Final Exam (based off review) Flashcards
Lecture & Lab
What are the 4 Somtosensory Conscious Pathways?
- Dorsal Column Upper Tract (Cuneatus)
- Dorsal Column Lower Tract (Gracilis)
- Anterior Spinothalamic Tract
- Lateral Spinothalamic Tract
Somatosensory Conscious Pathways Order:
1st order neuron (DRG) >DR> 2nd order (medulla) neuron > 3rd order neuron (VP thalamus) > internal capsule > corona radiata > postcentral gyrus
Dorsal Column Pathway (Lower tract, fasciculus gracilis):
DRG (1st cell body)
DR
Fasciculus gracilis (first axon)
Nucleus gracilis (2nd cell body)
Medial lemniscus (second axon “decussate”)
VP thalamus (3rd cell body)
Internal capsule (third axon)
Corona radiate
Postcentral gyrus
Dorsal Column Pathway (Upper tract, fasciculus cuneatus):
DRG (1st cell body)
DR
Fasciculus cuneatus (first axon)
Nucleus cuneatus (2nd cell body)
Medial lemniscus (second axon “decussate”)
VP thalamus (3rd cell body)
Internal capsule (third axon)
Corona radiata
Postcentral gyrus
Anterior Spinothalamic Tract Pathway:
DRG > DR > DH > AST > VP Thalamus > Internal Capsule > Corona Radiata > Postcentral gyrus
Lateral Spinothalamic Tract Pathway:
DRG > DR > DH > LST > VP Thalamus > Internal Capsule > Corona Radiata > Postcentral gyrus
Where do the dorsal column tracts 2nd order neuron decussate?
medulla (medial lemniscus)
What type of sensations are the dorsal column tracts responsible for?
fine touch and proprioception
What type of sensations is the anterior spinothalamic tract responsible for?
crude touch and pressure
What type of sensations is the lateral spinothalamic tract responsible for?
pain and temperature
What are the 2 Somatosensory Unconscious Pathways?
- Anterior Spinocerebellar Tract
- Posterior Spinocerebellar Tract
Anterior Spinocerebellar Tract:
DRG > DR > DH > lateral column (deccusate) > AST > inferior peduncles > cerebellar cortex
Posterior Spinocerebellar Tract:
DRG > DR > DH > lateral column (deccusate) > PST > superior cerebral peduncles > cerebellar cortex
What type of sensations are the Posterior & Anterior Spinocerebellar Tract Pathways responsible for?
Subconscious proprioception
What are the 3 Somatomotor Conscious Pathways? (pyramidal tracts)
corticospinal pathway
anterior corticospinal tract
lateral corticospinal tract
corticobulbar tracts
What are the somatomotor pathways responsible for?
subconscious movement of muscle
What type of sensations is the anterior corticospinal tract responsible for?
gross motor
What type of sensations is the lateral corticospinal tract responsible for?
fine motor
Corticospinal pathway:
What type of sensations is the corticospinal tract responsible for?
subconscious movements of the body
Lateral corticospinal pathway: (Contralateral) 75%-90% Fine Motor
Precentral gyrus (UMN) >
Corona radiata >
Internal capsule >
Cerebral peduncles >
Pyramids >
LCT >
Lateral Column >
Ventral horn (LMN)
Anterior corticospinal pathway: (Contralateral) 10%-25% Gross Motor
Precentral gyrus (UMN) >
Corona radiata >
Internal capsule >
Cerebral peduncles >
Pyramids >
ACT >
Lateral Column >
Ventral horn (LMN) (decussate)
Corticobulbar tract pathway:
Precentral gyrus (UMN) >
Corona radiata >
Internal capsule >
Cerebral peduncles >
Motor nuclei of cranial nerves 3-12 (LMN)
What type of sensations is the corticobulbar tract responsible for?
subconscious movements of the head
What are the 4 Somatomotor Unconscious Pathways? (extrapyramidal tracts)
rubrospinal tract
reticulospinal tract
vestibulospinal tract
tectospinal tract
Rubrospinal tract pathway:
red nucleus (UMN) > rubrospinal tract > VH (LMN)
Reticulospinal tract pathway:
reticular formation (UMN) > reticulospinal tract > VH (LMN)
Vestibulospinal tract pathway:
vestibular nucleus (UMN) >vestibulospinal tract > VH (LMN)
Tectospinal tract pathway:
tectum (UMN) > tectospinal tract > VH (LMN)
Which 3 somatomotor unconscious pathways go through the anterior white column?
