Exam 4 Flashcards
What are the five functions of the skin?
**BRETS
1- BARRIER (btw inside and outside environment)
2- REGULATION of BODY TEMPERATURE (sweating, changes in vessels diameters)
3- EXCRETION (water, sodium salts, urea, nitrogenous waste)
4- TRANSMITS SENSORY INFORMATION (touch, pain, pressure, temperature changes)
5- SYNTHESIS of VITAMIN D (when exposed to sun)
By doing the following, what is the skin acting as ?
- resist mechanical abrasion
- protection against invasion of pathogens
- prevents dehydration (Impermeable to water)
- protects against damage from UV irradiation (melanocytes in skin)
BARRIER
Skin is the LARGEST organ in the body. What are the layers (3) and appendages (3) of skin?
LAYERS
1) Epidermis
- stratified squamous keratinized epithelium
- AVASCULAR
- Derived from ECTODERM
2) Dermis
- dense irregular CT with blood vessels, nerves, glands and hair follicles, upper layer has loose irregular CT
- VASCULAR
- Derived from MESODERM
3) Hypodermis (layer below dermis)
- CT and fat
- superficial fascia
- subcutaneous layer
APPENDAGES
- Glands
- Hair
- Nails
What are the parts of the dermis and what CT is each made of?
1-Basement membrane separates the dermis from the epidermis
- the SUPERFICIAL layer in the dermis
- dermal papillae and epidermal ridges form EVAGINATIONS and INTERDIGITATIONS
- connective tissue filled with fibers, cells and blood vessels
- MEISSNER corpuscles present in dermal papillae of dermis
2- The DEEPER and THICKER layer in dermis
- Few cells present
- TYPE I COLLAGEN
- Blends inferiorly with hypodermis or subcutaneous layer (hypodermis) of superficial fascia
- contains ARTERIOVENOUS ANASTOMOSES (numerous in thick skin of fingers and toes, either bypass capillary to form AV or artery form thick wall called GLOMUS-shunt)
- contains PACINIAN CORPUSCLES (concentric lamellae of collagen fibers surround myelinated axons in pacinian corpuscles)
1) PAPILLARY layer (has dermal papillae, blood vessels, meissner corpuscles)
- LOOSE irregular CT
- has MEISSNER CORPUSCLES
2) RETICULAR layer
- DENSE irregular CT (TYPE 1)
- has PACINIAN CORPUSCLES
**There is no distinct boundary btw papillary and reticular layers
What part of skin form fingerprint?
EPIDERMAL RIDGE of epidermis
- made of stratified squamous keratinizing epithelium
- AVASCULAR
- Derived from ectoderm
Skin can be differentiated into thick vs thin skin. Identify which this is :
- palms of hands and soles of feet
- thick stratum corneum
- stratum LUCIDUM is present
- thicker strata SPINOSUM and GRANULOSUM
- All 5 layers of epidermis present and VISIBLE (corneum, lucidum, granulosum, spinosum, Basale)
- contains sweat glands
- LACKS SMOOTH MUSCLE
THICK SKIN
- Elaborate dermal elevations in thick skin (epidermal ridge)
- Increased bonding btw epidermal basement and dermis PROTECTS thick skin from ABRASION and increased wear compared to thin skin
Skin can be differentiated into thick vs thin skin. Identify which this is :
- All other skin
- thin stratum corneum
- stratum LUCIDUM is ABSENT
- thinner strata spinosum and granulosum
- has basale for production of new skin cells
- only 4 layers of epidermis present
- has arrector pili SMOOTH MUSCLE
THIN SKIN
- dermal papillae (papillary dermis) is not as pronounced
- hair follicles, sebaceous glands and sweat glands are present
Skin is the largest organ of the body and composed of 3 layers (epidermis, dermis and hypodermis) . Epidermis is the top most layer, Derived from ectoderm, is AVASCULAR and has stratified squamous keratinized epithelium. What are the 5 layers of epidermis? (Bottom to top most layer)
1- Stratum basale 2- stratum spinosum 3- stratum granulosum 4- stratum lucidum 5- stratum corneum
From 5 - 1 (Come, Let’s Get Sun Burned)
There are 5 layers of the epidermis. Identify this:
1) Consist of single layer of COLUMNAR to CUBOIDAL CELLS
2) Made up of BASAL cells that has :
- keratinocyte stem cells (increased mitotic activity)
- Melanocytes
- Langerhans cells
- Merkel Cells (sensory receptor cells in skin)
- What connects adjacent cells to each other?
- What connects basal cell to basement membrane ?
STRATUM BASALE
- HEMIDESMOSOMES connect basal cell to basement membrane
- DESMOSOMES connect adjacent basal cells to each other
There are 5 layers of the epidermis. What is the layer and what makes up the layer
- consists of 4-6 rows of cells
- cells SYNTHESIZE KERATIN FILAMENTS that become assembled into tonofilaments
- Spine represent states of Desmosomes attachments to keratin tonofilaments
STRATUM SPINOSUM which is made up of
KERATINOCYTES
- produce keratin (bundles of tonofilament) and LAMELLAR bodies containing lipids
- Take in melanin (pigment) from melanocyte cytoplasmic processes
** DESMOSOMES attach adjacent keratinocytes giving cell a “spiny” appearance
Identify structure
- form junctions btw keratinocytes
- hold keratinocytes together at cytoplasmic extensions
- gives resistance to distortion and abrasion
- connect to intracellular tonofilaments (keratin filament)
DESMoSOMES
There are 5 layers of epidermis . Identify this:
- keratinocytes becomes FLATTENED (squamous)
- DYING CELLS start to lose organelles, nucleus, and melanin granules
- KERATOHYALIN granules accumulate (keratohyalin are aggregates of keratin forming tonofilaments)
- Lamellar bodies (granules) containing lipids released into extracellular space forms WATER BARRIER and seals the skin
STRATUM GRANULOSUM
- 3-5 layers of FLATTENED cells
- secretory granules are not surrounded by a membrane by consist of a protein called FILAGGRIN
- *FILAGGRIN associates and cross-links with bundles of keratin tonofilaments
- Combination of keratin tonofilaments with FILAGGRIN of keratohyalin granules produces keratin through KERATINIZATION
- *KERATIN produced in this process is the soft keratin of skin
- Hydrolytic enzymes disrupt the nucleus and all cytoplasmic organelles which disappear as cells fill with keratin
There are 5 layers of epidermis. Identify this:
- Only found in THICK SKIN
- Dead, flattened keratinocytes filled with KERATIN and devoid of organelles and nucleus
- Translucent and barely visible
- densely packed keratin filaments
STRATUM LUCIDUM
There are 5 layers of epidermis. Identify this:
- Dead keratinocytes are now called SQUAMES (or flakes) COMPLETELY FILLED with KERATIN aggregated by FILAGGRIN
- Surface squames are shed (desquamation) with abrasion and replaced with new cells arising from the deep stratum basale
- MOST SUPERFICIAL layer of skin
- ALL nuclei and organelles have disappeared from cells
STRATUM CORNEUM
How many epidermal cell types are there? What are they?
