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

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2
Q

Acromioclavicular joint

A

acromial end of clavicle + acromion process of scapula; permits sliding/gliding movements

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3
Q

Sternoclavicular joint

A

sternal end of clavicle + sternum; Articular disc decreases incongruity between saddle shaped articular surface

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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)

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5
Q

Important ligaments of the clavicle

A

Trapezoid, conoid, superior transverse scapular, costoclavicular, interclavicular

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6
Q

Articulations of the humerus:

A

capitulum articulates w. radius

trochlea articulates w. ulna at the trochlear notch

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7
Q

What accomodates space for where elbow is bent?

A

radial fossa and coronoid fossa: anterior, distal end

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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

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9
Q

Fracture of the surgical neck of humerus

A

axillary n injury

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10
Q

fracture to middle of shaft of humerus

A

radial n injury: wrist drop

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11
Q

fracture to distal end of humerus

A

median n injury

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12
Q

fracture to medial epicondyle of humerus

A

ulnar n injury

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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

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14
Q

Shoulder joint supported by:

A
Coracohumeral ligament (superiorly)
3 weak glenohumeral l. (super., mid., infer.)
Coracoacromial l. – restricts movement
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15
Q

Compound Joint of the Elbow:

A

humeroulnar, humeroradial, proximal radioulna

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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
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17
Q

What’s between the ulna and radius?

A

Interosseous membrane

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18
Q

What happens in an Ulnar collateral l. injury in a sprain?

A

abnormal abduction of forearm

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19
Q

What happens in an radial collateral l. injury in a sprain?

A

abnormal adduction of forearm

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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
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21
Q

Pulled elbow:

A

dislocation of radius; generally affects children under 5

can happen by pulling kid too hard by hand/wrist

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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)

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23
Q

Cause of carpal bone fracture:

A

injuries of moderately high energy; possible disability if not recognized early

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24
Q

How is the carpal groove formed?

A

formed by hamulus: hook to hamate

concave anteriorly

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25
Q

Flexor Retinaculum layers:

A

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

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26
Q

How is carpal tunnel formed?

A

flexor retinaculum covers carpal groove

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27
Q

carpal tunnel syndrome: what and causes

A

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

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28
Q

treatment of carpal tunnel syndrome:

A

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

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29
Q

Wrist joint movement:

A

Radial deviation (abduction); Ulnar deviation (adduction); flexion and dorsiflexion (extension); circumduction

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30
Q

Wrist joint is reinforced by what ligaments:

A

Ulnar and radial collateral l.
Palmar and dorsal radiocarpal l.
Palmar ulnocarpal l. + others

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31
Q

Saddle joint? movement?

A

the 1st carpometacarpal joint: abduction/ adduction, opposition/reposition, circumduction

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32
Q

Collateral ligament restricts movement of what?

A

Metacarpophalengeal Joints

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33
Q

Interphalangeal joints: movement? supported by?

A

flexion/extension of digits; supported by collateral and palmer l.

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34
Q

brachial plexus: what roots? nerves that pass thru? nerves that originate there?

A

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

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35
Q

Deltoid: F & Inn

A

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)

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36
Q

Supraspinatus

A

Function: abductor of arm, part of rotator cuff muscle group

Innervation: suprascapular nerve (C4-C6)

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37
Q

Infraspinatus

A

Function: lateral rotator of arm, part of rotator cuff muscle group

Innervation: suprascapular nerve (C4-C6)

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38
Q

Teres Minor

A

Function: lateral rotator of arm, part of rotator cuff muscle group

Innervation: axillary nerve (C5-C6)

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39
Q

Teres Major

A

Function: adduction, medial rotation of arm

Innervation: lower subscapular nerve (C6-C7)

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40
Q

Latissimus Dorsi

A

Function: medial rotation, extension and adduction of arm (acts on humerus); coughing m.

Innervation: thoracodorsal nerve (C6-C8)

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41
Q

Subscapularis

A

Function: aids in adduction of arm, medial rotation, part of rotator cuff muscles

Innervation: subscapular nerves (C5-C7)

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42
Q

What happens if your subscapularis is paralyzed?

A

maximal lateral rotation of arm

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43
Q

Rotator Cuff Muscles:

A

Supraspinatus, Infraspinatus, Teres Minor, Subscapularis

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44
Q

What are some rotator cuff injuries:

A

Tendinopathy of supraspinatus (often in athletes)

Avulsion of greater tubercle

Calcification, pain, tendon rupture >40 years old + in young people

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45
Q

Pectoralis Major

A

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)

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46
Q

Pectoralis Minor

A

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

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47
Q

Coracobrachialis

A

Function: aids in flexion, adduction of arm

Innervation: musculocutaneous nerve (C5-C7) – origin: lateral cord of brachial plexus

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48
Q

Serratus Anterior (ventral & dorsal)

A

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

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49
Q

Possible long thoracic nerve injuries?

A

can be injured during surgical removal of lymph nodes

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50
Q

Winged scapula:

A

Winged Scapula: lifting arm beyond 90° not possible; if arm elevation is normal with winged scapula, it’s a rhomboid m injury.