vestibulospinal tract
reticulospinal tract
tectospinal tract
What is the only somatomotor unconscious pathway that goes through the lateral white column?
rubrospinal tract
Stretch postural reflex:
a protective mechanism that causes muscles to contract when stretched passively
Example of stretch reflex:
occurs when a muscle is stretched and as a result that same muscle contracts. An example of this in the human body is the “knee-jerk” reflex (tap the patellar with a small hammer).
Golgi tendon reflex:
a protective feedback mechanism to control the tension of an active muscle by causing relaxation before the tendon tension becomes high enough to cause damage.
Flexor/withdrawal reflex example:
if one steps on a tack, the involved lower limb flexes to remove the foot from the stimulus.
Crossed extensor reflex example:
The spinal reflex occurs, but additionally, the extensor muscles of the contralateral limb will contract to maintain stability against the force of gravity to ensure the person does not fall after withdrawing the limb from the painful stimulus.
Nerve that supplies the biceps brachii and brachialis muscles, and provides sensation to the lateral forearm
Musculocutaneous nerve
Nerve that supplies the flexor muscles and the skin of the palm and the two outer fingers
Median nerve
supplies the small muscles of the hand
Ulnar nerve
Nerve that supplies the shoulder muscles and the overlying skin
Axillary nerve
Nerve that supplies the extensor muscles and the skin of part of the arm and hand
Radial nerve
Brachial Plexus Injuries & Disorders:
Avulsion- the nerve is torn away from its attachment at the spinal cord; the most severe type.
Rupture- the nerve is torn, but not at the spinal cord attachment.
Neuroma-
Neurapraxia-
Erb’s Palsy-
Global Palsy-
Horner Syndrome-
Neurolysis-
CNS Injuries:
Injuries:
Stroke
Hematoma
Aneurysm
Thrombosis
Hemorrhage
Angioma (arteriovenous malformation)
CNS Disorders:
Neuropsychological and language disorders
Degenerative disorders of the neuromuscular system
Disorders of the basal nuclei
Disorders of the cerebellum
Somatosensory loss
Lower and upper motor neuron lesions
Cranial nerve lesions
What are the 2 motor compartments of the upper limb?
Anterior & Posterior
What are the 3 sensory compartments/patches of the upper limb?
Lateral
Medial
Posterior
The motor component of the anterior brachium is supplied by ______, and the posterior brachium is supplied by ______ nerve.
musculocutaneous; radial
The motor component of the anterior antebrachium is supplied by the _____ nerve except to 1 ½ mm, and the posterior antebrachium is supplied by the _____ nerve.
median; radial
The motor component of the anterior hand is supplied by the _____ nerve except to 1 ½ m groups.
ulnar
The sensory component of the upper lateral cut is supplied by the _____ nerve; The lower lateral cut is supplied by the _____ nerve; The posterior cut is supplied by _____ nerve.
axillary; radial; radial
The sensory component of the medial antebrachial cut and the lateral antebrachial cut is supplied by the _____ nerve. The posterior antebrachial cut is supplied by the _____ nerve.
musculocutaneous; radial
The sensory component of the hand is supplied by the terminal ____ nerve.; terminal _____ nerve.; terminal _____nerve.
ulnar; median; radial
What are the nerves to the true upper limb?
terminal branches (mixed nerves)
What does the true upper limb consist of?
arm
forearm
hand
The arm (brachium) has what type of sensory patches
brachial cutaneous nerves
The forearm (antebrachium) has what type of sensory patches
antebrachial cutaneous nerves
The hand (manus) has what type of sensory patches
cutaneous terminal branches of median, ulnar, and radial nerves
the distribution of all motor and sensory nerve fibers from one spinal cord segment.
segmental innervation
the sensory distribution to the specific area of skin from one spinal cord segment
dermatomes
Each nerve branch that comes off the brachial plexus is known as a
peripheral nerve
these nerves can be motor nerves, sensory nerves (cutaneous), or mixed nerves
peripheral nerves
What are the motor peripheral nerves to the upper limb?
