Midterm Flashcards
dorsal surface
top of foot or hand
palmar surface
palm of hand
plantar surface
bottom of foot
superior
above
inferior
below
proximal
closer to
distal
further from
lateral
away from midline
medial
towards midline
superficial
closer to body surface
deep
further from body surface
coronal/frontal plane
divides anterior and posterior
sagittal
divides right and left
transverse/hortizontal
divides superior and inferior
mid-sagittal
cutting down the midline and divide left and right
axial skeleton (trunk)
- bones of skull
- accessory bones
- vertebral column
- thoracic cage
appendicular skeleton (appendages)
- upper limbs and pectoral girdle
- lower limbs and pelvic girdle
how many bones are in the vertebral column?
26
vertebral column
24 vertebrae
- 7 cervical (C1-C7)
- 12 thoracic (T1-T12)
- 5 lumbar (L1-L5)
*sacrum
*coccyx
26 bones total in vertebral column
functions of vertebral column
- column of support
- protection of spinal cord = passage for nerves
- attachment site for muscles
spinous process
middle process from superior view, but actually sits posterior on the vertebrae
transverse process
lateral process on vertebra
lamina
joins spinous process and transverse process
vertebral foramen
opening within individual vertebrae
vertebral body
forms anterior part of each vertebra (thick)
pedicle
connects vertebral body to rest of the vertebrae
intervertebral foramen
hole between vertebrae - allow for passage of nerves
superior articular process + facet
above transverse process of a vertebra
inferior articular process + facet
below transverse process of vertebra
intervertebral discs
discs between vertebra
nucleus pulposus
medial portion of intervertebral discs (at centre)
annulus fibrosis
ring around the nucleus pulposus - lateral portion of intervertebral discs
herniated discs
nucleus pulposus protrudes into vertebral canal due to tear or rupture in annulus fibrosis
***CAUSES PAINS
cervical vertebrae
- small
- bifid spinous process - split into two notches
- vertebral body is oval shaped
- contains transverse foramina (for passage of arteries)
thoracic vertebrae
- medium
- downward sloping spinous process
- heart shaped vertebral body
- contains costal facets for ribs to articulate with (either 1 or 2 facets)
***LOOKS LIKE GIRRAFE
lumbar vertebrae
- large
- short and stumpy spinous process
- kidney shaped vertebral body
- does not contain any articular facets
***WEIGHT BEARING = LARGER
atypical vertebrae
atlas (C1) and axis (C2)
C1 vertebra
- first vertebra (above C2)
- hold skull
dens (odontoid process)
projection on C2
- held in place by a ligament on C1
C2 vertebra
- second vertebra (below C1)
- allows for axis to move
functions of thoracic cage
- encloses and protects viscera (internal organs) of thoracic cavity
- thoracic skeleton acts as an anchor for muscles (including muscles of respiration)
- attachment site for muscles that move the upper limb and scapula
how many pairs of ribs are there?
12 pairs
sternum
bone that sits at middle
contains:
- manubrium
- body
- sternal angle
- xiphoid process
- articulation sites for ribs
- clavicular notch
manubrium
superior to sternum body
sternum body
body of sternum
sternal angle
connects the manubrium and body
xiphoid process
inferior process on sternum
articulation sites for ribs
where ribs articulate with sternum (laterally)
clavicular notch
where medial end of clavicle articulates with the sternum
costal cartilage
provides articulation of ribs and sternum - contributes to elasticity of thoracic cage
*** ELASTCITY HELPS BREATHING
true ribs
articulate DIRECTLY with the sternum via costal cartilage
RIBS 1-7
false ribs
articulate INDIRECTLY via fused costal cartilage
RIBS 8-10
floating ribs
NO anterior articulation
RIBS 11 & 12
head of typical rib
articulates posteriorly with body of the thoracic vertebrae via costal facet
tubercle on typical rib
articulates with transverse process of thoracic vertebrae
costal groove on typical rib
runs along inferior surface of rib where veins, arteries and nerves run through
body of typical rib
flat and curved
sternal end of typical rib
anterior towards sternum and articulates with sternum
cervical vs. thoracic vs. lumbar vertebra
- cervical is the smallest
- thoracic is medium sized and heart shaped
- lumbar is the largest and kidney shaped
superficial muscles of the thoracic cage
- pectoralis major
- pectoralis minor
- subclavius
- serratus anterior
- serratus posterior
rami
spinal nerves that exit through vertebrae
deep muscles of the thoracic cage
- external intercostals
- internal intercostals
- innermost intercostals
- transversus thoracis
- subcostales
what is the less developed intercostal?
innermost intercostals
- less developed so play lesser role
hands in pockEts
External intercostals
hands in pIts
Internal/Innermost intercostals
what nerves keep the diaphragm alive?
