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JAFFY Anatomy > S2 - Upper Limb (Upper Arm) > Flashcards

S2 - Upper Limb (Upper Arm) Flashcards

1
Q

label all parts of this image

A
  • A = axilla
  • B = arm
  • C = cubital fossa
  • D = forearm
  • E = hand
  • F = digits
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2
Q

where are the flexor and extensor muscles of the upper limb housed (distal to the axilla)?

A
  • flexor muscles: anterior
  • extensor muscles: posterior
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3
Q

how many nerves innervate the anterior and posterior compartments of the upper limb (distal to the axilla)?

A
  • anterior: 3
  • posterior: 1
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4
Q

anatomically, where does the brachial plexus sit?

A
  • roots: begin at the intervertebral foramina and sit between the middle and anterior scalene muscles
  • trunks: between middle and anterior scalenes
  • divisions: deep to the clavicle
  • cords: deep to pectoralis minor
  • terminal branches: emerge at the lateral border of pec minor
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5
Q

do posterior or anterior rami form nerve plexus?

A
  • only anterior because limbs originate from the front of the body, not the back
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6
Q

label all components

A
  • A = intervertebral foramen (hole)
  • B = ventral root of spinal nerve
  • C = dorsal root ganglion
  • D = mixed spinal nerve
  • E = posterior ramus
  • F = anterior ramus
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7
Q

label A, B, C, D, E

A
  • A = roots
  • B = trunks
  • C = divisions
  • D = cords
  • E = terminal branches
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8
Q

label F, G, H, I, J

A
  • F = superior trunk
  • G = middle trunk
  • H = inferior trunk
  • I = anterior divisions
  • J = posterior divisions
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9
Q

label K, L, M

A
  • K = lateral cord
  • L = posterior cord
  • M = medial cord
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10
Q

label N, O, P, Q, R

A
  • N = musculocutaneous nerve
  • O = axillary nerve
  • P = radial nerve
  • Q = median nerve
  • R = ulnar nerve
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11
Q

musculocutaneous nerve:
- what roots is it made up of
- motor innervation
- sensory innervation
- where does it run anatomically

A
  • C5, C6, C7
  • motor: anterior flexor muscles of arm (biceps brachii, brachialis, coracobrachialis)
  • sensory: anterolateral forearm
  • starts as most lateral nerve from lateral cord, pierces coracobrachialis, runs between brachialis and biceps brachii, then continues as lateral cutaneous nerve down forearm
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12
Q

axillary nerve:
- what roots is it made up of
- motor innervation
- sensory innervation
- where does it run anatomically
- when is it at risk of damage

A
  • C5, C6
  • motor: deltoid + teres minor
  • sensory: regimental badge area (kind of over the deltoid)
  • starts from posterior cord (superior to radial nerve and posterior to axillary a.) and ends @ deltoid and teres minor
  • risk of damage during shoulder dislocation as it supplies glenohumeral joint
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13
Q

radial nerve
- what roots is it made up of
- motor innervation
- sensory innervation
- where does it run anatomically
- when is it likely to be injured

A
  • all 5 roots (C5, C6, C7, C8, T1)
  • motor: posterior upper arm (triceps brachii), posterior forearm - EXTENSORS
  • sensory: posterior arm and forearm, dorsal surface of lateral 1.5 digits
  • RUNS ABOVE TERES MAJOR, very close to humerus, between triceps heads. superficial sensory branch runs thru brachioradialis muscle and wraps around dorsal surface of thumb and deep motor branch passes thru supinator and turns into interosseous branches
  • injury: midshaft humeral fracture (wrist drop)
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14
Q

median nerve:
- what roots is it made up of
- motor innervation
- sensory innervation
- where does it run anatomically
- when is it at risk of injury

A
  • all 5 roots (C5, C6, C7, C8, T1)
  • motor: anterior forearm EXCEPT flexor carpi ulnaris and medial half of flexor digitorum profundus (ulnar nerve), thenar eminence, lateral 2 lumbricals (II and III phalanges)
  • sensory: lateral 3 digits + on dorsal surface and lateral 3.5 digits on palmar surface
  • runs medially down upper arm, passes thru cubital fossa and between 2 heads of pronator teres, goes thru carpal tunnel to supply lateral hand muscles
  • at risk: distal humeral fractures, compression in the carpal tunnel
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15
Q

ulnar nerve
- what roots is it made up of
- motor innervation
- sensory innervation
- where does it run anatomically
- when is it at risk?

