Exam 5 - upper limb -JB- pt 2 - slides 1-50 Flashcards
Functionally related skeletal muscles of the limbs along with their associated blood vessels and nerves are grouped together by ___ into regions called compartments
Fascia
Compartments are generally identified by their position or action of muscles:
Anterior, posterior, medial,
Superficial, deep
Flexor, extensor
Anterior (flexor), anterior (extensor), superficial anterior (flexor) etc
for reference
Muscles of the arm are located in anterior and posterior compartments which are separated by fascial planes: (2)
Anterior Compartment
Posterior Compartment
Muscles of the arm in anterior compartment
Biceps Brachii
Brachialis
Coracobrachialis
Muscles of the arm in posterior compartment
Triceps Brachii
Anconeus
Muscles of the arm are supplied by branches of the ___ artery, which is the continuation of the ___ artery
Brachial
Axillary
The ___ artery is used for taking arterial blood pressure in the arm using a BP cuff. The cuff compresses the ___ artery against the humerus, and occludes it
Brachial
All muscles of the anterior compartment are innervated by the _____ nerve
Musculocutaneous Nerve
Origin:
Long head: supraglenoid tubercle of scapula
Short head: coracoid process of scapula
Biceps Brachii
Insertion: tuberosity of radius (AKA radial tuberosity) and bicipital aponeurosis
Biceps Brachii
Action: flexes forearm at elbow joint, supinates forearm (at radioulnar joint), and flexes arm at shoulder joint.
Additionally, it is a powerful supinator.
Biceps Brachii
Biceps Brachii innervation:
Innervation: musculocutaneous nerve
Origin: humerus
Insertion: ulnar tuberosity and coronoid process of ulna
Brachialis
Action: flexes forearm at elbow joint (major flexor of elbow)
Brachialis
Brachialis innervation
Musculocutaneous nerve
The biceps is most efficient in producing flexion when the elbow is flexed close to 90º and the forearm is _____
Supinated
The biceps barely operates as a flexor when the forearm is ____.
Pronated
The _____ is always the main flexor of the forearm regardless of pronation or supination, but has little assistance from the ____ during pronation
Brachialis
Biceps
Origin: coracoid process of scapula
Insertion: shaft of humerus
Coracobrachialis
Action: flexes and adducts arm at the shoulder joint
Coracobrachialis
Coracobrachilis innervation:
Musculocutaeous nerve
All muscles of the posterior compartment of the arm are innervated by the:
Radial Nerve
Origin Long head: infraglenoid tubercle of scapula Lateral head: humerus Medial head: humerus Insertion: olecranon of ulna
Triceps Brachii
Action: extends forearm at elbow joint, extends arm at shoulder joint
Triceps brachii
Origin: lateral epicondyle of humerus
Insertion: olecranon of ulna
Anconeus
Action: assists triceps in extending forearm at elbow joint and stabilizes elbow joint
Anconeus
Artery (brachial)
From teres major to cubital fossa
Branches
Profunda brachii
Ulnar collaterals
Artery of Arm
Veins
Superficial: cephalic and basilic
Deep: brachial veins
Vein of Arm
Arterial branches of Arm:
Branches
___ ___
Ulnar collaterals
Profunda Brachii
The major arterial supply to the arm is from the brachial artery and its branches. The brachial artery is a continuation of the ____ ___, and extends from the lower border of the teres major to the lower part of the cubital fossa, where it terminates as the radial and ulnar arteries.
Axillary Artery
The major branch of the brachial artery is the deep brachial artery (___ ___ artery) in the proximal arm.
Profunda Brachii
The venous network of the upper limb includes
- Superficial veins which are located ___.
- Deep veins
There are many connections between the superficial and deep systems of veins
Just below the skin
-Deep veins
Much deeper than superficial veins, and are protected by ___ and ___
Usually accompany arteries, and are named for the corresponding artery (example: brachial veins)
Muscle and bone
The cephalic and basilic veins are located beneath the skin, and are superficial to the ___ ___ throughout much of their course.
Brachial Fascia
There is substantial variation in the interconnection of the basilic and cephalic veins in the cubital fossa.
In some instances, the median cubital vein is very large, diverting most or all of the blood to the basilic vein, and the ___ ___ vein may be small or even absent
Superior Cephalic
slide 18
Four main nerves pass through the arm and supply innervation to its structures:
Musculocutaneous
Radial
Median
Ulnar
Nerves of upper limb:
Two of these have no branches in the arm:
Median
Ulnar
The musculocutaneous nerve of the brachial plexus passes through the _____ and continues distally between the biceps brachii and brachialis muscles.
It gives off branches to all three muscles.
Coracobrachialis
slide 20
Above the elbow the _____ nerve supplies muscles.
Below the elbow it has cutaneous branches.
Musculocutaneous
The musculocutaneous nerve terminates as the lateral antebrachial cutaneous nerve (AKA ___ ___ nerve of the forearm), and supplies a large area of the forearm.
Lateral Cutaneous
The -___ nerve supplies all the muscles in the posterior compartment of the arm.
Radial
The ___ nerve travels through the arm without giving off any branches (It does branch to supply the forearm and hand).
Median
____ nerve also has no innervation to the arm… just passing through
Ulnar
Review of the structures at the elbow..
