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GA060807

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Explain Naming Rules for spinal nerves,
1. Superior to C8, spinal nerves are named for vertebrae immediately inferior to it.
2. Beginning at T1, the numbers of spinal nerves correpond to the vertebrae just superior to them.
What causes the intervertebral foramen to be compromised?
1. Osteophytes (excess bone growths)
2. Anything compromising the space is liable to impinge on that nerve and produce pain
Name the boundaries of the intervertebral foramen.
1. Superior & Inferior Boundary: Pedicles of the respective vertebrae.
2. Anterior Boundary: Intervertebral discs and the bodies
3. Posterior Boundary: articular processes or facets
Uncinate process
Corresponds to similar are on cervical vertebrae - often predisposed to develop these excess bony growths.
Name boundaries of the posterior triangle.
1. Posterior: Trepezius
2. Anterior: Sternocleidomastoid
3. Inferior: Middle 1/3 of clavicle
Why is posterior triangle important?
If unable to stop bleeding of brachial artery by pushing artery against humerus, there are other places to push artery against the bone (push against 1st rib)
What can be done for intractable pain in the upper limb?
Block sensations of the Brachial plexus by anesthetizing the entire brachial plexus at this point (sometimes done in surgery)
Where is a common place for introduction of a central line?

What is a central line? What is it used for?
1. In or near the posterior triangle.
2. Catheter into a vein & extending it to the central part of the body = the heart
3. Used to put anesthetics/liquid nutrition/chemo into bodies
4. Usually put in peripherally placed veins (e.g subclavian)
What muscle divides the posterior triangle and into how many parts?
1. omohyoid muscle (attaches to the medial margin of suprascapular notch)
2. two parts
3. Attaches to shoulder blade to hyoid bone
Name the regions superior & inferior to Omohyoid
1. Occipital triangle.
2. Supraclavicular triangle/Subclavian triangle.
Name two heads of Sternocleidomastoid?
1. Sternal head
2. Clavicular head
What else divides the posterior triangle and into what zones?
1. Spinal accessory nerve (CN XI)
2. Superior zone: Find occipital artery in apex of triangle (CAREFREE)
3. Inferior zone: Brachial plexus, Subclavian artery, subclavian vein - CAREFUL
What forms the 'floor' of the posterior triangle?
1. Muscles with fascial covering
2. Scalene muscles: Posterior, Middle, Anterior
3. Levator scapulae (CN XI crosses in front of it)
4. Splenius capitus
Where is nerve point located?
Junction of Superior 1/3 and Inferior 2/3 of posterior border of SCM
What is gap btwn to heads of SCM used for?
1. Interval is used for introduction of central line into the Internal Jugular Vein.
Torticollis
1. Wry-neck
2. Condition when develop spasms in SCM
3. Cut roots of the spinal accessory nerve that innervates the SCM
Contents of Posterior Triangle:
1. Veins
2. Arteries
3. Nerves
1. External Jugular Vein & Subclavian
2. Subclavian, Transverse cervical, suprascapular & occipital
3. Spinal accessory nerve, great auricular, transverse cervical, supraclavicular
Define fascia.
1. Dense connective tissue that surrounds muscle and is found in between muscles
Platysma muscle:
1. Define
2. Location
1. Muscle of facial expression
2. Contained in superficial plasma - 'paper thin' muscle
What else is in superficial fascia?
1. EJV
2. Cutaneous nerves
Fascia:
1. Superficial
2. Next layer
3. Relation to posterior triangle
1. Initial layer of deep fascia = investing layer of the deep fascia
1b. Fascial roof of triangle & envelops SCM
2. Internal to investing fascia, it is called prevertebral fascia (such as scalene muscles)
2b. Forms facial floor of triangle
What is most frequently injured neve by doctors?
-Spinal accessory nerve. When physicians are trying to diagnose pathology by taking a biopsy of lymph nodes, many of which are found along this nerve, they will injure it.
What does the EJV flow into and where does it lie?
1. The subclavian vein.
2. External to the SCM
What does IJV drain?
Where is it located?
1. Internal jugular vein drains the head.
2. Deep to the SCM.
What 2 veins form the right brachiocephalic vein?
1. Subclavian (drains brachium/ upper limb)
2. IJV (drains head)
What forms SVC (Superior vena cava)?
1. Right & left brachiocephalic veins
Name three branches off the aortic arch in order.
1. Brachiocephalic artery/trunk (right to left) which gives rise to right subclavian artery & right common carotid
2. Left common carotid (2nd) from left side of arch
3. Left subclavian artery (3rd) found laterally to L common carotid
Name the branches of the thyrocervical trunk.
1. Suprascapular artery
2. Transverse Cervical
3. Inferior thyroid
4. Ascending cervical

