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Med School > Anatomy Exam 1 UE > Flashcards

Anatomy Exam 1 UE Flashcards

1
Q

cutaneous innervation of the shoulder

A

supraclavicular nerves

derived from the cervical plexus

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2
Q

cutaneous innervation of the UE

A

derived from the brachial plexus:

  • arm: lateral, medial, and posterior cut. nerves of the arm
  • forearm: lateral, medial, posterior cut, nerves of the forearm
  • hand: cut. branches of median, ulnar, and radial nerves
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3
Q

occlusion of an end artery

A

interrupts blood supply to the structures it supplies leading to acute ischemia (infarction) and loss of function

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4
Q

potential collateral pathways

A
  • pre-existing, non-functional anastomosis
  • require time to open adequately
  • usually insufficient to compensate for sudden occlusion or ligation
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5
Q

chronic ischemia

A

gradual occlusion of the main vessel

-usually associated with activation of the collateral circulation

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6
Q

Subcutaneous and subfascial Bursitis

A

present as painless or painful swellings

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7
Q

subtendenous bursitis and tenosynovitis

A

presents as pain during muscle movement

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8
Q

Deltoid attachment

A

origin:

  • anterior deltoid: lateral one-third of the clavicle
  • lateral deltoid: lateral border of the acromion
  • posterior: lower lip of crest of spine of scapula
    insertion: deltoid tuberosity of humerus
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9
Q

deltoid innervation

A

axillary nerve (C5, C6)

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10
Q

lateral deltoid action

A

powerful abductors of the shoulder joint 15-90 degrees (muscle contracts from beginning to about 90)

  • deltoid become fully effective as an abductor after the initial 15
  • during first 15 degrees it is assisted by the supraspinatus
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11
Q

actions of anterior and posterior deltoid

A

anterior: flexors and medial rotators of the arm
posterior: extensors and lateral rotators of the arm
acting simultaneously they adduct the arm

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12
Q

Rotator cuff muscles (musculotendinous cuff of shoulder)

A
  • SITS
  • Supraspinatus, infraspinatus, teres minor, subscapularis
  • fixators muscles: important in strengthening the capsule of the glenohumeral joint (except inferiorly)
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13
Q

supraspinatus attachment

A

origin: medial 2/3 of the supraspinus fossa
insertion: upper impression on the greater tubercle of the humerus

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14
Q

supraspinatus innervation

A

suprascapular nerve

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15
Q

infraspinatus attachment

A

origin: medial 2/3 of the infraspinus fossa
insertion: middle impression on the greater tubercle of humerus

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16
Q

infraspinatus innervation

A

suprascapular nerve

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17
Q

teres major attachment

A

origin: upper 2/3 of lateral border of scapula
insertion: lowest impression of the greater tubercle of humerus

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18
Q

teres major innervation

A

axillary nerve

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19
Q

subscapularis attachment

A

origin: medial 2/3 of subscapular fossa
insertion: lesser tubercle of humerus

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20
Q

subscapularis innervation

A

upper and lower subscapular nerves

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21
Q

supraspinatus action

A

assists deltoid in the initiation of abduction 0-15 degrees

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22
Q

infraspinatus action

A
  • a powerful lateral rotator of the arm

- when arm at 90 degrees abduction, the infraspinatus pulls the arm posteriorly (horizontal extension)

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23
Q

teres minor action

A

assists in lateral rotation and adduction

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24
Q

subscapularis

A

medial rotator and adductor

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25
Q

supraspinatus canal

A

fibro-osseous (rigid canal
boundaries:
-posteriorly by spine of scapula and the acromion
-anteriorly by the coracoid process
-superiorly by coraco-acromial ligament (continuous with the acromion–> creates coraco-acromial arch)

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26
Q

impingement syndrome

A

supraspinatus tendon thickened by inflammatory or degenerative process leads to difficultly in muscle sliding through the canal

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27
Q

rotator cuff syndrome (tendonitis/impingement)

A
  • very common shoulder injury
  • direct application of the head of the humerus against the coraco-acromial arch (compressing the inflamed rotator cuff) is responsible for pain
  • Causes: repetitive use of the UE above the horizontal (sports injury) (aka pitcher rotator cuff)
  • direct trauma may tear or rupture one or more of the tendons of the SITS muscles (supraspinatus most common)
  • supraspinatus tendon ruptures = loss of initiation of abduction (0-15)
28
Q

subacromial (subdeltoid) bursa

A
  • largest bursa in body
  • deep to coraco-acromial arch and deltoid muscle
  • deep to the bursa are supraspinatus, its tendon, and the greater tubercle of the humerus
  • facilitates movement of supraspinatus tendon under the coraco-acromial arch
  • also facilitates movement of the deltoid over the joint capsule and greater tubercle of humerus
29
Q

bursitis

A

inflammation of bursa

-most often caused by repetitive minor injuries (sports), age plays a role (>40)

