Arm and Forearm Flashcards
Describe some features of the arm
4 muscles
2 fascial compartments
3 large nerves
LARGE MEDIAL neurovascular bundle
State the muscles in the anterior arm
Biceps brachii
Coracobrachialis
Brachialis
Describe a feature of the biceps brachii
2 heads - Long head + Short head
Where do the heads of the biceps brachii attach ?
Short head attaches to the coracoid process of the scapula
Long head attaches to the supraglenoid tubercle of the scapula
Where do the heads of the biceps brachii insert ?
The 2 heads insert into the forearm via 2 different things :
- Radial tuberosity
- Bicipital Aponeurosis
State the innervation of the biceps brachii muscle
Musculocutaneous nerve
C5,6,7 (MAINLY C6)
State the movement of the biceps brachii
Supination - then flexion (synergist in elbow flexion)
Short head associated with stability
Describe features of the coracobrachialis
Goes from the coracoid process to the arm.
Runs alongside the short head of biceps
Where does the coracobrachialis attach ?
The coracoid process of the scapula
State the innervation of the coracobrachialis muscle
Musculocutaneous nerve
C5,6,7 (MAINLY C6)
State the movement of the coracobrachialis muscle
Flexion, adduction at GH joint
Associated with stability
State the movement of the brachialis muscle
Prime mover in elbow flexion.
State the attachment of the brachialis muscle
The anterior surface of the humerus
State the insertion of the brachialis muscle
The coronoid process of the ulna
State the innervation of the brachialis muscle
Musculocutaneous nerve
C5,6
What does the musculocutaneous nerve become in the forearm ?
It becomes the lateral cutaneous nerve of the forearm.
What is the biceps reflex ?
Deep tendon reflex
Afferents from muscle spindles
Efferent alpha motor neurons
Function of the biceps reflex test
Tests C5 and C6 spinal segments
Elicits a flexion jerk
State the muscle(s) in the posterior arm
Triceps brachii (has 3 heads)
- Long head
- Lateral head
- Medial head
Where do the heads of the triceps brachii insert ?
All 3 heads come together and insert onto the olecranon process of the ulna.
State the innervation of the triceps brachii
The radial nerve
C6,7,8 (MAINLY C7 and 8)
Describe the movements associated with the triceps brachii
Extensor of the elbow
Long head - shoulder extension (associated with stability)
What nerve supplies the anterior arm compartment ?
Musculocutaneous nerve
What nerve supplies the posterior arm compartment ?
Radial nerve
What happens due to damage of the radial nerve ?
Paralysis in the muscles of the posterior forearm.
- Wrist drop (floppy wrist)
Function of the triceps reflex test
Tests C6 and C7 (C8) spinal segments
Elicit an extension jerk
State features of the cubital fossa
Area anterior to the elbow
Borders
Roof
Floor
Contents
State the borders of the cubital fossa
Pronator teres
Brachioradialis
Line between the lateral and medial epicondyles
(this forms a triangle called the cubital fossa)
State the roof of the cubital fossa
Bicipital aponeurosis
State the contents of the cubital fossa
From medial to lateral :
- Median nerve
- Brachial artery
- Biceps tendon
- Radial nerve
What is different about the radial nerve at the cubital fossa ?
Normally the radial nerve runs posteriorly but at the cubital fossa is come anteriorly at the elbow.
It branches into a deep and superficial branch.
The deep branch dives through the supinator muscle deep.
State the floor of the cubital fossa
- Supinator
- Brachialis
What structures is found superficial to the cubital fossa ?
The median cubital vein
What is the anterior forearm innervated by ?
Median nerve
(except 1 1/2 muscles by the ulnar nerve)
What is the posterior forearm innervated by ?
Radial nerve
Movements of the anterior forearm
Flexors and Pronators
*common flexor origin
State the layers of the anterior forearm
Superficial
Intermediate
Deep
State the contents of the superficial layer of the anterior forearm
Contains the following muscles :
Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris
State the superficial muscle of the anterior forearm located laterally
Pronator teres
C6,7 (mainly C7)
(located near the thumb)
State the order of the superficial muscles of the anterior forearm
(from lateral to medial)
Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris
What is unique about palmaris longus ?