Dorsal Scapular Nerve
Long Thoracic Nerve
Nerve to Subclavius
Suprascapular Nerve
Lateral Pectoral Nerve
Medial Pectoral Nerve
Upper Subscapular Nerve
Middle Subscapular (Thoracodorsal) Nerve
Lower Subscapular Nerve
What are the sensory (cutaneous) peripheral nerves to the upper limb?
Musculocutaneous Nerve
Median Nerve
Ulnar Nerve
Axillary Nerve
Radial Nerve
What are the mixed peripheral nerves to the upper limb?
Intercostobrachial Nerve (First intercostal nerve)
Upper Lateral Brachial Cutaneous Nerve (Axillary)
Lower Lateral Brachial Cutaneous Nerve (Radial)
Posterior Brachial Cutaneous Nerve (Radial)
Medial Brachial Cutaneous Nerve
Lat. Antebrachial Cut. N. (Musculocutaneous)
Medial Antebrachial Cutaneous Nerve
Posterior Antebrachial Cutaneous Nerve (Radial)
Terminal (cutaneous) branches of Median Nerve
Terminal (cutaneous) branches of Ulnar Nerve
Terminal (cutaneous) branches of Radial Nerve
the more proximal the nerve, the higher the spinal level that contributes axons to that _____.
nerve
Axillary nerve dermatomes:
C5 & C6
supplies the lateral (thumb side) arm and forearm
Radial dermatomes:
C5-C8
supplies the lateral arm, forearm, and whole hand
Musculocutaneous dermatomes:
C5-C7
supplies the lateral arm, forearm, thumb, and 2nd/3rd digits
Median dermatomes:
C5-T1
supplies the lateral/medial arm, forearm (except for the armpit), and the whole hand
Ulnar dermatomes:
C8 & T1
supplies the medial arm, forearm, half of the 4th digit, and the 5th digit (pinky)
What is a reflex arc? What are the components of a reflex arc?
A simple spinal reflex is the least complicated spinal reflect arc, and it includes the sensory and motor neurons working as a unit at the spinal level.
A reflex arc that involves one synapse between two neurons, an afferent (sensory) and an efferent (motor)
monosynaptic reflex arc
A reflex arc that involves multiple synapses (at least two) between an efferent neuron, an afferent neuron, and at least one interneuron.
polysynaptic reflex arc
What is an example of a monosynaptic reflex arc?
stretch-postural reflex
What is an example of a polysynaptic reflex arc?
flexor/withdrawal reflex
cross-extensor reflex
What is an example of a complicated polysynaptic reflex that occurs in conjunction with one of the simple spinal reflexes?
cross-extensor reflex
descending motor pathways from the brain that can inhibit or incite motor neurons of lower levels making it easier or more difficult for a reflex to occur. These influences are responsible for voluntary and some automatic control of the lower motor neurons.
supraspinal influences
What is an example of a neurological test for a supraspinal lesion?
Babinski reflex
What are the five regions of the brain?
Telencephalon
Diencephalon
Mesencephalon
Metencephalon
Mylencephalon
Name white/gray matter structures in the telencephalon:
White matter:
1. corona radiata
2. corpus callosum
Gray matter:
1. caudate nucleus- execution of movement
2. putamen- learning and motor control, including speech articulation
Name white/gray matter structures in the diencephalon:
White matter:
1. internal capsule
2. fornix
Gray matter:
1. thalamus-regulates consciousness, arousal, and attention
2. hypothalamus- maintains body temperature, metabolic rate, etc
Name white/gray matter structures in the mesencephalon:
White matter:
1. cerebral peduncles
2.
