Anatomical Areas Flashcards
Boundaries of axilla
Medial:
Medial: serratus anterior + thoracic wall
Boundaries of Axilla: Anterior:
Anterior: pec major and minor and subclavius
Boundaries of Axilla
Lateral:
Lateral: intertubercular groove of humerus
Boundaries of Axilla
Posterior:
Posterior:
Teres major, subscapularis, lat dorsi
Boundaries of Axilla
Apex:
Apex: 1st rib (lateral border), scapula (superior border), clavicle (posterior border)
Boundaries of Axilla
All
Apex: 1st rib (lateral border), scapula (superior border), clavicle (posterior border)
The axillary apex decreases in size most in:
A) abduction of arm
B) addiction of arm
A) abduction of arm
Which vessels are contained in the axilla?
Axillary artery and vein
Which nerve collection is contained in the axilla?
Brachial plexus
Which nodes are contained in the axilla?
Axillary nodes (diagnostic for breast ca)
Which 2 muscles pass through the axilla?
Where do they attach?
Biceps brachii + coracobrachialis
Both attach to coracoid process scapula
What are the three routes of exit of the axilla?
Upper arm
Quadrangular space
Clavipectoral triangle
What are the boundaries of the quadrangular space?
Superior:
Inferior:
Medial:
Lateral:
Superior: teres minor
Inferior: teres major
Medial: long head triceps brachii
Lateral: surgical neck of humerus
What 2 key structures exit through quadrangular space?
Posterior circumflex humeral artery
Axillary nerve
What 3 structures enter or leave through the clavipectoral triangle?
Cephalic vein (enters)
Medial and lateral pectoral nerves (leave)
What are the boundaries of the clavipectoral triangle?
Superior:
Inferior:
Lateral:
Superior: clavicle
Inferior: pec major
Lateral: deltoid
What are three causes of thoracic outlet syndrome?
1) trauma eg fractured clavicle
2) cervical rib
3) repetitive movements e.g. occupational
What percentage of lymph nodes from the breast drain into the axillary nodes?
75%
What is the lateral border of the cubital fossa?
Medial border brachioradialis
What is the medial border of the cubital fossa?
Lateral border pronator teres
What is the superior border of the cubital fossa?
Horizontal line between humeral epicondyles
What forms the roof of the cubital fossa?
bicipital aponeurosis, fascia, subcutaneous fat and skin
What forms the floor of the cubital fossa?
Brachialis proximally, supinator distally
Arrange the following contents of the cubital fossa laterally to medially:
Biceps tendon
Median nerve
Radial nerve
Brachial artery
Lateral - medial:
Radial nerve
Biceps tendon
Brachial artery
Median nerve
(Really need beer to be at my nicest)
Which vein lies superficially in the cubital fossa and joins the basilic and cephalic veins?
Median cubital vein
What humeral fracture is typically transverse or oblique and occurs commonly in children who FOOSH?
Supracondylar
What classification system is used for supracondylar fractures
Gartland classification:
1: minimally displaced (conservative mx)
2: displaced with intact posterior cortex (usually require k wire fixation)
3: completely displaced (also req fixation)
What is the medial border of the ulna canal?
Medial epicondyle of humerus
What is the lateral wall of the ulna canal?
Olecranon of ulna
What forms the roof of the ulna canal?
Cubital tunnel retinaculum (spans between medial epicondyle and olecranon) or arcuate ligament of Osbourne
What does the ulnar tunnel transmit?
Ulnar nerve
In cubital tunnel syndrome which nerve distribution may patients experience altered sensation?
Ulnar nerve
Medial 1.5 fingers and associated palm
In cubital tunnel syndrome which 4 muscles may become wasted?
Lumbricals, interosseous muscles, hypothenar eminence, adductor pollicis
Does cubital tunnel syndrome improve or worsen in elbow flexion?
Worsen (changes shape of tunnel causing increased pressure)
What forms the inferior border of the carpal tunnel? (4 things)
Scaphoid, trapezium, hamate, pisiform bones (lateral to medial)
What forms the roof of the carpal tunnel?
Flexor retinaculum
What 9 tendons lie within the carpal tunnel?
4 x FDP, 4 x FDS, 1 x FPL
What do the 2 synovial sheaths in the carpal tunnel contain?
1 = all FDS and FDP tendons
1 = FPL
Which nerve passes through the carpal tunnel?
Median
How does the median nerve divide after passing through the carpal tunnel?
Recurrent branch and palmar digital nerves
What areas do the palmar digital nerves from the median nerve innervate?
Palmar aspects of digits and nailbed of radial 3.5 digits
What is the most common mononeuropathy?
Carpal tunnel syndrome
What causes CTS?
Thickened tendons or flexor retinaculum
What are symptoms of CTS?
Numbness/tingling and pain in median nerve distribution
Name 2 tests when examining for CTS
Tinel’s (pain or tingling on tapping flexor retinaculum)
Phalen’s (pain or altered sensation when holding wrist in flexion for 69s)
In what position is the wrist held in when splinted for CTS?
Dorsiflexion
What muscles may appear wasted in CTS?
Thenar
How many extensor tendon compartments are there in the wrist?
6 (each lined by a synovial sheath)
1-6 lateral (radially) to medially (ulnarly)
What tendons lie in extensor compartment 1 of the wrist
EPB, APL
What tendons lie in extensor compartment 2 of the wrist
Extensor carpi radialis longus and brevis
Which tendons form the lateral and medial borders of the anatomical snuffbox
Lateral: APL & EPB
Medial: EPL
What is de Quervain’s tenosynovitis?
inflammation of the tendons within the first extensor compartment of the wrist, resulting in wrist pain and swelling
Most common in 30-50 year old women who use their wrists a lot
What tendons lie in extensor compartment 3 of the wrist
EPL (medial border of anatomical snuffbox)
What tendons lie in extensor compartment 4 of the wrist
Extensor digitorum and extensor indices
What tendons lie in extensor compartment 5 of the wrist
EDM
What tendons lie in extensor compartment 6 of the wrist
Extensor carpi ulnaris
What are the contents of the anatomical snuffbox?
Clue: artery, nerve and vein
Radial artery
Superficial branch radial nerve
Cephalic vein
What does the superficial branch of the radial nerve innervate
Dorsal aspects of radial 3.5 digits
Which carpal bone fracture elicits pain on pressure in the anatomical snuffbox?
Scaphoid
Why is the scaphoid at risk of avascular necrosis when fractured?
Retrograde blood supply
If missed fracture, likely to develop OA in later life
Where is guyons canal located?
Ulnar aspect of wrist
Which two bones does guyon’s canal extend from and to?
Pisiform to hook of hamate
What is the contents of guyon’s canal?
Ulnar neurovascular bundle and lymphatic vessels
How does the ulnar nerve split after leaving guyon’s canal?
Superficial (sensory) and deep (motor) branches
What sensory and motor features might a patient with ulnar (guyon’s) canal syndrome present with?
Sensory: altered sensation ulnar 1.5 digits
Motor (loss of function of ulnar innervated muscles)
Adductor pollicis: weakened thumb addiction
Interossei: finger abduction and adduction
Hypothenar: little finger flexion, abduction, opposition