A
  • C8, T1
  • motor: flexor carpi ulnaris, medial half of flexor digitorum profundus, all intrinsic hand muscles except thenar eminence and lateral 2 lumbricals (these are median nerve)
  • sensory = medial 1.5 digits on palmar and dorsal surfaces
  • runs very medial all the way down the arm, posterior to medial epicondyle
  • at risk in distal humerus (medial epicondyle) and wrist compression
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16
Q

what is A and what is its function?

A
  • dorsal scapular nerve
  • innervates levator scapulae (A), rhomboids major (C), and rhomboids minor (B)
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17
Q

what is B and what is its function?

A
  • long thoracic nerve
  • innervates serratus anterior
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18
Q

what is C and what is its function?

A
  • suprascapular nerve
  • innervates supraspinatus (A) and infraspinatus (B)
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19
Q

what is D and what is its function?

A
  • nerve to subclavius
  • innervates subclavius
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20
Q

what is E and what is its function?

A
  • E = lateral pectoral nerve - innervates upper pectoralis major
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21
Q

what are I, J and K and what is K’s function?

A
  • I = medial cutaneous nerve of the forearm
  • J = medial cutaneous nerve of the arm
  • K = medial pectoral nerve - innervates lower pectoralis major and pectoralis minor
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22
Q

what are F, G and H and what do they innervate?

A
  • F = lower subscapular nerve - innervates lower subscapularis teres major
  • G = middle subscapular/thoracodorsal nerve - innervates latissimus dorsi and teres major
  • H = upper subscapular nerve - innervates upper subscapularis
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23
Q

label all dermatomes

A
  • A = C3
  • B = C4
  • C = C5
  • D = C6
  • E = C7
  • F = C8
  • G = T1
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24
Q

myotome tests

A
  • C5: shoulder abduction and elbow flexion
  • C6: shoulder abduction, adduction and external rotation, elbow and wrist flexion
  • C7: shoulder adduction, elbow extension, wrist flexion and extension, finger flexion and extension
  • C8: finger flexion, extension, abduction, adduction, wrist extension, elbow extension, shoulder adduction
  • T1: finger adduction and abduction
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25
Q

describe the arterial supply of the entire arm

A
  • subclavian artery (under clavicle)
  • turns into axillary artery after clavicle)
  • axillary branches into anterior and posterior circumflex humeral arteries
  • axillary continues to become brachial artery @ inferior border of teres major
  • brachial branches into profound brachii and then continues, branching off into radial and ulnar arteries
  • radial and ulnar arteries join together to create the superficial and deep palmar arches
  • superficial palmar arch becomes common digital arteries
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26
Q

what do the axillary and brachial arteries supply?

A
  • axillary: glenohumeral joint and humeral head
  • brachial: medial posterior component of upper arm (i.e. triceps)
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27
Q

how does the axillary artery relate to the cords of the brachial plexus?

A
  • the cords are named relative to the axillary artery (medial, lateral, posterior)
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28
Q

describe the 3 parts of the axillary artery

A
  • 1st part: medial to pecs minor
  • 2nd part: deep to pecs minor
  • 3rd part: lateral to pecs minor
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29
Q

what do the radial and ulnar arteries supply?

A
  • radial: posterior lateral component of forearm inc. thumb and index finger
  • ulnar: anterior medial component of forearm
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30
Q

what do the deep and superficial palmar arches supply?

A
  • deep: wrist joint + digits
  • superficial: finger joints
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31
Q

label all components

A
  • A = axillary artery
  • B = posterior humeral circumflex artery
  • C = anterior humeral circumflex artery
  • D = subscapular artery
  • E = brachial artery
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32
Q

describe the superficial veins of the whole arm

A
  • cephalic vein (lateral): enters the axillary vein
  • basilic vein (medial): enters the axillary vein
  • median cubital vein: connects cephalic and basilic veins in cubital fossa
  • ANY 3 of these veins are used for venepuncture h/w median cubital vein is the most common
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33
Q

describe the deep veins of the whole arm

A
  • basically same as arteries
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34
Q

describe the axillary lymph nodes

A
  • apical nodes (@ the apex)
  • central nodes
  • subscapular nodes (posterior)
  • pectoral nodes (anterior)
  • humeral nodes (lateral)
35
Q

contents of axilla

A
  • axillary v. and a.
  • lymph nodes for upper limb
  • brachial plexus (cords and terminal branches)
  • short head of biceps + coracobrachialis
36
Q

describe the base of the axilla

A
  • armpit skin
  • subcutaneous tissue
  • deep axillary fascia
37
Q

describe the anterior wall of the axilla

A
  • pecs major and minor
  • subclavius
  • clavipectoral fascia
38
Q

describe the apex of the axilla

A
  • 1st rib
  • lateral 1/3 of the clavicle
  • superior edge of the scapula (coracoid process)
39
Q

describe the posterior wall of the axilla

A
  • subscapularis
  • teres major
  • latissimus dorsi tendon
40
Q

describe the medial wall of the axilla

A
  • serratus anterior
41
Q

describe the lateral wall of the axilla

A
  • bicipital groove of humerus
  • coracobrachialis
  • short head of biceps
42
Q

label A, B, C, D

A
  • A = medial border
  • B = superior angle
  • C = superior border
  • D = acromion
43
Q

label E, F, G, H

A
  • E = acromial angle
  • F = lateral angle
  • G = lateral border
  • H = inferior angle
44
Q

anatomical vs surgical neck of humerus

A
  • surgical = where the shaft starts
  • anatomical = more superior, where the epiphyseal plate is
45
Q

