Head And Neck

Head and Neck

Topographical view

Surface anatomy - neck

A. Hyoid

B. Thyroid cartilage

C. Cricoid cartilage

D. SCM muscle

E. Sternum

F. Chassaignac’s

tubercles

G. Sternal notch

Surface anatomy - neck

A. Inion

B. Trapezius

C. Trasversocostal muscle group

D. C7 spinous process

E. T1 spinous process

F. Nuchal ligament

G. Post. facet joint

H. Suboccipital muscle

I. Greator occipital nerve

Bony Landmark Trails

Muscles of the Head, Neck and Face

Sternocleidomastoid

Action Bilateral: Extends the head,

assists in respiratio when the head is fixed

Unilateral: Tilts the head to the same side, rotates the head to the opposite side

Origin Sternal head: Manubrium Clavicular head: Medial

third of the clavicle Insertion

Mastoid process and superior nuchal line

Innervation Acessory nerve and direct

branches from the cervical plexus (C1-2)

Sternocleidomastoid

Supine

Locate the matoid process, medial clavicle and the top of the sternum

Ask pt. to raise his head very slightly off the table as you palpate SCM

Sternocleidomastoid

Palpate along the

borders of the

SCM

Follow it behind

the earlobe and

then down to the

clavicle and

sternum

Test for SCM

Test for SCM

• Patient:Patient: Supine with elbows bent and hands beside the head, resting on table

• Fixation:Fixation: If the anterior abdominal muscles are weak, the examiner can provide fixation by exerting firm, downward pressure on the thorax

• Test:Test: Anterolateral neck flexion

• Pressure:Pressure: Against the temporal region of the head in an obliquely posterior direction

Scalene muscles

1. Anterior scalene

2. Middle scalene

3. Posterior scalene

Actions of scalenes muscles

Unilaterally: Laterally flex the head and neck to the same side, rotate head and enck to the opposite side

Bilaterally: Elevate the ribs during inhalation, flex the head and neck

Anterior scalene

Origin TP of 3rd through 6th

cervical vertebrae (ant. tubercle)

Insertion 1st rib

Innervation Cervical and brachial

plexus (C3-6)

Middle scalene

Origin TP of 3rd through 7th

cervical vertebrae (post. tubercle)

Insertion 1st rib


plexus (C3-6)

Posterior scalene

Origin TP of 5th through 7th

cervical vertebrae (post. tubercle)

Insertion 2nd rib


plexus (C3-6)

Scalenes as a group

Supine

Cradle the head to allow for easier palpation

Place your finger pad along the ant. and lat. sides of the neck b/w SCM and trapezius

Masseter Supine

Locate zygomatic arch and angle of the mandible

Place your fingers b/w these bony landmarks and palpate the surface of the masseter

Ask pt. to alternately clench and relax her jaw

Temporalis

Supine and locate the zygomatic arch

Place your finger pads 1 inch superior to the arch

Ask pt. to alternately clench and relax her jaw

Temporalis

To locate the

insertion site of the

temporalis tendon,

ask pt. to open her

mouth wide

Locate and explore

the coronoid

process

Occipitofrontralis Frontalis fibers

supine place fingers on the

forehead ask pt. to raise his

eyebrows

Occipitalis fibers supine or prone locate sup. nuchal

line slide fingers 1 inch

superiorly

Splenius muscles

Splenius muslces

7. Splenius cervicis

8. Splenius capitis

Splenius muscles

Action Entire muscle; bilateral contraction extends the

cervical spine and head, unilateral contraction flexes and rotates the head to the same side

Origin Splenius cervicis: Spinous process of T3-T6

vertebrae Splenius capitis: Spinous process of C3-T3 vertebrae

Insertion Splenius cervicis: Transverse process of C1-2 Splenius capitis: Lateral superior nuchal line,

mastoid process

Innervation Lateral branches of dorsal rami of spinal nerves C1-6

Splenius capitis Prone, locate the upper

fibers of the trapezius

Isolate the lat. edge of the trapezius by extending pt’s head slightly

Palpate just lateral to the trapezius and follow the oblique fiber up to the mastoid process

Both splenii muscles

Supine with head rotated 45° away from the side palpating

Cradle the head with one hand while the other hand locates the lamina groove of the upper cervical vertebrae

SuboccipitalisRectus capitis posterior major

Rectus capitis post. minor

Oblique capitis superior

Oblique capitis inferior

Suboccipitalis

1. Rectus capitis

posterior major

2. Rectus capitis

posterior minor

3. Rectus capitis

superior

4. Rectus capitis

inferior

Rectus capitis posterior major A: Bilateral contraction

extends the head.

Unilateral contraction

rotates the head to the

same side

O : SP of the axis

I : Inferior nuchal line of

the occiput

N : Suboccipital

Rectus capitis posterior minor

A: Bilateral contraction

extends the head. Unilateral

contraction rotates the head to

the same side

O : Tubercle of the posterior

arch of the atlas

I : Inferior nuchal line of the

occiput

N : Suboccipital

Oblique capitis superior



contraction tilts the head to the

same side and rotates it to the

opposite side

O : TP of Atlas

I : Above the insertion of the

rectus capitis posterior major

N : Suboccipital

Oblique capitis inferior



contraction rotates the head to

the same side

O : Sp of the axis

I : TP of the atlas

N : Suboccipital

Suboccipitalis

Supine position

Cradle the head in both hands

Passively extending the neck a bit

Locate sup. nuchal line and spinous process of C2 Suboccipital span the area between these two landmarks

Suboccipitals

Prone position

Locate lat. edge of the trapezius’ upper fiber

Palpating beside the level of C1, place one finger at the lateral edge of the trapezius

Slowly sink medially into the suboccipitalis

Test for posterolateral neck extensor

Test for posterolateral neck extensor

• Splenius capitis/cervicis, semispinalis capitis/cervicis, and cervical erector muscles

• Patient:Patient: Prone with elbows bent and hands overhead, resting on the table

• Fixation:Fixation: None necessary

• Test:Test: Posterolateral neck extension, with the face turned toward the side being tested

• Pressure:Pressure: Against the posterolateral aspect of the head in an anterolateral direction

Head And Neck

Health & Medicine

Transcript of Head And Neck