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MSK > Anatomy 17 > Flashcards

Anatomy 17 Flashcards

1
Q

What does the shaft of the humerus expand distally to form?

A

Bony prominences called the medial and lateral epicondyles

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2
Q

What are the names of the prominences that the distal humerus bears?

A

Trochlea
Capitellum

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3
Q

What do the trochlea and capitellum articulate with?

A

Trochlear notch of the ulna and the head of the radius,
respectively, at the elbow joint

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4
Q

What is the anterior wall of the axilla?

A

Pectoralis major and minor

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5
Q

What is the posterior wall of the axilla?

A

Subscapularis
Teres major
Latissimus dorsi

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6
Q

What is the lateral wall of the axilla?

A

Upper humerus

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7
Q

What is the medial wall of the axilla?

A

Serratus anterior and chest wall

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8
Q

What is the apex of the axilla?

A

First rib, clavicle and scapula.
It is the passage between the neck and the axilla

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9
Q

What is the base of the axilla?

A

Skin and fascia between the chest wall and arm

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10
Q

What is the function of the lymph nodes in the axilla?

A

Drain the upper limb, chest and the abdominal wall as far as the umbilicus

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11
Q

What is the axillary artery?

A

The major artery of the upper limb

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12
Q

What is the axillary vein?

A

The major vein draining the upper limb

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13
Q

What is the function of the brachial plexus?

A

Innervates the upper limb

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14
Q

How many groups of lymph nodes are in the axilla?

A

5

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15
Q

Which part of the axilla are the lymph nodes located?

A

Apex of the axilla

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16
Q

What is the function of the apical nodes?

A

Receive lymph from all other lymph nodes in the axilla

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17
Q

What disease can the axillary lymph nodes be involved in?

A

Cancer (metastasis) - as they drain lymph from a large area

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18
Q

Which type of cancer are the axillary lymph nodes particularly associated with?

A

Breast cancer

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19
Q

What may be the first sign of breast malignancy?

A

Detection of a lump in the armpit

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20
Q

The axillary artery is a continuation of which artery?

A

Subclavian artery

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21
Q

Where does the subclavian artery travel through?

A

Travels under the clavicle and into the axilla

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22
Q

Which branches does the axillary artery give rise to?

A

one above pectoralis minor,
two behind it and three below it

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23
Q

What does the axillary artery continue into the arm as?

A

Brachial artery

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24
Q

At what point does the axillary artery become the brachial artery?

A

As it crosses the inferior border of teres major

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25
Q

What is the axillary vein?

A

Large vein which drains the upper limb and is continuous with the subclavian vein

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26
Q

What does the axillary vein travel alongside?

A

Axillary artery

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27
Q

What is the axillary vein formed by?

A

Union of the deep veins of the arm with the basilic vein

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28
Q

What happens if the axillary vein or artery is injured?

A

It can cause life-threatening bleeding

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29
Q

How can you halt bleeding of the axillary vessels?

A

Compress them against the humerus

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30
Q

What is the brachial plexus?

A

Network of nerves that provides motor and sensory
innervation to the upper limb

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31
Q

What is the brachial plexus formed by?

A

Spinal nerves C5, C6, C7, C8 and T1

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32
Q

What are the 5 segments of the brachial plexus?

A

Roots
Trunks
Divisions
Cords
Branches

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33
Q

What are the ‘roots’ of the brachial plexus?

A

5 spinal nerves (C5 - T1) that exit the spinal cord and collectively give rise to the brachial plexus.
They are found in the neck

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34
Q

What are the ‘trunks’ of the brachial plexus?

A

Located in the neck
* C5 and C6 combine to form the superior trunk
* C7 continues as the middle trunk
* C8 and T1 combine to form the inferior trunk

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35
Q

What are the ‘divisions’ of the brachial plexus?

A

Each trunk divides into an anterior and a posterior division under the clavicle

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36
Q

What are the ‘cords’ of the brachial plexus?

A

Named relative to their position around the second part of the axillary artery

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37
Q

What is the lateral cord of the brachial plexus?

A

Anterior divisions of the superior and middle trunks combine

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38
Q

What is the posterior cord of the brachial plexus?

A

Posterior divisions of all the trunks combine

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39
Q

What is the medial cord of the brachial plexus?

A

Anterior division of the inferior trunk continues as the medial cord

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40
Q

Where are the branches of the brachial plexus located?

A

In the axilla

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41
Q

What is the axillary branch?

A

A branch from the posterior cord

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42
Q

What is the radial branch?

A

The continuation of the posterior cord

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43
Q

What is the musculocutaneous branch?

A

A branch from the lateral cord

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44
Q

What is the ulnar branch?

A

A branch from the medial cord

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45
Q

What is the median branch?

A

Formed by branches from the lateral and medial cords

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46
Q

What does the axillary nerve innervate?

A

Innervates deltoid and teres minor and a small region of skin over the upper lateral arm

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47
Q

What is the axillary nerve a branch of?

