Anatomy - Post ICA Flashcards
What is the innervation and action of the pectoralis major?
Innervation - Medial and Lateral pectoral nerves.
Action - Flexion at shoulder, adduction and medial rotation of shoulder.
What is the innervation and action of the pectoralis minor?
Innervation - Medial and lateral pectoral nerves.
Action - Pulls scapula forwards and downwards, elevates ribs during respiration, and stabilizes scapula.
Where does the clavipectoral fascia extend from?
From clavicle to pectoralis minor.
What does the clavipectoral fascia continues as?
Continues below as suspensory ligament of axilla.
What are the structures that pierce the clavipectoral fascia?
Cephalic vein.
Lateral pectoral nerve.
Thoraco-acromial artery.
From where does the cephalic vein form?
From lateral end of the dorsal venous arch.
Where does the cephalic vein lie?
Deltopectoral groove.
Where does the cephalic vein terminate?
Pierces clavipectoral fascia and opens into axillary vein.
From where does the basilic vein form?
Begins at the medial end dorsal venous arch.
Where does the basilic vein lie?
Upwards along medial border of forearm, pierces deep fascia at middle of arm.
Where does the basilic vein terminate?
With vena comitantes accompanying brachial artery; forms axillary vien.
Where can the median cubital vein be found?
It is overlying the cubital fossa.
What does the cubital vein connect?
The cubital vein connects the cephalic and basilic veins.
Where would a venipuncture happen?
The medial cubital vein.
Which vein would be used for a peripherally inserted central catheter?
Basilic vain.
What is specified as the shoulder girdle?
Connection of upper limb to axial skeleton. Has four joint; sternoclavicular joint, glenohumeral joint, acromioclavicular joint, scapulothoracic joint.
What type of joint is the sternoclavicular joint?
Saddle joint, but acts as a ball and socket joint.
What are the articulating surfaces of the sternoclavicular joint?
Sternal end of clavicle + Manubrium + 1st costal cartilage.
What are the static stabilizers of the sternoclavicular joint?
Joint capsule (with articular cartilage), anterior and posterior sternoclavicular, infraclavicular, and costoclavicular ligaments.
What is the neurovascular supply sternoclavicular joint?
Medial supraclavicular nerve + Nerve to subclavius.
Internal thoracic + suprascapular arteries.
What are the actions of the sternoclavicular joint?
Elevation
Rotation.
Depression.
Retraction.
Protraction.
What is the clinical relevance of the sternoclavicular joint?
Uncommon.
Anterior dislocation is most common.
What type of joint is the acromioclavicular joint?
Plane joint.
What are the articular surfaces of the acromioclavicular joint?
Acromial end of clavicle + anterior aspect of acromion.
What are the supporting structures of the acromioclavicular joint?
Trapezius, joint capsule, acromioclavicular and coracoclavicular ligaments.
What is the neurovascular supply of the acromioclavicular joint?
Lateral pectoral, axillary, and lateral supraclavicular nerves.
Suprascapular and thoracoacromial arteries.
What is the cause of osteoarthritis of acromioclavicular joint?
Degeneration of disc.
What are the actions of acromioclavicular joint?
Elevation.
Depression.
Allows movement to occur between clavicle and scapula.
What is the clinical relevance of acromioclavicular joint?
Caused by acute shoulder trauma - contact sports and FOOSH. ‘Piano Key sign’.
What type of joint is the glenohumeral joint?
Weak ball and socket joint.
What are the articulating surfaces of the glenohumeral joint?
Concave surface of glenoid fossa + Convexity of humeral head.
What stabilized the glenohumeral joint?
Rotator cuff muscles.
What are the rotator cuff muscles?
Suprapinatous.
Infraspinatous.
Teres minor.
Subscapularis.
What is the neurovascular supply of the glenohumeral joint?
Suprascapular, axillary + lateral pectoral nerves.
Anterior and posterior circumflex humeral + suprascapular arteries.
What injury can happen to the glenohumeral joint?
SLAP - Superior Labral Anterior Posterior lesion/tear.
What is a spinoglenoid ganglion cyst?
Pockets of fluid form/accumulate at spinoglenoid notch of scapula due to inflammation.
What is the innervation and action of subclavius?
Nerve to subclavius, pulls top of scapula down.
Where would the triangle of auscultation be?
Between trapezius, lattismus dorsi, and inferior angle of scapula.
What is the innervation and action of trapezius?
Accessory nerve - 11th cranial nerve.
Elevates scapula, Middle fibres retracts scapula, and lower fibres depress scapula.
What is the innervation and action of deltoid?
Axillary nerve.
Abduction from 15 to 90 degrees.
What is the innervation and action of levator scapulae?
Dorsal scapular nerve.
Elevates scapula.
