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Anatomy of the limbs > Shoulder and arm > Flashcards

Shoulder and arm Flashcards

1
Q

What are the bones of the pectoral girdle and arm?

A

Scapula Clavicle Humerus

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2
Q

List the anterior pectoral muscles.

A

Pectoralis major Pectoralis minor Subclavius Serratus anterior

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3
Q

List the posterior pectoral muscles.

A

Trapezius Latissimus dorsi Levator scapulae The rhomboids

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4
Q

List the intrinsic shoulder muscles.

A

Deltoid Teres major The rotator cuff muscles: -supraspinatus -infraspinatus -teres minor -subscapularis

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5
Q

List the muscles in the anterior compartment of the arm.

A

Biceps Brachialis Coracobrachialis

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6
Q

List the muscles in the posterior compartment of the arm.

A

Triceps Anconeus

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7
Q

What are the joints of the shoulder and arm?

A

Sternoclavicular joint (SCJ) Acromioclavicular joint (ACJ) Glenohumeral joint Scapulothoracic joint Elbow joint

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8
Q

What type of joint is the sternoclavicular joint?

A

Synovial joint Composed of 2 portions separated by a fibrocartilage articular disc.

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9
Q

Where does the strength of the sternoclavicular joint arise from?

A

Sternoclavicular ligaments.

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10
Q

What can result from injury to the sternoclavicular ligaments?

A

Sternoclavicular subluxation or dislocation.

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11
Q

What does the sternal end of the clavicle articulate with?

A

Sternum (manubrium) and first costal cartilage.

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12
Q

What is the only connection of the pectoral girdle to the axial skeleton, and what does it allow?

A

Sternoclavicular joint. Allows movement of the clavicle (and therefore the girdle) in 3 planes.

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13
Q

What type of joint is the acromioclavicular joint?

A

Synovial joint between the acromial end of the clavicle and the acromion process of the scapula.

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14
Q

What are the clinically important ligaments connecting and stabilising the acromioclavicular joint?

A

Acromioclavicular ligament Coracoclavicular ligament (conoid and trapezoid ligaments) Coracoacromial ligament

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15
Q

How may the acromioclavicular joint be injured?

A

Frequently injured by falls onto the outstretched hand. More minor dislocations occur when the acromioclavicular ligament alone is torn. More severe dislocations occur when the coracoclavicular ligaments are also torn.

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16
Q

What type of joint is the glenohumeral joint?

A

Synovial ball and socket joint between the glenoid cavity of the scapula and the head of the humerus. The glenoid fossa (socket) is shallow, but slightly deepened by a cartilaginous labrum.

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17
Q

What are the extensions of the capsule of the shoulder joint?

A

Glenoid to humeral head. Subacromial bursa- capsule extends above humeral head to form bursa between humeral head and overlying acromial process. An extension around the long head of biceps as it lies within the inter tubercular groove of the humerus.

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18
Q

What does the coracoacromial arch consist of and where does it lie?

A

Lies above the glenohumeral joint. Acromion, coracoid process and the coracoacromial ligament running between the 2.

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19
Q

What is the purpose of the coracoacromial arch?

A

Prevents the humerus from rising superiorly against the acromion.

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20
Q

Which clinically important ligaments blend in with the capsule of the glenohumeral joint?

A

Glenohumeral ligaments- strengthen the anterior portion of the shoulder capsule. Coracohumeral ligament- strengthens the capsule superiorly. Transverse humeral ligament- holds the tendon of the long head of biceps in the inter tubercular groove.

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21
Q

What are the movements of the glenohumeral joint and the muscles producing these movements?

A

Flexion- clavicular head of pectoralis major, anterior fibres of deltoid, coracobrachialis, biceps. Extension- latissimus dorsi. Abduction- supraspinatus (first 15 degrees), central fibres of deltoid (after 15 degrees). Adduction- pectorals major, latissimus dorsi. Internal rotation- subscapularis. External rotation- infraspinatus, teres minor. Circumduction (combination of movements).