3 types of humeral fractures

A
  • proximal (surgical neck - most common) - damage axillary nerve and posterior circumflex artery (FOOSH)
  • midshaft - radial nerve + profunda brachii (deep brachial artery), wrist extensors damaged
  • supracondylar - most likely to damage ulnar nerve due to extension fracture but may also harm radial and median nerve
46
Q

glenoid labrum

A
  • extra fibrocartilage around the glenoid fossa which increases the SA of the point of articulation
  • prevents dislocation
47
Q

what are A, B, C and D?

A
  • A = acromion (superior and posterior to coracoid)
  • B = coracoid process
  • C = head of humerus
  • D = glenoid fossa
48
Q

what are E, F, G and H?

A
  • E = greater tubercle (posterior lateral)
  • F = lesser tubercle (anterior medial)
  • G = subscapular fossa
  • H = supraspinous fossa
49
Q

what are I, J, K and L?

A
  • I = infraspinous fossa
  • J = spine of scapula
  • K = deltoid tubercle
  • L = suprascapular notch
50
Q

what are A, B and C?

A
  • A = coracoacromial ligament
  • B = coracohumeral ligament
  • C = glenohumeral ligament
51
Q

what are A and B?

A
  • A = subacromial bursa: bursitis causes pain in 70-120 degrees of abduction
  • B = subscapular bursa (communicates w/ joint)
  • (there is also a subdeltoid bursa)
  • flattened fibrous sac, lined w/ synovial fluid prevents friction during movement
52
Q

what are A, B, C, D and E?

A
  • A = periosteum
  • B = joint capsule
  • C = articular cartilage
  • D = synovial membrane
  • E = synovial/joint cavity containing synovial fluid
53
Q

3 ligaments which support the AC joint

A
  • acromioclavicular
  • coracoclavicular (formed by conoid and trapezoid ligaments)
54
Q

what are A, B, C and D? (rotator cuff)

A
  • A = supraspinatus (abduction, external rotation)
  • B = infraspinatus (external rotation, extension)
  • C = teres minor (external rotation, adduction and extension)
  • D = subscapularis (internal rotation, adduction)
55
Q

what are A and B?

A
  • A = deltoid (abduction)
  • B = teres major (adduction)
56
Q

what are A, B, C and D?

A
  • A = trapezius (scapular rotation)
  • B = levator scapulae
  • C = rhomboids minor
  • D = rhomboids major
57
Q

what are A, B, C and D?

A
  • A = pectoralis major
  • B = pectoralis minor (deep to pec major)
  • C = subclavius
  • D = serratus anterior (scapular protraction and upward rotation)
58
Q

why is the rotator cuff so stable?

A
  • all multipennate muscles which means they create little movement when they contract
  • work together to keep head of humerus against glenoid fossa during movement
59
Q

which muscles attach to the greater and lesser tubercle of the humerus?

A
  • greater: supraspinatus, infraspinatus, teres minor (posterior)
  • lesser: subscapularis (anterior)
60
Q

which position is the most susceptible to shoulder dislocation

A
  • abduction and external rotation b/c least stability (no muscles in the anterior/inferior position)
61
Q

what are A, B, C and D? (biceps brachii)
- what movements can the biceps do?
- describe its vasculature

A
  • A = long head (lateral): travels thru intertubercular groove and attaches onto supraglenoid tubercle (right above glenoid labrum)
  • B = short head (medial): originates at coracoid process
  • C = biceps tendon which attaches to radial tubercle
  • D = bicipital aponeurosis (fanning out of tendon to disperse force), attaches to forearm fascia
62
Q

biceps brachii:
- describe its origin and insertion
- describe its innervation
- describe its arterial supply
- what movements is it responsible for?

A
  • origin: short head originates @ coracoid process, long head originates @ bicipital groove
  • insertion: radial tuberosity and bicipital aponeurosis
  • innervation: musculocutaneous n.
  • arterial: brachial and anterior circumflex humeral a.
  • flexion and supination
63
Q

what is A?
- describe its origin and insertion
- describe its innervation
- describe its arterial supply
- what movement is it responsible for?

