Exam 5 Upper Extremity 52X Flashcards
What test is conducted to assess the patency of the radial and ulnar arteries and the collateral circulation in order to reduce risk of ischemia prior to radial arterial blood sampling or cannulation?
Allen’s Test
What are the general steps for conducting the Allen test?
1) Patient places hand palm up
2) Pressure is applied over the Radial and Ulnar arteries
3) Patient makes a fist for about 30 sec.
4) Patient opens hand
5) Ulnar occlusion is released
6) Return of color within 7 seconds indicates patent ulnar artery
7) ABG or cannulation of the Radial artery may now occur
Branches of what arteries supply blood to the hand?
Radial Artery
Ulnar Artery
Which artery branches near the wrist into superficial and deep branches in which the superficial branch gives rise to the superficial palmar arch?
Ulnar artery
Which artery completes the remainder of the superficial palmar arch?
Superficial branch of Radial artery
The anatomical snuff box is formed by which tendons of the hand?
Abductor pollicis longus
Extensor pollicis brevis
Extensor pollicis longus
What nerve provides cutaneous innervation to the anatomical snuff box and surrounding area?
Superficial branch of radial nerve
What are the muscles located between the metacarpals and which are responsible for abduction of the digits and which are responsible for adduction of the digits?
Interossei Muscles
- 4 Dorsal Interosseous Muscles: Abduct digits
- 3 Palmar interosseous Muscles: Adduct digits
Which nerve innervates the Interossei muscles?
Ulnar Nerve deep branch
All muscles of the posterior compartment are innervated by which nerve?
Radial Nerve
The origin of the Long Head of the Triceps Brachii?
Infraglenoid Tubercle of Scapula
The origin of the Lateral head of the Triceps Brachii?
Humerus (Posterior, superior to radial groove)
The origin of the Medial head of the Triceps Brachii?
Humerus (Posterior, inferior to radial groove)
The Triceps Brachii insertion?
Olecranon Process of Ulna (via triceps brachii tendon)
What are the actions of the Triceps Brachii?
- Extends forearm at elbow joint
- Extends arm at shoulder joint
Which nerve innervates the Triceps brachii?
Radial Nerve
What is the major muscle of the posterior compartment?
Triceps Brachii
Which head of the Triceps Brachii is the only head with origin above the shoulder joint?
Long Head of the Triceps Brachii
Which muscles has its origin at the lateral epicondyle of the posterior Humerus and insertion at the upper posterior surface of the ulnar olecranon?
Anconeus
What is the action of the Anconeus muscle?
Extension of forearm
Assists the triceps brachii
The Anconeus is innervated by which nerve?
Radial Nerve
What is the name of the major artery that supplies the arm and is a continuation of the axillary artery?
Brachial Artery
Where does the Brachial Artery extend from and to where?
- From: Lower border of teres major
- To: Inferior part of the cubital fossa
What does the Brachial artery terminate as? (Branches into what arteries)
Terminates as Radial and Ulnar Arteries
What are the Branches of the Brachial artery prior to termination point and which is the major, deep branch?
- Profunda Brachii Artery: Major and deep
- Ulnar Collaterals
What are the Superficial and Deep major veins of the arm?
- Superficial: Cephalic and Basilic Vein
- Deep: Brachial Vein
What veins of the arm are located beneath the skin and are superficial to the brachial fascia throughout much of their course?
Cephalic and Basilic Veins
What may occur if the if the Median Cubital vein is very large?
Divert most/all blood to Basillic vein. Superior Cephalic may be absent
What are the Four main nerves that provide innervation of the upper extremity?
Musculocutaneous Nerve
Radial Nerve
Median Nerve
Ulnar Nerve
Of the four main nerves which two have no branches in the arm?
Median Nerve
ulnar Nerve
The musculocutaneous Nerve passes through what muscle and continues distally between what two muscles, innervating all three as it passes?
