ANAT: Upper Limb (Upper Arm) Flashcards

1
Q

label all parts of this image

A
  • A = axilla
  • B = arm
  • C = cubital fossa
  • D = forearm
  • E = hand
  • F = digits
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2
Q

where are the flexor and extensor muscles of the upper limb housed (distal to the axilla)?

A
  • flexor muscles: anterior
  • extensor muscles: posterior
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3
Q

how many nerves innervate the anterior and posterior compartments of the upper limb (distal to the axilla)?

A
  • anterior: 3
  • posterior: 1
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4
Q

anatomically, where does the brachial plexus sit?

A
  • roots: begin at the intervertebral foramina and sit between the middle and anterior scalene muscles
  • trunks: between middle and anterior scalenes
  • divisions: deep to the clavicle
  • cords: deep to pectoralis minor
  • terminal branches: emerge at the lateral border of pec minor
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5
Q

do posterior or anterior rami form nerve plexus?

A
  • only anterior because limbs originate from the front of the body, not the back
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6
Q

label all components

A
  • A = intervertebral foramen (hole)
  • B = ventral root of spinal nerve
  • C = dorsal root ganglion
  • D = mixed spinal nerve
  • E = posterior ramus
  • F = anterior ramus
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7
Q

label A, B, C, D, E

A
  • A = roots
  • B = trunks
  • C = divisions
  • D = cords
  • E = terminal branches
  • Real Tradies Drink Cold Beer
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8
Q

label F, G, H, I, J

A
  • F = superior trunk
  • G = middle trunk
  • H = inferior trunk
  • I = anterior divisions
  • J = posterior divisions
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9
Q

label K, L, M

A
  • K = lateral cord
  • L = posterior cord
  • M = medial cord
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10
Q

label N, O, P, Q, R

A
  • N = musculocutaneous nerve
  • O = axillary nerve
  • P = radial nerve
  • Q = median nerve
  • R = ulnar nerve
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11
Q

musculocutaneous nerve:
- what roots is it made up of
- motor innervation
- sensory innervation
- where does it run anatomically

A
  • C5, C6, C7
  • motor: anterior flexor muscles of arm (biceps brachii, brachialis, coracobrachialis)
  • sensory: anterolateral forearm
  • starts as most lateral nerve from lateral cord, pierces coracobrachialis, runs between brachialis and biceps brachii, then continues as lateral cutaneous nerve down forearm
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12
Q

axillary nerve:
- what roots is it made up of
- motor innervation
- sensory innervation
- where does it run anatomically
- when is it at risk of damage

A
  • C5, C6
  • motor: deltoid + teres minor
  • sensory: regimental badge area (kind of over the deltoid)
  • starts from posterior cord (superior to radial nerve and posterior to axillary a.) and ends @ deltoid and teres minor
  • risk of damage during shoulder dislocation as it supplies glenohumeral joint
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13
Q

radial nerve
- what roots is it made up of
- motor innervation
- sensory innervation
- where does it run anatomically
- when is it likely to be injured

A
  • all 5 roots (C5, C6, C7, C8, T1)
  • motor: posterior upper arm (triceps brachii), posterior forearm - EXTENSORS
  • sensory: posterior arm and forearm, dorsal surface of lateral 1.5 digits
  • RUNS ABOVE TERES MAJOR, very close to humerus, between triceps heads. superficial sensory branch wraps around dorsal surface of thumb and deep motor branch turns into interosseous branches
  • injury: midshaft humeral fracture (wrist drop)
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14
Q

median nerve:
- what roots is it made up of
- motor innervation
- sensory innervation
- where does it run anatomically
- when is it at risk of injury

A
  • all 5 roots (C5, C6, C7, C8, T1)
  • motor: anterior forearm EXCEPT flexor carpi ulnaris and medial half of flexor digitorum profundus (ulnar nerve), thenar eminence, lateral 2 lumbricals (II and III phalanges)
  • sensory: lateral 3 digits + on dorsal surface and lateral 3.5 digits on palmar surface
  • runs medially down upper arm, passes thru cubital fossa and between 2 heads of pronator teres, goes thru carpal tunnel to supply lateral hand muscles
  • at risk: distal humeral fractures, compression in the carpal tunnel
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15
Q

ulnar nerve
- what roots is it made up of
- motor innervation
- sensory innervation
- where does it run anatomically
- when is it at risk?

