Quiz 1: Lecture 1-3 Flashcards
UE Anatomy
What is the axilla?
A pyramid shaped region between the pec and arm (also runs posterior to the clavicle)
Which structures make up the boundaries of the axilla?
Anterior Boundary: Pec major and minor
Medial Boundary: Serratus anterior
Posterior Boundary: Subscapularis, teres major, lats
Lateral Boundary: Humerus
What does the axilla contain?
- Axillary artery
- Axillary vein
- Brachial plexus
- Lymphatics
List the primary blood flow path through the upper extremity
Subclavian Artery, Axillary Artery, Brachial Artery
Which upper extremity arteries come off the subclavian
- Internal Thoracic (1st part of subclavian)
- Dorsal Scapular (3rd part of subclavian)
Which artery supplies blood from the superior to transverse scap ligament?
Suprascapular artery
Which artery supplies blood to the medial part of the scapula?
Dorsal scapular artery
T or F? The dorsal scapular artery and suprascapular artery make an anastamoses (overlapping circulation) of the inferior scapula
True
The subclavian artery is divided into 3 parts by which muscle?
Anterior scalene
The axillary artery is divided into 3 parts by which muscle?
Pec minor
Which artery branches off the 1st part of the axillary artery?
- Superior thoracic artery
Which arteries branch off the 2nd part of the axillary artery?
- Thoracoacromial trunk
- Lateral thoracic artery
Which arteries come off of the thoracoacromial trunk? (Think: Atlantic City Police Department)
- Acromial
- Clavicular
- Pectoral
- Deltoid
Which arteries branch off the 3rd part of the axillary artery?
- Subscapular artery
- Anterior circumflex humeral artery
- Posterior circumflex humeral artery
Which 3 arteries supply the posterior/inferior scapula?
- Suprascapular artery
- Dorsal scapular artery
- Scapular circumflex artery
Describe the anterior and posterior circumflex arteries
- Anterior is smaller than posterior
- both meet at the anterior humerus to create an anastomosis
What are the 4 veins of the axillary region?
- Basilic
- Cephalic
- Axillary
- Subclavian
When returning back to the heart, what is the order of bloodflow?
Basilic vein, axillary vein, subclavian vein
Which vein feeds into the axillary vein?
Cephalic vein
Which structures go through the quadrangular space?
- Axillary nerve
- Posterior circumflex humeral artery + vein
Which structures go through the triangular space?
- Circumflex scapular artery
Which structures go through the triangular interval?
- Radial nerve
- Deep brachial artery
What are the 3 spaces around the shoulder?
- Quadrangular space
- Triangular space
- Triangular interval
Which ligament runs on the superior scapula?
Superior transverse scap ligament
T or F? The suprascapular nerve runs overtop of the superior transverse scapular ligament, while the suprascapular artery runs below
False, the suprascapular artery runs overtop of the superior transverse ligament while the suprascapular nerve runs below
T or F? All upper extremity muscles are supplied by nerves from the brachial plexus
True
Where do the brachial plexus nerve roots originate?
C5-T1 and they emerge between the anterior and middle scalene muscles
What are the sections of the brachial plexus from proximal to distal?
Roots/rami, trunks, divisions, cords, branches
Which nerve roots form the upper trunk of the brachial plexus?
C5 + C6
Which nerve roots form the middle trunk of the brachial plexus?
C7
Which nerve roots form the lower trunk of the brachial plexus?
C8 + T1
The lateral cord’s terminal branch (main branch) is the…
musculocutaneous n.
The medial cord’s terminal branch (main branch) is the…
Ulnar n.
A branch of both the lateral and medial cord form together to make the…
Median n.
What are supraclavicular branches? List them
smaller nerves that branch off the nerves proximal to the clavicle
- Dorsal scapular n.
- Suprascapular n.
- Long thoracic n.
Which infraclavicular nerve comes off the lateral branch?
Lateral pectoral n.
Which infraclavicular nerves comes off the medial branch?
- Medial antebrachial n.
- Brachial cutaneous n.
- Medial pectoral n.
Which infraclavicular nerves comes off the posterior branch?
- Upper subscapular n.
- Lower subscapular n.
- Thoracodorsal n.
Which nerve innervates the lats?
Thoracodorsal n.
Which nerves innervate the subscapularis?
