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MSS > Muscles, Nerves, Arteries, Veins Upper Limb > Flashcards

Muscles, Nerves, Arteries, Veins Upper Limb Flashcards

1
Q

Erb’s Palsy

A
  • C5

* stretching injury of neck usually during difficult delivery

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2
Q

Klumke Paralysis

A
  • C8
  • injury to brachial plexus during difficult birth
  • usually affects lower arm and hand
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3
Q

Claw Hand

A
  • paralysis of lumbricals due to wrist injury

* deep branch of ulnar n., cannot extend digits 4 and 5

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4
Q

Pope’s Blessing

A
  • compression of median n. at forearm or elbow

* lateral half of FDP not innervated, digits 2 and 3 cannot flex (cannot make a fist)

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5
Q

Dupuyen’s

A
  • John Elway
  • gradual thickening and tightening under the skin of the hand
  • 4th and 5th fingers
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6
Q

Dorsal scapular n.

A
  • Levator scapulae, rhomboideus major and minor
  • deep branch of the transverse cervical artery (dorsal scapular artery)
  • C5 root
  • injury: compression or entrapment within middle scalene
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7
Q

Long thoracic n.

A
  • serratus anterior
  • C5, C6, C7 roots
  • injury: axillary lymph node node resection
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8
Q

Suprascapular n.

A
  • supraspinatous, infraspinatous
  • suprascapular a. - Nerve passes under suprascapular notch, artery passes over - both go through spinoglenoid note to enter infraspinatous
  • superior trunk
  • injury: cyst at either the scapular or sphenoglenoid notch
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9
Q

Superior Trunk

A

•C5 + C6

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10
Q

Middle Trunk

A

•C7

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11
Q

Inferior Trunk

A

•C8 + T1

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12
Q

Lateral cord

A

•anterior of superior and middle trunks

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13
Q

Medial cord

A

•anterior of inferior trunk

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14
Q

Posterior cord

A

•posterior of superior, middle and inferior trunks

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15
Q

Lateral pectoral n.

A
  • pectoralis major and minor
  • more medially positioned, larger found in deltopectoral triangle, see between pec major and minor (top!)
  • lateral cord
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16
Q

Medial pectoral n.

A
  • pectoralis major and minor
  • more laterally positioned, pierces pectoralis minor, see between pec major and minor (bottom!)
  • medial cord
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17
Q

Upper subscapular n.

A
  • subscapularis

* posterior cord

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18
Q

Middle subscapular n. (Thoracodorsal n.)

A
  • latissimus dorsi
  • injury: axillary lymph node resection
  • posterior cord
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19
Q

Lower subscapular n.

A
  • subscapularis and teres major

* posterior cord

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20
Q

Medial antebrachial cutaneous n.

A
  • skin of medial forearm
  • runs parallel and superficial to the ulnar n., basilic vein
  • medial cord
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21
Q

Musculocutaneous n.

A
  • muscles of the anterior arm
  • branch: lateral ante brachial cutaneous
  • terminal branch of the lateral cord, pierces corachobrachialis to lie on deep surface of biceps brachii
  • injury: iatrogenic
  • lateral cord
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22
Q

Axillary n.

A
  • deltoideus, teres minor,p arch on skin of superior lateral arm
  • posterior circumflex a.
  • terminal branch of the posterior cord, dives posteriorly thru the quadrangular space
  • injury: poorly positioned injection, fracture at surgical neck of humerus, shoulder dislocation, improper crutch use
  • posterior cord
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23
Q

Radial n.

A
  • triceps brachii, posterior forearm, skin of posterior forearm and dorsum of hand
  • in the posterior compartment of arm - deep brachial a.
  • terminal branch of posterior cord, slips into posterior arm just inferior to the edge of teres major (inferior to the quadrangular space)
  • injury: humerus fracture, misuse of crutches, Saturday night palsy
  • posterior cord
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24
Q

Median n.

A
  • muscles of anterior forearm- flexor carpi radial is, palmaris longus, pronator teres, flexor digitorum superficialis, 1/2 flexor digitorum profundus, muscles and skin of palm
  • brachial a.
  • travels along medial aspect of arm but DOES NOT provide branches to arm, dives below the bicipital aponeurosis, passes through carpal tunnel
  • injury: supracondylar humeral fracture, carpal tunnel syndrome
  • lateral and medial cord
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25
Q

Ulnar n.