A
  • C8, T1
  • motor: flexor carpi ulnaris, medial half of flexor digitorum profundus, all intrinsic hand muscles except thenar eminence and lateral 2 lumbricals (these are median nerve)
  • sensory = medial 1.5 digits on palmar and dorsal surfaces
  • runs very medial all the way down the arm, posterior to medial epicondyle
  • at risk in distal humerus (medial epicondyle) and wrist compression
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16
Q

what is A and what is its function?

A
  • dorsal scapular nerve
  • innervates levator scapulae (A), rhomboids major (C), and rhomboids minor (B)
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17
Q

what is B and what is its function?

A
  • long thoracic nerve
  • innervates serratus anterior
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18
Q

what is C and what is its function?

A
  • suprascapular nerve
  • innervates supraspinatus (A) and infraspinatus (B)
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19
Q

what is D and what is its function?

A
  • nerve to subclavius
  • innervates subclavius
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20
Q

what is E and what is its function?

A
  • E = lateral pectoral nerve - innervates upper pectoralis major
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21
Q

what are I, J and K and what is K’s function?

A
  • I = medial cutaneous nerve of the forearm
  • J = medial cutaneous nerve of the arm
  • K = medial pectoral nerve - innervates lower pectoralis major and pectoralis minor
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22
Q

what are F, G and H and what do they innervate?

A
  • F = lower subscapular nerve - innervates lower subscapularis and teres major
  • G = middle subscapular/thoracodorsal nerve - innervates latissimus dorsi and teres major
  • H = upper subscapular nerve - innervates upper subscapularis
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23
Q

label all dermatomes

A
  • A = C3
  • B = C4
  • C = C5
  • D = C6
  • E = C7
  • F = C8
  • G = T1
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24
Q