What is the innervation and action of the rhamboid major and minor?
Dorsal scapular nerve.
Elevates and retracts the scapula.
What is the clinical significance of the deltoid muscle?
Triangle with fingers - Site of intramuscular junction. Close to radial artery.
What is medial scapular winging?
Weakness of serratus anterior - dysfunction of long thoracic nerve.
What is lateral scapular winging?
Weakness of trapezius.
Dysfunction of accessory nerve.
What is the innervation and action of supraspinatus?
Suprascapular nerve.
Abduction from 0 - 15 degree.
What is the innervation and action of infraspinatus?
Suprascapular nerve.
Lateral rotation.
What is the innervation and action of teres minor?
Axillary nerve.
Lateral rotation.
What is the innervation and action of teres major?
Inferior subscapular nerve.
Medial rotation.
What is the innervation and action of long head of triceps brachii?
Radial nerve.
Extension of forarm.
Which of the rotator cuff muscles is more prone to impingement?
Supraspinatus.
Which of the rotator cuff muscles is more prone to rupture?
Subscapularis.
What are the actions of the glenohumeral joint?
Extension.
Flexion.
Adduction.
Abduction.
Medial rotation.
Lateral rotation.
Circumduction.
What are the borders of the quadrangular space?
Superiorly - Teres minor.
Inferiorly - Teres major
Medially - Long head of triceps.
Lateraly - Humerus.
What are the structures in the quadrangular space?
Axillary nerve.
Posterior circumflex humeral artery.
What are the contents of the triangular space?
Radial nerve.
Profunda brachii vessels.
What is the clinical relevance of the triangular space?
Entrapment of radial nerve.
What is the subacromial space?
Contains bursa, tendons (biceps + supraspinatus), ligaments.
What is the cause of bursitis?
Rotator cuff disease/tendinopathy.
What is the innervation and action of serratus anterior?
Long thoracic nerve.
Rotation of scapula, helps in elevation of scapula, allows arm to be raised above 90 degrees.
What is the innervation and action of latissimus dorsii?
Thoraco-dorsal nerve.
Adduction and Extension.
What layman’s term if for the axilla?
Armpit.
What are the borders of the axilla?
Anterior, posterior, medial and lateral.
What makes up the anterior wall of axilla?
Pectoralis major.
Pectoralis minor.
What makes up the posterior wall of axilla?
Latissmus dorsii.
Subscapularis.
Teres major.
What makes up the medial wall of the axilla?
Upper 4-5 ribs and intervening intercostal spaces.
Serratus anterior.
What makes up the lateral wall of axilla?
Very narrow.
Anterior and posterior walls meet.
What is the apex of axilla called?
Cervico-axillary canal.
What are the boundaries of the apex of axilla?
Clavicle - Anteriorly.
Outer border of 1st rib - Medially.
Upper border of scapula - Posteriorly.
What structures pass through the apex of axilla?
Axillary vessels.
Chords of brachial plexus.
Lymph trunks from apical axillary lymph nodes.
What makes up the floor of the axilla?
Formed by axillary fascia.
What are the major contents of the axilla?
Axillary artery, vein, lymph nodes, and axillary tail of spence.
Chords of brachial plexus and its branches; long thoracic nerve and intercostobrachial nerve.
What is the extent of the axillary artery?
Outer border of 1st rib to lower border of teres major.
What are the branches of the axillary artery?
1st part –> Superior thoracic artery.
2nd part –> Lateral thoracic and thoraco-acromial arteries.
3rd part –> Anterior and posterior circumflex humeral and subscapular arteries.
What does the axillary artery continue as?
Brachial artery.
Which regions does the axillary artery supply?
Lateral thoracic wall.
Scapular region.
Lateral portion of breast.
Proximal humerus including shoulder joint.
How does the axillary vein form?
Basilic vein and vena comitantes accompanying brachial artery join to form axillary vein.
What does the axillary vein continue as?
Subclavian vein.
What does the intercostobrachial nerve supply?
Supplies skin on medial aspect of arm and chest wall.
What can be injured during an axillary dissection?
Intercostobrachial nerve - Paraesthesia/anaesthesia over skin of medial aspect of arm.
Which roots form the long thoracic nerve?
C5,6,7.
What does the long thoracic nerve innervate?
Serratus anterior.
What happens when there is injury to the long thoracic nerve?
Winging of scapula.
What is the drainage area of the axillary lymph nodes?
Upper limb
Above level of umbilicus.
Most of mammary gland.
What are the axillary lymph nodes arranged by?
Anterior or pectoral group.
Posterior or subscapular group.
Lateral axillary LN.
Central group.
Apical group.
What is the axillary tail of spence?
Projection of mammary tissue in the upper outer quadrant into axilla.
