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
1) What are the actions of the FPL (of the deep layer of the forearm’s flexor/ pronator group)?
2) What nerve innervates it?
1) Flexes MCP and IP joints of thumb
-Assists with wrist and CMC
3) Median n.
What 3 things does Pronator quadratus do?
1) Pronates forearm
2) Bind radius and ulna
3) Helps during FOOSH injury
Will be on final
What is the difference between the distal insertions of FDS and FDP (and FPL)? What does this mean?
FDS inserts at 2nd phalanges, FDP (and FPL) insert at 3rd
-therefore FDS only flexes up to 2nd phalanx
What tendons “slip through” FDS (superficial) tendons prior to insertion @ P3?
FDP (deep) tendons
1) All of which forearm compartment is innervated by the radial nerve?
2) How many groups?
1) Posterior compartment (Extensor-supinator)
2) 3 groups
List the 3 groups of the posterior compartment extensor-supinators and list their members
1) 3 muscles that extend and ulnar/radial deviate the wrist:
-Extensor carpi radialis longus (ECRL), ECRB, ECU.
2) 3 muscles that extend digits 2-5:
-Extensor digitorum, extensor indicis, extensor digiti minimi
3) 3 muscles that manipulate the thumb:
-Abductor pollicis longus (APL), extensor pollicis brevis (EPB), extensor pollicis longus (EPL)
What tendons “slip through” FDS (superficial) tendons prior to insertion @ P3?
FDP (deep) tendons
1) All of which forearm compartment is innervated by the radial nerve?
2) How many groups?
1) Posterior compartment (Extensor-supinator)
2) 3 groups
List the 3 groups of the posterior compartment extensor-supinators and list their members
1) 3 muscles that extend and ulnar/radial deviate the wrist:
-Extensor carpi radialis longus (ECRL), ECRB, ECU.
2) 3 muscles that extend digits 2-5:
-Extensor digitorum, extensor indicis, extensor digiti minimi
3) 3 muscles that manipulate the thumb:
-Abductor pollicis longus (APL), extensor pollicis brevis (EPB), extensor pollicis longus (EPL)
1) Where do the 4 superficial extensors of the forearm have a common proximal tendon attachment?
2) List these 4 superfic. extensors and their distal attachments
1) Lateral epicondyle
2) ECRL/ECRB: MC
-Extensor indicus et. digitorum: digits 2-5
-EDM: digit 5
-ECU: 5th MC
Lateral epicondylitis is also called what? What group does it involve?
“Tennis elbow”; 4 superficial extensors
1) Extensor digitorum tendons expand on distal ends of what? What is this called?
2) What 2 things does this divide into? Where does each go?
1) MCs; extensor expansion or “dorsal hoods:
2) Dorsal hood divides:
a) Median band
-Passes to base of P2
b) 2 lateral bands
-Passes to base of P3
1) What makes up the snuff box dorsally?
2) What makes up its ventral side?
3) What abt proximally? Distally?
4) What 2 bones are involved?
5) What artery is here?
1) EPL
2) EPB and Abductor PL (APL tendon)
3) Radial styloid; Base of 1st MC
4) Scaphoid & trapezium (@ base of 1st MC)
5) Radial a.
1) Name a nerve and artery in ulnar canal of Guyon.
2) What nerve is in the carpal tunnel?
1) Ulnar n. and artery
2) Median n. in carpal tunnel
1) Brachial a. as it leaves cubital fossa is where?
2) What artery enters the hand via canal of Guyon? Where do you palpate the pulse?
1) In forearm
2) Ulnar a.; lateral side of FCU tendon
1) Radial a. winds around lateral aspect of wrist to cross _______________ and enter hand posteriorly via the __________________ web space.
2) Where do you palpate the radial artery’s pulse? (2 places)
1) anatomical snuff box; thumb&2nd MC [web space]
2) B/t FCR and APL/EPB tendons & in the snuff box
True or false: the hand includes the wrist, carpals, metacarpals, and phalanges
True
Where are the thenar and hypothenar groups of the palmer aspect of the hand?
1) Thenar: at base of thumb
2) Hypothenar: over 5th MC
True or false: thumb just has a proximal and distal phalange, and an IP and an MP joint
True
What is a usefulmnemonicto help remember thecarpal bones?
