artery

What do the Superior Intercostal and Deep Cervical artery supply?

Superior Intercostal artery: 1st-2nd Intercostal spaces | Deep Cervical artery: deep muscles of the neck

What are the anterior, posterior, and inferior relationship of the Subclavian Vein?

Anterior: Clavicle Posterior: Scalenus Anterior, Phrenic nerve Inferior: Upper surface of the 1st rib

What are the left and right draining structures of the Subclavian Vein?

L: Thoracic duct (thorax and abdomen) R: Right lymphatic duct (head and neck)

What structure starts as a dilatation in the abdomen?

Thoracic duct

Thoracic duct: Where is the Cisterna Chyli located?

In front of the first 2 LV | Below the diaphragm, at the right side of the aorta

Thoracic duct: What is the path of the Cisterna Chyli?

Moves to the left side of esophagus as it reaches the 4th TV or sternal angle

T or F: The Thoracic duct always drains into the IJV or the Subclavian Vein just prior to their union

False. Only sometimes

What are the 2 types of Cervical nodes?

Deep Cervical Lymph Nodes | Superficial Cervical Lymph Nodes

Which Cervical node forms a vertical chain along the course of the IJV within the Carotid Sheath?

Deep Cervical Lymph Nodes

What 3 structures do the Deep Cervical Lymph Nodes drain?

Tonsils Tongue Oral Cavity

Deep Cervical Lymph Nodes: What do the efferent Lymph vessels join to form?

Jugular Trunk

What does the Jugular Trunk drain into?

Thoracic duct (Right Lymph duct)

Where do the Deep Cervical Lymph Nodes receive lymph from?

Jugulodigrastic node | Jugulo-omohyoid node

Where is the Jugulodigrastic node located?

Below the angle of the jaw

Where is the Jugulo-omohyoid node located?

Close to the omohyoid muscle

Where are the Superficial Cervical Lymph Nodes located?

In the superfiscial fascia along the External Jugular Vein

What does the Superficial Cervical Lymph Nodes drain?

Skin of the face and scalp

What 3 structures does the Superficial Cervical Lymph Nodes receive lymph from?

The skin over the angle of the jaw Skin over the apex of the Parotid Gland Lobe of the ear

Where do the efferent lymph vessels of the Superficial Cervical Lymph Nodes drain into?

Deep Cervical Lymph Nodes

GL 3: Posterior Triangle of the Neck Flashcards

(137 cards)