Lecture 14 review Flashcards
[Nerves of the UE]
What does each innervate?:
1) Dorsal scapular n
2) Thoracodorsal n.
3) Long thoracic n.
4) Spinal accessory n.
Important*
1) Rhomboids, levator scapulae
2) Latissimus dorsi
3) Serratus anterior
4) Trapezius
Which is medial in AP, radius or ulna? Which finger is most lateral?
Ulna; thumb
What is the mnemonic to remember the carpal bones?
Some: Scaphoid.
Lovers: Lunate.
Tri: Triquetrum.
Positions: Pisiform.
That: Trapezium.
They: Trapezoid.
Can’t: Capitate.
Handle: Hamate.
What does the IM septa of the brachium/ arm form?
Anterior (flexor) & posterior (extensor) compartments
1) What is the roof of the carpal tunnel?
2) What tendons and nerve are here?
1) Roof is the flexor retinaculum
2) Flexor tendons and median nerve
1) What is the primary blood supply to the UE?
2) Where does the primary artery come from?
3) What does the primary blood supply artery turn into distally?
4) What does that artery then turn into?
1) Axillary a
2) Subclavian a. (1st rib or clavicle)
3) Brachial a
4) Radial and ulnar aa.
[Nerves of the UE]
What innervates each of the following?:
1) Rhomboids & levator scapulae
2) Latissimus dorsi
3) Serratus anterior
4) Trapezius
Important
1) Dorsal scapular n
2) Thoracodorsal n.
3) Long thoracic n.
4) Spinal accessory n.
List the scapulohumeral muscles; incl. which are rotator cuff muscles
Deltoid
Teres major
Supraspinatus*
Infraspinatus*
Teres minor*
Subscapularis*
- SITS = rotator cuff muscles
What 3 nerves innervate the rotator cuff muscles?
1) Suprascapular n. - SI
2) Axillary n. - T
3) Subscapular n. – S
Describe the distribution of the hand’s cutaneous innervation by the median nerve
Important
Lateral palm (first 3 fingers and half of 4th) and dorsal tips of those fingers.
Describe the distribution of the hand’s cutaneous innervation by the ulnar nerve
Important
-Medial palm (pinky and half of ring finger).
-Dorsal hand, pinky, almost all of ring finger, small pt of middle finger
Describe the distribution of the hand’s cutaneous innervation by the radial nerve
Important
Medial aspect of dorsal wrist.
Dorsal aspect of thumb, adjacent two fingers (except tips), and back of hand.
List the 5 nerves of the UE and what part of the cord they come from
1) Axillary.: posterior
2) Radial: posterior cord
3) Musculocutaneous: lateral cord
4) Median: lateral + medial cord
5) Ulnar: medial cord
List the 2 nerves that innervate the anterior forearm; specify what side each innervates
1) Median: Radial side [of flexors]
2) Ulnar: Ulnar side [of flexors]
List the 6 scapulohumeral muscles; incl. which are rotator cuff muscles
1) Deltoid
2) Teres major
3) Supraspinatus*
4) Infraspinatus*
5) Teres minor*
6) Subscapularis*
- SITS = rotator cuff muscles
1) What do the rotator cuff muscles form?
2) What does it insert on?
3) What do the tendons blend with?
1) Musculocutaneous rotator cuff around shoulder joint
2) (Posterior aspect of) greater tubercle
3) Joint capsule
What 3 nerves innervate the rotator cuff muscles?
1) Suprascapular n. - SI
2) Axillary n. - T
3) Subscapular n. – S
1) What artery and vein are found in the axillary region?
2) What nerves and plexus branches are here?
3) What other vessels are here? Are there lymph nodes here?
4) What immediately surrounds all of these/ bundles them together?
5) What is this embedded in?
1) Axillary artery & vein
2) Nerves of the cord & br. of brachial plexus
3) Lymphatic vessels; lymph nodes
4) Axillary sheath
5) All embedded in axillary fat
1) What artery supplies the posterior arm w blood?
2) What artery supplies the medial and anterior arm?
1) Profunda brachii a.
2) Brachial a.
What are the two types of veins of the arm? Do they anastomose? Describe.
Superficial and deep; freely anastomosis
List 3 superficial veins in the shoulder and arm. Where do they originate?
Cephalic, basilic, and antebrachial veins; in the dorsum of hand
1) Where do the deep veins of the arm lie?
2) What are they collectively called at the elbow? Why?
2a) What does this form proximally?
1) Deep to the investing fascia
2) Brachial veins; union of the ulnar and radial veins
2a) Axillary vein
List the 6 steps of the spread of breast cancer if it doesn’t go to the axillary nodes
Pectoral nodes > Central nodes > Apical nodes> Supraclavicular nodes > Subclavian trunk > Right lymphatic duct (if on right side; thoracic duct on left side)
1) What nerves (i.e from what spinal levels) make up the brachial plexus? From what rami?
2) What type of fibers make up this plexus, post synaptic or pre? Parasymp. or symp?