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22
Q

What muscles are involved in resisting dislocation of the glenohumeral joint?

A

Rotator cuff muscles- hold the humeral head against the glenoid cavity Deltoid Coracobrachialis Short head of biceps Long head of biceps

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23
Q

What is the scapulothoracic joint?

A

Theoretical concept, represents ‘articulation’ between the scapula and the chest wall.

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24
Q

What are the main movements of the scapula at the scapulothoracic ‘joint’?

A

Elevation and depression of the scapula Protraction of the scapula, i.e. forward and lateral movement of the scapula against the chest wall Retraction of the scapula, i.e. backwards and medial movement of the scapula against the chest wall Rotation of the scapula

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25
Q

What is the elbow joint the articulation between?

A

Distal humerus with radius and ulna.

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26
Q

What is the function of the axilla?

A

Passageway for nerve, blood and lymph vessels to enter/leave the upper limb.

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27
Q

What forms the base of the axilla?

A

Skin, subcutaneous tissue and fascia extending from the arm to the chest.

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28
Q

Where is the apex of the axilla?

A

Lies between the first rib, clavicle, and superior border of subscapularis muscle.

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29
Q

What is the anterior wall of the axilla formed by?

A

Pectoralis major Pectoralis minor

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30
Q

What is the posterior wall of the axilla formed by?

A

Scapula and subscapularis (superiorly) Teres major and latissimus dorsi (inferiorly)

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31
Q

What is the medial wall of the axilla formed by?

A

Chest wall (ribs 1-4) and serratus anterior

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32
Q

What is the lateral wall of the axilla formed by?

A

Intertubercular groove of the humerus

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33
Q

What are the contents of the axilla?

A

Arteries- the axillary artery and its branches Veins- the axillary vein and its tributaries Lymphatic vessels and lymph nodes- axillary lymph nodes (important) Nerves- the infraclavicular part of the brachial plexus, long thoracic and intercostobrachial nerves

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34
Q

What are the proximal attachments of the pectoralis major muscle?

A

Broad, on the medial ⅓ of the clavicle, the sternum and costal cartilages.

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35
Q

What is the distal attachment of the pectoralis major muscle?

A

Lateral lip of the intertubercular sulcus (groove).

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36
Q

What are the actions of the pectoralis major muscle?

A

Adducts and medially rotates the humerus. ‘Punching muscle’. Lesser actions on the scapula.

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37
Q

What are the attachments of the pectoralis minor muscle?

A

On ribs 2, 3, 4, and 5. Coracoid (‘crow’s beak’) process of scapula.

38
Q

What are the attachments and what is the role of the subclavius muscle?

A

Anchors the clavicle. First rib to under surface of clavicle.

39
Q

What are the attachments of the serratus anterior muscle, and what nerve is it supplied by?

A

Runs from medial border of scapula to the anterior attachments on the ribs. Supplied by the long thoracic nerve.

40
Q

What is the motor supply of the trapezius muscle?

A

Accessory nerve (CNXI).

41
Q

What nerve is the latissimus dorsi muscle supplied by?

A

Thoracodorsal nerve.

42
Q

What are the actions of the latissimus dorsi muscle?

A

Extends, adducts and rotates the humerus. Pulls the body up to the arms during climbing. Also important in rowing. Upper limb muscle associated with pelvic region.

43
Q

What are the attachments of the latissimus dorsi muscle?

A

Floor of intertubercular groove of humerus and thoracolumbar fascia attaches it to spinous processes of thoracic and lumbar vertebrae, sacrum and iliac crest.

44
Q

What nerve supplies the rhomboids?

A

Dorsal scapular nerve.

45
Q

What are the actions of the rhomboids (major and minor)?

A

Retract, rotate and fix the scapula.

46
Q

What are the attachments of the rhomboids?