Upper and lower subscapular nerves
Which nerve innervates the teres major?
Lower subscapular nerve
Which nerve innervates the serratus anterior?
Long thoracic n.
Which nerve innervates the levator scap and rhomboids?
Dorsal scapular n.
Which terminal nerve branch originates from C5-C7, pierces the coracobrachialis, runs deep to biceps, but superficial to brachialis?
Musculocutaneous nerve
Which terminal nerve branch originates from C6-T1 and innervates the anterior compartment muscles of the forearm except for 2 of them?
Median nerve
Which terminal nerve branch originates from C8-T1 innervates the other 2 muscles of the anterior forearm?
Ulnar nerve
Which terminal nerve branch originates from C5-C6 and enters the posterior arm via the quadrangular space to innervate the deltoid and teres minor?
Axillary nerve
Which terminal nerve originates from C5-T1 and innervates all of the forearm extensor muscles?
Radial nerve
Which nerve root does the axillary nerve root originate at?
C5-C6
Which nerve root does the radial nerve originate at?
C5-T1
Which nerve root does the musculocutaneous nerve originate at?
C5-C7
Which nerve root does the median nerve originate at?
C6-T1
Which nerve root does the ulnar nerve originate at?
C8-T1
Which nerves comes off of C5 alone?
- Dorsal scapular n.
- Suprascapular n.
Which nerve comes off of the lateral cord?
- Lateral pectoral n.
Which nerve comes off of C5, C6, C7?
- Long thoracic n.
Which nerves come off the posterior cord?
- Upper subscapular n.
- Lower subscapular n.
- Thoracodorsal n.
- Radial n.
- Axillary n.
Which nerves come off of the medial cord?
- Medial pectoral n.
- Medial antebrachial n.
- Brachial cutaneous n.
The lateral end of the clavicle articulates with the…
Acromion
The medial end of the clavicle articulates with the…
Manubrium of the sternum
What type of joint is the sternoclavicular (sc) joint?
Saddle
What is the conoid tubercle? Where is it? Which ligament attaches to it?
It is a small projection on the posterior/lateral clavicle that faces posterior and inferior
Conoid ligament attaches to it
What is the trapezoid line? Where is it located? What attaches here?
Lateral to the conoid tubercle, runs forward/lateral
Attachment: trapezoid ligament
The conoid and trapezoid ligaments together are called…
Coracoclavicular ligament
T or F? The scapula and humerus are hung on the clavicle
True
What are the functions of the clavicle?
- Allow the scapula and humerus to move more freely and increase range of motion
- Transmit forces to the center of the body
T or F? The anterior surface of the scapula articulates with the ribs?
True
T or F? The glenoid cavity of the scapula articulates with the humerus?
True
T or F? The acromion articulates with the clavicle?
True
Which muscles attach to the coracoid process?
- Pec minor
- coracobrachialis
- biceps brachii
Which muscle sits in the subscapular fossa?
Subscapularis
The spine of the scapula aligns with which spinal level?
T3
Which muscle sits in the supraspinous fossa?
Supraspinatus
Which muscle sits in the infraspinous fossa?
Infraspinatus
Which type of acromion curve is most common?
Type 2 (curved)
Which type of acromion curve is most common with rotator cuff injuries?
Type 3 (hooked)
Which type of acromion curve is the most rare?
Type 1 (flat)
Which bursa sits below the acromion and between the humeral head?
Subacromial bursa
Which muscle tendon runs right below the acromion?
Supraspinatus tendon
The scapular plane is about _____ degrees anterior to the frontal plane
35
Where is the anatomical neck of humerus? Where is the surgical neck of humerus?
Anatomical neck: immediately lateral to humeral head
Surgical neck: more distal than anatomical neck (located on proximal part of humeral shaft)
Which which tubercle/tuberosity of the humerus sits more lateral? Medial?
Lateral: greater tubercle
Medial: lesser tubercle
Which muscles attach to the greater tubercle?
Supraspinatus, infraspinatus, teres minor
Which muscle attaches to the lesser tubercle of the humerus?
Subscapularis
Which groove/sulcus sits between the greater and lesser tubercles?
Intertubercular sulcus (also called the bicipital groove)
Where can you find the deltoid tubercle?
Distal/inferior end of the groove (middle of humerus)
Which neck of the humerus is weaker? Anatomical or surgical?
