54 Upper Limb I Flashcards
- Draw and label correctly the clavicle and give 5 features on it
What is the clavicle an attachment for?
Clavicle: only bony attachment of the upper limb to the thorax Acromial end Sternal end Shaft Conoid tubercle Impression for costoclavicular ligament
- What does the scapula serve as a bridge to?
Draw and label the following structures on the Posterior scapula:
Acromion scapular spine supraspinous fossa infraspinous fossa Drawing
3. Draw and label the following structures on the Anterior scapula: Coracoid process suprascapular notch supraglenoid tubercle glenoid fossa infraglenoid tubercle subscapular fossa lateral border medial border
Drawing
4. Scapula: bridge between clavicle and humerus Glenoid cavity/fossa Supraglenoid and infraglenoid tubercles Suprascapular notch for suprascapular artery and nerve. The superior transverse ligament of scapula covers the notch, the artery is above, the nerve is below Neck Spine Acromion Coracoid process Superior and inferior angles Lateral and medial borders Subscapular fossa Infraspinous fossa Supraspinous fossa
Drawing
- What are the names of the 6 joint types?
Joint Types
Hinge Pivot Condyloid Saddle Ball and socket Plane
- Describe the hinge joint and its action
Hinge—uniaxial joint with concave to convex articulation. Generally restricted to flexion/extension. Example: elbow joint (humeroulnar)
- Describe the pivot joint and its actions
Pivot—uniaxial joint with rounded surface articulating with a ring that is restricted to rotation. Example: radioulnar joint
- Describe the condyloid joint and shape
Condyloid—biaxial joint with an oval surface fitting into an elliptical socket, allowing flexion/extension and adduction/abduction.
Example: radiocarpal joint
- Describe the saddle joint and actions
Saddle—biaxial joint with one concave surface and one convex surface, allowing for flexion/extension and adduction/abduction.
Example: first carpal/metacarpal joint
- Describe the Ball and socket joint and actions
Ball and socket—multiaxial joint with a rounded ball-like surface fitting into a concave cup-like socket.
Example glenohumeral joint
- Describe the Plane joint and actions
Plane—multiaxial gliding joint with flat articulating surface.
Example: intercarpal joints
Joints
12. The pectoral girdle has movement at what kind of joints; and between which 3 structures
The pectoral girdle involves movement at three synovial joints between the clavicle, scapula, and humerus.
Whereas the first 30º of elevation of the upper limb can occur without movement of the scapula,
- To be able to fully elevate one’s arm requires abduction at the glenohumeral joint and scapular rotation
the act of fully elevating the arm requires abduction at the glenohumeral joint and scapular rotation such that when the arm is fully elevated (180º of abduction or flexion) 120º occurs at the glenohumeral joint and 60º from scapular rotation.
- What kind of joint is the sternoclavicular joint? It serves as the only bony articular to?
Sternoclavicular joint: Saddle joint, but functions as a ball and socket joint. This is the only bony articulation (synovial joint) of the upper limb to the thorax
- What kind of joint is the acromioclavicular joint? Give three strengthening ligaments
Acromioclavicular joint: Plane synovial joint
Ligaments:
Acromioclavicular surrounding the joint capsule
Further strengthened by the coracoclavicular ligament and coracoacromial ligament
- 3 movements of scapula
Movements of the scapula
Elevation/Depression
Protraction/Retraction
Rotation
- Glenohumeral (shoulder) joint is what kind of joint? Give 3 movements
Glenohumeral (shoulder) joint: Ball and socket joint Movements: Medial/Lateral Rotation Abduction/Adduction Flexion/Extension
- The joint capsule is composed of stabilizing ligaments starting at?
Ligaments: the joint capsule is composed of a series of stabilizing ligaments initiating at the glenoid labrum (Latin for rim of a vessel),
19.
- What surrounds the glenoid cavity?
a fibrocartilaginous ring surrounding the glenoid cavity. The glenoid labrum expands the actual joint surface, yet still holds only 1/3 of the humeral head. The humeral head is therefore held in place by the tendons of the rotator cuff muscles. The joint capsule stretches medially from the margin of the glenoid fossa to the anatomical neck of the humerus. The capsule is weakest inferiorly as the coracoacromial arch and the rotator cuff muscles reinforce it anterior, posterior, and superiorly. Thus, the most common direction of humeral dislocation in inferiorly (antero-inferiorly).
- What area ligaments make up the Glenohumeral ligaments? What does it stabilize?
Glenohumeral ligaments (superior, middle, inferior): Stabilize the anterior aspect of the joint capsule
- What does the coracohumeral ligament stabilize?
Coracohumeral ligament: Stabilizes the superior aspect of the joint capsule
- What does the transverse humeral ligament stabilize?
Transverse humeral ligament: Stabilizes the long tendon of the biceps brachii between the lesser and greater tubercle of the humerus
- What does the Coracoacromial ligament help form? What does this prevent?
