Muscles, Arteries, Veins Of UE Flashcards
Subclavius
O, I, A, N, V (Vein) P (Postion)
O: junction of rub 1 and costal cartilage
I: inferior surface of middle 1/3 of clavicle
A: anchors and depresses clavicle, prevents dislocation of SC joint during pulling
N: nerve to subclavius (C5, 6)
*can contribute to brachial plexus compression/entrapment
V: Vlacivular branch of thoracoacromial trunk
P: deep to costal head of pectoralis major
Pectoralis Major
Sternal head (lower fibers)
O:
I:
N:
A:
Clavicular head (upper fibers)
O:
I:
N:
A:
BS: BOTH SHARE
Sternal head (lower fibers)
O: Sternum and costal cartilages 2-4
I: Lateral lip of the inter-tubercular groove of the humerus
N: lateral and medial pectoral (C6-T1)
A: horizontal adduction = lateral flexion
Clavicular head (upper fibers)
O: medial half of the clavicle
I: lateral lip of the inter-tubercular groove of the humerus
A: flexion of the arm at the shoulder joint
N: Lateral pectoral (C5-7)
BS: thoracoacromial trunk
Pectoralis Minor
O:
I:
N:
A:
BS:
O: ribs 3-5
I: coracoid process
N: medial pectoral nerve, may get communicating branches from lateral pec N
*Entrapment site for brachial plexus
A: Depression, downward rotation, and abduction of the scapula; elevation of the ribs
BS: thoracoacromial trunk
Serratus Anterior
O: I: A: BS:
O: ribs 1-9
I: medial border of the scapula
A: depression, abduction, and upward rotation of the scapula; elevation of the ribs when the scapula is fixed
BS: Lateral thoracic artery
Subscapularis
O: I: N: A: BS:
O: subscapular fossa
I: lesser tubercle of the humerus
N: Upper and lower subscapular (C5,6)
A: medial rotation of the head of the humerus
BS: subscapular artery
*Scapulothoracic joint - physiological joint between scapula and thorax/ribs
Subclavian Vein Description
It is the continuation of the axillary vein, which drains the arm. It extends from the outer border of the first rib to the sternal end of the clavicle, where it unites with the internal jugular, to form the brachiocephalic vein. It usually contains a pair of valves near its termination. Tributaries of the subclavian vein include the circumflex scapular and its extension, the suprascapular as well as the external jugular veins.
Subclavian Artery Description and Branches
It is the first part of the long truck that supplies the upper extremity on each side of the body. Its branches also course into the neck and thorax. The right and left subclavian arteries differ in length and origin. On the right side, the subclavian artery originates from the brachiocephalic trunk behind the right Sternoclavicular articulation, passing upward and laterally to the medial margin of the Silenus anterior. The left subclavian artery branches from the aortic arch behind the left common carotid and acvends in the superior mediastinal cavity to he root of the neck.
BRANCHES INCLUDE:
Thyrocervical trunk
Internal throacic
Vertebral
Costocervical trunk
Dorsal scapular
Axillary Artery Description and Branches
It is the continuation of the subclavian artery. Its branches supply the axilla, shoulder, and thoracic muscles. It begins at the outer border of the first rib and end at the lower border of the tendon of the teres major, where it becomes the brachial artery.
BRANCHES:
Thoracoacromial trunk
Lateral thoracic artery
Superior thoracic
Subscapular
Circumflex humeral, anterior
Circumflex humeral posterior
Levator Scapula
O: I: N: A:
N: is same as rhomboid major and minor
O:
I:
N: dorsal scapular (C5), C3-4
A:
*Dorsal scapular nerve: If you have a patient that comes into the office with dorsal scapular nerve entrapment first thought should be middle scalene and posterior scalene Levator scapula (problem will be felt at inferior angle of scapula)
Deltoid
O: I: N: A:
N: Axillary Nerve
Serratus Anterior
N:
Prone to what?
