Sternocleidomastoid | |
---|---|
Details | |
Pronunciation | ( /ˌstɜːrnoʊˌklaɪdəˈmæsˌtɔɪd,-nə-,-doʊ-/ [1] [2] ) |
Origin | Manubrium and medial portion of the clavicle |
Insertion | Mastoid process of the temporal bone, superior nuchal line |
Artery | Occipital artery and the superior thyroid artery |
Nerve | Motor: spinal accessory nerve sensory: cervical plexus Proprioceptive: ventral rami of C2-3 |
Actions | Unilaterally: contralateral cervical rotation, ipsilateral cervical flexion Bilaterally: cervical flexion, elevation of sternum and assists in forced inhalation. |
Identifiers | |
Latin | musculus sternocleidomastoideus |
TA98 | A04.2.01.008 |
TA2 | 2156 |
FMA | 13407 |
Anatomical terms of muscle |
The sternocleidomastoid muscle is one of the largest and most superficial cervical muscles. The primary actions of the muscle are rotation of the head to the opposite side and flexion of the neck. [3] The sternocleidomastoid is innervated by the accessory nerve. [3]
It is given the name sternocleidomastoid because it originates at the manubrium of the sternum (sterno-) and the clavicle (cleido-) and has an insertion at the mastoid process of the temporal bone of the skull. [4]
The sternocleidomastoid muscle originates from two locations: the manubrium of the sternum and the clavicle. [4] It travels obliquely across the side of the neck and inserts at the mastoid process of the temporal bone of the skull by a thin aponeurosis. [4] [5] The sternocleidomastoid is thick and narrow at its center, and broader and thinner at either end.
The sternal head is a round fasciculus, tendinous in front, fleshy behind, arising from the upper part of the front of the manubrium sterni. It travels superiorly, laterally, and posteriorly.
The clavicular head is composed of fleshy and aponeurotic fibers, arises from the upper, frontal surface of the medial third of the clavicle; it is directed almost vertically upward.
The two heads are separated from one another at their origins by a triangular interval (lesser supraclavicular fossa) but gradually blend, below the middle of the neck, into a thick, rounded muscle which is inserted, by a strong tendon, into the lateral surface of the mastoid process, from its apex to its superior border, and by a thin aponeurosis into the lateral half of the superior nuchal line of the occipital bone.
The sternocleidomastoid is innervated by accessory nerve of the same side. [6] [7] It supplies only motor fibres. The cervical plexus supplies sensation, including proprioception, from the ventral primary rami of C2 and C3. [6]
The clavicular origin of the sternocleidomastoid varies greatly: in some cases the clavicular head may be as narrow as the sternal; in others it may be as much as 7.5 millimetres (0.30 in) in breadth.
When the clavicular origin is broad, it is occasionally subdivided into several slips, separated by narrow intervals. More rarely, the adjoining margins of the sternocleidomastoid and trapezius are in contact. This would leave no posterior triangle.
The supraclavicularis muscle arises from the manubrium behind the sternocleidomastoid and passes behind the sternocleidomastoid to the upper surface of the clavicle.
The function of this muscle is to rotate the head to the opposite side or obliquely rotate the head. [4] It also flexes the neck. [4] When both sides of the muscle act together, it flexes the neck and extends the head. When one side acts alone, it causes the head to rotate to the opposite side and flexes laterally to the same side (ipsilaterally).
It also acts as an accessory muscle of respiration, along with the scalene muscles of the neck.
The signaling process to contract or relax the sternocleidomastoid begins in Cranial Nerve XI, the accessory nerve. The accessory nerve nucleus is in the anterior horn of the spinal cord around C1-C3, where lower motor neuron fibers mark its origin. The fibers from the accessory nerve nucleus travel upward to enter the cranium via the foramen magnum. The internal carotid artery to reach both the sternocleidomastoid muscles and the trapezius. After a signal reaches the accessory nerve nucleus in the anterior horn of the spinal cord, the signal is conveyed to motor endplates on the muscle fibers located at the clavicle. Acetylcholine (ACH) is released from vesicles and is sent over the synaptic cleft to receptors on the postsynaptic bulb. The ACH causes the resting potential to increase above -55mV, thus initiating an action potential which travels along the muscle fiber. Along the muscle fibers are t-tubule openings which facilitate the spread of the action potential into the muscle fibers. The t-tubule meets with the sarcoplasmic reticulum at locations throughout the muscle fiber, at these locations the sarcoplasmic reticulum releases calcium ions that results in the movement of troponin and tropomyosin on thin filaments. The movement of troponin and tropomyosin is key in facilitating the myosin head to move along the thin filament, resulting in a contraction of the sternocleidomastoid muscle. [8]
The sternocleidomastoid is within the investing fascia of the neck, along with the trapezius muscle, with which it shares its nerve supply (the accessory nerve). It is thick and thus serves as a primary landmark of the neck, as it divides the neck into anterior and posterior cervical triangles (in front and behind the muscle, respectively) which helps define the location of structures, such as the lymph nodes for the head and neck. [9]
Many important structures relate to the sternocleidomastoid, including the common carotid artery, accessory nerve, and brachial plexus.
