Cranial Nerve And Muscle Chart Case

Date 3 weeks after onset

Date 3 weeks after onset

© 2005 Florence P. Kendall. Author grants permission to reproduce for personal use but not for sale.

Muscles of Deglutition

Muscle tongue

Sup longttudinal

Transverse Vertical

Inf longitudinal Genioglossus

Hyoglossus

Origin insertion ntrlnt«

Action

Shortens tonguo I Rats ox SIÖ&» and hp of tonguo ! Lengthens and narrows tongue_

I Flattons and broadens tongue

Innervation

Motor Sensory

Hypoglossal XII

Intrinsic Mental spina i Shortens tongue I Turns Up Of tongue downward

Styloglossus Palatoglossus

Greater horn of hyoid Styloid procos*

j Tonguo and body of hyoid Oeprossos tonguo; protrudes J and retracts tonguu. J_______I elevates hyoid i (

Tongue

Aponeurosis of soft palate

Tongue

Tonguo

¡ Depresses and puffs tonguo posteriorly j Elevates and pulls tonguo posteriorly E lovâtes and pulls longue posteriorly. narrows fauces

Hypogfossaf XIÍ

SOFT PALATE

Tensor veil palatini

Levator veli palatini

Scaphoid fossa, spine of spheooid, >3ferai indi j tory tobo

Aponeurosis of soft palate j Tenses soft palate

' Petrous portion, temporal bone: medial auditory tube

Soft palale

Hypogfossaf XIÍ

General aenaaWon Ant. K—

Trigémina* V Post "S — Glossopharyngeal IX Base-Vagus X

Special sensation (t&sloj Ant K—

Fecial VN Post K-Glossopha ryngeal JX Base-Vagus X

Efevatos soft palate

Uvulae

Posterior nasal spmo aponeurosis of palate

L/vufa

Shortens soft palate

Pharyngeal plexus | Trigeminal V IX. X. XI If Glossopha rvngeai IX

FAUCES

Palatoglossus

See above

Palatopharyngeus

Aponeurosis o j soft paJaie

SUPRAHYOID

Digastric

Arn. belly Post belly

Mylohyoid

Inferior border of mandible near symphysis

Mastoid process

Mylohyoid lino of mandible

Median ridge of mandible

Posterior itoyroid ca^rlage^T Narrows fauces: Posterolateral pharynx

Elevates larynx and pharyi

Pharyngeal plexus

Flevates and pulls hyoid anteriorly

Intermediate tendon to ' Ass.sis in depressing the " body and cornu of mantlible hyoid I——--■—--------

tlevaios and pulls hyoid

J________j posteriorly i Body o/ hyoirf and mBdian FJewares hyo>d and L JL _ _______ I depresses mandible

» tiuvgtet nyoid and tonftue

I Trigeminal V 1 Facial VII

J TrigemmaJV

Glossopha rangeai IX

Role in Deglutition

Bolus Preparation During this phase the tongue and buccinator muscles keep the food boiwoon tho molar teeth where it is crushed and ground by the action muscles of mastication. Alternate aide to sido movements and twitting of the tongue, performed chiefly by the intrinsic muscles and by the styloglossi acting unilaterally, afd In mixing tho food with aaliva and in sorting larger particles from tho sufficiently ground portion which Is ready to bo rolled into a bolus and swallowed.

Voluntary Stage The tongue depressor muscles contract and form a groove in tho posterior portion of the dorsum of the tongue which cradles the bolus. A movement initiated by the intrinsic muscles raises the anterior portion and then the posterior portion of the tongue to the hard palate. This sequential movement dislodges the bolus and squeezes it toward the fauces. In turn the base of the tongue Is elevated and pulled posteriorly mainly by the action of the styloglossi muscles forcing the bolus through the fauces into tho pharynx. Occurring simultaneously with this elevation of the base of the tongue is a moderate elevation of the hyoid bona and tho larynx.

Involuntary (Reflex) Stage As the bolus passes through the fauces to the pharynx, branches of cranial nerves V, IX. and X are stimulated producing impulses in the afferent limb of the swallow reflex. Upon reaching the brainstem, these Impulses are transmitted across synapses to efferent fibers of cranial nerves IX. X and XI completing the reflex arc and effecting the following automatic events.

