The neck is one of the most important parts of the body in acupuncture therapy. Because of its critical involvement in both postural and physiologic homeostasis, it should be examined in every case and treated in most cases. The cervical plexus is not given particular attention in most anatomy textbooks, but its importance here cannot be overemphasized. This nerve plexus is described briefly here in order for readers to understand its anatomic scheme. Some of the most important neck ARPs are illustrated as well (see Fig. 8-6).
The branches of the cervical plexus are as follows:
• Cutaneous: lesser occipital, greater auricular, transverse cutaneous, and supraclavicular nerves
• Muscular branches to the neck muscles: Prevertebral muscles: sternocleidomastoid
(proprioceptive; arising from C2 and C3), levator scapulae (arising from C3 and C4), and trapezius (proprioceptive; arising from C3 and C4)
Omohyoid, sternohyoid, and sternothyroid muscles (arising from C1 to C3) Thyrohyoid and geniohyoid (arising from C1)
• Phrenic nerve to diaphragm: C3 to C5
The ventral primary rami of spinal nerves of C1 through C4, with a small contribution from C5, form the cervical nerve plexus. The nerves of the cervical nerve plexus innervate most of the anterior and lateral muscles of the neck, and its sensory fibers supply sensation to most of the neck and some part of the head. Readers should understand the innervation of this plexus because it is connected to many pathologic conditions of the neck and other physiologic systems.
The network of the cervical nerve plexus is formed by communications between the ventral rami of C1 through C5 (see Fig. 8-6). The plexus lies deep to the internal jugular vein and the ster-nocleidomastoid muscle. Cutaneous branches from the plexus emerge around the middle of the posterior border of the sternocleidomastoid to supply the skin of the neck and scalp, between the auricle and external occipital protuberance. The ventral rami of C2 to C4 of the cervical nerve plexus give rise to the great auricular, lesser occipital, transverse cervical, supraclavicular, and phrenic nerves.
After the communicating branches from C2 and C3, the main trunk of the great auricular nerve curves over the middle point of the posterior border of the sternocleidomastoid muscle and ascends vertically toward the parotid gland. It supplies branches to the skin of the neck and then divides into anterior and posterior branches, which supply the skin on the inferior part of the auricle on both anterior and posterior surfaces and an area extending from the mandible to the mastoid process.
The lesser occipital nerve, arising from C2 and sometimes C3, ascends a short distance along the posterior border of the sternocleidomastoid muscle before dividing into several branches that supply the skin of the neck and scalp posterior to the ear and the superior part of the auricle.
The transverse cervical nerve, arising from C2 and C3, curves around the posterior border of the sternocleidomastoid muscle near its middle point, too, and then passes transversely across it. Its branches supply the skin over the anterior triangle of the neck.
The supraclavicular nerve arises from C3 and C4 as a single trunk, which divides into medial, intermedial, and lateral branches. The small branches from this nerve travel to the skin of the neck and then penetrate the deep fascia just superior to the clavicle to supply the skin over the anterior aspect of the chest and shoulder. The medial and lateral supraclavicular nerves also supply the sternoclavic-ular and acromioclavicular joints.
The phrenic nerve, arising from C3 to C5, curves around the lateral border of the scalenus anterior muscle and then descends obliquely across its anterior surface deep to the transverse cervical and suprascapular arteries. The phrenic nerve enters the thorax by crossing the origin of the internal thoracic arteries between the subclavian artery and vein. The phrenic nerve is the only motor nerve that supplies the diaphragm.
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