Anatomy: Chapter 6 Flashcards
1
Q
Clavicle physical description:
A
convex anteriorly for it’s medial 2/3 and then concaves for the lateral 3rd part
2
Q
Acromioclavicular joint
A
acromial end of clavicle + acromion process of scapula; permits sliding/gliding movements
3
Q
Sternoclavicular joint
A
sternal end of clavicle + sternum; Articular disc decreases incongruity between saddle shaped articular surface
4
Q
Ossification of clavicle:
A
occurs in connective tissue; membranous ossification (like skull)
Endochondral ossification occurs at two ends (appears in 2nd decade of life)
clavicle might be missing in some people (defective ossification)
5
Q
Important ligaments of the clavicle
A
Trapezoid, conoid, superior transverse scapular, costoclavicular, interclavicular
6
Q
Articulations of the humerus:
A
capitulum articulates w. radius
trochlea articulates w. ulna at the trochlear notch
7
Q
What accomodates space for where elbow is bent?
A
radial fossa and coronoid fossa: anterior, distal end
8
Q
What happens to the olecranon process when elbow is extended?
A
Olecranon process of ulna fits into bigger size olecranon fossa; posterior, distal end
9
Q
Fracture of the surgical neck of humerus
A
axillary n injury
10
Q
fracture to middle of shaft of humerus
A
radial n injury: wrist drop
11
Q
fracture to distal end of humerus
A
median n injury
12
Q
fracture to medial epicondyle of humerus
A
ulnar n injury
13
Q
Other possible on humerus?
A
Traumatic separation of proximal epiphysis under 18-20 years; also in younger children since capsule is stronger
Dislocation of shoulder joint
14
Q
Shoulder joint supported by:
A
Coracohumeral ligament (superiorly) 3 weak glenohumeral l. (super., mid., infer.) Coracoacromial l. – restricts movement
15
Q
Compound Joint of the Elbow:
A
humeroulnar, humeroradial, proximal radioulna
16
Q
Ligaments that support the elbow:
A
- Medial/ulnar l. and lateral/radial l. : restrict movement
- Middle + distal radiocarpal joints:
assist in flexion/extension of elbow,
supination/pronation of forearm
17
Q
What’s between the ulna and radius?
A
Interosseous membrane
18
Q
What happens in an Ulnar collateral l. injury in a sprain?
A
abnormal abduction of forearm
19
Q
What happens in an radial collateral l. injury in a sprain?
A
abnormal adduction of forearm
20
Q
Colle’s Fracture and associated complications
A
also known as smith’s fracture; fractured distal end of radius giving dinner fork shape to forearm (known as silver fork deformity)
- Fracture of styloid process of ulna may or may not be present
- associated complications: median and ulnar nerve injuries
21
Q
Pulled elbow:
A
dislocation of radius; generally affects children under 5
can happen by pulling kid too hard by hand/wrist
22
Q
Carpal Bone Fracture:
A
- upper extremities: among most common fractures of skeletal system
carpal bones: 18% of hand fractures
most dislocated carpal bone: lunate
most freq. fractured: bones of proximal row
- scaphoid ( 70% of carpal fracture, 10% of all hand fractures)
- triquetral (14% of most wrist injuries)
23
Q
Cause of carpal bone fracture:
A
injuries of moderately high energy; possible disability if not recognized early
24
Q
How is the carpal groove formed?
A
formed by hamulus: hook to hamate
concave anteriorly
25
Flexor Retinaculum layers:
superficial layer: continuous of antebrachial fascia; reinforcement
deeper layer: strong lamina; features similar to ligament
4 insertions: tubercle of scaphoid, pisiform, tubercle of trapezium, hook of hamate
26
How is carpal tunnel formed?
flexor retinaculum covers carpal groove
27
carpal tunnel syndrome: what and causes
pain in anterior region of wrist joint
cause: compression of median nerve in carpal tunnel; repetitive movement of wrist, hypothyroidism, rheumatoid arthritis, pregnancy, and amyloidosis
28
treatment of carpal tunnel syndrome:
Nonsurgical/surgical treatment courses
Early surgery: with evidence of median nerve denervation or if patient elects
Local steroid injection/splinting suggested before surgery
Other options: oral steroids, ultrasound, carpal tunnel release
Surgical treatment by complete division of flexor retinaculum recommended
29
Wrist joint movement:
Radial deviation (abduction); Ulnar deviation (adduction); flexion and dorsiflexion (extension); circumduction
30
Wrist joint is reinforced by what ligaments:
Ulnar and radial collateral l.
Palmar and dorsal radiocarpal l.
