Neck and Head Neck fascia, compartments, neurovasculature, musculature

Objectives Describe the gross anatomy for each system (circulatory, muscular, nervous, and skeletal) in the neck and head. Integrate the systems to discuss the neck stability and mobility functions. Analyze common injuries in the neck. For each muscle, describe how the attachment sites result in an action around a joint. For each muscle, identify the innervation (peripheral nerve and nerve roots or cranial nerve). Describe the gross anatomy of the central nervous system.

Infrahyoid muscles (muscular triangle)

Suprahyoid muscles (submandibular & submental triangles)

The dorsal scapular artery arises directly from which proximal artery? A. Subclavian B. Thyrocervical trunk C. Cervicodorsal trunk D. Costocervical trunk

What is the 4 th branch off of the subclavian artery? RankResponses Other

Presentation Cervical Plexus

Which sensory nerves originate from C2 and C3? A. Transverse Cervical B. Lesser Occipital C. Phrenic D. Great Auricular E. Ansa Cervicalis

ERB’s point

Pre-quiz for CNS overview 1. Can a parasympathetic nerve carry both motor and sensory? 2. Can a sympathetic nerve carry motor and sensory? 3. Can a sympathetic nerve innervate skeletal muscle? 4. Can a sympathetic nerve innervate blood vessels? 5. Can a somatic nerve innervate blood vessels? 6. Can a somatic nerve innervate the digestive tract? 7. Can a somatic nerve innervate skeletal muscle? 8. Give an example of a somatic nerve. 9. What are the 3 parts of the brainstem? 10. What is the cerebral cortex? 11. What is white matter?

Clinical Relevance Torticollis  Spasmodic and congenital Nerve Blocks

Case Study y/o nurse, chronic neck pain Chiropractic neck manipulations 1/month for years After pain developed when turning head up to the right, she visited the chiropractor 4 times in a week 4 th visit – loud pop  Room was spinning, visual disturbances, vomited, loss of balance Chiropractor failed to recognize signs of stroke  Attempted “occipital adjustment” to relieve symptoms 1.5 hours later at the ER, discovered to have suffered “cervical artery dissection”

Case Study 2 24 y/o female with sinus headaches During neck manipulation, she suffered a brainstem stroke and died three days later. Autopsy revealed walls of vertebral arteries (both) split. Blood clots formed and entered the vertebrobasilar system. Vertebral arteries can be damaged easily: wash basins at hair salons, vehicle accidents, rapid stretching

“Although incidence of cervical artery dissection precipitated by chiropractic neck manipulation is unknown, it is an important risk. Given that risk, physical therapy exercises may be a safer option than spinal manipulation for patients with neck pain.” A study was conducted to examine incidence of strokes with neck manipulations. Of 13 patients: 9 recovered completely, 3 were permanently disabled, 1 died. Chiropractic strokes are recognized in the chiropractic literature: why is it downplayed?? DO NO HARM dicine.org/chiropractic- strokes-again-an-update/

The glossopharyngeal nerve DOES NOT carry what type of information from the carotid body to the brainstem? A. Blood pressure B. O2 levels in the blood C. CO2 levels in the blood D. Levels of free hydrogen ions in the blood

A patient complains of throbbing pain over the occipital region after turning the head too fast. Which nerve has most likely been affected? A. Great auricular B. Spinal accessory C. Supraclavicular D. Lesser occipital

Damage to the Ansa cervicalis would result in: A. Difficulty swallowing B. Anterior neck pain C. Difficulty breathing D. No deficits

Tight, enlarged scalene muscles would most likely result in: A. Sensory and motor deficits to the UE B. Sensory and motor deficits to the neck C. Reduced blood flow to the UE