Posterior Triangle Flashcards
(98 cards)
1
Q
What forms the apex, anterior, posterior, and inferior borders of the posterior ∆?
A
Apex:
Occipital Bone
Anterior:
SCM
Posterior:
Trapezius
Inferior:
Clavicle (Middle 1/3)
2
Q
What forms the roof of the posterior ∆?
A
Roof:
Investing Fascia
3
Q
What fascial layers form the floor of the posterior ∆?
- Underlying muscles from superior to inferior
A
Floor Fascia:
- Prevertebral Fascia
Floor Muscles:
- Splenius Capitis
- Levator Scapulae
- Posterior, middle, and Anterior Scalene muscles
4
Q
T or F: the scalene muscles are secondary muscles of respiration.
A
True
5
Q
What is the origin and insertion of Splenius Capitis?
A
Origin:
- Lower half of ligamentum nuchae
- Spinous processes of vertebrae C7-T4
Insertion:
- Mastoid Process
- Skull below lateral one-third of superior nuchal line
6
Q
What is the innervation and action of splenius capitis?
A
Innervation:
Posterior Rami of Middle Cervical Nerves
Action:
- Together: draw head backward
- Indiviual: Rotate head to one side (turn face to same side)
7
Q
What is the origin and insertion of anterior scalene?
A
Origin:
Transverse processes of Cervical Vertebrae (like all the scalenes)
Insertion:
1st Rib
8
Q
What is the action and innervation of the anterior scalene?
A
Innervation:
- Ventral Rami of the Cervical Plexus (like all of the scalenes)
Action:
- Laterally Bends the Neck
- Elevates the 1st Rib
9
Q
What is origin and insertion of the middle scalene?
A
Origin:
Transverse Processes of Cervical Vertebrae (like all of the scalenes)
Insertion:
1st Rib
10
Q
What is the action and innervation of the middle scalene?
A
Innervation:
- Ventral Rami of the cervical plexus (like all of the scales)
Action:
- Laterally Bends the Neck
- Elevates the 1st Rib
11
Q
What is the origin and insertion of the posterior scalene?
A
Origin:
- Transverse Processes of the Cervical Vertebrae (like all of the scalenes)
Insertion:
- 2nd Rib
12
Q
What is the action and innervation of the posterior scalene?
A
Innervation:
- Ventral Rami of the cervical plexus (like all of the scales)
Action:
- Laterally bends the Neck
- Elevates the 2nd rib
13
Q
What is the origin and insertion of levator Scapulae?
A
Origin:
-C1-C4 transverse Processes
Insertion:
- Medial Border of the Scapula (above the spine)
14
Q
Innervation and action of levator scapulae?
A
Innervation:
Dorsal Scapular n.
Action:
Moves the shoulder girdle
15
Q
What is the common innervation of all scalene muscles?
A
- Ventral Rami of the Cervical Plexus
16
Q
What muscle crosses the inferior border of the posterior ∆ crossing anterior to middle scalene?
A
- Inferior Belly of Omohyoid
17
Q
What are the borders of the scalene ∆?
A
Anterior:
Anterior Scalene
Posterior:
Middle Scalene
Inferior:
Rib 1
18
Q
What structures pass through the scalene ∆?
A
- Subclavian Artery
2. ROOTS and TRUNKS of the Brachial Plexus pass to upper limb
19
Q
T or F: the Phenic nerve and Subclavian Vein pass though the scalene ∆.
A
FALSE, these DO NOT
20
Q
What nerve roots give rise to the phrenic Nerve?
A
C3, C4, C5
C4 being the biggest contributor
21
Q
What muscles does the phenic nerve emerge from behind then subsequently travel along?
A
Anterior Scalene
22
Q
T or F: the subclavian artery provides an important source of oxygenated blood to the thyroid and brain.
A
True
23
Q
What defines the 3 parts of the subclavian a?
- How many branches off of each part?
A
Anterior Scalene Parts: 1. Medial to Scalene (3) 2. Posterior to Scalene (1) 3. Lateral to Scalene (1)
24
Q
What artery arises from the 3rd part of the subclavian?
A
Dorsal Scapular a. (to the rhomboids)
25
What major trunk does the 1st part of the subclavian give rise to?
- branches of this trunk?
Thryocervical Trunk
Gives rise to:
1. Inferior Thyroid
2. Transverse Cervical
3. Suprascapular aa.
26
What are the 3 branches off of the First Part of the Subclavian artery?
1. Vertebral a.
2. Thyrocervical trunk
3. Internal Thoracic a.
27
What branch comes off of the 2nd part of the subclavian BEHIND anterior scalene?
- describe additional branching from this structure
Costocervical Trunk
2 Branches:
1. Deep Cervical
2. Supreme Intercostal aa.
28
You notice is a patient that the Dorsal Scapular artery is not coming from the 3rd part of the Subclavian as you usually expect, but you see it coming off another structure. What is it?
- Branching off of Transverse Cervical Artery from the 1st Branch
**This happens about 30% of the time
29
Where can you find the cervical part of the SYMPATHETIC CHAIN?
