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Y2 CONTROL & MOVEMENT > A2 - Upper Arm & Elbow > Flashcards

A2 - Upper Arm & Elbow Flashcards

1
Q

What makes up the anterior border of the axilla?

A

pectoralis major and minor

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2
Q

What makes up the posterior border of the axilla?

A

subscapularis, teres major, latissimus dorsi

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3
Q

What makes up the medial border of the axilla?

A

serratus anterior and the thoracic wall

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4
Q

What makes up the lateral border of the axilla?

A

intertubercular sulcus

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5
Q

Label the structures that make up the borders of the axilla

A
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6
Q

What is contained within the neurovascular bundle of the axilla?

A
  1. the axillary vein
  2. the axillary artery
  3. lateral, medial and posterior cords of the brachial plexus
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7
Q

Label the structures that pass through the apex of the axilla and into the upper limb

A
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8
Q

What is the function of the axillary lymph nodes?

What is their relationship to breast cancer?

A

There are 4 groups of nodes which drain 75% of the lymph from the breast

They are the first place that breast cancer spreads to

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9
Q

How does infection affect the axillary lymph nodes?

A

It causes them to become enlarged

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10
Q

What is the function of the brachial plexus?

A

it gives rise to nerves which provide sensory and motor innervation to the WHOLE upper limb

this is provided by 5 major nerves that are formed in the axilla

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11
Q

Label the 4 divisions of the brachial plexus

A
  1. roots
  2. trunks
  3. divisions
  4. cords
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12
Q

What are the roots of the brachial plexus formed by?

A
  1. anterior rami of C5 to C8
  2. the most anterior ramus of T1

these are spinal nerves

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13
Q

What are the 3 trunks of the brachial plexus and what are they formed by?

A
  1. superior trunk - formed by the union of the C5 and C6 roots
  2. middle trunk - continuation of C7 root
  3. inferior trunk - formed by the union of C8 and T1 root
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14
Q

How do the trunks of the brachial plexus divide?

A

Each trunk splits into an anterior and posterior division

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15
Q

What is the difference between the anterior and posterior divisions of the brachial plexus?

A

the 3 anterior divisions give rise to nerves associated with the anterior compartments of the arm

the 3 posterior divisions give rise to nerves associated with the posterior compartments of the arm

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16
Q

What divisions form the lateral cord?

What contributions does it contain?

A

the union of the anterior divisions of the superior and middle trunk

contributions from C5 - C7

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17
Q

What are the 3 cords of the brachial plexus?

How are they named?

A
  1. lateral
  2. medial
  3. posterior

They are named relative to their position around the 2nd part of the axillary artery

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18
Q

What divisions come together to form the medial cord?

What contributions does it contain?

A

The medial cord is the continuation of the anterior division of the inferior trunk

It has contributions from C8 and T1

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19
Q

What divisions come together to form the posterior cord?

What contributions does it contain?

A

It is formed from the union of ALL 3 posterior divisions

It contains contributions from ALL roots of the brachial plexus (C5 - T1)

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20
Q

Label the trunks and cords of the brachial plexus

A
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21
Q

What are the 5 major terminal branches of the brachial plexus?

A
  1. musculocutaneous
  2. axillary
  3. median
  4. radial
  5. ulnar
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22
Q

Which cords form the axillary and musculocutaneous nerves?

A

axillary - posterior cord

musculocutaneous - lateral cord

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23
Q

Which cords form the median nerve?

A

lateral and medial cords

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24
Q

Which cords form the radial and ulnar nerves?

A

radial - posterior cord

ulnar - medial cord

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25
Q

Label the terminal branches of the brachial plexus

A
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26
Q

What muscles are innervated by the musculocutaneous nerve?

A

ALL muscles in the ANTERIOR compartment of the arm

  1. greater part of brachialis
  2. coracobrachialis
  3. biceps brachii
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27
Q

What skin is innervated by the musculocutaneous nerve?

A

skin on the lateral side of the forearm

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28
Q

What muscles are innervated by the axillary nerve?

A

deltoid and teres minor

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29
Q

What skin is innervated by the axillary nerve?

A

skin over the upper lateral part of the arm

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30
Q

What muscles are innervated by the median nerve?

A
  1. all muscles in the anterior compartment of the forearm (except FCU and medial 1/2 of FDP)
  2. thenar eminence muscles
  3. two lateral lumbrical muscles
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31
Q

What skin is innervated by the median nerve?

A

skin over the palmar surface of the lateral 3 ½ digits

skin over the lateral side of the palm and middle of the wrist

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32
Q

What muscles are innervated by the radial nerve?