upper limb myotomes

A
  • C5 arms out wide: shoulder abduction
  • C6 smell your wrist: elbow flexion and wrist extension
  • C7 no zombies in heaven: elbow extension and wrist flexion
  • C8 you’re doing great: thumb extension and ulnar deviation
  • T1 one and done: finger abduction
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25
describe the arterial supply of the entire arm
- subclavian artery (under clavicle) - turns into axillary artery after clavicle) - axillary branches into anterior and posterior circumflex humeral arteries - axillary continues to become brachial artery @ inferior border of teres major - brachial branches into profunda brachii and then continues, branching off into radial and ulnar arteries - radial and ulnar arteries join together to create the superficial and deep palmar arches - superficial palmar arch becomes common digital arteries
26
what do the axillary and brachial arteries supply?
- axillary: axilla, pectoral region, shoulder joint - brachial: all upper arm muscles (anterior and posterior)
27
how does the axillary artery relate to the cords of the brachial plexus?
- the cords are named relative to the axillary artery (medial, lateral, posterior)
28
describe the 3 parts of the axillary artery
- 1st part: medial to pecs minor - 2nd part: deep to pecs minor - 3rd part: lateral to pecs minor
29
what do the radial and ulnar arteries supply?
- radial: posterolateral component of forearm inc. thumb and index finger - ulnar: anteromedial component of forearm
30
label all components
- A = axillary artery - B = posterior humeral circumflex artery - C = anterior humeral circumflex artery - D = subscapular artery - E = brachial artery
31
describe the superficial veins of the whole arm and which is the most common for venepuncture?
- cephalic vein (lateral) and basilic vein (medial): both drain into axillary vein - median cubital vein: connects cephalic and basilic veins in cubital fossa - median antebrachial vein: diff anatomical variations for where it drains into - ANY of these veins are used for venepuncture h/w median cubital vein is the most common
32
describe the deep veins of the whole arm
- basically same as arteries
33
describe the axillary lymph nodes
- apical nodes (@ the apex) - central nodes - subscapular nodes (posterior) - pectoral nodes (anterior) - humeral nodes (lateral) - furthest from breast
34
contents of axilla
- axillary v. and a. - lymph nodes for upper limb - brachial plexus (cords and terminal branches) - short head of biceps + coracobrachialis
35
describe the base of the axilla
- armpit skin - subcutaneous tissue - deep axillary fascia
36
describe the anterior wall of the axilla
- pecs major and minor - subclavius - clavipectoral fascia
37
describe the apex of the axilla
- 1st rib - lateral 1/3 of the clavicle - coracoid process
38
describe the posterior wall of the axilla
- subscapularis - teres major - latissimus dorsi tendon
39
describe the medial wall of the axilla
- serratus anterior
40
describe the lateral wall of the axilla
- bicipital groove of humerus - coracobrachialis - short head of biceps
41
label A, B, C, D
- A = medial border - B = superior angle - C = superior border - D = acromion
42
label E, F, G, H
- E = acromial angle - F = lateral angle - G = lateral border - H = inferior angle
43
anatomical vs surgical neck of humerus
- surgical = where the shaft starts - anatomical = more superior, where the epiphyseal plate is
44
3 types of humeral fractures and what structures are at risk?
- proximal (surgical neck = most common) - damage axillary nerve and posterior circumflex artery (FOOSH) - midshaft - damage radial nerve + profunda brachii - supracondylar (distal) - most likely to damage ulnar nerve due but also radial and median nerve
45
glenoid labrum
- extra fibrocartilage around the glenoid fossa which increases the SA of the point of articulation - prevents dislocation
46
what are A, B, C and D?
- A = acromion (superior and posterior to coracoid) - B = coracoid process - C = head of humerus - D = glenoid fossa
47
what are E, F, G and H?
- E = greater tubercle (posterolateral) - F = lesser tubercle (anteromedial) - G = subscapular fossa - H = supraspinous fossa
48
what are I, J, K and L?
- I = infraspinous fossa - J = spine of scapula - K = deltoid tubercle - L = suprascapular notch
49
what are A, B and C?
- A = coracoacromial ligament - B = coracohumeral ligament - C = glenohumeral ligament
50
what are A and B?
- A = subacromial bursa: bursitis causes pain in 70-120 degrees of abduction - B = subscapular bursa
51
what are A, B, C, D and E?
- A = periosteum - B = joint capsule - C = articular cartilage - D = synovial membrane - E = synovial/joint cavity containing synovial fluid
52
3 ligaments which support the AC joint
- acromioclavicular - coracoclavicular (formed by conoid and trapezoid ligaments)
53
what are A, B, C and D and what are their functions?
- A = supraspinatus (abduction) - B = infraspinatus (external rotation) - C = teres minor (external rotation) - D = subscapularis (internal rotation)
54
what are A and B and what are their functions?
- A = deltoid (abduction 15-90˚) - B = teres major (adduction)
55
what are A, B, C and D?
- A = trapezius (scapular rotation) - B = levator scapulae - C = rhomboids minor - D = rhomboids major
56
what are A, B, C and D?
- A = pectoralis major - B = pectoralis minor (deep to pec major) - C = subclavius - D = serratus anterior (scapular protraction and upward rotation)
57
why is the rotator cuff so stable?
- all multipennate muscles which means they create little movement when they contract - work together to keep head of humerus against glenoid fossa during movement
58
which muscles attach to the greater and lesser tubercle of the humerus?
- greater: supraspinatus, infraspinatus, teres minor (posterior, from medial to lateral - SIT) - lesser: subscapularis (anterior)
59
