Chapter 7, Upper Limb (and Lecture 3 and 4) Flashcards
1
Q
name each layer passed on the way to the erectus spinae between the scapula and the vertebra
A
epidermis, papillary layer of dermis, reticular layer of dermis, superficial fascia (subcutaneous region), deep fascia, trapexius, rhomboids, erector spinae
2
Q
which bones make up the pectoral girdle?
A
the scapula and the clavicle. they attach the axilla to upper limbs.
3
Q
identify the medial border, superior border, spine of scapula, acromion, coracoid process, glenoid cavity, subscapular fossa, infraspinous fossa, and supraspinous fossa of the scapula
A
slide number 12
4
Q
identify the tubercles of the clavicle
A
slide 8
-conoid tubercle on inferior view and visible on anterior view. costal tuberosity on inferior view
5
Q
Identify the following on the humerus: greater and lesser tubercles, trochlea, capitulum, oleranon fossa, radial fossa, deltoid tuberosity, anatomical and surgical necks, medial and lateral epicondyles, coronoid fossa
A
slides 15, 16 and 17
6
Q
Identify the following (image) on radius: radial head, radial styloid process, radial tuberosity
A
slide 24
7
Q
identify the following (image) on ulna: olecranon, radial notch, ulnar styloid process, coronoid process, trochlear notch
A
slide 26
8
Q
Identify every carpal bone
A
slide 40
9
Q
which bone is the thumb missing?
A
the middle phalange
10
Q
draw each of the following muscles on a skeleton and identify their function
- Deltoid
- Supraspinatus
- Infraspinatus
- Subscapularis
- Teres minor
- Teres major
- Biceps brachii: two heads
- Triceps brachii: three heads
- Brachialis
- Brachioradialis
- Coracobrachialis
- Extensor carpi radialis
- Flexor carpi radialis
- Extensor carpi ulnaris
- Flexor carpi ulnaris
- Extensor digitorum
- Supinator
- Pronator teres
- Pronator quadratus
- Flexor digitorum(superficialis and profundus)
A
use ipad.
11
Q
what are the rotator cuff muscles?
A
the subscapularis, supraspinatus, infraspinatus, and teres minor
-they connect the scapula to the humerus and provide support for the glenohuneral joint.
12
Q
what is the intermuscular septa?
A
it is continuous with the deep fascia and it separates the anterior and posterior muscles in both the upper arm and the forearm. (in forearm, also the interosseous membrane between radius and ulna)
-bones are also part of the separation betewen anterior and posterior
13
Q
what are intrinsic muscles of the hand? what mound to they form
A
ones found only in the hand. fine motor movements. some of them form the thenar eminence, which is over metacarpal I, these muscles allow the thumb to move freely relative to other fingers.
14
Q
which muscles attach the bones of the shoulder to the trunk?
A
the trapezius, the levator scapulae, the rhomboid major, rhomboid minor, and latissimus dorsi.
15
Q
What is the brachial plexus? Where is it?
A
the network of nerves which innervates the upper limb. it is formed by the anterior rami of cervical spinal nerves C5-C8, and T1.
-it initially forms in the neck, and then continues through the axillary inlet into the axilla.
16
Q
which nerve innervates the anterior compartment of the arm?
A
MUSCULOCUTANEOUS NERVE (of brachial plexus)- all muscles in anterior compartment of the arm are innervated by this nerve
ARM is upper arm!
this nerve also innervates the skin on the anterolateral side of the forearm
17
Q
which nerve innervates the muscles in the anteiror compartment of the forearm?
A
THE MEDIAN NERVE (of brachial plexus).
- two exceptions; one flexor of the wrist (flexor carpi ulnaris muscle), and part of one flexor of the fingers (the median half of the flexor digitorum profundus muscle). these are both innervated by the ulnar nerve!!!
- also innervates the thenar muscles and the two lateral lumbrical muscles of hand
- also innervates the palmar surfave of the lateral three and one half digits,
18
Q
what does the ulnar nerve innervate?
A
most intrinsic muscles of the hand, except the thenar muscles and two lateral lumbrical muscles, which are innervated by the medial nerve!!!!!
19
Q
what does the radial nerve innervate?
A
all muscles in the posterior compartments of the arm and forearm!!!!!
also innervates skin on the posterior surface of the forearm and the dorsolateral surface of the hand
20
Q
which nerve innervates the palmar surface of the lateral three (and one half) digits?
A
the median nerve!
21
Q
which nerve innervates the skin on the anterolateral side of the forearm?