Where does the carcinoma of breast spread to?
Axillary LN.
Which roots form the brachial plexus?
Anterior ramus - C5,6,7,8, and T1.
What do the nerves of the brachial plexus pass between?
Anterior and medial scalene muscles.
The superior trunk of the brachial plexus is a combination of which roots?
C5,6.
The middle trunk of the brachial plexus is a combination of which roots?
C7.
The inferior trunk of the brachial plexus is a combination of which roots?
C8 and T1.
What is the lateral cord of the brachial plexus formed by?
Anterior division of the superior trunk.
Anterior division of the middle trunk.
What is the posterior cord of the brachial plexus formed by?
Posterior division of the superior trunk.
Posterior division of the middle trunk.
Posterior division of the inferior trunk.
What is the medial cord of the brachial plexus formed by?
Anterior division of the inferior trunk.
From which roots does the musculocutaneous nerve come from?
C5,6,7.
What does the musculocutaneous nerve supply?
Brachialis, biceps brachii, and coracobrachialis.
What does the musculocutaneous nerve pierce?
The coracobrachialis muscle.
What is the sensory innervation of the musculocutaneous nerve?
Sensation on the lateral forearm.
From which roots does the axillary nerve come from?
C5,6.
What does the axillary nerve supply?
Innervates teres minor and deltoid.
What is the sensory innervation of the axillary nerve?
Superior lateral sensation of arm.
From which roots does the median nerve come from?
C6 - T1.
What does the median nerve innervate?
Pronator teres, flexor carpi radialis, palmaris longus, flexor digitorum superficialis.
What median nerve gives rise to which nerve?
Anterior interosseous nerve.
What does the anterior interosseous nerve (branch of median nerve) supply?
flexor pollicis longus, pronator quadratus, and the lateral half of the flexor digitorum profundus.
What does the recurrent branch of median nerve innervate?
Innervates thenar muscles.
From which roots does the radial nerve come from?
C5 - T1.
What does does the radial nerve innervate?
Innervates the triceps brachii, and posterior compartment of forearm.
From which roots does the ulnar nerve come from?
C8 and T1.
What does the ulnar nerve innervate?
Flexor carpi ulnaris, and medial half of flexor digitorum profundus.
What is erb’s palsy?
Stretching injury, C5-C6 root injury - Waiter’s tip postition.
What muscles are affected during erb’s palsy injury?
Supraspinatus, infraspinatus, subclavius, biceps brachii, brachialis, coracobrachialis, deltoid and teres minor.
What motor functions are affected during erb’s palsy injury?
Abduction at shoulder, lateral rotation of arm, supination of forearm, and flexion at shoulder.
What is Klumpke’s palsy?
C8-T1 root injury - Clawed hand
What muscles are affected during Klumpke’s palsy?
The intrinsic hand muscles.
What are the minor branched of the brachial plexus?
Dorsal scapular, Nerve to subclavius, and long thoracic.
What happens when there is a radial nerve injury?
Partial paralysis of triceps. Wrist drop.
What happens when there is ulnar nerve injury at wrist?
Paralysis of intrinsic muscles of hand (except for radial lumbricals).
Wasting of interossei.
Claw hand deformity.
What happens when there is ulnar nerve injury at the elbow?
Paralysis of flexi carpi ulnaris and ulnar two flexi digitorum.
Claw hand.
Wasting of interossei.
What happens when there is injury to median nerve at the elbow?
Loss of pronation, paralysis of wrist and fingers (except flexor carpi ulnaris and ulnar two flexor digitorum).
Which structure does not pass through the carpal tunnel?
Radial artery.
Which structure does not pass through the cubital fossa?
Ulnar nerve.
Where does the ulnar nerve lie?
Posterior to the medial epicondyle of humerus.
What type of joint is the interosseous membrane?
Fibrous - Amphiarthrotic syndesmosis.
What is monteggia’s fracture?
Fracture of the proximal third of ulna and dislocation of head of radius at elbow.
What is galaezzi’s fracture?
Fracture of distal third of radius and partial dislocation of head of ulna at wrist joint.
What are the superficial muscles of the anterior forearm?
Pronator teres.
Flexor carpi radialis.
Palmaris longus.
Flexor carpi ulnaris.
What is the action and innervation of the pronator teres?
Pronation.
Median nerve.
What is the action and innervation of the flexor carpi radialis?
Flexion and abduction at wrist.
Median nerve.
What is the action and innervation of the palmaris longus?
Flexion at wrist.
Median nerve.
What is the action and innervation of the flexor carpi ulnaris?
Flexes and adducts wrist.
Ulnar nerve.
What passes deep to the flexor digitorum superficialis?
Median nerve and ulnar artery.
What does the flexor digitorum superficialis form?