A

Posterior cord

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48
Q

What spinal nerves does the axillary nerve contain fibres from?

A

Spinal nerves C5 and C6

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49
Q

What does the axillary nerve run close to?

A

The surgical neck of the humerus

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50
Q

What is the axillary nerve vulnerable to?

A

Injury in fractures of the surgical neck of the humerus or dislocations of the humeral head

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51
Q

What does the radial nerve innervate?

A
  • Triceps
  • All the muscles in the posterior compartment of the forearm – these muscles are extensors of the wrist and digits
  • Regions of skin over the arm, forearm and hand
52
Q

What is the radial nerve a continuation of?

A

The posterior cord

53
Q

What spinal cords does the radial nerve contain fibres from?

A

C5 - T1

54
Q

What does the radial nerve run along?

A

The radial (spiral) groove on the posterior surface of the humerus

55
Q

Where is the radius vulnerable in?

A

Radial (spiral) groove, mid-shaft fractures of the humerus

56
Q

What does the musculocutaneous nerve innervate?

A

3 muscles in the anterior arm

57
Q

What does the musculocutaneous nerve arise from?

A

Lateral cord

58
Q

What spinal nerves does the lateral cord contain fibres from?

A

C5 - C7

59
Q

What does the musculocutaneous nerve continue as?

A

Sensory nerve that innervates a region of skin over the forearm

60
Q

What is a benefit of the location of the musculocutaneous nerve?

A

Rarely injured in isolation

61
Q

What do the median and ulnar nerves innervate?

A

Innervate muscles in the anterior forearm and the hand
(Flexors of the wrist and digits)

Small muscles of the thumb. It innervates skin over the
lateral aspect of the palm of the hand and over the lateral digits

62
Q

Which cords is the medial nerve formed from?

A

Lateral and Medial

63
Q

Which spinal fibres does the medial nerve contain fibres from?

A

C6 - T1

64
Q

Where is the median nerve most vulnerable?

A

Cubital fossa - region where it crosses the anterior aspect of the elbow

65
Q

Which cord is the ulnar formed by the continuation of?

A

Medial

66
Q

Which spinal nerves does the ulnar nerve contain fibres from?

A

C8 - T1

67
Q

What does the ulnar nerve innervate?

A
  • Most of the small muscles in the hand and therefore is vital for fine movements of the digits
  • It also innervates skin over the medial aspect of the hand and medial digits
68
Q

Where is the ulnar nerve vulnerable to injury?

A

Behind the medial epicondyle as it lies in a superficial position here

69
Q

What is the most catastrophic type of brachial plexus injury?

A

When all five roots of the brachial plexus are injured

70
Q

What are the 3 muscles found in the anterior compartment of the arm?

A

Biceps brachii
Brachialis
Coracobrachialis

71
Q

What do the biceps brachii, brachialis and coracobrachialis act as?

A

Flexors

72
Q

What nerve are the biceps brachii, brachialis and coracobrachialis innervated by?

A

Musculocutaneous nerve

73
Q

Where does the biceps brachii lie?

A

Most superficially in the anterior arm

74
Q

How many muscle bellies does the biceps brachii have?

A

2 muscle bellies – the long head and the short head

75
Q

What are both muscle heads of the biceps brachii attached to?

A

Scapula
Long head to the supraglenoid tubercle
Short head to the coracoid process

76
Q

What do the two biceps muscle bellies converge via?

A

Common tendon onto the radial tuberosity of the radius

77
Q

What does the tendon of the long head pierce?

A

Pierces the capsule of the shoulder joint and helps to stabilise the joint

78
Q

What movements does the biceps execute?

A

Flexion of the elbow joint
Flexion of the shoulder joint
Supination of the forearm when the elbow is flexed

79
Q

Where is the brachialis located?

A

Deep to biceps

80
Q

Where is the brachialis attached?

A

Attached to the anterior aspect of the lower half of the shaft of the humerus

81
Q

Where does the brachialis insert?

A

Inserts distally upon the ulna tuberosity

82
Q

Where does the brachialis insert?

A

Inserts distally upon the ulna tuberosity

83
Q

What movement does the brachialis execute?

A

Flexion of the elbow

84
Q

Where does the coracobrachialis attach?

A

Attaches proximally to the coracoid process of the scapula
Distally to the medial aspect of the middle part of the humerus

85
Q

What movement does the coracobrachialis execute?

A

Crosses the shoulder joint and acts upon it as a weak flexor

86
Q

What is the cubital fossa?

A

Region anterior to the elbow joint
Referred to as antecubital fossa and abbreviated in medical notes to ‘ACF

87
Q

What is the lateral border of the cubital fossa?

A

Formed by brachioradialis, a posterior forearm muscle

88
Q

What is the medial border of the cubital fossa?

A

Formed by pronator teres, an anterior forearm muscle

89
Q

What is the superior border of the cubital fossa?