There are 5 cell types
1- keratinocytes 2- melanocytes 3- Langerhan’s Cells 4- Merkel Cells 5- Stem Cells
Name the epidermal cell types
- primary cell type from base to surface
- produce keratin from tonofilaments and keratohyalin granules
- becomes squames in cornfield layer
**How do the epidermal cells go from stem cells to squamous cells over the progression of diff layer?
KERATINOCYTES
**Progression/differentiation of keratinocytes through the layers
1- stratum BASALE; basal stem cells divde by mitosis to create new keratinocytes
2- stratum SPINOSUM; differentiating cells move away from basement membrane into spinosum
-lamella bodies and tonofilaments begin to form
3- stratum GRANULOSUM; nucleus degenerates and other organelles lost,
- keratohyalin graules with filagrin form keratin aggregates,
- lamella bodies with lipids exocytosis to form water barrier
4- stratum CORNEUM; squamous cells on surface have only keratin
Name the epidermal cell type
- Derived from NEURAL CREST (in basal layer)
- CLEAR cell cytoplasm
- ONLY IN BASAL LAYER
- mostly in THIN SKIN
- located btw stratum basale and stratum spinosum (bottom 2)
- LONG IRREGULAR cytoplasmic or dendritic extensions branch into epidermis
MELANOCYTES
- *PRODUCE MELANIN that is transferred to keratinocytes
- Tyrosinase made by rER, packaged into vesicles by Golgi, and fuse with melanosome vesicles
- Tyrosine - DOPA - Melanin via tyrosinase which is activated by UV light
- Melanin stored in membrane bound granules
- Melanin granules in cytoplasmic processes that insinuate btw keratinocytes
** Tanning INCREASES melanin PRODUCTION, NOT the NUMBER of MELANOCYTES
What is the fate of melanin granules?
What is the difference in melanin in light vs dark skin?
**Melanin granules are transferred to keratinocytes
- melanocytes have cytoplasmic processes btw keratinocytes
- melanin granules phagocytosed into keratinocytes
- melanin granules degraded over time
1) Light skin; melanin is more rapidly DEGRADED, not found in upper layers of spinosum
2) Dark skin; PLENTIFUL MELANIN found in granulosum and may still be found in CORNEUM
Name the epidermal cell type;
- ANTIGEN PRESENTING cell of IMMUNE system
- clear cell cytoplasm
- found in ALL LAYERS ; reside primarily in STRATUM SPINOSUM
LANGERHAN’S CELLS
- dendritic-type cells
- originate from BONE MARROW
- Migrate via blood to skin
Name the epidermal stem cell;
- discriminative touch receptor (mechanoreceptors for sensation)
- clear cell cytoplasm
- ONLY IN BASAL LAYER OF THICK SKIN
- NOT IN THIN SKIN AT ALL
MERKEL CELLS
**If you find merkel cells, know you are in THICK not THIN skin
there are 5 types of epidermal cells. what would stem cells look like and where found?
-dividing stem cell in basal layer of ALL skin (look for MITOTIC FIGURES but rare)
**The 5 epidermal cell types are; keratinocytes, melanocytes, Langerhan’s cells, merkel cells (THICK SKIN ONLY), stem cells
What are the 4 appendages and 2 sensory receptors of skin
**
1- HAIR (develop from surface epithelium of EPIDERMIS and reside in DERMIS)
2- SEBACEOUS GLANDS (produce oily secretion called SEBUM when cells die in sebaceous glands_
- Develop from EPIDERMAL CELLS
- located btw hair follicle and arrector pili muscle
- SEBUM OILS; keep skin smooth, waterproof skin, prevent skin from drying. Give skin some antebacterial protection)
- Numerous glands associated with each hair follicle
3- SWEAT GLANDS
4- NAILS (fingernails are just a specialized region of skin where the stratum CORNEUM is hard keratin)
**
5- Meissner’s cprpuscles
6- Pacinian corpuscles
There are 6 total (appendages and sensory receptors) of the skin.
Be specific
What has arrector pili muscle?
What is over most of body?
What is found in scalp/axilla/pubic?
HAIR 1- Pilosebaceous unit -hair follicle; shaft, bulb, papilla -sebaceous gland -ARRECTOR PILLI MUSCLE (smooth muscle that make hair erect); controlled by the AUTONOMIC NERVOUS SYSTEM, CONTRACT during strong EMOTIONS of fear and cold, contraction erects hair shaft, depresses skin where it inserts and produces a small bump on the surface of skin called GOOSE BUMP, contraction also forces SEBUM from sebaceous gland onto the hair follicle and skin)
2- TERMINAL HAIR
-thick in SCALP, AXILLA, pubic area
3- VELLUS HAIR
-fine, short and silky; OVER MOST OF the BODY
Hair is one of the appendages of skin. It can be differentiated into pilosebaceous unit, terminal and vellus hair. Pilosebaceous unit is made up of hair follicle, sebaceous gland and arrector pili muscle. The structure of hair follicle is made of a shaft, bulb and papilla.
What are the 5 layers of hair follicle /(from outermost to innermost layer)
1- CTS (connective tissue sheath)
2- GLASSY membrane (thick basement membrane for external root sheath)
3- ERS (external root sheath)
- downgrowth of the epidermis
4- IRS (internal root sheath)
- surrounds the beginning of the hair shaft at the hair bulb
- ends at the level of the sebaceous glands
5- SHAFT (has cuticle, cortex and medulla)
Hair is one of the appendages of skin. It can be differentiated into pilosebaceous unit, terminal and vellus hair. Pilosebaceous unit is made up of hair follicle, sebaceous gland and arrector pili muscle. The structure of hair follicle is made of a shaft, bulb and papilla.