A
musculocutaneous nerve!
22
Q
what are the major terminal branches of the brachial plexus and which parts of skin do they innervate? ****** (change reference to lecture slide 4 when its out)!!!!
A
musculocutaneous,median, ulnar, axillary, and radial
IMAGE ON 686
23
Q
What are the three nerves related to parts of the humerous pass and identify on an image ? (*** Change reference!!)
A
page 687
axillary, radial, and ulnar
24
Q
what is the bone framework of the shoulder
A
the pectoral girdle (scapula and the clavicle) and the proximal end of the humerus
25
what is the bone attachment between the truck and the upper limb?
clavicle is only bone attachment!
26
what are the conoid tubercle and the trapezoid line?
together make up a tuberosity on the inferior, lateral part of clavicle.. but they are there for attachment of the coracoclavicular ligament.
27
what is the infraglenoid tubercle?
a large triangular shaped roughening inferior to the glenoid cavity on the scapula, which is the site of attachment for the long head of the triceps brachii muscle.
28
what is the supraglenoid tubercle?
superior to glenoid cavity on the scapula. It is the site of attachment for the long head of the biceps brachii.
29
what is the costal surface of the scapula
AKA, the anterior part , subscapular fossa
30
what are the three large smooth facets there for on the greater tubercle?
the superior one is for attachment of the supraspinatus muscle
the middle facet is for attachment of the infraspinatus muscle
the inferior facet is for attachment of the teres minor
the fourth rotator cuff, subscapularis, is attached at the large smooth surface on the lesser tubercle (which is anterior)
31
the tendon of which muscle passes through the intertubercular sulcus?
long head of the biceps brachii
32
which muscles are the roughenings on the lateral and medial lips, and the floor of the intertuburcular sulcus attachments for?
the pectoralis major (lateral), teres major (medial), latissimus dorsi (floor of sulcus)
33
where does the deltoid attach to the humerus?
at a large v shaped deltoid tuberosity which is continuous with the lateral lip of the intertubercular sulcus. midway along the humerus length.
34
where does the coracobrachialis muscle INSERT and originate?
inserts at about the same length on the humerus as the deltoid except on the medial side.
originates at the coracoid process.
(tendon of coracobrachialis is partly blended with the short head biceps brachii)
35
what are the three joints of the shoulder region
sternoclavicular, acromioclavicular, and glenohumeral
sternoclavicular attaches pectoral girdle to the trunk. acromioclavicular attaches pectoral girdle bones to eachother.
36
what type of joint is the sternoclavicular joint?
synovial and saddle shaped
37
which ligaments reinforce the sternoclavicular joint
1. the anterior and posterior sternoclavicular ligaments (anterior and posterior to the joint)
2. the interclavicular ligament links the ends of the two clavicles to each other and to the superior surface of the manubrium of the sternum.
3. the costoclavicular ligament is lateral to the joint and links the proximal (to the joint) end of the clavicle to the first rip and related costal cartilage.
38
which ligaments reinforce the acromioclavicular joint?
surrounded by joint capsule and reinforced by:
1. a small acromioclavicular ligament superior to the joint and passing between adjacent regions of the clavicle and acromion
2. much larger coracoclavicular ligament, which isnt related directly to the joint but is an important strong accessory ligament, providing much of the weight bearing support for the upper limb on the clavicle and maintaining the clavicle position on the acromion. it goes from the coracoid process of scapula to the inferior surface of the acromial end of the clavicle. comprises an anterior trapezoid ligament, which attaches to the trapezoid line on the clavicle, and a posterior conoid ligament , which attaches to conoid tubercle.
39
what stabilizes the glenohumeral joint?
rotator cuff muscles (infraspinatus, supraspinatus, teres minor, subscapularis), long head of biceps brachii, extrascapular ligaments
40
41
what is the axillary inlet and what passes through it
It is on each side of the superior thoracic aperture which is at the base of the neck. it is the upper region or apex OF the axilla!!
- formed by the lateral margin of rib I, the posterior surface of the clavicle, the superior margin of the scapula and the medial surface of the coracoid process of the scapula.
- the major artery and vein of the upper limb pass between the thorax and limb by going over rib I, through the axillary inlet.-- the subclavian artery becomes the axillary artery as it crosses into inlet/axilla. And the axillary vein becomes the subclavian vein as it passes and leaves the axillary inlet/axilla (as each of these cross the lateral margin of rib I)
Nerves primarily from the cervical portion fo the spinal cord also come through the axillary inlet and the axilla to supply the upper limb. Brachial plexus (which comes from C5 to T1 anterior rami) supplies innervation to upper limbs and goes through axillary inlet too!!! From axillary inlet, enters axilla where the major nerves that ultimately innervate the arm are formed
-
at the axillary inlet, the axillary vein is anterior to the axillary artery which is anterior to the trunks of the brachial plexus!
