71d ago

Dissection 1.1 - Posterior Cervical Region

Dissection guide

Osteology and Surface Anatomy

  • Cervical vertebrae: ID spinous process and transverse processes

    • Spinous process of C1-6 can’t be palpated because of the nuchal ligament (extends from external occipital protuberance of the occipital bone to C7)

    • Transverse foramen are within the transverse foramen (vertebral a. runs through)

    • C1 = atlas

    • C2 = axis (has dens)

  • Thoracic vertebrae: spinous processes slant inferiorly and transverse processes have facets (rib articulation)

  • Lumbar vertebrae: spinous processes are short and directly posterior

  • Scapula: palpate spine and acromion process

  • Skull: Palpate external occipital protuberance

Skinning the Back

  • ID posterior cutaneous neurovascular bundles

    • Contain cutaneous branches of dorsal rami of cervical and upper thoracic spinal n.

    • Dorsal rami: innervate deep back muscles→ superficial back muscles (no innervation) → posterior cutaneous n. (SS to skin)

Muscles of the Back

  • Innervations…

    • Superficial m. innervated by ventral rami

    • Deep m. innervated by dorsal rami

  • Layer 1: Trapezius, latissimus dorsi, and deltoid (superior → inferior → lateral)

    • Trapezius extends from superior nuchal line and attach to cervical and upper thoracic spines

    • Latissimus dorsi extends from spinous process

  • Nerves and vessels deep to trapezius (seen after reflecting)

    • Spinal accessory n. (SM to trapezius)

    • Transverse cervical a. and v.

      • Transverse cervical a. pathway: Subclavian a. → Thyrocervical trunk → Transverse cervical a. - middle branch)

  • Layer 2: Levator scapulae, rhomboid minor, and rhomboid major (superior → inferior)

    • Deep to trapezius

    • Innervated by brachia plexus

  • Layer 3: Serratus posterior superior

    • Deep to rhomboids

    • Spinous process → Ribs

  • Layer 4: Semisplinalis capitis, splenisu capitis, and splenius cervicis (medial → lateral)

    • Semispinalis capitis: fibers run vertically

    • Splenius capitis and splenius cervicis: fibers run obliquely

  • Layer 5: Erector spinae muscles (medial → lateral)

    • Spinalis

    • Longissimus

    • Iliocostalis (originates from ribs)

Fascia and Skin

  • Epidermis → Dermis → Superficial fascia → Deep (investing fascia)

    • Dermis: contain blood and lymph vessels, nerves, hair follicles, erector pili muscles, sweat and sebaceous glands, and collegen

      • Collagen fibers organized in Langer’s lines (incisions parallel to lines heal with less gaping and scaring)

    • Superficial fascia: contains fat

    • Deep fascia: thin whitish CT that surrounds deeper structure (ex/ muscles)


Bolded terms

Acromion Process

  • Flat, expanded projection at the outer end of the spine of the scapula (shoulder) and articulates with clavicle

Cervical vertebrae

  • C1-7 (most superior vertebrae)

  • Short bifid spinous processes

  • Anterior and posterior tubercles

  • Transverse foramen holds vertebral artery (C1-6)

Deep (investing) fascia

  • Thin whitish connective tissue that surrounds skeletal muscles, blood vessels, nerves, etc.

Deltoid

  • Lateral to trapezius

  • Origin: Lateral 1/3 of Clavicle (clavicular part), Acromion (acromial part), Spine of Scapula (spinal part)

    Mnemonic: 'Deltoid helps you carry SACS'

  • Insertion: Deltoid tuberosity of humerus

Dermis

  • Contain blood and lymph vessels, nerves, hair follicles, erector pili muscles, and sweat and sebaceous glands

Epidermis

  • Superficial layer of skin

Erector spinae

  • 3 muscles that run longitudinally along the vertebrae (spinalis, longissimus, and iliocostalis)

External ocipital protuberance

  • Bump on occipital bone

Iliocostalis

  • Most lateral of the 3 erector spinae muscles

Langer’s Lines

  • Tension lines formed by the collagen and elastin composing dermis that are arranged in a parallel configuration

Latissimus dorsi

  • Inferior to trapezius

  • Origin: Spinous processes of lower thoracic vertebrae, thoracolumbar fascia, iliac crest, and inferior Âľ ribs

  • Insersion: Floor of intertertubercular groove of humerus

Levator scapulae

  • Origin: Transverse processes of C1-4

  • Insertion: Attaches to medial border of scapula (between superior angles and the root of the scapular spine)