A
  • muscles of anterior forearm - flexor carpi ulnaris, 1/2 flexor digitorum profundus, muscles of palm, skin of hand
  • ulnar a.
  • travels along medial aspect of arm but does NOT provide branches to arm, crosses posterior to the medial epicondyle, does not pass through carpal tunnel
  • injury: Claw Hand, Pope’s Blessing, fracture of humeral medial epicondyle, fracture of hamate or pisiform, handlebar palsy
  • medial cord
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26
Q

Accessory n.

A
  • trapezius
  • superficial branch of the transverse cervical artery
  • travels superficial to the levator scapulae and rhomboid muscles and deep to the trapezius, travels from skull to neck and emerges in the posterior triangle
  • injury: cervical lymph node resection
  • 11th cranial nerve
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27
Q

Lateral antebrachial cutaneous n.

A
  • lateral aspect of forearm into wrist
  • emerges from lateral edge of biceps brachii
  • musculocutaneous
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28
Q

Anterior interosseous n.

A
  • flexor pollicis longus
  • does not pass through carpal tunnel
  • median
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29
Q

Palmar n.

A
  • does not pass through carpal tunnel

* median

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30
Q

Recurrent branch n.

A
  • thenar eminence, 2 lumbricals
  • injury: vulnerable due to superficial position, loss of function of 2 lumbricals and thenar eminence (ape hand)
  • median
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31
Q

Common —> proper branch of median n.

A

•skin of lateral 3 1/2 digits

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32
Q

Superficial branch of radial n.

A

•dorsum of hand, lateral 3 1/2 digits

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33
Q

Deep branch of radial n.

A
  • posterior forearm
  • splits in forearm, after radial n. travels anterior to lateral epicondyle
  • radial
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34
Q

Dorsal branch of ulnar n.

A
  • skin of medial forearm, skin of dorsum, pinkie, 1/2 of ring finger
  • does not pass through carpal tunnel, ulnar n. branches in forearm
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35
Q

Superficial branch of ulnar n. —-> common —-> proper

A
  • two muscles and is sensory to the palmar surface of the medial palm, pinkie and 1/2 of the ring finger
  • does not pass through carpal tunnel
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36
Q

Deep branch of ulnar n.

A
  • majority of palm muscles

* does not pass through carpal tunnel

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37
Q

Subclavian a.

A

•major artery of upper thorax

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38
Q

Axillary a.

A

•subclavian becomes axillary after it enters axilla

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39
Q

Thyrocervical trunk

A

•branch of subclavian

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40
Q

Transverse cervical a.

A
  • branch off thyrocervical trunk

* superior to suprascapular a.

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41
Q

Superficial branch of transverse cervical a.

A
  • accessory n.

* travels superficial to the levator scapulae and rhomboid muscles and deep to the trapezius

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42
Q

Deep branch of the transverse cervical a.

A
  • dorsal scapular n.
  • travels deep to levator scapulae and rhomboideus muscles; not always present, in this case the artery branches directly off the subclavian and is called the dorsal scapular a.
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43
Q

Suprascapular a.

A
  • branch of thyrocervical trunk
  • suprascapular n.
  • passes above suprascapular notch to get to supraspinatous m. and around spinoglenoid notch to reach infraspinatous m.
  • forms anastomotic complex with scapular a. and deep branch of the transverse cervical/dorsal a. which ensures blood supply to the shoulder regardless of position of arm
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44
Q

Thoracoacromial a.

A
  • 1st branch of axillary a.
  • medial and lateral pectoral n.
  • splits into 4 branches that supply the shoulder area, between medial and lateral pectoral n.
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45
Q

Subscapular a.

A
  • 3rd branch of axillary a.

* splits almost immediately into thoracodorsal a. and circumflex scapular a.

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46
Q

Thoracodorsal a.

A
  • branch of axillary —> subscapular a.
  • Thoracodorsal n.
  • descends between the serratus anterior and latissimus dorsi
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47
Q

Circumflex scapular a.

A
  • branch of axillary —-> subscapular
  • passes through the triangular space to infraspinatous fossa and forms anastomotic complex with the suprascapular a. and deep branch of transverse servical a./dorsal scapular a.
48
Q

Posterior circumflex humeral a.

A
  • 5th branch of axillary
  • axillary n.
  • bigger of the two, passes through quadrangular space with the axillary n and winds around the posterior aspect of the humerus
49
Q

Anterior circumflex humeral a.

A
  • 4th branch of axillary a.

* smaller, assumes anterior position

50
Q

Brachial a.

A
  • axillary a branches
  • median n.
  • begins at inferior border of teres major, travels medially and then anteriorly, passing deep into the bicipital aponeurosis to enter the cubical fossa
51
Q

Deep brachial a.

