Exam 1 Flashcards
How many muscles are in anterior axioappendicular group? What do they do?
- 4
- Move the pectoral girdle
List the 4 muscles in the anterior axioappendicular group that move the pectoral girdle
- Pec major
- Pec minor
- Subclavius
- Serratus anterior
This vein is used for drawing blood
Median cubital
This vein crosses the antebrachial fossa and provides communication between cephalic and basilic veins
Median cubital vein
As the basilic vein courses on the medial side of forearm it pierces___fascia to join the ___vein which becomes the ____vein.
- Brachial fascia
- Brachial vein
- Axillary vein
The basilic vein starts on the ulnar side and courses on the ___ side of forearm
Medial
This vein begins on the ulnar side of the venous plexus
Basilic vein
The cephalic vein pierces___fascia to join the ___ vein.
- Clavipectoral
- Axillary
This vein pierces the clavipectoral fascia to join the axillary vein
Cephalic vein
This vein courses proximally on the lateral arm crossing the arm to the delto-pectoral groove.
Cephalic vein
This vein forms on the radial side of venous plexus
Cephalic vein
Veins begin in the ____ of the hand
Dorsal venus plexus
How many groups of shoulder muscles are there and what are they?
- There are 3
- . Anterior axioappendicular
- Posterior axioappendicular
- Scapulohumeral
List the 4 landmarks and their cutaneous innervations
- Deltoid-c5
- Thumb-c6
- 3rd digit-c7
- 5th digit-c8
These structures extend to the medial and lateral surface of the humerus
Medial and lateral intermuscular septa
Upper extremity lymphedema results from involvement of proximal brachial nodes or consequence of?
Metastatic Treatment
These 3 structures isolate an anterior and posterior compartment in the forearm
- Ante-brachial fascia
- Interosseous membrane
- Lateral inter-muscular septa
What are symptoms and intervention of compartment syndrome?
- pain
- weakness
- swelling
- RICE
- Surgery
What does RICE stand for?
- Rest
- -ice-
- compression
- -elevation
Pectoral fascia is also associated with the ___ of the ___ muscle.
Aponeurosis of the External oblique muscle
This fascia forms the floor of the axilla
Axillary fascia
This fascia is continuous with abdominal wall fascia
Pectoral fascia
Superficial and deep veins communicate through?
Perforating veins
The medial and lateral inter-muscular septa separates the arm into?
- Anterior-flexor
- Posterior-extensor Compartments
Compartment syndrome can occur as a result of these 4 things
- Injury procedure causes bleeding or edema within compartment
- Muscle tear-bleeding
- Over use injury causes swelling
- Inappropriate casting swelling
What bones does lunate articulate with?
Radius, scaphoid, triquetrum, capitate, hamate
Weakness results in “winging” of the scapula due to injury to?
Long thoracic nerve
How many regions are in the antebrachial region?
2
The hook of hamate forms the ___ border of ____
- Ulnar
- carpal tunnel
What muscle functions as a pad for the brachial plexus?
Subclavius
The ulna is the ____ bone of the forearm
Stabilizing bone
This fascia forms the suspensory ligament
Lower clavipectoral fascia
Clavipectoral fascia descends from the ______ and surrounds the ____ muscle and ____ muscle
- Clavicle
- -subclavius
- -pec minor
Which bone does trapezium articulate with?
- Mc 1 and 2
- T-zoid
- Scaphoid
Which bones does t-zoid articulate with?
- Scaphoid,
- 2nd metacarpal,
- t-zium,
- capitate
Which bones does capitate articulate with?
- Meta2-3-4
- Lunate
- scaphoid
- hamate
- t-zoid
What bones articulate with scaphoid
- Radius-
- lunate-
- capitate
- -tzium-
- tzoid
What bones do triquetrum articulate with?
- Hamate
- pisiform,
- lunate,
- disk of the wrist
Pisiform gives attachment to?
- Transverse carpal ligament also called flexor retinaculum
- Flexor carpi ulnaris
- Abductor digit minimi
Hamate fracture is associated with injury to ____ and _____ in _____canal
- Distal ulnar nerve
- and artery in Keons canal
The lateral and medial lips and floor of the intertubercular sulcus of humerus are attachment for which muscles?
- Pec major- lateral
- Teres major-medial
- Lattisimus dorsi-floor
Midshaft of humerus there is attachment for which muscle
Coracobrachialis
The lesser tubercle of the humerus is attachment for which muscle?
