The neck is the part of the body, on many terrestrial or secondarily aquatic vertebrates, that distinguishes the head from the torso or trunk. The adjective (from Latin) signifying "of the neck" is cervical (though this more frequently used to describe the cervix).
That is to say,it can be thought of as a column or pipe with several smaller pipes inside it. Each pipe is a wall of connective tissue; most structures run superiorly and inferiorly (up and down)
inside one particular space between these walls of connective tissue.
The outermost column is,of course, the skin. Anteriorly (in the front of the neck), immediately beneath the skin lies the platysma (this muscle will have been exposed by the peeling of the skin in the dissection of the
facial regions, because it is thin and inserts into the skin). If you tense the muscles of your neck
you can observe your platysma muscles. We will be more concerned with two groups of muscles:
the strap muscles of the neck, which lie deep to the platysma muscle, and the muscles forming
the floor of the oral cavity, underneath the tongue .
Before beginning the dissection, note the following bony and cartilaginous landmarks, which
you should be able to feel on your own neck.
It is worth gaining a good understanding of these landmarks before pursuing the dissection because they will be used to locate the muscles in the
anterior region of the neck. These locations of these landmarks are illustrated in Figure 4.1. They
are also shown in figure 4.3.
The hyoid bone, which lies between the floor of the mouth and the upper end of the neck.
Palpate this bone with a thumb and finger on either side of your neck, close to the mandible.
You should be able to feel the movements of the cornu (horns) of the hyoid bone by doing
the following:
Swallowing.
Saying the vowel sequence [i-a]; noting the higher position of the hyoid bone for the higher
vowel.
Saying a single vowel on different pitches. Usually, the higher the pitch, the higher the position
of the hyoid bone, though individuals differ in this respect.
The thyroid cartilage, which is the large cartilage of the larynx, forming the major part of the
laryngeal prominence (Adam’s apple). This will be larger in men than in women. Feel the
movements of the thyroid cartilage by repeating the exercises suggested above.
The cricoid cartilage, which is inferior to the thyroid cartilage and sits on top of the first ring
of the trachea. Its movements can also be felt by doing the previously suggested exercises.
Doctor Examination
That is to say,it can be thought of as a column or pipe with several smaller pipes inside it. Each pipe is a wall of connective tissue; most structures run superiorly and inferiorly (up and down)
inside one particular space between these walls of connective tissue.
The outermost column is,of course, the skin. Anteriorly (in the front of the neck), immediately beneath the skin lies the platysma (this muscle will have been exposed by the peeling of the skin in the dissection of the
facial regions, because it is thin and inserts into the skin). If you tense the muscles of your neck
you can observe your platysma muscles. We will be more concerned with two groups of muscles:
the strap muscles of the neck, which lie deep to the platysma muscle, and the muscles forming
the floor of the oral cavity, underneath the tongue .
Before beginning the dissection, note the following bony and cartilaginous landmarks, which
you should be able to feel on your own neck.
It is worth gaining a good understanding of these landmarks before pursuing the dissection because they will be used to locate the muscles in the
anterior region of the neck. These locations of these landmarks are illustrated in Figure 4.1. They
are also shown in figure 4.3.
The hyoid bone, which lies between the floor of the mouth and the upper end of the neck.
Palpate this bone with a thumb and finger on either side of your neck, close to the mandible.
You should be able to feel the movements of the cornu (horns) of the hyoid bone by doing
the following:
Swallowing.
Saying the vowel sequence [i-a]; noting the higher position of the hyoid bone for the higher
vowel.
Saying a single vowel on different pitches. Usually, the higher the pitch, the higher the position
of the hyoid bone, though individuals differ in this respect.
The thyroid cartilage, which is the large cartilage of the larynx, forming the major part of the
laryngeal prominence (Adam’s apple). This will be larger in men than in women. Feel the
movements of the thyroid cartilage by repeating the exercises suggested above.
