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Shoulder Complex

Palpation Practical

TermDefinition
Regions of the Neck
Palpate How to 1st Rib Patient in supine position: Right 1st rib = cervical side bend left and cervical rotation to the right Left 1st rib = cervical side bend right and cervical rotation to the left Patient sitting upright: Locate C7, go out a bi
2 Triangles
Anterior
Posterior
4 Regions
SCM region
Anterior Cervical
Posterior Cervical
Lateral Cervical
Lateral Region/Posterior Triangle
Sternocleidomastoid
Divides anterior region and lateral region
Is the Anterior boundary of lateral region
Posterior boundary is Upper trapezius
Inferior boundary is clavicle
Identify structures in each of the 4 regions and 2 triangles of the neck
Splenius capitis
Levator scapula
Middle, and posterior scalenes
Inferior part of anterior scalene
Inferior belly of Omohyoid (base)
Spinal accessory nerve
Roots of the brachial plexus (anterior rami of C5-T1)
Sup., middle, inf. trunks
Suprascapular nerve
Cutaneous branches of the cervical plexus (C1-C4):
Lesser occipital nerve (C2)
Great auricular nerve (C2,3)
Transverse cervical nerve (C2,3)
Supraclavicular nerves (C3,4)
Phrenic nerve (C3-5)
External jugular vein
Subclavian vein
Brachiocephalic vein
Cervicodorsal vein
Suprascapular artery
Occipital artery
3rd part of the subclavian artery
Lymph nodes
Structures
Splenius capitis
Levator scapula
Middle, and posterior scalenes
Inferior part of anterior scalene
Inferior belly of Omohyoid (base)
Spinal accessory nerve
Roots of the brachial plexus (anterior rami of C5-T1)
Sup., middle, inf. trunks
Suprascapular nerve
Cutaneous branches of the cervical plexus (C1-C4):
Lesser occipital nerve (C2)
Great auricular nerve (C2,3)
Transverse cervical nerve (C2,3)
Supraclavicular nerves (C3,4)
Phrenic nerve (C3-5)
External jugular vein
Subclavian vein
Brachiocephalic vein
Cervicodorsal vein
Suprascapular artery
Occipital artery
3rd part of the subclavian artery
Lymph nodes
Identify the main structures innervated by: spinal accessory n., suprascapular n., lesser occipital n., great auricular n., transverse cervical n., suprclavicular n., phrenic n.
Spinal accessory nerve
Deep to SCM
prascapular
Muscles
See Netter plate 29
Nerves :
Spinal accessory nerve
Deep to SCM
Roots of the brachial plexus (anterior rami of C5-T1)
Sup., middle, inf. trunks
Arise btw ant. and middle scalene
Suprascapular nerve
Off superior trunk to supra- and infra-
Cutaneous branches of the cervical plexus (C1-C4):
Lesser occipital nerve (C2): post neck/scalp
Great auricular nerve (C2,3): skin over parotid, skin over
post. auricle, skin from mandible to mastoid
Transverse cervical nerve (C2,3): ant. cervical skin
Supraclavicular nerves (C3,4): skin over shoulder, motor to
rhomboids (dorsal scap), serratus (LT)
Phrenic nerve (C3-5): , lies over ant. scalene, diaphragm
Vessels:
External jugular vein
Angle of mandible-> Lies over SCM,
Drains blood from scalp and face into subclavian
Subclavian vein
Major vein draining UE
Brachiocephalic vein
Juncture of IJV and SubC just posterior
to medial clavicle
Cervicodorsal (transverse cervical) vein
Suprascapular vein
Vessels:
Suprascapular artery
Posterior scapular muscles
Occipital artery
Supplies occiput/scalp
3rd part of the subclavian artery
Lateral to anterior scalene, to UE
Anterior Region/Triangle
2 Triangles
Anterior
Posterior
4 Regions
SCM region
Anterior Cervical
Posterior Cervical
Lateral Cervical
Muscles: plates 27-29; pg.592-599
Suprahyoids
Myo-
Genio-
Stylo-
Digastric
Infrahyoids
Omo-
Sterno-
Thyro-
Sternothyroid
Nerves
Hypoglossal (CNXII)
Deep to digastric
Glossopharyngeal (CNIX)
Vagus (CNX)
Vessels
Carotid System
Common Carotid
Right arises from brachiocephalic trunk
Left arises from arch of aorta
Common carotid ascends in a sheath with IJV and vagus n. to superior thyroid cartilage
Divides here into Internal and External
Carotid sinus: baroreceptor
Carotid body: chemoreceptor
Vessels
Internal Carotid
No branching in the neck
Enter skull via carotid foramina
Main arteries of brain and orbital structures
80-85% of bloodflow to brain
Vessels
External Carotid
Six main branches:
Superior Thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior Auricular
Ascends to parotid gland/neck of mandible, divides into maxillary and superficial temporal arteries
Veins
Internal Juglar Vein
Largest vein in neck
Drains blood from brain, anterior face/neck
Tributaries are veins that primarily accompany arteries
Superior Bulb
Enlargement near skull
Inferior Bulb
Has bicuspid valve that allows blood to flow
towards heart without backflow
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