Anatomy Test 3 (Modules 5-7) Flashcards
What’s included in the axial skeleton
The spinal cord, rib cage, neck and skull
What parts of the UE attach to the axial skeleton
the clavicle and the scapula
What is the joint that attaches the UE to the axial skeleton
The SC joint (sternoclavicular joint)
How do you tell the proximal from the distal end of the clavicle?
Distal end is flat, proximal end looks like a knob
How to tell the superior from the inferior end of the clavicle
Superior end everything is smooth on top. The inferior end is bumpy with grooves and tubercles. Also arch is on left side of superior and arch is on the right side of the inferior
Where does the clavicle and scapula meet (what is the meeting called)
The distal end (knob) connects to the acromion process of the scapula to form the acromionclavicular joint (AC joint)
Where does the scapula and Humerus meet? (what is the meeting called)
The Glenoid cavity of the scapula meets with the Humerus to form the Glenohumeral joint (GH joint)
What is the purpose of the supraspinous and infraspinous fossa
Attachment sites for the rotator cuff muscles
What goes through the suprascapular notch
The Suprrascapular artery and nerve
What are the bumps above and below the Glenoid cavity and what is their purpose.
The supraglenoid and infraglenoid tubercle. Purpose: Biceps and triceps land there.
The long head of the biceps goes up and over supraglenoid and lands on top and the long head of the triceps land under infraglenoid.
Borders of the scapula
Superior border: Top of scapula
Medial border: Side closest to spine
Lateral border: Side that forms an angle with humerus.
What forms the inferior angle of the scapula
the Medial and lateral borders
What are the junctions of the 3 borders of the scapula
Inferior angle - (most pertinent) forms the junction of the medial and lateral borders
Superior angle - forms the junction of the medial and superior borders
Lateral angle - forms the junction of the lateral and superior borders
What are the 2 necks of the humerus
The Anatomical neck (right below the head… before the lumps and bumps)
The Surgical neck (below the lumps and bumps)
Surgical necks claim to fame
the site of a lot of fractures
Purpose of Greater and lesser tubercle.
Attachment sites for the rotator cuffs
What’s located between the greater and lesser tubercle (what is its purpose)
the Bicipital groove - the long head of the bicep shoots thru there
Location and purpose of the radial (spiral) groove
The posterior side of the humerus.
Purpose: The radial nerve and deep artery go through there.
What are the two bumps on the side of the distal end of the humerus (what is their purpose). What is a known injury to the site
The Medial and lateral epicondyle
Purpose: The attachment sites of the long wrist flexors and extensors .
Tennis elbow is an injury to this. Golfers elbow is a medial epicondylitis
What are the contours that allow the forearm to flex and extend to the humerus
Radial head attaches to the radial fossa of the humerus. The capitulum articulates with the radius.
A bump off the ulnar bone attaches to the coronoid process of the humerus. The trochlea articulates with the unla
What is the big bump at the posterior distal end of the humerus and its purpose
The Olecranon fossa - the olecranon of the ulna articulates with it and allows the elbow to fully extend
Attachments for Pectoralis Major
Two attachment sites Clavicular head (medial clavicle) and Sternocostal head (anterior sternum) and lands on the proximal humerus (bicipital groove)
3 muscles that attach near the bicepital groove
Pec. major, Latissimus dorsi and Teres major
Nerves that innervate Pec Major
Lateral and medial pec nerve
Actions of the Pec Major
Adduction, internal rotation (twist in) and has an extension piece to it. (arm behind the back). Also flexes and extends humerus
Pectoralis minor - location and attachment
Deep to Pec Major. Attaches to coracoid process and ribs 3-5
Innervation of Pec Minor
Medial pec nerve
Action of Pec Minor
Anchored to scapula - it stabilizes it, and draws it inferiorly and anteriorly. Can contribute to rounded shoulders
Pec Minor claim to fame
Major artery and vein (Axillary) and part of the brachial plexus sneaks under it. So all major extension cords of arm go under it
What is thoracic output syndrome
When shoulders get rounded due to pec minor the Axillary artery and vein along with part of the brachial plexus can get pinched.
Subclavius - location
Sits right under the clavicle (small muscle)
Innervation of Subclavius
Nerve to subclavius
Action of Subclavius
Pulls the clavicle down. If fracture clavicle it protects the area due to nerve there.