The cricoid cartilage, which is inferior to the thyroid cartilage and sits on top of the first ring
of the trachea. Its movements can also be felt by doing the previously suggested exercises.
When placing a central venous catheter in the internal jugular vein , it becomes vital to know the internal anatomy and the surface landmarks which will guide you to help ensure a safe and successful cannulation.
The internal jugular vein begins just medial to the mastoid process at the base of the skull. (Remember from anatomy that thecarotid artery, internal jugular vein, and the vagus nerve are all contained in the same “carotid sheath†in the neck ) The internal jugular vein runs directly inferior from the mastoid process, passing under the sternal end of the clavicle. Here it joins thesubclavian vein, and then runs into the superior vena cava and then into the right atrium. As you know, the right atrium pumps blood through the tricuspid valve into the right ventricle, which sends the blood through the pulmonary valve into the pulmonary artery . The pulmonary artery then divides into left and right branches heading towards the capillary beds of the lungs.
Looking at the surface anatomy, the internal jugular vein courses like a straight line down from the mastoid process to the medial side of the insertion point of the clavicular head of the sternocleidomastiod muscle (SCM.) Recall that the SCM has two heads, theclavicular (lateral) head which inserts laterally on the clavicle, and the sternal (medial) head , which inserts medially on the sternum – giving the whole muscle the shape of an upside-down “V.†For purposes of internal jugular vein access, an important anatomic triangle is formed by the two heads of the SCM and the medial 1/3 of the clavicle. It is within this triangle that the right IJ is most safely and readily cannulated. Within this triangle, the carotid artery lies medial and slightly posterior to the internal jugular vein; therefore here there is less chance of accidentally puncturing the carotid artery during catheter insertion (which is a bad thing to do!)
Above is a dissection photo of the left anterior triangle the neck, clearly showing the internal jugular vein (InJ) with the carotid artery (CC) lying more medial. The clavicular head of the sternocleidomastiod muscle (SCM) is also visible, with the sternal head of the SCM (not shown) having been pulled back. Also visible:
Sh=sternohyoid; SOm=superior belly of omohyoid; IOm=inferior belly of omohyoid; Sth=stylohyoid;AnD=anterior belly of digastric; PD=posterior belly of digastric; AC=ansa cervicalis; Hn=hypoglossal nerve; SG=submandibular gland.
Looking at the surface anatomy, the internal jugular vein courses like a straight line down from the mastoid process to the medial side of the insertion point of the clavicular head of the sternocleidomastiod muscle (SCM.) Recall that the SCM has two heads, theclavicular (lateral) head which inserts laterally on the clavicle, and the sternal (medial) head , which inserts medially on the sternum – giving the whole muscle the shape of an upside-down “V.†For purposes of internal jugular vein access, an important anatomic triangle is formed by the two heads of the SCM and the medial 1/3 of the clavicle. It is within this triangle that the right IJ is most safely and readily cannulated. Within this triangle, the carotid artery lies medial and slightly posterior to the internal jugular vein; therefore here there is less chance of accidentally puncturing the carotid artery during catheter insertion (which is a bad thing to do!)
Risk Factors
There are several factors that increase your risk for cervical spondylosis. The following have all been linked to higher risks of neck pain and spondylosis:
- Genetics - if your family has a history of neck pain
- Smoking - clearly linked to increased neck pain
- Occupation - jobs with lots of neck motion and overhead work
- Mental health issues - depression/anxiety
- Injuries/trauma - car wreck or on-the-job injury
- Symptoms
- Pain from cervical spondylosis can be mild to severe. It is sometimes worsened by looking up or down for a long time, or with activities such as driving or reading a book. It also feels better with rest or lying down.
