Arm and Elbow Flashcards

1
Q

describe the role and structure of the axilla

A

provides gateway to upper limb, area of transition between neck and arm
formed by clavicle, scapula, upper thoracic wall, humerus and related muscles
pyramidal shape with four sides with an inlet and a floor

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2
Q

describe the shape and structure of the axillary inlet

A

triangular in shape and formed by the lateral border of rib 1, posterior surface of the clavicle and superior border o the scapula up to the caracoid process

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3
Q

what forms the anterior wall of the axilla

A

lateral part of the Pec Maj, pec minor, subclavian and underlying fascia

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4
Q

what forms the medial wall of the axilla

A

upper thoracic wall and serrates anterior

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5
Q

what forms the lateral wall of the axilla

A

narrow, formed by inter tubercular sulcus of humerus

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6
Q

the lateral wall is formed by the inter tubercular sulcus of the humerus but what muscles attach to this site

A

floor - lats
medial - teres major
lateral - pec major

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7
Q

which muscles make up the posterior wall of the axilla

A

subscap
distal parts of lat dorsi and teres major
proximal part of long head of triceps brachii

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8
Q

what forms the floor of the axilla

A

clavipectoral fascia and skin

anterior fold is superior to the posterior fold

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9
Q

what are the key major nerves and vessels that pass through the axilla

A

axillary artery
axillary vein
brachial plexus

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10
Q

running through the axilla space are two muscles what are they

A

biceps brachii

coracobrachialis

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11
Q

what lymphatics can be found in the axilla

A
all lymphatics of upper arm and large portion of adjacent trunk drain into axilla lymphatics: 
humeral nodes (lateral) 
pectoral nodes (anterior) 
subscapular nodes (posterior)
central nodes 
apical nodes
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12
Q

what is the brachial plexus formed by

A

ventral rami of C5 and C8 and most of T1

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13
Q

describe the route of the brachial plexus and where it originates

A

originates in the neck and passes laterally and inferiorly over rib 1 and enters the axilla

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14
Q

what are the three trunks of the brachial plexus

A

superior - formed by the union of C5 and C6 roots

middle - continuation of C7

inferior - union of C8 and T1

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15
Q

from the origin of the sup, middle and inf branches of the brachial plexus what happens to them next

A

they divide into a posterior and anterior division

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16
Q

what are the three cords of the brachial plexus after the trunk origins

A

the lateral cord is the merger of the anterior division of the superior and middle trunks

the posterior cord is formed by the merger of all posterior divisions of the trunks

the medial cord is an extension of the anterior division of the inferior trunk

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17
Q

there are 5 major terminal branches of the brachial plexus which come from the lateral, posterior and medial cords, what are they

A

musculocutaneous nerve from C5/6/7

axillary nerve from C5/6

Median Nerve from C5-T1

radial nerve from C5-T1

ulnar nerve from C8-T1

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18
Q

what is the role of the musculocutaenous nerve

A

innervates the brachialis, biceps brachiaii and coracobrachialis

provides sensation to the lateral half of the anterior forearm and a smaller portion of the posterior forearm

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19
Q

what is the role of the axillary nerve

A

innervates teres minor and deltoid

provides sensation to the inferior region of the deltoid

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20
Q

what is the role of the median nerve

A

innervates most of the flexor muscles of the forearm, thenar muscles and the two lateral lumbircals associated with the index finger and middle finger

provides sensation to the lateral part of the palm and the lateral three and a half fingers on the palmar surface of the hand

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21
Q

what is the role of the radial nerve

A

innervates the triceps brachii and the muscles in the posterior compartment of the forearm

provides sensation to the posterior aspect of the arm and the forearm - and posterolateral aspect of the hand

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22
Q

what is the role of the ulnar nerve

A

innervates the muscle of the hand (apart from thenar and two lateral lumbricals) flexor carpi ulnaris and medial half of flexor digitorum profundus

provides sensation to the anterior and posterior surfaces of the medial one and a half fingers and associated palm area

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23
Q

what is the distinctive M shape formed by in the gross axilla

A

Musculocutaneous, median and ulnar nerves

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24
Q

where does the axillary artery come from and what does it split into / supply

A

from subclavian, supplies the walls of the axilla and related regions - it becomes the brachial artery which has 6 branches

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25
Q

what are the 6 branches of the axillary artery which stems from the subclavian

A

superior thoracic artery

thoracic-acromial artery and lateral thoracic artery

subscapular artery, anterior and posterior humeral circumflex artery

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26
Q

what does the superior thoracic artery supply (first part)

A

supplies upper region of the medial and anterior axillary walls

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27
Q

what happens to the thoracic-acromial artery and lateral thoracic artery (from the second part)

A

TA artery immediately splits into pectoral, deltoid, clavicular and acromial branches

LT artery supplies the serrates anterior and the anterior walls of the axilla

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28
Q

what happens to the subscapular, anterior and posterior circumflex arteries

A

subscap supplies most of he posterior wall of the axilla
anterior supplies the glenohumoral joint and head of humerus
posterior supplies sculls surrounding the neck of the humerus before anastomosis with the anterior

29
Q

what are the size differences between the third part of the axillary artery ie subscap, anterior and posterior circumflex

A

subscap is the largest

anterior is smaller than the posterior

30
Q

describe the path of the axillary vein

A

continuation of the basilic vein - passes through axilla medial and anterior axiallary inlet and becomes the subclavian vein which crosses the border of rib 1

31
Q

describe the path of the brachial artery

A

continuation of the axillary artery found in anterior part of arm
starts at the lower border of the teres major and terminates just distal to the elbow joint where it divides into the radial and ulnar arteries
it starts lateral proximally but then moves medially in the distal arm between the lateral epicondyle and medial epicondyle of the humerus