Subscapularis muscle
This structure is an attachment for inferior part of middle trapezius
Deltoid tubercle
This fracture can be caused from ulnar deviation and supination of the wrist.
Chauffers fracture- hutchisons
The ulnar tuberosity is attachment for ____ muscle.
Brachialis muscle
What portion of the clavicle is the most fractured and percent?
- `the middle 1/3 at 80%
- Lateral 1/3 is 15%
- Medial 1/3 is 5% the least
What portion of clavicle is mid % of fractured?
Lateral 1/3 at 15%
What portion of clavicle is the least fracture and what %?
Medial 1/3 at 5%
Fracture of surgical-neck of the humerus effects which nerves and muscles?
- Axillary nerve
- Teres minor
- Deltoid
The sternal end of clavicle articulates with (part of sternum) ____ at _____ joint.
Manubrium at sternoclavicular joint
Strong ligaments attach the (location) _____ clavicle to the ____ rib and the distal ____ tubercle to the ____ process of the scapula
- Proximal
- 1st rib
- Conoid tubercle
- Coracoid process of the scapula
The angles of scapula include?
- Superior (medial angle)
- Lateral (anterior angle)
- Inferior
Name the muscles attached to the corocoid process?
- Pec minor
- Corocobrachialis
- biceps- short head
What muscles are in the clavipectoral fascia?
- Subclavius
- pec minor
Which bones articulate with hamate
- Lunate,
- meta4 and 5
- Capitate
- Triquetrum
The base of the meta-c articulate with which carpal bones?
- Trapezium
- Trapezoid
- Hamate
- Capitate
This fracture creates a “dinner fork” deformity from dorsal displacement of distal fragments
Colles fracture
This fracture is usually accompanied by an ulnar styloid avulsion fracture.
Colles fracture
This fracture is usually from dorsi flexion of the hand.
Colles fracture
The tubercle on the trapezium is attachment for ____ muscle.
- Abductor pollicis brevis muscle
- oppenens pollicis
The trapezium is located on the ____ side in the ___ row of carpal bones.
Radial side Distal row
The greater and lesser tubercles of the humerus lie at the junction of?
The anatomical neck and the shaft
This fracture is a transverse fracture of the distal radius
Colles fracture
The anatomical neck (of humerus) is seperated from the head by ? (structure)
Subcapital groove
The largest carpal bone is ___
Capitate
Superior to the glenoid fossa is a “beak” structure
Coracoid process
The “notch” on the superior border is called?
Supracapular notch
Greater scapular notch is formed by lateral extension of the ____
Acromion
The costoclavicular ligament is found between the clavicle and what structure?
1st rib
What structure is found passing through the intertubercular groove of the humerus?
Long head biceps brachii
Something that passes through the radial groove?
- Radial nerve
- deep brachial artery
In the distal humerus, the medial epicondyle is for what muscles______attachment.
Flexors
The hook of hamate forms the radial border of ___ canal.
Guyons
The distal radius articulates with the carpal bones _____ and _____
Scaphoid and lunate
Chauffers-hutchisons fracture cause by compression of ____ bone against the ____ distal radius
- Scaphoid bone
- Styloid process
Chauffeurs fracture is also called
Hutchisons
This fracture is the same as colles fracture but with ventral displacement of fragments.
Smiths fracture
What professions has the most robust clavicle
Manual laborers
Clavicles are thicker on the ____ side of right handed people
Right side
This c.bone is the largest proximal
Scaphoid
This fascia descends from the clavicle to surround the subclavius muscle and pec minor
Clavipectoral fascia
This fascia leaves the lateral border of pecs to become axillary fascia
Pectoral fascia
This fascia is around the pec muscles
Pectoral fascia
What are the muscles enclosed in the scapular fascia
- Supraspinatus
- infraspinatus
- subscapularis
This fascia envelopes muscles originating from the surface of the scapula
Scapular fascia
This ligament pulls the axilla fascia taught when the UE is abducted
Suspensory ligament
This structure acts to transmit force from the hand to humerus
Interosseous membrane
The clavicle suspends the upper limb (direction) from the body to allow freedom of motion
Laterally
This is a fibrous tissue that envelopes the body beneath the skin encloses the muscles into groups
Fascia
Where does the humerus articulate- with what bones?
- Glenohumeral joint- scapula
- Elbow joint- radius and ulna
The subscapular fossa is located on ___ side of the scapula
Anterior surface
The free upper limb has _____ bones , they are?
