1
Q
A
2
Q
Where does the branchial plexus travel through? What else goes through here?
A
middle and anterior scalene
* Subclavian a. also goes through here
3
Q
What is the PA, DA, and function of SCM?
A
- Has 2 bellies: Connects to clavical and strernum up to the mastoid process
- Flexes the neck laterally
4
Q
Where is the platysma and what is the function?
A
- Superior over all other muscles
- Every thin under skin
- Used for expression of shock and feak, manible depresser
5
Q
What is aids in respiration and shoulder levating
A
Scalene muscles (ant, post, middle)
6
Q
Where does the phrenic n go?
A
Superiorly over the anterior scalene
7
Q
A
8
Q
Label
A
- thryoid gland
- infrahyoid m
- SCM
- Common carotid a
- IJV
- Vagus n
- Sympathetic trunk
- Platysma m
- Ant. scalene m
- Mid. scalene m
- Post. scalene m
- Trachea
- Esophagus
- Trap m.
9
Q
What is within the carotid sheath?
A
- Common carotid artery
- Vagus
- IJV
9
Q
A
10
Q
What is an area in the neck that is a site of infection?
A
Retropharyngeal space
11
Q
What is the ligament that connects the spinous process to CT on posterior aspect of neck?
A
Nuchal ligament
12
Q
Congenital Torticollis:
* What is the function of SCM?
* What is the most common?
* Results from what?
A
- Contraction of the cervical muscles producing twisting of the neck and slanting of the head
- Most common type of congenital torticollis (wry neck)
- Results from a fibrous tissue tumor that develops in the SCM before or shortly after birth
13
Q
Congenital Torticollis:
* Occasionally, SCM injured when?
* What does it result in?
* What is a treatment option?
A
- Occasionally, SCM injured when head is pulled excessively during a difficult birth, tearing its fibers (muscular torticollis).
- Results in hematoma that may develop into a fibrous mass entrapping branch of the spinal accessory nerve (CN XI), thus denervating part of the SCM.
- Surgical release of a partially fibrotic SCM from its distal attachments to the manubrium and clavicle may be necessary.
14
Q
- What are the different triangles of the neck?
- What is the Root of Neck?
A
- Triangles: Sternocleidomastoid region, Trapezius (posterior cervical region), Posterior Triangle (lateral cervical region), Anterior Triangle (anterior cervical region)
- Root of Neck - Between thorax and neck, superior to thoracic inlet
15
Q
What is the posterior triangle made up of?
A
Also called: Lateral cervical region
* Occipital triangle
* Subclavian triangle
16
Q
What is the anterior triangle made up of?
A
Also called Anterior cervical region
* Submandibular triangle
* Submental triangle
* Carotid triangle
* Muscular triangle
17
Q
A
18
Q
What superficial vein runs over the neck?
A
EJV runs over SCM
19
Q
What inn. the SCM and trapz m?
A
CN XII
20
Q
A
21
Q
A
22
Q
What is contained in the superifical dissection of the posterior triangle?
A
- Great auricular nerve
- EJV
- CN XI
- Nerve point of neck
23
Q
A
24
What is an important land mark deep to the SCM
Nerve point of neck: with great auricular nerve and spinal accessory nerve
25
26
* Where does the EJV run?
* When and how can it be prominent?
* EJV runs vertically across the SCM toward the angle of the mandible.
* May be prominent, especially if distended, and can be visualized by asking the person to take a deep breath (**Valsalva maneuver**).
27
Where is the jugular notch fossa?
Jugular notch fossa between the sternal heads of the SCM
28
Where is the Lesser supraclavicular fossa?
between heads of SCM, overlies inferior end of IJV
29
What is deep to superior half of SCM?
Cervical plexus
30
What is deep to inferior half of SCM?
* IJV
* Common carotid artery
* Vagus nerve in carotid sheath.
31
What is deep dissection of posterior triangle?
1. CN XI Accessory
2. Brachial plexus (between anterior and middle scalene)
3. Phrenic nerve
4. IJV
32
33
What does the great auricular nerve inn?
Paratoid gland and mastoid process region
34
Phrenic nerve btw where?
Ant and middle scalene
35
What is a deeper dissection of the posterior triangle?
