Jugular Notch – Anatomy and Clinical Importance

What is the Jugular Notch?

The jugular notch (also known as the suprasternal notch or sternal notch; Latin: Incisura jugularis) is a crescent-shaped indentation located at the superior border of the manubrium sterni – the uppermost part of the sternum (breastbone). It is situated in the midline of the lower neck, just above the chest, and is easily visible and palpable from the outside. Anatomically, it corresponds to the level of the second to third thoracic vertebrae.

Anatomical Location and Significance

The jugular notch is positioned centrally between the two clavicles (collarbones) and forms the upper boundary of the thorax. It is a key anatomical landmark used by physicians, nurses, and other healthcare professionals, as it is easy to identify and serves as a reference point for various clinical measurements and examinations.

• It marks the location of the trachea (windpipe) at the level of the second thoracic vertebra.
• It is used as a reference for measuring the position of the superior vena cava during central venous catheter placement.
• It serves as an orientation mark during physical examination of the neck and chest.
• In medical imaging (X-ray, CT, MRI), it is a standardized reference point for positional measurements.

Clinical Relevance

Central Venous Catheter (CVC)

When placing a central venous catheter, the jugular notch is frequently used as a measurement point to determine the correct position of the catheter tip. The distance from the catheter insertion site to the jugular notch and onwards to the right atrium of the heart is calculated to ensure optimal catheter positioning.

Physical Examination

In clinical examination, the jugular notch assists in assessing venous congestion, for example in heart failure, and in inspecting the jugular veins. A visible bulge or pulsation in this area may indicate elevated venous pressure.

Emergency Medicine and Resuscitation

In emergency medicine, the jugular notch is an important reference point for correct positioning during chest compressions (cardiopulmonary resuscitation, CPR). It helps identify the correct compression point on the sternum.

Physiotherapy and Osteopathy

In physiotherapy and osteopathic practice, the jugular notch is used as a tactile reference point, particularly when treating conditions affecting the cervical spine, shoulders, or thoracic region.

Structure and Composition

The jugular notch is part of the manubrium sterni, the uppermost of the three sections of the sternum. On either side of the notch are the clavicular notches (Incisurae claviculares), where the clavicles articulate. Directly behind the jugular notch lie important structures including the trachea, major blood vessels such as the brachiocephalic vein, as well as nerves and lymphatic vessels.

References

1. Drake, R.L., Vogl, A.W. & Mitchell, A.W.M. (2019): Gray's Anatomy for Students. 4th edition. Elsevier.
2. Standring, S. (ed.) (2020): Gray's Anatomy – The Anatomical Basis of Clinical Practice. 42nd edition. Elsevier.
3. Moore, K.L., Dalley, A.F. & Agur, A.M.R. (2018): Clinically Oriented Anatomy. 8th edition. Wolters Kluwer.