SUB-OCCIPITAL

AND
POSTERIOR CERVICAL TRIANGLES

Sub-Occipital Region /
Triangle

Boundaries:
Rectus Capitis Major (Inf Nuchae line of Occiput => to Spinous process of C2 Axis-)
Rectus Capitis minor (Inf nuchae line of occiput Medial to Rectus Capitis Major => to Posterior tubercle of
Atlas C1-)
Obliquus Capitis Superior (Between Superior and Inferior Nuchae line Lateral to Rectus Capitis Major=> to
transverse Process of Atlas)
Obliquus Capitis Inferior (Transverse Process of Atlas => to Spinous Process of Axis)

All these muscles are deep to Semispinalis Capitis

 3 Structures

Sub-Occipital
Region

Vertebral Artery => Major source of blood supply to the

brain
Crosses the floor of the triangle
Runs from Lateral to Medial
From the foramen transversum of C1
Over the vertebral sulcus at the posterior arch of
C1
Reaches the foramen magnum
Damaged or constricted with excessive Lateral
Flexion or Rotation of the head
Sub-Occipital Nerve => From Dorsal ramus of C1
Innervates ALL the sub-occipital muscles
Greater Occipital Nerve => From Dorsal ramus of C2
Crosses superficially the triangle
Emerges below the Obliquus Capitis Inferior
Innervates the posterior scalp

The Greater Occipital nerve and the Occipital Artery

(Branch of the External Carotid) => Go together
The Greater Occipital nerve passes through =>
The Semispinalis Capitis and cranial end of the
Trapezius.
At this level can be compressed or entrapped with
muscle spasm or tightness.
Entrapment of nerve will cause headaches.
Botox is applied to muscle to relieve spam and
allow stretching
Less compression of nerve

Sub-Occipital Region

Posterior Cervical Triangle

SupraClavicular

Anatomical site for very important nerve and vascular structures

Observe the differences between the anterior aspect of the neck or cervical region with several triangles, and
the posterior cervical triangle
Sternocleidomastoid (anteriorly) and the trapezius (posteriorly) are the landmarks for the triangle
With the clavicle inferiorly and the Mastoid process of the temporalis bone at the skull, superior.
The posterior cervical triangle has 2 triangles within; as a bigger Occipital triangle and a smaller Supra-Clavicular
triangle
The Inferior Belly of the Omohyoideus serves as dividing point for this posterior cervical triangle

Posterior Cervical Triangle

Landmarks of the triangle
Sternocleidomastoid => Anterior
Trapezius => Posterior
Clavicle => Inferior
Mastoid process => Superior
Inferior Belly of the Omohyoid muscle divides into:
Occipital and Supra-Clavicular
Cervical Fascia
Superficial layer => Has Investing layer of fascia (In red)
Covers the SCM and Trapezius muscles
From Posterior => Lig. Nuchae and Spinous
processes of cervical vertebrae; to anterior at
Infrahyoid region ventral to Trachea
Pre-tracheal layer (In blue) => Located DEEP to the
superficial layer anteriorly
Surrounds the Trachea; Esophagus; Thyroid gland
Pre-Vertebral layer (In green) => Located DEEP to:
The Superficial layer Posterior and Lateral
The Pre-Tracheal layer Anteriorly
Holds all muscles of the Posterior cervical triangle (In
green rectangular boxes)

Posterior Cervical Triangle

The cervical fascia separates the posterior cervical
triangle in
Superficial and Deep regions
Superficial region is between the superficial (Investing)
layer and pre-vertebral layer
The Deep region is Deep to the pre-vertebral layer and
includes the muscular floor of the posterior cervical
triangle:
Splenius capitis and Cervicis
Levator Scapulae
3 scalenus muscles; Anterior, Medius; Posterior

Posterior Cervical Triangle

The Superficial Posterior Cervical Triangle
Review landmarks, as boundaries and review the structures within the Posterior Cervical Triangle
From Posterior border of SCM, halfway from cranial and caudal (Sup & Inf) attachments => Theres a Nerve
Network
Nerves seen in relation to the Sternocleidomastoid (SCM) muscle, from Cranial to Caudal
Lesser Occipital N=> From C2; runs on posterior border of SCM to innervate the skin behind the ear
Greater Auricular N => From C2-C3; crosses over the SCM and innervates the inferior ear and skin over
the mastoid process
Transverse Cervical N=> From C2-C3; crosses anteriorly the SCM to innervate the skin on the anterior
neck region
Spinal Accessory nerve => XI cranial nerve motor for Trapezius, and branches of C3-C4 for sensation of
Trapezius
Dorsal Scapular N=> From C5 to Levator Scapulae and Rhomboids (Major and Minor)
ds

