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KNES259 > Nerves. *brachial plexus + axilla + spinal cord > Flashcards

Nerves. *brachial plexus + axilla + spinal cord Flashcards

1
Q

Generally, which nerve innervates the superficial and intermediate layers of the extrinsic shoulder muscles?

A

Anterior rami

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2
Q

Which nerve innervates the intrinsic shoulder muscles?

A

Posterior rami

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3
Q

Through which foramen does the suprascapular nerve travel?

A

-Suprascapular foramen (formed by the suprascapular notch and the superior transverse ligament of the scapula)

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4
Q

What is the travel buddy and path of the suprascapular nerve?

A

-N travels through foramen while suprascapular artery travels superiorly to foramen (not through)
-They meet up by the supraspinatus
-They travel inferior to the spinoglenoid notch to get to the infraspinatus

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5
Q

The musculocutaneous nerve is ________ to the brachialis and ____________ to the biceps brachii.

A

Superficial
Deep

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6
Q

Musculocutaneous nerve pathway

A

-Arises from lateral cord of brachial plexus
-Pierces coracobrachialis
-Travels deep to biceps brachii and superficial to brachilis (sandwiched between them)
-Exits the muscle sandwich by travelling lateral to distal aspects of biceps brachii
-Terminates as lateral cutaneous nerve of forearm

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7
Q

What is the quadrangular space?

A

The square that makes up the route for the axillary nerve

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8
Q

What are the boundaries of the quadrangular space?

A

Superior: teres minor
Inferior: teres major
Medial: triceps brachii long head
Lateral: triceps brachii lateral head (or humerus)

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9
Q

What is directly inferior to the quadrangular space?

A

The triangular interval

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10
Q

What does the axillary nerve innervate?

A

Deltoids
Teres minor

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11
Q

What is the triangular interval?

A

The route for the radial nerve

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12
Q

Boundaries of the triangular interval?

A

Superior: teres major
Medial: triceps brachii long head
Lateral: triceps brachii lateral head (or humerus)

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13
Q

Identify the structures of the arm in this transverse section (start at top and move clockwise)

A

-Radial nerve
-Triceps brachii longhead
-Triceps brachii medial head
-Musculocutaneous nerve
-Biceps brachii short head
-Biceps brachii long head
-Brachialis
-Triceps brachii lateral head

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14
Q

Is coracobrachialis present? Why or why not?

A

No because the section is too distal

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15
Q

What is the femoral triangle?

A

The travel space for the femoral nerve, artery, and vein

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16
Q

Boundaries of femoral triangle

A

Superior: inguinal ligament (of external obliques)
Lateral: sartorius
Medial: adductor longus
Floor: iliopsoas (medial) and pectineus (lateral)

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17
Q

When travelling together, what is the arrangement (medial to lateral) of the femoral n/v/a?

A

Medial to Lateral:
1. Femoral vein
2. Femoral arterty
3. Femoral nerve

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18
Q

The biceps femoris LH is ________ and the biceps femoris SH is ______ to the sciatic nerve.

A

Superficial
Deep

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19
Q

Which artery and vein travel with the sciatic nerve?

A

Popliteal artery and vein

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20
Q

Where do the popliteal artery and vein travel through?

A

The popliteal fossa and adductor hiatus

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21
Q

Boundaries of the popliteal fossa (superior because we haven’t learned the calve muscles)

A

Superomedial: semitendinosus
Superolateral: biceps femoris short head

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22
Q

Which division of the sciatic nerve is more lateral?

A

Common fibular nerve

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23
Q

Identify these structures in this transverse section of the thigh (start at top and go clockwise). What is the yellow circle and the red circle?

A

-Rectus femoris
-Vastus lateralis
-Vastus intermedius
-Biceps femoris short head
-Biceps femoris long head
-Semitendinosus
-Semimembranosus
-Adductor magnus
-Gracilis
-Adductor brevis
-Adductor longus
-Sartorius

Yellow circle: sciatic nerve
Red circle: femoral artery nerve and vein

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24
Q

Which structures are missing and why?

A

-Pectineus
-Obturator externus
-Iliapsoas
They are too distal

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25
Q

Muscles in the anterior compartment of the thigh are innervated by the _________ nerve.