Gray matter:
1. tectum- auditory and vision
2. substantia nigra
Name white/gray matter structures in the metencephalon:
White matter:
1. corticospinal tract- voluntary motor function
2. spinothalamic tract- pain and temperature conscious
Gray matter:
1. pneumotaxic center- preventing overdistention of the lungs
2. apneustic center- controls the intensity of breathing and delay
Name white/gray matter structures in the myelencephalon:
White matter:
1. fasciculus gracilis- discriminative touch and conscious proprioceptive information from the lower half of the body to the brain
2. fasciculus cuneatus- discriminative touch and conscious
proprioceptive information from the upper half of the body
Gray matter:
1. nucleus gracilis- discriminative touch and conscious proprioceptive information
2. nucleus cuneatus- discriminative touch and conscious proprioceptive information
the ability of neurons to change their function, the quantity and types of neurotransmitters that they produce (i.e. their chemical profile), and/or their structure.
neuroplasticity
During motor learning, what happens to the number of active regions in the brain?
there is a reduction in the amount of active regions in the brain.
the act of attempting to decrease the exaggerated neural response to a stimulus.
habituation
Examples of Habituation:
- PT/OT treatment for tactile defensiveness-stimulating the child’s skin with gentle stimulation at first, then gradually increasing the stimulation, in an effort to cause the patient to be able to tolerate the tactile stimulation (and thereby achieve habituation).
- people with tinnitus. Hearing aids can be used to habituate to the ringing over a prolonged period of time.
- a learned experience in paying attention to certain important stimulations (like listening to a lecture) while tuning out certain other less important stimulations (like the itchiness of a sweater).
In adults, how is recovery from injury promoted in the CNS?
through neuroplasticity. Neuronal communication sites are continuously being created and broken.
Why does functional regeneration of axons occur more frequently in the peripheral nervous system (PNS) than in the CNS?
Because of the production of nerve growth factor by Schwann cells, the clearing of debris, and residual Schwann cell sheaths that guide peripheral axonal regrowth to the target. Schwann cells don’t exist in the CNS. If rehabilitative exercise begins 5 days after a (neurological injury) peripheral nerve lesion it can increase axonal regeneration and innervation of a muscle.
What are some rehabilitation mechanisms that can promote beneficial neural plasticity?
- Initiating therapy early after injury (for example rehabilitative exercise beginning 5 days after a peripheral nerve lesion), while avoiding vigorous use or overuse of the impaired extremity (such as in the upper limb).
- Practicing many repetitions of specific tasks to elicit beneficial adaptive neuroplasticity (such as in habituation and motor cortical reorganization)
- The use of transcranial magnetic stimulation (TMS) to enhance or inhibit motor learning and memory formation.
- Using evidenced-based therapy for chronic strokes such as task-specific training (for example forced use training (FUT)/ constraint-induced movement therapy (CIMT).
Upper Motor Neuron Lesions:
Spastic paralysis
*hyperreflexia
*hypertonia
*spasticity
Lower Motor Neuron Lesions:
Flaccid Paralysis
* hyporeflexia
*hypotonia
*atrophy
*flaccidity
Dorsal Column lesions:
Multiple Sclerosis, loss of proprioception in the hands and fingers, Astereognosis
Spinothalamic lesions:
Syringomyelia, loss of pain & temp awareness, Charcot’s joints
Blood supply to the brain:
The circle of Willis:
distributing vessels
vertebral arteries
internal carotid arteries
Blood supply to the spinal cord:
Anterior spinal arteries (anterior cord)
Left/Right posterior spinal arteries (posterior cord)
Left/Right radicular arteries (lateral cord)
Blood supply to the upper limb
Brachiocephalic trunk
Right Common Carotid artery
Right Subclavian artery
Axillary artery
Brachial artery (bifurcates)
Radial and Ulnar arteries
Deep palmar arches
Superficial palmar arches
Digital arteries & Princeps Pollicis artery
The subclavian artery gives off what artery?
thyrocervical trunk
What arteries branch off the thyrocervical trunk?
transverse cervical and suprascapular arteries
What 3 arteries anastomoses on the posterior scapular to form a collateral for blood supply?
transverse cervical artery
suprascapular artery
dorsal scapular artery
3 regions of the axillary artery?
1st region:
supreme thoracic artery
2nd region:
thoracoacromial artery
lateral thoracic artery
3rd region:
anterior circumflex humeral artery
posterior circumflex humeral artery
subscapular artery
What are the 4 regions of the thoracoacromial artery?