Supraclavicular N => From C3-C4

Medial, Middle, Lateral branches
Sensory Innervation skin over clavicle

Suprascapular N => From C5-C6

To Supraspinatus

dorsal scapular
suprascapular
(ds)
(ss)

SS

Posterior Cervical Triangle

The Superficial Posterior Cervical Triangle
Other structures, as vascular:
Transverse Cervical Artery and Vein => Just above the clavicle
From the Thyrocervical trunk off the subclavian artery
Occipital Artery => at the superior border of the triangle
From External Carotid artery
External Jugular Vein => Crosses the SCM obliquely => Outside
the superficial layer
Goes adjacent to the greater auricular N
Formed by union of the posterior auricular and the
retromandibular
Gets blood also from:
Anterior jugular v
Transverse cervical V

ds

SS

dorsal scapular
suprascapular
(ds)
(ss)

Posterior Cervical Triangle

Deep Posterior Cervical Triangle
Removal of Deep Prevertebral fascia
The floor is composed by

Splenius capitis and cervicis

Levator Scapulae
3 Scalenus muscles; Anterior, Middle and
Posterior.
Ventral Rami and Nerves of Cervical Plexus
Ventral rami and nerves from the Supraclavicular
part of Brachial plexus
Arteries and Veins in the Neck

Posterior Cervical Triangle

The DEEP Posterior Cervical Triangle
Removal / Retraction of SCM
Structures seen => Muscles (Floor) and Nerves
Spinal Accessory nerve => XI cranial nerve motor for Trapezius, and branches of C3-C4 for sensation of
Trapezius
Enters trapezium and Levator scapulae muscles
Dorsal Scapular N=> From C5 pierces the Scalenus muscle to innervate Levator Scapulae and Rhomboids
(Major and Minor)
Branches of C5-C7 forming the Long thoracic Nerve to Serratus Anterior
Suprascapular N => From C5-C6 => To Supraspinatus
Through Suprascapular notch for Infraspinatus
Ventral rami of C5-C6 => Forming Superior Trunk of BP
Ventral Ramus of C7 => Forming the Middle Trunk o f BP
Ventral Rami of C7-T1 => Forming the Inferior Trunk of BP
Nerve to the Subclavius => From superior trunk of BP
Phrenic Nerve => From C3-C4-C5
Crosses ventral to Scalenus anterior => to the diaphragm

Posterior Cervical Triangle

The DEEP Posterior Cervical Triangle
Spinal Accessory nerve => XI cranial nerve motor for Trapezius, and branches of C3-C4 for sensation of
Trapezius
Enters trapezium and Levator scapulae muscles
Dorsal Scapular N=> From C5 pierces the Scalenus muscle to innervate Levator Scapulae and Rhomboids
(Major and Minor)
Branches of C5-C7 forming the Long thoracic Nerve to Serratus Anterior
Suprascapular N => From C5-C6 => To Supraspinatus
Through Suprascapular notch for Infraspinatus
Ventral rami of C5- to T1 => Forming Trunks of BP
Subclavian Artery => 3rd part inferior to the middle and lower trunks of BP
Subclavian Vein=> Medial to artery and crossing in front of Scalenus Anterior
Suprascapular Artery => Arises for Thyrocervical trunk
Runs above and parallel to clavicle
Suprascapular Vein=> Goes along the artery an enters the subclavian vein
Inferior Thyroid artery=> From Thyrocervical trunk
Runs supero/medial of scalenus anterior
Dorsal scapular artery=> From Subclavian artery

Posterior Cervical Triangle

Trauma and Surgical problems => Causes
dysfunction
Scalenus Medius tightness=> Can compress
the Dorsal Scapular and Long Thoracic Nerves

Dorsal Scapular Nerve passes through a Vshaped of the muscle

Entrapment at the cleft with lateral flexion
and/or rotation of head & during shoulder
depression
Pain with swelling / by compression at:
Medial edge of scapula
Weakness of the Levator Scapula and
Rhomboid muscles

Long Thoracic Nerve from C5-C6 passes

through Scalenus Medius

Tightness, contracture/spasm=>
Compresses the nerve and causes
weakness of Serratus Anterior => Winging
of the scapula

Posterior Cervical Triangle