C7,8
- Absent in around 15% of people
- Evolutionary change
Where does the palmaris longus insert ?
Palmar aponeurosis
What nerve supplies the flexor capri ulnaris ?
The ulnar nerve C7,8
NOT THE MEDIAL NERVE
State the contents of the intermediate layer of the anterior forearm
One muscle :
- Flexor digitorum superficialis
- C7,8, T1
Where does the flexor digitorum superficialis insert ?
Middle phalanges (of the 4 digits) insertion
State the insertions of the flexor carpi ulnaris/radialis
Inserts into the wrist
State the contents of the deep layer of the anterior forearm
3 muscles
- Flexor digitorum profundus
- Flexor policis longus
- Pronator quadratus
Describe the innervation of flexor digitorum profundus
Medial 1/2 - Ulnar nerve (C8 and T1) : mainly T1
Lateral 1/2 - Anterior interosseous nerve (C8 and T1) : mainly C8
State the insertion of the flexor digitorum profundus
Distal phalanges insertion
Describe the innervation of the flexor policis longus
Anterior interosseous nerve (C8 and T1)
Describe the innervation of the pronator quadratus
Anterior interosseous nerve (C8 and T1)
What is the anterior interosseous nerve ?
A branch of the medial nerve
Pollex meaning
Thumb
Describe the position of the radial artery
Passes laterally, running alongside the superficial branch of the radial nerve
Describe the position of the ulnar artery
Runs alongside the ulnar nerve, and these structures run deep to the flexor carpi ulnaris
How can we get neurovascular structures and tendons into the hand ?
The carpal arch which is closed over by flexor retinaculum.
What is the flexor retuinaculum ?
A tendinous/ligamentous connective tissue sheath running across the top of the carpal arch creating a tunnel.
State the contents of the carpal tunnel
Flexor digitorum superificialis
Flexor digitorum profundus
Flexor policis longus
Median nerve
Describe the innervation of the dorsal (posterior) forearm
Radial nerve or its branches
Movements of the dorsal (posterior) forearm
Extensors and Supinators
State the groups of the dorsal (posterior) forearm
Superficial
Outcropping
Deep
State the origin of the dorsal (posterior) forearm muscles
Common extensor origin
- Lateral epicondyle of the humerus
State the muscle found in the superficial group of the dorsal (posterior forearm)
Brachioradialis
- Elbow flexor (synergist)
- 1/2 pronator
- 1/2 supinator
Where does the brachioradialis insert ?
Inserts into the distal radius
State the reflex associated with the brachioradialis
“Supinator reflex”
Elicits a flexion jerk
Function of the “supinator” reflex
Tests C5 and C6 spinal segments
(mainly C6)
What is the supinator reflex muscle ?
Brachioradialis
State the superificial group of extensor muscles in the forearm
Extensor carpi radialis longus - C7 radial nerve
Extensor carpi radialis brevis - C7 deep RN
Extensor digitorum - C7 deep RN
Extensor digiti minimi - C7 deep RN
Extensor carpi ulnaris - C7 deep RN
State the outcropping muscles of the dorsal (posterior forearm)
Abductor policis longus
Extensor policis brevis
Extensor policis longus
Anatomical snuff box
What nerve innervates the outcropping muscles ?
The posterior interosseous nerve
C7 and 8 (mainly C8)
Describe the anatomical snuffbox
Crossed by the cephalic vein, dorsal branch of the radial nerve
Contains the radial artery
Describe the floor of the anatomical snuff box
Scaphoid and Trapezium
How is the anatomical snuffbox formed ?
Gap between the extensor policis longus and extensor policis brevis
State the deep muscles of the dorsal (posterior forearm)
Supinator - deep radial nerve C7,8 (mainly 8)
Extensor indicis - post. interosseous nerve (mainly C7)