- Deep to the part of the PREVERTEBRAL fascia that is deep to the CAROTID SHEATH
30
What 6 nerves exit directly being SCM and almost immediately exits the posterior ∆ (except for 2)?
1. Lesser Occipital
2. Greater Auricular
3. Transverse Cervical
4. Medial Supraclavicular
^ All immediately exit
5. Lateral Supraclavicular
6. Intermediate Clavicular
^ remain inside the ∆ before exiting
31
T or F: strucutures that are deep to SCM are TECHNICALLY OUT of the posterior ∆.
True
32
What is the punctum nerosum?
Same thing as Nerve point its where the 6 nerves exit midway down the SCM
33
What issue might you run into when trying to adminster anesthetics to the nerve point?
- The Phrenic Nervis is nearby
34
What is the omoclavicular ∆?
- Lower Subdivision of the posterior ∆ formed by posterior belly of omohyoid
35
Describe how a ventral ramus exits the vertebral area in the cervical region.
- Passes POSTERIOR to the Vertebral a. (traveling through transverse foramen)
- ANTERIOR to the superior facet
THEN
- Anterior to middle scalene and Posterior to Anterior Scalene
36
What structures pass THROUGH the scalene ∆?
| -which pass OVER?
THROUGH:
- Superior, Middle, and Inferior trunks of the Brachial Plexus
- Subclavian Artery
OVER (but still IN it)
- Phenic N. (C3-5)
37
What passes anterior to the anterior scalene and thus is NOT in the scalene ∆?
subclavian VEIN
38
What 2 vein join just posterior to the sternoclavicular joint?
- Subclavian joins the internal jugular to form the brachiocephalic trunk
39
What the bifurcation of what artery happens at the sternoclavicular joint?
Brachiocephalic Truck bifurcates to RIGHT Subclavian and RIGHT common carotid
***NOTE THIS ONLY HAPPENS ON THE RIGHT SIDE
40
When does the subclavian artery becomes the axillary artery?
Just Lateral to the 1st Rib
41
What is the only branch of the subclavian artery to come off and go DOWN?
Internal Thoracic Artery
42
Where does the Vertebral Artery enter the costotransverse foramina?
C6
***NOTE that is skipped 8 and 7.
43
What nervous structure surrounds the origin of the vertebral artery?
Cervicaothoracic Ganglion (Sympathetic Branches)
44
What layer does the vertebral artery puncture to enter the brain?
Dura
45
T or F: in addition to being a major source of blood for the brain the vertebral a. supplies branches to the spinal cord and deep back muscles.
TRUE
46
What is formed by the joining of the vertebral arteries in the cranial vault?
Basilar Artery
47
Where does most of the blood from the thyrocervical trunk go?
To the thyroid gland and shoulder
48
What are the branches of the thyrocervical trunk?
1. Inferior thyroid artery
2. acending cervical artery
3. Suprascapular a.
49
What is the relationship of the inferior thyroid artery to the sympathetic truck, recurrent laryngeal n. and carotid Sheath?
Posterior to:
Sympathetic truck and Carotid Sheath
Anterior to:
Recurrent Laryngeal n.
50
What artery comes off at the inferior border of the thyroid with the inferior thyroid artery but continues straight along anterior scalene?
Ascending Cervical Artery
51
What branch(es) of the thyrocervical trunk (pt. 1 subclavian) goes laterally after branching off?
- Suprascapular a.
| - Transverse cervical artery (to underside of trap)
52
What nerve is pinned on anterior scalene by the Suprascapular n.?
Phenic n.
53
What 3 structures (muscle, artery, and nerve) travel to together to the suprascapular notch?
- Suprascapular a. and n.
| - Inferior Belly of Omohyoid
54
What two things does the costocervical truck (pt. 2 subclavian) branch into?
1. Highest Intercostal Artery
| 2. Deep Cervical a.
55
What does the highest intercostal a. supply?
- First two intercostal spaces
56
What artery might you see coursing THROUGH the trunks of the Brachial plexus?
Dorsal Scapular n.
| pt. 3 of subclavian
57
What splits the subclavian artery and vein at the 1st rib?
Anterior Scalene Muscle
58
What is the ONLY veinous tributary of the Subclavian vein?
External Jugular Vein
59
T or F: just BEFORE joining BOTH the External Jugular and Subclavian vein have valves
True
60
At the sternoclavicular joint on the RIGHT the Brachiocephalic vein and trunk are both present. What structures separate these two things?
1. Anterior Scalene
2. Phenic n.
3. Vagus n.
4. RIGHT lymphatic duct
**NOTE: NOT the thoracic duct (it is left side only)
**Also there is no brachiocephaic trunk on the left
61
What nerve passes from SCM to the Trap across the FLOOR of the posterior ∆?
Accessory Nerve (XI)
62
Where does CN XI (accessory) arise from?
| - what is its path
- oringiates from SPINAL CORD
- Goes up through Foramen Magnum
- Exits Jugular Foramen
- Travels down between INTERNAL jugular v. and INTERNAL carotid a.