Serratus Anterior attachments
All along the inside medial border of the scapula and ribs 1-8
Innervation of Serratus Anterior
Long thoracic nerve
Action of Serratus Anterior
Huge role in upper extremity function. Anchors the scapular and holds it against the thoracic wall (protraction). Upward rotation (raising arm up)
What happens if you lose function of Serratus Anterior
You would only be able to lift your arm up midway
Damage to the Serratus Anterior and long thoracic nerve can cause what condition
Winging of the scapula - if the scapula can’t slam against the ribcage (caused by a long thoracic nerve palsy).. scapula can’t rotate upward
Three muscles that help with upward rotation
Upper trap, lower trap and serratus anterior
Borders and contents of Deltopectoral triangle
Borders: Clavicle, deltoid and pec major
Content: Cephalic vein (returns blood flow from arm)
Role of Cephalic vein in Deltopectoral triangle
Its superficial as its coming up the arm but needs to dive back deep to the brachiocephalic and it does that here
Innervation of the Upper, middle and lower trapezius
CN-11
Action of the Upper Trap
Elevates scapula and upward rotation of the scapula
Action of the Middle Trap
Retracts scapula
Action of the Lower Trap
Depresses scapula and upward rotation of scapula (with upper trap)
Innervation of Latisimus Dorsi
Thoracodorsal nerve
Attachments of the Latisimus Dorsi
The thoracodorsal fascia and distally the bicipital groove on humerus
Actions of the Latisimus Dorsi
Downward rotation of scapula, arm extension, adduction and inwardly rotate (handcuffs)
Innervation of the Levator Scapulae
The dorsal scapula nerve (along with rhomboid)
Actions of the Levator Scapulae
Ipsilateral flexion and rotation of cervical spine. Scapula elevation and downward rotation
Location and Attachments of Levator Scapulae
Deep to SCM, Spenius capitus and trap.
Attachments: Cervical vertebrae 1-4 and scapula
Actions of the Rhomboids
Scapula retraction (with mid-scap)
Two muscles that retract the scapula
Rhomboids and middle scapula
3 regions of the Deltoid
Anterior, middle, posterior
Attachment and innervations of 3 deltoids
Attach: Proximal spine of scapula/clavicle and humerus
Innervation: Axillary nerve
Actions of 3 deltoids
Anterior: Flexion of the humerus and internal rotation
Middle - Abduction
Posterior -Arm extension and external rotation
Attachments of Rhomboids
T2-T5 and Medial border of scapula
Attachments to Teres Major
Scapula and bicepital groove of humerus
Innervation of the Teres Major
Subscapular nerve
Actions of Teres Major
Internal rotation, Adduction and a little extention
4 muscles of rotator cuff
Supraspinatous, Infraspinatous, Teres Minor and Subscapular
Overall Action of the 4 shoulder rotators
Dynamic stabilization of the shoulder (sucks humeral head into its socket)
Only rotator cuff on the front side
Subscapular muscle
Location and attachment of Supraspinatus
On the top of the shoulder, sneaks under the acromium and lands on the Greater tubercle of the humerus (starts at scapula)
Innervation and action of Supraspinatous
Innervation: Supraspinatus nerve.
Action: Abduction/pulls arm away from trunk)
Infraspinatous and Teres location/attachment/Innervation and Action
Infraspinatous most of what you see on posterior shoulder, Teres minor under and inferior to Infraspinatous
Attachment - Both scapula and greater tuberosity of humerus
Action - Both external rotation
Innervation - Infraspinatous (suprascapular n.), Teres minor (axillary)
3 muscles that land on the Greater tuberosity of the humerus
Supra and Infraspinatous and Teres Minor
Subscapularis - location, attachment, innervation, action and claim to fame
Location - Anterior side of shoulder
Attachement - LESSER tuberosity
Innervation - Lower subscapular n.
Action (claim to fame) - Only muscle that Internally rotates the shoulder
Borders and angles of the Upper triangle of shoulder
Superior: Teres minor,
Inferior: Teres major,
Lateral Long head of the triceps
Contents: Circumflex scapular artery
Borders and contents of the Lower triangle of the shoulder
Superior: Teres major
Medial: Long head of the triceps
Lateral - Lateral head of the triceps
Contents - Radial nerve and deep artery of arm
Borders and contents of the Quadrangular space
Superior - Teres minor and subscapularis Inferior - Teres major Medial - Long head of the triceps Latheral - Surgical head of the humerus Contents: Axillary nerve and posterior humeral circumflex artery
Borders and use of Triangle of Auscultation
Borders: trapezius, latissimus dorsi and medial border of scapula
Function: Breath sounds are heard more clearly here.