Coracoacromial ligament: Helps form the coraco-acromial arch which prevents superior dislocation/displacement
- Where are myofascial compartments below? What does it do?
Myofascial Compartments: below the superficial fascia, deep fascia surrounds each of the muscles, defining inter-muscular septa that divide the upper limb into distinct anterior and posterior compartments.
Each compartment has its own distinct biomechanical functionality, innervation, and blood supply. From the brachial plexus, recall the anterior and posterior Divisions are directly correlated to the anterior (flexor) and posterior (extensor) compartments.
- What divides the shoulder (axioappendicular) compartments?
Shoulder (axioappendicular) compartments are divided by the pectoral, axillary, and clavipectoral fascia
- What is the anterior compartment’s function? Innervation? Blood Supply?
Anterior compartment
Functions: arm adduction, flexion, and medial rotation
Innervation: medial and lateral pectoral nerves, long thoracic nerve and nerve to subclavius
Supply: thoracoacromial trunk, lateral thoracic
- What is the function and innervation of the posterior compartment?
Posterior compartment
Functions: arm abduction, extension, and lateral rotation (mostly)
Innervation: axillary nerve, suprascapular nerve, and upper and lower subscapular nerves
- What kinds of muscles are anterior axioappendicular muscles?
Anterior axioappendicular muscles: Pectoralis major Pectoralis minor Subclavius Serratus anterior
Extrinsic muscles attaching the upper limb to the thorax
30. For the pectoralis major of the anterior axioappendicular muscles, give: proximal attachment Distal attachment Innervation Actions
Anterior axioappendicular muscles:
Pectoralis major
Proximal attachment:
clavicular head: anterior medial shaft of the clavicle
sternal head: anterior surface of the sternum
Distal attachment: lateral lip of the intertubercular groove of the humerus
Innervation: lateral and medial pectoral nn.
Actions: adducts, medially rotates, and flexes the humerus. Can EXTEND the humerus from a flexed/elevated position.
31. Pectoralis minor: Proximal attachment Distal attachment Innervation Actions
Proximal attachment: 3rd–5th ribs
Distal attachment: medial border of the coracoid process (scapula)
Innervation: medial pectoral n.
Actions: stabilizes the scapula; elevates ribs (accessory muscle of respiration)
32. Subclavius Proximal attachment Distal attachment Innervation Actions
Proximal attachment: junction of the first rib and manubrium
Distal attachment: inferior center of the clavicle
Innervation: n. to the subclavius
Actions: anchors and depresses the clavicle
- Serratus anterior:
Distal attachment
Innervation
Actions
Serratus anterior
Proximal attachment: lateral parts of ribs 1–8
Distal attachment: medial anterior border of the scapula
Innervation: long thoracic n.
Actions: protracts, rotates, and stabilizes scapula on thorax
- What are the four of the Posterior axioappendicular muscles:
Latissimus dorsi
Rhomboideus major and minor
Levator Scapulae
Trapezius
35. Trapezius Proximal attachment Distal attachment Action Innervation
Proximal attachment: occipital bone, spinous processes of C1–T12
Distal attachment: lateral third of clavicle, acromion, superior border of scapular spine
Innervation: accessory n. (CN XI)
Action: elevates, retracts, rotates, and depresses scapula
36. Levator Scapulae Proximal attachment Distal attachment Action Innervation
Proximal attachment: transverse processes of C1–C4
Distal attachment: superior angle of scapula
Innervation: dorsal scapular n.
Action: elevates scapula
37. Rhomboideus major and minor Proximal attachment Distal attachment Action Innervation
Proximal attachment: major: spinous processes of T1–T4 minor: spinous processes of C6–C7 Distal attachment: major: medial border of scapula below scapular spine minor: medial border of scapula above scapular spine Innervation: dorsal scapular n. Action: retract and elevate scapula
38. Latissimus dorsi Proximal attachment Distal attachment Action Innervation
Proximal attachment: spinous processes of T7–T12, thoracolumbar fascia, iliac crest
Distal attachment: floor of the intertubercular groove on humerus
Innervation: thoracodorsal n.
Action: adducts, extends, and medially rotates humerus
- What are 3 Scapulohumeral muscles:
Deltoid Rotator Cuff Supraspinatus Infraspinatus Teres Minor Subscapularis Teres major (not part of the rotator cuff!)
40. Deltoid Proximal attachment Distal attachment Action Innervation
Proximal attachment: lateral third of clavicle, acromion, and scapular spine
Distal attachment: deltoid tuberosity of humerus
Innervation: axillary n.
Actions: anterior part flexes and medially rotates arm, middle part abducts the arm, and the posterior part extends and laterally rotates the arm
- What are four muscles that make up the rotator cuff? What is a muscle close to here that is an exception?
Rotator Cuff Supraspinatus Infraspinatus Teres Minor Subscapularis *****Teres Major NOT part of rotator cuff****
42. Supraspinatus Proximal attachment Distal attachment Action Innervation
Proximal attachment: supraspinous fossa of scapula
Distal attachment: superior aspect of the greater tubercle of the humerus
Innervation: suprascapular n.