42
what innervates the muscles in the anterior compartment of the arm? (upper arm)
Musculocutaneous nerve
43
which nerve innervates muscles in the anterior part of the forearm? What is the exception?
Median nerve!! The two exceptions are the flexor of the wrist (flexor carpi ulnaris) and part of one flexor of the fingers (the medial half of the flexor digitorum profundus) these two are innervated by the ULNAR NERVE instead!!
44
45
which nerve innervates the intrinsic muscles of the hand? what is the exception?
the ULNAR nerve!!! Exception is the thenar muscles and two lateral lumbrical muscles, which are innervated by the median nerve!!
46
which nerve is responsible for the muscles in the posterior compartments of the arm and forearm?
the Radial nerve innervates ALL posterior arm and forearm muscles!!
47
which major nerve innervates the skin on the anterolateral side of the forearm
the musculocutaneous nerve!
48
what are important things to know about musculocutaneous nerve?
It innervates all of the muscles in the anterior compartment of the upper arm. it also innervates the SKIN on the anterolateral part of the forearm.
49
what does the median nerve do?
It innervates the palmar surface of the lateral three and one half digits (palm of thumb, index, middle and half of the fourth) ALSO the thenar muscles (and two lateral lumbrical muscles) as well as the tips of the fingers 1-3 and half of 4 on the dorsal side.
It innervates the muscles in the anterior compartment of the forearm (other than the felxor carpi ulnaris and the medial half of the flexor digitorum-- flexes 4th and 5th digits)
50
what does the ulnar nerve do?
innervates intrinsic muscles of the hand EXCEPT thenar muscles and two lateral lumbrical muscles (which are innervated by the median nerve)
It also innervates the skin on the palmar and back of hand on the medial side and on the 5th and half of the fourth finger.
51
what does the radial nerve do?
It innervates ALL muscles in the posterior compartments of the arm and the forearm!
Also supplies innervation to skin on the posterior surface of the forearm and lower part of posterior of upper arm. (down the middle of the forarm with musculocutaneous on lateral part of forearm)
Also innervates skin on dorsolateral surface of hand - includes the dorsal part of thumb, index, middle, and half of the fourth finger (exluding the tips of these fingers which median nerve innervates)
52
where may a bone fracture damage the axillary nerve?
surgical neck of humerus!
It is where injuries often occur and the axillary nerve which supplies the deltoid (major abductor at GH joint)
53
what does the axillary nerve do?
It innervates the superior lateral part of arm (deltoid region, it also innervates the deltoid! )
-also innervates the teres minor
54
where may a bone fracture damage the radial nerve?
posterior end, halfway down the humerus!
It passes diagonally around the posterior surface of the middle of the humerus- in the radial groove!
55
what nerve flexes the wrist as well as the distal part of the middle and fourth fingers?
the ulnar nerve!
56
where may a bone injury damage the ulnar nerve?
the medial part of the elbow. the ulnar nerve closely passes by the medial epicondyle of the humerus!
57
what innervates the skin on the anterior medial part of the wrist posterior/anterior?
this is the ulnar nerve both posterior and anterior
58
what are the roots of the brachial plexus
they are the anterior rami of C5 - T1 (there are 5 of them, C5-C8 and T1)
59
what are the trunks of the brachial plexus and what do they form from?
C5 and C6 form the superior trunk
C7 forms the middle trunk
C8 and T1 form the inferior trunk
60
follow how each trunk becomes a cord
there are THREE cords - Lateral, Posterior, and Middle
Superior, middle and inferior all form anterior and posterior DIVISIONS.
- the LATERAL cord is formed by the anterior division of the superior trunk and the anterior division of the middle trunk
- the POSTERIOR cord is formed by the posterior division of the superior, middle and inferior trunks
- the MEDIAL cord is formed by the anterior division of the inferior trunk
61
where does the brachial plexus start?
Originates around the base of the neck
62
which cord does each terminal nerve of the brachial plexus form from?
(MAY NOT HAVE TO KNOW any of these types of q's)
musculocutaneous forms from lateral cord
median forms from lateral and medial cord
radial forms from the posterior cord
ulnar forms from the medial cord
63
which nerve innervates the latissmus dorsi?
thoracodorsal, coming from c8 and t1
64
which nerve innervates the levator scapulae, rhomboid minor and rhomboid majors?