INFRAHYOID

Thyrohyoid

Oblique line of thyroid _cartilage

Greater horn of hyold

Elevates the thyroid cartilage;

Ansa cervicitis CI. 2

Sternohyoid

Manubrium stem); medial end of clavicle

Body of byoid, inf. border

Depresses hyoid

Sternothyroid

Manubrium sterni; costal carrifage of 1st rib

Oblique line of thyroid cartilage

Depresses thyroid cartilage

Ansa cervicalis CI, 2, 3

Omohyoid-Sup. belly

Superior border of scapula near scapular notch

Intermediate tendon by fascia to clavicle

|--—

Inf. belly

Intermediate tendon by fascia to clavicle

Body of hyoid, inf. border

Depresses the hyoid

LARYNX Aryepiglottic

Apex of arytenoid cartilage

Lateral margin of epiglottis

Assists in closing inlet of larynx

Thyroepiglottic

Medial surface of thyroid cartilage

Lateral margin of epiglottis

Assists in closing Inletof larynx

Thyroarytenoid

Medial surface of thyroid cartilage

Muscular process of arytenoid cartilage

Assists in dosing glottis; shortens vocal folds

Arytenoid-Oblique

Base of one arytenoid cartilage

Apex of opposite arytenoid cartilage

Transverse

Posterior surface and lateral border of one arytenoid cartilage

Posterior surface and lateral border of opposite arytenoid cartilage

Assist in closing glottia by adducting arytenoid cartilages

Vagus X

Mainly accessory XI, cranial root

Vagus X

Lat. cricoarytenoid

Upper border of arch of cricoid cartilage

Muscular process of arytenoid cartilage

Adducts and medially rotates arytenoid cartilage

Vocalis

Medial surface of thyroid cartilage

Vocal process of arytenoid cartilage

Regulates tension of vocal

Post, cricoarytenoid --

Posterior surface of lamina of cricoid cartilage

Muscular process of arytenoid cartilage

Abducts arytenoid cartilage widening glottis

Cricothyroit}-Straight

Anterior and lateral part of arch of cricoid

Anterior border, inferior horn of thyroid cartilage

Elevates cricoid arch and

Oblique

cartilage

Lower border of lamina of thyroid cartilage

elongates vocal folds

Salpingopharyngeus Palatopharyngeus

Auditory tube Pharyngeal wall

Elevates pharynx

Pharyngeal plexus

Stylopharyngeus

Styloid process

Posterior border of thyroid cartilage; posterolateral wall of pharynx

Elevates pharynx and larynx

Glossopharyngeal IX

Superior constrictor

Medial pterygoid plata; pterygomandibular raphe; mandible

pharyngeal tubercle

Conatrict, sequentially, nasopharynx, oropharynx

Middle constrictor

Horna of hyoid

-pharyngeal raphe pharyngeal raphe

Pharyngeal plexus

Inferior constrictor

Thyroid and cricoid cartilages

pharyngeal raphe

laryngopharynx

Pharyngeal plexus IX. X. XI

IX and X

Cricopharyngeus

Arch of cricoid cartilage

Arch of cricoid cartilage

--J

Acts as sphincter to prevent air entering esophagus; relaxes during swallowing

The tort palate is elevated and brought into contact with the posterior pharyngeal wall by the contraction of the tensor and leva-tor veli palatini muscles. This action closes off the nasopharynx ensuring passage of the bolus into the lumen of the laryn-gopharynx. This passage is facilitated when the lumen is expanded by the elevation of the pharyngeal wall and the cranial and anterior movement of the hyoid bone and the larynx. When the last of the bolus leaves the oral cavity, the oropharynx opening is closed by contraction of the palatopharyngeal muscles and descent of the soft palate.