Palmar ulnocarpal l. + others
31
Saddle joint? movement?
the 1st carpometacarpal joint: abduction/ adduction, opposition/reposition, circumduction
32
Collateral ligament restricts movement of what?
Metacarpophalengeal Joints
33
Interphalangeal joints: movement? supported by?
flexion/extension of digits; supported by collateral and palmer l.
34
brachial plexus: what roots? nerves that pass thru? nerves that originate there?
C5-T1 roots; passes into axillary region and branches out into terminal nerves
Major nerves passing into axillary region: Median, Radial, Ulnar, Axillary (circumflex), Musculocutaneous
Major nerves that originate here: nerve to rhomboids, long thoracic nerves, medial + lateral pectoral nerves, supra- and infra- scapular nerves, and thoracodorsal
35
Deltoid: F & Inn
Function: arm abduction up to 90°; diff. parts have diff. function
Clavicular (anterior) adducts, flexes (anteversion), medial rotation
Acromial (middle) abducts, aids in clavicular part in anteversion
Spinal (posterior) extends (retroversion), lateral rotation
Innervation: axillary nerve (C5-C6)
36
Supraspinatus
Function: abductor of arm, part of rotator cuff muscle group
Innervation: suprascapular nerve (C4-C6)
37
Infraspinatus
Function: lateral rotator of arm, part of rotator cuff muscle group
Innervation: suprascapular nerve (C4-C6)
38
Teres Minor
Function: lateral rotator of arm, part of rotator cuff muscle group
Innervation: axillary nerve (C5-C6)
39
Teres Major
Function: adduction, medial rotation of arm
Innervation: lower subscapular nerve (C6-C7)
40
Latissimus Dorsi
Function: medial rotation, extension and adduction of arm (acts on humerus); coughing m.
Innervation: thoracodorsal nerve (C6-C8)
41
Subscapularis
Function: aids in adduction of arm, medial rotation, part of rotator cuff muscles
Innervation: subscapular nerves (C5-C7)
42
What happens if your subscapularis is paralyzed?
maximal lateral rotation of arm
43
Rotator Cuff Muscles:
Supraspinatus, Infraspinatus, Teres Minor, Subscapularis
44
What are some rotator cuff injuries:
Tendinopathy of supraspinatus (often in athletes)
Avulsion of greater tubercle
Calcification, pain, tendon rupture >40 years old + in young people
45
Pectoralis Major
Function: adduction of arm, medial rotation, lowers arm when raised, assist in respiration by expanding thoracic cage during forced respiration
Clavicular part: flexes upper arm
Innervation: lateral + medial pectoral nerves (C5-T1)
46
Pectoralis Minor
Function: pulls scapula forward/downward, scapula rotation so glenoid cavity faces downward
Innervation: medial pectoral nerve (C8-T1) – origin: lateral + medial cord of brachial plexus
47
Coracobrachialis
Function: aids in flexion, adduction of arm
Innervation: musculocutaneous nerve (C5-C7) – origin: lateral cord of brachial plexus
48
Serratus Anterior (ventral & dorsal)
Function: Arm elevation over 90°, protracts scapula, holds scapula against thoracic wall, rotates scapula laterally to elevate arms so glenoid cavity faces up, helps in respiration by lifting ribs
Innervation: Long thoracic nerve (C5-C7) – origin: proximal parts of brachial plexus on medial wall of axillary region between lymph node
49
Possible long thoracic nerve injuries?
can be injured during surgical removal of lymph nodes
50
Winged scapula:
Winged Scapula: lifting arm beyond 90° not possible; if arm elevation is normal with winged scapula, it’s a rhomboid m injury.
51
Subclavius
1st rib
Function: pulls clavicle towards the sternum
Innervation: nerve to the Subclavius (C5-C6)
52
Biceps Brachii
Both heads: flexion of shoulder joints, flexor of elbow joint, strong supinator of forearm
Long head: abduction of arm, medial rotation of arm
Short Head: adductor of arm
Innervation: musculocutaneous (C5-C6) – origin: lateral cord of brachial plexus
53
Biceps Jerk affects what nerve roots?
C5-C6
54
Brachialis:
Function: powerful flexor of elbow joint
Innervation: musculocutaneous nerve (C5-C6) + radial nerve (innervates some lateral parts)
55
Triceps Brachii
Function: strong extensor of forearm at elbow joint
Long head: acts on elbow and shoulder joints; retroversion and adduction of arm
Innervation: radial nerve (C6-C8)
56
Triceps Jerk affects what nerve roots?
