Equine Proximal Thoracic Limb Flashcards
Notable bony prominences scapula
scapular spine supraspinous fossa infraspinous fossa scapular notch supraglenoid tubercle scapular cartilage
scapular spine
lateral aspect in middle of scapula
supraspinous fossa
on cr lateral aspect of scapula, supraspinatus attaches to this
infraspinous fossa
on cd lateral aspect of scapula, infraspinatus attaches to this
supraglenoid tubercle
cr scapula, wedge like, on thin side of scapula, adjacent to scapular notch
- biceps brachii attaches here
scapular notch
on dorsal aspect of scapula, cr, adjacent to superglenoid tubercle (starts around narrowing of scapula)
scapular cartilage
on dorsal aspect of scapula on wide end; can become ossified
notable bony landmarks of humerus
greater tubercle
lesser tubercle
intermediate tubercle
medial and lateral epicondyles
notable bony landmarks of radius
medial and lateral styloid processes
notable bony process of ulna
- olecranon
- ulna is not complete in horse; the dorsal remnant of the the ulna is the lateral styloid process
greater tubercle of the humerus
lateral, has cr and cd part; cr part is pt of shoulder
lesser tubercle of the humerus
on medial side of humerus
intermediate tubercle of humerus
on dorsal aspect of humerus between greater and lesser tubercle
- biceps runs through groove divided by this
- teres major attaches here
what attaches to greater tubercle of the humerus
supraspinatus and infraspinatus
what attaches to the lesser tubercle of the humerus
supraspinatus and subscapularis
medial and lateral epicondyles of the humerus
on the ventral aspect of the humerus; will see jutting out of bone that is fairly rounded this is epicondyle
what attaches to lateral epicondyle of humerus
extensors of the carpus and digit
- Extensor carpi radialis
- common digital extensor
- Lateral digital extensor
- extensor carpi ulnaris
- all innervated by radial nerve
what attaches to medial epicondyle of humerus
flexors of the carpus and digit
- flexor carpi ulnaris
- Superficial digital flexor
- deep digital flexor
- flexor carpi radialis
- all innervated by mixed innervation from median and ulnar nerves
medial and lateral styloid processes
bony prominences of the radius
- on v surface (distal) of radius circular almost pointy looking bump of bone
- distal attachment points lateral ligaments?
olecranon
triceps brachii inserts here; this is the elbow
deltoid tuberosity
lateral on humerus; located mid bone
what attaches to deltoid tuberosity
deltoideus; teres minor attaches just proximal to deltoid tuberosity
carpal bones
accessory carpal bone, ulnar carpal bone, intermediate carpal bone, radial carpal bone, carpal bones 2,3, and 4
accessory carpal bone
located along back of carpus (cd aspect)
radial carpal bone
dorsal row, medial
intermediate carpal bone
dorsal row, between radial and ulnar carpal bones
ulnar carpal bone
dorsal row, lateral
carpal bones 2,3,4
2 v small v medial almost looks continuous with 3 grossly bt not on rad; 4th is lateral
what attaches to accessory carpal bone
- extensor carpi ulnaris short tendon
- flexor carpi ulnaris distal attachment
blood supply hind limb
- axillary
2a. subscapular
2b. Brachial
3b. Median
4b. Medial and lateral palmar
4bb. Medial and lateral palmar metacarpal
5b. Medial and lateral palmar digital
suprascapular nerve
innervates muscles sitting cr to spine of scapula aka lateral shoulder stabilizers (supraspinatus and infraspinatus); dives between subscapularis and infraspinatus
axillary nerve
innervates shoulder flexors (teres major and deltoideus; also innervates teres minor which is lateral stabilizer of shoulder not flexor); dives between supscapularis and teres major
subscapular nerve
innervates subscapularis; stays on medial side of shoulder
musculocutaneous
innervates elbow flexors (biceps brachii and brachialis); travels down brachium
radial nerve
innervates elbow extensors (triceps brachii) and carpal and digital extensors (extensor carpi radialis, common digital extensor, lateral digital extensor, extensor carpi ulnaris); weight bearing nerve of forelimb
median and ulnar nerves
innervate digital flexors (flexor carpi ulnaris, flexor carpi radialis, superficial digital flexor, deep digital flexor)
