후두하근(소후두직근, 대후두직근, 상두사근, 하두사근)

[문형철]

참고) rectus capitis anterior

 suboccipital releasing의 중요성은 백번, 천번을 강조해도 아깝지 않다.

소후두직근, 대후두직근, 하두사근은 "spinal dura mater"와 직접적으로 연결되어 있음. 

= myodural bridge

또한 소후두직근은 근육의 길이, 장력을 인지하는 muscle spindle이 대둔근에 비해 45배나 많음

① RCPM muscles : 36 spindles/g muscle

② RCPMaj muscles : 30.5 spindles/g muscle.

③ splenius capitis : 7.6 spindles/g muscle.

④ gluteus maximus : only 0.8 spindles/g muscle.

또한 Sympathetic postganglionic fibres(교감심경후절섬유)로 연결되어 있음

또한  the trigeminal nerve (CN V)로부터 나오는 구심성 섬유가 혼합되어 C 1과 C2의 substantia gelatinosa 척수의 회색질부위로 감각경로의 통로) 부위로 유입

통증을 호소하는 거의 모든 근골격계환자는 후두하근 shortening과 과긴장이 있음!!

C0-C1사이에서 빠져나오는 후두하신경(C1 dorsal primary ramus)의 지배

panic bird..

인체에서 유일하게 dural tension을 직접적으로 조절할수 있는 통로- myodural bridge

Suboccipital muscles are a group of muscles defined by their location to the occiput. Suboccipital muscles refers to the muscles located below the occipital bone. These are four muscles on the underside of the occipital bone, the two oblique muscles and the two rectus muscles, collectively these are called the suboccipital muscles.

The muscles are named

• Rectus capitis posterior major goes from the spinous process of the axis (C2) to the occipital bone.
• Rectus capitis posterior minor goes from the middle of the posterior arch of the atlas to the occipit.
• Obliquus capitis superior goes from the transverse process of the atlas to the occiput.
• Obliquus capitis inferior goes from the spine of the axis vertebra to the transverse process of the atlas.

Many are innervated by the suboccipital nerve.

참고) 후두하 신경

The suboccipital nerve is the dorsal primary ramus of the first cervical nerve (C1). It exits the spinal cord between the skull and the first cervical vertebra, the atlas. It lies within the suboccipital triangle along with the vertebral artery, where the artery enters the foramen magnum. It supplies muscles of the suboccipital triangle, the rectus capitis posterior major, obliquus capitis superior, and obliquus capitis inferior. The suboccipital nerve also innervates rectus capitis posterior minor.

대후두 직근

- C2(axis) 극돌기에서 기시하여 후두골 inferior nuchal line lateral part에 종지

The Rectus capitis posterior major (Rectus capitis posticus major) arises by a pointed tendon from the spinous process of the axis, and, becoming broader as it ascends, is inserted into the lateral part of the inferior nuchal line of the occipital bone and the surface of the bone immediately below the line.

In 2011, Scali et al., reported a soft tissue connection bridging from the rectus capitis posterior major to the cervical dura mater. Various clinical manifestations may be linked to this anatomical relationship.^[1] It has also been postulated that this connection serves as a monitor of dural tension along with the rectus capitis posterior minor. 

- 2011년 Scali 등은 대후두직근은  "경추 경막"과 연부조직으로 연결다리가 있음을 보고함.

- 이러한 해부학적 연관성은 다양한 임상 증상을 나타냄. 

- 대후두 직근의 이러한 구조적 특성은 소후두직근과 함께 경막긴장(dural tension) 모니터기능을 제공함. 

As the muscles of the two sides pass upward and lateralward, they leave between them a triangular space, in which the recti capitis posteriores minores are seen. Its main actions are to extend and rotate the atlanto-occipital joint.

- 대후두 직근 주요기능은 C0-C1의 capital nodding과 회전을 주로 담당함. 