Surgical neck
Which structures run posterior to the surgical neck of the humerus?
- Axillary nerve
- posterior humeral circumflex arteries
Humeral head faces which direction? How many degrees of retroversion does it take to align in the scapular plane?
Medial and superior
30 degrees
T or F? The glenoid cavity is very shallow
True
What are the 4 joints of the shoulder?
- Sternoclavicular (SC) joint
- Acromioclavocular (AC) joint
- Scapulothoracic (ST) joint
- Glenohumeral (GH) joint
T or F? The SC joint is a synovial joint
True
Which 5 motions can the sternoclavicular (SC) joint perform?
Elevation, depression, protraction, retraction, posterior rotation
Which 6 motions occur at the AC joint?
Upward rotation, downward rotation, anterior tilt, posterior tilt, internal rotation, external rotation
Which muscle provides stability between the scapulothoracic joint?
Serratus anterior
What are the 4 motions of the scapula?
Elevation, depression, protraction, retraction
What type of joint is the GH joint?
Ball and socket (synovial)
How much of the humeral head fits into the glenoid cavity?
1/3 of it
What is the glenoid labrum?
Fibrocartilagenous ring that surrounds the glenoid fossa
How many layers to a capsule?
2; fibrous and synovial
T or F? The GH joint capsule covers both the anatomical neck of humerus and glenoid/labrum
True
What is the empty space inferior to the GH joint called? What is its function?
Axillary pouch; allows the humeral head to shift inferiorly during abduction
What is a communicating bursa?
A bursa that is located adjacent to a joint and shares the same synovial fluid
Which of the following is a communicating bursa? Subscapular bursa or subscromial bursa?
Subscapular bursa
Subacromial bursa is a non-communicating bursa
T or F? The GH capsule is thicker on the anterior and superior regions, along with between the greater and lesser tubercles
True
Which ligaments make the anterior part of the GH capsule thick?
Superior, middle, and inferior glenohumeral ligaments
Which ligaments make the superior part of the GH capsule thick?
Coracohumeral ligament
Which ligament make the space between the greater and lesser tubercles thick?
Transverse humeral ligament
What is another name for the coraco-acromial ligament?
Coraco-acromial arch
What is the main function of the coraco-acromial ligament?
Provide protection to the humeral head as shoulder abduction occurs
Which 3 structures pass beneath the coraco-acromial ligament?
Biceps long head tendon, supraspinatus tendon, subacromial bursa
Which structures make up the boundaries of the triangular space?
- long head of triceps
- teres major
- teres minor + subscapularis
Which structures make up the borders of the quadrangular space?
- Inferior margin of teres minor / subscapularis
- Surgical neck of humerus
- Superior margin of teres major
- Lateral margin of long head of triceps
Which structures make up the boundaries of the triangular interval?
- Lateral margin of long head of triceps
- Shaft of humerus
- Inferior margin of teres major
Where does the upper trap originate and insert?
Origin: Occiput + nuchal ligament
Insertion: Posterior lateral 1/3 of clavicle and acromion
Where does the middle trap originate and insert?
Origin: Spinous processes of T1-T4
Insertion: Medial border of acromion
Where does the lower trap originate and insert?
Origin: Spinous processes of T5-T12
Insertion: Inferior middle part of scapular spine
Which actions does the trapezius perform?
Upper: Elevation + upward rotation
Middle: Retraction
Lower: Depression + upward rotation
Which artery supplies the trapezius? nerve?
Blood supply: Transverse cervical artery
Innervation: Spinal accessory (CN XI)
Where does the latissimus dorsi originate and insert?
Origin: Spinous process of T7-T12, thoracolumbar fascia, Iliac crest, lower ribs
Insertion: Medial intertubercular sulcus
Which actions does the latissimus dorsi perform?
Adduction, internal rotation, extension of humerus
Which artery supplies the latissimus dorsi? nerve?
Blood Supply: Thoracodorsal artery
Innervation: Thoracodorsal nerve (C6,C7,C8 posterior cord)
Where does the levator scapula originate and insert?
Origin: Transverse processes of C1-C4
Insert: Superior medial border of scapula
Which actions does the levator scapula perform
Elevation, downward rotation of scapula
Which artery supplies the levator scapula? nerve?
