Lecture 14: Upper extremity pt 1

Question 1

Clavipectoral triangle is where the ____________ vein runs & pierces _________ fascia to join the ________ vein.

Answer 1

cephalic; deep; axillary

Question 2

What is the volar surface?

Answer 2

Anterior wrist

Question 3

Which UE digit is 1st?

Answer 3

Thumb

Question 4

What finger is first in anatomic postion?

Answer 4

Thumb

Question 5

What is the UEs job?

Answer 5

To put the hand in the correct position to interact with the environment

Question 6

What was formerly known as the shoulder joint?

Answer 6

Glenohumeral joint

Question 7

The pectoral or shoulder girdle is incomplete where?

Answer 7

posteriorly

Question 8

What completes the pectoral (shoulder) girdle anteriorly?

Answer 8

Sternum

Question 9

List:
1) 1 articulation
2) 2 joints
2) 2 bones
of the pelvic (aka shoulder) girdle

Answer 9

1) Scapular thoracic articulation
2) AC and SC joints
3) Scapula and clavicle

Question 10

1) What makes up the AC [acromioclavicular] joint?
2) What abt the SC [sternoclavicular] joint?

Answer 10

1) Clavicle’s [acromion end] and scapula’s acromion
2) Sternum [manubrium] and clavicle’s sternal end

Question 11

Regarding the clavicle:
1) True or false: both ends articulate
2) What does it stabilize?
3) What does it protect?
4) How is it frequently injured?

Answer 11

1) True
2) Scapula
3) Deeper structures
4) Lateral impact to shoulder

Question 12

Regarding the scapula:
1) What is it also called?
2) What ribs does it span?

Answer 12

1) Shoulder blade
2) ~ribs #2-7

Question 13

Regarding the scapula:
1) What are its 2 posterior fossas? What is its other main feature?
2) What are its two main anterior features?

Answer 13

1) Supraspinatus and infraspinatus fossas; spine (incl. acromion)
2) Subscapular fossa and coracoid process

Question 14

1) What lines the glenoid cavity of the scapula?
2) What attaches the coracoid process of the scapula to the clavicle?
3) What is below the acromion of the scapula?
4) In lateral view, what fossa of the scapula appears as the space b/t the AC joint and the supraglenoid tubercle?

Answer 14

1) Labrum
2) Coracoid ligament
3) Subacromial space
4) Supraspinous fossa

Question 15

1) Where are the necks of the humerus?
2) What is the intertubercular sulcus of the humerus also called? What is it for?

Answer 15

1) Both are on proximal end; anatomic neck is just dist. to glenohumeral joint, surgical neck is further and distal to intertubercle sulcus.
2) Bicipital groove; long head of biceps

Question 16

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

Answer 16

1) Medial for flexors [of wrist], lateral for extensors [of wrist]
2) Condyles
3) Capitulum (lateral w/ radius) and trochlea (medial w/ ulnar)

Question 17

Posterior arm:
1) The radial groove for nerve and artery is located at the posterior arm and may be damaged by a __________________ Fx; clinically r/o
2) What occurs at the olecranon of the ulna? What bursa is here?

Answer 17

1) mid shaft humeral
2) Notch articulates with the olecranon fossa; olecranon bursa

Question 18

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?

Answer 18

1) Anterior and posterior circumflex aa.
2) Radial groove posterior with radial nerve and artery

Question 19

Radial median nerves (anterior to elbow joint, while the ulnar nerve is posterior) are at risk during what kind of fracture?

Answer 19

Supracondylar Fx

Question 20

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?

Answer 20

1) Radius
2) Radial styloid process (feature of radius)

Question 21

The radius’s proximal head articulates with what 2 things? Describe the motion of each

Answer 21

1) Capitulum of humerus: hinge (flex/extend elbow)
2) Medially with ulna: rotation (supination/pronation)

Question 22

What two things does the radius distally articulate with?

Answer 22

1) Head of ulna
2) Scaphoid and lunate carpals

Question 23

List the bones/ features involved with the 3 articulations of the elbow region

Answer 23

1) Capitulum: with radial head
2) Olecranon & trochlea: with trochlea notch
3) Radial head: with radial notch of ulna

Question 24

1) Is the olecranon fossa (for olecranon during extension of elbow) located in the anterior or posterior elbow?
2) What 2 other things are involved in extension of the elbow?

Answer 24

1) Posterior
2) Coronoid process and radial notch

Question 25

List the 3 regions of the hand and how many bones are in each

Answer 25

1) Carpus (wrist): 8 carpals
2) Metacarpus: 5
3) Phalanges: 14
(2 in thumb, 3 in all other digits)
= 27 bones

Question 26

What is the mnemonic to remember the carpal bones?

Answer 26

Some: Scaphoid.
Lovers: Lunate.
Tri: Triquetrum.
Positions: Pisiform.
That: Trapezium.
They: Trapezoid.
Can’t: Capitate.
Handle: Hamate.

Question 27

Which is medial in AP, radius or ulna? Which finger is most lateral?

Answer 27

Ulna; thumb

Question 28

1) What is the proximal articulation of the ulna?
2) What about for the radius?

Answer 28

1) Ulna: Trochlea
2) Radius: Capitulum

Question 29

1) Ascaphoid(navicular)fractureoccurs most often after what?
2) What are the symptoms?