A

Femoral

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26
Q

Muscles in the posterior compartment of the thigh are innervated by __________________.

A

Divisions of the sciatic nerve

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27
Q

Muscles in the medial compartment of the thigh are innervated by the ____________ nerve.

A

Obturator

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28
Q

Muscles in the superficial and intermediate layers of anterior compartment of the forearm are innervated by _________.

A

Median nerve

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29
Q

Muscles in the deep later of anterior compartment of the forearm are innervated by ______.

A

Anterior interosseus nerve

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30
Q

Travel path of the median nerve

A

-Travels through the medial aspect of the arm
-Travels anterior to elbow joints
-Travels between the two heads of pronator teres
-Travels between FDS and FDP
-Reappears superficially, lateral to palmaris longus tendon
-Enters the hand via the carpal tunnel

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31
Q

Travel path of the ulnar nerve and artery

A

-Arises from medial cord of the brachial plexus
-Travels through the arm on the medial aspect
-Travels posterior to the medial epicondyle
-Reappears in the anterior compartment of the forearm deep to flexor carpi ulnaris travelling with ulnar artery
-Enters the hand with ulnar artery superficial to the flexor retinaculum

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32
Q

Travel path of the anterior interosseus nerve

A

-Arises from median nerve between the two heads of pronator teres
-Travels anterior to the interosseus membrane between flexor digitorum and flexor pollicis longus
-Terminates in pronator quadratus

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33
Q

Extrinsic back muscles are generally innervated by the __________ rami of the spinal nerves. Which exception is there?

A

-Anterior rami
-Trapezius: Spinal accessory nerve (cranial nerve XI)

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34
Q

Intrinsic back muscles are generally innervated by the ______ rami of spinal nerves. Which exception is there?

A

-Posterior
-Intertransversarii: anterior rami and posterior rami

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35
Q

How can you find the dorsal scapular and spinal accessory nerves using a muscle? Which muscle is this?

A

If you find levator scapulae, DSN is medial and SAN is lateral to it.

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36
Q

From which view can you see the thoracodorsal nerve?

A

Anterior view in a supine donor

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37
Q

Why is the intertransversarii innervated by posterior and anterior rami of spinal nerves?

A

-The muscles are very close to the intervertebral foramina so close to both ramis

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38
Q

Which nerves innervate the respiratory diaphragm?

A

-Right phrenic nerve and left phrenic nerve

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39
Q

What is the travel buddy/path for the phrenic nerves?

A

-Phrenic nerve in PHRONT of the vessels arises from/travelling to the heart
-Phrenic nerves are lateral to the heart
-Starts at neck
-Travels through thorax to superior thoracic aperture
-Travels with the pericardiacophrenic artery

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40
Q

Are spinal nerves part of the PNS or CNS?

A

PNS

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41
Q

How many pairs of bilateral spinal nerves are in each segment of the spinal cord?

A

Cervical: 8
Thoracic: 12
Lumbar: 5
Sacral: 5
Coccygeal: 1

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42
Q

Why are there cervical and lumbosacral enlargements of the spinal cord?

A

-Enlargements accomodate the plexi arising from these locations
-Cervical: brachial plexus
-Lumbosacral: lumbosacral plexus

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43
Q

How long is the spinal cord?

A

Spans C1 to L2

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44
Q

Medullary cone

A

-Tapering inferior to end of spinal cord at L2

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45
Q

Why is the spinal cord not the full length of our our vertebral column?

A

-During development, our vertebral column lengths and our spinal cord ascends within the vertebral canal and outgrows us

46
Q

Cauda equina

A

-Bundle of spinal nerve roots inferior to L2 in vertebral canal and sacral canal

47
Q

Filum terminale (terminal filament)

A

-Extension of neural and connective tissue covered in pia mater (in dural sac)
-It’s rightttt in the middle and descends through the cauda equina
-It pierces the dural sac at the end near the coccyx
-When it exists the dural sac, it’s still covered in dura mater

48
Q

Where do the spinal nerves exit the vertebral canal?