C7-C8
57
Anconeus
Function: assists tricep brachii in elbow extension
Innervation: radial nerve (C7-C8, T1)
58
Innervation of posterior of arm:
radial n
59
Innervation of anterior forearm:
median n. except for Flexor Carpi Ulnaris and two tendons of the flexor digitorum profundus
60
Superficial Layer of muscles of the anterior forearm?
Palmaris Longus, Pronator Teres, Flexor Carpi Radialis, Flexor Digitorum Superficialis, Flexor Carpi Ulnaris
61
Deep Layer of muscles of anterior forearm
Flexor Pollicis Longus, Flexor Digitorum Profundus, Pronator Quadratus
62
Palmaris Longus
Function: Hand flexion, tenses palmar aponeurosis
Innervation: Median nerve (C7-C8)
63
Pronator Teres
Function: pronation of forearm, elbow flexion
Innervation: median nerve (C6-C7) – passes between two heads of pronator teres
64
Pronator Syndrome:
squeezing of median n. in between the pronator teres heads
Treatment: Can go in and remove part of surrounding muscle to relieve n.
65
Flexor Carpi Radialis
Function: palmar flexion, radial abduction of hand, flexion and pronation of elbow
Innervation: median nerve (C6-C7)
66
Flexor Digitorum Superficialis
Function: flexion of elbow, wrist, and fingers
Innervation: median nerve (C7, C8, T1)
67
Flexor Carpi Ulnaris
Function: flexion and adduction of hand
Innervation: ulnar nerve (C7-C8)
68
Flexor Pollicis Longus
Function: flexion of terminal phalanx (thumb)
Innervation: median nerve (anterior interosseous branch) (C8-T1)
69
Flexor Digitorum Profundus
Function: wrist flexion including midcarpal, metacarpophalangeal, + phalangeal joints
Innervation: median nerve (anterior interosseous branch) laterally, ulnar nerve medially
70
Pronator Quadratus
Function: pronation of forearm (together w. pronator teres)
Innervation: median nerve (anterior interosseous branch)
71
What passes thru the carpal tunnel?
flexors digitorum superficialis and profundus, median nerve between them, flexor pollicis longus
72
Brachioradialis
beer drinking m.
Function: pronation + supination of forearm; in mid-prone position: forearm flexion at elbow joint
Innervation: radial nerve (C5-C7)
73
Extensors Carpi Radialis Longus
Function: extension + radial abduction of hand at wrist joint, weak flexion of elbow, aids in pronation/supination of forearm
Innervation: radial nerve (C6-C7)
74
Extensors Carpi Radialis Brevis
Function: extension and abduction of hand at wrist joint, weak flexion of elbow
Innervation: deep branch of radial nerve (C7)
75
Elbow Tendinitis:
tennis/golfer’s elbow; periosteal irritation or pain on lateral epicondyle
76
What are the superficial muscles of the posterior forearm?
Extensor Digitorum
Extensor Digiti Minimi
Extensor Carpi Ulnaris
77
Extensor Digitorum
Function: extends 4 medial fingers, strong dorsiflexion of hand at wrist
Innervation: posterior interosseous branch of deep radial nerve (C7-C8)
78
Dorsal digital expansion:
intertendinous connections between tendons of extensor digitorum on hand forming: The Dorsal Aponeurosis
79
Extensor Digiti Minimi
Function: extension of 5th digit, dorsiflexion of hand
Innervation: posterior interosseous branch of deep radial nerve (C7-C8)
80
Extensor Carpi Ulnaris
Function: extension and adduction of hand at wrist
Innervation: posterior interosseous branch of deep radial nerve (C7-C8)
81
Deep muscles of posterior forearm:
```
Supinator
Abductor Pollicis Longus
Extensor Pollicis Brevis
Extensor Pollicis Longus
Extensor Indicis
```
82
Supinator
Function: supinates forearm
Innervation: deep branch of radial nerve (C5-C6)
83
Abductor Pollicis Longus
Abductor Pollicis Longus
| innervated by posterior interosseous branch of deep radial nerve
84
Extensor Pollicis Brevis
Function: extension of proximal phalanx at metacarpophalangeal joint
innervated by posterior interosseous branch of deep radial nerve
85
Extensor Pollicis Longus
Function: extends thumb (at metacarpophalangeal and interphalangeal joints) using crest on radius as fulcrum
innervated by posterior interosseous branch of deep radial nerve
86
Extensor Indicis
Function: index extension, hand dorsiflexion
innervated by posterior interosseous branch of deep radial nerve
87
Deep muscles of posterior forearm innervation:
posterior interosseous branch of deep radial nerve except supinator
88
Extensor Retinaculum Formation & Compartment Contents
Covers carpal bones dorsally; septae extends between retinaculum and underlying bones forming 6 tendon compartments
1st: abductor pollicis longus and extensor pollicis brevis
2nd: extensors carpi radialis brevis and longus
3rd: extensor pollicis longus
4th: extensor digitorum and extensor indicis
5th: extensor digiti minimi
6th: extensor carpi ulnaris
89
Palmar Aponeurosis composition and attachments?