A

all muscles in the posterior compartments of the arm and forearm

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33
Q

What skin is innervated by the radial nerve?

A
  1. skin on posterior aspects of arm and forearm
  2. skin on lateral surface of the arm
  3. skin on the dorsal lateral surface of the hand
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34
Q

What muscles are innervated by the ulnar nerve?

A

ALL the intrinsic muscles of the hand

(except 3 thenar muscles and 2 lateral lumbricals)

Flexor carpi ulnaris

Medial half of flexor digitorum profundus

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35
Q

What skin is innervated by the ulnar nerve?

A

skin over the palmar surface of the median 1½ digits and associated palm and wrist

skin over dorsal surface of medial 1 ½ digits

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36
Q

Where does the axillary artery originate from?

Where does it terminate?

A

it is a continuation of the subclavian artery after it passes under the clavicle at the lateral margin of rib I

the axillary artery becomes the brachial artery at the inferior margin of teres major

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37
Q

Label the arteries and landmarks:

A
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38
Q

What are the branches of the axillary artery that arise inferior to pectoralis minor?

A

the anterior and posterior circumflex humeral arteries

they form an anastomosis around the surgical neck of the humerus

39
Q

What is the alternative name for the profunda brachii?

What is significant about this artery?

A

also called the deep artery of the arm

it is the main supplier of blood to the upper arm

40
Q

How does the posterior circumflex humeral artery reach the posterior aspect of the humerus?

A

It travels backwards through the axilla and through the quadrangular space

the axillary nerve also passes through the quadrangular space

41
Q

Label the arteries and branches

42
Q

Where does the profunda brachii travel?

What nerve accompanies it?

A

It runs down the posterior aspect of the humerus in the radial groove

The radial nerve also runs in the radial groove

43
Q

Where does the brachial artery bifurcate?

What is the result of this?

A

It runs down the anterior arm and bifurcates at the level of the elbow joint

It bifurcates in the radial and ulnar arteries

44
Q

Where does the axillary vein commence?

At which point does it become the subclavian vein?

A

It commences at the lower border of teres major

It becomes the subclavian vein at the lateral border of the first rib

45
Q

What are the 2 main superficial veins in the arm?

What do they form?

A

the cephalic and basilic veins

they travel up the arm and form the axillary vein

46
Q

What are the 3 superficial veins in the upper limb that are used for venepuncture and cannulation?

A
  1. basilic vein
  2. cephalic vein
  3. median cubital vein
47
Q

Label the veins of the upper limb

48
Q

What is the median cubital vein?

A

it connects the cephalic and basilic veins in the antecubital fossa

this is the region anterior to the elbow joint

49
Q

What are the 2 compartments of the arm and their relationship to the humerus?

A

the flexor compartment lies anterior to the humerus

the extensor compartment lies posterior to the humerus

50
Q

What are the main muscles in the anterior and posterior compartments of the arm?

How are they separated from each other?

A

anterior - biceps and brachialis

posterior - triceps

they are separated from each other by the intermuscular septum

51
Q

Label the muscles and the nerves in the arm

52
Q

What are the 3 muscles within the flexor compartment (anterior) of the arm?

What is their blood and nerve supply?

A
  1. brachialis
  2. biceps brachii
  3. coracobrachialis

they are innervated by the musculocutaneous nerve and supplied by branches of the brachial artery

53
Q

Label the muscles of the flexor compartment

54
Q

What are the proximal and distal attachments of biceps brachii?

A

Proximal:

Short head - apex of coracoid process

Long head - supraglenoid tubercle of scapula

Distal:

Radial tuberosity

55
Q

What are the 3 main actions of biceps brachii?

A
  1. powerful flexor of the forearm at elbow joint
  2. supinator of the forearm
  3. accessory flexor of the arm at glenohumeral joint
56
Q

What are the proximal and distal attachments of brachialis?

A

Proximal:

anterior aspect of the humerus

Distal:

tuberosity of the ulna

57
Q

What are the proximal and distal attachments of the coracobrachialis muscle?

A

Proximal:

apex of coracoid process

Distal:

linear roughening on midshaft of medial side of humerus

58
Q

What are the functions of brachialis and coracobrachialis?

A

Brachialis:

flexor of the forearm at the elbow joint

Coracobrachialis:

flexor of the arm at the glenohumeral joint

59
Q

What are the steps involved in performing a biceps reflex test?

A
  1. patient’s arm rests on their lap with the elbow slightly flexed
  2. examiner palpates biceps tendon in cubital fossa
  3. place forefinger/thumb over biceps tendon
  4. swing the head of the tendon hammer onto the position of the thumb/finger
60
Q

What is the biceps reflex test testing?