A
  • brachialis
  • origin: distal humerus and intermuscular septum
  • insertion: proximal ulna
  • innervation: musculocutaneous (medial) and radial nerve (lateral)
  • arterial: brachial a.
  • movement: elbow flexion
64
Q

what muscle is B?
- describe its origin and insertion
- describe its innervation
- describe its arterial supply
- what movements is it responsible for

A
  • coracobrachialis
  • origin: coracoid process
  • insertion: middle of humerus
  • innervation: musculocutaneous n.
  • arterial: brachial + anterior circumflex arteries
  • movements: shoulder flexion and adduction
65
Q

isotonic and isometric movements

A
  • isotonic: muscle length changes
    > concentric: contraction during shortening
    > eccentric: contraction during lengthening
  • isometric: length of muscle doesn’t change
66
Q

what are A, B and C? (triceps brachii)
- where does each head originate?
- what is the insertion?

A
  • A = long head (originates @ scapula)
  • B = lateral head (originates @ posterior humerus)
  • C = medial head (over the top of the long and lateral head, originates @ intermuscular septum)
  • all 3 heads join and insert @ ulna
67
Q

triceps brachii:
- describe its innervation
- describe its arterial supply
- what movements is it responsible for?

A
  • innervation: radial nerve
  • arterial: deep brachial artery
  • movement: extension
68
Q

triple test approach re: breast lesion

A
  • clinical examination
  • breast imaging (usually mammography and U/S, +/- MRI)
  • biopsy/tissue pathology
69
Q

what are A, B, C and D?

A
  • A = nipple/areolar complex
  • B = adipose tissue
  • C = pec major
  • D = fibroglandular tissue
70
Q

what is the innervation of: pecs major and minor, serratus anterior

A
  • pecs major: medial and lateral pectoral nerve
  • pecs minor: medial pectoral nerve
  • serratus anterior: long thoracic nerve
71
Q

what is the innervation of: latissimus dorsi, deltoid, teres major

A
  • lats: thoracodorsal n.
  • deltoid: axillary n.
  • teres major: lower subscapular n.
72
Q

describe the innervation of the rotator cuff

A
  • subscapularis: upper and lower subscapular n.
  • infraspinatus and supraspinatus: suprascapular n.
  • teres minor: axillary n.
73
Q

describe the innervation of the anterior upper arm muscles

A
  • biceps brachii: musculocutaneous n.
  • coracobrachialis: musculocutaneous n.
  • brachialis: musculocutaneous and radial n.
74
Q

describe the innervation of: trapezius, levator scapulae, rhomboids

A
  • trapezius: accessory spinal nerve
  • levator scapulae: dorsal scapular nerve
  • rhomboids: dorsal scapular nerve
75
Q

innervation of subclavius

A
  • subclavian nerve
76
Q

list some bones commonly fractured during a FOOSH

A
  • clavicle (change in curvature)
  • humerus (surgical neck or supracondylar)
  • distal radius head or neck
  • scaphoid (esp. @ its waist)
77
Q

deltoid function

A
  • anterior deltoid: shoulder flexion
  • middle deltoid: abduction past 15 degrees (first 15 degrees are supraspinatus)
  • posterior deltoid: shoulder extension
78
Q

describe the mechanism of shoulder abduction to 180˚

A
  • 0-15˚: supraspinatus (glenohumeral)
  • 15-90˚: deltoid (glenohumeral)
  • 90-150˚: scapulothoracic joint (formed by medial border of scapula and ribs) rotates scapula upwards, facilitated by trapezius and serratus anterior. sternoclavicular joint elevates clavicle
  • 150-180˚: AC joint
  • NB pain @ 65 degrees = impingement
79
Q

varus and valgus

A
  • valgus: outward (lateral) angulation
  • varus: inward (medial) angulation
80
Q

clavicle fracture:
- where is it most common to occur?
- causes
- what can this damage

A
  • most common where it changes curvature
  • causes: FOOSH
  • may damage divisions of brachial plexus
81
Q

rotator cuff tendinopathy

A
  • usually affects supraspinatus b/c tendon runs thru subacromial space
  • usually caused by overuse e.g. swimming
  • can lead to bursitis + impingement
82
Q

what is thoracic outlet syndrome

A
  • when nerves + artery in the thoracic outlet are compressed
  • thoracic outlet = space b/n clavicle and 1st rib
  • due to having an extra rib, physical trauma, pregnant or pancoast tumour
83
Q

boundaries of quadrangular space + triangular space + triangular interval (posterior shoulder)

A

JAFFY Anatomy (14 decks)

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