Some – Scaphoid.
Lovers – Lunate.
Try – Triquetrum.
Positions – Pisiform.
That – Trapezium.
They – Trapezoid.
Can’t – Capitate.
Handle – Hamate.
What are the two fascia of palm (palmer aspect)?
1) Palmar aponeurosis
2) Fibrous digital sheaths
List the 3 joints of shoulder complex
1) SC/AC
2) Scapulothoracic “articulation”
3) Glenohumeral
1) What type of joint is the shoulder/ glenohumeral joint?
2) What kind of ROM does it have? Is it stable or unstable?
1) Ball and socket
2) Wide ROM; inherently unstable
What 3 (groups of) things aid in stability of shoulder/ glenohumeral joint?
Which adds depth + surface area to the “socket”?
1) Glenoid labrum: adds depth + surface area to “socket”
2) Joint capsule, ligaments, orbicular zone
3) Muscle tendons
Where is the glenohumeral joint capsule the weakest? Why?
Inferiorly; loose for movement of joint
What are the two articular surfaces of the humerus at the elbow joint? List what each articulates with
1) Trochlea (spool): ulna
2) Capitulum (spheroidal): radial head
1) List the 2 notches of the ulna.
2) What stabilize the elbow joint?
1) Trochlear (trochlear) and radial notches (radial head).
2) Collateral ligaments
Name and describe a pathology of the SQ olecranon bursa.
Olecranon bursitis; one of the most freq. types of bursitis, redness and pain at tip of elbow, can be due to infection.
1) The anular ligament is involved in what radio-ulnar joint?
2) At the proximal radio-ulnar joint, radius rotates within ___________ ligament, ulna fixed.
3) At the distal radio-ulnar joint, radius pivots around relatively fixed__________________ during ___[what movement?]____
1) Proximal radio-ulnar
2) annular
3) distal ulna; supination/pronation
_____________ ligaments of _____ MCP are injured most frequently
Collateral; 1st
(skier’s thumb/ game keeper’s thumb if holding ski pole)
Which UE digit is 1st?
Thumb
The pectoral or shoulder girdle is incomplete where?
posteriorly
Anterior arm:
1) What are the purposes of the medial and lateral epicondyles of the humerus?
2) What are the articular surfaces of the distal humerus?
3) List the names of what these surfaces articulate with
1) Medial for flexors [of wrist], lateral for extensors [of wrist]
2) Condyles
3) Capitulum (lateral w/ radius) and trochlea (medial w/ ulnar)
1) What two arteries can be damaged w a fracture of the surgical neck?
2) What are at risk for injury with a mid shaft humeral Fx?
1) Anterior and posterior circumflex aa.
2) Radial groove posterior with radial nerve and artery
1) On the lateral (thumb) side (in anatomic position) of the forearm, will you find the radius or the ulna?
2) What bony feature is located at the lateral wrist?
1) Radius
2) Radial styloid process (feature of radius)
The radius’s proximal head articulates with what 2 things? Describe the motion of each
1) Capitulum of humerus: hinge (flex/extend elbow)
2) Medially with ulna: rotation (supination/pronation)
What two things does the radius distally articulate with?
1) Head of ulna
2) Scaphoid and lunate carpals
List the bones/ features involved with the 3 articulations of the elbow region
1) Capitulum: with radial head
2) Olecranon & trochlea: with trochlea notch
3) Radial head: with radial notch of ulna
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.
Which is medial in AP, radius or ulna? Which finger is most lateral?
Ulna; thumb
What was formerly known as the shoulder joint?
Glenohumeral joint
1) What is the proximal articulation of the ulna?
2) What about for the radius?
1) Ulna: Trochlea
2) Radius: Capitulum
What are the two fascia of the arm (brachium)? Which encloses the arm muscles?
1) Superficial fascia (SQ)
2) Brachial fascia (deep fascia): encloses arm muscles
1) Is the anterior or posterior fascial compartment of the brachium (arm) superior?
2) What does fascia attach to?
1) Anterior is superior
2) Supracondylar ridges
1) What are the fascia of the forearm (antebrachium)?
2) What two things form its compartments?
3) What are the compartments?