What gives rise to the shaft of the hair?
HAIR BULB
-MATRIX (root) that gives rise to the SHAFT of the hair
*Stem cells divide and differentiate into cells of the shaft and internal root sheath (increases the length of the hair shaft)
*Keratinocytes produce hard KERATIN
*Melanocyte produce hair COLOR
(Graying of hair due to loss of tyrosinase production)
Hair is one of the appendages of skin. It can be differentiated into pilosebaceous unit, terminal and vellus hair. Pilosebaceous unit is made up of hair follicle, sebaceous gland and arrector pili muscle. The structure of hair follicle is made of a shaft, bulb and papilla.
What supplies nutrients to the hair bulb?
HAIR PAPILLA
- loose CT containing blood vessel
- *SUPPLY NUTRIENTS to hair BULB (brings essential nutrients to hair follicle cells)
Hair is one of the appendages of skin. It can be differentiated into pilosebaceous unit, terminal and vellus hair. Pilosebaceous unit is made up of hair follicle, sebaceous gland and arrector pili muscle. The structure of hair follicle is made of a shaft, bulb and papilla.
What are the parts of hair shaft?
3 parts
1) Cuticle - layer of overlapping DEAD SQUAMOUS cells
2) Cortex
- CUBOIDAL cells
- KERATINIZED portion of the hair shaft
- contains MELANOSOMES
3) Medulla
- found only in THICK HAIR
- large vacuolated cells
Name the stages of the hair growth cycle
1- ANAGEN/growing phase
- up to 85% of hair in this phase at one time
- can last 2-5 years
2- CATAGEN/Involuting phase
-lasts 3-6 weeks
3- TELOGEN/resting phase
- Up to 15% of hair in this phase at one time
- can last 3-5 months
Sweat gland is one of the appendages of the skin. What are the 2 types of sweat gland and their secretions and types?
1- CONTAINS 2 cell types ; CLEAR cells (NO secretory GRANULES, WATERY/electrolyte secretion) and darK cells (has secretory granules with MUCUS secretion)
- Myoepithelial cells; surround basal region of the secretory portion of each sweat gland, contraction of these cells expels the secretion/sweat from sweat glands
- Most numerous in thick skin (palm and sole)
- Assist in temperature regulation (through evaporation of water from sweat on body surfaces)
- Excrete water, sodium salts, ammonia, Uric acid and urea
2- FOUND IN DERMIS
- primarily limited to ; axilla, anus, areolar regions of breast
- also develop down growth of epidermis
- larger than eccrine sweat glands
- ducts open into hair follicle Canal
- becomes functional at puberty when sex hormones are produced
- produces VISCOUS SECRETION; acquires a distinct and unpleasant odor after bacterial decomposition
2 types of sweat gland
1) ECCRINE sweat gland (simple coiled tubular glands)- produce watery secretion
A- ducts; coiled stratified cuboidal epithelium of DARK stained cells,
-SMALL OD.
-leads to skin surface (ascends, straightens and penetrates epidermis)
B- secretory units; simple to stratified cuboidal epithelium of LIGHT stained cells
-LARGE OD
-Found deep in DERMIS
2) APOCRINE sweat gland - produce protein/lipid secretion
Nails is one of the appendages of skin.
FINGER NAILS are just a specialized region of skin where hard keratin is the stratum corneum.
What does the following nail terminology mean 1- Eponychium 2-Nail plate 3- Hyponychium 4- Nail matrix
1- Eponychium (cuticle); not so hard keratin
2- Nail plate (finger nail); lies on the nail bed/epidermis
3- Hyponychium; hurts when you cut your finger too close
4- Nail matrix; region that generated hard keratin, is seen through the nail as the lighter colored lunula
How is the skin developed?
- EPIDERMIS is derived from surface ectoderm
- division of the surface ectoderm cells creates a surface layer f squamous cells called the PERIDERM and a BASAL LAYER of cells (Periderm cells are shed into the amniotic fluid)
- The BASAL LAYER continues to divide and creates INTERMEDIATE LAYERS that become the SPONGIOSUM/SPINOSUM
- All layers established by the END OF 4 MONTHS
- Neural crest cells migrate into the basal layer and become MELANOCYTES
- Proliferation of the basal cells produces the epidermal ridges (form the fingerprints)
- DERMIS forms primarily from MESODERM
- Paraxial- dermis of back
- Somatic lateral plate - dermis of limbs and body wall
- NEURAL CREST forms dermis of face and neck
What is this/
- White paste that covers the skin at birth
- mixture of desquamated epidermal cells, sebum and other secretions
- protects skin from amniotic fluid
VERNIX CASEOSA
How does hair develop?
1) Proliferation of basal layer into the dermis forms a HAIR BUD
* becomes the EPIDERMAL ROOT SHEATH
* small bud on the side of the bud forms the SEBACEOUS GLAND
2) Hair bud continue to migrate into the dermis and forms the hair bulb
* surrounding mesenchyme forms the DERMAL ROOT SHEATH
3) MESENCHYME invades the hair bulb to form the PAPILLA
4) ARRECTOR PILI MUSCLE forms from MESENCHYME
5) FIRST HAIR is called LANUGO (eyebrows form first)
- soft, fine and light pigment
- plentiful by week 17-20
The muscles of the back are complex but divisible into 3 groups, what are they and their importance/associations
A. SUPERFICIAL GROUP; associated with upper extremity (SCAPULA attached to vertebrae by this group) 1-Trapezius 2-Latissimus dorsi 3-Levator scapulae 4-Rhomboideus minor 5-Rhomboideus major
B. INTERMEDIATE GROUP; associated with respiration
1-Levatores costarum
2-Serratus posterior superior
3- Serratus posterior inferior
C. DEEP GROUP; associated with movement of the trunk and back, support body weight
1- Splenius muscles (crevicis and capitis)
2-Erector Spinae (Iliocostalis, longissimus, spinalis)
3- Transversospinalis (semispinalis, multifidus, rotatores)
The muscles of the back are complex but divisible into 3 groups: superficial, intermediate and deep group.
TRAPEZIUS Group Origin Insertion Action Nerve
Group; Superficial
Origin
SKULL - External occipital protuberance
FASCIA - LIGAMENTUM nuchae
VERTEBRAE - spines of C7, T1-12
Action
- BOTH elevates upper fibers and depress lower fibers of the shoulder
- Retracts scapula
- Extends head
Nerve
- ACCESSORY NERVE (CRANIAL NERVE XI)
- *can test shrug shoulders
The muscles of the back are complex but divisible into 3 groups: superficial, intermediate and deep group.