30
Q

calcific supraspinatus tendinitis and subacromial bursitis

A
  • calcium deposition into supraspinatus tendon irritates overlying subacromial bursa, causing subacromial bursitis
  • inflammation and calcification of subacromial bursa results in pain, tenderness, and limited movement of glenohumeral joint. causes increased local pressure leading to severe pain during abduction
  • adducted arm = pain free, pain occurring during 60-120 degrees abduction = subacromial painful arc syndrome. during the arc, supraspinatus tendon is in contact with acromion which is the cause of pain
31
Q

subscapular (SSB) and subcoracoid (SCB) bursae

A
  • located between the joint capsule and tendon of subscapularis, and the coracoid process
  • SSB and SCB are merged into a unique wide bursa in 30% of individuals
  • SSB usually continuous with synovial cavity of glenohumeral joint (aka subscapular recess (SSR)), and it is described as an outpouching of the glenohumeral joint capsule
  • subscapular bursitis is a common cause of shoulder pain
32
Q

teres major attachment

A

origin: oval area on dorsal surface of the inferior angle of scapula
insertion: medial lip of the intertubercular sulcus of humerus
- flat tendon of lat. dorsi winds around its lower border and comes to lie anterior to it

33
Q

teres major innervation

A

subscapular nerve (C5,C6)

34
Q

teres major action

A

adductor and medial rotator of the arm

35
Q

quadrangular space

A

boundaries:
-superior: teres minor behind and subscapularis in front (space is roofed by the capsule of shoulder joint)
-inferior: teres major
-medial: long head of triceps
-lateral: surgical neck of the humerus
contents:
-axillary nerve, posterior circumflex humeral artery

36
Q

triangular space

A 
boundaries:
-superomedial: teres minor
-inferior: teres major
-lateral: long head of triceps
contents:
-circumflex scapular artery
37
Q

triangular interval

A 
boundaries:
-superior: teres major
-medial: long head of triceps
-shaft of humerus
contents:
-radial nerve and profunda brachii artery
38
Q

axillary nerve (C5, C6)

A

-smaller of the 2 terminal branches of the posterior cord of the brachial plexus
-runs downward and laterally to lie on the subscapularis
-leaves axilla by winding around lower border of subscapularis and exits by passing through the quadrangular space
-axillary nerve and posterior circumflex humeral artery pass laterally deep to deltoid, and directly on the posterior surface of the surgical neck of humerus-
branches:
- muscular: deltoid and teres minor
-cutaneous: superior lateral cutaneous nerve of the arm

39
Q

axillary nerve injury

A
  • usually injured during fracture of the surgical neck of the humerus
  • also injured during dislocation of the glenohumeral joint, and by compression from the incorrect use of crutches
  • inability to abduct the arm (15-90)
  • loss of sensation may occur over lateral aspect of the proximal part of the arm
  • deltoid atrophy gives the shoulder a flattened appearance and produces a slight hollow inferior to the acromion
40
Q

subscapular nerve (C4, C5, C6)

A
  • arises from superior trunk of brachial plexus
  • passes posterolateral through suprascapular foramen to reach the supraspinous fossa, the descends through the greater scapular notch to reach the infrascapular fossa
  • accompanied by suprascapular artery (however artery enters supraspinous fossa by passing superior to transverse scapular ligament
  • innervates: supraspinatus and infraspinatus (no cut. branch)
41
Q

suprascapular nerve palsy

A
  • relatively uncommon
  • suprascapular nerve entrapment or injury is prime cause of suprascapular neuropathy
    • injury to suprascapular notch affects both supra and infraspinatus muscles
    • injury to spinoglenoid notch is more common and only affects infraspinatus
  • mechanism of injury
    • traction (repetitive overhead motions (sports) or direct trauma)
    • compressive (cyst)
  • weakness or atrophy of supra and/or infraspinatus
  • supraspinatus involvement = painless weakness of initiation of abduction
  • infraspinatus involvement = weakness of lateral rotation of shoulder (paralysis of infra = position of arm being medially rotated due to loss of lateral rotation)
42
Q

anastomoses around scapula

A
  • occurs in 3 fossae of scapular
  • between branches of the 1st part of subclavian artery and branches of 3rd part of axillary artery
  • formed by:
    • suprascapular artery, branch of thyrocervical trunk (subclavian artery)
    • dorsal scapular artery, branch of transverse cervical artery, branch of thyrocervical trunk (subclavian artery)
    • circumflex scapular artery, branch of subscapular artery which arises from 3rd part of axillary artery
43
Q

obstruction of proximal parts (1st and 2nd parts) of axillary artery

A

circumflex scapular/subscapular artery provides collateral circulation to upper limb through its anastomoses with branches of the subclavian artery