The cranial movement of the thyroid cartilage toward the hyoid bone and of these two structures, in turn, toward the base of the tongue results in tilting the epiglottis posteriorly. The weight of the bolus as it contacts the anterior surface of the epiglottis assists in increasing this posterior tilt. The change of position of the epiglottis aids in directing the bolus material around the sides of the larynx through the piriform sinuses and over the tip of the epiglottis into the hypopharynx. It also aids in preventing foodstuffs from entering the larynx. The major mechanism for protecting the larynx, however, is the concurrent, sphincter-like closure of the laryngeal inlet to the vestibule and the closure of the vestibular and vocal folds of the glottis.

Occurring simultaneously with the above events is a sequential contraction of the superior, middle and inferior constrictors which strips the pharynx forcing the bolus toward the esophagus. Horizontally oriented fibers found between the inferior constrictor and the esophagus have been named the cricopheryngeua muadm. This muscle acts as a sphincter and functionally is related mora to the esophagus then to the pharynx. It relaxes when the bolus reaches the caudal extent of the hypopharynx permitting the foodstuff to enter the esophagus.

1. Bourban B. Musculoskeletal analysis: the temporomandibular joint and cervical spine. In: Scully R, Barnes M, eds. Physical Therapy. Philadelphia: JB Lippincott; 1989.

2. Rocabado M. Arthrokinematics of the temporomandibular joint. Dent Clin North Am. 1983;27:573-594.

3. Yusiin D, Rieger M, McGuckin R. Determination of the existence of hinge movements of the temporomandibu-lar joint during normal opening by cine-MRI and computer digital addition. J Prosthodont. 1993;2: 190-195.

4. Travell J. Temporomandibular joint pain referred from muscles of the head and neck. The Journal of Prosthetic Dentistry. 1960;10(4):745-763.

5. Grace E, Sarlani E, Reid B, Read B. The use of an oral exercise device in the treatment of muscular TMD. The Journal of Craniomandibular Practice. 2002;20(3):204-208.

wwmiiiim

CONTENTS

Introduction

143

Section I: Innervation and Movements

144

Section IV: Painful Conditions

159

Spinal Cord and Nerve Roots

144

light Posterior Neck Muscles

159

Spinal Nerve and Muscle Chart

144

Upper Trapezius Strain

160

Cervical Plexus

145

Cervical Nerve Root Pressure

160

Joint Movements of the Cervical Spine

146

Computer Ergonomics

161

Neck Range of Motion

147

Section V: Treatment

162

Section II: Neck Muscles

148

Massage of Neck Muscles

162

Anterior and Lateral Neck Muscles, Charts

148, 149

Exercises to Stretch Neck Muscles

163

Suprahyoid and Infrahyoid Muscles

150, 151

References

164

Cervical Spine Extension and Flexion

152

Faulty Head and Neck Positions

153

Section III: Neck Muscle Tests

154

Anterior Neck Flexors

154

Error in Testing Neck Flexors

155

Anterolateral Neck Flexors

156

Posterolateral Neck Flexors

157

Upper Trapezius

158

The cervical spine and the muscles of the neck form a remarkable structure that provides for movement of the head in all directions, and for stability in various positions. The neck supports the weight of the head in the upright position. For the gymnast who performs a headstand, the neck supports the weight of the body momentarily!

The "standard" (also referred to as normal) position of the head is one in which the head is "level" based on the fact that "eyes seek eye level." The neck is in a position of slight anterior curve, and the upper back is in a position of slight posterior curve.

In typical faulty posture, the alignment of the head does not change, but the alignment of the neck changes in response to altered upper back positions. If the upper back is straight, the neck will be straight. If the upper back curves posteriorly into a kyphotic position, the neck extension increases correspondingly to the extent that a marked kyphosis may result in a position of full neck extension with the head maintaining a level position. (See p. 153, Figures B and D.)

Chronic problems of the neck may result from faulty posture of the upper back. As seen in the radiographs on p. 153, the extension occurs in the lower cervical area with the upper vertebrae maintaining a level position for support of the head.

Along with many attributes, the neck is also vulnerable to stress and serious injury. Occupational or recreational activities may demand positions of the head that result in alignment and muscle imbalance problems. (See p. 161 for examples of incorrect and corrected positions in a workplace situation.)

