Anatomy Exam 2 Flashcards
superficial veins of upper limb
basillic- runs medially
cephalic- runs laterally
drain into axillary vein
connected by median cubital
lymphatics of axilla
humeral, pectoral, subscapular, central, apical
arteries of upper limb
subclavian artery arises from brachiocephalic trunk on right and directly from arch of the aorta
what does the subclavian artery become and when
becomes axillary artery at lateral border of 1st rib
first axillary artery branch
superior thoracic artery
second axillary artery branch
thoraco-acromial trunk
lateral thoracic artery
what does the thoraco-acromial trunk branch into
acromial, clavicular, deltoid, and pectoral branches
third axillary artery branch
subscapular artery
anterior humeral circumflex a.
posterior humeral circumflex a.
what does the subscapular artery branch into
thoracodorsal artery and circumflex scapular artery
musculocutaneous nerve
formed from lateral cord
c5-c7 ventral rami contributions
pierces through coracobrachialis m
major nerve of anterior arm
continues as lateral cutaneous nerve
innervates skin of lateral forearm
ulnar nerve
formed from medial cord
C8-T1 ventral rami contributions
located medial to brachial artery in arm
innervates nothing in arm
runs behind medial epicondyle
major nerve of hand
median nerve
Formed from 1/2 lateral cord and 1/2 medial cord
C6-T1 ventral rami contributions
passes medial to arm muscles
lateral to brachial artery proximally
distally crosses medial side of brachial artery
innervates nothing in arm
major nerve of anterior forearm
axillary nerve
formed from posterior cord
C5-C6 ventral rami contributions
circles behind humerus in quadrangular space with posterior circumflex humeral artery
inn. deltoid and teres minor
radial nerve
formed from posterior cord
C5-T1 ventral rami
passes posterior to humerus, travels with profunda brachii artery in radial groove, pair seen in triangular space
gives off cutaneous branches:
inferior lateral cutaneous nerve of arm
posterior cutaneous n of forearm
major nerve of posterior arm and forearm
dorsal scapular n
C5
passes posteriorly to reach and travel along the medial border of scapula
levator scapulae and rhomboids
long thoracic n
C5-C7
passes vertically down neck, through the axillary inlet, and down medial wall of axilla
runs with lateral thoracic artery
lies on superficial aspect of serratus anterior muscle
serratus anterior
suprascapular n
C5-C6
passes laterally through the posterior triangle of neck and through suprascapular notch/foramen to enter the posterior scapular region
supraspinatus
infraspinatus
N to subclavius
C5-C6
passes anteroinferiorly over the subclavian artery and vein
subclavius
lateral pectoral n
C5-C7
branches from lateral cord
pec major
medial pectoral n
C8-T1
branches from medial cord
pec major and minor
upper subscapular n
C5-C6
first branch off posterior
passes posteriorly to directly innervate subscapularis and teres major
thoracodorsal n
C6-C8
second branch posterior cord
runs inferolaterally along posterior axillary wall
close to thoracodorsal artery
from back to humerus
lower subscapular n
C5-C6
third branch off posterior
runs inferolaterally deep to subscapular a
innervates teres major and subscapularis
medial brachial cutaneous n
C8-T1
sensory to medial arm
second branch off medial cord
runs along medial side of axillary and branchial veins
medial antebrachial cutaneous n
C8-T1
sensory to medial forearm
third branch off medial cord
initially runs with ulnar nerve but pierces deep fascia with basilic vein and enters subcutaneous tissue
thoracic outlet syndrome
compression of subclavian artery and vein or brachial plexus
most commonly affects nerves
causes: trauma, anatomical defects, tumor, poor posture, pregnancy, repetitive arm mvmts
injury to upper plexus
C5-C6
result from excessive increase in angle between neck and shoulder
see effects in shoulder
injury to lower plexus
C8-T1
may occur when upper limb suddenly pulled superiorly
see effects in hand
2 compartments of arm muscles
anterior: flexors
posterior: extensors
biceps brachii
Origin: short head- coracoid process of scapula
long head: supraglenoid tubercle of scapula
Insertion: radial tuberosity and fascia of forearm via bicipital aponeurosis
Inn: musculocutaneous n
Action: supinates flexed forearm, flexes forearm when supine, short head resists dislocation
brachialis
Origin: distal half of anterior humerus
Insertion: coronoid process and ulnar tuberosity
Inn: musculocutaneous and radial n
Action: flexes forearm in all positions
coracobrachialis
Origin: coracoid process of scapula
Insertion: middle third of medial surface of humerus
Inn: musculocutaneous n
Action: flexes, adducts, and resists dislocation
triceps brachii
Origin: long head: infraglenoid tubercle of humerus
lateral head: posterior surface of humerus superior to radial groove
medial head: posterior surface of humerus inferior to radial groove
Insertion: olecranon process of ulna and fascia of forearm
Inn: radial n
Action: chief extensor of forearm, long head resists dislocation
anconeus muscle
triceps little helper
inn: radial n
actions: assists triceps in forearm extension, stabilizes elbow joint, may abduct during pronation
what action does C5 test
shoulder abduction
what action does C6 test
elbow flexion
testing biceps tendon
what action does C7 test
elbow extension
testing triceps tendon
the axillary artery becomes what and where
brachial artery at inferior border of teres major
what does the brachial artery branch into
radial and ulnar arteries
what are the branches of the brachial artery
- profunda brachii a
- radial collateral a
- middle collateral a - humeral nutrient a
- superior ulnar collateral a
- inferior ulna collateral a
- radial a
- ulnar artery
trapezius
Origin: nuchal ligament and spinous processes
Insertion: lateral 1/3 of clavicle, acromion, and spine of scapula
Inn: accessory n
Action: elevates, depresses, retracts, rotates glenoid cavity superiorly
latissimus dorsi
Origin: spinous processes, iliac crest, ribs
Insertion: bicipital groove
Inn: thoracodorsal n
Action: adducts, medially rotates, and extends humerus; pulls body toward arms during climbin
levator scapula
Origin: transverse processes of cervical spine
Insertion: superior portion of medial border of scapula
Inn: dorsal scapular n
Action: elevates scapula, rotates glenoid cavity inferiorly by rotating scapula
rhomboids (major and minor)
Origin: minor: nuchal ligament
major: spinous processes of thoracic spine
Insertion: minor: medial border of scapula
major: medial border of scapula
Inn: dorsal scapular n.