44
Q

deltopectoral groove

A
  • between deltoid and pectoralis major
  • contains cephalic vein
  • superiorly diverge to form clavipectoral triangle (can feel coracoid process)
  • this groove is an internervous plane commonly used in the surgical approach to the shoulder joint
45
Q

clavipectoral fascia

A
  • deep to pectoralis major
  • upper part encloses subclavius, inferiorly encloses pect. minor and becomes suspensory ligament of the axilla
  • between clavicle and pect. minor it forms a well-developed band called costocoracoid ligament
46
Q

4 structures that pierce clavipectoral fascia

A

traveling inwards:
-cephalic vein
-lymphatics from infraclavicular nodes to apical axillary nodes
traveling outwards:
-lateral pectoral nerve
-thoracoacromial artery or its branches (pectoral, acromial, deltoid, and clavicular)

47
Q

pectoralis major attachment

A

origin: (2 heads)
-clavicular head arises medial half of clavicle
-sternocostal head arises from anterior surface of manubrium and body of sternum and adjacent costal cartilages (1-7)
insertion: by a bilaminar tendon
-anterior lamina is shorter and receives the clavicular and manubrial fibers
-posterior lamina is longer and receives the sternocostal fibers
the 2 laminae (U-shaped) attach to lateral lip of intertubercular sulcus

48
Q

pectoralis major innervation

A

meidal and lateral pectoral nerves

49
Q

pectoralis major action

A
  • acting as a whole, the muscle adducts and medially rotates the shoulder joint (arm)
  • clavicular head flexes the arm
  • sternocostal head extends the flexed arm
50
Q

pectoralis minor attachment

A

origin: 3,4,5 ribs, and the deep fascia that covers the intervening intercostal spaces
insertion: medial border and upper surface of the coracoid process

51
Q

pectoralis minor innervation

A

medial pectoral nerve

52
Q

pectoralis minor action

A
  • depresses the tip of the shoulder

- assists serratus anterior muscle in drawing the scapular forward (protraction)

53
Q

subclavius attachment

A

origin: 1st rib at the costochondral junction
insertion: groove on inferior surface of the middle third of clavicle

54
Q

subclavius innervation

A

nerve to subclavius from upper trunk of brachial plexus

55
Q

subclavius action

A

pulls clavicle medially to stabilize sternoclavicular joint during movements of the shoulder joint

56
Q

serratus anterior (boxer’s muscle) attachment

A

origin: by 8 digitations from the upper 8 ribs and from the fascia covering the intervening intercostal spaces
insertion: the muscle forms a flattened sheet, which passes posteriorly around thoracic wall to insert on the costal surface of the medial border of the scapula

57
Q

serratus anterior innervation

A

long thoracic nerve derived from roots of brachial plexus

58
Q

serratus anterior action

A
  • pulls scapular forward around the chest wall to protract upper limb (pushing and punching movements)
  • fibers inserted into inferior angle of the scapular contract to the inferior angle and rotate the scapula so the glenoid cavity is turned upward
  • tonic contraction of the muscle keeps the costal surface of scapula closely opposed to the thoracic wall
59
Q

paralysis of serratus anterior

A
  • long thoracic nerve courses on the superficial aspect of serratus anterior making it vulnerable to injury (knife fight, mastectomy, and axillary lymph node clearance)
  • medial border and inferior angle of the scapula are unduly prominent (winged scapula)
  • unable to do pushing action
  • may not be able to abduct the arm above the horizontal position
  • attempt to do these movements make wing more prominent
60
Q

suspensor ligament of cooper

A

connects dermis of the skin to the ducts of the breast and to the deep fascia. helps maintain protuberance of the young breast. well developed in superior part of breast. atrophy of the suspensor ligament causes pendulous breast in old age

61
Q

dimpling of the overlying skin of the breast

A

when the suspensory ligament of cooper is contracted by fibrosis with certain carcinomas of the breast

62
Q

peau d’orange sign

A

pitting of the edematous skin that results from malignant involvement of the dermal lymphatics (looks like orange peel, caused by lymphatics)

63
Q

blood supply of mammary gland

A

medial mammary branches of the internal thoracic artery (branch of subclavian)
lateral mammary branches from lateral thoracic artery (branch of the axillary artery)
venous drainage is mainly by deep vein that run with deep arteries to internal thoracic and axillary veins

64
Q

sensory innervation of the breast

A

anterior and lateral cutaneous branches of 2nd to 6th intercostal nerves
nipple innervated by 4th or 5th intercostal nerve

65
Q

lymphatics of the breast

A

75% of drainage passes to the axillary lymph nodes, mainly the anterior nodes (pectoral group)

  • lymphatics from medial part drain into parasternal lymph nodes along internal thoracic vessels
  • few lymphatics follow intercostal vessels and drain into posterior intercostal nodes
  • lymph from inferior breast may pass deeply to abdominal lymph nodes
  • superficial lymphatics have connections with those of the opposite breast
66
Q

breast cancer

A

terminal duct is the most common site of origin of malignant breast tumors due to lots of cell growth normally

Med School (5 decks)

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