which position is the most susceptible to shoulder dislocation
- abduction and external rotation b/c least stability (no muscles in the anterior/inferior position)
60
what are A, B, C and D? (biceps brachii) - what movements can the biceps do? - describe its vasculature
- A = long head (lateral): travels thru intertubercular groove and attaches onto supraglenoid tubercle (right above glenoid labrum) - B = short head (medial): originates at coracoid process - C = biceps tendon which attaches to radial tubercle - D = bicipital aponeurosis (fanning out of tendon to disperse force), attaches to forearm fascia
61
biceps brachii: - describe its origin and insertion - describe its innervation - describe its arterial supply - what movements is it responsible for?
- origin: short head originates @ coracoid process, long head originates @ bicipital groove - insertion: radial tuberosity and bicipital aponeurosis - innervation: musculocutaneous n. - arterial: brachial and anterior circumflex humeral a. - flexion and supination
62
what is A? - describe its origin and insertion - describe its innervation - describe its arterial supply - what movement is it responsible for?
- brachialis - origin: distal humerus and intermuscular septum - insertion: proximal ulna - innervation: musculocutaneous (medial) and radial nerve (lateral) - arterial: brachial a. - movement: elbow flexion
63
what muscle is B? - describe its origin and insertion - describe its innervation - describe its arterial supply - what movements is it responsible for
- coracobrachialis - origin: coracoid process - insertion: middle of humerus - innervation: musculocutaneous n. - arterial: brachial + anterior circumflex arteries - movements: shoulder flexion and adduction
64
isotonic and isometric movements
- isotonic: muscle length changes > concentric: contraction during shortening > eccentric: contraction during lengthening - isometric: length of muscle doesn't change
65
what are A, B and C? (triceps brachii) - where does each head originate? - what is the insertion?
- A = long head (originates @ scapula) - B = lateral head (originates @ posterior humerus) - C = medial head (over the top of the long and lateral head, originates @ intermuscular septum) - all 3 heads join and insert @ ulna
66
triceps brachii: - describe its innervation - describe its arterial supply - what movements is it responsible for?
- innervation: radial nerve - arterial: deep brachial artery - movement: extension
67
triple test approach re: breast lesion
- clinical examination - breast imaging (usually mammography and U/S, +/- MRI) - biopsy/tissue pathology
68
what are A, B, C and D?
- A = nipple/areolar complex - B = adipose tissue - C = pec major - D = fibroglandular tissue
69
what is the innervation of: pecs major and minor, serratus anterior
- pecs major: medial and lateral pectoral nerve - pecs minor: medial pectoral nerve - serratus anterior: long thoracic nerve
70
what is the innervation of: latissimus dorsi, deltoid, teres major
- lats: thoracodorsal n. - deltoid: axillary n. - teres major: lower subscapular n.
71
describe the innervation of the rotator cuff
- subscapularis: upper and lower subscapular n. - infraspinatus and supraspinatus: suprascapular n. - teres minor: axillary n.
72
describe the innervation of the anterior upper arm muscles
- biceps brachii: musculocutaneous n. - coracobrachialis: musculocutaneous n. - brachialis: musculocutaneous and radial n.
73
describe the innervation of: trapezius, levator scapulae, rhomboids
- trapezius: accessory spinal nerve - levator scapulae: dorsal scapular nerve - rhomboids: dorsal scapular nerve
74
innervation of subclavius
- subclavian nerve
75
list some bones commonly fractured during a FOOSH
- clavicle (change in curvature) - humerus (surgical neck or supracondylar) - distal radius head or neck - scaphoid (esp. @ its waist)
76
deltoid function
- anterior deltoid: shoulder flexion - middle deltoid: abduction past 15 degrees (first 15 degrees are supraspinatus) - posterior deltoid: shoulder extension
77
describe the mechanism of shoulder abduction to 180˚
- 0-15˚: supraspinatus (glenohumeral) - 15-90˚: deltoid (glenohumeral) - 90-150˚: scapulothoracic joint (formed by medial border of scapula and ribs) rotates scapula upwards, facilitated by trapezius and serratus anterior. sternoclavicular joint elevates clavicle - 150-180˚: AC joint - NB pain @ 65 degrees = impingement
78
clavicle fracture: - where is it most common to occur? - causes - what can this damage
- most common where it changes curvature - causes: FOOSH - may damage divisions of brachial plexus
79
rotator cuff tendinopathy
- usually affects supraspinatus b/c tendon runs thru subacromial space - usually caused by overuse e.g. swimming - can lead to bursitis + impingement
80
what is thoracic outlet syndrome
- thoracic outlet = space b/n clavicle and 1st rib containing brachial plexus, subclavian a. and v. - can be compressed due to having an extra rib, physical trauma, pregnant or pancoast tumour (tumour of lung apex) - pancoast tumour can compress inferior trunk of brachial plexus = ulnar nerve
81
boundaries of quadrangular space + triangular space + triangular interval (posterior shoulder)
82
which muscle is responsible for preventing winging of the scapula?
- serratus anterior
83
if the AC joint is disolocated, which way will the shoulder joint drop?
- anteriorly and inferiorly
84
Saturday night palsy
- compression of radial nerve in axilla - leads to wrist drop - i.e. due to sleeping weirdly after getting drunk
85
erb's palsy
- damage to upper trunk - arm rests in waiter’s tip position with elbow extended and pronated and wrist flexed - often caused by childbirth
86
klumpke's palsy
- damage to lower trunk (C8,T1) - arm rests in claw hand position with elbow flexed and supinated and fingers flexed - caused by childbirth (poor bubbas can’t catch a break) or grabbing something to break your fall