LARTISSIMUS DORSI (large in swimmers) Group Origin Insertion Action Nerve
Group; superficial
origin
- VERTEBRAE; spines of T6–T12
- FASCIA; thoracolumbar fascia
- PELVIC BONE; iliac crest
Insertion
HUMERUS; Intertubercular (bicipital) groove
Action
-Adducts, Extends and medially rotates arm
Nerve
THORACODORSAL NERVE
The muscles of the back are complex but divisible into 3 groups: superficial, intermediate and deep group.
LEVATOR SCAPULAE Group Origin Insertion Action Nerve
Group; superficial
Origin
VERTEBRA - Transverse processes of C1-C4
Insertion
SCAPULA; superior angle and medial border
Action
-elevates and adducts scapula
Nerve
-DORSAL SCAPULAR NERVE
The muscles of the back are complex but divisible into 3 groups: superficial, intermediate and deep group.
RHOMBOID MINOR Group Origin Insertion Action Nerve
Group; Superficial
Origin
VERTEBRAE; spines of C7, T1
Insertion
SCAPULA; medial border
Action
Elevates and adducts scapula
Nerve
DORSAL SCAPULAR NERVE
The muscles of the back are complex but divisible into 3 groups: superficial, intermediate and deep group.
RHOMBOID MAJOR Group Origin Insertion Action Nerve
Group; Superficial
Origin
Vertebrae; spines of T2-T5
Insertion
SCAPULA; Medial border to inferior angle
Action
Elevates and adducts scapula
Nerve
DORSAL SCAPULAR NERVE
The muscles of the back are complex but divisible into 3 groups: superficial, intermediate and deep group.
LEVATORES COSTARUM Group Origin Insertion Action Nerve
Group; Intermediate group
Origin
- VETEBRAE; Transverse processes of C7, T1-11
Insertion
-RIBS; inferior to origin
Action
-Raise ribs in inspiration
Nerve
-DORSAL RAMI OF THORACIC SPINAL NERVES
The muscles of the back are complex but divisible into 3 groups: superficial, intermediate and deep group.
SERRATUS POSTERIOR SUPERIOR Group Origin Insertion Action Nerve
Group; Intermediate
Origin
VERTEBRAE; spines of cervical and upper thoracic vertebrae
Insertion
-RIBS
Action
Raise ribs in inspiration
Nerve
INTERCOSTAL NERVES
The muscles of the back are complex but divisible into 3 groups: superficial, intermediate and deep group.
SERRATUS POSTERIOR INFERIOR Group Origin Insertion Action Nerve
Group; Intermediate
Origin
-VERTEBRAE; spines of upper lumbar and lower thoracic vertebrae
Insertion
RIBS
Action
LOWER ribs in expiration
Nerve
INTERCOSTAL NERVES
The muscles of the back are complex but divisible into 3 groups: superficial, intermediate and deep group.
SPLENIUS Group Origin Insertion Action Nerve
Group; Deep group
Origin
VERTEBRAE; spines of T1-T4
Insertion
SPLENIUS CAPITIS TO SKULL; occipital and temporal bones
SPLENIUS CERVICIS TO VERTEBRAE; transverse processes of C2-C3
Action
Extend neck and head (rotate in unilateral action)
Nerve
DORSAL RAMI OF SPINAL NERVES
The muscles of the back are complex but divisible into 3 groups: superficial, intermediate and deep group.
ERECTOR SPINAE Group Origin Insertion Action Nerve
Deep group
Origin
1- ILIOCOSTALIS -from ilium and ribs
2- LONGISSIMUS - from transverse processes of vertebrae
3- SPINALIS - from spinous processes
Insertion
1-ILIOCOSTALIS to ribs and transverse process
2- LONGISSIMUS to transverse process of vertebrae
3- SPINALIS to spinous process
Action
Extend trunk and vertebral column
Nerve
DORSAL RAMI OF SPINAL NERVES
The muscles of the back are complex but divisible into 3 groups: superficial, intermediate and deep group.
TRANSVERSOSPINALIS Group Origin Insertion Action Nerve
Deep group Muscle has ((semispinalis, multifidus, rotatores)
Origin
TRANSVERSE PROCESS OF VERTEBRAE
Insertion
All insert upon SPINES OF VERTEBRAE SUPERIOR TO ORIGIN: Differ in how many vertebrae they extend across
1) SEMISPINALIS extend across 5 or 6 vertebrae
2) MULTIFIDUS extend across 3 or 4 vertebrae
3) ROTATORES extend across 1 or 2 vertebrae
Action
All extend trunk in bilateral action and rotate vertebral column in unilateral action
Nerve
DORSAL RAMI OF SPINAL NERVES
1) What is the only bony link to skeleton in the upper extremity
1- CLAVICLE
Scapula is linked to skeleton ANTERIORLY by CLAVICLE
**CLAVICLE is the most frequently BROKEN BONE in the body
Scapula articulates with humerus where?
- How does scapula attach to vertebrae?
- What does this allow for?
scapula articulates with humerus at the GLENOHUMERAL JOINT (ball and socket)
**scapula attach to vertebrae by muscles; the glenohumeral joint allows for other muscles to act on arm
What is this
**covers deep muscles of the back
- attaches MEDIALLY to spines of the vertebrae
- attached INFERIORLY to ilium (pelvic bone)
**Provides For Muscle attachment
FUNCTION; bilateral force, weight distribution
THORACOLUMBAR (LUMBAR) FASCIA
**orientation of CROSSING collagen fibers MAY HELP SUPPORT BODY WEIGHT when you lift opposite leg
**Collagen fibers CROSS IN MIDLINE above the sacrum
**POTENTIAL USE AS SURGICAL LANDMARK
What are the 3 muscles that
ACTION; All ELEVATE and ADDUCT scapula
Innervation; All by DORSAL SCAPULAR NERVE
LEVATOR SCAPULAE
RHOMBOID MINOR
RHOMBOID MAJOR
- What overlies the 6th intercostal space; floor has no large muscles - good place for listening with stethoscope ?
- What are the boundaries?