Action: retract scapula, rotate glenoid cavity inferiorly, fix scapula to thoracic wall
triangle of auscultation
latissimus dorsi, trapezius, rhomboid major
floor: 6th intercostal
respiratory sounds
lumbar triangle
iliac crest, lat, external oblique
floor: internal oblique
lumbar herniation
serratus posterior superior
action: elevates ribs
serratus posterior inferior
action: depresses ribs
splenius capitus
Origin: spinus processes
Insertion: mastoid process
Inn: dorsal rami of spinal n
Action: rotate head ipsilaterally and laterally flexes neck, extends head and neck
splenius cervicis
Origin: spinous processes of cervical and thoracic spine
Insertion: transverse processes of cervical spine
Inn: dorsal rami of spinal n
Action: rotate head ipsilaterally, laterally flexes neck, extends head and neck
erector spinae (iliocostalis, longissimus, spinalis)
Origin: sacrum, ilium crest
Insertion: ribs
Inn: dorsal rami of spinal n
Action: extends vertebral column and head when back flexed and controls movement via eccentric contraction, laterally flexes vertebral column
semispinalis capitus, semispinalis cervicis, semispinalis thoracis
Origin: transverse processes of cervical and thoracic spine
Insertion: occipital bone
Inn: dorsal rami
Action: extend head, cervical and thoracic regions of vertebral column, rotates contralaterally
multifidus
Origin: PSIS of ilium
Insertion: SP of vertebrae
Inn: dorsal rami
Action: stabilizes vertebrae, involved in lower back pain
rotatores
Origin: TP of vertebrae
Insertion: lamina and TP or spine
Inn: dorsal rami
Action: rotate, stabilize, and extend spine
interspinales
aid in extension and rotation
intertransversarii
aid in lateral flexion, stabilization
levatores costarum
elevates ribs, assists with respiration and lateral flexion
suboccipital triangle
rectus capitus posterior major, rectus capitus posterior minor, obliquus capitus inferior, obliquus capitus superior
contains suboccipital nerve and vertebral a
Actions:
Rectus capitus posterior major and minor: extension and rotation of head
Obliquus capitus superior: extension and lateral flexion
Obliquus capitus inferior: rotation of head
craniovertebral joint
atlanto-occipital
atlanto-axial
joints of articular processes
zygopophysial
joints of vertebral bodies
uncovertebral
intervertebral
intervertebral joints
symphysis joints
contain annulus fibrosus and nucleus pulposus
what causes a herniated nucleus pulposus
portion of nucleus pulposus is pushed through weakened portion of annulus fibrosis
most common L4-L5 and L5-T1, no PLL or ALL
Ligamenta flava
connect adjacent laminae of vertebra
Action: limits flexion
anterior longitudinal ligament
Action: prevents hyperextension
posterior longitudinal ligament
prevents hyperflexion
nuchal ligament
resists flexion
supraspinous ligament
connects tips of spinous processes
Action: limits hyperflexion
interspinous ligament
Connects adjacent spinous processes
Action: limits hyperflexion
what causes whiplash
muscle injury of neck due to sudden hyperextension and possible hyperflexion as head rebounds
possible stretching or tearing of ALL
possible facet jumping (pedicles) or locking of cervical vertebrae due to arch dislocation
what happens with illegal face blocking
hyperextension and likely injure posterior portions of vertebrae
T11/T12 most common non-cervical break; going from an area of mobility to non-mobility
epidural space
contains fat and blood vessels
outermost space
dura mater
most external meninge
fuses with epineurium that surrounds the spinal nerves
subdural space
separates dura mater from arachnoid mater
potential space, very small, sometimes fuses with dura mater
arachnoid mater
deep to dura mater and subdural space
subarachnoid space
between arachnoid mater and pia mater
real space, filled with CSF
pia mater
adheres directly to spinal cord
forms lateral extensions called denticulates that anchor spinal cord to dura mater
what do ventral roots contain
motor axons
what do dorsal roots contain
sensory axons
where do anterior and posterior roots unite to become spinal nerve
in intervertebral foramen
what is the arterial supply of scapula
segmental arteries coming off aorta that pass through intervertebral foramen
how many longitudinal arteries supply spinal cord
3; 1 anterior, 2 posterior
how many veins supply spinal cord
6; 3 anterior, 3 posterior
conus medularis
tapering inferior end of spinal cord
ends between T12-L3 usually L1
termination of spinal cord
cauda equina
bundle of nerve roots running inferior to spinal cord
