Anatomy (The Upper Limb and Breast) Flashcards
Joining of bones of pectoral girdle
Acromioclavicular joint
(incomplete articular disc in joint)
Some unique points about clavicle
• It has no medullary cavity.
• It is the first bone to ossify in the fetus.
• It is the only long bone to develop in membrane.
• It may be pierced by the supraclavicular nerves.
• It transmits forces from the upper limb to the axial skeleton.
• It acts as a strut to hold the arm free from the trunk.
• It is the most commonly fractured bone in the body, the fracture usually occurring at the junction of the middle and outer thirds.
Anatomical neck vs surgical neck of humerus
• The HEAD is separated from the greater and lesser TUBERCLES by the anatomical neck.
• The upper END and SHAFT meet at the surgical neck,around which lies the axillary nerve and circumflex humeral vessels.
Proximal carpal row
lateral to medial—scaphoid, lunate, triqu-
etral (plus ATTACHED pisiform).
Attachment of flexor retinaculum
From the scaphoid and trapezium laterally to the pisiform and hook of the hamate medially
Carpus Arch is also maintained by the flexor retinaculum, together with shape of individual bones.
Proximal articulation of second metacarpal bone
• Second metacarpal articulates with three carpal bones:trapezium,trapezoid,capitate.
Distal articulation of capitate
• Capitate articulates with three metacarpals: second,third and fourth.
Origin and insertion of rotator cuff muscles
Scapulal dial surface, central surface and lateral border>Humeral greater & lesser tuberosity
What is boxer’s muscle
Serratus anterior
because it’s responsible for the protraction of the shoulder blade, which is a movement used when throwing a punch.
How does the serratus anterior abduct the shoulder joint above 90°?
By rotation of the scapula upwards by C567
What is Supraspinatus tendinitis
• Supraspinatus tendinitis results in a painful arc of shoulder movement between 60° and 120°. It is during this range of movement that the tendon IMPINGES against the overlying acromion and coracoacromial ligament.
Elbow Joint composition
Consists of three articulations and ONE synovial cavity.hinge+ball and
socket+pivot
The medial and lateral epicondyles are extracapsular.
What is breastbone)
Sternum
Types of synovial joints according to shape of bones and movement
*Ball and socket joint
Allows for the GREATEST RANGE of movement, with a ball-shaped structure fitting into a cup-like socket.
*Hinge joint
Allows for flexion and extension in one plane, similar to a DOORS opening and closing
* Pivot joint
Allows for bone ROTATION around another bone, such as the joint between the first and second vertebrae in the neck,
radioulnar joints
*Condyloid joint
This joint is shaped like a condyle that fits into an elliptical cavity. Condyloid joints allow for movement in TWO planes, but without rotation. The knuckles and the joints at the base of the fingers are examples of condyloid joints.
*Saddle joint
This joint is shaped like a saddle, with one bone resting on top of the other like a rider on a horse. Saddle joints allow for movement in ALL directions EXCEPT axial rotation. The joint at the base of the thumb is an example of a saddle joint.
*Gliding joint
Allows for limited movement, such as the wrist joints, where smooth surfaces SLIP over one another
Location of deep transverse ligaments of hand
• Metacarpophalangeal joints of fingers (not thumb) are joined by deep transverse ligaments which prevent them spreading during a firm grip.
Function of interossei
PAD (1 into ulnar 2,3 into radial side)
DAB (1,2 into radial 3,4 into ulnar side)
Flex the metacarpophalangeal joints.
Extend the interphalangeal joints.
*Middle metacarpal and phalanx have no palmer interossei
*DORSAL interossei have DOUBLE belly
Insertion of thenar muscles
All but opponens(metacarpal) into bar of proximal phalanx
WEAK adductor and abductor of metacarpophalangeal joints and when they work
• The long flexors have a weak adduction action.
• Extensor digitorum has a weak abduction action.
• The abductor/adductor actions of extensor digitorum and the long flexors are eliminated by placing the hand flat on a table. Abduction/adduction then become the actions of the intrinsic muscles only.