A

Medial border of scapula and spinous processes (C7-T2 minor, T2-T5 major)

47
Q

What nerve supplies the levator scapulae muscle?

A

Dorsal scapular nerve (+ C34)

48
Q

What are the actions of the levator scapulae muscle?

A

Elevates and rotates the scapula Shrugging shoulders

49
Q

What are the attachments of the levator scapulae muscle?

A

Transverse processes of C1-4 Superior angle of scapula

50
Q

What nerve supplies the deltoid muscle?

A

Axillary nerve

51
Q

What is the action of the deltoid muscle?

A

Abducts arm

52
Q

What are the attachments of the deltoid muscle?

A

Posteriorly attaches to spine of scapula Also attaches to acromial region and clavicle

53
Q

What nerve supplies the teres major muscle?

A

Lower subscapular nerve

54
Q

What are the attachments of the teres major muscle?

A

Inferior angle of scapula Medial lip of intertubercular sulcus of humerus

55
Q

What nerve are the muscles of the anterior compartment of the arm supplied by?

A

Musculocutaneous nerve. (Biceps brachii, brachialis, coracobrachialis)

56
Q

What are the attachments of the biceps brachii muscle?

A

Coracoid process 2 heads converge to form a single tendon, part of which attaches to radial tuberosity and part of which splays out into biceps aponeurosis

57
Q

What are the attachments of the brachialis muscle?

A

Medial and distal end of shaft of humerus Coronoid process of ulna

58
Q

What nerve are the muscles of the posterior compartment of the arm supplied by?

A

Radial nerve (Triceps, anconeus)

59
Q

What are the attachments of the triceps muscle?

A

Crosses shoulder joint, tendon crosses elbow joint and attaches to olecranon process of ulna

60
Q

What are the attachments of the anconeus muscle?

A

Lateral epicondyle of humerus to olecranon process of ulna

61
Q

Describe the path of the subclavian artery.

A

Arises from right brachiocephalic artery (right side) or aorta (left side) in the chest. Runs towards axilla in the root of the neck. Becomes the axillary artery as it passes over the first rib.

62
Q

Describe the path of the axillary artery.

A

Passes through the axilla from over the first rib to become the brachial artery at the inferior border of the teres major muscle. Divided into 3 parts according to its relation to the pectoralis major muscle (superior, deep, inferior) and gives off branches in the axilla. Extensive collateral circulation in this region around the scapula.

63
Q

What is the main artery to the arm?

A

Brachial artery

64
Q

How does the brachial artery end?

A

Divides at the elbow into the radial and ulnar arteries

65
Q

What is the largest muscular branch of the brachial artery?

A

Profunda brachii artery, which follows the radial nerve

66
Q

Name 2 tributaries that the axillary vein receives

A

Cephalic vein (superficial vein of the arm) Lateral thoracic vein

67
Q

How is the axillary vein (a deep vein) formed?

A

As the basilic vein (superficial vein of the arm) passes through the deep fascia to join the venae comitantes of the brachial artery (brachial veins) at the level of the lower border of teres major.

68
Q

At what point does the axillary vein become the subclavian vein?

A

At the level of the 1st rib

69
Q

What connects the superficial epigastric vein to the lateral thoracic vein?

A

Thoracoepigastric vein Can act as a shunt for blood if th portal system develops hypertension or blockage, e.g. by tumour.

70
Q

What are the superficial veins of the forearm and arm?

A

Cephalic vein Basilic vein

71
Q

Describe the path of the cephalic vein.

A

Ascends on the lateral aspect of the forearm and arm and terminates by passing deep in the delta-pectoral groove to join the axillary vein.

72
Q

Describe the path of the basilic vein.

A

Ascends on the medial side of the forearm and arm and passes deep halfway to form the axillary vein with the venae comitantes of the brachial artery.

73
Q

What does lymph from the hand drain via?

