Dystonia

INDEX

 

 

The muscle is deep to the levator scapulae muscle at the C5 level, and its depth greatly varies from patient to patient, being unexpectedly superficial in some adults.

Longissimus capitis acting bilaterally will extend the vertebral column (acting unilaterally flexes the head and neck laterally).

Figure 6. Sequential layers removed from superficial to deep: Trapezius, and then splenius capitis with longissimus capitis lying deep to splenius capitis.

Figure 8. Posterior muscles of the neck, and their relations to longissimus capitis.

 

Note that in the figure on the right, splenius capitis is transparent, allowing for the longissimus capitis to be seen deep to splenius.

The longissimus capitis lies between the longissimus cervicis (which is directly lateral to it) and the splenius capitis (which is directly medial to it).
 

Relationships of Longissimus capitis muscle Anatomy: Relationships of Longissimus capitis muscle

Anatomy: Relationships of Longissimus capitis muscle 

 

Anatomy: Origin and insertion of Longissimus capitis muscle  Anatomy: Origin and insertion of Longissimus capitis muscle

 

   

Figure 5. Relationships of the surrounding muscles to Longissimus Capitis

 

Figure 7. Ultrasound image at C4 level

From: Fietzek UM, Nene D, Schramm A, Appel-Cresswell S, Košutzká Z, Walter U, Wissel J, Berweck S, Chouinard S, Bäumer T. The Role of Ultrasound for the Personalized Botulinum Toxin Treatment of Cervical Dystonia. Toxins (Basel). 2021 May 20;13(5):365. 

 

Ultrasound Technique
1. Palpate the spinous process of the axis and move the operator's finger to the third cervical (C3) spinous process.
2. Place the linear transducer horizontally at this level over the triangle formed posteriorly by the trapezius, anteriorly by the sternocleidomastoid, and inferiorly by the middle third of the clavicle.
3. Move the transducer a little dorsally and localize the transverse process of C3 on the right lower part of the screen. The longissimus capitis muscle can be seen in the direction of 10‐11 o'clock from the transverse process with a deformed and widened letter D‐chape (the vertical line of the letter D represents the fascia, discriminating it from the semispinalis capitis muscle)
4. After the injection, repeat the procedure at the C5 level. Color Doppler imaging at this level occasionally detects an artery, which is  the superficial branch of the transverse cervical artery.

Ultrasound approach for Longissimus capitis muscle

From: Mezaki T. Ultrasound‐guided botulinum toxin therapy for deep muscles in cervical dystonia. Neurol Clin Neurosci 2020; 8: 3–10.

References