- Passes through: Coracobrachilis Muscle
- Between: Biceps Brachii and Brachialis Muscles
The Musculocutaneous nerve arise from where?
Brachial Plexus
What is significant about the level of the elbow for the Musculocutaneous Nerve?
- Above Elbow: Muscular innervation
- Below Elbow: Cutaneous innervation
The Musculocutaneous Nerve terminates as what nerve and what is innervated by it?
- Lateral Antebrachial Cutaneous Nerve (AKA Lateral Cutaneous Nerve of the Forearm)
- Innervates: Large lateral portion of forearm
Which Nerve arises from contribution of medial and lateral cords of the brachial plexus and does not give off any branches in the arm? Where does it branch?
- Median Nerve
- Branches: supply forearm and hand
The Trochlear Notch (at elbow) is formed by what?
Coronoid Process and Olecranon
What Type and classification does the Elbow Joint have?
- Type: Synovial Joint
- Classified: Hinge Joint
What does the elbow permit?
Flexion and Extension of Forearm
What reinforces the weak articular capsule (lined by synovial membrane) of the elbow?
Collateral ligaments which limit side to side movement
The radial collateral ligament extends from where and goes to where?
Lateral Epicondyle of Humerus to Radial notch of ulna
What is the name of the ligament that surrounds the head of the radius?
Anular Ligament
The Ulnar collateral ligament extends from where and goes to where?
Medial Epicondyle of Humerus to Coronoid Process and Olecranon of the Ulna
What is Subluxation?
Incomplete or partial dislocation of a joint or organ
What is the difference between Golfer’s Elbow and Tennis Elbow?
Golfer’s Elbow: Medial Epicondylitis
Tennis Elbow: Lateral Epicondylitis
What is the thin, strong, fibrous membrane that joins the radius and ulna of the forearm an provides attachment for some deep forearm muscles?
Interosseous Membrane
The interosseous membrane provides the general plane for dividing the forearm into what compartments?
Posterior (Extensor) Compartment -Deep -Superficial Anterior (Flexor) Compartment -Deep -Superficial
The Anterior Compartment of the forearm contains muscles that complete what actions?
Flexors and Pronators
The Posterior Compartment of the forearm contains muscles that complete what actions?
Extensors and Supinator’s
The muscles of the Superficial Anterior (Flexor) compartment originate where and typically insert where?
Origin: Medial Epicondyle of Humerus
Insert: Carpals, Metacarpals, and Phalanges
The muscles of the superficial anterior (flexor) compartment have what function?
Flexors (and bellies of muscles form bulk of forearm)
What are the names of the muscles of the Superficial anterior (flexor) compartment?
- Pronator teres
- Flexor carpi radialis
- Palmaris longus
- Flexor carpi ulnaris
- Flexor digitorum superficialis
What are the muscles of the Deep anterior (flexor) compartment, in which insert on the base of the distal phalanges and function as flexors?
- Flexor pollicis longus
- Flexor digitorum profundus
- Pronator quadratus
What are the Muscles of the Superficial posterior (extensor) compartment? name from lateral to medial
- Brachioradialis
- Extensor carpi radialis longus
- Extensor carpi radialis brevis
- Extensor digitorum
- Extensor digiti minimi
- Extensor carpi ulnaris
Which muscles of the superficial posterior (extensor) compartment have their origin more distal portion of the Humerus and are innervated by the radial nerve?
- Brachioradialis
- Extensor carpi radialis longus
Which muscles of the superficial posterior (extensor) compartment have their origin on the lateral epicondyle of the Humerus and are innervated by the deep radial nerve?
- Extensor carpi radialis brevis
- Extensor digitorum
- Extensor digiti minimi
- Extensor carpi ulnaris
The Brachioradialis reflex (AKA Supinator reflex) is carried by which nerve and mediate where?
Radial Nerve
Mediated at: C5 - C6 spinal nerves
What are the muscles of the deep posterior (extensor) compartment?
