Overview of Upper Extremity Flashcards
1
Q
What are the Divisions of the Upper Extremity
A
- Pectoral Girdle/Shoulder
- Axilla (Armpit)
- Arm (Brachium): between shoulder and elbow
- Cubital fossa: anterior aspect of elbow
- Forearm (Antebrachium): between elbow and wrist
- Wrist (Carpus)
- Hand (palmar and dorsal aspects) (Note: the thumb is lateral and the pinkie is medial)
2
Q
What is the Osteology of the Upper Extremity
A
Includes: clavicle, scapula, humerus, ulna (medial bone of forearm), radius (lateral bone of forearm), 8 carpals (proximal row: scaphoid, lunate, triquetrum, pisiform; distal row: trapezium, trapezoid, capitate, hamate), 5 metacarpals (proximal part is the base, distal part is the head), 14 phalanges (proximal, middle, distal; the pollex (thumb) has a proximal and distal phalanx only)
3
Q
Describe the Clavicle
A
- S-shaped bone that connects upper extremity to axial skeleton
- Acts as a strut to hold upper limb in a lateral position
4
Q
Describe the Scapula borders, angles, processes, and notches.
A
Borders: Superior, Medial, and Lateral Borders
Angles
- Superior angle (superomedial corner)
- Inferior angle (inferomedial corner)
Processes
- Coracoid process (anterior projection)
- Spine of the scapula (posterior ridge)
- Acromion process (projection at lateral end of scapular spine)
Suprascapular notch
- on superior border
- Superior transverse scapular ligament spans the notch to form a foramen for the passage of the suprascapular nerve
5
Q
Describe the Scapula fossae
A
- Supraspinous fossa (posterior surface, superior to spine of scapula)
- Infraspinous fossa (posterior surface, inferior to spine of scapula)
- Subscapular fossa (anterior surface, faces ribs)
- Glenoid cavity (lateral surface, articulates with head of humerus)
6
Q
Describe the Head, neck, and tubercles of the Humerus
A
Head (articulates with glenoid cavity of scapula)
Tubercles and associated structures
- Greater tubercle (lateral)
- Lesser tubercle (anterior)
- Intertubercular (bicipital) groove: Houses the tendon of the long head of biceps brachii
Necks
- Anatomical neck between head and tubercles
- Surgical neck between tubercles and shaft (body)
7
Q
Describe other features of the Humerus
A
- Deltoid tuberosity (lateral prominence on proximal humeral shaft)
- Medial Epicondyle (medial protuberance of distal humerus)
- Lateral Epicondyle (lateral protuberance of distal humerus)
- Capitulum (ball shaped structure on distal humerus; articulates with radial head)
- Trochlea (spool shaped structure on distal humerus; articulates with proximal ulna)
- Radial groove (on posterior shaft; oblique groove for radial nerve & deep artery of the arm)
8
Q
Describe the Radius & Ulna
A
Radius (lateral bone of forearm)
-Radial tuberosity (proximal end; anteromedial surface)
Ulna (medial bone of forearm)
- Olecranon process (most proximal part of bone)
- Ulnar tuberosity (proximal end; anterior surface)
9
Q
Describe the Sternoclavicular (SC) Joint
A
- Synovial joint between the clavicle and the manubrium of sternum
- Allows the clavicle to move anterior/posterior and superior/inferior
10
Q
Describe the Acromioclavicular (AC) Joint
A
- Synovial joint between the clavicle and the acromion of scapula
- Allows the acromion to rotate on the clavicle
11
Q
Describe the Scapulothoracic (ST) Joint
A
- Not a true anatomic joint (no synovial tissue, no osseous connection)
- It is a functional joint, permitting movement
- Refers to the movement of the scapula on the thoracic wall
12
Q
Describe the Movements of the Scapula
A
- Elevation moves the scapula superiorly
- Depression moves the scapula inferiorly
- Retraction draws the scapula posteriorly, such that the medial borders of the two scapulae are drawn together
- Protraction draws the scapula anteriorly, such that the medial borders of the two scapulae are pulled apart
- Upward rotation directs the surface of the glenoid cavity superiorly
- Downward rotation directs the surface of the glenoid cavity inferiorly
13
Q
Describe the Glenohumeral (GH) Joint
A
- Head of the humerus articulates with the glenoid cavity of the scapula
- Ball and socket synovial joint with a wide range of motion
- Flexion moves the upper extremity (UE) anteriorly
- Extension moves the UE posteriorly
- Abduction draws the UE away from the midline of the body
- Adduction draws the UE towards the midline of the body
- Medial and lateral rotation-humerus rotates around its long axis
14
Q
Describe the Scapulohumeral Rhythm
A
- Movements of the SC, AC, and ST joints are all coordinated with movements of the glenohumeral joint to produce a full range of motion.
- Every 2 degrees of glenohumeral motion is associated with 1 degree of scapulothoracic movement (occurring as combined actions of the SC, AC, & ST joints).