Slide 26
The ____ is formed by the coronoid process and the olecranon
Trochlear notch
The elbow joint is a ___ joint
Synovial
It is structurally classified as a ___ joint
It permits the action of flexion and extension of the forearm
Hinge
at the Elbow joint: The articular capsule is lined by ____
Synovial Membrane
Elbow Joint:
The articular capsule is weak, and is reinforced by ___ ___ which limit side-to-side displacement of the bones of the joint
Collateral Ligaments
Radial collateral ligament goes from the lateral epicondyle of the humerus to the __ __ of the ulna
Radial Notch
___ ___ surrounds the head of the radius
Annular Ligament
Ulnar collateral ligament goes from the medial epicondyle of the humerus to the ___ ___ and the ___ of the ulna
Coronoid Process
Olecranon
____ is an incomplete or partial dislocation of a joint or organ
Subluxation
Radial head subluxation: Commonly encountered injury in the pediatric population Peaks in the age range of 2 to 3 years More common in girls than boys Affects the \_\_\_ side more than the \_\_\_
Left side more than right
Sublux of radial head:
Mechanism of injury is a sudden longitudinal traction on the arm with the elbow ___
Extended
Cradle the affected elbow with the examiner’s thumb over the radial head and the other hand holding the child’s wrist. The elbow will start out in the flexed position and in one smooth combined movement the wrist should be supinated with pressure over the radial head with the examiner’s thumb while placing the elbow in full extension. A slight “pop” will often be felt when it reduces, and within minutes the child will be playing normally
get back out there kid
These conditions are somewhat related in that both
Affect an epicondyle of the elbow
Generally result from excessive use (or overuse), and repeating the same strenuous motions
Cause pain
Golfer’s Elbow
Tennis Elbow
Golfer’s elbow is ___ epicondylitis
Tennis elbow is ___epicondylitis
Golf = Medial
Tennis = Lateral
Muscles of the forearm are ____ muscles of the hand
Extrinsic
Muscles of forearm:
Anterior compartment
___ and ___
Superficial group
Deep group
Flexors and Pronators
Muscles of forearm:
Posterior compartment
___ and ___
Superficial group
Deep group
Extensors and supinators
A thin, strong, fibrous membrane, the ___ ___, joins the radius and ulna of the forearm
It provides attachment for some deep forearm muscles
Interosseous Membrane
The interosseous membrane provides the general plane for dividing the forearm into poster and anterior compartments.
Slide 37
Superficial anterior compartement forearm:
These muscles of the forearm originate on the ___ ___ of the humerus
Medial Epicondyle
They typically insert on the ___ and ___
Function as ____
Bellies of these muscles form the bulk of the forearm
Metacarpals and phalanges
Flexors
Superficial anterior flexor compartment are:
Flexor carpi radialis Palmaris longus Flexor carpi ulnaris Flexor digitorum superficialis Pronator teres
Origin: medial epicondyle of humerus
Insertion: radial anterior hand (anterior side of bases of 2nd and 3rd metacarpals)
Flexor Carpi Radialis
Action: flexes and abducts hand at wrist (radial deviation)
Innervation: median nerve
Flexor Carpi Radialis
Origin: medial epicondyle of humerus via the common flexor tendon
Insertion: flexor retinaculum and palmar aponeurosis
Palmaris Longus
Action: flexes hand at wrist and tightens palmar aponeurosis
Innervation: median nerve
Palmaris Longus
Origin
Humeral head: medial epicondyle of humerus via common flexor tendon
Ulnar head: olecranon and posterior border of ulna
Flexor Carpi Ulnaris
Insertion: ulnar anterior hand carpals (pisiform, hook of hamate, and base of 5th metacarpal)
Flexor Carpi Ulnaris
Action: flexes and adducts hand at wrist (ulnar deviation)
Innervation: ulnar nerve
Flexor Carpi Ulnaris
Origin: medial epicondyle of humerus via common flexor tendon and also the upper radius and upper ulna
Insertion: anterior surface of the middle phalanges of the fingers (digits 2 – 5)
Flexor Digitorum Superficialis
Action: flexes fingers, flexes hand at wrist
Innervation: median nerve
Flexor Digitorum Superficialis
Deep anterior compartment (forearm)
Muscles of the digits insert on the base of distal phalanges
Function as ___
Flexors
Deep Anterio (flexor) compartment are:
Flexor pollicis longus
Flexor digitorum profundus
Pronator quadratus
Origin: radius and interosseous membrane
Insertion: distal phalanx of thumb
Flexor Pollicis Longus
Action: flexes distal phalanx of thumb
Innervation: median nerve
Flexor Pollicis Longus
Origin: ulna and interosseous membrane
Insertion: anterior surface of digits 2 – 5 (distal phalanx of digits 2 – 5)
Flexor Digitorum Profundus
Action: flexes fingers at distal phalanges and assists with flexion of hand
Innervation: median and ulnar nerves
Flexor Digitorum Profundus
Flexor digitorum superficialis inserts on the ___ phalanges (anterior surface). Flexor digitorum profundus inserts on the ___ phalanges (anterior surface).
Middle
Distral
Solution to flexor digitorum superficialis and profundus…
Camper Chiasm
slide 49
Examination for ___ ___ ___ injury:
Examiner holds middle phalanx in full extension, which isolates the FDP
Patient actively flexes the distal phalanx
Flexor Digitorum profundus
This is an assessment for function of the flexor digitorum profundus and/or the ___ ___ (which innervates FDP and FDS)
Median Nerve