Longissimus

  • Middle of the 3 erector spinale muscles

Lumbar vertebrae

  • 5 lumbar vertebare

Mastoid process

  • Part of temporal bone just behind the ear

  • An attachment site for many muscles

Nuchal ligament

  • Ligament that extends from eternal occipital protuberance to spinous process of C7

Posterior cutaneous VAN

  • Superficial branches of dorsal rami

  • Provide somatosensation and vasculature to skin on back

Rhomboid major and minor

  • Located deep to trapezius

  • Rhomboid major

    • Origin: Spinous process of T2-4

    • Insertion: Medial border of scapula

  • Rhomboid minor

    • Origin: Nuchal ligament and spinous processes of C7-T1

    • Insersion: Medial border of scapula (at level of scapular spine)

Scapula

  • Flat triangular bone that connects upper arm to collarbone

Semispinalis capitis

  • Vertically running muscle

  • Deep to splenis capitis and splenis cervicis

Superficial fascia

  • Connective tissue that is deep to the skin and contains varying amounts of fat

Skull

Spinal accessory nerve (CN XI)

  • Root of CN XI exit cranium via foramen magnum (jugular foramen → foramen magnum)

Spinalis

  • Most medial of 3 erector spinale muscles (next to vertebral column)

Spinous process

  • Posterior projection of vertebrae

Splenius capitis

  • Oblique running muscles

  • “Middle” of the 3 capitis/cervicis muscles

  • Superior to splenis cervicis

Splenius cervicis

  • Deep to trapezius

  • Obliquely oriented fibers

  • “Most lateral” of the 3 capitis/cervicis muscles

Suboccipital fascia

Superior nuchal lines

  • Faint bony ridge that extends laterally from external occipital protuberance

Thoracic vertebrae

  • T1-12

  • Heart shaped body

  • Articular facets -superior-inferior orientation

  • Rib articulations (2 demi-facets on body + 1 facet on transverse process)

Transverse cervical a. and v.

  • Transverse cervical a. arises from thyrocervical trunk (branch of subclavian)

Transverse process

  • Lateral processes off of vertebrae

Trapezius

  • Large diamond-shaped muscle

Vertebral prominens

  • C7


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Dissection 1.1 - Posterior Cervical Region

Dissection guide

Osteology and Surface Anatomy

  • Cervical vertebrae: ID spinous process and transverse processes

    • Spinous process of C1-6 can’t be palpated because of the nuchal ligament (extends from external occipital protuberance of the occipital bone to C7)

    • Transverse foramen are within the transverse foramen (vertebral a. runs through)

    • C1 = atlas

    • C2 = axis (has dens)

  • Thoracic vertebrae: spinous processes slant inferiorly and transverse processes have facets (rib articulation)

  • Lumbar vertebrae: spinous processes are short and directly posterior

  • Scapula: palpate spine and acromion process

  • Skull: Palpate external occipital protuberance

Skinning the Back

  • ID posterior cutaneous neurovascular bundles

    • Contain cutaneous branches of dorsal rami of cervical and upper thoracic spinal n.

    • Dorsal rami: innervate deep back muscles→ superficial back muscles (no innervation) → posterior cutaneous n. (SS to skin)

Muscles of the Back

  • Innervations…

    • Superficial m. innervated by ventral rami

    • Deep m. innervated by dorsal rami

  • Layer 1: Trapezius, latissimus dorsi, and deltoid (superior → inferior → lateral)

    • Trapezius extends from superior nuchal line and attach to cervical and upper thoracic spines

    • Latissimus dorsi extends from spinous process

  • Nerves and vessels deep to trapezius (seen after reflecting)

    • Spinal accessory n. (SM to trapezius)

    • Transverse cervical a. and v.

      • Transverse cervical a. pathway: Subclavian a. → Thyrocervical trunk → Transverse cervical a. - middle branch)

  • Layer 2: Levator scapulae, rhomboid minor, and rhomboid major (superior → inferior)

    • Deep to trapezius

    • Innervated by brachia plexus

  • Layer 3: Serratus posterior superior

    • Deep to rhomboids

    • Spinous process → Ribs

  • Layer 4: Semisplinalis capitis, splenisu capitis, and splenius cervicis (medial → lateral)

    • Semispinalis capitis: fibers run vertically

    • Splenius capitis and splenius cervicis: fibers run obliquely

  • Layer 5: Erector spinae muscles (medial → lateral)

