Exam 1 Flashcards
_________ is a sheet of fibrous tissue that envelopes the body beneath the skin and or encloses muscles and groups of muscles
Fascia
_______ _____ invests the pectoral muscle and is continuous with abdominal wall fascia
Pectoral fascia
Pectoral fascia leaves the lateral border of the pectoralis to become what two fascia?
Axillary fascia
Clavipectoral fascia
______ forms the floor of the axilla
Axillary fascia
______ _____ descends from the clavicle to surround the subclavius muscle and pectoralis muscle
Clavipectoral fascia
The lower clavipectoral form the _____ _______ of the axilla
Suspensory ligament
What is the function of the suspensory ligament of the axilla?
Pulls the axillary fascia taught when the UE is abducted
______ ______ invests each muscle originating from the surface of the scapula creating a tough fascia compartment
Scapular fascia
The ______ _____ ensheathes the arm and attaches inferiorly to the epicondyles and olecranon
Brachial fascia
The medial and lateral _________ ______ extend to the medial and lateral surface of the humerus
Medial and lateral intermuscular septa
______________ separates the arm into the anterior and posterior compartments
Medial and lateral intermuscular septa
What isolates an anterior and a posterior compartment in the FOREARM?
Antebrachial fascia, introsseous membrane and the lateral intermuscular septa
Describe the cutaneous innervation of the upper limb: Deltoid: \_\_\_\_ Thumb: \_\_\_\_ 3rd digit:\_\_\_\_ 5th digit:\_\_\_\_\_
Deltoid C5
Thumb C6
3rd digit C7
5th digit C8
Superficial and deep veins communicate via _______ ____
Perforating veins
Veins begin in the ________ _____ plexus of the hand
Dorsal venous plexus
______ ______ forms on the radial side of venous plexus and courses proximally on the lateral arm crossing the arm to the delta-pectoral groove
Cephalic vein
______ ____ will pierce the clavipectoral fascia to join the axillary vein
Cephalic vein
_____ ___ begins on the ulnar side of the venous plexus
Basilic vein
______ _____ courses on the medial aspect of the forearm and arm piercing the brachial fascia to join the brachial vein and form the axillary vein
Basilic vein
Basilic vein courses on the medial aspect of the forearm and arm piercing the ______ ______ to join the ______ _____ and form the ______ _____
Brachial fascia
Brachial vein
Axillary vein
The _____ _____ vein crosses the antebrachial fossa to communicate between the cephalic and basilic veins
Median cubital vein
The median cubital vein crosses the antebrachial fossa to communicate between the ______ and _____ veins
Cephalic and basilic vein
What are the 4 lymphatics of the upper limb?
Cubital nodes
Humeral nodes
Subscapular nodes
Axillary nodes
UE lymphedema may result from metastatic involvement of _______ _______ nodes or as a consequence of its _____
Proximal brachial nodes; treatment
What are the causes of lymphedema?
Breast cancer
Trauma
Infection
Decreased mobility
What are the three distinct groups of shoulder muscles?
Anterior axioappendicular muscles
Posterior axioappendicular muscles
Scapulohumeral muscles
Anterior axioappendicular muscles - _____ muscles that move the _________
4 muscles that move the pectoral girdle
Posterior axioappendicular muscles- _____ muscles which attach the _____ to the _______
4 muscles which attach the UL to the skeleton of the trunk
Scapulohumeral muscles - _____ muscles that act on the ________
6 muscles that act on the glenohumeral joint
What are the 4 anterior axioappendicular muscles?
Pec major, Pec minor, subclavius, serratus anterior
_______ forms the anterior and inferior border of the axilla
Pec major
______ forms the inferior border of the deltopectoral groove that contains the cephalic vein
Pec major
Pec major has two heads, claavicular head and the sternocostal head. Which originates from the medial half of the anterior clavicle?
Clavilcular head
Pec major has two heads, the sternocostal head and the clavicular head. Which originates from the anterior surface of the sternum and the first 6 costoclavicular cartilages and the aponeurosis of the external oblique muscle?
Sternocostal head
Where does the pec major insert?
Into the lateral lip of the intertubercular groove of the humerus
What is the innervation of the pec major?
Medial and lateral pectoral nerve
What is the action of the pec major?
Adducts and medially rotates the humerus
Draws scapula anteriorly and inferiorly by pulling on the humerus
The clavicular head of pec major acts alone to ______ the humerus
When flexed, the sternocostal head _______ it from its flexed position
Flex
Extend
______ _____ forms the anterior wall of the axilla beneath the ____ ____
Pec minor
Pec major
_____ ____ originates from the anterior ends of the 3-5 ribs near the costal cartilage
Pec minor
____ _____ inserts into the medial border and superior surface of the coracoid process of the scapula
Pec minor
What innervates the pec minor?
Medial pectoral nerve
What are the actions of the pec minor?
Stabilizes the scapula when the UE moves
Draws scapula forward and downward
Accessory muscle of inspiration by elevating ribs
_____ _____ is the key to organizing the axilla
Pec minor
what is found on the inferior surface of the clavicle to the first rib?