A

Intervertebral foramina

49
Q

C1-C7 spinal nerves exit _______ their vertebrae that has the same name as them

A

Above

50
Q

C8 spinal nerves exit _________ to the ______ vertebrae

A

superior, T1

51
Q

T1 - Co1 spinal nerves exit ________ their vertebrae that has the same name as them

A

Below

52
Q

Rootlets stem ______________

A

directly from spinal cord

53
Q

The convergence of which structures form the rami?

A

Rootlets + Roots + Spinal nerves = Rami

54
Q

Rootlets from both _______ and ________ form the posterior and anterior roots, which form the ________

A

Anterior and posterior
Spinal nerve

55
Q

Anterior rootlets/roots are for __________ information

A

Efferent (motor)

56
Q

Posterior rootlets/roots are for _________ information

A

Afferent (sensory)

57
Q

True/False: Spinal nerves are made up of both efferent and afferent rootlets/roots

A

True

58
Q

What point is where afferent and efferent information mixes?

A

Spinal nerve

59
Q

What part of the spinal nerve is exiting at the intervertebral foramen?

A

The spinal nerve itself, not the roots or rootlets

60
Q

What makes up the spinal meninges (from deepest to superficial)?

A

-Pia mater
-Arachnoid mater
-Dura mater

61
Q

How does dura mater surround each spinal nerve pair?

A

Encloses each pair in dural root sheaths

62
Q

Where does the arachnoid mater adhere to?

A

Directly to internal surface of dura mater

63
Q

Arachnoid traceculae

A

Wisps of connective tissue

64
Q

Denticulate ligament

A

-Wisps on lateral aspect of spinal cord that anchors the pia mater to arachnoid-lined dura

65
Q

Where does the pia mater adhere to?

A

directly to spinal cord

66
Q

Subarachnoid space

A

-Deep to arachnoid mater and superficial to pia mater
-Contains cerebrospinal fluid

67
Q

Epidural space

A

-Superficial to dura mater
-Fat-filled space

68
Q

Epidural anesthesia injection. Which structure would the needle pass through if injection in lumbar region?

A

-Inject anesthetic agent in epidural space in lumbar or sacral region
-Ligamentum flavum (hear a pop)

69
Q

Lumbar puncture to collect CSF. Which space would you collect from and what structures would your needle pass through?

A

-Subarachnoid space
-Ligamentum flavum
-Dura mater
-Arachnoid mater

70
Q

What is the axilla?

A

Passageway for structures traveling to and from the upper limb

71
Q

Boundaries and function of apex of axilla.

A

-Cervico-axillary canal
-Opening for structures to pass through.

Medial: Rib 1
Anterior: clavicle
Posterolaterally: superior border of scapula

72
Q

Base of axilla

A

Skin and fascia

73
Q

Boundary of lateral wall of axilla

A

Humerus

74
Q

Boundaries of medial wall of axilla

A

-Thoracic cage and wall
-Serratus anterior

75
Q

Boundaries of anterior wall of axilla

A

-Pectoralis major (superficially)
-Pectoralis minor (deep)

76
Q

Boundaries of posterior wall of axilla

A

-Subscapularis
-Teres major
-Latissimus dorsi

77
Q

Contents of the axilla

A

-Axillary artery and branches
-Axillary vein
-Brachial plexus (cords and branches)
-Lymphatic vessels and lymph nodes
-Adipose tissue

78
Q

From smallest/proximal to biggest/distal, list the structures that contribute to the brachial plexus

A

Rootlets, posterior and anterior roots, trunks, divisions, cords, branches

79
Q

What does the brachial plexus innervate?

A

-Upper limb
-Overlying skin

80
Q

What spinal nerves contribute to the brachial plexus?

A

Anterior rami of C5, C6, C7, C8, T1

81
Q

What are the 3 different trunks in the brachial plexus?

A

Superior
Middle
Inferior

82
Q

In the divisions of the brachial plexus, what are the two different divisions?

A

Anterior and posterior

83
Q

For the divisions of each different trunk of the brachial plexus, what is the ordering of the posterior and anterior divisions?

A

Superior: A then P
Middle: A then P
Inferior: P then A

84
Q

What are the three cords of the brachial plexus?

