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MM Test 1 > B6.004 Shoulder, Axilla, Brachial Plexus, Arm > Flashcards

B6.004 Shoulder, Axilla, Brachial Plexus, Arm Flashcards

1
Q

what are extrinsic shoulder muscles

A

muscles have attachments to the thoracic wall

thoracoappendicular

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2
Q

what are the extrinsic shoulder muscles

A

4 anterior: pec major, pec minor, subclavius, serratus anterior
4 posterior: superficial - trapezius, latissimus dorsi and deep - levator scapulae, rhomboids

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3
Q

what are intrinsic shoulder muscles

A

muscles only attach to shoulder bones

scapulohumeral

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4
Q

what are the intrinsic shoulder muscles

A

deltoid
teres major
4 rotator cuff muscles (supraspinatus, infraspinatus, teres minor, subscapularis)

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5
Q

pec major orientation

A

forms anterior wall of axilla
inferior border forms anterior axillary fold
forms deltopectoral triangle w deltoid and clavicle

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6
Q

vein in pec major

A

cephalic vein runs in deltopectoral triangle/groove

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7
Q

innervation of pec major

A

medial and lateral pectoral nerves

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8
Q

function of pec major

A

adducts and medially rotates the humerus

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9
Q

origin of pec major

A

3 origins
clavicle
sternum
costal cartilage

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10
Q

insertion of pec major

A

lateral lip of intertubercular groove on humerus

twists on itself when arm is adducted

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11
Q

how can you rupture your pec major insertion

A

bench pressing too much weight

hurt a lot and take months to recover after surgery

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12
Q

orientation of pec minor

A

deep to the pec major

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13
Q

insertion of pec minor

A

coracoid of scapula

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14
Q

origin of pec minor

A

ribs 3,4,5

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15
Q

function of pec minor

A

fixes scapula to thoracic wall
stretch arms forward/upward to touch an object our of reach
helps with inspiration by lifting ribs

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16
Q

innervation of pec minor

A

medial pectoral nerve

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17
Q

orientation of serratus anterior

A

medial wall of axilla

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18
Q

function of serratus anterior

A

protracts the scapula when reaching anteriorly
rotates inferior angle of the scapula so glenoid cavity is raised when arm is above shoulder
holds scapula against thoracic wall

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19
Q

insertion of serratus anterior

A

anterior surface of medial border of scapula

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20
Q

origin of serratus anterior

A

external surface of ribs 2-8

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21
Q

innervation of serratus anterior

A

long thoracic nerve

SALT

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22
Q

cause of paralysis of serratus anterior

A

injury to long thoracic nerve or any injury above this nerve’s spinal level

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23
Q

appearance of paralysis of serratus anterior

A

winged scapula
medial border and inferior angle of scapula is markedly pulled away from the posterior thoracic wall
arm cannot abduct above horizontal because serratus anterior is used to pull the inferior scapula laterally

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24
Q

function of trapezius

A

superior - elevates scapula
middle - retract (adducts) the scapula
inferior - depress the scapula and lower the shoulder
involved in scapular rotation w cooperation between superior and inferior fibers

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25
Q

insertions of trapezius

A

acromion

spine of scapula

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26
Q

origins of trapezius

A

superior nuchal line
C7
T12

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27
Q

how do you test the trapezius

A

shrug against resistance

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28
Q

innervations of trapezius

A

spinal accessory nerve CN X1

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29
Q

function of latissimus dorsi

A

extends, adducts, and medially rotates the humerus
brings body towards arms when climbing
forms part of posterior wall of axilla

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30
Q

innervation of latissimus dorsi

A

thoracodorsal nerve

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31
Q

origin of latissimus dorsi

A

T7-12
thoracolumbar fascia
iliac crest

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32
Q

insertion of latissimus dorsi

A

intertubercular groove of humerus (medial lip)

superior fibers insert inferiorly on humerus (twisting when arm is adducted)

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33
Q

what do trapezius and lat dorsi have in common

A

both superficial back muscles and muscles of the upper extremity

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34
Q

injury to thoracodorsal nerve

A

can be injured in surgery (radical breast dissections)
if injured, patient cannot use axillary crutch because there will be no counter force for the shoulder when it is pushed up by the crutch
cannot do pull ups