A
  • axillary —-> brachial —-> deep brachial
  • radial n.
  • posterior arm, branches quickly after axilla
52
Q

Ulnar a.

A
  • axillary a. —-> brachial a. —-> ulnar a.
  • brachial a. branches into ulnar and radial shortly after exiting cubical fossa larger, passes deep to the pronator teres, travels in a medial direction towards the FCU and ulnar n. and ultimately forms the main palmar arch, elbow anastomosis
53
Q

Common interosseous a. —-> anterior interosseous a. and posterior interosseous a.

A
  • axillary —> brachial —> ulnar —-> common interosseous —> anterior and posterior
  • anterior and posterior surfaces of the interosseous membrane to supply the deepest layers of the forearm
54
Q

Radial a.

A
  • axillary —> brachial —-> radial
  • brachial a. branches into ulnar and radial shortly after exiting cubical fossa, smaller than ulnar, runs deep to brachioradialis, emerges distally from the lateral edge of the FCR tendon, winds posteriorly to enter the anatomical snuff box and then penetrates to the first interosseous space to enter the palm to form the deep palmar arch, before entering snuffbox it gives off a branch that joins the superficial palmar arch; elbow anastomosis
55
Q

Axillary v.

A
  • union of brachial v. and basilic v. at the level of the teres major m.
  • ends at first rib, becomes subclavian v.
56
Q

Cephalic v.

A
  • lateral aspect of the dorsum of hand (thumb side) and travels the lateral aspect of the limb
  • enters deltopectoral groove and empties into the terminal portion of the axillary v.
57
Q

Basilic v.

A
  • on the lateral aspect of the dorsum of the hand (pinkie side) and runs along the medial aspect of the limb
  • pierces brachial fascia and empties into the axillary v. at its beginning
58
Q

Brachial v.

A
  • deep vein

* brachial a.

59
Q

Quadrangular space

A
  • a window that connects the posterior shoulder and arm to the axilla, permitting vessels and nerves to access the posterior shoulder
  • teres major, teres minor, triceps brachii (long head) humerus
  • axillary n. , posterior circumflex a.
60
Q

Triangular space

A
  • a window that connects the posterior shoulder and arm to the axilla, permitting vessels and nerves to access the posterior shoulder
  • teres minor, teres major, triceps brachii
  • INFERIOR TO QUADRANGULAR SPACE
  • circumflex scapular a.
61
Q

Suprascapular notch

A
  • a window that connects the posterior shoulder and arm to the axilla, permitting vessels and nerves to access the posterior shoulder
  • suprascapular notch and superior transverse ligament
  • suprascapular n. (Artery passes above!)
62
Q

Deltopectoral triangle

A
  • a window that connects the posterior shoulder and arm to the axilla, permitting vessels and nerves to access the posterior shoulder
  • deltoideus, pectoralis major, clavicle
  • cephalic v., branch of thoracoacromial a., lateral pectoral n.
63
Q

Anatomical snuffbox

A
  • bounded by the EPL medially, EPB and APL laterally, floor formed by trapezium and scaphoid
  • radial a. passes through, a branch of the superficial radial n. passes through superficially
  • tenderness at snuffbox may indicate a fractured scaphoid, the most frequently fractured carpal; requires immediate attention to avoid a vascular necrosis
64
Q

Carpal tunnel

A
  • passageway into palm

* 9 tendons (FDS, FDP, FPL) and 1 nerve (medial)

65
Q

Axillary boundaries

A
  • apex = cervicoaxillary canal
  • anterior wall = clavicle, pectoralis minor and major
  • posterior wall = scapula, subscapularis, teres major and latissimus dorsi
  • medial wall = ribs, serratus anterior
  • base = concave inferior floor formed by skin and subcutaneous fascia extending from the thoracic wall to the arm
66
Q

Rotator cuff

A

•teres minor, supraspinatous, infraspinatous subscapularis

67
Q

Guyon’s canal

A
  • superficial to carpal tunnel

* ulnar n. passes into palm

68
Q

Extensor/flexor retinaculum

A

•forms a strap over the extensor tendons and the flexor tendons, preventing them from bowstringing during contraction

69
Q

Glenoid labrum

A

•fibrocartilage our ring that deepens the glenoid cavity

70
Q

Acromioclavicular ligament

A

•acromiomial end of clavicle and the acromion process of scapula - thickening of joint capsule

71
Q

Transverse humeral ligament

A

•bridges the inter tubercular groove forming a tunnel for the tendon of the long head of the biceps (bicipital tendinitis)