Acromial
Deltoid
Pectoral
Clavicular
What blood vessel emerge through the triangular space (on the scapular)?
scapular circumflex artery
What blood vessels emerge through the quadrangular space (superior triceps)?
posterior humeral circumflex artery
axillary artery
What blood vessels and nerves emerge through the triangular interval space (triceps below quadrangular space)?
deep brachial artery (profunda brachiii)
radial nerve
What are the 5 portions of the Brachial Plexus?
Roots
Trunks
Divisions
Cords
Terminal branches
What are the 5 ventral roots of the brachial plexus?
C5
C6
C7
C8
T1
What are the 3 trunks of the brachial plexus?
Superior
Middle
Inferior
How many divisions are in the brachial plexus?
Lateral
Posterior
Medial
What are the 5 terminal branches of the brachial plexus?
Musculocutaneous nerve
Axillary nerve
Radial nerve
Median nerve
Ulnar nerve
What nerves does the “M” in the brachial plexus stand for?
Musculocutaneous nerve
Median nerve
Ulnar nerve
What is the pathway from C5 rami to the Dorsal Scapular Nerve through the plexus?
C5 > Superior trunk > dorsal scapular nerve >
(muscles innervated “rhomboids or levator scapulae”)
What is the pathway from C6 rami to the Suprascapular Nerve through the plexus?
C6 > Suprascapular nerve >
( muscles innervated “Supraspinatus or Infraspinatus”)
What is the pathway from C6 rami to the Musculocutaneous Nerve through the plexus?
C6 > Superior trunk > Anterior division > Lateral cord > musculocutaneous nerve
(muscles innervated “biceps brachii, brachialis, and coracobrachialis”)
What is the pathway from C7 rami to the Median Nerve through the plexus?
C7 > Middle trunk > Anterior division > Lateral cord > Median nerve
(muscles innervated “pronator teres, palmaris longus, and the flexor digitorum superficialis, flexor pollicis longus, abductor pollicis brevis, opponens pollicis, and adductor pollicis”)
What is the pathway from C7 rami to the Axillary Nerve through the plexus?
C7 > Middle trunk > Posterior division > Posterior cord > Axillary nerve
(muscles innervated “Deltoid & Teres Minor”)
Flow of C6, C7, C8 rami together through brachial plexus (Radial nerve):
C6 C7 C8 > Super/Middle/Inferior trunks > Posterior cord > Radial nerve
(muscles innervated “triceps brachii, anconeus, extensor carpi radialis longus, and brachioradialis”)
Flow of T1 rami through brachial plexus:
T1 > Inferior trunk > Anterior division > Medial cord > Ulnar nerve
(muscles innervated “Flexor carpi ulnaris and flexor digitorum profundus, Palmaris brevis, lumbricals, hypothenar, and interossei muscles”)
What division do axillary and radial nerves come off?
posterior division
The musculocutaneous nerve can receive fibers from which spinal cord segments?
C5, C6, and C7
Which of the brachial plexus cords does the musculocutaneous nerve originate from?
lateral cord
The median nerve can receive fibers from which spinal cord segments?
C6, C7, C8, and T1
Which of the brachial plexus cords does the median nerve originate from?
lateral and medial
The radial nerve can receive fibers from which spinal cord segments?
C5, C6, C7, C8, and T1
Which of the brachial plexus cords does the radial nerve originate from?
posterior cord
The ulnar nerve can receive fibers from which spinal cord segments?
C8 and T1
Which of the brachial plexus cords does the ulnar nerve originate from?
medial cord
The axillary nerve can receive fibers from which spinal cord segments?
C5 and C6
Which of the brachial plexus cords does the axillary nerve originate from?
posterior cord
The posterior cord gives rise to what two terminal branches?
axillary & radial nerves
The lateral cord gives rise to what terminal branches?
musculocutaneous & median nerve
The medial cord gives rise to what terminal branches?
median & ulnar nerves
What are dorsal rami? What structures come off dorsal rami? What structures do they innervate?