Levator scapulae : branches from C3 and C4 anterior rami, and by branches (c5) from dorsal scapular nerve
Rhomboid minor/major - dorsal scapular nerve C4 and C5
65
what innervates the pectoralis major/minor
the lateral pectoral is primarily the pectoralis major (c5, C6, C7, C8, T1)
pectoralis major - lateral and medial pectoral nerves
pectoralis minor - medial pectoral nerve (c7 and C8 primarily, also C5, C6, T1)
66
what nerve innervates the subscapularis and teres major
lower subscapular nerve -- teres major c5,c6,c7
subscapularis - upper and lower subscapular nerves -primarily c6 (also c5 and c7)
67
what nerve innervates the teres minor and deltoid?
posterior branch of axillary! after it goes through quadralangular space
-the small patch of skin in deltoid area + deltoid is anterior branch
68
what nerve innervates the serratus anterior
long thoracic nerve of bell. ?
69
what innervates the supraspinatus and infraspinatus?
the suprascapular nerve , C5! and c6
70
what passes through the suprascapular notch area?
suprascapular foramen (formed as suprascapular ligament and notch)-suprascapular nerve is through the notch. suprascapular artery and suprascapular vein are just above ligament but in the same region!
71
what importantly passes the quadralangular space?
axillary nerve and posterior circumflex humeral artery and vein. its also right by the surgical neck of the humerus so they are there too.
72
what are the significant superficial veins of the upper limb?
the cephalic, basilic, and medial cubital veins.
-they are superficial because they are in the superficial fascia of the upper limb.
73
where do the cephalic and basilic veins drain from?
The dorsal venous network on the back of the hand
- the cephalic vein originates over the anatomical snuff box at the base of the thumb (eventually passes through the clavipectoral triangle between deltoid and pectoralis major, and clavicle. at this point the vein passes into the axilla by penetrating the deep fascia just inferior to the clavicle)
- the basilic vein originates from the medial side of the dorsal venous network of the hand and passes up teh anterior surface of the limb just inferior to the elbow. (eventually penetrates deep fascia midway up the humerus)
74
what is the median cubital vein?
it connects the cephalic and basilic veins at the elbow (in cubital fossa)
75
what is the primary ROOT nerve responsible for the following movements (not as important to know as the terminal nerves I think)
abduction at GH joint
flexion of forearm
extension of forearm
flexion of fingers
abduction and adduction of the index, middle, and ring fingers
abduction at GH joint: C5
flexion of forearm: C6
extension of forearm: C7
flexion of fingers: C8
abduction and adduction of the index, middle, and ring fingers: T1
76
what are the primary muscle functions for the terminal nerves
musculocutaneous : all muscles in anterior compartment of (upper) arm
Median nerve : most flexors in forearm , and the thenar muscles in the hand (exceptions are flexor carpi ulnaris and medial part of the flexor digitorum profundus)
Radial Nerve: all muscles in the posterior compartment of the upper arm and forearm (aka, all extensions!!)
Ulnar nerve : intrinsic muscles of the hand as well as the flexor carpi ulnaris and the medial part of the flexor digitorum profundus
77
what is the function of the trapezius?
powerful elevator of the scapula. it rotates the scapula during abduction of humerus above the horizontal. middle fibers retract the scapula and lower fibers depress scapula.
innervated by motor spinal part of accessory nerve (XI). sensory (proprioception) anterior rami of C3 and C4
78
what is the function of the levator scapulae?
elevates the scapula
innervated by branches directly from anterior rami of c3 and c4 and also by Dorsal scapular nerve (coming from C5)
79
what is the function of the rhomboids?
elevate and retract the scapula
| (dorsal scapular nerve, C4 and C5)
80
what forms the triangular space from the posterior view and what is it providing passage between? what passes through?
area of communication between the axilla and the posterior scapular region.
from posterior view -
bordered on the lateral side by the medial side of tricep brachii long head, on inferior side the upper part of the teres major, and on superior side the lower part of teres minor
circumflex scapular artery and vein pass through!
81
what forms the triangular interval and what passes through, what is it a passage between?