72
Q

Palmar aponeurosis

A

•fascia of palm condenses, blends with flexor retinaculum and palmaris longus tendon; protects pal, compartmentalises palm, anchors the long flexor tendons

73
Q

Deltoideus

A
  • HUMERUS MOVER
  • flexes, abducts and extends arm
  • axillary n.
74
Q

Pectoralis major

A
  • HUMERUS MOVER
  • adducts and medially rotates humerus; upper portion flexes arm and lower portion extends arm from flexed position
  • medial and lateral pectoral n.
75
Q

Pectoralis minor

A
  • SCAPULA ADJUSTER
  • protracts and depresses scapula
  • medial and lateral pectoral n.

•proximal attachment: coracoid process

76
Q

Serratus anterior

A
  • SCAPULA ADJUSTER
  • protracts scapula, rotates glenoid upwards and holds scapula against thorax
  • long thoracic n.
77
Q

Biceps brachii

A
  • FOREARM MOVERS
  • primarily supinate and flexes forearm, may help flex arm
  • musculocutaneous
  • most superficial muscle in arm
  • short head - coracoid process
  • long head - supraglenoid tubercle of scapula
78
Q

Brachialis

A
  • FOREARM MOVERS
  • flexes forearm
  • musculocutaneous, some radial
  • inferior and lateral to corachobrachialis - deep
79
Q

Corachobrachialis

A

•HUMERUS MOVER
•flexes and addicts arm
•musculocutaneous
Superior and medial to brachialis - deep

•proximal attachment: coracoid process

80
Q

Subscapularis

A
  • ROTATOR CUFF
  • medially rotates arm, stabilises shoulder joint
  • upper and lower subscapular n.

•distal attachment: lesser tubercle

81
Q

Infraspinatous

A
  • ROTATOR CUFF
  • laterally rotates arm, stabilises shoulder joint
  • suprascapular n.

•distal attachment: greater tubercle (middle facet)

82
Q

Latissimus dorsi

A
  • HUMERUS MOVER
  • addicts, extends and medially rotates humerus
  • thoracodorsal n.
83
Q

Levator scapulae

A
  • SCAPULA ADJUSTER
  • elevates scapula; tilts glenoid downwards
  • dorsal scapular n.
  • sweet tea injury!
84
Q

Rhomboideus major and minor

A
  • SCAPULA ADJUSTER
  • retract and elevate scapula, tilts glenoid fossa downward in addiction of arm against resistance
  • dorsal scapular
85
Q

Supraspinatous

A
  • ROTATOR CUFF
  • abducts arm (initiates), stabilises shoulder joint
  • suprascapular n.

•distal attachment: greater tubercle (highest facet)

86
Q

Teres major

A
  • HUMERUS MOVER
  • addicts, extends and medially rotates arm
  • lower subscapular
  • mini version of latissimus dorsi
87
Q

Teres minor

A
  • ROTATOR CUFF
  • laterally rotates arm, stabilizes shoulder joint
  • axillary n.

•distal attachment: greater tubercle (lowest facet)

88
Q

Trapezius

A
  • SCAPULA ADJUSTER
  • elevates, depresses and retracts scapula, tilts glenoid upward in abduction of arm
  • accessory
89
Q

Triceps brachii

A
  • FOREARM MOVER
  • extends arm and forearm
  • radial n.

•distal attachment: olecranon process

90
Q

Palmaris longus

A
  • flexes hand and tenses palmar aponeurosis
  • median n.
  • between FCU and FCR

•proximal attachment: medial epicondyle

91
Q

Flexor carpi radialis

A
  • flexes and abducts hand
  • median n.

•proximal attachment: medial epicondyle

92
Q

Flexor carpi ulnaris

A
  • flexes and addicts hand
  • ulnar n.
  • most medial of superficial flexors

•proximal attachment: humeral head - medial epicondyle

93
Q

Flexor digitorum superficialis

A
  • flexes PIPs and MCP of four fingers, flexes wrist
  • median n.
  • intermediate layer, 4 tendons enter carpal tunnel, CENTRAL OR MIDPALMAR COMPARTMENT
  • proximal attachment: humeroulnar head - medial epicondyle
  • distal attachment: middle phalanges of four fingers
94
Q

Flexor digitorum profundus

A
  • flexes DIP, PIP, MCP of four fingers, flexes wrist
  • anterior interosseous branch of median n. for radial half, ulnar for ulnar n. half
  • four tendons enter carpal tunnel; CENTRAL OR MIDPALMAR COMPARTMENT

•distal attachment: distal phalanges of four fingers

95
Q

Flexor pollicis longus

A
  • flexes I, MCP, and CP joints of thumb
  • anterior interosseous branch of median n.
  • lateral to FDP, tendon enters carpal tunnel, CENTRAL OR MIDPALMAR COMPARTMENT
  • brevis is in the hand!