Supinator Abductor pollicis longus Extensor pollicis brevis Extensor pollicis longus extensor indicis
Pronation is essentially a function of which nerve and Supination is essentially a function of which nerve?
Pronation: Median Nerve
Supination: Musculocutaneous and Radial Nerves
Which muscles are responsible for Pronation?
- Pronator teres
- Pronator quadratus
- Brachioradialis
Which muscle pronates the forearm at the radioulnar joint?
Pronator quadratus
Which muscles are responsible for supination?
- Supinator muscle
- Biceps brachii
- Brachioradialis
What are the superficial veins of the forearm?
Cephalic
Basilic
Median Antebrachial
The radial pulse is palpated where the radial artery lies between the tendons of what two muscles?
Flexor carpi radialis
Abductor pollicis longus
The wrist and hand consist of how many bones and muscles?
28 bones
19 intrinsic muscles
20 extrinsic muscles
What is formed by the antebrachial fascia thickening posteriorly over the distal ends of the radius and ulna?
Extensor retinaculum
The extensor retinaculum function and prevents what?
Retains extensor tendons in position
Prevents bowstringing
The flexor retinaculum extends from where to where?
Across Wrist: Scaphoid and trapezium bones on radial side to hamate and pisiform bone on ulnar side
The Flexor retinaculum forms what structure?
Carpal tunnel
What lies outside the Flexor retinaculum (Carpal tunnel) but under the palmar carpal ligament?
Tendon of Palmaris longus muscle
Ulnar nerve
Ulnar artery
What encompasses the tendons within the flexor retinaculum?
Synovial sheath
What transmit through the flexor retinaculum?
Tendons of:
- Flexor pollicis longus
- Flexor digitorum superficialis
- Flexor digitorum profundus
What other significant items lies within the carpal tunnel?
Median nerve
What results from any lesion that significantly reduces the size of the carpal tunnel?
Carpal tunnel syndrome
Carpal tunnel syndrome affects what portion of the hand for cutaneous sensation and which part for motor function?
Cutaneous (Sensory): Lateral 3 and one-half digits (thumb to lateral aspect of middle finger)
Motor: Thenar muscle coordination. unable to oppose the thumb
What is Tinel sign often referred to?
Distal tingling on percussion
What the name of the extension of the tendon of the palmaris longus muscle, that is most superficial structure of the hand and which fibers attach to overlying skin at the palmer creases, goes deep to fascia, metacarpals, and phalanges?
Palmar aponeurosis
What are the intrinsic muscles of the hand?
Thenar muscles Hypothenar muscles Adductor muscle Lumbrical muscles Interosseus muscles
What are the muscles of the thenar compartment and together form the Thenar eminence?
Abductor pollicis brevis
Flexor pollicis brevis
Opponens pollicis
What is the name of the muscle that is fan shaped, adducts the thumb, providing power to the grip?
Adductor pollicis muscle
What are the muscles of the Hypothenar compartment that together form the hypothenar eminence?
Abductor digiti minimi
Flexor digiti minimi brevis
Opponens digiti minimi
Which nerve innervates the muscles of the hypothenar compartment?
Ulnar nerve
Which nerve innervate the muscles of the Thenar compartment?
Recurrent branch of median nerve (motor branch)
What is the name of the muscles that have a wormlike appearance and attach proximally to tnedons of the flexor digitorum porfundus and distally to parts of the extensor digitorum tendon called extensor expansions?
Lumbrical muscles
Which Lumbrical muscles are innervated by the median nerve and which by the ulnar nerve?
Median: Lateral two lumbrical muscles
Ulnar: Medial two lumbrical muscles
What function do the lumbrical muscles serve?
Flex the digits at the metacarpophalangeal Joint (MCP joint) and extend the interphalangeal joints
Which lumbricals are unipennate and which are bipennate?
Unipennate: 1st and 2nd
Bipennate: 3rd and 4th