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RB Y2 MSK 01 Anatomy > Axilla and Brachial Plexus, and Posterior Shoulder > Flashcards

Axilla and Brachial Plexus, and Posterior Shoulder Flashcards

1
Q

what are the borders of the axilla

A
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2
Q

what are 2 of the main muscles of climbing

A

latissimus dorsi and pectoralis major

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3
Q

what is the axillary vein a continuation of

A

brachial vein (deep vein of arm)

it becomes the axillary vein at the lower border of teres major muscle

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4
Q
A

teres major

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5
Q

where can pulsations of the subclavian artery be palpated

A

where it crosses the first rib

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6
Q

what are the cords of the brachial plexus named in relation to

A

the axillary artery

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7
Q

where do the roots and trunks of the brachial plexus lie

A

mainly between the anterior and middle scalene muscles in the root of the neck

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8
Q

where do the divisions of the brachial plexus lie

A

deep to the clavicle (posterior to subclavian vessels in root of neck)

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9
Q

where do the cords of the brachial plexus lie

A

around the axillary artery

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10
Q

what supplies the anterior muscles of the arm

A

musculocutaenous nerve

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11
Q

what muscle does the musculocutaenous nerve pierce on its way down to arm

A

coracobrachialis

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12
Q

where does the axillary nerve lie in relation to the radial nerve

A

superior

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13
Q

describe the path of the axillary nerve around the humerus

A

wraps around the posterior aspect of the surgical neck of the humerus - vulnerable to injury in shoulder dislocation or fractured neck of humerus

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14
Q

describe the path of the radial nerve around the humerus

A

wraps around posterior aspect of mid shaft of the humerus - in the radial groove

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15
Q

what compartment of the arm are the axillary and radial nerves in

A

posterior

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16
Q

what is the deltoid muscle innervated by

A

axillary nerve

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17
Q

function of the posterior part of deltoid

A

extend the shoulder

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18
Q

function of the middle part of deltoid

A

abduction at shoulder

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19
Q

anterior part of deltoid action

A

flexion of shoulder

(clavicular part)

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20
Q

what is the trapezius innervated by

A

CNXI (spinal accessory nerve)

also innervates the sternocleidomastoid

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21
Q

function of the trapezius

A

descending (superior) part - elevates scapula

middle - retracts scapula

ascending (inferior) part - depresses scapula

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22
Q

what parts of the trapezius produce superior rotation of glenoid fossa

A

ascending and descending (abduction movement)

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23
Q

what is the action of the levator scapulae

A

elevation of scapula and inferior rotation of glenoid fossa (adduction movement)

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24
Q

what is the action of the rhomboid muscles

A

retraction of scapula and inferior rotation of glenoid fossa

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25
Q

action of rotator cuff muscle

A
  • supraspinatus - first 15 degrees abduction of shoulder
  • infra spinatus and teres minor - external rotation
  • sub scapularis - internal rotation
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26
Q

innervation of the rotator cuff muscles

A
  • supra and infra spinatus - suprascapular nerve
  • subscapularis - upper and lower subscapular nerve
  • teres minor - axillary nerve
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27
Q

painful arc syndrome

A

impingement of supraspinatus tendon between the humerus and the acromion process can lead to this

patients typically complain of pain during 50-130 degrees of abduction

patient will tend to throw upper limb to the side to initiate abduction

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28
Q

elevation of scapula

A

descending part of trapezius

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29
Q

depression of scapula

A

gravity

and ascending trapzius etc

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30
Q

protraction of scapula

A

serratus anterior

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31
Q

retraction of scapula

A

middle part of trapezius and rhomboids

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32
Q

upward rotation of scapula

A

descending and ascending part of trapezius and serratus anterior

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33
Q

downward rotation of scapula

A

mainly latissimus dorsi

also rhomboids

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34
Q

what is the deltoid muscle supplied by

A

axillary nerve

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35
Q

what is the teres minor suplied by

A

axillary nerve

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36
Q

attachments of the deltoid

A

lateral 1/3 of clavicle

deltoid tuberosity of humerus

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37
Q

where does the subacromial bursa lie

A

between supraspinatus tendon and acromion process of scapula

inflammation may give rise to shoulder pain, especially on abduction

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38
Q

medially, what is the sensory innervation to the posterior aspect of the arm

A

anterior rami of spinal nerves C8, T1 and T2

intercostal brachial nerve, medial and posterior cutaneous nerves of arm and medial cutaneous nerve of forearm

