Neck

Question 1

List 3 taught points in the neck and describe their location

Answer 1

Neck points

1. GV14

On the midline of the neck, between C7 and T1 spinous processes

2. GB20

In the depression below the occipital bone at the level of GV 16, between the origin of trapezius and sternocleidomastoid muscles, midway between the midline and the mastoid process

3. SI15

2 cun lateral to the midline at the level of the lower border of spinous process of C7 (GV 14).

Question 2

GV14 location and needling technique

Answer 2

GV14 location and needling technique

Location

On the midline of the neck, between C7 and T1 spinous processes

Insertion

slightly superiorly, generally the needle will follow the space between the spinous processes.

Depth

1 cun

Question 3

List relevant GV14 anatomy

• Muscles (3)
• Ligaments (3)
• Nerves (1)
• Vessels (1)

Answer 3

GV14 anatomy

Muscles

1. transversospinales: multifidus, rotatores, spinalis

Ligaments

1. supraspinous ligament
2. interspinous ligament
3. posterior longitudinal ligament

Nerves

1. medial branch of the posterior primary ramus anastomosis C7-T1

Vessels

1. branch of transverse cervical artery

Question 4

List 7 neuroanatomical indications for GV14

Answer 4

GV14 indications

1. Influence on C7, C8 and T1
2. Generalized effect on muscles of head, neck, back
3. Myofascial pain and inflammation of paraspinal muscles in the C6-T1 area
4. Ligamentous strain of C7 level
5. Osteoarthritis
6. Whiplash
7. Facilitates extension of the neck.

Nb Sympathetic switch

Question 5

GB20 location and needling technique

• Location
• Insertion
• Depth

Answer 5

GB20 location and needling technique

Location:

In the depression below the occipital bone at the level of GV 16, between the origin of trapezius and sternocleidomastoid muscles, midway between the midline and the mastoid process

Insertion:

Towards the tip of the nose or opposite eye on a horizontal plane

Depth:

0.5-1 cun, no deeper to avoid puncturing the vertebral artery

Caution: avoid deep needling (vertebral artery at ~ 40mm from skin), and avoid directing the needle towards the foramen magnum.

Question 6

List relevant GB20 anatomy

• Muscles (2)
• Nerves (3)
• Vessels (4)

Answer 6

GB20 anatomy

Muscles:

1. sternocleidomastoid
2. trapezius

Nerves:

1. greater auricular nerve C2, 3
2. lesser occipital nerve C2
3. accessory nerve (XI)

Vessels:

1. & 2. occipital artery and vein
2. & 4. vertebral artery and vein

Question 7

List 5 neuroanatomical indications for GB20

Answer 7

GB20 indications

1. Occipital neuralgia
2. Pain and inflammation of sternocleidomastoid and trapezius
3. Vascular headache and dizziness
4. Fibromyalgia
5. Spastic and spasmodic torticollis

Nb Sympathetic switch

Question 8

SI15 location and needling technique

• Location
• Insertion
• Depth

Answer 8

SI15 location and needling technique

Location

2 cun lateral to the midline at the level of the lower border of spinous process of C7 (GV 14).

Insertion

Oblique, inferior to superior, towards the midline

Deep perpendicular insertion may cause pneumothorax. Pick up muscle while inserting.

Depth

0.5 – 1.0 cun

Question 9

List relevant SI15 anatomy

• Muscles (3)
• Nerves (2)
• Vessels (2)

Answer 9

SI15 anatomy

Muscles

1. trapezius
2. levator scapulae
3. rhomboids

Nerves

1. lateral cutaneous branch of the posterior ramus of C8 and T1
2. dorsal scapular nerve

Vessels

1. & 2. dorsal scapular artery and vein

Question 10

List 3 neuroanatomical indications for SI15

Answer 10

SI15 indications

1. rhomboid strain
2. levator scapulae myofascial pain and dysfunction
3. pain and inflammation in the neck/shoulder region