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51
Q

Subclavius

A

1st rib

Function: pulls clavicle towards the sternum

Innervation: nerve to the Subclavius (C5-C6)

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52
Q

Biceps Brachii

A

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

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53
Q

Biceps Jerk affects what nerve roots?

A

C5-C6

54
Q

Brachialis:

A

Function: powerful flexor of elbow joint

Innervation: musculocutaneous nerve (C5-C6) + radial nerve (innervates some lateral parts)

55
Q

Triceps Brachii

A

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
Q

Triceps Jerk affects what nerve roots?

A

C7-C8

57
Q

Anconeus

A

Function: assists tricep brachii in elbow extension

Innervation: radial nerve (C7-C8, T1)

58
Q

Innervation of posterior of arm:

A

radial n

59
Q

Innervation of anterior forearm:

A

median n. except for Flexor Carpi Ulnaris and two tendons of the flexor digitorum profundus

60
Q

Superficial Layer of muscles of the anterior forearm?

A

Palmaris Longus, Pronator Teres, Flexor Carpi Radialis, Flexor Digitorum Superficialis, Flexor Carpi Ulnaris

61
Q

Deep Layer of muscles of anterior forearm

A

Flexor Pollicis Longus, Flexor Digitorum Profundus, Pronator Quadratus

62
Q

Palmaris Longus

A

Function: Hand flexion, tenses palmar aponeurosis

Innervation: Median nerve (C7-C8)

63
Q

Pronator Teres

A

Function: pronation of forearm, elbow flexion
Innervation: median nerve (C6-C7) – passes between two heads of pronator teres

64
Q

Pronator Syndrome:

A

squeezing of median n. in between the pronator teres heads

Treatment: Can go in and remove part of surrounding muscle to relieve n.

65
Q

Flexor Carpi Radialis

A

Function: palmar flexion, radial abduction of hand, flexion and pronation of elbow
Innervation: median nerve (C6-C7)

66
Q

Flexor Digitorum Superficialis

A

Function: flexion of elbow, wrist, and fingers
Innervation: median nerve (C7, C8, T1)

67
Q

Flexor Carpi Ulnaris

A

Function: flexion and adduction of hand
Innervation: ulnar nerve (C7-C8)

68
Q

Flexor Pollicis Longus

A

Function: flexion of terminal phalanx (thumb)
Innervation: median nerve (anterior interosseous branch) (C8-T1)

69
Q

Flexor Digitorum Profundus

A

Function: wrist flexion including midcarpal, metacarpophalangeal, + phalangeal joints
Innervation: median nerve (anterior interosseous branch) laterally, ulnar nerve medially

70
Q

Pronator Quadratus

A

Function: pronation of forearm (together w. pronator teres)
Innervation: median nerve (anterior interosseous branch)

71
Q

What passes thru the carpal tunnel?

A

flexors digitorum superficialis and profundus, median nerve between them, flexor pollicis longus

72
Q

Brachioradialis

A

beer drinking m.
Function: pronation + supination of forearm; in mid-prone position: forearm flexion at elbow joint
Innervation: radial nerve (C5-C7)

73
Q

Extensors Carpi Radialis Longus

A

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
Q

Extensors Carpi Radialis Brevis

A

Function: extension and abduction of hand at wrist joint, weak flexion of elbow
Innervation: deep branch of radial nerve (C7)

75
Q

Elbow Tendinitis:

A

tennis/golfer’s elbow; periosteal irritation or pain on lateral epicondyle

76
Q

What are the superficial muscles of the posterior forearm?

A

Extensor Digitorum
Extensor Digiti Minimi
Extensor Carpi Ulnaris

77
Q

Extensor Digitorum

A

Function: extends 4 medial fingers, strong dorsiflexion of hand at wrist
Innervation: posterior interosseous branch of deep radial nerve (C7-C8)

78
Q

Dorsal digital expansion:

A

intertendinous connections between tendons of extensor digitorum on hand forming: The Dorsal Aponeurosis

79
Q

Extensor Digiti Minimi

A

Function: extension of 5th digit, dorsiflexion of hand
Innervation: posterior interosseous branch of deep radial nerve (C7-C8)

80
Q

Extensor Carpi Ulnaris

A

Function: extension and adduction of hand at wrist
Innervation: posterior interosseous branch of deep radial nerve (C7-C8)

81
Q

Deep muscles of posterior forearm:

A
Supinator
Abductor Pollicis Longus
Extensor Pollicis Brevis
Extensor Pollicis Longus
Extensor Indicis
82
Q

Supinator

A

Function: supinates forearm
Innervation: deep branch of radial nerve (C5-C6)

83
Q

Abductor Pollicis Longus

A

Abductor Pollicis Longus

innervated by posterior interosseous branch of deep radial nerve

84
Q

Extensor Pollicis Brevis

A

Function: extension of proximal phalanx at metacarpophalangeal joint

innervated by posterior interosseous branch of deep radial nerve

85
Q

Extensor Pollicis Longus

A

Function: extends thumb (at metacarpophalangeal and interphalangeal joints) using crest on radius as fulcrum

innervated by posterior interosseous branch of deep radial nerve

86
Q

Extensor Indicis

A

Function: index extension, hand dorsiflexion

innervated by posterior interosseous branch of deep radial nerve

87
Q

Deep muscles of posterior forearm innervation:

A

posterior interosseous branch of deep radial nerve except supinator

88
Q

Extensor Retinaculum Formation & Compartment Contents

A

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
Q

Palmar Aponeurosis composition and attachments?

