Head And Neck

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  • Head And Neck

    1. 1. Head and Neck
    2. 2. Topographical view
    3. 3. Surface anatomy - neck <ul><li>Hyoid </li></ul><ul><li>Thyroid cartilage </li></ul><ul><li>Cricoid cartilage </li></ul><ul><li>SCM muscle </li></ul><ul><li>Sternum </li></ul><ul><li>Chassaignac’s tubercles </li></ul><ul><li>Sternal notch </li></ul>
    4. 4. Surface anatomy - neck <ul><li>Inion </li></ul><ul><li>Trapezius </li></ul><ul><li>Trasversocostal muscle group </li></ul><ul><li>C7 spinous process </li></ul><ul><li>T1 spinous process </li></ul><ul><li>Nuchal ligament </li></ul><ul><li>Post. facet joint </li></ul><ul><li>Suboccipital muscle </li></ul><ul><li>Greator occipital nerve </li></ul>
    5. 5. Bony Landmark Trails
    6. 6. Bony Landmark Trails
    7. 7. Bony Landmark Trails
    8. 8. Muscles of the Head, Neck and Face
    9. 9. Sternocleidomastoid <ul><li>Action </li></ul><ul><ul><li>Bilateral: Extends the head, assists in respiratio when the head is fixed </li></ul></ul><ul><ul><li>Unilateral: Tilts the head to the same side, rotates the head to the opposite side </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Sternal head: Manubrium </li></ul></ul><ul><ul><li>Clavicular head: Medial third of the clavicle </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Mastoid process and superior nuchal line </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Acessory nerve and direct branches from the cervical plexus (C1-2) </li></ul></ul>
    10. 10. Sternocleidomastoid <ul><ul><li>Supine </li></ul></ul><ul><ul><li>Locate the matoid process, medial clavicle and the top of the sternum </li></ul></ul><ul><ul><li>Ask pt. to raise his head very slightly off the table as you palpate SCM </li></ul></ul>
    11. 11. Sternocleidomastoid <ul><ul><li>Palpate along the borders of the SCM </li></ul></ul><ul><ul><li>Follow it behind the earlobe and then down to the clavicle and sternum </li></ul></ul>
    12. 12. Test for SCM
    13. 13. Test for SCM <ul><li>Patient: Supine with elbows bent and hands beside the head, resting on table </li></ul><ul><li>Fixation: If the anterior abdominal muscles are weak, the examiner can provide fixation by exerting firm, downward pressure on the thorax </li></ul><ul><li>Test: Anterolateral neck flexion </li></ul><ul><li>Pressure: Against the temporal region of the head in an obliquely posterior direction </li></ul>
    14. 14. Scalene muscles <ul><li>Anterior scalene </li></ul><ul><li>Middle scalene </li></ul><ul><li>Posterior scalene </li></ul><ul><li>Actions of scalenes muscles </li></ul><ul><ul><li>Unilaterally: Laterally flex the head and neck to the same side, rotate head and enck to the opposite side </li></ul></ul><ul><ul><li>Bilaterally: Elevate the ribs during inhalation, flex the head and neck </li></ul></ul>
    15. 15. Anterior scalene <ul><li>Origin </li></ul><ul><ul><li>TP of 3 rd through 6 th cervical vertebrae (ant. tubercle) </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>1 st rib </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Cervical and brachial plexus (C3-6) </li></ul></ul>
    16. 16. Middle scalene <ul><li>Origin </li></ul><ul><ul><li>TP of 3 rd through 7 th cervical vertebrae (post. tubercle) </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>1 st rib </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Cervical and brachial plexus (C3-6) </li></ul></ul>
    17. 17. Posterior scalene <ul><li>Origin </li></ul><ul><ul><li>TP of 5 th through 7 th cervical vertebrae (post. tubercle) </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>2 nd rib </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Cervical and brachial plexus (C3-6) </li></ul></ul>
    18. 18. Scalenes as a group <ul><ul><li>Supine </li></ul></ul><ul><ul><li>Cradle the head to allow for easier palpation </li></ul></ul><ul><ul><li>Place your finger pad along the ant. and lat. sides of the neck b/w SCM and trapezius </li></ul></ul>
    19. 19. Masseter <ul><ul><li>Supine </li></ul></ul><ul><ul><li>Locate zygomatic arch and angle of the mandible </li></ul></ul><ul><ul><li>Place your fingers b/w these bony landmarks and palpate the surface of the masseter </li></ul></ul><ul><ul><li>Ask pt. to alternately clench and relax her jaw </li></ul></ul>
    20. 20. Temporalis <ul><ul><li>Supine and locate the zygomatic arch </li></ul></ul><ul><ul><li>Place your finger pads 1 inch superior to the arch </li></ul></ul><ul><ul><li>Ask pt. to alternately clench and relax her jaw </li></ul></ul>
    21. 21. Temporalis <ul><ul><li>To locate the insertion site of the temporalis tendon, ask pt. to open her mouth wide </li></ul></ul><ul><ul><li>Locate and explore the coronoid process </li></ul></ul>