C3, C4 & C5
what happens to pressure when volume increases?
pressure decreases (vice versa)
- pressure and volume are inversely related
breathing (atm vs. lung)
before inhalation: Patm = Plung
inhalation: Patm > Plung
exhalation: Patm < Plung
accessory muscle of inspiration
scalenes & sternocleidomastoid
steps of inspiration
- ribs pulled superiorly (diaphragm lowers)
- sternum pushed anteriorly
- parietal and visceral pleura pulled outwards
- lung volume increases
- Patm > Plung
accessory muscles of expiration
innermost intercostals & anterior abdominal wall muscles
steps of expiration
- muscles relax (diaphram returns)
- structures return to pre-inspiratory position
- decrease size of thoracic cavity
- lung volume decreases
- Patm < Plung
pectoralis major
most superficial layer
ORIGINS of pectoralis major
- anterior surface of clavicle
- anterior surface of sternum
- external oblique aponeurosis
INSERTION of pectoralis major
greater tubercle of humerus
ACTIONS of pectoralis major
- adducts arm
- flexes arm
- medially rotates arm
INNERVATION of pectoralis major
medial & lateral pectoral nerve
pectoralis minor
second layer deep to pec major
ORIGIN of pectoralis minor
ribs 3-5 (anteriorly)
INSERTION of pectoralis minor
coracoid process of scapula
ACTION of pectoralis minor
pulls scapula down and anteriorly
INNERVATION of pectoralis minor
medial pectoral nerve
subclavius
same depth as pec minor but more superior
ORIGIN of subclavius
1st rib (anterior surface)
INSERTION of subclavius
interior surface of clavicle
ACTION of subclavius
pulls down and stabilizes clavicle
INNERVATION of subclavius
cervical nerves C5 & C6
serratus anterior
boxing muscle
ORIGIN of serratus anterior
surface of ribs 1-8
INSERTION of serratus anterior
medial border of scapula on the costal (ribs) surface
ACTIONS of serratus anterior
- protract scapula
- elevate ribs
INNERVATION of serratus anterior
long thoracic nerve
ORIGIN of serratus posterior - SUPERIOR
C7-T3 spinous processes
INSERTION of serratus posterior - SUPERIOR
superior borders of ribs 2-4
ACTION of serratus posterior - SUPERIOR
elevates upper ribs when contracts
INNERVATION of serratus posterior - SUPERIOR
T1-T4 ventral rami
ORIGIN of serratus posterior - INFERIOR
T11-L2 spinous processes
***further down from serratus posterior -superior
INSERTION of serratus posterior - INFERIOR
inferior borders of ribs 9-12
ACTION of serratus posterior - INFERIOR
depresses lower ribs when contracts
INNERVATION of serratus posterior - INFERIOR
T9-T12 anterior rami
external intercostals
most superficial, travel medially and inferiorly down
ORIGIN of external IC
inferior border of ribs
INSERTION of external IC
superior border of the rib below origin
ACTION of external IC
elevate ribs (INSPIRATION)
INNERVATION of external IC
intercostal nerves
internal intercostals
deep to external IC, muscle fibres travel more medially, anteriorly and superiorly
ORIGIN of internal IC
inferior border of ribs
INSERTION of internal IC
superior border of the rib below origin
ACTION of internal IC
lower ribs (EXPIRATION) - back to the normal position
INNERVATION of internal IC
intercostal nerves
innermost intercostals
deepest IC, less developed so they play a lesser role
ORIGIN of innermost IC
inferior border of ribs
INSERTION of innermost IC
superior border of rib below origin
ACTION of innermost IC
lower ribs (EXPIRATION)
INNERVATION of innermost IC
intercostal nerves
transversus thoracis
inside ribcage
ORIGIN of transversus thoracis
pleural surface (faces lungs) of ribs 2-6 (anteriorly)
INSERTIONS of transversus thoracis
- posterior surface of sternum
- xiphoid process
ACTION of transversus thoracis
lowers ribs (EXPIRATION)
INNERVATION of transversus thoracis
intercostal nerves
subcostales
small muscles under the ribs
ORIGIN of subcostales
pleural surface of lower ribs (posteriorly)
INSERTIONS of subcostales
- superior border of ribs below origin
- lower ribs
ACTION of subcostales
contracts and pull ribs down (EXPIRATION)
INNERVATION of subcostales
intercostal nerves
Diaphragm