TRIANGLE OF AUSCULTATION
-Medial to scapula
BOUNDARIES
Inferior - Latissimus dorsi
Superior - Trapezius
Lateral - Rhomboid major
- What is the intermediate group associated with?
- where do they all originate form?
- Insertion
- Associated with RESPIRATION
- ALL ORIGIN is VERTEBRAE
- ALL insert to RIBS
What innervated the Serratus posterior superior and Serratus posterior inferior
INTERCOSTAL NERVES
NAME THE GROUP
- all extend trunk of neck when act bilaterally
- all located dorsal to vertebral column
- all innervated by DORSAL RAMI OF SPINAL NERVES
DEEP GROUP OF MUSCLES OF THE BACK
- Splenius
- Erector Spinae (Iliocostalis, longissimus, spinalis)
- Transversospinalis (semispinalis, multifidus, rotatores)
What is this?
1) Sensory and motor axons to REGION OF BACK; sensory to skin of back and posterior neck, motor axons to deep muscles of back and neck
2) Sensory and motor axons to OTHER PARTS of the BODY; sensory to skin of extremities (arm, leg) and anterior and lateral regions of trunk; motor to muscles of extremities and anterior and lateral regions of trunk
1- DORSAL RAMUS (AKA DRSAL PRIMARY RAMUS)
2- VENTRAL RAMUS (AKA VENTRAL PRIMARY RAMUS)
The PECTORAL REGION has how many muscles? List them
4 muscles 1- PECTORALIS MAJOR 2- PECTORALIS MINOR 3- SERRATUS ANTERIOR 4- SUBCLAVIUS
There are 4 muscles of the pectoral region
PECTORALIS MAJOR Origin Insertion Action Nerve
Origin;
- clavicular head; MEDIAL half of CLAVICLE
- sternocostal head; STERNUM and upper six costal cartilages
Insertion
-lateral lip of bicipital groove (intertubercular sulcus)
Action
- ADDUCTS and MEDIALLY rotates the arm
- FLEXES arm
Nerve
-MEDIAL and LATERAL pectoral nerves
There are 4 muscles of the pectoral region
PECTORALIS MINOR Origin Insertion Action Nerve
Origin
3rd to 5th ribs near cartilages
Insertion
Coracoid process of scapula
Action
- DEPRESSES scapula
- ELEVATES ribs of origin for deep inspiration
Nerve
MEDIAL PECTORAL
There are 4 muscles of the pectoral region
SERRATUS ANTERIOR Origin Insertion Action Nerve
Origin
Upper eight ribs
Insertion
-Medial (vertebral) border of scapula
Action
- rotates scapula
- Draws scapula forward around thoracic wall (protraction)
- Holds scapula against thoracic wall
Nerve
LONG THORACIC NERVE
There are 4 muscles of the pectoral region
SUBCLAVIUS Origin Insertion Action Nerve
Origin
1st costal cartilage
Insertion
CLAVICLE
Action
ANCHORS and DEPRESSES clavicle during upper limb movements
Nerve
NERVE TO SUBCLAVIUS
There are 6 total muscles of the shoulder. 4 muscles make up the ROTATOR CUFF. Name them
what is the function of rotator cuff?
ROTATOR CUFF
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis
- Function; hold the head of the humerus against the glenoid cavity while the limb is being moved
Others
- Deltoid
- Teres major
There are 6 muscles in the shoulders. 4 are rotator cuff muscles.
DELTOID Origin Insertion Action Nerve
Origin
-Lateral clavicle, acromion process and spine of scapula
Insertion
-Deltoid tuberosity of humerus
Action
ANTERIOR part; flexes and medially rotates arm
MIDDLE part; abducts arm
POSTERIOR part; extends and laterally rotates arm
Nerve
AXILLARY
There are 6 muscles in the shoulders. 4 are rotator cuff muscles.
SUPRASPINATUS Origin Insertion Action Nerve
Origin
SUPRASPINOUS fossa of scapula
Insertion
Greater tubercle of humerus
Action
Initiates abduction of arm; stabilizes shoulder joint
Nerve
SUPRASCAPULAR
There are 6 muscles in the shoulders. 4 are rotator cuff muscles.
INFRASPINATUS Origin Insertion Action Nerve
Origin
Infraspinous fossa of scapula
Insertion
Greater tubercle of humerus
Action
Laterally rotates arm; stabilizes shoulder joint
Nerve
SUPRASCAPULAR
There are 6 muscles in the shoulders. 4 are rotator cuff muscles.
TERES MINOR Origin Insertion Action Nerve
Origin
Lateral border of scapula
Insertion
Greater tubercle of humerus
Action
Laterally rotates arm; stabilizes shoulder joint
Nerve
AXILLARY NERVE
There are 6 muscles in the shoulders. 4 are rotator cuff muscles.
SUBSCAPULARIS Origin Insertion Action Nerve
Origin
Subscapular fossa of scapula
Insertion
Lesser tubercle of humerus
Action
Medially rotates arm; stabilizes shoulder joint
Nerve
UPPER AND LOWER SUBSCAPULAR NERVE
There are 6 muscles in the shoulders. 4 are rotator cuff muscles.
TERES MAJOR Origin Insertion Action Nerve
Origin
Inferior angle of scapula
Insertion
Medial lip of the intertubercular groove (bicipital groove) of humerus
Action
Medially rotates and ADDUCTS arm
Nerve
LOWER SUBSCAPULAR NERVE
Name this
- modified sweat gland located in superficial fascia
- AXILLARY tail of gland (tail of spence) extends into armpit
MAMMARY GLAND
*TAIL of Spence is removed in modified radical or radical mastectomy
What ligaments in mammary gland acts as walls to separate breast into 15-20 lobes/compartments?
-Each lobe contains milk glans via LACTIFEROUS DUCT to nipple
What is the removal of a single lobe?
SUSPENSORY/COOPER’S LIGAMENTS
Lobectomy is removal of a single lobe
In a SAGITTAL section of mammary gland, what is the layer of loose CT separating breast from deep fascia?
- potential space that allows movement of breast over underlying structures
- tumor can invade deep fascia and pectoralis major leading to fixation of breast to thoracic wall
RETROMAMMARY SPACE
What is the arterial supply of the mammary gland? (3)
1- Internal thoracic artery from subclavian artery
2- Thoracoacromial artery from AXILLARY artery
3- Lateral thoracic artery from AXILLARY artery
Lymph fluid is formed from interstitial/tissue fluids and lymph nodes filter pathogens and cancerous cells from lymph.