15
Q
Describe the Elbow Joint
A
- Distal humerus articulates with the proximal radius and ulna
- Hinge synovial joint
- Flexion brings the forearm closer to the anterior aspect of the arm
- Extension draws the forearm away from the anterior aspect of the arm
16
Q
Describe the Proximal and Distal Radioulnar Joints
A
- Synovial joints (ulna is stable, the radius rotates)
- Supination directs the palmar surface of the hand anteriorly (palm anterior; anatomical position)
- Pronation directs the palmar surface of the hand posteriorly (palm posterior)
17
Q
Describe the Wrist (Radiocarpal) Joint
A
- Synovial joint between the distal radius, articular disc, and 3 out of the 4 proximal carpals (scaphoid, lunate, and triquetrum); the distal ulna does not contribute to this joint; the fibrocartilaginous articular disc lies between the distal ulna and the proximal row of carpals
- Flexion brings the palm of the hand closer to the anterior aspect of the forearm
- Extension draws the palm away from the anterior aspect of the forearm
- Abduction (radial deviation) draws the hand away from the midline of the body
- Adduction (ulnar deviation) draws the hand towards the midline of the body
18
Q
Describe the Carpometacarpal (CMC) Joints
A
- Synovial joints between the carpals and the metacarpals
- Movement of the thumb primarily occurs at this joint
- Extension of thumb (draws thumb lateral to the palmar surface of the hand)
- Flexion of thumb (draws thumb medially across the palmar surface of the hand)
- Abduction of the thumb (draws thumb anterior to the palmar surface of the hand)
- Adduction of the thumb (draws thumb back from abduction)
- Opposition of the thumb (draws thumb to bring the tip toward tip of the pinkie)
- Reposition of the thumb (returns to anatomical position)
19
Q
Describe the Metacarpophalangeal (MCP) Joints
A
- Synovial joints between the metacarpals and the proximal phalanges
- Extension of fingers (away from the palmar surface of the hand)
- Flexion of fingers (towards the palmar surface of the hand)
- Abduction of the fingers (away from a line passing through the third digit)
- Adduction of the fingers (towards a line passing through the third digit)
20
Q
Describe the Interphalangeal (IP) Joints
A
- Hinge synovial joints between the phalanges
- Proximal interphalangeal joints (PIPs): between proximal & middle phalanges
- Distal interphalangeal joints (DIPs): between middle & distal phalanges
- The pollex has a single IP joint between its proximal & distal phalanges
- Flexion of fingers (towards the palmar surface of the hand)
- Extension of fingers (away from the palmar surface of the hand)
21
Q
What are the Fascia of the Upper Extremity?
A
- Superficial fascia: Contains: fat, cutaneous nerves, superficial veins, lymphatic vessels, lymph nodes
- Deep fascia: Dense connective tissue (very strong)
22
Q
Describe the Deep fascia of the Upper Extremity
A
- Dense connective tissue (very strong)
- Includes the following subdivisions: pectoral fascia, deltoid fascia, axillary fascia, brachial fascia, antebrachial fascia, palmar fascia (with central thickening called the palmar aponeurosis)
- In the arm, the brachial fascia gives rise to two septa that divide the arm into 2 compartments: anterior and posterior
- In the forearm, the antebrachial fascia gives rise to a septum; this septum and the interosseous membrane divide the forearm into 2 compartments: anterior and posterior
- Near the wrist joint, the antebrachial fascia forms flexor and extensor retinacula; these bands keep the tendons in place
23
Q
Describe Veins of the Upper Extremity
A
- There are superficial and deep veins in the upper extremity
- The deep veins parallel the arteries, and we will study these in subsequent labs
- There are perforating veins connecting the superficial and deep veins
24
Q
What are the Superficial veins of the Upper Extremity?
A
- Dorsal venous network (on dorsal aspect of the hand)
- Cephalic vein
- Basilic vein
- Median cubital vein (site of venipuncture)
25
Q
Describe the Cephalic vein
A
- Arises from the lateral aspect of the dorsal venous network
- Travels along the lateral aspect of the forearm and arm
- Enters the deltopectoral triangle (space between deltoid, pectoralis major, and the clavicle) and drains into the axillary vein
26
Q
Describe the Basilic vein
A
- Arises from medial aspect of the dorsal venous network
- Courses along the medial aspect of the forearm and arm
- Joins the brachial veins to form the axillary vein
27
Q
Describe the Median cubital vein (site of venipuncture)
A
- Arises from the cephalic vein
- Crosses superficial in the cubital fossa
- Empties into the basilic vein
- A common variation: median antebrachial vein, which divides into median cephalic and median basilic veins (important to know about this variation as venipuncture is common in this region)
28
Q
Describe Superficial Lymphatics of the Upper Extremity
A
- Superficial lymphatic vessels accompanying the cephalic vein first drain into deltopectoral or axillary lymph nodes (note: if drainage is first to the deltopectoral nodes, the lymph then drains to the axillary nodes)
- Superficial lymphatic vessels accompanying the basilic vein first drain into the cubital lymph nodes, then drain into the axillary lymph nodes
29
Q
Describe Deep Lymphatics of the Upper Extremity
A
- Deep lymphatic vessels accompany deep veins & drain into the axillary lymph nodes
- Inflammation of the axillary lymph nodes may indicate infections/pathologies in the upper extremity, but they are also a site for metastasis of breast cancer (recall that superficial tissues superior to the umbilicus drain towards the axillary lymph nodes)
30
Q
Describe the Brachial Plexus
A
- Network of nerves in the neck and axilla that gives rise to the motor and sensory nerves of the upper extremity (including the pectoral region)
- Formed by the ventral rami of C5-T1
- We will study the brachial plexus in more detail during the Axilla/Arm lab
31
Q
Describe Dermatomes of the Upper Extremity
A
Note the distribution of the dermatomes associated with the upper extremity (although there are two dermatome maps in use, note the general trend: superior cervical levels (e.g., C4-C5) near shoulder and inferior cervical levels (e.g., C6-C8) in hand)