Composed of longitudinal + transverse fascicles connecting in a flat triangular tough band
Upper angle merges w. flexor retinaculum and attaches to palmaris longus tendon
90
Palmaris brevis
between medial edge of palmar aponeurosis + skin on hypothenar eminence
Innervation: ulnar n.
91
Dupuytren’s Contracture
progressive fibrosis; thickening and shortening of aponeurosis leading to partial flexion of ring and small finger
may mimic ulnar nerve injury but ulnar nerve injury causes claw hand; Dupuytren's does not
92
What are the thenar muscles?
Abductor Pollicis Brevis
Flexor Pollicis Brevis
Opponens Pollicis
Adductor Pollicis
93
Abductor Pollicis Brevis
Function: abduction of thumb
Innervation: median n. (C8-T1)
94
Flexor Pollicis Brevis
Function: flexion of thumb
Innervation: superficial head by median nerve, deep head by ulnar nerve
95
Opponens Pollicis
Function: thumb opposition
Innervation: median nerve (C8-T1)
96
Adductor Pollicis
Function: thumb adduction
Innervation: deep branch of ulnar nerve (C8-T1)
97
All hypothenar muscles innervation:
deep branch of ulnar nerve
98
Abductor Digiti Minimi
Function: abducts 5th digit
innervated by deep branch of ulnar nerve
99
Flexor Digiti Minimi
Function: flexes 5th digit
| innervated by deep branch of ulnar nerve
100
Opponens Digiti Minimi
Function: opposition of 5th finger to thumb
| innervated by deep branch of ulnar nerve
101
Muscles of the metacarpus?
Lumbrical Muscles
Palmar Interossei
Dorsal Interossei
102
Lumbrical Muscles
Innervation: 2 lateral muscles by median nerve, 2 medial muscles by ulnar nerve
103
Palmar Interossei
3 single-headed
Function: adduction of digits and assisting the lumbricals
Innervation: deep branch of ulnar n. and median n
104
Dorsal Interossei
4 double headed
Function: Abduction of digits
Innervation: deep branch of ulnar n. and median n
105
Radial N. Injuries: proximal to triceps origin, to radial groove, to forearm?
Triceps origin: wrist drop, flexed elbow, no triceps reflex, all extensors and supinator are paralyzed and thumb is flexed and adducted
Radial groove: fractures of humerus, wrist drops, sensory loss in dorsolateral aspect of forearm and hand
Forearm: deep radial nerve is injured, wrist drop, extension of thumb and metacarpal is disturbed
106
Median N. Injuries: Above elbow? At wrist joint?
Above Elbow: Thenor muscles atrophy (ape hand), wrist flexor paralyzed except 4th and 5th tendons, Hand of Papal Benediction: pronation of forearm paralyzed and sensory loss over median n. area
Wrist Joints: Ape hand, Short muscles of thumbs may be paralyzed except adductor, Sensory loss over median nerve sensory area
Can happen while hand is out of window of moving automobile, attempted suicide by cutting wrists
107
Tinel's sign
way to detect irritated nerves
percussion on median n in wrist area leading to heightened paraesthesis in carpal tunnel syndrome
108
Ulnar N Injuries: At elbow? At wrist?
Elbow: Paralysis of flexor carpi ulnaris and medial portion of flexor digitorum profundus
Ulnar deviation of wrist is weakened, hand is abducted and extended, in addition to problems of injury at the wrist
wrist: claw hand, Tendons of flexor digitorum profundus (2 medial muscles) are paralyzed; flexion of ring and little finger not possible at distal phalangeal joints, piano playing and writing impaired
109
In brachial plexus syndromes, T1 involvement in injure may lead to:
autonomic deficits
110
Horner's syndrome:
drooping of eyelid, constriction of pupil
111
```
Upper brachial plexus lesion (C5-C6):
trauma to shoulder?
paralysis of deltoid and supraspinatus?
paralysis of biceps and brachialis?
loss of biceps and supinator function?