What is the lymphatic drainage of the mammary gland and how (4)
Why is the lymphatic drainage system of breast important?
**Drains into AXILLARY LYMPH NODES in superficial fascia
1) Pectoral/anterior AXILLARY nodes;
- drains LATERAL breast
- receive approx. 75% of lymph from breast
2) Parasternal nodes (adjacent to internal thoracic vessels)
- drain MEDIAL breast
- receive MOST of the REMAINING lymph from breast
3) Abdomen nodes
- LOWER quadrants of breast
4) Other breast
**Breast lymph drainage system is important since tumor cells can spread from breast to other bodily regions via lymphatic vessels
What causes WINGED SCAPULA?
Damage to the LONG THORACIC NERVE
- Serratus anterior muscle no longer holds scapula to thoracic wall
- *Medial border and inferior angle of the scapula thrust POSTERIORLY when patient pushes hand against wall
The fascia of the pectoral region invests the four pectoral muscles ; which is which
1) covers the pectoralis MAJOR
2)
- encloses the pectoralis MINOR and SUBCLAVIUS and attaches to the clavicle
- protects the underlying neurovascular structures that supply upper limb (e.g BRACHIAL PLEXUS and AXILLARY VESSELS)
1) PECTORAL FASCIA
2) CLAVIPECTORAL FASCIA
What is the clavipectoral fascia pierces by? (3)
1- CEPHALIC VEIN
-drains lateral side f superficial aspect of upper limb, enters deltopectoral triangle and pierces clavipectoral fascia to join the AXILLARY vein
2- THORACOACROMIAL ARTERY
-A branch of the AXILLARY artery
3- LATERAL PECTORAL NERVE
-A branch of the lateral cord of the brachial plexus (beside pectoralis minor- medial)
What is the triangular depression Inferior to the lateral part of the clavicle called?
What are the borders and contents?
DELTOPECTORAL/CLAVIPECTORAL TRIANGLE
BORDERS;
- Superiorly; Clavicle
- Laterally; Deltoid
- Medially; Pectoralis major
CONTENTS
- CEPHALIC vein (superficial)
- Tip of coracoid process (Deep; can palpate - like a RAVEN’S PEAK)
WHAT IS THIS
- pyramidal shaped area btw the arm and upper thorax
- passageway for the neurovascular supply to the upper limb
What are the borders?
AXILLA/ARMPIT
BORDERS
1- Anterior wall
-Pectoralis major and minor muscles
2-Posterior wall
-scapula, subscapular is, latissimus dorsi (insertion) and Teres major
3- Medial wall
-Upper 4 ribs, intercostal muscles btw ribs and Serratus anterior
4- Lateral wall
-Intertubercular groove of humerus
The contents of the axilla is made of neurovascular bundle enveloped by sheath of connective tissue, the AXILLARY SHEATH.
What are the 3 contents of axilla
1- AXILLARY ARTERY (STLSAP- sixties teens loved sex and pot)
2- AXILLARY VEIN
3- AXILLARY LYMPH NODES
The AXILLARY artery is the continuation of what artery?
SUBCLAVIAN ARTERY
*Begins at the lateral border of rib 1 and ends at the inferior border of the Teres major (inferior border of axilla) where it becomes brachial artery
subclavian artery - AXILLARY artery - brachial artery
What are the branches of the AXILLARY artery
3 parts
PART 1
1- Superior thoracic artery
PART 2
2- Thoracoacromial artery
3- Lateral thoracic artery
PART 3
4- Anterior circumflex numeral artery
-small artery; winds ANTERIORLY around surgical neck of humerus
5- Posterior circumflex artery
-winds POSTERIORLY around surgical neck of humerus
6- Subscapular artery (largest branch
-courses along LATERAL border of scapula
NAME THIS
- located medial the AXILLARY artery
- begins as a continuation of the basilica vein from the arm
- receives tributaries that correspond to the AXILLARY artery and the CEPHALIC vein
AXILLARY VEIN
NAME THIS
- group of nodes located in the connective tissue
- receive lymph from the upper limb and breast
- drain into the subclavian lymph trunks, which drain into the right lymphatic duct (right side of body) and thoracic duct (left side of body)
What are the drainage patterns
AXILLARY LYMPH NODES
1- HUMERAL nodes; drain the UPPER LIMB
2- SUBSCAPULAR/POSTERIOR NODES; drain POSTERIOR wall of axilla
3- Pectoral/anterior nodes; drain anterior wall of axilla, including the lateral breast
4- Central nodes; receive lymph from humeral, subscapular and pectoral nodes
5- Apical nodes; receive lymph from central node
6- Supraclavicuar nodes; receive lymph from apical nodes and drain into the subclavian lymph trunk
The brachial plexus is divided into 2 parts. One in neck and other in axilla. What are they called? And there further divisions
1- Supraclavicular part IN NECK
- VENTRAL RAMI (spina nerves C5-T1)
- TRUNK
- DIVISIONS
2- Infraclavicular part IN AXILLA
- CORDS
- TERMINAL BRANCHES
**PNEMONIC
Randy Travis Drinks Cold Beer
How many trunks in the brachial plexus? What are they and the spinal nerves??
3 trunks
1- SUPERIOR (C5 and C6)
2- MIDDLE (C7)
3-INFERIOR (C8 and T1); Located on rib 1
What do the anterior and posterior divisions of the brachial plexus supply?
ANTERIOR division; supply anterior compartments (FLEXORS) of the arm and forearm e.g lateral cord-musculocutaneous nerve
- formed by superior and middle trunks C5, C6,C7
- formed by inferior trunk C8,T1
POSTERIOR division; supply the posterior compartment (EXTENSOR) of the arm and forearm e.g radial and AXILLARY nerve
How are cords formed and how are they named?