- 30 bones
- Humerus
- Radius
- Ulna
- Carpals
- Metacarples
- Phalanges
The upper extremities includes which bones?
Clav Scap Hum Ulna Rad Car Meta Phal
This bone is the most fractured bone in the UE
Clavicle
This bone is the largest bone of the UE
Humerus
The distal extensions of the tubercles on the humerus form?
Crests or lips
The intertubercular groove of the humerus lies which tendon?
Tendon of the long head of the biceps brachii
The location of humerus is the most prone to fracture?
Surgical neck
What structure lies in the radial groove on the humerus
Radial nerve and deep brachial artery
These bones are two rows of 4 bones giving ROM
Carpal bones
The backfire of a hand crank is origination of this fracture name
Chauffeurs fracture-hutchisons
Proximal fractures of the humerus occur at?
Surgical neck
The trochlear notch articulates with ____ of the humerus
Trochlea
Which part of metacarpals articulate with phalanges?
Head of meacarpals
The acromial end of the clavicle articulates with the ____ of the scapula at the ____ joint
- Acromion
- Acromioclavicular joint
These bones form the palm and dorsum of the hand
Metacarpals and phalanges
Avascular necrosis is a risk of this fracture of carpal bones
Scaphoid fracture
This carpal bone articulates with the disc of the radioulnar joint
Triquetrum
Recite- identify the mnemonic phrase for the carpal bones
So long to pinkie here comes the thumb
What is the smallest bone in the distal row of carpals?
Trapezoid
Inferior facet of the greater tubercle is attachement for which muscles?
Teres minor
Which structures lie distal on the humerus?
- Trochlea
- Capitulum
- Olecranon fossa
- Radial fossa
- Coronoid fossa
- Supracondylar ridge
- Medial and Lateral Epicondyles
The borders of the scapula include
- Medial
- Lateral
- Superior
___accomodates olecranon of the ulna at full extension
Olecranon fossa
___ accommodates the coronoid process of the ulna at full flexion
Coronoid fossa
This structure of humerus is on medial and lateral sides
Supracondylar ridges
Superior facet on the greater tubercle is attachment for which muscles
Supraspinatus
Middle facet of greater tubercle is attachment for which muscle
Infraspinatus
This is attachment for flexor muscles
Medial epicondyle
This is attachment for extensor muscles
Lateral epicondyles
___accommodates the head of the radius at full flexion
Radial fossa
The ___ and _____ articulates with the ulna on the proximal end.
Trochlea and head of radius
The spine of scapula flattens to form the ______?
Acromion
This part of the ulna serves as a short stout lever arm for extension
Olecranon
Action of lat dorsi
- Extends
- Retracts
- medially rotates the humerus
This structure covers the intercostal space between rib 6 and 7
Triangle of auscultation
This structure enable you to hear breathing sounds of the lung most clear
Triangle of auscultation
Levator scapulae is superficial or deep
Deep
Insertion of levator scapulae
Superior medial scapula
Innervation of lebator scapulae
Dorsal scapula nerve- through the scalene muscle C3-C4
Are rhomboid major and minor deep or superficial where are they located?
They are deep muscle
deep to trapezius
Action of levator scapulae
- Elevates scapula
- Assists in downward rotation of scapula
- Bilaterally extends neck
- Unilateral action flexes neck laterally
This fascia ensheaths the arm and attaches to the epicondyles and olecranon.
Brachial fascia
Biceps brachii tendon inserts here?
Radial tuberosity
Identify structures and muscle attachment
Explain damage when midshaft fracture occurs
This fracture is an isolated fracture of the radial styloid
Chauffeurs fracture (hutchisons)
What is the most common fracture site of radius and ulna
Middle 3rd of styloid process
It the humerus breaks at these locations What nerves and muscles are damaged?
Identify
Swelling and tenderness in the snuff box due to this type of fracture.
Scaphoid fracture
This carpal bone fracture is associated with a fall open palm and occurs across the “waist” of the bone.
Scaphoid fracture
Draw carpal bones
List the order of force transfer when a fall on the hand occurs
The proximal head of the radius articulates with ____ of the humerus and the ____ of the proximal ulnar head
capitulum- radial notch
The proximal end of ulna articulates with ___ and ____
Trochlea and head of radius
Which styloid process is larger and longer?