A

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
Q

Palmaris brevis

A

between medial edge of palmar aponeurosis + skin on hypothenar eminence

Innervation: ulnar n.

91
Q

Dupuytren’s Contracture

A

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
Q

What are the thenar muscles?

A

Abductor Pollicis Brevis
Flexor Pollicis Brevis
Opponens Pollicis
Adductor Pollicis

93
Q

Abductor Pollicis Brevis

A

Function: abduction of thumb
Innervation: median n. (C8-T1)

94
Q

Flexor Pollicis Brevis

A

Function: flexion of thumb
Innervation: superficial head by median nerve, deep head by ulnar nerve

95
Q

Opponens Pollicis

A

Function: thumb opposition
Innervation: median nerve (C8-T1)

96
Q

Adductor Pollicis

A

Function: thumb adduction
Innervation: deep branch of ulnar nerve (C8-T1)

97
Q

All hypothenar muscles innervation:

A

deep branch of ulnar nerve

98
Q

Abductor Digiti Minimi

A

Function: abducts 5th digit

innervated by deep branch of ulnar nerve

99
Q

Flexor Digiti Minimi

A

Function: flexes 5th digit

innervated by deep branch of ulnar nerve

100
Q

Opponens Digiti Minimi

A

Function: opposition of 5th finger to thumb

innervated by deep branch of ulnar nerve

101
Q

Muscles of the metacarpus?

A

Lumbrical Muscles
Palmar Interossei
Dorsal Interossei

102
Q

Lumbrical Muscles

A

Innervation: 2 lateral muscles by median nerve, 2 medial muscles by ulnar nerve

103
Q

Palmar Interossei

A

3 single-headed

Function: adduction of digits and assisting the lumbricals

Innervation: deep branch of ulnar n. and median n

104
Q

Dorsal Interossei

A

4 double headed
Function: Abduction of digits
Innervation: deep branch of ulnar n. and median n

105
Q

Radial N. Injuries: proximal to triceps origin, to radial groove, to forearm?

A

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
Q

Median N. Injuries: Above elbow? At wrist joint?

A

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
Q

Tinel’s sign

A

way to detect irritated nerves

percussion on median n in wrist area leading to heightened paraesthesis in carpal tunnel syndrome

108
Q

Ulnar N Injuries: At elbow? At wrist?

A

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
Q

In brachial plexus syndromes, T1 involvement in injure may lead to:

A

autonomic deficits

110
Q

Horner’s syndrome:

A

drooping of eyelid, constriction of pupil

111
Q
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?
A

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
Q

Lower brachial plexus lesion (C8-T1)

A

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
Q

Describe the blood supply of the upper limb:

A

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
Q

skin inn of deltoid region:

A

axillary nerve laterally, radial nerve posteriorly

115
Q

skin inn of Axillary region

A

interconnections between upper intercostal n. and medial cutaneous brachial n.

Both nerves known as intercostobrachial anastomosis (nerves)

116
Q

skin inn of medial aspect of upper arm

A

medial cutaneous brachial nerve

117
Q

Lateral + Posterior aspect of upper arm skin inn

A

cutaneous branches of radial nerve

118
Q

Medial aspect of forearm skin inn

A

medial cutaneous antebrachial nerve

119
Q

Lateral aspect of forearm skin inn

A

cutaneous branches of musculocutaneous (lateral antebrachial) nerve

This nerve also innervates upper arm by motor component

120
Q

hypothenar and thenar side of palm and fingers

A

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
Q

dorsum of hand and tips of fingers skin inn

A

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
Q

Volkmann’s ischemic contracture

A
  • 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
Q

arterial blood pressure is measured with:

A

sphygmometer

124
Q

Brachial artery occlusion/laceration leads to

A

deep flexor paralysis

125
Q

Lymphangitis:

A

inflammation of lymphatic vessels and channels

126
Q

Contents of the Medial Bicipital Groove:

A

between biceps and intermuscular septa

Median N
Brachial A. and V.
Basilic V.
Medial cutaneous antebrachial N.
Ulnar N. medially
127
Q

Tendons of Snuff box and contents

A
  • abductor pollicis longus: most lateral
  • extensor pollicis brevis: middle
  • extensor pollicis longus: most medial
128
Q

Lymph Nodes of Axillary Region and drainage

A
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
Q

Saturday night palsy/honeymoon palsy

A

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
Q

guyon’s canal? guyon’s canal syndrome?

A

contains: ulnar nerve

also known as handlebar palsy; compression of ulnar nerve due to prolonged pressure

131
Q

tachycardia? brachycardia?

A

tachycardia: increased pulse
bradycardia: decreased pulse

132
Q

Borders of the quadrangular space:

A

teres minor, teres major, humerus, long head of triceps