```
Traction of arm at birth: Erb-Duchenne paralysis (nerve roots may be pulled out of spinal cord)
Trauma to shoulder can injure upper part of plexus – root may even be pulled out of spinal cord
Paralysis of deltoid and supraspinatus: no arm abduction
Infraspinatus paralysis, leading to medial rotation of arm
Paralysis of biceps and brachialis: no elbow flexion
Loss of biceps and supinator function: weak supination at elbow
Adductors of shoulder are mildly affected
112
Lower brachial plexus lesion (C8-T1)
Sudden upward pull of shoulder
Forced abduction of shoulder at birth: Klumpke’s paralysis (Atophic paralysis of forearm, claw hand, and sympathetic palsy; eg: horner’s syndrome)
Paralysis of intrinsic muscle of hand and (small muscles)
Not as common as upper brachial plexus lesion
113
Describe the blood supply of the upper limb:
Subclavian A. (accompanied by subclavian vein) passes through the scalene gap and reached axillary region by passing under clavicle
After passing under clavicle subclavian = axillary A. and V.
Axillary artery gives 6 arterial branches: superior thoracic artery, thoracoacromial artery, lateral thoracic artery, subscapular artery, anterior and posterior circumflex humeral arteries
After passing lower boundary of teres major/latissimus dorsi in brachial region of arm, axillary = brachial artery
Brachial A. gives off deep brachial artery on posterior aspect of humerus
Brachial A. divides into radial and ulnar arteries in elbow region
Ulnar gives off common interosseous artery which divides into the anterior and posterior interosseous arteries that run near interosseous membrane
Radial and Ulnar join each other twice; give off branches that form superficial and deep palmar arches
Deep palmar arches give off superficial and deep palmar arteries
Dorsal carpal artery branches from radial artery in dorsum of hand branches into dorsal metacarpal and digital arteries
114
skin inn of deltoid region:
axillary nerve laterally, radial nerve posteriorly
115
skin inn of Axillary region
interconnections between upper intercostal n. and medial cutaneous brachial n.
Both nerves known as intercostobrachial anastomosis (nerves)
116
skin inn of medial aspect of upper arm
medial cutaneous brachial nerve
117
Lateral + Posterior aspect of upper arm skin inn
cutaneous branches of radial nerve
118
Medial aspect of forearm skin inn
medial cutaneous antebrachial nerve
119
Lateral aspect of forearm skin inn
cutaneous branches of musculocutaneous (lateral antebrachial) nerve
This nerve also innervates upper arm by motor component
120
hypothenar and thenar side of palm and fingers
Hypothenar side of palm and fingers (3 half-digit): ulnar nerve
Thenar side of palm and fingers (7 half-digit) from thumb to half of ring finger: Median nerve
121
dorsum of hand and tips of fingers skin inn
Dorsum of hand on small finger side (3 or 5 half digit): ulnar nerve
Dorsum of hand, Radial side (7 or 5 half-digit): superficial radial nerve
Dorsally, tips of fingers: median nerve
122
Volkmann’s ischemic contracture
- lack of blood to lower arm leads to fibrosis of tissue
- death of muscles
- Occurs when: accident involving brachial artery laceration; compression of brachial artery
123
arterial blood pressure is measured with:
sphygmometer
124
Brachial artery occlusion/laceration leads to
deep flexor paralysis
125
Lymphangitis:
inflammation of lymphatic vessels and channels
126
Contents of the Medial Bicipital Groove:
between biceps and intermuscular septa
```
Median N
Brachial A. and V.
Basilic V.
Medial cutaneous antebrachial N.
Ulnar N. medially
```
127
Tendons of Snuff box and contents
- abductor pollicis longus: most lateral
- extensor pollicis brevis: middle
- extensor pollicis longus: most medial
128
Lymph Nodes of Axillary Region and drainage
```
5 major groups:
1. Pectoral (medial)
Location- lateral border of pectoralis minor and major m
Drains- 75% of the mammary gland (breasts)
2. Lateral (humeral)
Drains- major lymphatics of upper limb
3. Apical
Drains- subclavian lymphatic trunk
4. Subscapular (posterior)
Drains- posterior part of shoulder
5. Central groups
Drains- drains the above groups and drain their lymphatics into apical region. Lymphatics of the breasts are drained into central groups
```
129
Saturday night palsy/honeymoon palsy
Saturday Night Palsy = honeymoon palsy <-- same conditions
- radial nerve injury (compression)
- wrist drop
- if more proximal: no flexion? at elbow as well
- not normally permanent
130
guyon's canal? guyon's canal syndrome?
contains: ulnar nerve
also known as handlebar palsy; compression of ulnar nerve due to prolonged pressure
131
tachycardia? brachycardia?
tachycardia: increased pulse
bradycardia: decreased pulse
132
Borders of the quadrangular space:
teres minor, teres major, humerus, long head of triceps