Radial styloid process
This structure traverses the space between the radius and ulna
interosseous membrane
The fibers of the interosseous membrane run _____ from the ____ to the ____ (bone)
Infero-medialy from the radius to the ulna
This structure is proximal to _____.
What structures form the trochlear notch?
Coronoid process and olecranon process
The radial styloid prcess is ____ from the ulnar syloid process.
I cm distally
Identify this muscles
Pec major
This bone has an anteriorly directed hook
Hamate
This is a pea like bone on the palmer surface
Pisiform
This bone is moon shaped
Lunate
This bone ossifies before any other bone of the body
Clavicle
At what year does the clavicle completely ossify
25 years
The pectoral girdle has ____ bones, they are ____ and ____
- 2 bones
- Clavicle
- Scapula
The bones of the upper extremties are divided in ____ groups
2 groups
This bone is triangle shaped flat bone
Scapula
The two groups of the upper extremities are ___ and ____
- Pectoral girdle
- Free upper limbs
The clavicle connects the UE_____skeleton to the ___ skeleton
- Appendicular skeleton
- Axial skeleton
The posterior surface of the scapula is divided into ____ and ____ by the scapula spine
Infra and supra spinous fossa
This muscle forms the inferior border of the deltopectoral groove that contains the cephalic vein.
Pec major
Action of pec major
- Adducts and medially rotates the humerus 2. Draws scapula anteriorly and inferiorly by pulling on the humerus
The heads of pec major can act independently - explain
- clavicular head acts to flex the humerus
When the humerus is flexed the sternocostal head extends it from its flexed position
This muscle forms the anterior wall of the axilla beneath the pectoralis major
Pec minor
Pec minor origins
Originates from the anterior ends of the 3-5th ribs near the costal carilage
Innervation of pec minor
Medial pectoral nerve
Action of pec minor (5)
- Stabilizes the scapula when UE moves
- accessory of inspiration
- anterior wall of axilla beneath pec major
- draws scapula forward and downward
- key to the axilla
The muscle is the key to the axilla
Pec minor
Origin of subclavius
Originates at eh junction of the 1st rib and costal cartilage
Insertion of the subclavius
Inserts into the inferior surface of middle 1/3rd of the clavicle
Innervation of subclavius
Nerve to subclavius
Action of subclavius 3
- Pads the brachial plexus and subclavian as they pass between the clavicle and 1st rib 2. Anchors and depresses scapula 3. Helps prevent dislocation at the steroclavicular joint
Innervation of serratus anterior
Long thoracic nerve
Action of serratus anterior 3
- Protracts scapula 2. Inferior portion rotates the elevate the glenoid fossa 3. Stabalizes the scapula against the thoracic wall so other muscles can act on UE
This muscle is known as the “boxer muscle”
Serratus anterior
Injury to this structure results in “winging” and inability to raise the arm past horizontal due to inability to rotate glenoid
Long thoracic nerve
This muscle is a large flat muscle that attaches the pectoral girdle to the trunk
Trapezius
Trapezius is a ____ muscle (deep or superficial)
Superficial
The origin of trapezius is?
-Medial 1/3 of superior nuchal line -External occipital protuberance - nuchal ligament - spinous process of C7-T12
Insertion of trapezius is
Spine of scapula Acromion Later 1/3 of clavicle
Innervation of trapezius is?
Cranial nerve XI (11) spinal accesory nerve C3-C4
Action of trapeziua
Superior- elevates and rotate scapula Middle- retracts scapula Inferior- depresses and rotates
What does superior portion of traps do? Action
Elevates and rotates scapula
What does the middle portion of traps do? Action
Retracts scapula- attached to the deltoid tubercle on the spine of the scapula
What does the inferior portion of traps do? Action
Depresses and rotates
This muscle raises the trunk to the arm (pull-ups)
Latissimus dorsi
Latissimus dorsi is a deep or superficial muscle?
Superficial
Insertion of lat dorsi
Floor of interubercular groove of humerus
Innervation of lattisimus dorsi
Thoracodorsal nerve
This joint holds the UE to the axial skeleton
Sternoclavicular joint
This is shallow concave structure for articulation of the humeral head
Glenoid cavity
The most common site of a sesmoid bone in the hand is?
In the tendon of flexor pollicis longus
Deltoid tuberosity is attachment for? Where is this located?
Deltoid muscle tuberosity located on the humerus
This muscle is a fan shaped muscle on the superior thorax
Pectoralis major
This muscle forms the anterior wall and inferior border of the axilla.