innervation distal limb thoracic limb
median and ulnar nerves
median nerve
- Median nerve
2a. Medial palmar nerve
3a. Communicating branch
2b. Lateral Palmar nerve
3b. Deep branch
4b. Medial and lateral palmar metacarpal nerves
2c. Medial and lateral palmar digital nerves
ulnar nerve
palmar brach blends with lateral palmar nerve
components of the passive stay apparatus do what
Overall goal is minimal energy expenditure (ligaments and tendons, want to extend every jt not flex bc flex = buckled)
- Avoid shoulder flexion
- Avoid carpal and elbow flexion
- Avoid carpal overextension
- Avoid pastern and fetlock overextension
What structure(s) avoids shoulder flexion
-Biceps brachii tendon
what structure(s) avoid carpal and elbow flexion
- Lacertus fibrosis
- extensor carpi radialis
- collateral ligaments
what structure(s) avoid carpal overextension
- palmar carpal ligament
what structure(s) avoid pastern and fetlock overextension
- suspensory apapratus
- check ligaments (proximal and distal)
collateral ligaments that avoid carpal and elbow flexion
obliquely oriented; kind of lock (on cd surface of leg)
palmar carpal ligament
avoids carpal overextension; on back of carpal bones; flexor retinaclum in palmar aspect of this
check ligaments
avoid pastern and fetlock overextension; help with extension of carpus passively
- proximal goes to SDF
- Distal goes to DDR distal to carpus (this is the check ligament that gets injured)
suspensory apparatus of the horse thoracic limb
prevents the pastern from buckling forward and the fetlock from dropping
suspensory apparatus of horse components
- body of suspensory
- suspensory branches (medial and lateral)
- extensor branches
- distal sesamoidean ligaments
body of suspensory
proximal aspect arises from dorsal row tarsal or carpal bones
suspensory branches
medial and lateral
- distal 1/3rd of canon bone
- attach to proximal sesamoid bones
extensor branches of suspensory
- attach to extensor tendons
distal sesamoidean ligaments
These are on palmar aspect
- straight (attaches to P2)
- oblique (attaches to P1)
- cruciate (attaches sesamoids -> P1)
Lateral stabilizers of shoulder
spuraspinatus (main), infraspinatus (main), and teres minor (minor)
- supraspinatus and infraspinatus innervated by suprascapular nerve
- teres minor innervated by axillary nerve
supraspinatus attachments and innervation
- supraspinous fossa to greater and lesser tubercles of humerus
supraspinatus innervation
suprascapular nerve
supraspinatus fx
lateral shoulder stabilizer, can extend shoulder
infraspinatus attachments and innervatoin
- infraspinous fossa to greater tubercle of the humerus
- innervation suprascapular nerve
infraspinatus fx
lateral shoulder stablizer
teres minor attachments and innervation
- distal half of cd border of scapula (cd to infraspinatus) to just proximal to deltoid tuberosity
- innervation axillary nerve
teres minor fx
lateral shoulder stabilizer
medial shoulder stabilizers
subscapularis; innervated by subscapular nerve
subscapularis fx
medial shoulder stabilizer
subscapularis attachments and innervaiton
- subscaplular fossa to lesser tubercle of humerus
- subscapular nerve
shoulder flexors
teres major and deltoideus
innervated by axillary nerve
teres major attachments and innervaiton
- cd border of scapula to teres major tuberosity
- axillary nerve
teres major fx
shoulder flexor
deltoideus attachments and innervation
- scapular spine and cd border of scapula (aponeurosis superficial to infraspinatus) to deltoid tuberosity
- axillary nerve
deltoideus fx
shoulder flexor
shoulder extensors
supraspinatus, biceps brachii
biceps brachii attachments and innervation
- supraglenoid tubercle to proximal radisu
- lacerates fibrosis (to ECR– attach at MC3 tuberosity on proximal dorsal aspect and helps with passive stay apparatus)
- innervated by musculocutaneous nerve
biceps brachii fx
- shoulder extensor
- elbow flexor
elbow flexors
biceps brachii and brachias
innervated by musculocutaneous nerve
elbow extensors
triceps brachii innervated by radial nerve
triceps brachii attachments and innervation
4 heads long, lateral, medial, and anconeus