N: Long thoracic (C5-7)
- Prone to trauma, impingement, inflammation
- Serratus anterior is important in holding the scapula to the ribcage and preventing scapula winging
Supraspinatus
I:
N:
I: Upper facet of GT
N: suprascapular (C5,6)
*Atrophy in volleyball players w/ enervation of suprascapular nerve
Infraspinatus
I:
N:
I: Middle facet of GT
N: Suprascapular (C5,6)
Teres Minor
I:
N:
I: (Posterior) lower facet of greater tubercle of humerus
N: Axillary Nerve (C5, C6)
*stabilises arms when they are held overhead
Teres Major
I:
N:
I: Medial lip of intertubercular crest = crest of lesser tubercle
N: Lower subscapular Nerve
*Posterior Compartment
Triceps Brachii (Long, Medial, Lateral) heads
N:
N: radial nerve
(C5-T1)
Quadrangular Space:
(lateral) quadrangular space borders are?
Structures transmitted?
Clinical significance?
Superior: inferior margin of teres minor
BORDERS
Inferior: superior margin of teres major
Lateral: surgical neck of humerus
Medial: lateral margin of long head of triceps
Anterior: subscapularis
STRUCTURES TRANSMITTED:
- Axillary nerve
- Posterior humeral circumflex artery and vein
CLINICAL SIGNIFICANCE:
- Axillary nerve becomes compressed —> deltoid weakness
Triangular Space
(Medial) Triangular Space Borders are?
Structures transmitted?
BORDERS:
Superior: teres minor or subscapularis
Inferior: superior aspect of teres major
Lateral: medial aspect of long head of triceps
STRUCTURES TRANSMITTED:
- Scapular circumflex artery and vein
Triangular interval
What are the borders?
Contents transmitted?
BORDERS:
Superior: teres major
Medial: long head of triceps
Lateral: Humerus or lateral head of triceps
CONTENTS TRANSMITTED:
- Radial nerve (en route to posterior compartment)
- Profunda brachii artery
Anconeus
O: I: A: N: V: P:
Vein
Position
O: lateral epicondyle of humerus
I: lateral olecranon process and proximal posterior ulna
A; aids in extension of elbow, stabilises elbow, maybe adducts ulna during pronation
N: radial n (C7-T1)
V: profunda brachii, recurrent interosseous
P: best isolated when attempting to hyperextend elbow
Pronator teres
O: I: A: N: V:
O:
ulnar head: coronoid process
Humeral head: medial epicondyle of humerus (common flexor origin)
I: Lateral surface of radius
A: pronates and flexes forearm
N: Median n (C6-7)
*cut through both heads to see deeper structures
Flexor Carpi Radialis
O: I: A: N: V: P:
O: medial condyle of humerus
I: base of 2nd metacarpal
A: flexes and abducts wrist
N: median n
V: ulnar a
P: differentiate between FCR and other flexors of forearm
Palmaris Longus
*inconsistent muscle. Tendon frequently harvested for surgical repair of elbow, shoulder, wrist.
O: I: A: N: V: P:
O: medial epicondyle of humerus
I: distal flexor retinaculum, palmar aponeurosis
A: flexes wrist and tenses palmar aponeurosis
N: median n (C7-8)
V: Ulnar a
P: tendon is visible superficial to flexor retinaculum
Flexor Digitorum Superficialis (Anterior forearm: intermediate (2nd) later)
O: I: A: N: V: P:
O:
Humero-ulnar head: medial epicondyle coronoid process
Radial heal: radius below radial tuberosity
I: sides of shafts of middle phalanges of medial 4 digits
A: flexes at PIP joint, more strongly flexes at MCP joint
N: Median N
V: ulnar artery
P: Deep to layer 1
Flexor Digitorum Profundus (Anterior forearm: Deep (3rd) layer)
O: I: A: N: V: P:
O: Proximal 3/4 of medial and anterior surfaces of ulna and IOM
I:
Medial (ulnar) part: bases of distal 4th and 5th digit phalanges
Lateral (radial) part: bases of distal 2nd and 3rd digit phalanges
A: flexes at DIP
N:
Medial (ulnar) part: Ulnar N (C8, T1)
Lateral (radial) part: Median N (C8-T1) - via interior interosseous n (a branch of median nerve)
V: Ulnar and anterior interosseous as
P: Deep to FDS
Supinator
O: I: A: N: V: P:
O: lateral epicondyle of humerus, radial collateral & annular ligaments, Supinator fossa, crest of ulna
I: lateral posterior and anterior surfaces of proximal 1/3 of radius
A: supinates radius
N: Deep radial n
V: recurrent radial a
P: deepest of muscles in this area
*look for deep radial nerve passing under Supinator- a common entrapment site!!