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39
Q

where is a common site for referred cardiac pain

A

left upper limb

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40
Q

laterally, what is the sensory innervation to the posterior aspect of the arm

A

anterior rami of spinal nerves C5 and C6 via the axillary nerve

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41
Q

muscle in pos compartment of the arm

A

triceps brachii

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42
Q

what is the triceps brachii innervated by

A

radial nerve

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43
Q

attachments of the triceps brachii

A

proximal:

long head - infraglenoid tubercule of scapula

superior (lateral head) and inferior (medial head) to radial groove of humerus

distal:

all 3 heads combine to form triceps tendon, which attaches to olecranon process of the ulna

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44
Q
A
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45
Q

what nerve roots is the axillary nerve made up of

A

C5 and C6

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46
Q

what muscles does the axillary nerve supply

A

deltoid and teres minor

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47
Q

what is the sensory function of the axillary nerve

A

give rise to superior lateral cutaenous nerve of arm - innervates badge area

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48
Q

what is the quadrangular space

A

gap in muscles of posterior scapular region

the axillary nerve passes through this space

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49
Q

what should patients who have sustained an inferior dislocation of the shoulder joint undergo

A

assessment of sensation in region of badge patch to test function of axillary nerve

it can also be tested by asking patient to abduct their limb above 15 (middle deltoid)

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50
Q

what nerve roots make up the radial nerve

A

C5- T1

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51
Q

where is the radial nerve found in the humerus

A

in the radial groove

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52
Q

how does the radial nerve enter the forearm

A

through the cubital fossa

53
Q

what is the radial nerve vulnerable to

A

mid shaft fracture of humerus

its function can be tested by testing the triceps barchii

54
Q

what is the action of the superficial muscles of the posterior forearm

A

extension, adduction, abduction of the wrist

extension of fingers

55
Q

what is the action of the deep muscles of the forearm

A

extension and abduction of the thumb

supination of the forearm

56
Q

where do the deep muscles of the anterior forearm attach

A

shafts of radius and ulna and the interosseous membrane

57
Q

what holds the tendons in place as they cross the wrist

A

extensor retinaculum

58
Q

brachioradialis

A
  • classified as posterior as supplied by radial nerve, but located in boundary between anterior and posterior compartments
  • main action is flexion of semi-pronated arm
  • eg when drinking from cup
59
Q

where does the radial nerve split into superficial and deep branch

A

anterior to lateral epicondyle (cubital fossa)

60
Q

describe the course of the deep branch of radial nerve

A

passes into pos compartment of the forearm by winding around the neck of radius and passing through supinator muscle, which it supplies

now renamed posterior interosseous nerve

61
Q

what are the muscles in the anterior compartment of the arm supplied by

A

musculocutaneous nerve

62
Q

what do muscles does the spinal accessory nerve supply

A

sternocleidomastoid and trapezius

63
Q

what muscles act to externally rotate the shoulder

A

supra and infraspinatus and teres minor

64
Q

what muscles act to internally rotate the shoulder

A

sub scapularis

65
Q

action of the triceps brachii

A

weak extension of the arm at shoulder joint

extension of the forearm at elbow joint

66
Q
A
67
Q
A
68
Q

what are the attachments of the biceps brachii

A

proximally: long head to supraglenoid tubercule of scapula and short head to coracoid process of scapula
distally: biceps tendon to radial tuberosity

bicipital aponeurosis blends into deep (antebrachial fascia) on the medial side of proximal forearm

69
Q

what are the 3 muscles that attach to the coracoid process

A

pec minor

CORACObrachialis

short head of biceps

70
Q

path of long head of biceps brachii

A

passes superiorly in the intertubercular groove of humerus and then becomes enclosed within the fibrous layer of the shoulder joint capsule to reach the supraglenoid tubercule of scapula

71
Q

what can cause biceps tendinitis

A

movement of the long head of biceps in the intertubercular groove

causes shoulder pain that is reproduced on direct palpation of the tendon

72
Q

what nerve roots is musculocutaneous nerve made up of

A

C5, 6, 7

73
Q

what does a positive biceps deep tenon (myotactic) reflex confirm

A
  • function of muscle, musculocutaneous nerve, central connections at spinal cord level and above
  • C5 and 6
74
Q

how is a biceps deep tendon reflex elicited

A

placing thumb on biceps tendon in cubital fossa and striking thumb with a hammer

muscle should involuntarily contract - flexion of forearm at elbow

75
Q

attachments of the coracobrachialis

A

coracoid process

humerus

76
Q
A

coracobrachialis

77
Q

how is the coracobrachialis separated from the triceps

A

medial intermuscular septum

78
Q

attachments of brachialis

A

humerus

coronoid process of ulna

79
Q

how is the brachialis separated from the triceps

A

lateral intermuscular septae

80
Q

biceps brachii action

A

powerful supinator and flexor (supination is most powerful in flexion)