    • Spinalis

    • Longissimus

    • Iliocostalis (originates from ribs)

Fascia and Skin

  • Epidermis → Dermis → Superficial fascia → Deep (investing fascia)

    • Dermis: contain blood and lymph vessels, nerves, hair follicles, erector pili muscles, sweat and sebaceous glands, and collegen

      • Collagen fibers organized in Langer’s lines (incisions parallel to lines heal with less gaping and scaring)

    • Superficial fascia: contains fat

    • Deep fascia: thin whitish CT that surrounds deeper structure (ex/ muscles)


Bolded terms

Acromion Process

  • Flat, expanded projection at the outer end of the spine of the scapula (shoulder) and articulates with clavicle

Cervical vertebrae

  • C1-7 (most superior vertebrae)

  • Short bifid spinous processes

  • Anterior and posterior tubercles

  • Transverse foramen holds vertebral artery (C1-6)

Deep (investing) fascia

  • Thin whitish connective tissue that surrounds skeletal muscles, blood vessels, nerves, etc.

Deltoid

  • Lateral to trapezius

  • Origin: Lateral 1/3 of Clavicle (clavicular part), Acromion (acromial part), Spine of Scapula (spinal part)

    Mnemonic: 'Deltoid helps you carry SACS'

  • Insertion: Deltoid tuberosity of humerus

Dermis

  • Contain blood and lymph vessels, nerves, hair follicles, erector pili muscles, and sweat and sebaceous glands

Epidermis

  • Superficial layer of skin

Erector spinae

  • 3 muscles that run longitudinally along the vertebrae (spinalis, longissimus, and iliocostalis)

External ocipital protuberance

  • Bump on occipital bone

Iliocostalis

  • Most lateral of the 3 erector spinae muscles

Langer’s Lines

  • Tension lines formed by the collagen and elastin composing dermis that are arranged in a parallel configuration

Latissimus dorsi

  • Inferior to trapezius

  • Origin: Spinous processes of lower thoracic vertebrae, thoracolumbar fascia, iliac crest, and inferior Âľ ribs

  • Insersion: Floor of intertertubercular groove of humerus

Levator scapulae

  • Origin: Transverse processes of C1-4

  • Insertion: Attaches to medial border of scapula (between superior angles and the root of the scapular spine)

Longissimus

  • Middle of the 3 erector spinale muscles

Lumbar vertebrae

  • 5 lumbar vertebare

Mastoid process

  • Part of temporal bone just behind the ear

  • An attachment site for many muscles

Nuchal ligament

  • Ligament that extends from eternal occipital protuberance to spinous process of C7

Posterior cutaneous VAN

  • Superficial branches of dorsal rami

  • Provide somatosensation and vasculature to skin on back

Rhomboid major and minor

  • Located deep to trapezius

  • Rhomboid major

    • Origin: Spinous process of T2-4

    • Insertion: Medial border of scapula

  • Rhomboid minor

    • Origin: Nuchal ligament and spinous processes of C7-T1

    • Insersion: Medial border of scapula (at level of scapular spine)

Scapula

  • Flat triangular bone that connects upper arm to collarbone

Semispinalis capitis

  • Vertically running muscle

  • Deep to splenis capitis and splenis cervicis

Superficial fascia

  • Connective tissue that is deep to the skin and contains varying amounts of fat

Skull

Spinal accessory nerve (CN XI)

  • Root of CN XI exit cranium via foramen magnum (jugular foramen → foramen magnum)

Spinalis

  • Most medial of 3 erector spinale muscles (next to vertebral column)

Spinous process

  • Posterior projection of vertebrae

Splenius capitis

  • Oblique running muscles

  • “Middle” of the 3 capitis/cervicis muscles

  • Superior to splenis cervicis

Splenius cervicis

  • Deep to trapezius

  • Obliquely oriented fibers

  • “Most lateral” of the 3 capitis/cervicis muscles

Suboccipital fascia

Superior nuchal lines

  • Faint bony ridge that extends laterally from external occipital protuberance

Thoracic vertebrae

  • T1-12

  • Heart shaped body

  • Articular facets -superior-inferior orientation

  • Rib articulations (2 demi-facets on body + 1 facet on transverse process)

Transverse cervical a. and v.

  • Transverse cervical a. arises from thyrocervical trunk (branch of subclavian)

Transverse process

  • Lateral processes off of vertebrae

Trapezius

  • Large diamond-shaped muscle

Vertebral prominens

  • C7