driver of breathing
ORIGINS of diaphragm
- xiphoid process of sternum
- L1-L4 vertebra (anterior)
- costal arch of ribs 7-12
INSERTION of diaphragm
central tendon of diaphragm
ACTIONS of diaphragm
- contracts and compresses abdomen (INSPIRATION)
- relaxes (EXPIRATION)
INNERVATION of diaphragm
phrenic nerve
blood supply - ANTERIOR - RIGHT
- arch of aorta
- brachiocephalic artery
- right subclavian artery
- right internal thoracic artery
- anterior intercostal arteries
blood supply - ANTERIOR - LEFT
- arch of aorta
- left subclavian artery
- left internal thoracic artery
- anterior intercostal arteries
***NO BRANCHING OFF ARCH OF AORTA
blood supply - POSTERIOR
- arch of aorta
- descending thoracic aorta
- posterior intercostal arteries
venous drainage
reverse passage of arterial supply
- hemiazygos vein
- accessory hemiazygos vein (2 of them)
- azygos vein
- superior vena cava
a joint
site where 2 or more bones connect
- link skeletal system together
- joints facilitate movement of the skeleton
joint structure and function
function and range of motion of each joint is dependent upon its structure (anatomy)
stability vs. mobility
as something become less mobile, it becomes more stable
ex. ball and socket joint - most mobile, but least stable
function of joints (types)
- synarthrosis: no movement (fibrous, cartilaginous, bony fusion)
- amphiarthrosis: little movement (fibrous, cartilaginous)
- diarthrosis: wide range of motion (synovial)
fibrous synarthrosis
immovable, strong union between bones
ex. sutures of the skull
bony fusion synarthrosis
created when bones fuse together (can’t really see)
ex. bones of pelvis
cartilaginous ampiarthrisis
bones joined by a wedge of cartilage
ex. intervertebral discs or pubic symphasis
synovial joints (diarthrisis)
freely moveable joints
- typically found at end of long bones
components of synovial joints
- joint capsule
- articular cartilage
- joint cavity filled with synovial fluid
- synovial membrane
- accessory structures
joint capsule (articular capsule)
surrounds synovial joint, and encloses joint cavity
Made of:
1. outer dense connective tissue layer (external)
2. inner synovial membrane (internal)
synovial membrane
lines inner surface of joint and produces synovial fluid
synovial fluid
- fills joint cavity
- lubricates and reduces friction
- absorbs shock
- distributes nutrients to cells of articular cartilage
articular cartilage
covers surfaces for articulating bones to reduce friction during movement
***on top of bone
accessory structures of synovial joints
- menisci
- ligaments
- bursae
- fat pads
- all provide support and stability
menisci (meniscus)
fibrocartilage pads between bone of knee
1. reduce friction
2. disperse weight
3. protect and cushion joint surface
ligaments (synovial)
fibrous connective tissue connecting bone to bone that support and strengthen synovial joints
can be:
1. outside joint capsule- extracapsular (PCL)
2. inside joint capsule- intracapsular (ACL)
bursa (bursae)
small fluid-filled pockets in connective tissue, around tendons and bones
1. filled with synovial fluid and lines by synovial membrane
2. reduce friction
3. shock absorbers (due to synovial fluid)
fat pads (synovial)
yellow substance that protects articular cartilages and cushions the joint
***found around periphery (outside) of the joint
types of synovial joint movements
- gliding
- angular
- rotational
- special movements
gliding movement
two opposing flat surfaces slide past each other
ex. intertarsal joints
angular movement
changes the angle between articulating bones
1. flexion (decrease angle)
2. extension (increase angle)
3. abduction
4. adduction
5. circumduction (combo of movements above - ball and socket joints)
rotational movement
- medial (internal) rotation
- lateral (external) rotation
- supination
- pronation
special movements (foot)
- inversion (sole in)
- eversion (sole out)
- dorsiflexion (elevate sole)
- plantar flexion (elevate heel)
special movement (thumb)
- opposition (thumb touch)
- reposition
special movements (others)