1. Phrenic nerve (running over anterior
scalene)
2. Brachial plexus (between anterior and middle scalenes)
3. Brachiocephalic vein
4. IJV-> bring blood back from brain (sinuses)
5. EJV goes into SC vein
6. Subclavian vein (changes at clavicle) goes into ax v.
7. Axillary vein
8. Subclavian artery (changes at clavicle) goes into ax. a.
9. Axillary artery
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38
Where are the superior deep cervical lymph nodes
angle of jaw more posterior
39
Where are the submandibular lymph nodes located?
Anterior, close to submandibular gland
40
What does the ansa cervicalis inn and a part of??
* supplies infrahyoid muscles: sternohyoid, sternothyroid, thyrohyoid, omohyoid
* Roots of Spinal nerves of C1,2,3
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42
What is CN XII next to?
IJV and ext. cardotid artery
43
How does common carotid go into?
Bifurcates and becomes internal (lateral and deeper) and external (medially and superior) common carotid artery
44
What is present in the superifical dissection of an anterior triangle (anterior cervical region)
1. Internal Jugular Vein (IJV)
2. CN XI
3. Ansa cervicalis: supplies infrahyoid 4. Facial Nerve
5. Submandibular lymph nodes
6. Deep cervical lymph nodes
45
What is present in deep dissection of the anterior (carotid triangle)
1.Common carotid artery
2. Internal carotid
3. External carotid
* Carotid body: monitor [O2]
* Carotid sinus: baroreceptor
4.Internal Jugular Vein (IJV)
5.Ansa cervicalis
6.CN IX Glossopharyngeal
7.CN X Vagus branches: pharyngeal, laryngeal, cardiac branches 8.CNXII Hypoglossal
46
What is present in the dissection of root of neck?
1. Phrenic Nerve (running over Anterior Scalene)
2. Brachial Plexus
3. Recurrent laryngeal nerves
4. Vagus Nerves (running over bifurication of brachiocephalic and subclavian artery)
5. Vertebral Artery
6. Right lymphatic duct
7. Thoracic duct
8. Cervical Pleura
47
Where does the recurrent laryngeal nerves come from? Where is it?
* From the vagus n.
* Goes over the subclavian artery and goes down into the mediumsteum
48
Where is the right lymphatic duct?
Jxn of IJV and right subclavian vein
49
Where is the thoracic duct?
Between IJV and left subclavian vein
50
How does the phrenic nerve get the diaphragm
Over ant. scalene, go down into the mediastinum and go laterally into the pericardial sac to diaphragm
51
Where is the left recurrent laryngeal nerve?
more medial over esophagus
52
53
What are the different lymphatic drainage of head and neck?
54
55
56
57
58
What is in the posterior compartment and anterior compartment in the arm?
59
What in the posterior and anterior compartment of forearm?
.
60
What are the ligaments that are important for AC dislocation?
Superior acromioclavicular and coracoacromial ligament
61
What attaches to the coracoid process which is close to the Acromioclavicular joint?
Biceps brachi
62
Where does the long head of the bicep brachi attach
supraglendiod of humeral
63
64
What are the rotator cuff muscles?
1. supraspinatus -greater, external rotation
2. infraspinatus -greater, external rotation
3. teres minor -greater, external rotation
4. subscapularis- lesser, internal rotation
## Footnote
Not teres major m-> attach to humerus shaft
65
Glenohumeral joint dislocation:
* Most dislocations of the humeral head occur in what?
* How does this happen?
* What may happen?
* What may be injured?
* Most dislocations of the humeral head occur in the **downward (inferior) direction (described clinically as anterior)** (humeral head has descended anteriorly)
* A hard blow to the humerus when the **glenohumeral joint is fully abducted** tilts the head of the humerus inferiorly onto the **inferior weak part of the joint capsule.**
* This may **tear the capsule** and dislocate the joint.
* The **axillary nerve may be injured** because of its close relation to the inferior part of the capsule of this joint
66
67
68
69
What Are the flexors of the arm and the bony attachments?
70
What are the externsor muscles of the arm and the bony attachments?
71
Fractures of humerus:
* Fractures of the surgical neck of the humerus are especially common in who?
* Fracture of the distal part of the humerus, where?
* Fractures of the surgical neck of the humerus are especially common in elderly people with osteoporosis
* Fracture of the distal part of the humerus, near the supra- epicondylar ridges, is a supra- epicondylar (supracondylar) fracture.
72
Because nerves are in contact with the humerus, they may be injured when the associated part of the humerus is fractured: (4)
- surgical neck, axillary nerve
- radial groove, radial nerve
- distal humerus, median nerve
- medial epicondyle, ulnar nerve
73
What are the different type of fractures?