Pec major
This muscle lies anterior to the clavipectoral fascia
Pec major
Pec major has how many heads? They are? And how many origins?
2 heads
- Clavicular head- originates from the medial half of the anterior clavicle
- Sternocostal head- originates from the anterior surface of the sternum and the 1st 6 costoclavicular cartilages
- Aponeurosis of the external oblique muscle
- 3 origins
Insertion of pec major
Inserts into the lateral lip of the intertubercular groove of the humerus
Innervation of pec major
Medial and lateral pectoral nerve (the muscle is so BIG it needs 2 nerves)
Pec minor insertions
Inserts into the medial border and suprerio surface of the coracoid process of the scapula
This muscle is found on the inferior surface of the clavicle to the 1st rib.
Subclavius
this muscle is located along the lateral thorax, and forms the medial wall of the axilla- it attaches the whole length of the medial scapula- MOST POWERFUL MUSCLE OF THE PECTORAL GIRDLE
Serratus anterior
Origin of serratus anterior
originates from the external surface lateral 1st-8th or 9th ribs
Insertion of serratus anterior
inserts onto the anterior surface of the medial border of the scapula
Weakness to this muscles impairs climbing ability
Latissimus dorsi
Origins of lat dorsi
spinour process t6-l5
thoracolubar fascia
iliac crest
This structure is found between the traps and lat dorsi and medial border of the scapula
Traingle of ausculatation
What is the floor of triangle of ausculatation
Rhomboid major
Origin of levator scapula
Transverse process of C1- C4
Insertion of levator scapulae
Superior medial scapula
Innervation of levator scapulae
Dorsal scapular nerve -through scalene muscles
C3-C4
Action of levator scapulae
- Elevates scapula
- Assists in downward rotation of scapula
- Bilaterally extend neck- neck extensor
- Unilateral action flexes neck laterally
Origin of rhomboid major and minor-
Major- spinous process of T2-T5
minor- spinous process of C7-T1
Insertion of rhomboid major and minor
Major- medial border of scapula below spin of scapula
minor- medial scapula, root of spine
Innervation of rhomboid major and minor
dorsal scapular nerve
Insertion of deltoid
Deltoid tuberosity
Innervation of deltoid
Axillary nerve
This muscles forms the posterior inferior inferior border of the axilla
Teres major
Origin of teres major
Posterior inferior angle of scapula
Insertion of teres major
medial lip of the intertubercular groove of humerus
Innervation of teres major
lower subscapular nerve
Action of teres major
adducts the arm
medially rotates the arm: due to fact that it starts at the back
Rotator cuff muscles are also called the _______muscles
scapulohumeral muscles
The rotator cuff/scapulohumeral muscles include?
- Supraspinatus
- Infraspinitus
- Teres minor
- Subscapularis
These intrinsic muscles form a musculotendinous cuff that blends with the glenohumeral joint capsule.
Rotator cuff muscles- shoulder muscles.
The supraspinatus does not _____ the arm at all.
Does not rotate
What is origin of supraspinatus
supraspinus fossa- posterior side of scapula above the spine of scapula
Insertion of supraspinatus
Superior facet of greater tubercle of the humerus
Innervation of supraspinatus
Suprascapular nerve
Origin of infraspinatus
Infraspinous fossa
Insertion of infraspinatus
Middle facet of greater tubercle of humerus
Innervation of infraspinatus
Suprascapular nerve
This muscle is hidden by the deltoid
Teres major
The origin of teres minor
lateral border of scapula
Insertion of teres minor
Inferior facet of greater tubercle of humerus
Origin of subscapularis
subscapular fossa
Insertion of subscapularis
Lesser tubercle of humerus
This structure 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
This structure serves as a passage way for neurovascular structures from the trunk to the upper extremity.
Axilla
The axilla is protected by _____ and _____.
Musculofascial and bony structures
The axilla structure consists of?
Axillary borders
apex
base
four walls- 3 muscles and one bony
The apex of the axilla is at the ______ canal which is also called _______.
Cervicoaxillary canal- thoracic outlet
This structure serves as the passageway between the neck and the axilla
cervicoaxillary canal - thoracic outlet
These Structures are boundaries and create the apex or the top portion of the axilla
Clavicle- 1st rib- scapula
What passes through the axilla ?
Arteries- nerves- veins- and lymphatics to the upper extremity
The base of the axilla is formed from what tissues (extending from what to what?)