Subclavius
Where does the subclavius originate at?
The junction of the first rib and costal cartilage
Where does subclavius insert?
Into the inferior surface of the middle 1/3rd of the clavicle
Subclavius is innervated by the ______
Nerve to subclavius
What are the actions of subclavius?
Pads the brachial plexus and subclavian as they pass between the clavicle and first rib
Anchors and depresses scapula
Helps prevent dislocation at the sternoclavicular joint
__________ located along lateral thorax, forms the medial wall of the axilla
Serratus anterior
______ attaches to the whole length of the medial scapula
Serratus anteiror
What is the most powerful muscle of the pectoral girdle?
Serratus anterior
What muscle originates form the external surface of lateral 1st-8th or 9 ribs
Serratus anterior
What muscle inserts onto the anterior surface of the medial border of the scapula
Serratus anterior
What nerve innervates the serratus anterior?
Long thoracic nerve
What are the actions of Serratus anterior?
Strong protractor of the scapula (boxers muscle)
Inferior part rotates the scapula to elevate the glenoid fossa
Stabilizes the scapula against the thoracic wall so other muscles can act on UE
Injury to what nerve results in winging of the scapula and in ability to raise the arm past horizontal due to inability to rotate the glenoid
Long thoracic nerve
The ____ is a truncated pyramidal space located medial and inferior to the glenohumeral joint and superior to the axillary fascia located at the junction of the arm and thorax
Axilla
______ serves as a passageway for neurovcascaular structures from the trunk to the UE
Axilla
Apex- _________ canal or ________
Cervicoaxillary canal or thoracic outlet
______ serves as the passageway between the neck and the axilla
Apex - Cervicoaxillary canal - thoracic outlet
What are the boundaries of the apex of the axilla?
Clavicle, first rib, and scapula
What does the apex conduct?
Arteries, nerves, veins and lymphatics to the UE
What is the base of the axilla formed by?
Formed by the skin, subcutaneous tissue and fascia extending from the UE to thorax
Where is the base of the axilla located?
4th rib
What forms the anterior wall of the axilla?
The pec major and minor and the clavipectoral fascia
What forms the posterior wall of the axilla? (Anteriorly and inferiorly)
Formed mainly by the scapula and subscapular (anteriorly)
Inferiorly by teres major and lat dorsi
What forms the medial wall of the axilla?
Formed by the lateral thoracic wall (4th and 5th ribs) and serratus anterior
What forms the lateral wall of the axilla?
Formed by the intertubercular groove of humerus
What are all part of the axillary sheath?
Nerve, artery, and vein
What are the contents of the axilla?
Axillary sheath (nerve, artery, and vein) and lymphatics
_________ artery is an extension of the subclavian artery as it passes the lateral border of the first rib
Axillary artery
Axillary artery changes to the _______ artery at the inferior border of the ________
Brachial artery
Teres major
What muscle is the key to describing the axillary artery?
Pec minor
The axillary artery is divided into 3 parts by ________
Pec minor
Part 1 of axillary artery is ______ to pec minor with a branch called _________ artery which supplies the first two intercostal spaces
Superior thoracic artery
Part 2 of the axillary artery is ______ to pec minor and has 2 main branches, _______ and ______
Deep
Branches: thoracoacromial trunk and lateral thoracic artery
What are the branches of part 2 of the axillary artery in the thoracoacromial trunk
Acromial, deltoid, pectoral, clavicular
One branch of part 2 of the axillary artery, The lateral thoracic artery, to __________ and runs with the ________ nerve
Serratus anterior and runs with long thoracic nerve
Part 3 of axillary artery is _______ to pec minor
Inferior
What are the branches to part 3 of the axillary artery?
Subscapular artery
Anterior humeral circumflex
Posterior humeral circumflex
What are the further branches of subscapular artery that branches off part 3 of axillary artery?
Circumflex scapular artery
Thoracodorsal artery
3rd segment of the axillar artery branched to form a _____________ System with distal subclavian branches
Peri-scapular collateral circulation system
Occlusion of the axillary artery proximal to the subscapular artery or distal to the thyrocervical trunk can be tolerated due to __________
Anastomotic network
Proximally the axillary vein lays __________ to the artery and is formed by the union of the ______ vein and the ________ vein at the inferior border of the teres major
Anteromedial; brachial vein; basilic vein
What is the correct order of the axillary lymph nodes?
Humeral, subscapular and pectoral Lymph nodes come together to lead into the central -> apical -> supraclavicular
What are the borders of the quadrangular space?
Teres major and minor, long head of triceps and humerus
What are the contents of the quadrangular space?
Axillary nerve
Posterior circumflex humeral vessels
What are the borders of the triangular space?
Teres major and minor and long head of triceps
What are the contents of the triangular space?
Circumflex scapular vessels
What are the borders of the Triangular INTERVAL?
Teres major
Long head of triceps
Lateral head of triceps
What are the contents of the triangular INTERVAL?
