Midterm I: Ventral Upper Limb Regions (Ben)

Question 1

What are the borders of the axillary region/fossa?

(actually more like “walls” of the fossa, rather than borders here)

Answer 1

Ventral: pec major/minor

Dorsal: latissimus dorsi

Lateral: neck of humerus, coracobrachialis, short head biceps brachii

Medial: serratus anterior

Question 2

What are the borders of the deltoid region?

Answer 2

margins of the deltoid muscle

Question 3

What are the borders of the anterior brachial region?

Answer 3

Superior: transverse line along lower margin pec. major

Inferior: transverse line 3 fingers above cubital fossa

Lateral: lateral bicipital groove

Medial: medial bicipital groove

Question 4

What are the borders of the anterior cubital region?

Answer 4

Superior: 3 fingers above cubital fossa

Inferior: 3 fingers below cubital fossa

Lateral: line thru humerus’ lateral epicondyle

Medial: line thru humerus’ medial epicondyle

Question 5

What are the borders of the anterior antebrachial region?

Answer 5

Superior: 3 fingers below cubital fossa

Inferior: transverse line across head of ulna

Lateral: line btwn lateral epicondyle and styloid proc. of radius

Medial: line btwn medial epicondyle and styloid proc. of ulna

Question 6

What are the borders of the anterior carpal region?

Answer 6

Superior: transverse line across head of ulna

Inferior: line btwn medial + lateral carpal eminences

Lateral/Medial: borders of wrist

Question 7

What are the borders of the palmar region?

Answer 7

Superior: line btwn radial/ulnar carpal eminences

Inferior: skin folds at base of fingers (middle of proximal phalanges)

Radial: edge of thenar eminence + skin fold btwn thumb and index finger

Ulnar: edge of hypothenar eminence

Question 8

What are the contents of the axillary region/fossa?

5 things

Answer 8

1. Axillary Vessels (A + V and branches)
2. Lymphatics (vessel + axillary lymph nodes)
3. Brachial Plexus Cords (medial, lateral, posterior)
4. Tendon of Coracobrachialis
5. Short Head Biceps Brachii

Question 9

What innervates the skin of the axillary region?

Answer 9

Intercostobrachial Nerves

• anastamoses btwn intercostal nerve 2 + medial brachial cutaneous nerve

Question 10

What is the “apex” of the axillary region?

Answer 10

Cervicoaxillary Canal

• extends superiorly to neck from within axillary fossa
• btwn 1st rib, clavicle + superior border scapula

Question 11

What innervates the skin of the deltoid region?

2 nerves

Answer 11

1. Lateral Supraclavicular Nerves
2. Superior Lateral Brachial Cutaneous Nerve

Question 12

What are the contents of the quadrangular space (in the deltoid region)?

Borders?

Answer 12

Contents:

• Posterior Circumflex Humeral Artery
• Axillary Nerve

Borders:

• Sup: Teres minor
• Inf: Teres major
• Lat: Humerus
• Med: Long Head Triceps

Question 13

What are contents of the medialtriangular space (in the deltoid region…sort of)?

Borders?

Answer 13

Contents:

• Circumflex Scapular Artery

Borders:

• Sup: Teres minor
• Inf: Teres major
• Lat: Long Head, Triceps

Question 14

What are the contents of the lateral triangular space (in the deltoid region)?

Borders?

Answer 14

Contents:

• Radial Nerve
• Deep Branch, Brachial Artery

Borders:

• Sup: Teres major
• Med: Long Head, Triceps
• Lat: Humerus + Lateral Head, Triceps

Question 15

What innerves the skin of the anterior brachial region?

2 nerves

Answer 15

1. Medial Brachial Cutaneous N. (from brachial plex., medial cord)
2. Superior Lateral Brachial Cut. N. (from axillary n.)

Question 16

What are the 3 important subcutaneous structures of the anterior brachial region?

(2 vessels, 1 fascia)

(What is special about the fascia?)

Answer 16

1. Cephalic Vein (laterally, thru deltopectoral groove + triangle to axillary vein)
2. Basilic Vein (medially, pierces brachial fascia at brachial hiatus)
3. Brachial Fascia
   
   • continuation of deltoid, pectoral, infraspinatus + axillary fasciae
   • gives lat/med intermuscular septa, dividing flexor/ext. compartments of upper arm

Question 17

What are the muscles of the anterior brachial region (3)?

Their innervation?

(Something special about this nerve?)