- protraction (anteriorly along transverse plane)
- retraction (posteriorly)
- elevation (up - superior)
- depression (down - inferior)
special movements (the vertebral column)
- lateral flexion (bending vertebral column side to side)
- flexion & extension (bending front and back)
- rotation (twisting)
types of synovial joints
- gliding (plane) joint
- hinge joint
- pivot joint
- ellipsoidal (condylar) joint
- saddle joint
- ball-and-socket joint
gliding (plane) joint
flattened or slightly curved surface slide across one another
ex. intertarsal joints of the foot
hinge joint
CONVEX surface of a bone fits into a CONCAVE surface of a bone
- Monoaxial: across one axis (flexion/extension)
ex. elbow joint, ankle joint, knee joint, interphalangeal joints
pivot joint
pointed surface of bone articulates with a ring
- Monoaxial: only rotation
ex. atlanto-axial joint (C1 and C2)
- proximal radioulnar joint (radius head rotates)
ellipsoidal (condylar) joint
condyle (oval) sits within a depression on the opposing surface
- Biaxial: motion across 2 axes
(flexion/extension & abduction/adduction & circumduction)
ex. metacarpophalangeal joints 1-5
saddle joint
articular surface of a bone fits into saddle-shaped bone
- Biaxial: opposition
ex. first carpometacarpal joint (base of thumb)
ball-and-socket joint
round head of a bone sits into a cup-shaped depression of a bone
- Triaxial: 3 axes
(angular motion, rotation & circumduction)
ex. hip and shoulder joint
appendicular skeleton
- pectoral girdle
- arm and forearm
- wrist and hand
pectoral girdle
clavicle and scapula
clavicle
- acromial/lateral end articulates with acromion of scapula (furthest from neck)
- sternal/medial end articulates with sternum (closer to neck)
- rough INFERIOR surface = attachment site for muscles and ligaments
clavicle orientation
- lateral 1/3 CONCAVE anteriorly
- medial 2/3 CONVEX anteriorly (protrudes outwards)
sternoclavicular joint
join clavicle and sternum together at the clavicular notch of the manubrium
***SADDLE joint
borders of scapula
- medial (comes together at middle of back)
- lateral (outside)
- superior (top)
3 fossae of scapula
- supraspinous fossa (above scap. spine)
- infraspinous fossa (below scap.spin)
- subscapular fossa (anterior)
anterior scapula
- acromion
- coracoid process
acromion
- articulates with lateral end of clavicle
- larger process
- posterior
coracoid process
- smaller process
- anterior
posterior scapula
- spine of scapula - divides supra and infraspinous fossae
- acromion - lateral end of spine
lateral scapula
- glenoid fossa/cavity- forms shoulder joint with head of humerus
glenohumeral joint
joins head of humerus and glenoid fossa
- ball-and-socket joint protected by bursa
acromioclavicular joint
joins lateral end of clavicle to acromion via the acromioclavicular ligament
coracoacromial joint
joins coracoid process and acromion via the coracoacromial ligament
proximal humerus
ANTERIOR
1. head of humerus (pointing IN medially)
2. greater tubercle (larger & lateral)
3. lesser tubercle (smaller & medial)
3. intertubercular groove (between tubercles)
POSTERIOR
4. anatomical neck (end of head)
5. surgical neck (where humerus narrows)
shaft of humerus
- deltoid tuberosity
- shaft (main part)
tuberosity
rough, elevated surface, usually named for muscle attachments
distal humerus
ANTERIOR
1. condlye (capitulum & trochlea)
- capitulum = head
- trochlea = 2 bony prominences
POSTERIOR
1. trochlea
3 fossae of distal humerus
- radial fossa (smaller & lateral)
- coronoid fossa (larger & medial)
- olecranon fossa (largest & posterior)
bony prominences of distal humerus
- lateral epicondyle (small beside capitulum)
- medial epicondyle (larger beside trochlea)
epicondlye
rounded bump on a condyle
condyle
rounded knob that articulates with other bone
radius
lateral - thumb side
ulna
medial - pinkie side
- elbow joint range of motion
proximal radius
- head (flat)
- neck
- radial tuberosity (surface on anterior radius)
proximal ulna
- olecranon
- trochlear notch
- radial notch
- coronoid process