It is formed by the skin- subcutaneous tissue and fascia extending from the upper extremity to the thorax
Where is the base of the axilla located?
At the level of the 4th rib
Which portion of the axilla is mobile depending on the position of the upper limb?
The floor of the axilla (base)
The walls of the axilla consist of?
Anterior- posterior- lateral- medial
What is the anterior wall of the axilla formed by?
- Formed by the pec major
- pec minor
- subclavius
- clavicopectoral fascia
What is the posterior wall of the axilla formed from?
- Formed mainly by the scapula and subscapularis on the anterior surface, inferiorly by teres major and latissimus dorsi and the long head of triceps brachii muscle.
The medial wall of the axilla is formed by?
The lateral-upper throacic wall- 4th and 5th ribs and serratus anterior
The lateral wall of the axilla is a bony wall- it is formed by?
By the intertubercular groove of the humerus
This structure is connective tissue that is located in the axilla- it holds structures like _____,____ and _____ and _____.
- Axillary sheath-
- nerve- artery- vein and lymphatics
The axillary vein is (in front or behind) the axillary artery?
In front of the axillary artery- the vein must be removed in order to view the artery.
The axillary artery is an extension of the ______artery and passes the ______ border of the _____ rib
Subclavian artery- lateral border of the 1st rib
At what location does the axillary artery turn into the brachial artery?
At the inferior border of the teres major
This muscle is the “key” to describing the axillary artery
pectoralis minor muscle
The axillary artery is divided into 3 parts by which muscle?
Pectoralis minor
What are the structures in part 1 of the axillary artery?
Before pec minor- superior thoracic artery- supplies the first two intercostal spaces
What structures are included in part 2 of axillary artery?
Under the pectoralis minor- branch include thoracoacromial trunk- with sub-branches- acromial- deltoid- pectoral- clavicular AND lateral thoracic artery to serratus anterior which runs along with the long thoracic nerve.
In portion 1 what is the artery circled and what does it supply?
- superior thoracic artery
- supplies the 1st two intercostal spaces
Portion 1 of the axillary artery is superior to what muscle?
Pec minor
Draw and label the entire axillary artery with divisions and supplies.
Part 2 of axillary artery is deep to this muscle.
Pec minor
What are the arterial branches in the 2nd part of axillary artery
- Thoracoacromial trunk- which includes the following branches
- : acromial branch-
- deltoid branch-
- clavicular branch-
- pectoral branch-
- lateral thoracic artery.
What does part 3 of the axillary artery consist of? (Muscle and artery branches)
- Teres major-
- circumflex humeral ant/post artery
- subscapular artery-
- circumflex scapular artery-
- thoracadorsal artery
- brachial artery
Identify all arteries and branches
These arteries wrap around the surgical neck of the humerus and can be injured if there is a break in the surgical neck.
- Anterior humeral circumflex-
- posterior humeral circumflex
This artery supports the latissimus dorsi
thoracodorsal artery
The 3rd segment of the axillary artery branches form _____ circulation system with the distal ______ branches.
Peri-scapular collarteral circulation system-
distal subclavian branches
An occlusion of the axillary artery close to the subscapular artery or far from the thyrocervical trunk can be tolerated due to the ____________
anastomotic network
Where does the axillary vein lie in regards to the axillary artery?
The axillary vein lies anteromedial to the artery
What union forms the axillary vein? and where does this union occur?
The union of the brachial vein and the basilic vein occurs at the inferior border of the teres major.
At what location does the axillary vein become the subclavian?
At the inferior border of the 1st rib
What becomes the subclavian vein at the inferior border of the 1st rib?
Axillary vein
List the progression of lymph within axillary lymph nodes.
humeral- pectoral and posterior nodes all empty into?
central node
Lymph in axillary region goes from central node to?
Apical node
From apical nodes the lymph drains into?
Supraclavicular node
Thoracic outlet syndrome is produced by compression of the _______, the ______ or the __________.
- Brachial plexus
- subclavian artery
- subclavian vein
Subtypes of thoracic outlet syndrome are referred to as?
- Neurogenic TOS
- arterial TOS
- venous TOS
Regarding TOS- Compression caused by positional is caused by movement of the _____ and ______ with arm movement.
Clavicle and shoulder girdle
Regarding TOS- Static compression of TOS is caused by ______ or ______ of the varous muscles surrounding the ____,___,and _____. The muscles are?
