Neck and HeadNeck fascia, compartments, neurovasculature, musculature

Objectives• Describe the gross anatomy for each system (circulatory,

muscular, nervous, and skeletal) in the neck and head.• Integrate the systems to discuss the neck stability and mobility

functions.• Analyze common injuries in the neck.• For each muscle, describe how the attachment sites result in

an action around a joint.• For each muscle, identify the innervation (peripheral nerve

and nerve roots or cranial nerve).• Describe the gross anatomy of the central nervous system.

Infrahyoid muscles (muscular triangle)

Suprahyoid muscles (submandibular & submental triangles)

Presentation• Cervical Plexus

ERB’s point

Pre-quiz for CNS overview

1. Can a parasympathetic nerve carry both motor and sensory?2. Can a sympathetic nerve carry motor and sensory?3. Can a sympathetic nerve innervate skeletal muscle?4. Can a sympathetic nerve innervate blood vessels?5. Can a somatic nerve innervate blood vessels?6. Can a somatic nerve innervate the digestive tract?7. Can a somatic nerve innervate skeletal muscle?8. Give an example of a somatic nerve.9. What are the 3 parts of the brainstem?10. What is the cerebral cortex?11. What is white matter?

Clinical Relevance• Torticollis• Spasmodic and congenital

• Nerve Blocks

Case Study• 2012• 37 y/o nurse, chronic neck pain• Chiropractic neck manipulations 1/month for 12-15 years• After pain developed when turning head up to the right, she

visited the chiropractor 4 times in a week• 4th visit – loud pop• Room was spinning, visual disturbances, vomited, loss of balance

• Chiropractor failed to recognize signs of stroke• Attempted “occipital adjustment” to relieve symptoms

• 1.5 hours later at the ER, discovered to have suffered “cervical artery dissection”

Case Study 2• 24 y/o female with sinus headaches• During neck manipulation, she suffered a brainstem stroke and

died three days later.• Autopsy revealed walls of vertebral arteries (both) split.• Blood clots formed and entered the vertebrobasilar system.

• Vertebral arteries can be damaged easily: wash basins at hair salons, vehicle accidents, rapid stretching

https://www.sciencebasedmedicine.org/chiropractic-strokes-again-an-update/

“Although incidence of cervical artery dissection precipitated by chiropractic neck manipulation is unknown, it is an important risk. Given that risk, physical therapy exercises may be a safer option than spinal manipulation for patients with neck pain.”

A study was conducted to examine incidence of strokes with neck manipulations. Of 13 patients: 9 recovered completely, 3 were permanently disabled, 1 died.Chiropractic strokes are recognized in the chiropractic literature: why is it downplayed??

DO NO HARM