Emotional stress may cause an acute onset of pain with spasm of the neck muscles. The problem may be only temporary or the stress may be long-standing and result in chronic problems. The appropriate use of massage in the early stages can be an important part of treatment. (See p. 162.)

A common cause of whiplash injury to the neck is one in which a stopped or very slow-moving vehicle is hit from the rear by a fast-moving vehicle. By the impact, the head is suddenly thrust backward resulting in hyperextension of the neck, followed immediately by a sudden thrust forward resulting in hyperflexion of the neck. Trauma caused by a whiplash may result in temporary and relatively mild symptoms, or may cause severe and long-term problems.

This chapter presents basic evaluation and treatment procedures in relation to faulty and painful neck conditions.

SPINAL CORD AND NERVE ROOTS

SPINAL NERVE AND MUSCLE CHART

NECK AND DIAPHRAGM

Date

MUSCLE STRENGTH GRADE

MUSCLE

PERIPHERAL NERVES KEY-* D. - Dorsal Pflm. Ramus I

Ö

>

>

>

a.

CL

freo

00

CL."

al

a.

—i

5

G.

_J

a.

_i

s

V. • Vent. Prim. Ramus P.R. - Plexus Rao! S.T. ■ Superior Trunk P. = Posterior Con) L. = Lateral Cord M, = Medial Cord

SPINAL SEGMENT

-

<u o

CD

<9

ni

m s" 10 m"

V

in

lf> T

rC" to tfî

1

tb »

r-to" u>

£

in lO

in

r*-*

i_>

O

CO o

Z

= ri

-I

3

=3

o

a

en u

o

(J

O

o

S

^ 1

HEAD & NECK EXTENSORS

1

2

3

TtT

6

7

s

i

Cervical nerves

INFRAHYOID MUSCLES

1

2

3

RECTUS CAP ANT. 4 LAT.

t

2

LONGUS CAPITIS

1

2

3

w

LONGUS COLLI

2

3

4

5

6

(71

P

LEVATOR SCAPULAE

#

3

4

5

SCALENIfA M. P.)

3

4

S

6

7

e

STE RNOCLEIDOMASTOID

(1)

2

3

TRAPEZIUS (U. M L)

2

3

4

H

DIAPHRAGM

3

4

5

© 2005 Florence P. Kendall. Author grants permission to reproduce for personal use bul not for sale.

© 2005 Florence P. Kendall. Author grants permission to reproduce for personal use bul not for sale.

The cervical plexus is formed by the ventral primary rami of spinal nerves CI through C4, with a small contribution from C5. Peripheral nerves arising from the cervical plexus innervate most of the anterior and lateral muscles of the neck and supply sensory fibers to part of the head as well as to much of the neck.

Lesser occipital C2, 3

Greater auricular C2,3

Accessory N. (XI)

Sternocleidomastoid XI

to Levator scapulae C3 4 5

Longus capitis C1,2,3, (4) and

Longus colli C2,3,4

Lesser occipital C2, 3

Greater auricular C2,3

Accessory N. (XI)

Sternocleidomastoid XI

to Levator scapulae C3 4 5

Neck Anesthesia

Longus capitis C1,2,3, (4) and

Longus colli C2,3,4

Geniohyoid CI, (2)

Thyrohyoid C1,(2)

Transverse cutaneous of the neck C2,3

Supraclavicular C3,4

Ansa cervicalis: superior root C1 ,(2)

inferior root C2, 3

to Omohyoid to Sternohyoid I — to Sternothyroid

L- to Omohyoid

Supraclavicular C3,4

Geniohyoid CI, (2)

Thyrohyoid C1,(2)

Transverse cutaneous of the neck C2,3

Ansa cervicalis: superior root C1 ,(2)

inferior root C2, 3

to Omohyoid to Sternohyoid I — to Sternothyroid

L- to Omohyoid

Was this article helpful?

0 0
Peripheral Neuropathy Natural Treatment Options

Peripheral Neuropathy Natural Treatment Options

This guide will help millions of people understand this condition so that they can take control of their lives and make informed decisions. The ebook covers information on a vast number of different types of neuropathy. In addition, it will be a useful resource for their families, caregivers, and health care providers.

Get My Free Ebook


Post a comment