Neck and Cervical Spine Anatomy

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Body of cervical vertebrae

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Anterior tubercle of transverse process: attachment for anterior scalene

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Canal for spinal nerve

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Posterior tubercle of transverse process: attachment for middle and posterior scalene

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Lamina groove of cervical spine: attachment for semispinalis capitis

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Spinous process of cervical spine: serves as attachment for muscles

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Lamina of cervical spine: attachment for multifidus

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Superior facet of cervical spine: form facet joints (flexion, extension, rotation, lateral flexion of neck)

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Transverse process of cervical spine: serve as attachment scalenes and erector spinae

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Transverse foramen of cervical spine: passageway for vertebral artery

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Atlas (C1): supports skull; articulates with C2 to allow head to rotate; site of Jefferson’s fracture

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Axis (C2): supports skull; allowss for C1 to rotate; site of Hangman’s fracture

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Odontoid process (dens): aids in stability while rotating head on axis

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Atlanto-occipital joint: articulation between occipital and atlas; synovial joint allowing for flexion, extension, lateral flexion of head

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Atlanto-axial joint: articulation between atlas/axis; allows rotation of head; composed of a pivot and 2 lateral joints

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Alar ligament: helps stabilize head and neck; leads to instability when ruptured; sprained in whiplash

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Transverse ligament of atlas: help stabilize head and neck; keeps dens in place

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Mastoid process: large superficial bump behind earlobes; attachment for sternoclediomastoid, longissimus

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C1 transverse process: deep to sternoclediomastoid; distal and anterior to tip of mastoid process

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C2 spinous process: attachment for several muscles; superficial to palpate

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C7 spinous process: attachment for upper trapezius and ligamentum nuchae; bony prminence when neck is flexed

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Ligamentum flavum: prevents excessive morion on posterior aspect of spine

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Ligamentum nuchae: stabilizes head and neck; attachment for trapezius, splenius capitis; runs along sagittal plane from external occipital protuberance to spinous process of C7

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Carotid artery: primary blood supplier of head and neck

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Splenus cervicis: deep to spleunus capitis; generally located in lamina groove of upper T-spine/C-spine

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Cervical lymph nodes: superficial and deep; superficial along underside of mandible, posterior and inferior to earlobe; tender on palpation; swell/enlarge in infection

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Thyroid gland: between jugular notch and cricoid cartilage; soft texture on top of trachea

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Brachial plexus: large bundle of nerves innervating shoulder and upper extremity; tenderness at Erb’s point; compression/traction = sharp, shooting sensation down arm

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Trachea: airway; thick cartilage deep to thyroid gland

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Cricoid cartilage: between trachea and thyroid

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thyroid cartilage: prominent/larger than cricoid (Adam’s apple); superior to cricoid

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Hyoid: site of muscle attachments in throat and neck; rises when swallowing

Anterior triangle of neck

borders: sternoclediomastoid (lateral), base of mandible (superior), trachea (medial)

function: allows carotid artery to pass through

Posterior triangle of neck

borders: sternocleidomastoid, clavicle, upper trapezius

function: allows from brachial plexus, subclavian artery, and subclavian vein to pass through

Sternocleidomastoid

origin: sternal head: top of manubrium

clavicular head: medial 1/3 of clavicle

insertion: mastoid process/lateral portion of superior nuchal line of occiput

action: unilateral: laterally flex head/neck to same side; rotate head/neck to opposite side

bilateral: flex neck/elevate rib cage during inhalation

Anterior scalene

origin: anterior tubercle of transverse processes of C3-C6

insertion: 1st rib

action: flex head and neck; unilateral: laterally flex head/neck to same side; rotate neck to opposite side

bilaterally: elevate ribs during inhalation

Middle scalene

origin: posterior tubercle of transverse processes of C2-C7

insertion: 1st rib

action: unilateral: laterally flex head/neck to same side; rotate neck to opposite side

bilaterally: elevate ribs during inhalation

Posterior scalene

origin: posterior tubercle of transverse processes of C6/C7

insertion: 2nd rib

action: unilateral: laterally flex head/neck to same side; rotate neck to opposite side

bilaterally: elevate ribs during inhalation

Splenius capitis

origin: mastoid process; lateral portion of superior nuchal line

insertion: inferior ½ of ligamentum nuchae; spinous process C7-T4

action: unilateral: rotate/laterally flex head and neck

bilateral: extend head/neck

Upper trapezius

origin: external occipital protuberance, medial portion of superior nuchal line, ligamentum nuchae, spinous process of C7-T12

insertion: lateral 1/3 of clavicle, acromion, spine of scapula

action: bilateral: extend head/neck

unilateral: lateral flexion of head/neck; elevate/upwardly rotate scapula

Dens/odontoid fracture

caused by hyperextension/flexion with rotational/shearing force

Cervical dislocation

cervical spine shifted off; caused by high impact trauma

Whiplash

acute, rapid hypermovement causic eccentric contraction of muscles; leads to spasms, and compress ligaments (alar, tansverse, post/anterior longitudinal ligament)

Brachial plexus neurapraxia

caused by rapid stretch/compression

Thoracic outlet syndrome

3 primary causes: hypertrophy, cervical rib, pec minor compression; causes disruption to neurovascular structures (subclavian artery and vein)