Additional symptoms include:
- Neck pain and stiffness (may be worse with activity)
- Numbness and weakness in arms, hands, and fingers
- Trouble walking, loss of balance, or weakness in hands or legs
- Muscle spasms in neck and shoulders
- Headaches
- Grinding and popping sound/feeling in neck with movement
Determining the source of the pain is essential to recommend the appropriate treatment and rehabilitation. Therefore, a comprehensive examination is required to determine the cause of neck pain. Your doctor will take a complete history of the difficulties you are having with your neck. He or she may ask you about other illnesses or injuries that occurred to your neck. Questions may include: When did your neck begin to hurt? Has it ever hurt like this before? When your neck hurts, how often and for how long does it hurt? Does anything make it better or worse? Were you ever involved in an accident or had an injury to your neck? Have you ever been treated for your neck pain? A thorough physical exam will include your neck, shoulders, arms, and frequently your legs, as well. Your strength, touch sensation, reflexes, blood flow, flexibility of your neck and arms as well as your walking may be tested. The doctor may press on your neck and shoulders, and feel for trigger (tender) points or swollen glands.
Tests
Your doctor may supplement your evaluation with blood tests, and, if necessary, consult with other medical specialists. Other tests which may help your doctor confirm your diagnosis include:
X-rays
These pictures are traditionally ordered as a first step in imaging the spine. X-rays will show aging changes, like loss of disk height or bone spurs.
Magnetic resonance imaging (MRI)
This study can create better images of soft tissues, such as muscles, disks, nerves, and the spinal cord.
Computed tomography (CT) scans
This specialized x-ray study allows careful evaluation of the bone and spinal canal.
Myelography
This specific x-ray study involves injecting dye or contrast material into the spinal canal. It allows for careful evaluation of the spinal canal and nerve roots.
Electromyography (EMG)
Nerve conduction studies and electromyography may be performed by another doctor to look for nerve damage or pinching.
Treatment
Nonsurgical Treatment
Physical therapy. Strengthening and stretching weakened or strained muscles is usually the first treatment that is advised. Your physical therapist may also use cervical (neck) traction and posture therapy. Physical therapy programs vary, but they generally last from 6 to 8 weeks. Sessions are scheduled 2 to 3 times a week.
Medications. Several medications may be used together during the first phase of treatment to address both pain and inflammation.- Acetaminophen. Mild pain is often relieved with acetaminophen.
- Non-steroidal anti-inflammatory drugs (NSAIDs). Often prescribed with acetaminophen, drugs like ibuprofen and and naproxen are considered first-line medicines for neck pain. They address both pain and swelling, and may be prescribed for a number of weeks, depending on the specific problem. Other types of pain medicines can be considered if you have serious contraindications to NSAIDs, or your pain is not well controlled.
- Muscle relaxants. Medications such as cyclobenzaprine or carisoprodol can also be used in the case of painful muscle spasms.
Ice, heat, other modalities. Careful use of ice, heat, massage, and other local therapies can help relieve symptoms.
Steroid-Based Injections. Many patients find short-term pain relief from steroid injections. Various types of these injections are routinely performed. The most common procedures for neck pain include:
Cervical epidural block. In this procedure, steroid and anesthetic medicine is injected into the space next to the covering of the spinal cord ("epidural" space). This procedure is typically used for neck and/ or arm pain that may be due to a cervical disk herniation, also known as radiculopathy or a "pinched nerve."
Epidural injection in the cervical spine.
Cervical facet joint.
Facet joint injection in the cervical spine.
Although less invasive than surgery, steroid-based injections are prescribed only after a complete evaluation by your doctor. Before considering these injections, discuss with your doctor the risks and benefits of these procedures for your specific condition.
Surgical Treatment
It is uncommon for people with only cervical spondylosis and neck pain to be treated with surgery. Surgery is reserved for patients who have severe pain that has not been relieved by other treatment. Some patients with severe pain will unfortunately not be candidates for surgery. This is due to the widespread nature of their arthritis, other medical problems, or other causes for their pain, such as fibromyalgia.
People who have progressive neurologic symptoms, such as weakness, numbness, or falling, are more likely to be helped by surgery.
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