Ulnar Artery overview.
What does this artery branch into?
One of two terminal branches of the brachial artery (the other being the radial artery), and it plays a crucial role in supplying blood to the forearm and hand. The ulnar artery originates from the brachial artery in the cubical fossa. After its origin, the ulnar artery travels down the forearm along the medial side of the forearm, travelling alongside the ulnar nerve.
It passes between the flexor carpi ulnaris and flexor digitorum superficialis muscles.
BRANCHES:
Anterior ulnar recurrent artery - curves around the medial epicondyle of the humerus and anastomoses with the brachial artery.
Anastomosis with inferior ulnar collateral => brachialis, pronator teres
Posterior ulnar recurrent artery - runs behind the medial epicondyle and also forms an anastomosis with the brachial artery. Anastomosis with superior ulnar collateral => flexor digitorum profundus, flexor digitorum superficialis, flexor carpi ulnaris, elbow joint.
Common Interosseous: Divides into- anterior interosseous (supplies deep muscles of forearm) and Posterior interosseous (supplest the back of the forearm)
AT WRIST: planar carpal branch and Dorsal Carpal branch
IN HAND:
Deep palmar branch- anastomosis with deep palmar arch of radial artery
Superficial palmar arch - the termination fo the Ulnar Artery
Common Palmar digital - palmar digital as to digits.
I
Radial Artery Overview and branches.
The radial artery arises from the brachial artery just below the elbow, of the lateral (thumb) side of the forearm. Travels down the forearm along the lateral side (closer to the radius bone).
As it reaches the wrist, it passes around the lateral side of the wrist. It enters the hand across the anatomical snuffbox.
In the hand, the radial artery gives off:
- Superficial palmar branch - forms an anastomosis with the terminal portion of the ulnar artery = superficial palmar arch -> the air muscles of thumb
- Deep palmar branch - is the terminal part of the radial artery; it gives rise to palmar metacarpal aa. The deep palmar arch anastomosis with the deep palmar branch of ulnar artery.
Superficial palmar branch forms an anstomosis with the terminal portion of the ulnar artery = the Superficial palmar arch.
At the wrist: Dorsal Carpal Branch - arises from radial artery deep to the extensor tendons of the thumb, runs medically across the dorsal carpal surface to anastomose with the dorsal carpal branch of the ulnar a and anterior interosseous a.
What muscle is going to regulate the distance between the clavicle and the first rib?
Subclavius
What is the thoracic outlet?
What does this include?
Neurovascular bundle of the upper extremity
Includes: Axillary artery, brachial plexus (C5-T1)
Name the rotator cuff muscles.
- Supraspinatus (only muscle that does abduction; Shares innervation with Infraspinatus)
- Infraspinatus (Shares innervation with supraspinatus)
- Teres Minor
- Subscapularis
How many muscles are there in the posterior forearm?
Name these muscles and there groupings.
12 (4 groups of 3 muscles)
- Raidalis Group
1. BR = BrachioRadialis
2. ECRL = Extensor Carpi Radialis Longus
3. ECRB = Extensor Carpi Radialis Brevis
*Extensor Group
1. ED = Extensor Digitorum
2. EDM = Extensor Digiti Minimi
3. ECU = Extensor Carpi Ulnaris
*Pollicis Group
1. APL = Abductor Pollicis Longus
2. EPB = Extnsor Pollicis Brevis
3. EPL = Extensor Pollicis Longus
*Deep Group
1. A = Anconeus
2. S = Supinator
3. EI = Extensor Indicis
What structures pass through the carpal tunnel?
8 tendons; 1 nerve
Flexor digitorum profundus tendons (4 tendons, one for each finger except the thumb)
Flexor Digitorum superficialis (4 tendons, one for each finger except the thumb)
Median Nerve: provides sensation to the palm side of the thumb, index, middle and part of the ring finger, and motor function of the hand
How many muscles of the anterior forearm are there?
What are these muscles?