Examination of the sternocleidomastoid muscle forms part of the examination of the cranial nerves. It can be felt on each side of the neck when a person moves their head to the opposite side. [9]
The triangle formed by the clavicle and the sternal and clavicular heads of the sternocleidomastoid muscle is used as a landmark in identifying the correct location for central venous catheterization.[ medical citation needed ] [10]
Contraction of the muscle gives rise to a condition called torticollis or wry neck, and this can have a number of causes. Torticollis gives the appearance of a tilted head on the side involved. Treatment involves physiotherapy exercises to stretch the involved muscle and strengthen the muscle on the opposite side of the neck. Congenital torticollis can have an unknown cause or result from birth trauma that gives rise to a mass or tumor that can be palpated within the muscle.
The neck is the part of the body on many vertebrates that connects the head with the torso. The neck supports the weight of the head and protects the nerves that carry sensory and motor information from the brain down to the rest of the body. In addition, the neck is highly flexible and allows the head to turn and flex in all directions. The structures of the human neck are anatomically grouped into four compartments: vertebral, visceral and two vascular compartments. Within these compartments, the neck houses the cervical vertebrae and cervical part of the spinal cord, upper parts of the respiratory and digestive tracts, endocrine glands, nerves, arteries and veins. Muscles of the neck are described separately from the compartments. They bound the neck triangles.
The trapezius is a large paired trapezoid-shaped surface muscle that extends longitudinally from the occipital bone to the lower thoracic vertebrae of the spine and laterally to the spine of the scapula. It moves the scapula and supports the arm.
The accessory nerve, also known as the eleventh cranial nerve, cranial nerve XI, or simply CN XI, is a cranial nerve that supplies the sternocleidomastoid and trapezius muscles. It is classified as the eleventh of twelve pairs of cranial nerves because part of it was formerly believed to originate in the brain. The sternocleidomastoid muscle tilts and rotates the head, whereas the trapezius muscle, connecting to the scapula, acts to shrug the shoulder.
Torticollis, also known as wry neck, is a painful, dystonic condition defined by an abnormal, asymmetrical head or neck position, which may be due to a variety of causes. The term torticollis is derived from Latin tortus 'twisted' and collum 'neck'.
The lesser occipital nerve is a cutaneous spinal nerve of the cervical plexus. It arises from second cervical (spinal) nerve (C2). It innervates the skin of the back of the upper neck and of the scalp posterior to the ear.
In human anatomy, the subclavian arteries are paired major arteries of the upper thorax, below the clavicle. They receive blood from the aortic arch. The left subclavian artery supplies blood to the left arm and the right subclavian artery supplies blood to the right arm, with some branches supplying the head and thorax. On the left side of the body, the subclavian comes directly off the aortic arch, while on the right side it arises from the relatively short brachiocephalic artery when it bifurcates into the subclavian and the right common carotid artery.
The levator scapulae is a slender skeletal muscle situated at the back and side of the neck. It originates from the transverse processes of the four uppermost cervical vertebrae; it inserts onto the upper portion of the medial border of the scapula. It is innervated by the cervical nerves C3-C4, and frequently also by the dorsal scapular nerve. As the Latin name suggests, its main function is to lift the scapula.
The cervical plexus is a nerve plexus of the anterior rami of the first four cervical spinal nerves C1-C4. The cervical plexus provides motor innervation to some muscles of the neck, and the diaphragm; it provides sensory innervation to parts of the head, neck, and chest.
The platysma muscle is a superficial muscle of the human neck that overlaps the sternocleidomastoid. It covers the anterior surface of the neck superficially. When it contracts, it produces a slight wrinkling of the neck, and a "bowstring" effect on either side of the neck.
The sternohyoid muscle is a bilaterally paired, long, thin, narrow strap muscle of the anterior neck. It is one of the infrahyoid muscles. It is innervated by the ansa cervicalis. It acts to depress the hyoid bone.
The splenius capitis is a broad, straplike muscle in the back of the neck. It pulls on the base of the skull from the vertebrae in the neck and upper thorax. It is involved in movements such as shaking the head.
The occipital artery is a branch of the external carotid artery that provides arterial supply to the back of the scalp, sternocleidomastoid muscles, and deep muscles of the back and neck.
The posterior triangle is a region of the neck.
The supraclavicular nerve is a cutaneous (sensory) nerve of the cervical plexus that arises from the third and fourth cervical (spinal) nerves. It emerges from beneath the posterior border of the sternocleidomastoid muscle, then split into multiple branches. Together, these innervate the skin over the shoulder.
The nerve point of the neck, also known as Erb's point, is a site at the upper trunk of the brachial plexus located 2–3 cm above the clavicle. It is named for Wilhelm Heinrich Erb. Taken together, there are six types of nerves that meet at this point.
The deep cervical fascia lies under cover of the platysma, and invests the muscles of the neck; it also forms sheaths for the carotid vessels, and for the structures situated in front of the vertebral column. Its attachment to the hyoid bone prevents the formation of a dewlap.
The subclavian triangle, the smaller division of the posterior triangle, is bounded, above, by the inferior belly of the omohyoideus; below, by the clavicle; its base is formed by the posterior border of the sternocleidomastoideus.
Cervical lymph nodes are lymph nodes found in the neck. Of the 800 lymph nodes in the human body, 300 are in the neck. Cervical lymph nodes are subject to a number of different pathological conditions including tumours, infection and inflammation.
The investing layer of deep cervical fascia is the most superficial part of the deep cervical fascia, and encloses the whole neck.
The following outline is provided as an overview of and topical guide to human anatomy:
This article incorporates text in the public domain from page 390 of the 20th edition of Gray's Anatomy (1918)