olecranon
- limit on extension (prevent hyperextension)
- projects into olecranon fossa on POSTERIOR HUMERUS
trochlear notch
articulates with TROCHLEA of humerus
- bony prominences of trochlea fit
radial notch
articulates with head of radius
- forms radio-ulnar joint
coronoid process
- limit of flexion
- projects into coronoid fossa on ANTERIOR HUMERUS
muscles that move the arm - rotator cuff group
- supraspinatus
- infraspinatus
- teres minor
- subscapularis
muscles that move the arm - non-rotator cuff group
- deltoid
- coracobrachialis
- pectoralis major
muscles that move the forearm
- biceps brachii (most superficial)
- brachialis
- brachioradialis
- triceps brachii
ORIGIN of supraspinatus
supraspinous fossa
INSERTION of supraspinatus
greater tubercle of humerus (lateral)
ACTION of supraspinatus
abduction of arm at shoulder
INNERVATION of supraspinatus
suprascapular nerve
ORIGIN of infraspinatus
infraspinous fossa
INSERTION of infraspinatus
greater tubercle of humerus
ACTION of infraspinatus
external (lateral) rotation of arm at shoulder
INNERVATION of infraspinatus
suprascapular nerve
ORIGIN of teres minor
lateral border of scapula
INSERTION of teres minor
greater tubercle of humerus
ACTION of teres minor
external (lateral) rotation of arm at shoulder
INNERVATION of teres minor
axillary nerve
ORIGIN of subscapularis
subscapular fossa
INSERTION of subscapularis
lesser tubercle of humerus (medial)
ACTION of subscapularis
- medial (internal) rotation of arm at shoulder
- adduct arm at shoulder
INNERVATION of subscapularis
subscapular nerve
ORIGIN of deltoid
- lateral clavicle
- acromion
- spine of scapula
INSERTION of deltoid
deltoid tuberosity of humerus
ACTION of deltoid
- abduction of arm at shoulder
- medial and lateral rotation of arm
- flexion and extension of arm
INNERVATION of deltoid
axillary nerve
ORIGIN of coracobrachialis
coracoid process of scapula
INSERTION of coracobrachialis
medial shaft of humerus
ACTION of coracobrachialis
- adduction of arm at shoulder
- flexion of arm at shoulder
INNERVATION of coracobrachialis
musclulocutaneous nerve
ORIGIN of biceps brachii
- long head: supraglenoid tubercle of scapula
- short head: coracoid process
INSERTION of biceps brachii
radial tuberosity
ACTION of biceps brachii
- flexes arm and forearm at elbow
- abducts and medially rotates arm
- supination (forearm)
INNERVATION of biceps brachii
musculocutaneous nerve
ORIGIN of brachialis
anterior humerus
INSERTION of brachialis
- ulnar tuberosity
- coronoid process
ACTION of brachialis
flexes forearm at elbow
INNERVATION of brachialis
- musculocutaneous nerve
- radial nerve
ORIGIN of brachioradialis
lateral supracondylar ridge of humerus (proximal 2/3)
INSERTION of brachioradialis
styloid process of radius
ACTION of brachioradialis
flexes forearm at elbow joint
INNERVATION of brachioradialis
radial nerve
ORIGIN of triceps brachii
- long head: scapula
- lateral head: humerus
- medial head: humerus but DEEP
INSERTION of triceps brachii
olecranon of ulna
ACTION of triceps brachii
- extends and adducts arm
- extends forearm
INNERVATION of triceps brachii
radial nerve
ORIGIN of internal oblique
- thoracolumbar fascia
- iliac crest
INSERTION of internal oblique
- linea alba
- pubis
- inferior ribs & costal cartilage
ACTION of internal oblique
same as external oblique but IPSILATERAL rotation
ORIGIN of external oblique
ribs 5-12
INSERTION of external oblique
- linea alba
- iliac crest
- pubic crest
ACTION of external oblique
- bilateral contraction: flexion of vertebral column & abdominal compression
- unilateral contraction: lateral flexion; trunk rotation (CONTRALATERAL)
thoracolumbar fascia
multilayer arrangement of fascia (sheet of connective tissue) in lumbar region
ORIGIN of rectus abdominus
pubic symphysis
INSERTION of rectus abdominis
- xiphoid process
- costal cartilage of ribs 5-7
ACTION of rectus abdominis
- flexion of the trunk
- abdominal compression
tendinous instersections
transverse, fibrous bands that partially separate the muscle fibers of the rectus abdominis into segments