• The above can be tested by gripping a card between the fingers (tests T1 and partly ulnar nerve integrity).
Fascia pierced but cephalosporin vein
Pierces the clavipectoral fascia to enter the axillary vein.
Deltopectoral/Clavipectoral triangle with importance
The clavipectoral triangle (also known as the deltopectoral triangle) is an anatomical region found in humans and other animals. It is bordered by the following structures:
Clavicle (superiorly)
Lateral border of Pectoralis Major(medially)
Medial border of Deltoid muscle (laterally)
Importance
#It contains the CEPHALIC vein(it is superficial until it reaches the deltopectoral triangle) and deltopectoral FASCIA, which is a layer of deep fascia that invests the three structures that make up the border of the triangle. The deltoid branch of the THORACOACROMIAL artery also passes through this triangle, giving branches to both the deltoid and pectoralis major muscles.
The subclavian VEIN and the subclavian ARTERY may be ACCESSED via this triangle, as they are deep to it.
Formation of axillary vein
*Basilic vein joins venae comitantes of brachial artery, eventually forming the axillary vein.
The venae comitantes(accompanying) of the brachial artery are the brachial veins, which are a pair of deep veins that run alongside the brachial artery in the arm
What is Cimino–Brescia fistulae
radiocephalic fistulae for dialysis
Some points of axillary artery
*lateral border of the first rib
*lower border of teres major
*by pectoralis minor(1st>1,2nd>2,3rd>3)
*cords surround
Relation of brachial artery and median nerve
•Artery is crossed superficially from the lateral to medial side by the median nerve at the level of the MIDHUMERUS.
*nerve guards artery
Where the radial artery is palpated at the wrist.
In the distal forearm it lies between brachioradialis and flexor carpi radialis
#Passes deep to tendons of abductor pollicis longus and extensor pollicis brevis to enter the anatomical snuffbox where it is palpable.
Termination of radial artery
• Pierces first dorsal interosseous and adductor pollicis to contribute to deep palmar arch.
Point of palpation of ulnar artery
• Lies on flexor digitorum profundus, overlapped by flexor carpi ulnaris
• Distally in the forearm it becomes superficial between the tendons of the flexor carpi ulnaris and flexor digitorum profundus.
Termination of ulnar artery
• Crosses in front of the flexor retinaculum to form the superficial palmar arch with the superficial branch of the radial artery
Relation of median nerve with ulnar artery
Ulnar artery if crossed superficially by the median nerve separated from it by the deep head of pronator teres.
Which part of brachial plexus is related to scalenus muscle
Roots: between scalenus anterior and scalenus medius
What part of the brachial plexus is in posterior triangle
Trunks: in the posterior triangle of the neck.
Point of division of trunk of branch plexus
Behind clavicle into anterior and posterior
Location of chords of brachial plexus
in the axilla.
What part of nerve forms root of brachial plexus
Anterior primary rami of C5, 6, 7, 8, T1.
Area of supply of dual scapular nerve C5 of brachial plexus
Levator scapulae
Rhomboid minor
Rhomboid major
Difference among nerves
Dorsal scapular
Long thoracic
Thoracodorsal
C5>Dorsal S.>Levator S.Rhomboid Mj.&Mi.
C567>Long T.>Serratus A.
Posterior cord>Thoraco D.>Latissimus D.
Root value of axillary nerve with muscular branch
C5, 6.
Muscular branches to deltoid, teres minor.
Root value of radial nerve , accompanied artery in arm . Muscle supplied
•C5, 6, 7, 8, T1
• Accompanied by profunda brachii artery.
• Main radial nerve supplies triceps, anconeus, brachioradialis, extensor carpi radialis longus and PART of BRACHIALIS.
• Posterior interosseous branch supplies supinator, abductor pollicis longus and all remaining extensor muscle.
Root of musculocutaneous nerve, supplied muscles
C5, 6, 7.
• Pierces coracobrachialis and runs between biceps and brachialis & SUPPLIES them
Root of median nerve, entrance point into forearm , supplied muscles
C6, 7, 8, T1.
• Enters the forearm between the heads of pronator teres.