Answer 17

1. Biceps Brachii - lateral long + medial short heads
2. Coracobrachialis - in superior medial 1/2 of region, deep to biceps
3. Brachialis - inferior 1/2 of region, deep to biceps

• all innervated by musculocutaneous nerve which pierces the coracobrachialis (+ continues to become lateral antebrachial cutaneous n.)

Question 18

What two spaces are found along the length of either side of the anterior brachial region?

One of the two has many contents. What are they?

(5 nerves, 4 vessels)

Answer 18

• Lateral Bicipital Groove - only contains cephalic vein
• Medial Bicipital Groove, contains:
  
  • Median Nerve
  • Medial Brachial and Antebrachial Cutaneous Ns.
  • Musculocutaneous N.
  • Ulnar Nerve (goes posteriorly to groove behind medial epicondyle)
  • Superior Collateral Ulnar Artery (from Brachial A., less important)
  • Brachial Artery
  • _2 B_rachial Veins
• remember MMMMUUBBB

Question 19

What 3 minor branches does the brachial artery give in the anterior brachial region?

(maybe not so important)

Answer 19

1. Superior Ulnar Collateral A.
2. Inferior Ulnar Collateral A.
3. Deep Brachial A.

Question 20

What innervates the skin of the anterior cubital region (3 things)?

What vessels run with these nerves?

Answer 20

Lateral Inferior Brachial Cutaneous N.

Medial Brachial + Antebrachial Cutaneous Nerves

Basilic Vein runs w/ medial, Cephalic w/ lateral

Question 21

What important anastamosis exists in the cubital fossa?

Answer 21

Median Cubital Vein

• btwn cephalic and basilic veins
• commonly used for blood drawing

Question 22

What are the borders of the cubital fossa?

Include floor and roof.

Answer 22

• Roof: Bicipital Aponeurosis + Antebrachial Fascia
• Floor: Brachialis (also supinator laterally)
• Medial: Pronator Teres ( + forearm flexors)
• Lateral: Brachioradialis ( + forearm extensors)
• Superior: Line btwn 2 humeral epicondyles

Question 23

What are the contents of the cubital fossa?

(medial to lateral)

Answer 23

1. Median Nerve
2. Brachial Artery
3. Tendon of Biceps Brachii (inserts on radial tuberosity)
4. (lymph nodes throughout)

• in lateral to medial direction, remember TAN

Question 24

What important motor nerve is found laterally in the anterior cubital region (but not in the cubital fossa)?

Where exactly?

Answer 24

Radial Nerve

• between biceps tendon and brachioradialis, lying on top of brachialis

Question 25

Many forearm muscles originate in the **anterior cubital region**. What two groups and from what two sites?

Answer 25

**Flexors** from the **medial epicondyle** **Extensors** from the **lateral epicondyle**

Question 26

What innervates the skin of the **anterior antebrachial region**?

Answer 26

**Medial and Lateral Antebrachial Cutaneous Nerves** (from brachial plexus + musculocutaneous n., respectively)

Question 27

What are the _superficial_ muscles found in the **anterior antebrachial region**, in radio-ulnar direction? (6 muscles, including 2 non-flexors visible on the radial side + 1 inconstant muscle)

Answer 27

1. **Brachioradialis** (also included in dorsal antebrachial region) 2. **Pronator Teres** 3. **Flexor Carpi Radialis** 4. **Palmaris Longus** (inconstant) 5. **Flexor Digitorum Superficialis** 6. **Flexor Carpi Ulnaris**

Question 28

What nerve innervates the muscles of the **anterior antebrachial region**? What are the 2 exceptions?

Answer 28

**Median Nerve** - except **flexor carpi ulnaris** + **medial part of flexor digitorum profundus** innervated by **_ulnar nerve_** (and brachioradialis is not included here)

Question 29

What are the _deep_ muscles of the **anterior antebrachial region**? (3 muscles, and one from posterior antebrachial also slightly visible)

Answer 29

1. **Flexor Pollicis Longus** 2. **Flexor Digitorum Profundus** 3. **Pronator Quadratus** (distal, near wrist) 4. Supinator (proximally + quite deep)

Question 30

What two structures run under the deep muscles of the **anterior antebrachial region**? On top of what membrane?

Answer 30

**Anterior Interosseous Artery and Nerve** on top of **interosseous membrane**

Question 31

A motor nerve runs between two parts of a muscle in the proximal **anterior antebrachial region**. What nerve and what muscle?

Answer 31

**median nerve** runs between humeral and ulnar heads of **pronator teres** (before running between flexor digitorum sup. + prof. in the fascia of FDS)

Question 32

What innervates the skin of the **anterior carpal region**? What other epifascial nerves are found here?