- formed by the union of divisions
- named in their relationship TO THE AXILLARY ARTERY e.g posterior cord is posterior to the AXILLARY artery, lateral cord is lateral to the AXILLARY artery and medial cord is medial to the AXILLARY artery
What are the terminal branches of the posterior cord? And spinal nerves/
which is which branch
1- innervated deltoid and Teres minor muscles and sensory fibers to skin of UPPER LATERAL ARM
2-LARGEST branch
- motor to extensors of posterior arm and posterior forearm
- sensory to skin of posterior arm, posterior forearm, dorsolateral hand and dorsal side of proximal part of lateral 3.5 digits
-formed by the union of all 3 posterior divisions (C5-T1)
1- AXILLARY nerve (C5, C6)
-innervated deltoid and Teres minor muscles and sensory fibers to skin of UPPER LATERAL ARM
2- RADIAL NEERVE (C5-C8, T1)
-LARGEST branch
-motor to extensors of posterior arm and posterior forearm
-sensory to skin of posterior arm, posterior forearm, dorsolateral hand and dorsal side of proximal part of lateral 3.5 digits
There are 3 SIDE branches of the posterior cord. Name them
1- innervates subscapularis
2-innervates latissimus dorsi
3- innervates suubscapularis and Teres major
1- UPPER SUBSCAPULAR NERVE
2- THORACODORSAL NERVE
3- LOWER SUBSCAPULAR NERVE
Name the cord
-formed by the union of the anterior divisions of the upper and middle trunk (mostly C5-C7)
WHAT ARE THE TERMINAL BRANCES
LATERAL CORD
TERMINAL BRANCHES
1- Musculocutaneous nerve (C5-C7)
Key landmark;Nerve pierces corrracobrachialis muscle of arm
-innervates anterior arm muscles (coracobrachialis, biceps brachii and brachialis)
-is a CUTANEOUS nerve to lateral forearm
2- LATERAL PART OF MEDIAN NERVE (C5-C7)
-joins a similar contribution from the medial cord to form the median nerve
Name the side branch of lateral cord
-innervates pectoralis major
LATERAL PECTORAL NERVE
-is names lateral for the cord it branches from and not in relation to the medial pectoral nerve (medial pectoral nerve is lateral to lateral pectoral nerve)
What cord is the continuation of the anterior division of the lower trunk (C8 and T1)
What are the branches?
MEDIAL CORD
TERMINAL BRANCHES
1- ULNAR NERVE (C8, T1)
-innervates medial 1.5 muscles of forearm (flexor Capri ulnaris and medial part of flexor digitorum profunda) and most intrinsic muscles of hand
-cutaneous branches to medial 1/3rd of palm and dorsum of hand and medial 1.5 fingers (little finger and medial side of ring finger)
2-MEDIAL PART OF MEDIAN NERVE
-joins the lateral part of the median nerve from the lateral cord to form the median nerve
What are the side branches of the medial cord
1- Medial pectoral nerve ; innervate the pectoralis major and minor
2- Medial cutaneous nerve of arm
3- Medial cutaneous nerve of forearm
Name the nerve
-medial to most muscles of anterior compartment, thenar muscles to thumb and lateral 2 lumbricals of palm of hand
What is exception/
MEDIAN NERVE
Exception
- flexor Carpi ulnaris and medial art of flexor digitorum profundus and most intrinsic muscles of palm of the hand
- sensory to skin of lateral 2/3rds of palm of hand, palmar side and nail beds of lateral 3.5 fingers
Name the branches of ventral rami respectively;
1
- branch of the ventral RAMUS of C5
- innervate LEVATOR scapulae, rhomboid major and rhomboid minor muscles that attach to medial border of scapula
2- branch of the ventral rami of C5-C7
1- DORSAL SCAPULAR NERVE
2- LONG THORACIC NERVE (nerve to Serratus anterior)
Name the side branches from upper trunk
Which one innervates supraspinatus and Infraspinatus muscles
1- SUPRASCAPULAR NERVE (C5 and C6)
-innervates supraspinatus and Infraspinatus muscles
2- Nerve to SUBCLAVIUS
-innervates subclavius
Tell me about the anterior compartment in general
Muscles
Action
Innervation
Muscles; Biceps brachii, brachialis, coracobrachialis
Action; Major FLEXOR at elbow joint and supination of forearm at superior and inferior radioulnar joints
Innervation; MUSCULOCUTANEOUS NERVE
There are 4 muscles of the arm. 3 of the anterior compartment and 1 posterior compartment
Name them
Anterior
1- Biceps brachii (long head and short head)
2- Coracobrachialis
3- Brachialis
Posterior
1-Triceps brachii (long, lateral and medial head)
There are 4 muscles of the arm. 3 of the anterior compartment and 1 posterior compartment
BICEPS BRACHII
Long head
Short head
Origin
Long head- Supraglenoid tubercle
Short head - Coracoid process
Insertion - Radial tuberosity
Action-
- Powerful flexor of forearm at elbow joint
- Powerful supination of forearm
- Weak flexor of arm at glenohumeral joint
Nerve
MUSCULOCUTANEOUS NERVE
There are 4 muscles of the arm. 3 of the anterior compartment and 1 posterior compartment
CORACOBRACHIALIS
Origin - Coracoid process
Insertion - Mid-shaft humerus
Action- FLEXION of arm at glenohumeral/shoulder joint
Nerve -MUSCULOCUTANEOUS NERVE
There are 4 muscles of the arm. 3 of the anterior compartment and 1 posterior compartment
BRACHIALIS
Origin- Anterior humerus
Insertion- Ulnar tuberosity
Action - Flexes forearm
Nerve - MUSCULOCUTANEOUS NERVE
There are 4 muscles of the arm. 3 of the anterior compartment and 1 posterior compartment
TRICEPS BRACHII
Long head
Lateral head
Medial head
Origin
Long head; Infraglenoid tubercle
Lateral head; posterior lateral surface of humerus
Medial head; posterior medial surface of humerus
Insertion
Olecranon of ulna
Action
Extends forearm
Nerve
RADIAL NERVE
What is the clinical condition
-Flexing elbow results in prominent bulge of the muscle belly (popeye’s sign)
Rupture of Long head of biceps brachii
- What artery changes to what artery at the lower border of Teres major/ axilla into the anterior arm
- also terminates just below elbow joint as what arteries?
1) AXILLARY artery - BRACHIAL artery (from axilla to anterior arm- lower border of Teres major)
2) BRACHIAL artery - ULNAR and RADIAL arteries (just below elbow joint)
1) What artery descends the arm with the median nerve
2) What artery is palpable and can be compressed against the humerus in the in the proximal arm to stop hemorrhage?
3) Where is the site for placement of blood pressure cuff? What does it compress?
4) Where is the site where a stethoscope is place on what artery? Why?