Radial nerve
Deep brachial vessels (profunda brachii)
What are the 3 brachial muscles in the anterior compartment?
Coracobrachialis
Biceps brachii (long head and short head)
Brachialis
All muscles of the anterior brachial compartment are innervated by _________ nerve
Musculocutaneous nerve
Coracobrachialis is a landmark for other structures:
- _______ nerve and ______ artery run posterior medial to it
- __________ artery of humerus enters at distal end
- pierce by ______ nerve
Median nerve and brachial artery
Nutrient artery
Musculocutanous nerve
What is the origin, insertion and innervation of the coracobrachialis?
Origin: coracoid process of scapula
Insertion: medial surface of humerus
Innervation: musculocutaneous
What are the two actions of coracobrachialis?
Flex arm
Adduct arm
______ _____ has no direct attachment to humerus
Biceps brachii
The short head of biceps brachii originates at the _____
The long head of scapula originates at _________
Short head: coracoid process of scapula
Long head: supraglenoid tubercle of scapula
The _________ of biceps brachii passes through the intertubercular sulcus under the transverse humeral ligament
Long head
What is the innervation and insertion of biceps brachii?
Innervation: muscuocutaneous
Insertion: radial tuberosity and bicipital aponeourosis
What are the three actions of the biceps brachii?
Flexes arm
Flexes forearm
Supinate forearm
What is the strongest forearm flexor with forearm at 90 degrees and supinated?
Biceps brachii
What is the strongest forearm supinator with forearm at 90 degrees?
Biceps brachii
________ is the workhorse of the anterior compartment
Brachialis
_______ is located deep to biceps brachii and is a pure flexor
Brachialis
What is the origin, insertion, innervation and action of brachialis?
Origin: anterior humerus
Insertion: conoid process of ulna (ulnar tuberosity)
Innervation: musculocutaneous
Action: flexes forearm
What are the 2 brachial muscles in the posterior compartment?
Triceps brachii
Anconeus
What are the triceps and anconeus (posterior compartment brachial muscles) innervated by?
Radial nerve
What actions does triceps brachii do?
Extends forearm
Extends and adducts arm (long head- weak)
What is the origin and insertion and innervation of Anconeus?
Origin: lateral epicondyle of humerus
Insertion: lateral olecranon and posterior surface of ulna
Innervation: radial nerve
________ is a triangular space with a roof and a floor
Cubital fossa
What are the superior, medial and lateral boundaries of the cubital fossa?
Superior: a line from the medial to the lateral condyles
Medial: common flexor forearm tendon and pronator teres
Lateral: extensor tendon from the lateral epicondyle, brachioradialis
What is the floor and roof of the cubital fossa?
Floor: brachialis and supinator
Roof: skin, medial cubital vein, fat, fascia and bicipital aponeurosis
What are the contents from medial to lateral in the cubital fossa?
Median nerve
Terminal brachial artery (radial and ulnar branches form at apex)
Biceps tendon
Deep radial nerve????
In the cubital fossa, the superior border is _____
The medial border is the lateral border of the ________ and the lateral border is the medial border of the ______
Imaginary line between the epicondyles
Lateral border of the pronator teres
Medial border of the brachioradialis
______ is a continuation of the axillary artery and begins at the lower border of teres major
Brachial artery
where does the brachial artery begin and end?
Begin at the lower border of teres major
Ends in cubital fossa
What does the brachial artery splits into ?
The radial and ulnar arteries opposite the neck of the radius
The brachial artery runs in the _____ _____, anterior to the _______ and _______, medial to the _______
Bicipital groove; triceps; humerus
The brachial artery enters the _____ _____ with median nerve anterior to the __________
Cubital fossa
Medial supracondylar ridge
What are the muscular branches of the brachial artery?
Nutrient artery
Profunda brachii -> middle and radial collateral branches -> anastomoses with recurrent radial artery
Superior ulnar collateral
Inferior ulnar collateral
Brachial artery -> nutrient artery to ______ at ________
Humerus at coracobrachialis
Brachial artery-> profunda brachii with the _____ nerve in the ________
Radial nerve in the radial groove
Profunda brachii branches into ____and _____ ______ Branches at the lateral epicondyle and anastomoses with ____________
Middle and radial collateral branches
Recurrent radial artery
Brachial artery-> superior ulnar collateral -> anastomoses with __________ artery
Posterior recurrent ulnar artery
Brachial artery-> inferior ulnar artery -> anastomoses with __________
Anterior ulnar recurrent artery
What allows flow to continue distally when the forearm is fully flexed with resulting near occlusion of the brachial artery?
The peri-elbow collateral circulation
What are the superficial veins in the brachium?
Cephalic, basilic, median cubital
Deep brachial vein, forms at the _______ by the confluence of the ________ and ______ veins
Elbow; radial and ulnar veins
What is the most common complication of humeral nerve fractures?
Radial nerve entrapment
What results in the inability to extend the wrist and fingers
Radial nerve palsy