It is formed by the shaft of the humerus, the lateral part of the long head of tricep brachii, and the inferior part of the teres major
- passage between the anterior and posterior compartments of the arm and between the posterior compartment of the arm and the axilla
- the radial nerve , the profunda brachii artery (deep artery of the arm) and associated veins pass through it
82
what forms the POSTERIOR quadralangular space and what passes through?
from the posterior scapular side, its bordered with the teres minor above, the teres major below, the surgical neck of the humerus on the lateral side, and the lateral side of the long head of the triceps brachii on the medial side.
83
what is the path of the suprascapular nerve?
Originates in base of the neck from the superior trunk of the brachial plexus. It passes posterolaterally from its origin, through the suprascapular foramen to reach the posterior scapular area. It's between bone and muscle here. it innervates the supraspinatus and then passes through the greater scapular notch, and terminates in and innervates the infraspinatus muscle.
84
what is the axilla formed by in borders?
what is on its anterior wall, inlet, medial wall, lateral wall, posterio wall and floor?
formed by the clavicle, the scapula, the thoracic wall, and related muscles. It has four sides, an inlet and a floor.
Anterior wall is the pectoralis major and minor muscles, the subclavius muscle, clavipectoral fascia
Inlet is the lateral margin of rib 1, clavicle, superior margin of scapula to coracoid process
the medial wall is the upper thoracic wall, and serratus anterior muscle.
the floor is the skin of the armpit, it opens on the lateral end into the arm.
lateral wall is the intertubercular sulcus of the humerus
The posterior wall is the subscapularis, the teres major, latissmus dorsi muscles, and the long head of tricep brachii.
85
what is the path of the axillary nerve?
It originates from the posterior cord of the brachial plexus, and it exits the axilla by passing through the quadralangular space in the posterior wall of the axilla, entering the posterior scapular area. with the posterior circumflex humeral artery and vein, it is directly related to the posterior surface of the surgical neck of the humerus.
It innervates the deltoid and teres minor muscles. It has a cutaneous branch- the superior lateral cutaneous nerve of the arm, which is skin sensation over the inferior part of the deltoid muscle.
86
what is the significance of the axilla?
all major structures passing into and out of the upper limb pass through it.
87
(incase) what is the function of the pectoralis major?
flexion, adduction and medial rotation of the arm at the glenohumeral joint. the clavicular head - flexion of extended arm. sternocostal head - extension of flexed arm
88
(incase) what is the function of the pectoralis minor?
pulls tip of shoulder down, protracts scapula.
89
what is the function of the serratus anterior?
keeps the scapula postitioned on the rib cage primarily- keeps medial border and inferior angle of scapula opposed to thoracic wall! Also protraction and rotation of the scapula.
90
what forms the quadralangular space viewed anteriorly?
the inferior part of subscapularis, lateral part of long head tricep, superior part of teres major, and the surgical neck of humerus.
(axillary nerve and posterior circumflex humeral artery and vein pass here)
91
what forms the triangular space from anterior view?
inferior part of subscapularis, superior part of teres major, and medial part of long head tricep.
(circumflex scapular artery and vein pass here)
92
what forms the triangular interval from anterior view?
lateral margin of long head tricep, shaft of humerus, inferior part of teres major
(radial nerve passes out of axilla traveling through this to get to the posterior part of the arm. also the profunda brachii artery passes)
93
what is the suprascapular artery for?
supraspinatus and infraspinatus as well as other muscles along its course!
it originates in the base of the neck as a branch of the thyrocervical trunk which is a branch of the subclavian artery
94
what is the psoterior circumflex humeral artery?
originates from the third part of the axillarty artery in the axilla. leaves axilla through quadralangular space in posterior wall along with axillary nerve. enter posterior scapular region. supplies the related muscles and the glenohumeral joint.
95
what passes through the axilla (overall)
major vessels, nerves, and lymphatics of the upper limb. Also contains the proximal parts of two muscles of the arm, the axillary process of the breast, and collections of lymph nodes, which drain the upper limb, chest wall and breast
proximal parts o fbiceps brachii and coracobrachialis muscles pass through the axilla too.
96
97
what are the three parts of the axillary artery ?
At the lateral margin of rib 1, subclavian artery becomes the axillary artery.
It is divided into three parts by the pectoralis muscle which crosses anteriorly to the vessel. the 1st part is proximal to pectoralis minor, the second is posterior to the pectoralis muscle, and the third is distal. (the muscle is diagonal from the coracoid process)
the first part has one branch originating from it - the superior thoracic artery
the second part has two branches originating from it - the thoraco-acromial artery and the lateral thoracic artery
the third part has three branches. - the subscapular artery, the anterior circumflex humeral artery, and the posterior circumflex humeral artery.
-
98