8 total
*4 superficial (“Pass, Fail, Pass, Fail”)
1. P = Pronator Teres
2. FCR = Flexor Carpi Radialis
3. PL = Palmaris Longus
4. FCU = Flexor Carpi Ulnaris
*1 intermediate
1. FDS = Flexor Digitorum Superficialis
*3 deep (muscles to complete a “punch”)
1. FDP = Flexor Digitorum Profundus
2. FPL = Flexor Pollicis Longus
3. PQ = Pronator Quadratus
What three muscles insert into the coracoid process?
Bicep Brachii Short Head
Coracobrachialis
Pectoralis Minor
What is the deepest muscle in the proximal forearm?
Supinator
The long thoracic artery travels with what?
Long thoracic nerve
The Thoracodorsal nerve travels with what?
Thoracodorsal artery
The posterior circumflex humeral artery goes through what space with what nerve?
Axillary nerve through quadrangular space
The axillary descends to become the?
Profunda (deep) brachii artery
T or F
The coracobrachialis helps in flexion of the elbow
F
Because it does not cross the elbow
T or F
The coracobrachialis helps in flexion of the elbow
F
Because it does not cross the elbow
What three muscles insert on the greater tubercle of the humerus?
Infraspinatus
Supraspinatus
Teres minor
NOT** subscapular, bc that inserts on the anterior side => lesser tubercle of the humerus!
What muscles originate at the lateral epicondyle of the humerus?
Extensor carpi ulnaris
Extensor digitorum
Extensor carpi radialis brevis
Supinator
Extensor digiti minimi
Anconeus (Back part of Lateral epicondyle of humerus)
Brachioradialis (ridge superior to the lateral epicondyle of the humerus and lateral intermuscular septum)
The transverse humeral ligament is the continuation of what muscle?
Subscapularis
The axillary artery terminates where?
Lateral border of teres muscles
The thoracoacromial trunk is what? And adjacent to what structures?
Branch from the axillary artery.
In most individuals it is found right in between the lateral and medial cord
What is the lateral thoracic artery?
What nerve does the lateral thoracic artery meet up with?
The lateral thoracic artery is the second major branch from the axillary artery
The lateral thoracic artery travels with the LONG thoracic nerve
Where can you find the subscapular artery?
What branch does this artery give off? What anatomical landmark does this structure go through?
- On the anterior surface of the subscapularis muscle .
- Gives off the circumflex scapula or scapula circumflex artery.
- Goes through QUADRANGULAR space
The thoracodorsal nerve travels with what other structures and innervates what muscle?
Thoracodorsal artery and innervates the latissimus dorsi
What artery is the largest branch of the brachial artery and what nerve does it run with? And where?
Deep brachial (profunda brachii) artery. The largest branch of the brachial artery; runs with Radial Nerve in radial (spiral) groove.
What three muscles for the anatomical snuffbox?
Abductor pollicis longus
Extensor pollicis brevis
Extensor pollicis longus
Both heads of the biceps insert where?
Radial tuberosity
Most muscles in the medial compartment originate where? When these muscles get injuries this is referred to as what compared to the posterior side?
Medial epicondyle
Golfers elbow (medial epicondylitis)
Tennis elbow (lateral epicondylitis)
The Palmaris longus contributes to what movement.
Flexion of the head at the wrist joints. OPPOSITIONAL movements
What muscle is found in only about 80% of people?
Palmaris longus
What is one important noted aspect of the flexor digitorum superficialis and the carpal tunnel?
4 of 9 tendons go through the carpal tunnel
What are all the tendons that travel through the carpal tunnel?
4 tendons of flexor digitorum superficialis
4 tendons of flexor digitorum profundus
1 tendon for flexor pollicis longus
The common interosseous artery comes from what larger artery and splits into what arteries?
Comes from the Ulnar Artery!
-Posterior interosseous artery
And
-Anterior interosseous artery
Define agonist, fixator, synergist, and antagonist.
Agonist - muscle responsible for the specific action
Fixator - stabilizes one part of body to for a base for another action
Synergist - facilitates the action of other muscles by being an antagonist to an undersirable motion, thus facilitating the action of the primary mover
Antagonist - produces the opposite action of an agonist
Define isometric, isotonic, and concentric, and eccentric contraction of muscles.