A

Superficial lymphatics which run alongside the cephalic and basilic veins.

74
Q

What are the 5 groups of axillary lymph nodes?

A

Apical Pectoral Subscapular Humeral Central

75
Q

What do the axillary lymph nodes drain via?

A

Apical lymph nodes

76
Q

What do the apical lymph nodes drain into?

A

Subclavian lymphatic trunk and then the right lymphatic duct (right side) or thoracic duct (left side).

77
Q

Describe the organisation of lymphatics in the upper limb.

A

Some lymphatics pass directly and superficially up the arm but there are also some cubital lymph nodes at the elbow. There are some delto-pectoral lymph nodes alongside the cephalic vein. Lymph from the superficial system drain to the axillary lymph nodes. Deep lymphatics run alongside deep veins and terminate in the axillary lymph nodes. The axilla contains a large number of axillary lymph nodes.

78
Q

What is the clinical significance of axillary lymph nodes?

A

Carcinoma of the breast- lymphatic drainage of the breast includes these lymph nodes, could metastasise.

79
Q

Which two nerves are in close relation to the axillary lymph node region?

A

Long thoracic nerve- supplies serrates anterior muscle Thoracodorsal nerve- supplies latissimus dorsi muscle

80
Q

What spinal nerves is the brachial plexus formed from?

A

Anterior primary rami of C5-T1 spinal nerves

81
Q

What does the brachial plexus consist of?

A

Roots formed in the neck from the spinal nerve roots Trunks formed from the roots in the posterior triangle of the neck Divisions formed from the trunks behind the clavicle Cords formed from the divisions in the axilla in close proximity to the axillary artery Branches of the peripheral nerves supplying the upper limb itself

82
Q

What muscle does the long thoracic nerve supply?

A

Serratus anterior

83
Q

What muscles does the suprascapular nerve supply?

A

Supraspinatus Infraspinatus

84
Q

What muscle do the medial and lateral pectoral nerves supply?

A

Pectoralis major

85
Q

What muscle does the thoracodorsal nerve supply?

A

Latissimus dorsi

86
Q

What does the axillary nerve supply?

A

Teres minor muscle Deltoid muscle An area of skin over the deltoid

87
Q

What nerves are included in the brachial plexus?

A

Long thoracic nerve Suprascapular nerve Medial and lateral pectoral nerves Thoracodorsal nerve Axillary nerve Musculocutaneous nerve Ulnar nerve Median nerve Radial nerve

88
Q

What does the musculocutaneous nerve (C567) supply, what is its path and clinical significance?

A

Anterior compartment of the arm (coracobrachialis, brachialis and biceps). It continues as the lateral cutaneous nerve of the forearm. It lies close to the subscapularis tendon anterior to the shoulder and is at risk during surgery to the anterior gleno-humeral joint.

89
Q

What does the ulnar nerve (C8,T1) supply, what is its path and clinical significance?

A

Anterior compartment of the forearm but is mainly the nerve of the hand. It has no branches in the arm and passes though the arm in the anterior compartment initially but more distally in the posterior compartment. It lies posterior to the medial epicondyle of the elbow and is at risk there.

90
Q

What does the median nerve (C678,T1) supply, what is its path and clinical significance?

A

Anterior compartment of the forearm and hand. It has no branches in the arm. It passes through the arm in the anterior compartment. At the level of the elbow it lies alongside the brachial artery and is at risk in supracondylar fractures of the humerus.

91
Q

What does the radial nerve (C5678,T1) supply, what is its path and clinical significance?

A

Posterior compartment of the arm as well as the posterior compartment of the forearm. It lies on the humerus in the radial groove and is at risk in humeral shaft fractures. Just proximal to the elbow, it divides into the superficial radial nerve (sensory) and the posterior interosseous nerve (motor).

92
Q

Label the following diagram of the brachial plexus:

A

Anatomy of the limbs (9 decks)

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