3) Where is it located?
4) What are its 2 parts?
1) Anterior rami C5-T1 spinal n.
2) Post synaptic sympathetic fibers
3) Lateral region of neck over middle and anterior scalene m.
4) Supraclavicular vs. Infraclavicular parts
1) C5-T1 [roots] form 3 trunks’ that have ant. and post. divisions; what do the posterior divisions form?
2) What does that form + where do they go? What are nerves are these called?
1) Posterior cord, which forms :
2) Terminal nerves to posterior arm/ forearm; axillary & radial nn.
1) The anterior divisions of the 3 trunks of C5-T1 are from what two pts of the cord? What type of nerves do these form to the anterior arm and forearm?
2) What are the names of these 3 nerves? Where does each specifically go?
1) Lateral and medial; terminal nerves
2) Musculocutaneous n. to arm;
-Median & ulnar nn. to forearm and hand
1) What is the dermatome of the Axillary nerve?
2) What is it the terminal branch of?
3) What joint does it supply?
4) List 2 specific muscles it supplies (highlighted)
5) Does it innervate any skin? Explain?
1) C5-6
2) Posterior cord
3) Shoulder joint
4) Teres minor and deltoid m.
5) Skin inferior deltoid region
1) What dermatomes make up the radial nerve?
2) What is it a branch of?
3) What muscles does it supply? What do these muscles do?
4) What areas of skin does it supply? (3)
1) C5-8, T1
2) Posterior cord
3) All muscles posterior compartments of arm & forearm
-Extend elbow, wrist, fingers
4) Posterior lateral arm, forearm and laterodorsal hand and finger
1) What nerve travels in radial groove with Profundis brachial a.?
2) What does this make it vulnerable to?
1) Radial
2) Fracture of mid shaft humerus.
1) What groups of muscles are supplied by the median nerve?
2) What distribution to the hand does it have?
1) Flexors of wrist and fingers
2) “Carpal Tunnel Syndrome” distribution to hand; aka lateral palm (first 3 fingers and half of 4th) and dorsal tips of those fingers.
1) What spinal cord levels does the ulnar nerve come from? What pt of the cord?
2) What compartment does it supply?
1) C7-8, T1; medial cord
2) Anterior compartment (medial) of forearm
1) What spinal nerves does the ulnar nerve come from?
2) What muscles does it innervate (3 main categories)
1) C7-8, T1
2) -Flexor carpi ulnaris
-Ulnar half of flexor digitorum profundus in forearm
-Most intrinsic hand muscles
Biceps tendon DTR (deep tendon reflex) tests what nerve? What spinal levels is this?
Musculocutaneous nerve; C 5-6
1) Triceps reflex tests what tendon?
2) What nerve is this? What spinal levels?
1) Triceps tendon
2) Radial nerve; C6-7
1) What group of muscles have a common proximal attachment at medial epicondyle of humerus/ at “flexor wad”?
(inf. to 2nd digit/ pointer finger)
2) What do these do?
1) Flexors from medial epicondyle of humerus
2) Act on wrist and hand
[Flexor-pronator group/superficial layer of ant. forearm]:
1) Which members have a common flexor origin at medial epicondyle (flexor “wad”)?
2) Which are/is innervated by ulnar nerve?
3) True or false: all 4 members of this group do not act directly on digits
1) All 4 (PT, FCR, PL, FCU)
2) FCU (Flexor carpi ulnaris)
3) True; not directly on digits
1) What muscle is the exception and is functionally an elbow flexor, but is in the posterior arm compartment?
2) What innervates it?
1) Brachioradialis
2) Radial nerve
What does the flexor-pronator group’s intermediate layer insert on?
Digits
What does the flexor-pronator group’s intermediate layer (FDS) insert on?
Digits
1) What nerve controls the FDS of the intermediate layer of anterior forearm?
2) What is their proximal attachment?
3) What is their [distal] insertion? (will be on test)
1) Median nerve
2) Medial epicondyle (short story)*
3) Middle phalanx of digits 2-5
What 3 things do the flexor digitorum superficialis (FDS)* flex? Where does it flex each?
*(aka superficial digital flexors, aka intermediate layer of flexor pronator group/ ant. forearm)
1) Wrist at C-MC joints
2) Proximal phalanges 2-5 @ MC-P
3) Digits 2-5 @ PIP joints
1) Does the deep layer of the flexor-pronator group/deep layer cross elbow joint?
2) What are its 3 members?
3) What does FDP insert on?
4) What are FDP’s actions?
1) No
2) -Flexor digitorum profundus (FDP)/ deep digital flexors.
-Flexor pollicis longus (FPL).
-Pronator quadratus.
3) Insert into distal phalanges 2-5
4) Flexes C-MC & DIP digits 2-5
-Assists in flexion of wrist
Describe the mixed innervation of the FDP (of the deep layer of the forearm’s flexor/ pronator group)
1) Median n. to lateral part: Digits 2-3
2) Ulnar n. to medial part: Digits 4-5