소후두 직근

꼭 먼저 읽기 - 소후두직근에 관한 논문(클릭)

The rectus capitis posterior minor (rectus capitis posticus minor) arises by a narrow pointed tendon from the tubercle on the posterior arch of the atlas, and, widening as it ascends, is inserted into the medial part of the inferior nuchal line of the occipital bone and the surface between it and the foramen magnum, and also takes some attachment to the spinal dura mater.

- 소후두직근은 C1의 후두융기에서 기시하여 후두골의 Inferior nuchal line의 medial part로 이어짐

- 소후두 직근은 spinal dura mater(경막)으로 이어짐.

The synergists are the rectus capitus posterior major and obliquus capitis. Connective tissue bridges were noted at the atlanto-occipital joint between the rectus capitis posterior minor muscle and the dorsal spinal dura. Similar connective tissue connections of the rectus capitis posterior major have been reported recently as well.^[1] The perpendicular arrangement of these fibers appears to restrict dural movement toward the spinal cord. The ligamentum nuchae was found to be continuous with the posterior cervical spinal dura and the lateral portion of the occipital bone. Anatomic structures innervated by cervical nerves C1-C3 have the potential to cause headache pain. Included are the joint complexes of the upper three cervical segments, the dura mater, and spinal cord.

The dura-muscular, dura-ligamentous connections in the upper cervical spine and occipital areas may provide anatomic and physiologic answers to the cause of the cervicogenic headache. This proposal would further explain manipulation's efficacy in the treatment of cervicogenic headache.^[2]

- 경추성 두통 치료는 dura-muscular, dura-ligamentous connection의 문제를 해결하는 것

상두사근

The obliquus capitis superior muscle is a small muscle in the upper back part of the neck. It arises from the lateral mass of the atlas bone. It passes superiorly and posteriorly to insert into the lateral half of the inferior nuchal line on the external surface of the occipital bone. The muscle is innervated by the suboccipital nerve, the dorsal ramus of the first spinal nerve. It acts at the atlanto-occipital joint to extend the head and flex the head to the ipsilateral side.

- 상두사근은 C1의 lateral mass(횡돌기)로부터 기시하여 후두골의 inferior nuchal line으로 이어짐. 

- 이 근육은 후두하신경의 지배

하두사근

The obliquus capitis inferior muscle is the larger of the two oblique muscles of the neck. It arises from the apex of the spinous process of the axis and passes laterally and slightly upward, to be inserted into the lower and back part of the transverse process of the atlas. It lies deep to the semispinalis capitis and trapezius muscles. The muscle is responsible for rotation of the head and first cervical vertebra (atlanto-axial joint). It forms the lower boundary of the suboccipital triangle of the neck. The naming of this muscle may be confusing, as it is the only capitis (L. "head") muscle that does NOT attach to the cranium.

- 하두사근은 C2의 극돌기에서 기시하여 C1의 횡돌기에 부착함. 

- 하두사근은 승모근과 두반극근 안에 있음.

- 하두사근은 C1-C2구조에서 두부, 경추의 회전을 주로 담당

Proprioception[edit]

The obliquus capitis inferior muscle, like the other suboccipital muscles, has an important role in proprioception. This muscle has a very high density of Golgi organs and muscle spindles which accounts for this. It is believed that proprioception may be the primary role of the inferior oblique (and indeed the other suboccipital muscles) allowing accurate positioning of the head on the neck.

- 하두사근은 다른 후두하근과 마찬가지로 고유수용감각에 중요한 역할

- 하두사근은 매우 높은 밀도의 golgi organ과 근방추를 가지고 있음. 

- 하두사근은 경추 위의 머리에 정확한 위치감각을 전달하는 주요기능을 함. 

후두하근의 Trp탐구

[heoss]

감사합니다.

[박승혁]

눈에 쏙 들어오네요~^^

[정호현]

감사합니다ㅎ

[잠보]

감사합니다

[박수홍]

읽기 후두하근 감사합니다

[독립군]

좋은자료 감사합니다^^

[sonny]

굉장합니다.!

[문형철]

굉장하죠 ㅎㅎㅎ

[꿈다방]

감사합니다.

[su76]

정말 고맙습니다^^