Blood Supply: Dorsal scapular artery (has 3 branches)
Innervation: Dorsal scapular nerve
Where does the rhomboid minor originate and insert?
Origin: Spinous processes of C7-T1
Insertion: Root of scapular spine
What actions does the rhomboid minor perform?
Elevation, retraction, downward rotation of scapula
Which artery supplies the rhomboid minor? nerve?
Blood Supply: Dorsal scapular artery
Innervation: Dorsal scapular nerve
Where does the rhomboid major originate and insert?
Origin: Spinous processes T2-T5
Insertion: Medial border of scapula
What actions does the rhomboid major perform?
Elevation, retraction, downward rotation of scapula
Which artery supplies the rhomboid major? nerve?
Blood supply: Dorsal scapular artery
Innervation: Dorsal scapular nerve
T or F? The posterior rotator cuff muscles attach to the greater tubercle while the anterior rotator cuff muscle attaches to the lesser tubercle
True
Where does the supraspinatus originate and insert?
Origin: Supraspinous process
Insertion: Greater tubercle of humerus
What is the action of the supraspinatus?
Abduction after 30 degrees
Which artery supplies the supraspinatus? nerve?
Blood Supply: Suprascapular artery
Innervation: Suprascapular nerve
Where does the infraspinatus originate and insert?
Origin: Infraspinous fossa
Insertion: Greater tubercle of humerus
What is the action of the infraspinatus?
External rotation, GHJ stability
Which artery supplies the infraspinatus? nerve?
Blood supply: Suprascapular artery
Innervation: Suprascapular nerve
Where does the teres minor originate and insert?
Origin: Lateral border of scapula
Insertion: Greater tubercle of humerus
What is the action of the teres minor?
External rotation, GHJ stability
Which artery supplies the teres minor? nerve?
Blood Supply: Posterior circumflex humeral artery, circumflex scapular artery
Innervation: Axillary nerve
Where does the subscapularis originate and insert?
Origin: Subscapular fossa
Insertion: Lesser tubercle of humerus
What action does the subscapularis perform?
GHJ internal rotation
Which artery supplies the subscapularis? nerve?
Blood Supply: Subscapular artery
Innervation: Superior subscapular nerves, inferior subscapular nerves
Which structure marks the point in which the brachial plexus divisions divide
Clavicle
Which structure divides the subclavian artery into 3 parts?
Anterior scalene
Which structure divides the axillary artery into 3 parts?
Pec minor
Which structure creates the boundaries of the 3 parts of the subclavian artery?
anterior scalene (Lateral 1st rib marks the transition between the 3rd part of the subclavian, and the first part of axillary artery
Which arteries come off of the first part of the subclavian?
Vertebral artery, internal thoracic, thyrocervical trunk
The subclavian gives off which arteries to the upper extremities?
suprascapular artery, dorsal scapular artery
Which artery comes off the third part of the subclavian?
Dorsal scapular artery
What structures make up the boundaries of the axillary artery?
1st part:
- Lateral border of first rib
- Superior border of pec minor
2nd part:
- Superior border of pec minor
- Inferior border of pec minor
3rd part:
- Inferior border of pec minor
- Inferior border of teres major
Which arteries come off each part of the axillary?
1st Part:
- Superior thoracic artery
2nd Part:
- Thoracoacromial trunk
- Lateral thoracic artery
3rd Part:
- Subscapular artery
- Anterior circumflex humeral artery
- Posterior circumflex humeral artery
Which nerve pierces through the pec minor and major?
Medial pectoral nerve
The axis of rotation for the scapula is where?
AC joint
T or F? The middle trap is only responsible for scapular retraction?
True
Which nerve comes off the trunk of C5-C6?
Suprascapular n.
Which arteries come off the thyrocervical trunk?
Suprascapular artery, Transverse cervical artery
Which arteries come off the subscapular artery?
Thoracodorsal artery, Circumflex scapular
What is the primary function of the quadratus plantae?
Correct the line of pull of the Flexor Digitorum Longus
T or F? The subscapular bursa is a communicating bursa (shares synovial fluid with joint)
True
T or F? The long head biceps tendon contains synovial fluid
True
Which structures pass below the coracoacromial arch?
Long head of biceps tendon, subacromial bursa, supraspinatus
T or F? The supraspinatus is responsible for the first 30 degrees of GH abduction, followed by action from the deltoid
True