- posterior division of the spinal nerves
- upper, middle, & lower subscapular nerves come off dorsal rami
- Upper (upper subscapularis), Middle (Latissimus dorsi), Lower (lower subscapularis & Teres major)
The shoulder is supplied by nerves that come off what parts of the brachial plexus?
roots, trunks, and cords
The free limb is supplied by what nerves from the brachial plexus?
musculocutaneous, median, ulna, radial
What is the division of the brachial plexus that supplies developmental ventral structures (muscles & skin) from dermomyotomes?
anterior division
What is the division of the brachial plexus that supplies developmental dorsal structures (muscles & skin) from dermomyotomes?
posterior division
What cutaneous nerve and terminal branch supplies the arm/brachium?
upper/lower lateral brachial cutaneous nerves
musculocutaneous nerve
What cutaneous nerve and terminal branch supplies the forearm/antebrachium?
lateral/medial/posterior antebrachial cutaneous nerve
medial cord, ulnar nerve, and musculocutaneous nerve
What cutaneous nerve and terminal branch supplies the hand?
median/ulnar/radial terminal nerves
median and ulnar terminal nerves
Segmental Innervation vs Dermatome:
Segmental innervation- the distribution of all motor and sensory nerve fibers from one spinal cord segment.
Dermatome- the sensory distribution to the specific area of skin from one spinal cord segment.
What is a nervous system lesion?
What is an inter-nervous line?
This may be safely opened up, the 2 muscles pulled apart and access gained to the deeper parts of the forearm without fear of damaging motor nerves.
How many inter-nervous lines are there in the forearm?
3
What is the significance of inter-nervous lines?
What is a palsy?
paralysis or paresis
Name at least 4 such palsies that involve the brachial plexus:
Erb’s palsy
Global palsy
Klumpke’s palsy
What are some symptoms (motor and sensory) of median nerve palsy? Where and why would you expect those symptoms
symptoms: ape hand, flattened thenar eminence, loss of pincer grasp
cause: paralysis and wasting away of the thenar eminence
What are some symptoms (motor and sensory) of ulnar nerve palsy? Where and why would you expect those symptoms
symptoms: claw hand, loss of add/abd of fingers
causes: paralysis of the hypothenar muscles
What are some symptoms (motor and sensory) of radial nerve palsy? Where and why would you expect those symptoms
symptoms: wrist drop, Saturday night palsy, honeymoon palsy, crutch palsy
causes: trauma or compression of the radial nerve
Trace the neurological path from the CNS where the initiation of a motor command begins (like abduction of the shoulder deltoid) to the final specific effector of the upper limb:
precentral gyrus
corona radiata
internal capsule
cerebral peduncle
pons
medulla
ACT
anterior white column
Ventral Horn (decussate)
Ventral Root
C7 ramus
middle trunk
posterior division
posterior cord
axillary nerve
shoulder abduction of the deltoid
Trace the neurological path from a region of skin covering the trunk or upper limb to the destination where a specific sensation from that skin region is perceived:
What are the 6 branches of the axillary artery?
Supreme thoracic a
Thoracoacromial a
Lateral thoracic a
Anterior Humeral circumflex a.
Posterior Humeral Circumflex a.
Subscapular a.
ST-LAPS
What are the 4 regions of the thoracoacromial artery:
Acromial
Pectoral
Deltoid
Clavicular
What regions of the thoracoacromial artery are innervated by the pectoralis minor?
pectoral and clavicular
What regions of the thoracoacromial artery are innervated by the pectoralis major?
acromial and deltoid
What travels through the triangular space?
axillary nerve and circumflex scapular artery/vein
Where is the triangular space located?
the axilla
What travels through the triangular interval space?
radial nerve and profundus brachii artery
Where is the triangular interval space located?
superior triceps below the quadrangular space
What travels through the quadrangular space?
axillary nerve and posterior circumflex humeral artery
Where is the quadrangular space located?
superior triceps
What does the long thoracic nerve change its name to?
thoracodorsal nerve
What muscles are shown on the back of the cadaver?
trapezius
rhombhoids minor
rhombhoids major
levator scapulae
Supraspinatus
Infraspinatus
What nerve & vein is covered by the Infraspinatus?
scapular artery & vein
What muscles are shown on the front of the cadaver?