• Supplies in its course all muscles of the flexor aspect of the forearm (except flexor carpi ulnaris and the ulnar half of flexor digitorum profundus), the muscles of the thenar eminence and the radial two lumbricals.
Root of ulnar nerve, point of palpability, relation with flexor retinaculum
Ulnar tunnel syndrome, also known as Guyon’s canal syndrome or Handlebar palsy, is ulnar neuropathy at the wrist where it passes through the ulnar tunnel (Guyon’s canal). The most common presentation is a palsy of the deep motor branch of the ulnar nerve causing weakness of the interosseous muscles. Ulnar tunnel syndrome is usually caused by a ganglion cyst pressing on the ulnar nerve, other causes include traumas to the wrist and repetitive movements like long distance bicycle rides are associated with transient alterations in ulnar nerve function.But often the cause is unknown (idiopathic).
C7, 8, T1.
•It is palpable behind the medial epicondyle
• Crosses the flexor retinaculum superficially within it’s own canal called Guyon’s canal
Sensory loss in the ring and small fingers is usually due to ulnar nerve entrapment at the cubital tunnel near the elbow, which is known as cubital tunnel syndrome, although it can uncommonly be due to compression at the wrist.
cubital tunnel syndrome
Chronic compression of the ulnar nerve in the cubital tunnel is known as cubital tunnel syndrome.There are several sites of possible compression, traction or friction of the ulnar nerve as it courses behind the elbow.It may also be caused by repetitive strain from the use of a cell phone for example manifested SENSORY loss in the ring and small fingers.
The cubital tunnel is bordered medially by the medial epicondyle of the humerus, laterally by the olecranon process of the ulna and the tendinous arch joining the humeral and ulnar heads of the flexor carpi ulnaris.The roof of the cubital tunnel is elastic and formed by a myofascial trilaminar retinaculum (also known as the epicondyloolecranon ligament or Osborne band)
cubital tunnel syndrome
Chronic compression of the ulnar nerve in the cubital tunnel is known as cubital tunnel syndrome.There are several sites of possible compression, traction or friction of the ulnar nerve as it courses behind the elbow.It may also be caused by repetitive strain from the use of a cell phone for example
The cubital tunnel is bordered medially by the medial epicondyle of the humerus, laterally by the olecranon process of the ulna and the tendinous arch joining the humeral and ulnar heads of the flexor carpi ulnaris.The roof of the cubital tunnel is elastic and formed by a myofascial trilaminar retinaculum (also known as the epicondyloolecranon ligament or Osborne band)
What is Erb’s (Erb–Duchenne) Paralysis
Root C5, C6 affected.
•Forced downward traction on arm
during birth.,Fall on side of head and shoulder, forcing the two apart.
• Paralysis of deltoid, supraspinatus, infraspinatus, brachialis, biceps. Resulting in WAITER’S tip position
What is Klumpke’s paralysis
damage T1 (Wasting) Resulting in Claw hand due to
unopposed action of long flexors and long extensors
• Associated area of numbness along inner and upper arm and forearm CENTRED on elbow JOINT level. Area of T1 dermatome
• Upward traction on arm breech delivery,Pancoast’s tumour,a cervical rib.
• Intrinsic muscles of hand paralysed, wasted resulting inClaw hand due to
unopposed action of long flexors and long extensors
• May be associated with Horner’s syndrome due to traction on sympathetic chain(miosis,anhydrosis,ptosis?
Nerve injured in ‘Saturday night palsy’
trapping the RADIAL nerve between the chair and the humerus other than that
fractures of midshaft of humerus
Which nerve injury will of wrist drop
wrist drop if the main RADIAL nerve is damaged (due to extensor carpi radialis longus, which is supplied by the main radial nerve before the posterior interosseous branch is given off which may be damaged in fractures or dislocations of the radial head or in the surgical
approach to the radial head.
Area of sensory loss in radial nerve injury
Small area of anaesthesia on the skin on dorsum of first web space.
Mode of injury of axillary nerve
Damaged in fracture of surgical neck of humerus or anterior dislocation of the shoulder joint.