ORIGIN of transverse abdominis
- costal cartilage of inferior ribs
- iliac crest
- thoracolumbar fascia
INSERTION of transverse abdominis
- linea alba
- pubis
ACTION of transverse abdominis
abdominal compression
rectus sheath
formed by aponeuroses of external & internal oblique, and transverse abdominis
- encloses rectus abdominis
- converges centrally as linea alba
aponeurosis
sheet-like tendon by which muscles connect to bone or fascia
trapezius
paired, trapezoid-shaped muscle
ORIGIN of trapezius
- occipital bone of the skull
- spinous process of thoracic vertebrae (T1-T12)
INSERTION of trapezius
- scapula (acromion & scapular spine)
- lateral aspect of clavicle
ACTIONS of trapezius
- upper fibers: elevate scapula
- middle fibers: retract scapula & upward rotation of scapula (ARM ABDUCTION)
- lower fibres: depress scapula & upward rotation of scapula (ARM ABDUCTION)
ORIGIN of latissimus dorsi
- spinous processes of lower thoracic vertebrae & lumbar vertebrae (T6-L5)
- sacrum
- iliac crest
- thoracolumbar fascia
INSERTION of latissimus dorsi
humerus (intertubercular groove)
ACTIONS of latissimus dorsi
- adduction of arm
- extension of arm
- medial rotation of arm at shoulder
INNERVATION of latissimus dorsi
thoracodorsal nerve (brachial plexus)
ORIGIN of levator scapulae
transverse processes superior cervical vertebrae (C1-C4)
INSERTION of levator scapulae
superior/medial border of scapula
ACTION of levator scapulae
elevation of scapula
INNERVATION of levator scapulae
dorsal scapular nerve (brachial plexus)
ORIGIN of rhomboids (major & minor)
spinous processes of C7-T5
INSERTION of rhomboids (major & minor)
medial border of the scapula
ACTIONS of rhomboids (major & minor)
- retraction of scapula
- downward rotation of scapula (ARM ADDUCTION)
INNERVATION of rhomboids (major & minor)
dorsal scapular nerve (brachial nerve)
rhomboid minor vs major
major = below
minor = above
- minor is below levator scapulae
ORIGIN of teres major
inferior angle of scapula (posterior)
INSERTION of teres major
medial lip of intertubercular groove
ACTIONS of teres major
- adduction of arm
- extension of arm
- medial rotation of arm
INNERVATION of teres major
lower subscapular nerve (brachial plexus)
erector spinae muscles
DEEPEST group of paired muscles running along vertebral column
1. iliocostalis (lateral)
2. longissimus (middle)
3. spinalis (medial)
erector spinae muscles ACTIONS
- bilateral contraction: extension of vertebral column
- unilateral contraction: lateral flexion of vertebral column
arterial blood supply (O2 blood from heart to tissues)
- subclavian artery
- axillary artery
- brachial artery (supplies arm)
- profunda brachii
- radial artery
- ulnar artery
cubital fossa
area on anterior part of elbow joint that splits profunda brachii into radial and ulnar artery
where does the subclavian artery become the axillary artery?
at the border of the first rib
where does the axillary artery become the brachial artery?
at the inferior border of teres major
venous drainage (Deoxy blood back to heart)
- deep veins (accompany arteries)
- superficial veins (run subcutaneously)
venous drainage - deep veins
- palmar venous arches (deep & superficial)
- ulnar vein
- radial vein
- brachial vein
- axillary vein
venous drainage - superficial veins
- digital veins
- palmar venous arches (deep & superficial)
- basilic vein (medial)
- cephalic vein (lateral)
- axillary vein
venous drainage
- radial vein
- ulnar vein
- brachial vein
- basilic vein (medial)
- cephalic vein (lateral)
- axillary vein
- subclavian vein
the axilla
pyramidal space located between thorax (ribs) and upper limb where blood vessels and nerves pass
base= skin of ARMPIT
walls of the axilla
- anterior wall = pec. minor & major
- lateral wall = humerus
- posterior wall = subscapularis & teres major
- medial wall = thoracic wall & serratus anterior
brachial plexus
network of nerves that innervates muscles of pectoral girdle and upper limb and skin of arm, forearm and hand
what is the brachial plexus divided into?
