Anatomy: Chapter 6 Flashcards
Clavicle physical description:
convex anteriorly for it’s medial 2/3 and then concaves for the lateral 3rd part
Acromioclavicular joint
acromial end of clavicle + acromion process of scapula; permits sliding/gliding movements
Sternoclavicular joint
sternal end of clavicle + sternum; Articular disc decreases incongruity between saddle shaped articular surface
Ossification of clavicle:
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)
Important ligaments of the clavicle
Trapezoid, conoid, superior transverse scapular, costoclavicular, interclavicular
Articulations of the humerus:
capitulum articulates w. radius
trochlea articulates w. ulna at the trochlear notch
What accomodates space for where elbow is bent?
radial fossa and coronoid fossa: anterior, distal end
What happens to the olecranon process when elbow is extended?
Olecranon process of ulna fits into bigger size olecranon fossa; posterior, distal end
Fracture of the surgical neck of humerus
axillary n injury
fracture to middle of shaft of humerus
radial n injury: wrist drop
fracture to distal end of humerus
median n injury
fracture to medial epicondyle of humerus
ulnar n injury
Other possible on humerus?
Traumatic separation of proximal epiphysis under 18-20 years; also in younger children since capsule is stronger
Dislocation of shoulder joint
Shoulder joint supported by:
Coracohumeral ligament (superiorly) 3 weak glenohumeral l. (super., mid., infer.) Coracoacromial l. – restricts movement
Compound Joint of the Elbow:
humeroulnar, humeroradial, proximal radioulna
Ligaments that support the elbow:
- Medial/ulnar l. and lateral/radial l. : restrict movement
- Middle + distal radiocarpal joints:
assist in flexion/extension of elbow,
supination/pronation of forearm
What’s between the ulna and radius?
Interosseous membrane
What happens in an Ulnar collateral l. injury in a sprain?
abnormal abduction of forearm
What happens in an radial collateral l. injury in a sprain?
abnormal adduction of forearm
Colle’s Fracture and associated complications
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
Pulled elbow:
dislocation of radius; generally affects children under 5
can happen by pulling kid too hard by hand/wrist
Carpal Bone Fracture:
- 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)
Cause of carpal bone fracture:
injuries of moderately high energy; possible disability if not recognized early
How is the carpal groove formed?
formed by hamulus: hook to hamate
concave anteriorly
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
How is carpal tunnel formed?
flexor retinaculum covers carpal groove
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
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
Wrist joint movement:
Radial deviation (abduction); Ulnar deviation (adduction); flexion and dorsiflexion (extension); circumduction
Wrist joint is reinforced by what ligaments:
Ulnar and radial collateral l.
Palmar and dorsal radiocarpal l.
Palmar ulnocarpal l. + others
Saddle joint? movement?
the 1st carpometacarpal joint: abduction/ adduction, opposition/reposition, circumduction
Collateral ligament restricts movement of what?
Metacarpophalengeal Joints
Interphalangeal joints: movement? supported by?
flexion/extension of digits; supported by collateral and palmer l.
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
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)
Supraspinatus
Function: abductor of arm, part of rotator cuff muscle group
Innervation: suprascapular nerve (C4-C6)
Infraspinatus
Function: lateral rotator of arm, part of rotator cuff muscle group
Innervation: suprascapular nerve (C4-C6)
Teres Minor
Function: lateral rotator of arm, part of rotator cuff muscle group
Innervation: axillary nerve (C5-C6)
Teres Major
Function: adduction, medial rotation of arm
Innervation: lower subscapular nerve (C6-C7)
Latissimus Dorsi
Function: medial rotation, extension and adduction of arm (acts on humerus); coughing m.
Innervation: thoracodorsal nerve (C6-C8)
Subscapularis
Function: aids in adduction of arm, medial rotation, part of rotator cuff muscles
Innervation: subscapular nerves (C5-C7)
What happens if your subscapularis is paralyzed?
maximal lateral rotation of arm
Rotator Cuff Muscles:
Supraspinatus, Infraspinatus, Teres Minor, Subscapularis
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
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)
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
Coracobrachialis
Function: aids in flexion, adduction of arm
Innervation: musculocutaneous nerve (C5-C7) – origin: lateral cord of brachial plexus
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
Possible long thoracic nerve injuries?
can be injured during surgical removal of lymph nodes
Winged scapula:
Winged Scapula: lifting arm beyond 90° not possible; if arm elevation is normal with winged scapula, it’s a rhomboid m injury.
Subclavius
1st rib
Function: pulls clavicle towards the sternum
Innervation: nerve to the Subclavius (C5-C6)
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