Scalenes
Subclavius
Subscapularis
Pectoralis major
Pectoralis minor
Serratus Anterior
Latissimus dorsi
Corticospinal tract upper motor neuron lesions:
hyperreflexia
dystonia
spasticity
clonus
babinske sign
asthenia (no energy, strength)
Internervous (between nerve) lines:
Septum between the flexor carpi ulnaris and the flexor digitorum superficialis
Septum between the ulnar and radius nerve
Septum between the medium nerve and radial nerve
Internervous lines dysfunction:
Ape hand (median nerve)
Claw hand (ulnar nerve)
Wrist drop (radial nerve)
What nerve comes off the upper trunk?
suprascapular nerve
What cords do the anterior divisions connect to?
lateral cord and medial cord
What terminal branches do the lateral cord branch into?
musculocutaneous nerve, median nerve
What other nerve branches off the lateral cord?
lateral pectoral nerve
What terminal branch does the medial cord branch into?
median nerve and ulnar nerve
What other nerves branch off the medial cord?
medial pectoral nerve, medial cutaneous nerves of the arm and forearm
What terminal branch does the posterior cord branch into?
radial nerve
What other nerves branch off the posterior cord?
upper subscapular nerve
middle subscapular nerve (thoracodorsal nerve)
lower subscapular nerve
Erb’s Pasly happens from damage to what nerve?
musculocutaneous nerve
A winged scapular happens from damage to what nerve?
long thoracic nerve
What nerve is compressed through the carpal tunnel?
median nerve
What muscle does the lateral pectoral nerve innervate?
pectoralis major
The musculocutaneous nerve comes off the lateral cord to innervate what compartment of the upper limb?
Anterior arm
What compartment of the arm does the medial pectoral nerve innervate?
pectoralis minor and part of the pectoralis major
What compartment of the arm does the medial cutaneous nerve of the arm innervate?
medial surface of the arm
What compartment of the arm does the medial cutaneous nerve of the forearm innervate?
medial surface of the forearm
What compartment of the upper limb does the ulnar nerve innervate?
intrinsic muscle of the hand EXCEPT 1st & 2nd lumbricals and three of the thenar muscles
flexor carpi ulnaris
ulnar half of the flexor digitorum profundis to the pinky/ring finger
What does the upper subscapular nerve innervate?
the superior half of the subscapularis
What does the lower subscapular nerve innervate?
the inferior half of the subscapularis
What does the axillary nerve innervate?
deltoid
teres minor
glenohumeral joint
What does the radial nerve innervate?
all muscles of the posterior compartment or the arm and forearm
What does the thoracodorsal nerve innervate?
latissimus dorsi
What muscle does the long thoracic nerve innervate?
serratus anterior
What muscle does the dorsal scapular nerve innervate?
rhomboids
levator scapulae
What muscle does the nerve subclavius nerve innervate?
subclavius
sternoclavicular joint
What muscle does the suprascapular nerve innervate?
supraspinatus
infraspinatus
glenohumeral joint
The main components (framework) of the brachial plexus are:
primary rami (5), trunks (3), divisions (6), and cords (3).
What muscles are involved in scapular elevation?
Upper trapezius
Rhomboids
Levator scapulae
What muscles are involved in scapular depression?
lower trapezius
serratus anterior
What muscles are involved in scapular protraction (abduction)?
serratus anterior
pectoralis minor
What muscles are involved in scapular retraction(adduction)?
middle trapezius
Rhomboids
What muscles are involved in scapular downward rotation?
Rhomboids
pectoralis minor
levator scapulae
What muscles are involved in scapular upward rotation?
upper trapezius
serratus anterior
lower trapezius
What muscles are involved in shoulder flexion?
Coracobrachialis
Long head, biceps brachii
Pectoralis major
Deltoid (w/medial rotation)
What muscles are involved in shoulder extension?
teres major
latissimus dorsi
long head, triceps brachii
deltoid (w/lateral rotation)
What muscles are involved in shoulder abduction?
Supraspinatus
Deltoid
What muscles are involved in shoulder adduction?
coracobrachialis
teres major
Latissimus dorsi
What muscles are involved in shoulder medial rotation?
Subscapularis
Pectoralis major
Latissimus dorsi
Deltoid (w/flexion)
Teres major
What muscles are involved in shoulder lateral rotation?
infraspinatus
teres minor
Deltoid (w/extension)
What muscles are involved in elbow flexion?
Biceps brachii
Brachialis
Brachioradialis
What muscles are involved in elbow extension?
triceps brachii
anconeus
What muscles are involved in elbow pronation?