- Abnormalities
- enlargement
- arteris
- veins
- brachial plexus
- the muscles are ant/mid scalene muscles
Which scalenes most often cause compression of TOS?
Anterior and middle scalene muscles
How is the brachial plexus formed?
Formed by the union of the anterior rami of c5-c8 and t1 these are the roots of the brachial plexus
The roots of the brachial plexus pass (direction) between the _____ and _____ (muscle) with the ______ artery.
The roots of the brachial plexus pass LATERALLY between the ANTERIOR AND MIDDLE SCALENE muscles with the SUBCLAVIAN ARTERY.
Regarding the brachial plexus formation- the ________ fibers from the middle and inferior cervical ganglia join the roots as they pass between the ________ (muscles)
Sympathetic fibers
scalene muscles
Regarding brachial plexus- superior upper trunk is?
C5 and C6
Regarding brachial plexus- the middle trunk comes from?
C7
Regarding the brachial plexus- inferior trunk comes from?
C8 and T1
Name all the brached nerves
Name the roots, trunks, divisions and cords
Draw the complete brachial plexus and the muscles the nerves supply
Regarding the brachial plexus: in the supraclavicular area the ______ unite to form _____.
Roots unite to form trunks
What type of athlete is at most risk of rotator cuff injury?
Throwing athletes
Regarding the brachial plexus: the superior trunk (upper) come from ______ roots?
C5 and c6
Regarding the brachial plexus: the middle trunk comes from ______ root
C7
Nerves and vessels are compressed between the clavicle and the first rib causing______?
Thoracic outlet syndrome
Hypertrophied ______ muscles compresses the vessels and nerves against the clavicle.
Scalene
With regards to TOS- these structures get entrapped between these 2 structures..what are the structures?
Structure being entrapped are:
- Lower trunk of the brachial plexus
- subclavian artery
structures that are entrapping are:
- Cervical rib and
- scalene muscles- (anterior and middle scalene)
Regarding the brachial plexus: the inferior trunk comes from _____ root.
C8 and T1
Regarding the brachial plexus: as the trunks pass lateral to the________(structure) each trunk splits into anterior and posterior _________as they pass beneath the _____ and enter the ________ canal.
- 1st rib
- divisions
- clavicle
- cervicoaxillary canal
The borders of quadrangular space are?
- Teres minor
- teres major
- long head of triceps
- humerus
Contents of the quadrangular space are?
- Axillary nerve
- posterior circumflex humeral vessels
Borders of the traingular space are?
Teres minor- teres major
long head of triceps
Contents of the triangular space are?
Circumflex scapular vessels which come off of subscapular- thoracodorsal
Border to the triangular interval are?
Teres major- long head of triceps- lateral head of triceps
Triangular interval contents are?
Radial nerve- deep brachial vessels- also called profunda brachii
The brachial anterior compartment has how many muscles? What are they?
There are 3
coracobrachialis
biceps brachii (long and short head)
brachialis
This muscle is a landmark in the anterior compartment for other structures.
Coracobrachialis
A nutrient artery of humerus enters at the distal end of this muscle.
Coracobrachialis
This muscle is pierced by the musculocutaneous nerve.
Coracobrachialis
Coracobrachialis origin and insertion
origin: coracoid procedss of scapula
insertion: medial surface of humerus
This muscles sit on top of the humerus but has no direct attachment to it?
Biceps brachii
How many head does this muscles have and what is the origin of biceps brachii?
- 2 heads
- short head- coracoid process of scapula
- long head- supraglenoid tubercle of scapula- passes through intertubercular groove under the transverse humeral ligament.
*
Insertion of the biceps brachii?
- radial tuberosity
- bicipital aponeurosis
Action of biceps brachii?
- Flexes the arm weakly
- flexes the forearm strong- the strongest forearm flexor with forearm at 90 degrees
- supinates forearm- the strongest supinator with forearm at 90 degrees.
This muscle is the strongest forearm supinator with the forearm at 90 degrees.
Biceps brachii
This muscle is the strongest forearm flexor with the forearm at 90 degrees and supinated.
Biceps brachii
This muscles is the workhorse of the anterior compartment.
Brachialis
This muscle is located deep to biceps brachii.
Brachialis
This muscle is a pure flexor- this is all that it does.
Brachialis
Origin and insertion of the brachialis?