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35
Q

orientation of levator scapulae

A

superior 1/3 lies deep to the SCM

inferior 1/3 lies deep to trapezius

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36
Q

origin of levator scapulae

A

transverse process of C1-C4

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37
Q

insertion of levator scapulae

A

medial border of scapula, cranial to spine of scapula

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38
Q

function of levator scapulae

A

elevate and rotate scapula

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39
Q

innervation of levator scapulae

A

dorsal scapular nerve

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40
Q

orientation of rhomboid muscles

A

deep to trapezius

cannot be seen, but can be palpated

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41
Q

innervation of rhomboids

A

dorsal scapular nerve

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42
Q

origins of rhomboids

A

minor: C7-T1
major: T2-T5

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43
Q

insertion of rhomboids

A

medial borders of scapula

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44
Q

rhomboid test

A

patient lie prone with hand over small of back

ask patient to lift hand off which hand on rhomboid

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45
Q

function of rhomboids

A

adduct, retract the scapula toward the middle of the back

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46
Q

function of deltoid

A

cannot initiate abduction when arm is fully adducts (assisted by supraspinatus for first 15 degrees)
stabilized shoulder joint by holding head of humerus in the glenoid cavity during movement
anterior part - flex shoulder
posterior part - extend shoulder

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47
Q

innervation of deltoid

A

axillary nerve

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48
Q

origins of deltoid

A

acromion
spine of scapula
clavicle

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49
Q

insertion of deltoid

A

deltoid tuberosity

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50
Q

causes of damage to axillary nerve

A

shoulder joint dislocation
humeral surgical neck fracture
intramuscular injection

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51
Q

appearance of damage to axillary nerve

A

loss of sensation on lateral side of proximal arm skin

loss of shoulder contour

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52
Q

deltoid muscle test

A

abduction of shoulder beyond 15 degrees

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53
Q

orientation of teres major muscle

A

inferior border of the posterior wall of the axilla

intercepts with long head of triceps to form triangular space and quadrangular space

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54
Q

function of teres major

A

stabilizes humeral head
counteracts deltoid during abduction
adduction of humerus
medially rotates the humerus

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55
Q

origin of teres major

A

inferior angle of scapula

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56
Q

insertion of teres major

A

medial lip of interturbercular groove

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57
Q

innervation of teres major

A

lower subscapular nerve

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58
Q

importance of triangular space

A

exits circumflex scapular artery

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59
Q

important of quadrangular space

A

exits posterior circumflex humeral artery and axillary nerve

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60
Q

rotator cuff muscles

A 
supraspinatus
infraspinatus
teres minor
subscapularis
SItS
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61
Q

function of rotator cuff

A

stabilize the shoulder and secure humeral head in the glenoid (ALL)
abduct arm- supraspinatus helps with initial 15
adduct the arm - subscapularis, teres minor
medial rotation - subscapularis, teres major
lateral roation- infraspinatus, teres minor

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62
Q

shoulder exam of infraspinatus and teres minor

A

lateral rotators

patient rotates forearm against resistant

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63
Q

shoulder exam of subscapularis

A

lift off test
patient lifts hand off the small of back against resistant
tests medial rotation of shoulder joint

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64
Q

shoulder exam of supraspinatus

A

empty can test
arms extended held 90 abduction with 30 flexion anteriors
turn thumbs down and elevate arms against resistant

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65
Q

most frequently compromised muscle of rotator cuff

A

supraspinatus

can be compressed during shoulder abduction by acromion

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66
Q

what is a bursa

A

small viscous fluid filled sac lined by synovial membrane

completely separate from glenohumeral joint capsule

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67
Q

causes of rotator cuff injuries

A

falls
avoiding crashing into an object using the arm
throwing a ball hard
shoulder joint dislocation

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68
Q

result of rotator cuff injuries

A

pain in anterosuperior part of the shoulder

shoulder joint dislocation

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69
Q

test for rotator cuff injuries

A

ask patient to lower a fully abducted arm slowly and smoothly
drop arm test

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70
Q

epidemiology of rotator cuff injuries

A

2 million people in US in 2013
presents w dull ache in shoulder, worsened by sleeping on it
most often in repeated overhead motion

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71
Q

subacromial bursitis and calcification / supraspinatus tendonitis

A

occurs between tendon of supraspinatus and the acromion, coracoid ligament, and deltoid

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72
Q

result of subacromial bursitis and calcification / supraspinatus tendonitis

A

pain during abduction in 50-130 degree range

painful arc syndrome

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73
Q

triangular space

A

circumflex scapular artery

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74
Q

quadrangular space

A

axillary nerve

posterior circumflex humeral artery

75
Q

triceps hiatus / triangular interval

A

radial nerve

profundal brachii artery

76
Q

what is the axilla

A

pyramidal shaped space between arm and thorax providing a passage for vessels and nerves to reach the upper limb
neurovascular structures are ensheathed in a fascial sleeve called axillary sheath

77
Q

origin of axillary artery

A

continues from subclavian arty just lateral to first rib

78
Q

how many branches of axillary artery?