Pronator teres
Pronator quadratus
What muscles are involved in elbow supination?
supinator
biceps brachii
What muscles are involved in wrist flexion?
Flexor carpi radialis
Flexor carpi ulnaris
Palmaris longus
Flexor digitorum superficialis
Flexor digitorum profundus
What muscles are involved in wrist extension?
extensor carpi radialis longus
extensor carpi radilais brevis
Extensor carpi ulnaris
What muscles are involved in wrist radial deviation?
Flexor carpi radialis
extensor carpi radialis longus
Abductor Pollicis longus
Extensor pollicis brevis
What muscles are involved in wrist ulnar deviation?
Flexor carpi ulnaris
Extensor carpi ulnaris
What muscles are involved in the flexion of MP?
Flexor pollicis brevis
Flexor pollicis longus
Lumbricals
Flex. Dig. Sup.
Flex.dig.prof.
Adductor pollicis
What muscles are involved in the extension of the MP?
extensor pollicis brevis
extensor digitorum
extensor indicis
Extensor digiti minimi
What muscles are involved in the flexion of the DIP/PIP?
Flex. Dig.sup.
Flex. Dig.prof.
Flex. Pollicis longus
Extensor indicis
What muscles are involved in the extension of the DIP/PIP?
lumbricals
extensor digitorum
Extensor digiti minimi
What muscles are involved in the abduction of the digits?
Abductor Pol. Brevis
Adbductor Pol. Longus
Dorsal interossei
Abductor digiti minimi
What muscles are involved in the adduction of the digits?
adductor pollicis
palmar interossei
Extensor indicis
Flexor pollicis
What muscles are involved in thumb opposition
Opponens pollicis
Opponens digiti minimi
Flexor pollicis brevis
Where do the flexors of the forearm and wrist originate from?
medial epicondyle
Where do the extensors of the forearm and wrist originate from?
lateral epicondyle
Embryology:
Mesodermal regions:
Axial- forms the notochord
Paraaxial- forms somites
lateral plate- form bones of upper limb
3 regions of the Somites:
Sclerotome- axial skeleton (ribs, sternum, vertebrae)
Dermatome- forms dermis of the skin (sensory)
Myotome- forms skeletal muscle (motor)
Hypomere & Epimere:
Hypomere- posterior extensors & anterior flexors comes from here
Epimere- erector spinae
Blood supply to the cerebrum:
left and right vertebral aa off subclavian and left and right internal carotid aa from the left common carotid off the aortic arch or brachiocephalic trunk
Blood supply to the cerebellum:
basilar artery>left and right superior cerebellar arteries and the left and right anterior inferior cerebellar aa and the left and right vertebral arteries>left and right posterior inferior cerebellar arteries.
Blood supply to the brainstem:
left and right pontine arteries off the basilar a.
What are the 3 compartments of the hand?
Thenar
Hypothenar
Palmar
What muscles are in the thenar compartment of the hand?
abductor pollicis brevis
flexor pollicis brevis
opponens pollicis
What muscles are in the hypothenar compartment of the hand?
abductor digiti minimi
flexor digiti minimi
opponens digiti minimi
What muscles are in the palmar compartment of the hand?
palmaris brevis
lumbricals (4)- flex MCP & extend PIP
Dorsal interossei(4) Abduct digits
Palmar interossei(3) Adduct digits
Adductor pollicis
The median nerve innervates all of the muscles in the forearm except what two muscles?
flexor carpi ulnaris and 1/2 of the ulnar side of the flexor digitorum profundus
The ulnar nerve innervates all of the muscles of the hand except what two muscles?
thenar group and 1/2 groups and half of the radial side of the lumbricals (1 & 2)
What muscle of the hand does some ppl not have?
Palmaris longus
Palmar Arches:
Dep palmar arch: radial artery
Superficial palmar arch: ulnar artery
What muscles form the anatomical snuff box?
extensor pollicis longus
extensor pollicis brevis
abductor pollicis longus
What makes up the interscalene triangle?
scalenus anterior muscle,
scalenus medius muscle
first rib
what blood vessel and nerve is located under the supraspinatus and infraspinatus muscles?
suprascapular artery and nerve