Roots
Trunks
Divisions
Cords
Branches
***Remember To Drink Cold Beer
ROOTS - brachial plexus
formed by spinal nerves C5-T1
***C8
1. dorsal scapular nerve
2. long thoracic nerve
dorsal scapular nerve
innervates levator scapulae & the rhomboids
long thoracic nerve
contributes from C5-C7 roots form LTN
- innervates serratus anterior
TRUNKS - brachial plexus
- superior
- suprascapular nerve - middle
- inferior
suprascapular nerve
located on superior trunk
- innervates supraspinatus & infraspinatus
DIVISIONS - brachial nerve
- 3 anterior divisions
- 3 posterior divisions
CORDS - brachial plexus
once anterior and posterior divisions enter the AXILLA, they combine to form 3 CORDS - lateral, posterior, medial
LATERAL cord
supplies lateral pectoral nerve: innervates pectoralis major
MEDIAL cord
supplies medial pectoral nerve: pectoralis major & minor
POSTERIOR cord
supplies…
1. thoracodorsal nerve: innervates latissimus dorsi
2. subscapular nerves: innervates subscapularis & teres major
BRANCHES - brachial plexus
- musculocutaneous nerve
- axillary nerve
- median nerve
- radial nerve
- ulnar nerve
musculocutaneous nerve
lateral cord (C5-C7)
- innervates muscles of anterior compartment of arm
axillary nerve
posterior cord (C5,C6)
- innervates deltoid & teres minor
median nerve
lateral and medial cords (C5-T1)
- innervates muscles of anterior forearm (other than 2) and muscles of the hand
radial nerve
posterior cord (C5-T1)
- innervates muscles of posterior arm and forearm
ulnar nerve
medial cord (C8-T1)
- innervates muscles of hand, FCU and FDP (rest of muscles of forearm from median)
distal radius
- ulnar notch - articulates with head of ulna and forms distal RADIO-ULNAR joint
- styloid process
distal ulna
- styloid process
difference between styloid processes
radius = bigger (lateral)
ulna = smaller and dips down (medial)
fibrous radioulnar ligaments
- interoserrous membrane
- annular ligament
- radioulnar ligaments
interosseous membrane
fibrous sheath between radius and ulna
- separates forearm muscles into anterior and posterior compartments
annular ligament
thick band surrounding head of radius that holds the radius to the ulna
- flexibility allows for pronation and supination
- PROXIMAL radioulnar joint
radioulnar ligaments
stabilizers
- DISTAL radioulnar joint
proximal row bones of the wrist
(lateral to medial)
- scaphoid
- lunate
- triquetrium
- pisiform (on top triq.)
So Long To Pinky
distal row bones of the wrist
(medial to lateral)
- hamate
- capitate
- trapezoid
- trapezium (at joint of thumb)
Here Comes The Thumb
what carpal bones can you not see form the dorsal view?
pisiform and hook of hamate
wrist joints
- radiocarpal joint
- ulnocarpal joint
radiocarpal joint
synovial condylar joint
- radius articulates with scaphoid, lunate & triquetrium
- direct articulation
ulnocarpal joint
ulna connects with lunate & triquetrium
- no direct articulation due to bursae
- common site of wrist injuries
phalanges
- proximal interphalangeal joints
- distal interphalangeal joints
- thumb (pollox) only had PROXIMAL & DISTAL phlanges (no middle)
metacarpals
- numbered 1-5 lateral to medial
- carpometacarpal joints
- metacarpal phalangeal joint
anterior compartment of forearm
- superficial
- intermediate
- deep
posterior compartment of forearm
- superficial
- deep
superficial layer of anterior compartment
- pronator teres
- flexor carpi radialis
- palmaris longus
- flexor carpi ulnaris
common flexor origin (CFO)
medial epicondyle of humerus
ORIGIN of pronator teres
medial epicondyle of humerus
INSERTION of pronator teres
lateral radius
ACTION of pronator teres
pronation of forearm
ORIGIN of flexor carpi radialis
medial epicondyle of humerus
INSERTION of flexor carpi radialis
2nd and 3rd metacarpals
ACTIONS of flexor carpi radialis
- flexion of wrist
- abduction of wrist (on radial side)
ORIGIN of palmaris longus
medial epicondyle of humerus
INSERTION of palmaris longus
palmar aponeurosis
ACTION of palmaris longus
weak flexion of wrist
***weak because it doesn’t have much function, not all people have it
palmar aponeurosis
thickening of palmar fascia (CT)
- continuous with tendon of palmaris longus
ORIGIN of flexor carpi ulnaris
- medial epicondyle of humerus
- olecranon of ulna
INSERTION of flexor carpi ulnaris
- carpals - pisiform & hook of hamate
- 5th metacarpal
ACTIONS of flexor carpi ulnaris
- flexion of wrist
- adduction of wrist (ulnar side)
intermediate layer of anterior compartment
- flexor digitorum superficialis
deep layer of anterior compartment
- flexor digitorum profundus
- pronator quadratus
- flexor pollicis longus
ORIGINS of flexor digitorum superficialis
- medial epicondyle of humerus
- anterior surface of radius & ulna
INSERTION of flexor digitorum superficialis