A

3 parts

6 branches

79
Q

first part of axillary artery

A

superior thoracic artery

80
Q

second part of axillary artery

A

thoracoacromial

lateral thoracic artery

81
Q

third part of axillary artery

A

subscapular

anterior and posterior circumflex humeral arteries

82
Q

lateral thoracic artery

A

important source of blood to lateral part of mammary gland in women
runs with long thoracic nerve to serratus anterior

83
Q

subscapular artery

A

largest branch of axillary artery

divides into circumflex scapular and thoracodorsal arteries

84
Q

circumflex scapular artery

A

supplies subscapularis and teres major

85
Q

thoracodorsal artery

A

supplies lat dorsi

86
Q

circumflex humeral arteries

A

anterior and posterior anastomose w each other and supplies delt, teres major and minor, and long head of triceps

87
Q

compression of the axillary artery

A

do this when there is heavy bleeding of the arm
2 compression locations
1. distal part of axillary artery, palpate the inferior part of the lateral wall of the axilla against the humeral bone
2. at beginning of artery, downward pressure in the angle between the clavicle and the attachment of SCM muscle against 1st rib

88
Q

mnemonic for axillary artery branches

A

1: Superior thoracic
2: Thoracoacromial
Lateral thoracic
3: Subscapular
Anterior
Posterior circumflex humeral
“screw the lawyer, save a patient”

89
Q

axillary lymph node dissection

A 
2 vulnerable nerves
long thoracic nerve (serratus anterior, winged scapula if cut)
thoracodosal nerve (lat dorsi)
90
Q

location of brachial plexus

A

C5-T1

91
Q

overview of brachial plexus

A

union of anterior rami of C5, C6, C7, C8, and T1
begins in neck and extends into axilla
carries nerve fibers from motor neurons, sensory neurons, and autonomic (sympathetic) neurons

92
Q

5 sections of the brachial plexus

A 
roots -5
trunks -3
divisions - 6
cords - 3
terminal branches -5
93
Q

roots of brachial plexus

A

C5-8

T1

94
Q

3 nerves given out of roots of brachial plexus

A 
dorsal scapular (C5)
phrenic (C3,4,5)
long thoracic (C5,6,7)
95
Q

dorsal scapular nerve

A

rhomboids and levator scapulae

96
Q

phrenic nerve

A

diaphragm

97
Q

long thoracic nerve

A

serratus anterior

C5,6,7 wings to heaven

98
Q

anatomy of long thoracic nerve

A

travels between middle and posterior scalene muscles
hypertrophy of these muscles (Swimmers) can cause compression and loss of function
SUPERFICIAL to serratus anterior (rare)

99
Q

3 trunks of brachial plexus

A

superior
middle
inferior

100
Q

superior trunk of brachial plexus

A

union of C5 and C6 roots
give out 2 nerves
1. subclavius
2. suprascapular nerve (C4,5,6)

101
Q

suprascapular nerve

A

supraspinatus
infraspinatus
glenoid joint

102
Q

middle trunk of brachial plexus

A

continuation of C7 root

103
Q

inferior trunk of brachial plexus

A

union of C8 and T1

104
Q

3 cords of brachial plexus

A

lateral
posterior
medial
named for relationship to axillary artery

105
Q

lateral cord

A

union of anterior division of superior and middle trunks

carry fibers from C5,6,7

106
Q

branch off of lateral cord

A

lateral pectoral nerve (C5,6,7)

107
Q

lateral pectoral nerve

A

innervates pec major

108
Q

medial cord

A

formed from continuation of the anterior division of the inferior trunk
fibers from C8-T1
three branches

109
Q

branches off medial cord

A

medial pectoral nerve (C8, t1)
medial cutaneous nerve of arm (C8, T1)
medial cutaneous nerve of the forearm (C8,T1)

110
Q

medial pectoral nerve

A

pec major and minor

111
Q

medial cutaneous nerve of arm

A

supplies skin on medial side of the arm and superior part of the forearm

112
Q

medial cutaneous nerve of the forearm

A

supplies skin on medial side of forearm

113
Q

posterior cord

A

formed by posterior divisions of all 3 trunks
carrying fibers from C5-T1
three branches