Isometric - force generated without changing length of muscles (i.e. static hold)
Isotonic - force generated as length of muscle changes
Concentric - muscle fibers shorten as force is generated (i.e. bicep curl)
Eccentric - muscle fibers lengthen as the opposite force is greater than the strength of the muscle.
What rotator cuff muscle is most common to injury?
Supraspinatus, tendon most prone to trauma, repetitive stress as it passes between humeral head and acromion.
The biceps brachii long head is ________
Short head is ______
Lateral (long)
Short head (medial)
What nerve travels through the coracobrachialis?
Musculocutaneous nerve
What triceps is the only one that assists in shoulder extension? Why?
Triceps long head because it crosses the shoulder
What two structures travel together between the two heads of the flexor digitorum superficialis?
Median nerve and ulnar artery travels between heads.
Name the intrinsic muscles of the hand in the thenar region.
Abductor pollicis brevis
Flecor pollicis brevis
Opponenes pollicis
Adductor pollicis
Name the intrinsic muscles of the hand in the hypothenar region.
Palmaris brevis
Abductor digiti minimi
Flecor digiti minimi
Opponens digiti minimi
What two muscles mainly flex the elbow and what nerve innervates them?
Brachioradialis and brachialis
Radial nerve
The deep thorax: musculature (intercostals) are innervated by ?
Intercostal nerves T1-11
Name and describe the intercostal layers.
N: intercostal nerves 1-11
A: Anterior and posterior intercostal arteries
1. External intercostal
• Fibers run down and in
• Elevate inferior rib to expand rib cage- inhalation
2. Internal intercostal
• Fibers run up and in
• Depress ribcage- forced exhalation
3. Innermost intercostal*
• Fibers run I-S
• Stabilize ribs
What muscle is involved in upper crossed syndrome? Innervated by what nerve?
Trapezius
N: spinal accessory CN XI (motor)
What are the two arteriole branches of the subclavian artery?
Suprascapular artery
Dorsal scapular artery
The superior thoracic (highest thoracic) artery is in what region of the axillary artery (describe location) and provides innervation to what muscles?
1st region, just lateral to first rib.
Supplies pec minor, major, and thoracic wall.
*not part of dissection list but should know
What two major branches come from the second region of the axillary artery?
What four branches come from the thoracoacromial artery?
Please
Act
Calm
Dennis
Thoracoacromial artery
- pectoral
- acromial
- clavicular
- deltiod
Lateral thoracic
What nerve and artery supply the Serratus anterior?
Long thoracic nerve
Lateral thoracic artery
Part 3 of the axillary artery has how many branches and what are they?
3 branches
- Subscapular artery —> circumflex scapular artery (Triangular Space) AND Thoracodorsal artery
- Posterior Humeral Circumflex (Quadrangular Space) w/ axillary nerve
- Anterior Humeral Circumflex
The brachial artery branches into what vessel? And that vessel forms into what?
- Just before the elbow the brachial artery branches into the deep brachial artery —> radial collateral artery —> radial recurrent artery and then forms an anastomosis with the radial artery
- Just after the elbow the brachial artery branches into the ulnar artery (on ulnar side) Brachial artery also has posterior ulnar recurrent (lateral side) artery and anterior ulnar recurrent (medial side) branches before the elbow and connecting after the elbow.
Coming off the ulnar artery is the common interosseous artery (splits into ant. Interosseous and post. Interosseous a.) - Just after the elbow the brachial artery branches into the radial artery (on radius side)
The median cubical vein forms an anastomosis with what two veins?
Basilic and cephalic veins
On the lateral forearm the cephalon view is connected to the basilic (medial) vein via? At the elbow crease
Median cubical
What vein is most common for vein punctures/blood draws?
Medial cubical vein
The cephalic vein drains into what major vein?
Axillary vein
The basilic vein drains into ?