Answer 29

1) A fall onto an outstretched hand
2) Pain and tenderness in the area just below the base of the thumb “snuff box”

Question 30

Do scaphoid (navicular) fractures heal well? Explain why or why not

Answer 30

1) Distal fxs heal okay
2) Middle or proximal fx more problematic due to poor blood supply

Question 31

What are the two fascia of the arm (brachium)? Which encloses the arm muscles?

Answer 31

1) Superficial fascia (SQ)
2) Brachial fascia (deep fascia): encloses arm muscles

Question 32

What does the IM septa of the brachium/ arm form?

Answer 32

Anterior (flexor) & posterior (extensor) compartments

Question 33

1) Is the anterior or posterior fascial compartment of the brachium (arm) superior?
2) What does fascia attach to?

Answer 33

1) Anterior is superior
2) Supracondylar ridges

Question 34

1) What are the fascia of the forearm (antebrachium)?
2) What two things form its compartments?
3) What are the compartments?

Answer 34

1) Superficial and Antebrachial (deep) fascia
2) Interosseous membrane & IM septa
3) Anterior (flexor) & posterior (extensor) compartments

Question 35

The distal antebrachial fascia forms what posteriorly? What abt anteriorly?

Answer 35

Extensor retinaculum posteriorly; flexor retinaculum anteriorly

Question 36

1) What is the roof of the carpal tunnel?
2) What tendons and nerve are here?

Answer 36

1) Flexor retinaculum
2) Flexor tendons & median nerve

Question 37

Fascia of the wrist:
1) The palmar carpal ligament covers what muscle?
2) What nerve?

Answer 37

1) Palmaris longus
2) Ulnar nerve

Question 38

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?

Answer 38

1) Axillary a
2) Subclavian a. (1st rib or clavicle)
3) Brachial a
4) Radial and ulnar aa.

Question 39

1) Where does the brachial artery end?
2) What deep artery does it give off (near its proximal end)?

Answer 39

1) Antecubital fossa
2) Profunda brachii a.

Question 40

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?

Answer 40

1) Ulna a
2) Radial a
3) Superficial and deep palmer arches

Question 41

List the path of blood flow through the UEs by discussing the locations of the pulses (and arteries)

Answer 41

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

Question 42

1) How do you perform an Allen test?
2) When is it done?

Answer 42

1) Check for blood flow thru both radial and ulna
2) PRIOR to IA catheter placement or surgery.

Question 43

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?

Answer 43

1) Dorsal venous network of hand
2) Cephalic vein

Question 44

Describe the path of the Basilic vein (5 steps)

Answer 44

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

Question 45

1) What muscles does the cephalic vein pass between proximally?
2) What does it enter?
3) What does it pierce and join?

Answer 45

1) Deltoid and pec major
2) Clavipectoral triangle
3) Deep fascia; joins axillary v.

Question 46

1) Where are the deep veins of the UE?
2) Do they run individually? If not, what do the pairs run with?
3) Do they anastomose?

Answer 46

1) Deep to investing/ deep fascia
2) Paired and run with arteries
3) Continually interanastomosing

Question 47

Where are the lymphatic plexuses of the UE?

Answer 47

Fingers, palm, dorsum of hand

Question 48

What 4 groups of lymph node are in the UE?

Answer 48

1) Cubital nodes (medial epicondyle)
2) Axillary regional nodes
3&4) Supra and infra clavicular nodes

Question 49

What vein pierces deep fascia and joins axillary v.?

Answer 49

Cephalic v.

Question 50

1) Most cutaneous nerves of the arm & forearm are ______________ peripheral nerves
2) What are these peripheral nerves derived from (plexus and rami/ spinal level)?

Answer 50

1) multisegmented peripheral nerves
2) Brachial plexus; anterior rami of C5-T1

Question 51

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?

Answer 51

1) cervical
2) Anterior rami C1-4; nerve point of the neck

Question 52

What side of the UE is developmentally more cranial?

Answer 52

Thumb side, lateral

(medial side is less)

Question 53

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?

Answer 53

1) Anterior compartment of arm; flexors of the shoulder & arm; C5-7
2) Lateral forearm ; the “Lateral cutaneous nerve of the forearm”

Question 54

1) The median nerve supplies motor to what compartment?
2) What muscles are located here?

Answer 54

1) Forearm anterior compartment
2) Flexors, and thenar muscles of hand

Question 55

1) What does the median nerve supply sensory innervation to?
2) What spinal levels does it come from?

Answer 55

1) Lateral hand
& first 3 ½ digits + wrap dorsal distally
2) C 5-8, T1

Question 56

1) Ulnar nerve supplies what compartment?
2) What muscles are here?

Answer 56

1) Motor medial forearm anterior compartment
2) Flexors (FCU, FDP med part)
& most of the intrinsic m. of hand

Question 57

1) What does the ulnar nerve supply sensory to?
2) What spinal segments form the ulnar n?

Answer 57

1) Medial 1 ½ digits, palm, and dorsum of hand
2) C 7-8, T1

Question 58

1) What does the radial nerve supply motor to?
2) What types of muscles are here?

Answer 58

1) Posterior compartment
2) Extensors of arm and forearm

Question 59

1) What does the radial nerve supply sensory to?
2) What’s the catch?
3) What spinal segments form the radial n?

Answer 59

1) Sensory to posterior arm, forearm, dorsum of hand first 2 ½ digits
2) Less distal ends
3) C 5-8, T1