A

Lateral
Posterior
Medial

85
Q

Supraclavicular region of the brachial plexus

A

-Contains roots and trunks
-Some branches arise from this region

86
Q

Infraclavicular region of the brachial plexus

A

-Contains cords and branches
-Axilla is located here

87
Q

At the level of the clavicle, which parts of the brachial plexus are located here?

A

Divisions

88
Q

Which spinal nerves make up the 3 different trunks?

A

Superior: C5 + C6
Middle: C7
Inferior: C8 + T1

89
Q

Where do the divisions of the brachial plexus enter the axilla?

A

-Posterior to clavicle through cervico-axillary canal

90
Q

Which divisions make up the 3 different cords of the brachial plexus?

A

Lateral cord: superior anterior + middle anterior
C5 + C6 + C7

Posterior cord: superior posterior + middle posterior + inferior posterior
C5 + C6 + C7 + C8 + T1

Medial cord: inferior anterior
C8 + T1

91
Q

Which artery do the cords of the brachial plexus surround? How does this dictate their names?

A

-Axillary artery
-Lateral cord is lateral to artery
-Medial cord is medial to artery
-Posterior cord is posterior to artery

92
Q

Cords are located _________ to pectoralis minor in brachial plexus

A

Deep

93
Q

Where do the branches of the brachial plexus arise from?

A

Either from the cords in infraclavicular region (terminal branches) or from the roots/trunks in supraclavicular region

94
Q

Which branches arise from the lateral cord of the brachial plexus? Which spinal nerves contribute to these nerves?

A

-Musculocutaneous nerve (splits laterally)
-Lateral root of the median nerve (splits medially)

C5 + C6 + C7

95
Q

Which branches arise from the medial cord of the brachial plexus? Which spinal nerves contribute to these nerves?

A

-Medial root of the median nerve (splits laterally)
-Ulnar nerve (splits most medially)

C8 + T1

96
Q

The median nerve is formed by :

A

The medial root of medial cord and lateral root of lateral cord

97
Q

Which branches arise from the posterior cord of the brachial plexus? Which spinal nerves contribute to these nerves?

A

-Axillary nerve (C5 - C6)
-Radial nerve (C5 - T1)

98
Q

Which branches arise from the roots of the brachial plexus? Which spinal nerves contribute to these nerves?

A

-Dorsal scapular nerve (C5 anterior rami)
-Long thoracic nerve (C5-C7 anterior rami)

99
Q

Which branches arise from the trunks of the brachial plexus? Which spinal nerves contribute to these nerves?

A

-Suprascapular nerve (C5 + C6)
-Subclavius nerve (C5 + C6)

100
Q

Which branches arise from higher up on the lateral cord of the brachial plexus? Which spinal nerves contribute to these nerves?

A

-Lateral pectoral nerve
C5 + C7

101
Q

Which branches arise from higher up on the medial cord of the brachial plexus? Which spinal nerves contribute to these nerves?

A

-Medial pectoral nerve (C8 + T1)
-Medial cutaneous nerves of the arm and forearm (C8 + T1)

102
Q

The lateral pectoral nerve sits more _______ on the pectoralis minor compared to the medial pectoral nerve

A

Medially

103
Q

Which branches arise from higher up on the posterior cord of the brachial plexus? Which spinal nerves contribute to these nerves?

A

-Upper subscapular nerve (C5-C6)
-Lower subscapular nerve (C5-C7)
-Thoracodorsal nerve (C6-C8)

104
Q

At which level is the medullary cone?

A

L2

105
Q

Spinal nerves exiting superior to the vertebrae form the __________ margin of that IV foramen

A

Inferior

106
Q

Spinal nerves exiting inferior to the vertebrae form the _________ margin of that IV foramen

A

superior

107
Q

The coccygeal segment has _______ pair(s) of bilateral spinal nerves.

A

1

108
Q

The cervical enlargement spans which vertebraes?

A

C4 to T1

109
Q

The lumbosacral enlargement spans which vertebraes?

A

T11 to L1

110
Q

Which level does the cauda equina start at?

A

L1/L2

111
Q

Which back muscles are innervated by the anterior rami of the spinal nerves?

A

Rhomboids & Levator Scapulae (dorsal scapular nerve)
Intertransversarii (both anterior and posterior rami)

KNES259 (11 decks)

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