- Origin- anterior humerus
- insertion- coronoid process of the ulna - Ulnar tuberosity
This muscle inserts on the ulnar tuberosity
Brachialis
This muscle has 3 heads with 3 origins.
Triceps brachii
What are the origins of the 3 heads of triceps brachii?
- Long head- infraglenoid tubercle of scapula
- lateral head- posterior humerus, superior to the radial groove
- medial head- posterior humerus, inferior to the radial groove
Insertion of triceps brachii?mm
olecranon process of ulna
Origin of anconeus?
Lateral epicondyle of humerus
Insertion of anconeus?
- Lateral olecranon of ulna
- posterior surface of the ulna
This is a triangular space with a roof and floor in the elbow area.
Cubital fossa
List the boundaries of the cubital fossa?
- Superior- a line from the medial to the lateral epicondyles
- medial- common flexor forearm tendon and pronator teres
- lateral- extensor tendon from the lateral epicondyle, brachioradialis
- floor- brachialis and supinator
- roof- skin, median cubital vein, fat, fascia and bicipital aponeurosis
What are the contents (medial to lateral) of cubital fossa?
- Most medial is median nerve
- terminal brachial artery- radial and ulnar branches form the apex
- biceps tendon
- deep radial nerve
What is the vein that crosses and connects the cephalic and basilic at the cubital fossa?
Median cubital vein
The ______ artery begins at the lower border of teres major.
Brachial artery
The brachial artery splits into _____ and ______ arteries opposite the neck of the radius.
- Radial
- ulnar
This artery runs in the bicipital groove.
Brachial artery
The bicipital aponeurosis ________ the ________ (artery) and _______ nerve.
- Protects
- brachial artery
- median nerve
List the brachial artery muscular branches.
- Nutrient artery
- profunda brachii
- superior ulnar collateral
- inferior ulnar collateral
Regarding branches of brachial artery: the nutrient artery is for ? Located where?
Nutrient artery is for the humerus located next to the coracobrachialis
Regarding the branches of brachial artery: this artery runs with the radial nerve in the radial groove.
Profunda brachii
Profunda brachii artery branches into _____ and ______ ______ branches at lateral epicondyle. They anastomose with _______ _______ artery.
- Middle and radial collateral branches
- Recurrent radial artery.
This brachial branch anastomose with the posterior ulnar recurrent artery.
superior ulnar collateral
This brachial artery branch anastomose with the anterior ulnar collateral.
Inferior ulnar collateral
What are the deep veins?
Brachial vein
axillary vein
The deep brachial vein forms at the ______ by the confluence of the _____ and _____ veins.
Elbow- radial and ulnar
After the deep brachial is formed at the elbow it is joined by the _____ to form the _____ vein.
Basilic- axillary
(This) results in the inability to extend the wrist and fingers.
Radial nerve palsy
What are the large branches of the brachial plexus?
- Musculocutaneous
- median
- ulnar
- radial
- axillary
This nerve comes from root C5- C6- C7 and the terminal branch of the lateral cord along with lateral branch to the median nerve.
Musculocutaneous
Dthis nerve pierces the coracobrachialis (medial to lateral) and emerges on the anterior surface.
Musculocutaneous nerve
This nerve runs between the brachialis and biceps muscle bodies.
Musculocutaneous
This nerve pierces the brachial fascia to end as the lateral cutaneous nerve of the forearm running along the cephalic vein.
Musculocutaneous
This nerve innervates the muscles of the anterior compartment of the arm. What is the nerve and what are the muscles?
- Nerve is musculocutaneous nerve
- muscles are biceps brachii
- corocobrachialis
- brachialis
This nerve is sensory to the lateral antebrachium
musculocutaneous
This nerve is formed by roots c6, c7, c8, and t1
median nerve
This nerve is formed by the medial and lateral branches of the lateral and medial cords.
Median nerve
This nerve forms anterior to the axillary artery
median nerve
This nerve runs on the lateral surface of brachial artery.
Median nerve
This nerve crosses the arm Mid arm to the medial side and comes in contact with the brachialis muscle.
Median nerve
This nerve enters the cubital fossa deep to the bicipital aponeuroses and median cubital vein.
Median nerve
This nerve forms from root c8 and t1
ulnar nerve
This nerve in a continuation of the medial cord on the medial aspect of the axillary artery.
Ulnar nerve
This nerve runs anterior to the insertion of the teres major and long head of the triceps on the medial aspect of the axillary- brachial artery.
Ulnar nerve