114
Q

branches off posterior cord

A 
upper subscapular (C5,6)
thoracodorsal (C6,7)
lower subscapular (C6,7)
115
Q

upper subscapular nerve

A

subscapularis

116
Q

thoracodorsal nerve

A

lat dorsi

117
Q

lower subscapular nerve

A

teres major

inferior subscapularis

118
Q

anatomy of thoracodorsal

A

travels with thoracodorsal artery to lat dorsi

119
Q

5 terminal branches

A 
musculocutaneous - lat cord
axillary - post cord
median - lat and med cords
radial - post cord
ulnar - med cord
120
Q

mnemonic for branches

A

most alcoholics must really urinate

121
Q

anatomy of axillary nerve

A

quadrangular space

122
Q

axillary nerve

A

deltoid
skin over lower half of deltoid
teres minor
abducts shoulder

123
Q

fracture of the surgical neck

A

can damage axillary nerve
common in elderly due to FOOSH
fracture may be stable due to ligaments surrounding this region

124
Q

injury of the axillary nerve

A

loss of sensation on skin of medial shoulder

125
Q

test for injury of axillary nerve

A

abduction of the shoulder joint beyond the first 15 degrees and continued abduction against resistant

126
Q

musculocutaneous nerve

A

innervates all 3 muscles in anterior compartment of the arm

flexes shoulder and elbow

127
Q

branches of musculocutaneous nerve

A

coracobrachialis
biceps
brachialis
lateral cutaneous nerve of forearm

128
Q

radial nerve

A

innervates all posterior arm muscles
innervates all 11 posterior compartment forearms muscles
extends shoulder, elbow, and wrist

129
Q

nerve and vessel injuries related to humerus fractures

A

surgical neck = axillary nerve
mid humeral = radial nerve and deep arm vessels
distal end = median nerve (rare)
medial epicondyle = ulnar nerve

130
Q

radial nerve injury

A

before triceps: paralysis of triceps (loss of elbow extension), brachioradialis, supinator and extensor muscles of the wrist and digits. loss of sensation on back of hand over first 3 fingers.
after triceps: same except triceps still functions (can extend elbow)

131
Q

radial neuropathy

A

Saturday night palsy
wrist and finger drop
numbness in hand
weak supination and elbow flex

132
Q

median nerve

A

innervates all anterior compartment muscles of forearm except 1.5 (innervated by ulnar)
flexes wrist and fingers
3 thumb muscles and 1/2 lumbricles

133
Q

ulnar nerve

A

innervates 1.5 forearm muscles (flexor carpi ulnaris and half of flexor digitorum profundus)
innervates all hand muscles

134
Q

relationship between roots and terminal branches

A

axillary- C5,6
musculocutaneous - C5,6,7
ulnar- C8,T1
median and radial- C5-T1

135
Q

cause of brachial plexus injuries

A

mechanical, sometimes cancer

136
Q

presentation of brachial plexus injuries

A

paralysis or anesthesia

137
Q

superior brachial plexus injuries

A

C5,6

Erb’s palsy

138
Q

inferior brachial plexus injuries

A

C8.T1

Klumpkes palsy

139
Q

causes of erbs palsy

A

excessive separation of the head and neck such as falling with shoulder on ground
shoulder dystocia, head delivers but babies shoulders get stuck in birth canal causing excessive stretching of babies head from shoulder(1-3 per 1000)

140
Q

appearance of erbs palsy

A

waiter tip position
limb hangs at side in medial rotation
loss of sensation on lateral aspect of limb down to thumb

141
Q

nerves injured in erbs pals

A

suprascapular
musculocutaneous
axillary

142
Q

muscle paralysis in erbs

A 
supraspinatus
infraspinatus
deltoid
biceps
brachialis
brachioradialis
143
Q

cause of klumpkes palsy

A

sudden pull of arm superiorly such as grasping a tree during a fall

144
Q

appearance of klumpkes palsy

A

short muscles of hand form a claw when trying to form a fist
similar to ulnar nerve damage
rare

145
Q

brachial plexitis

A

sharp, severe sudden onset pain in nerves of brachial plexus or a portion
weakness, pain and atrophy follow
unknown cause

146
Q

treatment of brachial plexitis

A

corticosteroids and gabapentin
teakes months to slowly improve
2-3 years for recovery, some have permanent damage

147
Q

2 compartments of arm muscles

A

anterior: biceps brachii, brachialis, coracobrachialis
posterior: triceps brachii, anconeous