4 tendons split and insert on middle phalanges 2-5
ACTIONS of flexor digitorum superficialis
- flexion of wrist
- flexion of metacarpophalangeal joints 2-5
- flexion of proximal interphalangeal joints 2-5
ACTIONS of flexor digitorum profundus
- flexion of wrist
- flexion of metacarpophalangeal joints 2-5
- flexion of proximal interphalangeal joints 2-5
- flexion of distal interphalangeal joints 2-5
flexor digitorum profundus vs. flexor digitorum superficialis
FDS splits into two to allow FDP to pass through to distal interphalangeal joints
ORIGIN of flexor pollicis longus
- anterior radius
- interserrous membrane
INSERTION of flexor pollicis longus
digital phalanx of the thumb
ACTIONS of flexor pollicis longus
flexion of thumb
ORIGIN of pronator quadratus
distal anterior surface of ulna
INSERTION of pronator quadratus
distal anterior surface of radius
ACTION of pronator quadratus
pronation of forearm
anterior forearm innervation
- median nerve innervates all forearm muscles other than ones innervated by ulnar nerve
- ulnar nerve innervates FLEXOR CARPI ULNARIS & MEDIAL HALF of FLEXOR DIGITORUM PROFUNDUS
flexor retinaculum
fibrous connective tissue band located on palmar surface of hand that hold tendons of flexor muscles in place
- forms roof of CARPAL TUNNEL
carpal tunnel
flexor retinaculum arches over carpal bones to form carpal tunnel
contains:
1. flexor digitorum superficialis
2. flexor digitorum profundus
3. flexor pollicis longus
4. median nerve
superficial layer of posterior compartment
- brachioradialis
- extensor carpi radialis longus (most superficial)
- extensor carpi radialis brevis (deep to longus)
- extensor digitorum
- extensor digiti minimi
- extensor carpi ulnaris
deep layer of posterior compartment
- supinator
- abductor pollicis longus (most lateral)
- extensor pollicis brevis (shorter tendon on radius)
- extensor pollicis longus (longer tendonon ulna)
- extensor indicis
common extensor origin (CEO)
lateral epicondyle of humerus
ORIGIN of extensor carpi radialis longus & brevis
lateral epicondyle of humerus
INSERTION of extensor carpi radialis longus & brevis
2nd & 3rd metacarpals
ACTIONS of extensor carpi radialis longus & brevis
- extension of wrist
- abduction of wrist (radial side)
ORIGIN of extensor carpi ulnaris
lateral epicondyle of humerus
INSERTION of extensor carpi ulnaris
base of 5th metacarpal (pinky)
ACTIONS of extensor carpi ulnaris
- extension of wrist
- adduction of wrist (ulnar side)
ORIGIN of extensor digitorum
lateral epicondyle of humerus
INSERTION of extensor digitorum
posterior surfaces of phalanges 2-5
ACTIONS of extensor digitorum
- extension of wrist
- extension of fingers
ORIGIN of extensor digiti minimi
lateral epicondyle of humerus
INSERTION of extensor digiti minimi
- middle phalanx of pinky finger (5th digit) - posterior surface
ACTIONS of extensor digiti minimi
- extension of wrist
- extension of pinky finger
ORIGIN of supinator
- lateral epicondyle of humerus
- proximal ulna
INSERTION of supinator
lateral proximal radius
ACTION of supinator
supination
ORIGIN of abductor pollicis longus
proximal ulna & radius - posterior surface
INSERTION of abductor pollicis longus
1st metacarpal
ACTION of abductor pollicis longus
abduction of thumb & wrist
ORIGIN of extensor pollicis longus
- posterior ULNA
- interosseus membrane
INSERTION of extensor pollicis longus
distal phalanx of the thumb
ACTION of extensor pollicis longus
extension of thumb
ORIGIN of extensor pollicis brevis
- posterior RADIUS
- interosseous membrane
INSERTION of extensor pollicis brevis
proximal phalanx of the thumb
ACTION of extensor pollicis brevis
extension of thumb
ORIGIN of extensor indicis
- posterior distal ULNA
- interosseous membrane
INSERTION of extensor indicis
index finger
ACTIONS of extensor indicis
- extensor of index finger
- extension of wrist
lateral border of anatomical snuffbox
- abductor pollicis longus tendon
- extensor pollicis brevis tendon
medial border of anatomical snuffbox
- extensor pollicis longus tendon
posterior forearm innervation
radial nerve innervates all posterior forearm muscles
extensor retinaculum
fibrous connective tissue band located on dorsal surface of hand that holds tendons of the extensor muscles in place
extrinsic muscles of the hand
- originate in forearm and insert on hand
- control crude movements
ex. flexor digitorum profundus
intrinsic muscles of the hand
- originate and insert within the hand
- control fine movements
ex. hypothenar and thenar muscles
hypothenar and thenar muscles
hypothenar = base of pinky
thenar = bulging muscles base of thumb
ORIGIN of flexor digitorum profundus
- ulna
- interosseus membrane
INSERTION of flexor digitorum profundus
distal phalanges 2-5