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Deep structures of the neck: Prevertebral muscles

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Deep structures of the neck: Prevertebral muscles

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Notes

Figure 1: Prevertebral muscles, anterior view.

Figure 2: Prevertebral muscles, lateral view.

Figure 3: Transverse section at C6.

Muscle
Origin
Insertion
Innervation
Action
Anterior Prevertebral Muscles
Longus colli
  • bodies of C5-T3
  • transverse processes of C3-C5 
  • anterior tubercle of C1 
  • bodies of C2-C4
  • transverse processes of C3-C6
  • anterior rami of C2-C6
Bilaterally
  • flexion of the neck
Unilaterally
  • rotation to the opposite side
Longus capitis
  • anterior tubercles of the transverse processes of  C3-C6
  • basilar part of occipital bone
  • anterior rami of C1-C3
  • flexion of the head at the atlanto-occipital joint
Rectus capitis anterior
  • anterior surface of the lateral mass of the atlas (C1)
  • base of the cranium, anterior to the occipital condyles
  • branches from the loop between C1 & C2 spinal nerves
  • flexion of the head at the atlanto-occipital joint
Anterior scalene
  • anterior tubercles of the transverse processes of the C3-C6
  • 1st rib
  • anterior rami of C4-C6
  • elevate the first rib during forced inspiration
Bilaterally
  • flexion of the neck
Unilaterally
  • lateral flexion of the neck
Lateral Prevertebral Muscles
Rectus capitis lateralis
  • transverse process of the atlas (C1)
  • jugular process of the occipital bone
  • branches from the loop between C1 & C2 spinal nerves
  • stabilizes and flexes the atlanto-occipital joint
Middle scalene
  • posterior tubercles of transverse processes of C3-C7
  • superior surface of the first rib
  • anterior rami of C3-C7
  • elevate the first rib during forced inspiration
Bilaterally
  • flexion of the neck
Unilaterally
  • lateral flexion of the neck
Posterior scalene
  • posterior tubercles of the transverse processes of C5-C7
  • external border of the 2nd rib
  • anterior rami of C7 & C8
  • elevates the second rib during forced inspiration
Bilaterally
  • flexion of the neck
Unilaterally
  • lateral flexion of the neck
Levator scapulae
  • posterior tubercles of the transverse processes of C1-C4
  • superior part of the medial border of the scapula
  • anterior rami of C3 & C4
  • dorsal scapular nerve
  • elevation the scapula 
  • downward rotation of the scapula
Splenius capitis
  • inferior half of the nuchal ligament
  • the spinous processes of C7 to T4
  • mastoid process of temporal bone 
  • lateral 1/3 of the superior nuchal line
  • posterior rami of the middle cervical spinal nerves
Bilaterally
  • extension of the head and neck 
Unilaterally
  • lateral flexion 
  • rotation of the head to the same side
Questions
Preview

A patient who is a chronic smoker is experiencing pain in the anterior aspect of their neck, especially during forced inspiration. Upon physical examination, the physician notes elevation of the first rib bilaterally. Which prevertebral muscle is most likely strained?


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Transcript

The neck is the anatomical region between the base of the cranium superiorly and the clavicles inferiorly and it joins the head to the trunk and limbs, serving as a major conduit for structures passing between them.

The neck contains superficial structures, located in the anterior and posterior triangles and deep structures, like the cervical viscera and the prevertebral muscles.

Now, the prevertebral muscles are deep to the prevertebral layer of the deep cervical fascia and they are divided into anterior prevertebral muscles and lateral prevertebral muscles.

The anterior prevertebral muscles are located directly posterior to the retropharyngeal space and medial to the neurovascular plane of the cervical plexus, brachial plexus and subclavian artery, and they are represented by longus colli, longus capitis, rectus capitis anterior and anterior scalene muscles.

Now, the longus colli originates from the bodies of C5 to T3 vertebrae and the transverse processes of C3 to C5 vertebrae.

It inserts onto the anterior tubercle of the C1 vertebra, the bodies of the C2 to C4 vertebrae and the transverse processes of C3 to C6 vertebrae.

It’s innervated by the anterior rami of C2 to C6 spinal nerves

When it contracts bilaterally, it produces flexion of the neck and when it contracts unilaterally it produces rotation to the opposite side.

Next, there’s the longus capitis, which originates from the anterior tubercles of the transverse processes of C3 through C6 and inserts onto the basilar part of occipital bone.

It’s innervated by the anterior rami of spinal nerves C1 through C3 and its contraction results in flexion of the head at the atlanto-occipital joint.

Next, the rectus capitis anterior originates from the anterior surface of the lateral mass of the atlas, which is the first cervical vertebra, and inserts onto the base of the cranium, anterior to the occipital condyles.

It’s innervated by branches from the loop between C1 and C2 spinal nerves and its contraction also results in flexion of the head at the atlanto-occipital joint.

Finally, the anterior scalene muscle originates from the anterior tubercles of the transverse processes of the C3 to C6 vertebrae and inserts onto the first rib.

It’s innervated by the anterior rami of spinal nerves C4 to C6.

It functions to elevate the first rib during forced inspiration, and when the rib is fixed, bilateral contraction produces flexion of the neck and unilateral contraction produces lateral flexion of the neck.

Next up, there are the lateral prevertebral muscles, located posterior to the neurovascular plane of the cervical and brachial plexuses and subclavian artery.

These are the rectus capitis lateralis, middle and posterior scalene muscles, levator scapulae, and splenius capitis.

Rectus capitis lateralis originates from the transverse process of the atlas and inserts onto the jugular process of the occipital bone.

It’s innervated by branches from the loop between C1 and C2 spinal nerves and when it contracts, it stabilizes and flexes the atlanto-occipital joint.