148
Q

anterior compartment of arm muscles

A

flexors

musculocutaneous innervation

149
Q

posterior compartment of arm muscles

A

extensors of elbow

innervated by radial nerve

150
Q

proximal origins of biceps brachii

A

short head from coracoid process

long head from supraglenoid tubercle

151
Q

path of long head of biceps brachii

A

runs through glenohumeral joint, surrounded by synovial membrane, then over the head of the humerus, inside the intertubercular groove where it is fixed by the transverse humeral ligament

152
Q

insertions of biceps brachii

A

distal end forms a tendon which attaches to the tuberosity of the radius
distal end continues as the bicipital aponeurosis, a membranous band that runs from the biceps tendon around the cubital fossa and merges with antebrachial fascia

153
Q

bicipital aponeurosis

A

protects brachial artery and medial nerve in the cubital fossa, esp during median cubital vein

154
Q

function of biceps brachii

A

flexes arm and forearm

supinates the forearm when elbow is flexed at 90 degrees

155
Q

biceps tendinitis

A

affects the tendon of the long head which is enclosed by a synovial sheath and lies in the intertubercular groove
caused by repetitive microtrauma
similar pain levels w active and passive motion

156
Q

subluxation/dislocation of the tendon of the long head of the biceps

A

may be caused by tendinitis and a traumatic separation of the proximal epiphysis of the humerus
disruption of the transverse humeral ligament
associated with rotator cuff injury 70% of the time

157
Q

symptoms of subluxation/dislocation of the tendon of the long head of the biceps

A

popping or catching sensation in anterior shoulder

particularly when shoulder is abducted to 90 degrees

158
Q

rupture of the tendon of the long head of the biceps

A

causes: excessive forceful flexion of the arms or wear and tear of an inflamed tendon
appearance: popeye deformity, ball near center of the distal part of the anterior aspect of the arm
may also avulse its insertion into radial tuberosity or rarely tear the central belly of the muscle

159
Q

dislocation of proximal humeral epiphysis

A

happens to children or adolescents when arm or shoulder is directly hit by a flow

160
Q

brachialis muscle orientation

A

deep to biceps

161
Q

origin of brachialis

A

distal half of anterior surface of humerus

162
Q

insertion of brachialis

A

coronoid process and tuberosity of ulna

163
Q

innervation of brachialis

A

musculocutaneous

164
Q

function of brachialis

A

elbow flexor

165
Q

origin of coracobrachialis

A

coracoid process

166
Q

insertion of coracobrachialis

A

mid 1/3 of humerus

167
Q

innervation of coracobrachialis

A

musculocutaneous

PIERCES this muscle and innervates it

168
Q

function of coracobrachialis

A

flexes and adducts shoulder

stabilizes glenohumeral joint

169
Q

anatomy of coracobrachialis

A

median nerve and humeral artery run deep

musculocutaneous runs anterior to the inferior part of the muscle

170
Q

origin of triceps

A

long head - infraglenoid tubercle
lateral head - posterior of humerus
medial head - distal posterior humerus

171
Q

insertion of triceps

A

olecronon process of ulna

172
Q

function of triceps

A

extends elbow

adduction and extends shoulder

173
Q

triceps test

A

abduct arms 90 degrees

extend elbow joint against resistance

174
Q

innervation of triceps

A

radial nerve

175
Q

brachial artery anatomy

A

starts from inferior teres major and ends in cubital fossa under the bicipital aponeurosis
divides into radial and ulnar arteries

176
Q

profundal brachii

A

deep artery of the arm
largest branch of brachial artery, accompanies radial nerve through radial groove
divides around elbow joint

177
Q

2 groups of arm veins

A
  1. superficial - runs in the subQ tissue

2. deep - runs along with arteries

178
Q

superficial veins of arm

A

cephalic
basilic
median cubital

179
Q

cephalic vein

A

anterolateral surface of proximal forearm and arm

pass through deltopectoral groove and deltopectoral triangle into axillary vein

180
Q

basilic vein

A

medial side of inferior arm

merge with veins accompanying brachial artery to for axillary vein

181
Q

median cubital vein

A

2 veins forms anastomoses in the forearm and communicate in the cubital fossa

182
Q

result of musculocutaneous nerve injury

A

paralysis of coracobrachialis, biceps, and brachialis
weakened shoulder flexions
weakened forearm flexion and supination
loss of sensation on lateral forearm

183
Q

what is the cubital fossa

A

hollow area on the anterior aspect of the elbow
contains: brachial artery (and radial and ulnar branches), deep veins, biceps brachii tendon, median nerve, radial nerve branches

184
Q

venipuncture from cutaneous vein

A

median cubital vein is a common location of blood sampling, infusion, injection, and cath

MM Test 1 (20 decks)

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