32
Q

what are the branches of the brachial artery

A

two ulnar collateral vessels which surround the elbow
profunda brachial artery (passes into the posterior compartment)
nutrient arteries to the humerus which enter humerus anteriomedially

33
Q

describe the path of the paired brachial veins

A

medial and lateral sides of the brachial artery (deep veins of arm)

34
Q

what are the two superficial veins of the arm

A

large subcutaneous basilic and cephalic

35
Q

describe the path of the basilic vein

A

passes vertically in distal part of arm then penetrates deep fascia to assume position medial to the brachial artery and becomes axillary vein at lower border of teres major

36
Q

describe the path of the cephalic vein

A

superiorly on the anterior-lateral aspect of arm through anterior wall of axilla to reach axillary vein

37
Q

where do the cephalic and basilic vein anastomose

A

anterior elbow joint via the median cubital fossa

38
Q

what is the difference in role of the two compartments of the arm

A

anterior predominantly flex the elbow joint

posterior extend the joint

39
Q

which muscles are found in the anterior compartment

A

coracobrachilais
brachiallis
biceps brachii

40
Q

what innervates the anterior muscles of the arm

A

musculocutaneous (flexors)

41
Q

describe the path off the coracobrachialis

A

tip of coracoid process to medial side of the midshaft of the humerus
passes through axilla

42
Q

describe the path of the biceps brachii

A

two heads
short head - originates from the coracoid process with the coracobracialis
long head oprginiates as a tendon from the supraglenoid tubercle of the scapula

43
Q

describe the long head of the biceps brachii

A

long head (tendon) passes through glenohumeral joint superior to the head of the humerus and through the inter tubercular sulcus from the supraglenoid tubercle

44
Q

where does the biceps brachii insert

A

radial tuberosity

45
Q

where does the brachialis originate and insert and travel path

A

distal half of anterior aspect of humerus
it is deep to the biceps brachii
connects as a tendon to the ulnar tuberosity

46
Q

what is the only muscle of the posterior compartment of the arm

A

triceps brachii

47
Q

describe the structure of the triceps brachii

A

long head originates from infraglenoid tubercle of scapula
medial head originates from the shaft of the humerus inferior to the radial groove
the lateral head originates from a roughening above the radial groove

48
Q

where to the 3 heads of the triceps converge and insert

A

converge onto olecranon of the ulna

49
Q

what innervates the tricep muscle

A

branches of the radial nerve

50
Q

why do we test the reflexes of the biceps and triceps

A

to check damages to the brachial plexus

51
Q

what does poor reflex of the triceps vs biceps indicate

A

poor biceps = damage to musculocutaneous nerve

poor triceps = damage to radial nerve

poor in both = damage to superior trunk or roots C5/6

52
Q

what are the borders of the quadrilateral space

A
superior = teres minor 
lateral = surgical neck of humerus 
inferior = teres major 
medial = long head of the triceps
53
Q

what important structures pass through the quadrilateral space

A

axillary nerve and posterior circumflex humeral artery

54
Q

how can you identify the posterior aspect of the humerus

A

linear diagonal roughing which marks the attachment of the triceps brachii
starts at the surgical neck and finishes diagonally down at the deltoid tuberosity

55
Q

where is the radial groove situated

A

posterior surface of the humerus running along side the diagonal roughening

56
Q

what lies in the radial groove

A

radial nerve and profunda brachii artery

57
Q

what does the bone of the humerus distally turn into

A

lateral supraepicondylar ridge

medial supraepicondylar ridge

58
Q

describe the structure of the distal end of the humerus

A

condyle - made up of the capitulum (lateral, articulates with the radius) and trochlea (medial, articulates with the ulna)

epicondyles lateral (attach muscles in posterior forearm) and medial (attach muscles in the anterior)

three fossae:
radial - anterior surface immediately superior to capitulum
coronoid fossa - superior to trochlea
olecranon - largest, posterior surface superior to trochlea

59
Q

which part of the condyle of the humerus is visible on the posterior aspect

A

trochlea

60
Q

describe the route of the ulnar nerve in the arm to forearm

A

around the posterior surface of the medial epicondyle and can be palpated against the bone

61
Q

what are the three main features of the proximal radius

A

head, neck and radial tuberosity

62
Q

describe the articulation of the radius to the humerus and the ulna

A

proximal radius is horizontal disc shaped which articulates with the capitulum of the humerus
the medial aspect of the radius articulates with the radial notch on the ulna

63
Q

what is found on the neck of the radius

A

radial tuberosity - roughened for the attachment of the biceps brachii

64
Q

describe the structure of the proximal ulna

A

larger than proximal head of ulna

consists of the: olecranon, coronoid process, trochlear notch, radial notch, tuberosity of the ulna

65
Q

what is the olecranon of the ulna

A

large projection of bone

has an articular anterolateral surface for the trochlear notch which articulates with the trochlear of the humerus

66
Q

what is found at the very superior point of the olecranon of the ulna

A

roughened surface for articulation with the triceps brachii

67
Q

describe the role and structure of the coronoid process of the ulna

A

aids in forming the trochlear notch

the lateral surface is marked by the radial notch for articulation with the head of the radius

68
Q

what are the three joints of the elbow

A

Elbow joint: (flexion and extension of forearm)
humero-ulnar
humero-radial

superior radioulnar joint (pronation and supination of the forearm)

69
Q

describe the surrounding structure of the elbow joint

A

articulating surfaces covering in hyaline cartilage covered in synovial membrane as well as areas of pads of fat
all enclosed in a fibrous membrane