81
Q

innervation of the muscles of the forearm anterior

A

median nerve

except flexor carpi ulnaris and medial half of flexor digitorum profundus - ulnar nerve

82
Q

superficial muscles of anterior forearm from lat to medial

A
83
Q

where does the palmaris longus attach to distally

A

palmar aponeurosis

84
Q

where do the flexor carpi ulnaris and radialis attach distally

A

metacarpals on ulnar and radial side, respectively

85
Q

where do the superficial muscles of ant compartment of the forearm attach proximally

A

via common flexor tendon to medial epicondyle of the humerus

86
Q
A

flexor digitorum superficialis

87
Q

where does the FDS attach

A

proximally to distal humerus, coronoid process of ulna and radial head

88
Q
A
89
Q

what is the palmar aponeurosis

A

thickened central area of palmar fascia

usually continuation of palmaris longus (superficial layer anterior compartment)

90
Q

proximal attachment of FPL

A

shaft of radius and ulna and interosseous membrane

91
Q

proximal attachment of PQ

A

distal anterior surfaces of radius and ulna

92
Q

where does teh common flexor tendon attach

A

medial epicondyle of humerus (superficial anterior muscles of forearm)

93
Q

what is pain in the medial epicondyle of the humerus referred to as

A

golfers elbow

can be a result of tendonitis of the flexor tendon

94
Q

what are the borders of the cubital fossa

A
95
Q

what is the superficial contents of the cubital fossa

A

median cubital vein, cephalic vein, basilic vein

96
Q

what is the deep contents of the cubital fossa

A

distal tendon and aponeurosis of the biceps brachii

median nerve, brachial artery and radial nerve

97
Q

describe the location of the cephalic and basilic veins and how they communicate

A

median cubital vein

98
Q

what does the brachial artery do at the apex of the cubital fossa

A

bifurcate into radial and ulnar arteries

99
Q

where is the ulnar nerve found and readily injured

A

posterior surface of the medial epicondyle of the humerus - funny bone site

passes through the flexor carpi ulnaris to reach the anterior compartment of the forearm

100
Q
A
101
Q

how is the shoulder joint stabilised (static)

A

labrum and joint capsule

102
Q

bankart lesion

A

injury of anterior (inferior) glenoid labrum of the shoulder due to anterior disocation of the humerus

103
Q

adhesive capsulitis

A

eg frozen shoulder

capsule of joint necomes really tight - restricts motion (particularly external rotation) and causes chronic pain

104
Q

wrist drop

A

cant extend arm due to injury to the radial nerve (supplies all the extensor muscles (posterior) in the upper limb)

105
Q

where is radial nerve susceptible to injuries

A

humeral shaft fractures

106
Q

where do the extensors(posterior) of the forearm attach

A

lateral epicondyle

107
Q

where do the flexors (anterior) of the forearm attach

A

medial epicondyle

108
Q

tennis elbow

A

lateral epincondylitis

109
Q

how does tennis elbow occur

A

repetitive strain injury in tennis players and those who often perform resisted extension at the wrist

can also be a degenerative enthesopathy

same for golf elbow

110
Q

pathology of tennis elbow

A

micro tears in the common extensor origin

111
Q

golf elbow

A

medial epicondylitis

112
Q

what risk does injection into the area of golf elbow carry

A

injury to ulnar nerve

113
Q

what joints in the arm facilitate supination and pronation

A

proximal and distal radio-ulnar (pivot type joints)

114
Q

monteggia fracture

A

high energy fracture

mid shaft of ulna

115
Q

galeazzi fracture dislocation

A

fracture of radius and dislocation of ulna

116
Q
A
117
Q

triceps jerk

A

C6-7, radial nerve

118
Q

what fracture is notoriously difficult to spot on x ray and has a risk of AVN

A

scaphoid fracture (falling on outstretched hand)

risk of AVN due to retrograde blood supply

119
Q

duputyrens contracture

A

thickening of the palmar fascia

cant be gotten rid of

120
Q

trigger finger

A

fingers catch or lock when bent

happens when tendons become inflamed

121
Q

how does one test the function of the median nerve

A
122
Q

how does one test the adductor pollicus

A

froment’s test

123
Q

describe the dermatomal distribution of the arm

A
  • C6 - make a 6 with thumb and finger
  • C8 - pinkie
124
Q

describe the sensory supply of the arm

A
125
Q
A

supraspinatus

126
Q
A

infraspinatus

127
Q
A

teres minor

128
Q
A

teres major

129
Q

brachioradialis reflex

A

C5-6, radial nerve

RB Y2 MSK 01 Anatomy (4 decks)

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