Pathway of Axillary artery
Arises from subclavian artery, begins at the outer border of the 1st rib sneaks under pec minor and ends at the teres major. Becomes the Brachial artery
3 sections of the Axillary artery (where each starts and ends)
Part 1 - Begins at 1st rib and goes until it sneaks under the pec minor
Part 2 - the part where its under the space under the pec minor
Part 3 - from where it comes out of the pec minor to the teres major
Pathway of the Brachial artery
Arises from the Axillary artery at the inferior border of the Teres major. Ends when it divides into the radial and ulnar arteries at the elbow
What branches off the Brachial artery
The deep artery - which wraps along the back side and takes care of posterior circulation
Name the 3 artery anastomoses that supply the back of the scapula
1) Dorsal scapular a. - off the subclavian follows median border
2) Suprascapular - off the thyrocervical trunk to the back of the scap
3) Circumflex scapular a. - under the bottom of scapula, comes from the subscapular artery
Name the 2 arteries that make up the Shoulder anastomoses
The anterior and posterior circumflex humeral arteries (branch off the 3rd part of the axillary a. )
Name the 4 arteries that make up the elbox/distal humerus anastomoses
1) Radial collaterals (from deep artery)
2) Ulnar collaterals (from brachial artery)
3&4) Radial and Ulnar Recurrent arteries - of radial and ulnar arteries. (U-turn up back to elbow)
6 boundaries of the Axilla
Medial wall - Thoracic wall (ribs 1-4, intercostals and serratus anterior)
Lateral wall- Humerus (bicipital groove)
Anterior wall - Pectoralis major and minor
Posterior wall - Subscapularis, teres major, lat. dorsi and scapula
Base - Axillary fascia
Apex - Space btwn clavicle, 1st rib and scapula
Clinical correlation of the Axilla
A spot to palpate and identify enlarged lymph nodes (lymph drainage from breasts drain into nodes located here)
Contents of the Axillary sheath (what the contents are called)
Neurovascular bundle (contains Axillary vein, artery (and its branches) and Brachial plexus
Where the roots of the nerves that make up the brachial plexus come from
Spinal nerves C4 - T1 (debated it starts at C5) . It comes out from between the anterior and middle scalenes
Major peripheral nerves of the upper limbs
Axillary, Musculocutaneous, Radial, Ulnar, and Median
5 regions of the brachial plexus
1) Roots 2) Trunks 3) Divisions 4) Cords 5) branches
3 trunks that come from the roots of the brachial plexus (from which roots)
1) Superior trunk - formed by C5 and C6
2) Middle trunk - formed by C7
3) Inferior trunk - formed by C8 and T1
Two peripheral nerves that emerge from the Brachial plexus roots (what they plug into)
1) Dorsal scapular n. (plugs into levator and rhomboid)
2) Long thoracic n. (plugs into serratus anterior)
Two peripheral nerves that emerge from the trunks of the brachial plexus (what they plug into)
1) Nerve to subclavious - Subclavian muscle (duh!)
2) Suprascapular n. (plugs in supra and infraspinatus)
What trunks of the brachial plexus merge into
An anterior and posterior branch from each trunk forms the Anterior and posterior divisions
What Divisions of the brachial plexus merge into (name how each is formed)
1) Lateral cord - formed from anterior divisions of superior and middle trunk.
2) Medial cord - formed from anterior division of inferior trunk
3) Posterior cord - formed from the posterior divisions of all 3 trunks
How are the cords of the brachial plexus are named
According to their relationship with the axillary artery
Basic name of what the cords of the brachial plexus become
Branches
3 branches of the lateral cord of the brachial plexus (what they supply)
1) Musculocutaneous n. (supplies biceps brachii, brachialis and coracobrachialis
2) Lateral pectoral n. - (Supplies pec. major)
3) (with the medial cord) merge to for Median N. (muscles of the forearm and hand)
5 branches of the medial cord of the brachial plexus (what they supply)
1) Medial pectoral n. (supplies pec. major and minor)
2) Medial brachial cutaneous n. (skin of medial arm)
3) Medial antibrachial cutaneous n. (skin of medial arm)
4) Ulnar n. (muscles of forearm and hand)
5) (with the lateral cord) merge to for Median N. (muscles of the forearm and hand)
5 branches of the posterior cord of the brachial plexus (what they supply)
1) Axillary nerve - (supplies deltoid and teres major)
2) Radial n. - (supplies triceps, anconeous and brachioradialis
3) thoracodorsal n. (supplies Lat. dorsi)
4) Upper subscapular ( supplies portions of subscapularis)
5) Lower subscapular n. (inferior portion of subscap and teres major)
Two compartments of arm (muscles in each and what they’re innervated by)
Anterior - contains biceps brachii and coracobrachialis (innervated by musculocutaneous n. )
Posterior - Triceps and anconeus (innervated by radial n.)