Actions: initiates abduction, stabilization of glenohumeral joint
43. Infraspinatus Proximal attachment Distal attachment Action Innervation
Proximal attachment: infraspinatus fossa of the scapula
Distal attachment: greater tubercle of the humerus
Innervation: suprascapular n.
Actions: lateral rotation, stabilization of glenohumeral joint
44. Teres Minor Proximal attachment Distal attachment Action Innervation
Proximal attachment: lateral border of scapula
Distal attachment: greater tubercle of humerus
Innervation: axillary n.
Actions: lateral rotation, stabilization of glenohumeral joint
45. Subscapularis Proximal attachment Distal attachment Action Innervation
Proximal attachment: subscapular fossa
Distal attachment: lesser tubercle of humerus
Innervation: upper and lower subscapular nn.
Actions: medial rotation, stabilization of glenohumeral joint
46. Teres major (not part of the rotator cuff!) give Proximal attachment Distal attachment Action Innervation
Proximal attachment: posterior surface of inferior angle of scapula
Distal attachment: medial lip of the intertubercular groove of humerus
Innervation: lower subscapular n.
Actions: adduction and medial rotation of arm
Arterial System: Many branches you will find go directly to muscles and have no specific names, these are generally referred to as muscular branches.
- What are two branches of the subclavian artery? (One of these has two more branches of itself)
Subclavian Thyrocervical trunk Transverse cervical a. Dorsal scapular a. Suprascapular a.
- The subclavian changes its name to axillary. What are the three parts?
Part 1: proximal to pectoralis minor
Part 2: deep (posterior) to pectoralis minor
Part 3: Distal to pectoralis minor
Axillary: As subclavian passes under the clavicle it changes names to the axillary. Three parts defined by their position relative to pectoralis minor and named based on how many arteries originate from them
- What are the parts of the axillary part artery part 1: proximal to pectoralis minor artery?@
Superior thoracic a.
- What are the parts of the axillary artery Part 2: deep (posterior) to pectoralis minor
Thoraco-acromial trunk
Acromial, pectoral, clavicular, and deltoid branches
Lateral thoracic a.
- What are the parts of the axillary Part 3: Distal to pectoralis minor
Anterior circumflex humeral a. Posterior circumflex humeral a. Subscapular a. Circumflex scapular a. Thoracodorsal a.
- Give the scapular anastomoses
Scapular anastomoses
subclavian > thyrocervical trunk > transverse cervical > dorsal scapular > thoracodorsal > subscapular > axillary
subclavian > thyrocervical trunk > suprascapular > circumflex scapular > subscapular > axillary
- What makes up the Humeral anastomosis
anterior circumflex humeral > posterior circumflex humeral
Venous system: more variable than the arterial system
Deep veins: generally follow the arteries and are so named
- Superficial veins go into subclavian vein. Where does the cephalic and basilica vein go through?
Superficial veins: into subclavian, highly variable network
Cephalic vein: Passes through deltopectoral groove
Basilic vein: Into axillary, passes through basilic hiatus
- What are 5 kinds of axillary nodes?
Lymphatic system: ascend and frequently anastomose with venous system Five groups of axillary nodes humeral subscapula pectoral: : central: apical:
- Give location of humeral node:
lateral wall of the axillary fossa medial and posterior to axillary vein
- Give location of subscapular node:
posterior wall of axillary fossa along posterior axillary fold and subscapular blood vessels
- Give location of pectoral node:
medal wall of axilla, surrounding lateral thoracic vein and inferior border of pectoralis minor
- Give location of central node: @ deep to pectoralis minor
- Give location of apica node l:
at apex of axillary fossa along medial side of axillary vein and 1st part of axillary artery
Give the Basilic v. drainage?
enters cubital nodes > humeral axillary nodes
- Give the drainage for Cephalic v.
drainage enters apical axillary nodes
Axillary nodes drain ~75% of lymph from breast tissue and are clinically important in staging of breast cancer
62. For clinical purposes axillary nodes are divided into three levels, what are they?
Level 1: lateral to pectoralis minor Level 2: deep to pectoralis minor Level 3: medial to pectoralis minor Five year survival rate decreases with increasing levels of metastasis Level 1: 65% Level 2: 31% Level 3: ~0%
Important landmarks
63. Quadrangular space borders, nerve, and supply?
Lateral border
Medial border
Superior border
Inferiorly
- Quadrangular space: contains axillary nerve and posterior humeral circumflex artery
Lateral border—humerus
Medial border—long head of triceps brachii
Superior border—teres minor
Inferiorly—teres major
axillary nerve and posterior humeral circumflex artery
65. Triangular space: Superior border Inferior border Lateral border Blood supply?
Lateral border —long head of the triceps
Superior border —teres minor
Inferior border —teres major
contains the scapular circumflex artery