1&2 run superficial to anterior scalene muscles which attach to the first rib
What divides subclavian artery into 3 parts?
Anterior scalene muscle
1. Proximal is 1st
2. Posterior is 2nd
3. Distal/Lateral is 3rd

Note: Thyrocervical trunk branches from subclavian part 1.
What divides axillary artery into 3 parts?
Pectoralis Minor
1. Proximal is 1st.
2. Posterior is 2nd
3. Distal/lateral is 3rd.
What are intercostal nerves.
1. Ventral rami in the thoracic region lie in between ribs
What do ventral rami form in the cervical & lumbaral regions?
1. Ventral rami form plexuses (network of nerves)
Cervical plexus
1. Components
2. How many parts and name them.
1. Ventral Rami of C1-C4
2. Five parts:
Phrenic nerve
4 Cutaneous nerves
Sensory contributions to spinal accessory nerve
Phrenic nerve
1. Components
2. Location
3. Function
1. Arises from C3, C4, C5
2. Anterior surface of anterior scalene muscle
2b. Runs accross anteior surface of SCM
2c. Runs inferior to transverse cervical and suprascapular nerves
3. Innervates respiratory diaphragm

NOTE: Crushed to cure chronic hiccups
Sensory contributions to CN XI
1. Why needed?
2. Importance
1. CN XI is strictly motor to SCM & Trapezius
2. Generally tell us location of neck
Name 4 Cutaneous branches of cervical plexus
1. Greater auricular - runs posterior with EJV, across anterior surface of SCM
2. Lesser occipital nerve - ventral ramus
3. Transverse cervical nerve - runs transversely across the neck
4. Supraclavicular nerves: 3 parts: Medial, Intermediate, Lateral - they arise from C3, C4
Axilla:
1. Define
2. Contents
3. Location
4. Borders
1. Armpit
2. Axillary vein & artery, brachial plexus, filled w/ fat, lymphatics, & fascia
3.
4. Shaped like pyramid:
Medial border = serratus anterior
Posterior border = subscapularis
Anterior border = Pec. major/minor
Lateral border = Intertubecular groove (where latissimus attaches)
Contents of Cervical Axillary Canal Region
AKA = Axilla
1. Subclavian artery
2. Subclavian Vein
3. Brachial Plexus
4. Apex of lung
What divides Brachial plexus?
Clavicle divides it into supraclavicular part & infraclavicular part
Brachial Plexus:
1. Origin
2. What does it supply?
1. Ventral Rami of spinal nerves C5-T1
2. Supplies whole upper limb
Path or Brachial plexus.
1. 5 spinal nerves / roots
2. 3 Trunks
3. 6 Divisions (3 anterior/ 3 posterior)
4. 3 Cords
5. 5 Branches
Name 3 Trunks:
1. Upper/Superior
2. Middle
3. Lower/Inferior
Name 6 Divisons:
1. Anterior div. upper trunk
2. Anterior div. middle trunk
3. Anterior div. lower trunk
4. Posterior div. upper trunk
5. Posterior div. middle trunk
6. Posterior div. lower trunk
Name 3 cords and what forms them.
1. 2 Anterior divisions form Lateral cord
2. Single anterior division from lower trunk forms medial cord
3. 3 Posterior divisions form posterior cord

Note: all named according to their relative position to axillary artery
Name 5 terminal branches.
1. Musculocutaneous (5,6,7)
2. Axillary (5,6)
3. Radial (5,6,7,8,T1)
4. Median (5,6,7,8,T1)
5. Ulnar (7,8,T1)
Which spinal nerves does
1. long thoracic nerve,
2. dorsal scapular,
3. suprascapular,
4. N to subclavius
5. Medial/Lateal Pect. Nervescontain.
1. C5, C6, C7
2. C5
3. C5, C6
4. C5, C6
5. Medial = C5, C6/Lateral = C8, T1
Name attachments of scalene muscles.
1. Anterior & middle scalene muscles attach to 1st rib.
2. Posterior scalene muscle attaches to 2nd rib.
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