A

Formed by an imaginary line drawn between the medial and lateral epicondyles of the humerus

90
Q

What is the apex of the cubital fossa?

A

Most distal, ‘pointing’ towards the forearm and hand

91
Q

Where does the tendon of the biceps brachii travel in the cubital fossa?

A

Travels to its insertion point on the radial tuberosity

92
Q

How is the bicep reflex examined?

A

Biceps tendon is tapped with a tendon hammer

93
Q

What is the bicipital aponeurosis?

A

Fascial extension of the biceps tendon

94
Q

What is the function of the biciptal aponeurosis?

A

It separates the superficial veins from deeper structures in the fossa; the brachial artery and the median nerve

95
Q

Where does the brachial artery lie?

A

Medial to the biceps tendon

96
Q

What does the brachial artery bifurcate into?

A

Its terminal branches – the radial and ulnar arteries
– in the cubital fossa

97
Q

Where is the median nerve located?

A

Medial to the brachial artery

98
Q

Does the median nerve innervate any muscles in the arm?

A

No - travels through the anterior compartment of the arm and the cubital fossa on its journey to the anterior forearm and hand

99
Q

What does the median nerve innervate?

A

Muscles in the anterior forearm and hand

100
Q

What does the radial nerve pass through?

A

Lateral aspect of the cubital fossa

101
Q

Where is the radial nerve located?

A

Deep to the brachioradialis

102
Q

Why are the superficial veins that lie in the subcutaneous tissue over the cubital fossa clinically important?

A

Commonly accessed for:
* venepuncture (taking blood)
* intravenous access (i.e. placing a cannula for administering fluids or drugs)

103
Q

What nerves are at risk when removing axillary lymph nodes?

A

Long thoracic nerve
Thoracodorsal nerve

104
Q

What does the long thoracic nerve innervate?

A

Serratus anterior

105
Q

Where is the long thoracic nerve located?

A

Lies superficially on the surface of the muscle in the medial wall of the axilla

106
Q

What happens if there is an injury to the long thoracic nerve?

A

Causes weakness or paralysis of serratus anterior

107
Q

What is the function of the serratus anterior?

A

Hold the medial border of the scapula flat against the posterior chest wall

108
Q

What would happen if the serratus anterior were paralysed?

A

the medial border lifts off the chest wall and appears to ‘stick out’. This is called a ‘winged’ scapula

109
Q

Why is the thoracodorsal nerve vulnerable to injury?

A

Runs along the subscapularis muscle, which forms the posterior wall of the axilla

110
Q

Why is the ulnar nerve vulnerable in the lower arm?

A

As it travels behind the medial epicondyle
– it is superficial here

111
Q

What may injure the ulnar nerve?

A

Fractures of the medial epicondyle

112
Q

What may injury to the ulnar nerve lead to?

A

Motor impairments of the hand (as it innervates most of the small muscles of the hand)
and causes sensory impairment in the hand (the medial side of the hand and the medial 1½ fingers)

113
Q

What happens if you bang your elbow in the region of the ulnar nerve?

A

The region is referred to as the ‘funny bone’.
A blow to the nerve here causes pain and tingling in the same regions of the hand

114
Q

What is the injury to the upper brachial plexus referred to?

A

‘Erb’s Palsy’

115
Q

What spinal cords are involved when the upper brachial plexus is injured?

A

C5 - C6, or C5 - 7

116
Q

What happens when the upper brachial plexus is injured?

A

Paralysis of the lateral rotators of the shoulder and the extensors of the wrist
The affected limb typically appears medially rotated with the wrist flexed

117
Q

What can injury to the upper brachial plexus be caused by?

A

Typically caused by trauma – specifically mechanisms that stretch the head away from the shoulder.

This is typically seen when someone is thrown from a motorbike or a horse.

It may also be seen in newborns if the baby’s shoulder becomes stuck during delivery and its neck is excessively stretched

118
Q

What is injury to the lower brachial plexus referred to?

A

‘Klumpke’s Palsy’

119
Q

What spinal cords are involved when the lower brachial plexus is injured?

A

Typically C8 and T1

120
Q

What happens when the lower brachial plexus is injured?

A

Paralysis of the small muscles of the hand

121
Q

What can injury to the lower brachial plexus be caused by?

A

Typically caused by trauma – specifically mechanisms that forcefully and suddenly pull the arm upwards – this stretches the lower nerves of plexus.

It may be sustained by babies during delivery if the arm is forcefully pulled.

122
Q

What is horner’s syndrome?

A

Triad of drooping of the eyelid (ptosis),
a constricted pupil (miosis) and
lack of sweating (anhidrosis) on one side of the face

123
Q

What is horner’s syndrome a result of?

A

Sympathetic nerve supply to the face is interrupted

124
Q

Which spinal nerve carries sympathetic fibres which are destined to supply the face?

A

T1

125
Q

What is a brachial plexus block?

A

Form of regional anaesthesia and can be used as an alternative to general anaesthesia for surgery on the upper limb

MSK (10 decks)

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