    22. 22. Occipitofrontralis <ul><li>Frontalis fibers </li></ul><ul><ul><li>supine </li></ul></ul><ul><ul><li>place fingers on the forehead </li></ul></ul><ul><ul><li>ask pt. to raise his eyebrows </li></ul></ul><ul><li>Occipitalis fibers </li></ul><ul><ul><li>supine or prone </li></ul></ul><ul><ul><li>locate sup. nuchal line </li></ul></ul><ul><ul><li>slide fingers 1 inch superiorly </li></ul></ul>
    23. 23. Splenius muscles
    24. 24. Splenius muslces <ul><li>7. Splenius cervicis </li></ul><ul><li>8. Splenius capitis </li></ul>
    25. 25. Splenius muscles <ul><li>Action </li></ul><ul><ul><li>Entire muscle; bilateral contraction extends the cervical spine and head, unilateral contraction flexes and rotates the head to the same side </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Splenius cervicis: Spinous process of T3-T6 vertebrae </li></ul></ul><ul><ul><li>Splenius capitis: Spinous process of C3-T3 vertebrae </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Splenius cervicis: Transverse process of C1-2 </li></ul></ul><ul><ul><li>Splenius capitis: Lateral superior nuchal line, mastoid process </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Lateral branches of dorsal rami of spinal nerves C1-6 </li></ul></ul>
    26. 26. Splenius capitis <ul><ul><li>Prone, locate the upper fibers of the trapezius </li></ul></ul><ul><ul><li>Isolate the lat. edge of the trapezius by extending pt’s head slightly </li></ul></ul><ul><ul><li>Palpate just lateral to the trapezius and follow the oblique fiber up to the mastoid process </li></ul></ul>
    27. 27. Both splenii muscles <ul><ul><li>Supine with head rotated 45° away from the side palpating </li></ul></ul><ul><ul><li>Cradle the head with one hand while the other hand locates the lamina groove of the upper cervical vertebrae </li></ul></ul>
    28. 28. Suboccipitalis Rectus capitis posterior major Rectus capitis post. minor Oblique capitis superior Oblique capitis inferior
    29. 29. Suboccipitalis <ul><li>Rectus capitis posterior major </li></ul><ul><li>Rectus capitis posterior minor </li></ul><ul><li>Rectus capitis superior </li></ul><ul><li>Rectus capitis inferior </li></ul>
    30. 30. Rectus capitis posterior major <ul><li>A: Bilateral contraction extends the head. Unilateral contraction rotates the head to the same side </li></ul><ul><li>O : SP of the axis </li></ul><ul><li>I : Inferior nuchal line of the occiput </li></ul><ul><li>N : Suboccipital </li></ul>
    31. 31. Rectus capitis posterior minor <ul><li>A: Bilateral contraction extends the head. Unilateral contraction rotates the head to the same side </li></ul><ul><li>O : Tubercle of the posterior arch of the atlas </li></ul><ul><li>I : Inferior nuchal line of the occiput </li></ul><ul><li>N : Suboccipital </li></ul>
    32. 32. Oblique capitis superior <ul><li>A: Bilateral contraction extends the head. Unilateral contraction tilts the head to the same side and rotates it to the opposite side </li></ul><ul><li>O : TP of Atlas </li></ul><ul><li>I : Above the insertion of the rectus capitis posterior major </li></ul><ul><li>N : Suboccipital </li></ul>
    33. 33. Oblique capitis inferior <ul><li>A: Bilateral contraction extends the head. Unilateral contraction rotates the head to the same side </li></ul><ul><li>O : Sp of the axis </li></ul><ul><li>I : TP of the atlas </li></ul><ul><li>N : Suboccipital </li></ul>
    34. 34. Suboccipitalis <ul><ul><li>Supine position </li></ul></ul><ul><ul><li>Cradle the head in both hands </li></ul></ul><ul><ul><li>Passively extending the neck a bit </li></ul></ul><ul><ul><li>Locate sup. nuchal line and spinous process of C2 </li></ul></ul><ul><ul><li> Suboccipital span the area between these two landmarks </li></ul></ul>
    35. 35. Suboccipitals <ul><ul><li>Prone position </li></ul></ul><ul><ul><li>Locate lat. edge of the trapezius’ upper fiber </li></ul></ul><ul><ul><li>Palpating beside the level of C1 , place one finger at the lateral edge of the trapezius </li></ul></ul><ul><ul><li>Slowly sink medially into the suboccipitalis </li></ul></ul>
    36. 36. Test for posterolateral neck extensor
    37. 37. Test for posterolateral neck extensor <ul><li>Splenius capitis/cervicis, semispinalis capitis/cervicis, and cervical erector muscles </li></ul><ul><li>Patient: Prone with elbows bent and hands overhead, resting on the table </li></ul><ul><li>Fixation: None necessary </li></ul><ul><li>Test: Posterolateral neck extension, with the face turned toward the side being tested </li></ul><ul><li>Pressure: Against the posterolateral aspect of the head in an anterolateral direction </li></ul>

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