What is a normal observation?

A

it tests the function of the C5 and C6 spinal nerves and musculocutaneous nerve

a jerk of the forearm should be observed

61
Q

What is the only muscle within the posterior (extensor) compartment of the arm?

A

triceps brachii

it has 3 muscle bellies which converge distally onto one common tendon

62
Q

Where do the 3 heads of triceps brachii originate from?

A

Long head:

Originates from infraglenoid tubercle of scapula

Lateral head:
originates from posterior surface of the humerus

Medial head:

originates from the posterior surface of the humerus

63
Q

Label the components of triceps brachii

64
Q

Where do all 3 muscle bellies of triceps brachii insert?

A

the olecranon

65
Q

What is the function of triceps brachii?

A

extension of the forearm at the elbow joint

the long head is also involved in extension and adduction at the shoulder joint

66
Q

What is the nerve supply and arterial supply to triceps brachii?

A

it is innervated by the radial nerve

it is supplied by the radial artery

67
Q

What are the stages involved in testing the triceps reflex?

A
  1. patient’s arm is held across their body and the weight of the limb supported
  2. examiner palpates the triceps tendon superior to its insertion on the olecranon
  3. the tendon is tapped with a tendon hammer
68
Q

What is the triceps reflex test testing?

What is a normal response?

A

it tests the function of spinal nerve C7 and the radial nerve

normal triceps reflex shows sudden extension of the arm

69
Q

What are the 4 borders of the quadrangular space?

A

superior - teres minor

inferior - teres major

medial - long head of triceps brachii

lateral - surgical neck of humerus

70
Q

What point marks the location of the quadrilateral space?

A

where the tendon of the long head of triceps brachii crosses teres major and teres minor at right angles

71
Q

What artery and nerve pass through the quadrangular space?

A

the axillary nerve

the posterior humeral circumflex artery

72
Q

Label the nerves, vessels and muscles

73
Q

What articulations are involved in formation of the elbow joint?

A
  1. distal end of the humerus
  2. proximal end of the radius
  3. proximal end of the ulna
74
Q

What joints in the elbow are involved in flexion and extension of the forearm?

A
  1. a joint between the trochlea of the humerus and the trochlear notch of the ulna
  2. a joint between the head of the radius and the capitulum of the humerus
75
Q

What is the joint in the elbow that is involved in pronation and supination of the forearm?

A

the proximal radio-ulnar joint

this is between the head of the radius and the radial notch of the ulna

76
Q

Label the features of the radius, ulna and humerus

77
Q

What are the following movements of the elbow joint?

78
Q

What is the condyle made up of?

What does it articulate with?

A

the condyle consists of the capitulum and the trochlea

the capitulum articulates with the radius

the trochea articulates with the ulna

79
Q

What are the 3 fossae on the distal end of the humerus?

A
  1. radial fossa
  2. coronoid fossa
  3. olecranon fossa (posterior surface of humerus)
80
Q

Label the features of the distal end of the humerus

81
Q

What are the 3 features of the proximal end of the radius?

A
  1. head
  2. neck
  3. radial tuberosity
82
Q

What does the head of the radius articulate with?

A

the capitulum of the humerus

the thick medial margin of the head articulates with the radial notch on the proximal end of the ulna

83
Q

Which muscle attaches to the radial tuberosity?

A

the biceps brachii tendon

84
Q

Identify the features of the radius and the humerus

85
Q

What are the 5 features of the proximal end of the ulna?

A
  1. olecranon
  2. coronoid process
  3. trochlear notch
  4. radial notch
  5. tuberosity of the ulna
86
Q

What muscle attaches to the olecranon of the ulna?

A

triceps brachii muscle

87
Q

What do the trochlear notch and the radial notch of the ulna articulate with?

A

the trochlear notch articulates with the trochlea of the humerus

the radial notch articulates with the head of the radius

88
Q

Label the features of the proximal end of the ulna

89
Q

What is the role of collateral ligaments of the elbow joint?

A

they strengthen the medial and lateral aspects of the joint

the anular ligament of the radius holds the head of the radius in place

90
Q

What causes ‘pulled elbow’?

A

the head of the radius dislocates from the anular ligament

91
Q

Label the ligaments of the elbow joint

92
Q

What nerves are at risk in a dislocation/fracture of the elbow?

A
  1. radial nerve
  2. ulnar nerve
  3. median nerve
94
Q

What is the name of the fibro-osseous tunnel in which the ulnar nerve is contained within?

A

the cubital tunnel

this runs behind the medial epicondyle

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