Answer 32

Once again... end branches of **lateral/medial antebrachial cutaneous nerves** - also **palmar branches** of **radial/ulnar nerves** on their respective sides

Question 33

What are the 2 branches of a _laterally located_ motor nerve in the **anterior antebrachial region**? Describe their courses.

Answer 33

**Superficial** and **deep** **branches** of the **radial nerve**. ... bifurcate in the proximal part of the region. _Deep branch_ **pierces supinator + becomes posterior interosseous nerve**. _Superficial branch_ runs **under brachioradialis with radial artery**.

Question 34

What 2 nerves pierce a fascia in the **anterior carpal region** to reach the palm?

Answer 34

**Palmar branches** of **ulnar** and **median nerves**... pierce the _antebrachial fascia_

Question 35

What structure on the _ulnar side_ transmits _two things_ from the forearm to the hand in the **anterior carpal region**? What two things?

Answer 35

**Guyon's Canal** - transmits **ulnar artery and nerve**

Question 36

What passage in the middle of the **anterior carpal region** transmits several structures to the hand/wrist? What covers it? What is its "floor"? What structures (4)?

Answer 36

**Carpal Tunnel** covered by the **flexor retinaculum** transmits... 1. **Median Nerve** 2. **Flexor Digitorum Sup. Tendons** 3. **FD Profundus Tendons** 4. **Flexor Pollicis Longus Tendon** (FDS/P tendons in _common tendinous sheath_)

Question 37

What innervates the skin of the **palmar region?**

Answer 37

**Median Nerve** - from thumb to radial side of ring finger + palm **Ulnar Nerve, sup. branch** - from pinkie to ulnar side of ring finger + palm

Question 38

What CT structure covers the palm of the hand? It has extensions which subdivide the hand into compartments. What are the **extensions** (less important) and the **compartments** they create (important)?

Answer 38

**Palmar Aponeurosis** - gives off _medial_, _intermediate_, and _lateral palmar septa_ to divide palm into... * **Thenar Eminence** (thumb side) * **Mesothenar/Central Compartment** * **Hypothenar Eminence** (pinky side)

Question 39

What are the two arterial arches of the palm? And what arteries contribute to them?

Answer 39

**Superficial Palmar Arch** - formed by _ulnar artery_ and closed on radial side by _superficial palmar branch of radial artery_ **Deep Palmar Arch** - formed by _radial artery_ and closed on ulnar side by _deep palmar branch of ulnar artery_

Question 40

Which palmar arch supplies most of the fingers? Via what branches?

Answer 40

**Superficial Palmar Arch** gives off the... **Common Palmar Digital Arteries** which each branch into two... **Proper Palmar Digital Arteries** on either side of each finger.

Question 41

What arteries, which supplies radial-side digits, branches off the _deep palmar arch_?

Answer 41

**Princeps Pollicis Artery** **radial indicis artery** to the index finger

Question 42

What hand muscles does the ulnar nerve innervate? Via what branch?

Answer 42

**Deep branch** of ulnar nerve leaves Guyon's canal to innervate... 1. ALL **Hypothenar** muscles * **Flexor digiti minimi brevis** * **Abductor digiti minimi** * **Adductor digiti minimi** 2. **Adductor Pollicis** 3. **Deep Head, Flexor Pollicis Brevis** 4. **Interossei** 5. **Lumbricals 3 + 4**

Question 43

List the _thenar muscles_ from superficial to deep. And _hypothenar_ muscles, superficial to deep.

Answer 43

* **Abductor Pollicis Brevis** * **Flexor Pollicis Brevis** (sup. + deep heads) * **Opponens Pollicis** * **Adductor Pollicis** Same pattern for hypothenar: Abductor --\> Flexor --\> Opponens (no adductor)

Question 44

What is the fascia of the **anterior cubital region**? What muscle-connected structure is related to it?

Answer 44

**cubital fascia** - the _bicipital aponeurosis_ radiates in the medial edge of the fascia

Question 45

What are the nerves and vessels found in the anterior forearm in radioulnar order?

Answer 45

Remember NANAN 1. **Radial N., sup. branch** (--\> dorsal side in distal 1/3) 2. **Radial Artery** (under brachioradialis) 3. **Median Nerve** (btwn 2 pr. teres heads \> btwn fl. digitorum mm.) 4. **Ulnar Artery** 5. **Ulnar Nerve** (N + V under the FC Ulnaris)