- long arises from caudal border of scapula, rest from proximal humerus
- all insert on olecranon
- innervation radial nerve
triceps brachii fx
elbow extensor
carpus/ digital extensors
all innervated by radial nerve, all proximal attachments lateral epicondyle of humerus
- Extensor carpi radialis
- Common Digital extensor
- Lateral digital extensor
- Extensor carpi ulnaris
extensor carpi radialis attachments and innervation
- lateral epicondyle of humerus -> MC3 (proximal dorsal aspect- MC tuberosity)
- radial nerve
common digital extenosor attachments and innervation
- lateral epicondyle of humerus -> P1 (with LDE), P2 and P3 (with extensor process)
radial nerve
Lateral digital extensor attachment and innervation
- lateral epicondyle of humerus -> P1 (with CDE)
- radial nerve
extensor carpi ulnaris
- lateral epicondyle of humerus -> long and short tendons (long to proximal MC4, short to Ac bone)
- radial nerve
Extensor carpi radialis fx
carpal/ digital extensor
common digital extensor fx
carpal/ digital extensor
lateral digital extensor fx
carpal/ digital extensor
extensor carpi ulnaris fx
carpal/ digital extensor
Carpal/ digital flexors
- mixed innervation from median and ulnar nerves
- proximal attachment for all is medial epicondyle of humerus
- Flexor carpi ulnaris
- Superficial digital flexor
- Deep digital flexor
- Flexor Carpi radialis
Flexor carpi ulnaris attachments and innervation
medial epicondyle of humerus -> distal attachment to Ac bone
- mixed innervation from median and ulnar nerves
flexor carpi ulnaris fx
carpal/ digital flexor
superficial digital flexor attachments and innervation
medial epicondyle of humerus -> P1 and P2
- mixed innervation from median and ulnar nerves
deep digital flexor attachments and innervation
medial epicondyle of humerus -> P3
- mixed innervation from median and ulnar nerves
superficial digital flexor fx
carpal/ digital flexor
deep digital flexor fx
carpal/ digital flexor
Flexor carpi radialis attachments and innervaiton
medial epicondyle of humerus -> proximal aspect of MC2
- mixed innervation from median and ulnar nerves
flexor carpi radialis fx
carpal/ digital flexor
degenerative suspensory ligament desmitis (DSLD)
aka. EPSA; often in older horses likely multifactorial cause (genetic and enviornemtnal); pastern becomes horizontal to ground
clinical signs degenerative suspensory ligament desmitis
lameness, frequently laying down, pain on palpation, swelling, stance to alleviate strain on ligament can’t stop this; manage for pain; see dropped fetlock
proximal and/ or distal check ligament desmotomy
flexural deformities carpus, fetlock, usually cut check ligaments to alleviate strain; club foot at level of coffin jt, can have arthritis to D aspect of joint bc stand more up
laminitis
lots causes; sensitive and insensitive lamina can become inflamed and loose connection and P3 rotates bc pulled by DDF which attaches to palmar aspect P3 sometimes cut DDF sometimes cut DDF to decrease pull and sometimes cut distal check ligament bc pulls on DDF so decrease pull here leads to decreased pull of DDF
bicipital bursa
freely communicates with shoulder joint in small animals; separate synovial structure in lg animals bursa separate from shoulder jt
arthrocentesis of shoulder joint
do it standing with 3-5 inch needle; palpate cr and cd its of greater tubercle, needle inserted at notch between two
Sweeney
damage to suprascaplular nerve
sweeney acute
lateral instability of shoulder; abduction
sweeny chronic
atrophy of shoulder stabilizers (supra and infraspinatus)
elbow joint components
md and lateral collateral ligaments flexors form md epicondyle and flexors from lateral epicondyle
arthrocentesis of elbow joint
access on either side of lateral collateral ligament (palpate lateral epicondyle of humerus and lateral tuberosity of radius)
nerves of brachial plexsus
suprascapular, subscapular, radial, median, ulnar, and axillary nerve
radial nerve
accompanied by branch of deep brachial artery, winds around the humerus on cd border of brachial (is seen on medial and lateral sides of leg)
median nerve path
cranial to medial collateral ligament; crosses radial artery obliquely and proximal to carpus divides into two terminal branches