Attachments of Coracobrachialis
Coracoid process of scapula and middle 1/3 of medial humerus
Innervation and action of Coracobrachialis
Innervation - Musculocutaneous (pierces thru muscle)
Action - Flex and adduct arm
Attachments of the biceps brachii
Proximal (long head) Supraglenoid tubercle of scapula (thru bicipital groove) (short head) coracoid process of scapula.
Distal head Radial tuberosity of radius
What is the bicipital apnoeuroiss
The fascia that extends from the distal biceps tendon and blends with fascia of flexor muscles of forearm (it provides protection for structures in the cubital fossa
Innervation and action of biceps brachii
Innervation - Musculocutaneous nerve
Action - Flexes arm and forearm, supinates forearm
What is biceps tendonitis
Irritation of the long head tendon as it passes through the bicipital groove
Attachments of the Brachialis
Distal 1/2 of the anterior surface of humerus and coronoid tuberosity of ulna
Innervation and action of Brachialis
Innervation - Musculocutaneous nerve
Action - Primary flexor of the forearm, flexes forearm in all positions (supinated, neutral and pronated)
Attachments of the triceps brachii
Proximal
Long head - Infraglenoid tubercle
Lateral head - post, humerus (post. to radial groove)
Medial head - post. humerus (inferior to radial groove)
Distal
Olecranon process of ulna
Innervation and action of Triceps brachii
Innervation: Radial nerve
Action - Primary extensor of the forearm and elbow
Attachments of Anconeus
Lateral epicondyle of humerus and Olecranon process of ulna
Innervation and action of Anconeus
Innervation - Radial nerve
Action - Assists forearm (elbow) extension, stabilizes the elbow joint.
Pathway of the Musculocutaneous nerve
Begins at inferior border of pec minor. Pierces coracobrachialis. Travels btwn (innervates) biceps brachii and brachialis. After innervation it becomes lateral cutaneous nerve of forearm
Pathway of radial nerve
Pops off posterior cord. Travels posterior to brachial artery and medial to humerus. Descends with deep artery of arm. Goes in radial groove. Travels btwn brachialis and brachioradialis. Goes in front of elbow.
Pathway of the median nerve
Pops of the meeting of the medial and lateral cord. In the arm it follows the brachial artery (first lateral then medial). Does nothing until it passes the elbow. Goes in front of elbow
Pathway of the Ulnar nerve
Comes from medial cord. Travels medial to brachial artery and anterior to triceps. Passes posterior to medial epidondyle. Dives behind the elbow.
Pathway of the brachial artery
Axillary artery becomes brachial at inferior border of teres major. Gives off the ulnar collateral branches that supply the medial elbow. Ends at the cubital fossa where it divides to the radial and ulnar arteries. Deep artery branches off of brachial off and travels posterior to humerus in the radial groove (with radial nerve) and braches to radial collateral arteries that supply the lateral elbow.
2 major (and 2 minor) ligaments of the AC joint
AC ligament and Coracoclavicular ligaments. The Coracoclavicular ligaments are made up of the trapezoid and conoid ligaments
Two ligaments that make up the coracoclavicular ligament
Trapezoid ligament - coracoid process to trapezoid line of clavicle
Conoid ligament - Coracoid process to conoid tubercle of clavicle
3 kinds of AC joint separations
Type 1 - Partial injury to the AC ligament (strain or sprain). coroclavicular ligament is intact.
Type 2 - Disruption to the AC ligamentcoroclavicular ligament is strained. but intact.
Type 3 - Disruption to the AC and coroclavicular ligament. Clavicle is displaced superiorly.
Type 1 AC joint separation
Partial injury to the AC ligament (strain or sprain). coroclavicular ligament is intact.
Type 2 AC joint separation
Disruption to the AC ligamentcoroclavicular ligament is strained. but intact
Type 3 C joint separation
Disruption to the AC and coroclavicular ligament. Clavicle is displaced superiorly.
What makes up the Glenohumeral joint
The humeral head articulating with the glenoid cavity of the humerus.
Coracoracromial ligament
Forms part of the coracoacromial arch which also consists of the acromion process. Has ‘subacromial space which the supraspinatus tendon passes thru.
Transverse humeral ligament
Acts as a ‘bridge’ (quote/unquote) over the bicipital groove that contains the long head of the bicep tendon.