1) Superficial and Antebrachial (deep) fascia
2) Interosseous membrane & IM septa
3) Anterior (flexor) & posterior (extensor) compartments
Fascia of the wrist:
1) The palmar carpal ligament covers what muscle?
2) What nerve?
1) Palmaris longus
2) Ulnar 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.
1) Where does the brachial artery end?
2) What deep artery does it give off (near its proximal end)?
1) Antecubital fossa
2) Profunda brachii a.
1) What artery descends medial thru anterior compartment of antebrachium (arm)?
2) What artery descends lateral thru anterior compartment of antebrachium?
3) What do these two arteries become distally?
1) Ulna a
2) Radial a
3) Superficial and deep palmer arches
slide 45
1) What compartment does the musculocutaneous n supply motor to? What muscles are here? What spinal levels does this nerve come from?
2) What does the musculocutaneous n supply sensory to? What is it also called?
1) Anterior compartment of arm; flexors of the shoulder & arm; C5-7
2) Lateral forearm ; the “Lateral cutaneous nerve of the forearm”
List the path of blood flow through the UEs by discussing the locations of the pulses (and arteries)
1) Axillary artery: in axilla
2) Brachial artery: in bicipital groove
3) Brachial artery: in cubital fossa
4) Radial and ulnar arteries: at wrist
5) Radial artery: snuff box
6) Radial goes to ulnar artery
Superficial veins of UE:
1) Where do the [superficial] veins arise from distally?
2) Which supplies the lateral aspect of dorsal venous network, lateral wrist, & anterolateral forearm and arm?
1) Dorsal venous network of hand
2) Cephalic vein
Describe the path of the Basilic vein (5 steps)
1) Dorsal venous network medially
2) Dorsolateral forearm
3) Joins median cubital vein medial cubital fossa
4) Then dives deep to brachial fascia to run with brachial a.
5) Merges with accompanying v. to form the axillary vein
Where are the lymphatic plexuses of the UE?
Fingers, palm, dorsum of hand
What 4 groups of lymph node are in the UE?
1) Cubital nodes (medial epicondyle)
2) Axillary regional nodes
3&4) Supra and infra clavicular nodes
What vein pierces deep fascia and joins axillary v.?
Cephalic v.
1) Most cutaneous nerves of the arm & forearm are ______________ peripheral nerves
2) What are these peripheral nerves derived from (plexus and rami/ spinal level)?
1) multisegmented peripheral nerves
2) Brachial plexus; anterior rami of C5-T1
1) Cutaneous nerves of the neck & shoulder are derived from the ______________ plexus
2) What spinal nerves (or CNs) is this plexus derived from? What this area it also called?
1) cervical
2) Anterior rami C1-4; nerve point of the neck
What side of the UE is developmentally more cranial?
Thumb side, lateral
(medial side is less)
1) What compartment does the musculocutaneous n supply motor to? What muscles are here? What spinal levels does this nerve come from?
2) What does the musculocutaneous n supply sensory to? What is it also called?
1) Anterior compartment of arm; flexors of the shoulder & arm; C5-7
2) Lateral forearm ; the “Lateral cutaneous nerve of the forearm”
1) The median nerve supplies motor to what compartment?
2) What muscles are located here?
1) Forearm anterior compartment
2) Flexors, and thenar muscles of hand
1) What does the median nerve supply sensory innervation to?
2) What spinal levels does it come from?
1) Lateral hand
& first 3 ½ digits + wrap dorsal distally
2) C 5-8, T1
1) Ulnar nerve supplies what compartment?
2) What muscles are here?
1) Motor medial forearm anterior compartment
2) Flexors (FCU, FDP med part)
& most of the intrinsic m. of hand
1) What does the ulnar nerve supply sensory to?
2) What spinal segments form the ulnar n?
1) Medial 1 ½ digits, palm, and dorsum of hand
2) C 7-8, T1
1) What does the radial nerve supply motor to?
2) What types of muscles are here?
1) Posterior compartment
2) Extensors of arm and forearm
1) What does the radial nerve supply sensory to?
2) What’s the catch?
3) What spinal segments form the radial n?
1) Sensory to posterior arm, forearm, dorsum of hand first 2 ½ digits
2) Less distal ends
3) C 5-8, T1