- Then to Trap and SCM
63
What cervical nerves help out the accessory n. XI at innervating SCM and Trap.?
SCM
- C2 and C3
Trap.
- C3 and C4
64
What spinal cord segments contribute to the formation of the accessory n. (XI)?
C1-5
65
Why is the accessory n. not just a spinal n.?
1. 4-6 different segments collect into 1 nerve
2. Not from the same region as other GSE fibers
3. Goes UP through foramen magnum and OUT through Jugular foramen
66
What JOINT is involved in NODDING your head ANTERIOR to POSTERIOR?
- LEFT to RIGHT?
Anterior to Posterior:
Atlanto-Occipital joint
Left to Right:
Atlanto-Axial Joint
67
What structures form the Altlanto-Axial joint?
- Dense (as axis)
Anterior:
- Arch of the Atlas
Posterior:
- Stabilizing Ligament
68
What two structures does the sympathetic trunk travel between?
Posterior to Sym Trunk:
Prevertebral muscles
Anterior to Sym Trunk:
Carotid Sheath
69
Fibers in the Cervical part of the sympathetic truck contain Mostly ASCENDING PREGANGLIONIC AXONS. What roots do these come from?
T1 and T2
70
T or F: the spinal nerves that form plexues around the internal and external carotid used white rami to get there?
FALSE. It ONLY uses GRAY RAMI, white rami do NOT exist past T1
71
What are the 3 sympathetic Ganglia of the cervical region?
| - contributing nerve roots?
1. Superior Cervical Ganglion (C1 and C2)
2. Middle Cervical Ganglion (C5 and C6)
3. Cervicothoracic Ganglion (C7-C8)
72
Besides the superior cervical, middle cervical, and cervicothoracic ganglia, what other sympathetic ganglia exists in the neck to head?
- A ganglia associated with the vertebral artery
73
What is the common path for most of the lymphatic drainage of the head and neck?
- Deep Cervical Lymphatic Chain
74
What divides the deep lymph nodes that lie along the internal jugular into superior and inferior nodes?
- Omohyoid Muscle (as it crosses the internal jugular)
75
Where do NODES from the RETROPHARYNGEAL space drain?
Superior Group of Nodes
| aka above Omohyoid
76
Where would you expect lymph nodes to be inflammed if someone had an infection in their retropharyngeal space?
Superior nodes (SUPERIOR TO THE OMOHYOID)
77
Where would you expect an infection to manifest if a kid stuck a pencil in their throat and poked too deep?
Retropharyngeal space
78
What node would become enlarged with infection of the TONGUE or PALATINE Tonsil?
-Jugulodigastic Node
79
Where is the Jugulodigastric node?
- Where the Posterior Belly of the Digastric crosses the IJV
80
When would you expect the Jugulodigastric node to become enlarged?
- Throat or Respiratory Infections
81
What is another name for the inferior deep lymph nodes of the neck?
- Supraclavicular nodes
82
What doe the inferior draining nodes join?
- Thoracic Duct OR
| - Right Lymphatic Duct
83
What causes lymph to flow?
The flow of systemic circulation pulls in through the lymph system
84
Where does the thoracic duct empty?
The junction of the jugular and subclavian veins (ON ThE LEFT SIDE)
85
What does the Right lymph duct drain?
Right Side of the Body above the diaphragm
86
What is indicated by protrusion of the external jugular when at rest?
High blood pressure in the Right Atrium
87
T or F: many structures of the anterior and posterior ∆ sit on the copula of the lung
True
88
What fascial plane are the cutaneous nerves of the neck located in?
Investing fascia
89
What fascia OVERLIES the nerves of the trunks of the brachial plexus and spinal nerves?
Prevertebral fascia
90
What areas are supplied by branches of the subclavian a.?
1. Anterior Thoracic Wall
2. Thyroid Gland
3. Dorsal Scapula and Superficial Back
4. Brain and Brain Stem
5. Deep Neck Muscles
91
T or F: between the two heads of the SCM is an important surgical window.
True - Review what happens here
92
What joint does the vertebral artery wrap around?
atlantooccipital joint
93
What artery do the vertebral arteries combine to form?
Basilar
94
* ***What are cervical ribs?
| - associated risk of having these?
- Extra Ribs from transverse processes of Cervical vertebra
Can Compress:
1. Brachial Plexus (most likely)
2. Subclavian Vein
3. Subclavian artery (least likely)
95
What causes symptoms Thoracic Outlet Syndrome?
| **Caused by carrying around heavy things
- Pectoralis and Anterior Scalene can crush structures running under or over them.
E.G. - anterior scalene presses subclavian vein off when lifting the arm above the head
96
***Think about different places to injure accessory nerve (in jugular foramen or between SCM and Trap
**
97
What kind of movement is permitted by the atlantooccipital joint?
Front and Back movement
98
What type of cranial nerve lesion could cause shoulder drop or difficulty turning the head?
Accessory n.