Axillary vein
O: I: N: A: V:
Triceps long head
O: infraglenoid tuberosity
I: olecranon of ulna
N: radial nerve
A; ext of forearm at elbow and ext of arm at shoulder
V: Deep brachial artery
O: I: N: A: V:
Triceps lateral head
O: posterior surface of the body of the humerus
I: olecranon of ulna
N: radial nerve
A; ext of forearm at elbow
V; deep brachial artery
O: I: N: A: V:
Triceps medial head
O; posterior surface of body of humerus
I; olecranon of ulna
N; radio nerve
A; ext of horse arm at elbow
C; deep brachial artery
Rectus Abdominis
O: I: N:
O: pubic tubercle/front of pubic symphysis
I: Cartilages of the 5th and 6th and 7th ribs, xiphoid process
N: spinal nerves T7-12
Name the layers of the abdominal wall from superficial to deep.
Layer 1 - external oblique
Layer 2 - internal oblique
Layer 3 - trans versus abdominis
What direction does each layer of the abdominal wall run? And what action does this muscle indicate?
External Oblique (layer 1) = fibers run down
*putting hands in pockets
—> contrilateral rotation
Internal Oblique (layer 2) = fibers run up
*putting hands on opposite sides
—> ipsilateral rotation
Transverses adominis (layer 3) = fibers run horizontal
“Core” stabilization, “weight-lifting belt”
What is the lines alba?
Name the A: and N: of the lines alba.
Midline, fusion of aponeuroses that runs from xiphoid to pubic symphysis
A: determined by direction of fibers ad bilateral or unilateral
contraction, compression of abdominal contents (defecation,
Valsalva)
N: T6/7- L1 thoracoabdominal, subcostal, iliohypogastric,
Ilioinguinal
What to conditions associate with the lines alba?
Melanocytes and Diastasis recti-
What major abdominal line is halfway between umbilicus and pubic crest?
Arcuate line
Explain the rectus sheath orientation of layers. Including above and below the arcuate line. *found on slide 8
- The orientation of fibers in the muscles of
the left and right abdominal wall give it
strength and flexibility of movement in
many directions. By contrast, the fibers
of the rectus sheath are oriented for
flexing the trunk. • The anterior wall is reinforced by the
tough rectus sheath and one muscle.
Since the sheath is composed of
aponeuroses anchored at the midline,
the lateral muscles oppose one another
to make the trunk of the body rigid when
they contract (for structural support or to
increase intra-abdominal pressure). • The anterior rectus sheath is complete,
but the posterior sheath is deficient
(absent) below the arcuate line.
Where is the inguinal canal located and what aspects are associated with this region?
Just above inguinal ligament
- Bilateral • From deep (inner) inguinal ring to
superficial (external) • ~4cm • Runs parallel to and just superior to
(~1.25cm) inguinal ligament • Contains:
• Lymphatics • Ilioinguinal nerve • Males: Spermatic cord
• Descent of testes during development • Females: Round ligament of the uterus
Describe the inguinal (poupart’s) ligament:
Describe the superficial inguinal ring and its location:
• Inguinal (Poupart’s) Ligament:
extends from anterior superior
iliac spine to pubic tubercle;
represents the inferior border of
the aponeurosis of the external
oblique m.
• Superficial Inguinal Ring:
located just above the pubic bone
near the pubic tubercle;
represents a gap in the
aponeurosis of the external
oblique m.
Name the borders of the inguinal canal.
• Anterior Wall =
aponeurosis of external
oblique
• Posterior Wall =
transversalis fascia
• Medial Wall = conjoined
tendon & rectus sheath
• Lateral Wall = internal
oblique & transversus
abdominis
• Floor = inguinal ligament
• Roof = arched fibers of
internal oblique and
transversus abdominis
The external spermatic fascia is derived from the aponeurosis of _________ _______.
External oblique
The cremaster muscle and its fascia is derived from ________ ________ ______.
Internal oblique muscles
T or F
Regarding the spermatic cord the transversus abdominus is not a covering.
T
What type of inguinal hernia is most common?
Indirect inguinal hernia
What is an indirect inguinal hernia?
What is a direct inguinal hernia?
Indirect Inguinal Hernia – (most common type) peritoneal sac leaves abdomen through
deep inguinal ring and may travel entire length of inguinal canal eventually passing
through the superficial inguinal ring if left unrepaired
Direct Inguinal Hernia – peritoneal sac leaving abdomen passes through or around the
conjoined tendon, then eventually through the superficial inguinal ring