Four tendons which pass through the carpal tunnel and into the four fingers.
What is the action and innervation of the flexor digitorum superficialis?
Flexes wrist, flexes metacarpophalangeal joints and proximal interphalangeal joints.
What is the action and innervation of pronator quadratus?
Pronation.
Anterior interosseous nerve (branch of median).
What is the action and innervation of the Flexor pollicis longus?
Flexes interphalangeal joint of thumb and metacarpophalangeal joint of thumb.
Anterior interosseous nerve.
What is the action and innervation of the flexor digitorum profundus?
Flexes distal interphalangeal joint of lateral four fingers.
Lateral half by anterior interosseous nerve and medial half by ulnar nerve.
What are the borders of the cubital fossa?
Superiorly - imaginary line between lateral and medial epicondyles.
Medially - Pronator teres.
Laterally - Brachiordialis.
What are the contents of the cubital fossa?
Radial nerve.
Biceps tendon.
Brachial artery.
Median nerve.
What does the brachial artery divide into?
Radial and ulnar arteries.
What is pronator syndrome?
Causes underlying metabolic disorder. Median nerve is compressed between two muscle heads.
What is cubital tunnel syndrome?
Ulnar nerve entrapment.
What is the superficial group of the posterior compartment of forearm?
Anconeus.
Brachioradialis.
Extensor carpi radialis longus and brevis.
Extensor digitorum.
Extensor digiti minimi.
Extensor carpi ulnaris.
What is the deep group of posterior compartment of forearm?
Supinator..
Abductors pollicis longus and brevis.
Extensor indicis.
What is the innervation of the posterior compartment of forearm?
Radial/posterior interosseous nerve.
What is the action of brachioradialis?
Flexion at the elbow.
What is the action of the extensor carpi radialis longus and brevis?
Extends and abducts the wrist.
What is the action of extensor digitorum?
Extends medial four digits.
What is the action of extensor digiti minimi?
Extends the pinki.
What is the action of extensor carpi ulnaris?
Extend and adduct the wrist.
What is the action of the anconeus?
Extend the wrist.
What is the action of the supinator muscle?
Supinates forearm.
What is the action of the abductor pollicis longus?
Abducts the thumb.
What is the action of extensor pollicis brevis?
Extend at mcp and cm of thumb.
What is the action of extensor pollicis longus?
Extend at cm, mcp and ip.
What is the action of the extensor indicis?
Extends the index finger.
What does the dorsal tubercle act as?
It acts as a pulley and separates the extensor carpi radialis brevis and longus tendons.
What are symptoms of a scaphoid fracture?
Falling on outstretched hand.
Wrist swelling, ecchymosis.
What type of joint is the wrist?
Condyloid.
What type of joint is the distal radio-ulnar?
Pivot.
What is ulnar canal?
From proximal aspect of pisiform to the origin of hypothenar muscles at hook of hamate.
What is ulnar canal syndrome?
Compression of ulnar nerve in canal, formation of ganglion cysts.
What is carpal tunnel?
Formed anteriorly at wrist by a deep arch formed by the carpal bones and the floor retinaculum..
What is carpal tunnel syndrome?
Compression of median nerve.
Where would the site of cannulation be at the wrist?
Cephalic vein - snuff box.
If there was swelling in the dorsum of hand, what should we look at?
Look at palm, because the infection might be in palm.
What would form the palmar aponeurosis?
Palmaris longus.
What is aponeurosis attached by?
Aponeurosis is attached to skin by fibrous tissue that breaks up subcutaneous fat into loculi.
What are the muscles of the thenar eminence?
Abductor pollicis brevis.
Flexor pollicis brevis.
Opponens pollicis.
What is the innervation of the thenar eminence?
Recurrent branch of median nerve.
What is the innervation of the adductor pollicis?
Ulnar nerve.
What are the muscles of the hypothenar eminence?
Abductor digiti minimi.
Flexor digiti minimi.
Opponens digiti minimi.
What is the innervation of the hypothenar muscles?
Ulnar nerve.
What is the action of the lumbricals?
Flex mcp and extend ip.
What is the innervation of the lumbricals?
Ulnar two by ulnar nerve.
Radial two by median nerve.
What is the innervation of the interossei?
Ulnar nerve.
What is the action of interossei?
PAD.
DAB.
Where does the cannula pass?
Via subclavian to brachiocephalic vein to the superior vena cava to the right atrium.
What is dupuytren’s contracture?
Palmar aponeurosis becomes fibrous and nodular.
What is the test for the interossei muscles?
Pull a card between fingers - PAD.
Place hand in table and test for abduction with resistance - DAB.
What is the test for lumbricals?
OK sign - paralysis of lumbricals will cause nail to nail contact.