74
75
Biceps tendon rupture:
* Rupture of the tendon of the long head of the biceps usually results from what?
* Normally, the tendon is torn from what?
* The rupture is commonly what?
* The detached muscle belly forms what?
* Rupture of the **tendon of the long head** of the biceps usually results from wear and tear of an inflamed tendon (**biceps tendinitis**).
* Normally, the tendon is torn from its attachment to the **supraglenoid tubercle** of the scapula.
* The rupture is commonly dramatic and is associated with a **snap or pop.**
* The detached muscle belly forms a ball near the center of the distal part of the anterior aspect of the arm (**Popeye deformity**)
76
77
78
79
80
81
What is supporting the elbow on the laterally and medial side?
* Lateral: radial collateral ligament and anular ligment of radius
* Medial: ulnar collateral ligament (anterior band-cord like, posterior-fan like, obilque band)
82
Avulsion of Medial Epicondyle:
* What is a result from?
* What does it result in?
* Anatomical basis of avulsion of the medial epicondyle is what?
* What is a complication of the abduction type of avulsion of the medial epicondyle?
* Avulsion of medial epicondyle in children can result from a fall that causes severe abduction of the extended elbow.
* Resulting traction on the ulnar collateral ligament pulls the medial epicondyle distally.
* Anatomical basis of avulsion of the medial epicondyle is that the epiphysis for the medial epicondyle may not fuse with the distal end of the humerus until up to age 20 years.
* Traction injury of the ulnar nerve is a complication of the abduction type of avulsion of the medial epicondyle.
83
Proximal radioulnar joint. The head of the radius rotates in the “socket” formed by what?
anular ligament
84
85
86
87
What is used for pronation?
Pronator teres and quadratus
88
Nursemaid's elbow:
* Happens how?
* The radial head then moves how?
* The proximal part of the torn ligament happen?
* The source of pain is what?
* What is the treatment?
* The tear in the anular ligament soon heals when ?
89
90
Distal radius fractures:
* A direct injury usually produces what?
* Because the shafts of these bones are firmly bound together by the interosseous membrane, a fracture of one bone is what?
* Fractures of both the ulna and radius are the result of severe injury.
* A direct injury usually produces transverse fractures at the same level, often in the middle third of the bones.
* Because the shafts of these bones are firmly bound together by the interosseous membrane, a fracture of one bone is likely to be associated with dislocation of the nearest joint.
91
What is the difference of colles and smith fracture?
92
93
94
94
What are the muscles of the posterior forearm (superifical and deep layer)?
* Superifical layer: Brachioradialis, externsor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum, externsor digiti minimi and externsor carpi ulnaris
* Deep layer: supinator, abductor pollicis longus, extensor pollicis longus, externsor pollicis brevis and extensor indicis
95
96
97
98
99
100
De Quervain Tenosynovitis (radial styloid tenosynovitis)
* Caused how?
* Causes what?
* Local tenderness is felt over?
101
Synovial/ganglion cyst:
* Sometimes, a nontender cystic swelling appears where?
* The thin-walled cyst contains what?
* These synovial cysts are where?
* What is a common site for such a cyst?
* A cystic swelling of the common flexor synovial sheath on the anterior aspect of the wrist can enlarge enough to produce what?
102
103
104
105
What are the carpel tunnel contents?
106
* What is skier's thumb?
* This injurt results from what?
* What happens in severe injuries?
* Skier’s thumb (historically, “gamekeeper’s thumb”) refers to the rupture or chronic laxity of the collateral ligaments of the 1st metacarpophalangeal joint.
* The injury results from hyperabduction of the metacarpophalangeal joint of the thumb, which occurs when the thumb is held by a ski pole while the rest of the hand hits the ground or enters the snow.
* In severe injuries, the head of the metacarpal has an avulsion fracture.
107
107
Mallet or Baseball Finger:
* How does this happen
* What is an example?
* These actions avulse the attachment of what?
* What is the result?
* Distal interphalangeal joint suddenly being forced into extreme flexion (hyperflexion) when the tendon is attempting to extend the distal phalanx
* For example, when a baseball is miscaught (hyperflexing it) or the finger is jammed into a base pad.
* These actions avulse the attachment of the tendon from the base of the distal phalanx.
* As a result, the person is unable to extend the distal interphalangeal joint