1- BRACHIAL ARTERY
2- BRACHIAL ARTERY
3- MID-ARM, to compress BRACHIAL ARTERY
4- CUBITAL FOSSA, To listen for pulse during blood pressure measurement
What are the respective branches of the brachial artery
1- courses into posterior/radial groove (joins RADIAL NERVE here)
2- Courses with ULNAR NERVE to pass posterior to medial epicondyle and posterior to elbow joint
3- descends ANTERIOR to the ELBOW joint
1- DEEP (profunda) brachial artery
- go to posterior compartment of arm - joins RADIAL NERVE (in radial groove of humerus)
- TERMINAL BRANCHES; Radial collateral and middle collateral -participate in ARTERIAL ANASTOMOSIS at elbow joint
2- SUPERIOR ULNAR COLLATERAL ARTERY
- courses with ULNAR NERVE to pass posterior to the medial epicondyle of the humerus ad posterior to the elbow joint.
- Also do ARTERIAL ANASTOMOSIS at elbow joint
3- INFERIOR ULNAR COLLATERAL ARTERY
- Descends anterior to the elbow joint
- participates in the ARTERIAL ANASTOMOSIS at elbow joint
What are the branches of brachial artery that participate in ARTERIAL ANASTOMOSIS AT ELBOW JOINT
1- Radial and middle collateral artery (branches from deep/profunda brachial artery)
2- Superior ulnar collateral artery
3- Inferior ulnar collateral artery
- *All 3 branches of the Brachial artery
- So when brachial artery is compressed at mid-arm during hemorrhage, elbow anastomosis still allow blood flow to the forearm
Name the nerves
- pass along medial side of arm into anterior forearm
- do NOT innervate brachial muscles but innervate muscle of anterior forearm and hand
MEDIAN and ULNAR Nerves
Name the nerve
- is most medially located in arm
- passes POSTERIORLY to pierce medial inter muscular septum
- descends along posterior side of medial epicondyle of humerus
- *Site for damage by compression against bone (funny bone)
ULNAR NERVE
** DO NOT innervate any branches in the arm (just forearm/hand)
Name the nerve
- innervates the anterior compartment muscles of arm
- pierces and innervates the coracobrachialis
- passes POSTERIORLY to pierce medial intermuscular septum
- descends btw the brachialis and biceps brachii innervating these muscle
- emerges laterally above elbow joint as the lateral cutaneous nerve of forearm (anterbrachial) supplying skin of lateral forearm
MUSCULOCUTANEOUS NERVE
Name the nerve
- innervates the posterior compartment muscles of arm from nerve branches in the axilla
- gives off sensory nerves, the inferior lateral brachial cutaneous nerve and the posterior cutaneous nerves of arm and forearm
- descends diagonally in the radial groove of the humerus with the deep brachial artery btw the medial and lateral heads of the triceps
RADIAL NERVE
FRACTURE of the HUMERUS (shaft) at the radial groove can injure the radial nerve, which also innervates extensors of posterior compartment of forearm.
What is this called?
WRIST-DROP (Inability to extend the wrist and digits)
What are the artery/nerve associations of the following?
1- Ulnar nerve medial to what?
2- Ulnar nerve - with what artery above the medial epicondyle
3- Radial nerve - with what artery in radial groove
4- Median nerve with what artery
5- Radial collateral artery with at nerve at elbow joint?
1- Ulnar nerve; medial to brachial artery
2- Ulnar nerve - superior ulnar collateral artery above medial epicondyle (pierce medial intermuscular septum)
3- Radial nerve - profunda brachial artery in radial groove
4- Median nerve- brachial artery
5- Radial collateral artery - radial nerve above elbow
Radial nerve damage (in mid shaft/ radial groove of humerus) does not significantly affect what action?
-Does not significantly affect extension of arm at elbow joint
- *Most of Triceps brachii is innervated proximal to radial groove
- damage of radial nerve by fx of mid-shaft will not affect most of triceps brachii
- So extension of arm at elbow joint will not be significantly affected
Where is the cubital fossa and what are the borders and contents ?
USE?
**Median cubital vein is located in superficial fascia in the cubital fossa
-TRIANGULAR Depression is anterior to elbow
BORDERS
A. Horizontal plane btw medial and lateral epicondyle of humerus
B. Lateral border; BRACHIORADIALIS
C. Medial border; PRONATOR TERES
CONTENTS
- Biceps brachii TENDON
- Brachial ARTERY
- Median NERVE
* *TAN
**CUBITAL FOSSA is site of stethoscope placement for blood pressure assessment
What nerve is deep to brachioradialis at lateral border of cubital fossa?
What are the terminal branches? (Which is motor? Sensory?)
RADIAL NERVE - deep to brachioradialis at lateral border of cubital fossa
BRANCHES
1- DEEP branch of radial nerve
- MOTOR nerve to posterior compartment of forearm, which extend hand at wrist
2- SUPERFICIAL branch of radial nerve
-SENSORY nerve innervation the dorsolateral hand and proximal part of lateral 3.5 digits
Venipuncture of what may inadvertently puncture underlying brachial artery?
What is it protected by?
MEDIAL CUBITAL VEIN
**Brachial artery Protected by bicipital aponeurosis
What are all the arteries of anatomosis at elbow joint?
Use?
- allows blood flow distally into the forearm and hand if brachii artery is compressed by prolonged FLEXION of forearm at elbow joint or if the brachial artery is ligated to suppress hemorrhaging of lacerated artery
Above elbow joint (2 branches)
1- Branches of deep brachial artery
- Radial collateral a.
-Middle collateral a.
2- Branches of brachial a.
- Superior ulnar collateral a.
- Inferior ulnar collateral a.
Below elbow joint (3 branches)
1- Branch of radial a.
-Radial recurrent a.
2- Branch of common interosseous a.
-Interosseous recurrent a.
3- Branches of ulnar
- Posterior ulnar recurrent a.
- Anterior ulnar recurrent a.
What are the elbow anatomosis?
1- Radial collateral a. (above elbow joint) to Radial recurrent a. (Below)
2- Middle collateral a. To Interosseous recurrent a.
3- Superior ulnar collateral a. To Posterior ulnar recurrent a.
4- Inferior ulnar collateral a. To Anterior ulnar recurrent a.
What are the extrinsic muscles of the shoulder?
Origin
Insertion
5 total Superficial group 1- Trapezius 2- Latissimus dorsi 3- Serratus anterior
Deep group
1- LEVATOR scapulae
2- Rhomboid major and minor