•distal attachment: distal phalanx of thumb

96
Q

Pronator teres

A
  • flexes forearm, pronates and flexes forearm
  • median n.
  • superficial, medial wall of cubical fossa, short, only crosses elbow joint

•proximal attachment: humeral head - medial epicondyle

97
Q

Brachioradialis

A
  • flexes forearm
  • radial n.
  • most superior origin, lateral border of cubical fossa, thumb side, superficial
98
Q

Extensor carpi radialis longus

A
  • extends and abducts arm
  • radial n.
  • superficial
99
Q

Extensor carpi radialis brevis

A
  • extends and abducts hand
  • deep radial n.
  • superficial

•proximal attachment: lateral epicondyle

100
Q

Extensor digitorum

A
  • extends fingers at MCP and IP joints
  • deep radial —> posterior interosseous n.
  • superficial

•proximal attachment: lateral epicondyle

101
Q

Extensor carpi ulnaris

A
  • extends and adducts hand
  • deep radial —-> posterior interosseous n.
  • superficial

•proximal attachment: lateral epicondyle

102
Q

Supinator

A
  • supinates forearm
  • deep radial n.
  • deep, short

•proximal attachment: lateral epicondyle

103
Q

Abductor pollicis longus

A
  • abducts and extends thumb
  • deep radial —> posterior interosseous n.
  • higher up on arm, long tendon
  • brevis is in the hand!

•distal attachment: base of 1st metacarpal

104
Q

Extensor pollicis longus

A
  • extends thumb at IP, MCP and CM joints
  • deep radial —> posterior interosseous n.
  • next to EPB (most medial of the three)

•distal attachment: base of proximal phalanx of thumb

105
Q

Extensor pollicis brevis

A
  • extends thumb at MCP and CM joints
  • deep radial —> posterior interosseous n.
  • next to APL

•distal attachment: base of distal phalanx of thumb

106
Q

Dorsal interosseous

A
  • 4
  • CENTRAL OR MIDPALMAR COMPARTMENT
  • abducts digits 2, 3 and 4 - this movement is only performed by these muscles, use this to detect injury at wrist
  • flex these digits at MCP joint and extend at IP joints
  • deep branch of ulnar n.
107
Q

Palmar interosseous

A
  • 3
  • CENTRAL OR MIDPALMAR COMPARTMENT
  • adducts digits 2, 4 and 5 this movement is only performed by these muscles, use this to detect injury at wrist
  • flex these digits at MCP joint and extend at IP joints
  • deep branch of ulnar n.
108
Q

Adductor pollicis

A
  • ADDUCTOR COMPARTMENT
  • adducts and flexes thumb - unique to this intrinsic muscle
  • deep branch of ulnar n.
109
Q

Lumbrical muscles

A
  • 4
  • CENTRAL OR MIDPALMAR COMPARTMENT
  • flex at MCP joint, extend at IP joint
  • lateral half - common digits branches of median n.
  • medial half - deep branch of ulnar n.
110
Q

Opponens digiti minimi

A
  • HYPOTHENAR COMPARTMENT
  • draws 5th metacarpal forward and rotates it laterally
  • deep branch of ulnar n.
111
Q

Flexor digiti minimi

A
  • HYPOTHENAR COMPARTMENT
  • flexes little finger at MCP
  • deep branch of ulnar n.
112
Q

Abductor digiti minimi

A
  • HYPOTHENAR COMPARTMENT
  • abducts little finger
  • deep branch of ulnar n.
113
Q

Opponens pollicis

A
  • THENAR COMPARTMENT
  • abducts, medially rotates and flexes MC of thumb - unique to this muscle, use to test wrist injury
  • recurrent branch of median n.
114
Q

Flexor pollicis brevis

A
  • THENAR COMPARTMENT
  • flexes thumb at CMC and MCP joints; aids in opposition
  • superficial head - recurrent branch of median n.
  • medial head - deep branch of ulnar n.
  • FPL comes form the forearm!
115
Q

Abductor pollicis brevis

A
  • THENAR COMPARTMENT
  • abducts thumb, assists in early stages of opposition by rotating proximal phalanx slightly medially
  • recurrent branch of median n.
  • APL comes from forearm!

MSS (14 decks)

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