where stick the needle in and roots move out of way
filum terminale
thin strand of pia mater that helps anchor conus medullaris to coccyx
tethers spinal cord inferiorly
where do you do a lumbar puncture
L4-L5 in subarachnoid space
where do you do an epidural
L4-L5 in epidural space; fat filled to hold analgesic
what is a laminectomy used for and what is a potential after effect of it
used to release pressure in IV discs
could cause bony outgrowth
deltoid
Origin: lateral 1/3 clavicle, acromion, spine of scapula
Insertion: deltoid tuberosity
Inn: axillary nerve
Action: abduction past first 15 degrees
teres major
lats major helper
Origin: posterior surface of inferior angle of scapula
Insertion: medial lip of bicipital groove
Inn: lower subscapular n
Action: adducts and medially rotates arm
supraspinatus
delts super helper
Origin: supraspinous fossa of scapula
Insertion: superior facet of greater tubercle
Inn: suprascapular n
Action: assists delt with abduction- does first 15 degrees
infraspinatus
Origin: infraspinous fossa of scapula
Insertion: middle facet of greater tubercle
Inn: suprascapular n
Action: laterally rotates arm
teres minor
Origin: middle part of lateral border of scapula
Insertion: inferior facet of greater tubercle
Inn: axillary n
Action: laterally rotates arm
subscapularis
Origin: subscapular fossa of scapula
Insertion: lesser tubercle
Inn: upper and lower subscapular n
Action: medially rotates
what causes rotator cuff injuries
repeated abduction and flexion causes wear on tendons as they rub on the acromion and coracoacromial ligament
tendon of supraspinatus is most vulnerable
weakest inferiorly because incomplete inferiorly
what rotator cuff dislocation is most common
anterior humeral dislocation
pec major
Origin: sternocostal head and clavicular head
Insertion: bicipital groove
Inn: lateral and medial pectoralis n
Action: adducts, medially rotates humerus, draws scapula inferiorly and anteriorly
clavicular head flexes while sternocostal head extends humerus from a flexed position
pec minor
Origin: ribs 3-5
Insertion: coracoid process of scapula
Inn: medial pectoral nerve
Action: stabilizes scapular by drawing it inferiorly and anteriorly against thoracic wall
important in respirations
subclavius
Origin: junction of 1st rib and costal cartilage
Insertion: inferior surface of clavicle
Inn: nerve to subclavius
Action: depresses and anchors clavicle
serratus anterior
Origin: lateral part of ribs 1-8
Insertion: medial border of scapula
Inn: long thoracic n
Action: protract, rotate, and hold scapula against thoracic wall
what causes paralysis of serratus anterior
injury to long thoracic nerve
characteristic of someone with an injury to their long thoracic n
winged appearance
scapula moves away from thoracic wall
quadrangular space
teres minor, teres major, triceps brachii long head, shaft of humerus
what does the quadrangular space contain
axillary nerve and posterior circumflex humeral artery
triangular space
teres major, teres minor, triceps brachii long head
what does the triangular space contain
circumflex scapular artery
what is the blood supply of the scapula
arteries interconnecting around scapula forming an anastomosis
allows for blood supply even in the event of a gradual blockage
flow of milk in breast
produced in alveoli
moves to lactiferous ducts
moved to lactiferous sinuses before being expelled out the nipple with the let down reflex
what nerve innervates the breasts
anterior and lateral cutaneous branches of 4th-6th intercostal n
what arteries provide blood to the breasts
lateral thoracic, posterior intercostal, medial mammary branches, internal intercostal
where does most of the breast drain
via pectoral, central, and apical axillary nodes to subclavian lymph trunk
where do medial breasts drain
parasternal nodes
where does the subclavian lymph trunk drain into the venous system
subclavian and internal jugular junction
direction of lymphatic flow in breast
pectoral, humeral, and subscapular nodes drain into central nodes
central node drains into axillary node
axillary node drains into supraclavicular node which drains into right or left venous angle
what are the signs of breast cancer
skin dimpling, nipple retraction and deviation, abnormal contours, edema of skin
what causes herpes zoster
viral disease of spinal ganglia
reactivation of varicella zoster or chickenpox virus
causes sharp burning pain in dermatome, skin becomes red, and possible muscle weakness in same myotome
