Study Guide Flashcards
common palmar digital arteries
parent: superficial palmer arch
pronation
C7, C8
Lower plexus injury (klumpke’s palsy)
- arm forcibly abducted and pulled
- stretches lower trunk and or c8/t1 spinal nerves
- symptoms: paralysis of intrinsic hand muscles (complete claw hand); sensory loss over the medial arm, forearm, and hand
- median nerve is effected
Anterior humeral circumflex
parent: axillary artery
C5, C6, C7, C8, T1
radial, median, and lateral + medial pectoral
flexor carpi radialis
attachments:
- Medial epicondyle of humerus
- Base of 2nd and 3rd metacarpals
innervation:
- median nerve
Action:
Flexion and abduction of hand
The general scheme then is that the shoulder muscles are C5 and C6 (except the pectoralis major brings in C7 and latissimus dorsi brings in C7 and C8). The flexor arm is C5 and C6 while extensor arm is C7 and C8. As we get into the forearm, C5 goes away and C8 is added. Finally, the intrinsic hand muscles are all C8 and T1 (mostly T1).
The general scheme then is that the shoulder muscles are C5 and C6 (except the pectoralis major brings in C7 and latissimus dorsi brings in C7 and C8). The flexor arm is C5 and C6 while extensor arm is C7 and C8. As we get into the forearm, C5 goes away and C8 is added. Finally, the intrinsic hand muscles are all C8 and T1 (mostly T1).
gluteal region nerves
gluteal region nerves
Metacarpals and phalanges
- Metacarpals form the palm
- Phalanges: proximal (to metacarpals), middle, and distal
median
origin: medial and lateral cords
spinal segments: c5 to c7 via lateral cord; c8, t1 via medial cord
motor: all muscles in the anterior compartment of the forearm (except flexor carpi ulnaris and medial half of flexor digitorum profundus), three thenar muscles of the thumb and two lateral lumbrical muscles
cutaneous: palmer surface of the lateral three and one-half digits and over the lateral side of the palm and middle of the wrist
flexor digitorum profundus
attachments:
- Ulna and interosseous membrane
- Four tendons → distal phalanges of digits 2-5
innervation:
- Lateral half – median nerve (anterior interosseous)
- Medial half – ulnar nerve
Action: Flexion of MP and distal IP joints, wrist
radial nerve innervations
BEST:
Brachioradialis
Extensors
Supinator
Triceps
wrist extension
C6
Extensor carpi radialis brevis
attachments:
- Lateral epicondyle of humerus
- Base of 2nd and 3rd metacarpals
innervation:
-Radial nerve
action:
Extension and abduction of hand
pectoralis minor
attachments:
- Ribs and costal cartilages 3-5
- Coracoid process of scapula
innervation:
- Medial and lateral pectoral nerves
Action:
-Depression and protraction of the scapula
semimembranosus
attachments:
- Ischial tuberosity
- Medial tibia
innervation:
- Tibial division of the sciatic nerve
action:
-Flexion of the leg and extension of the thigh
cephalic vein
- superficial
- radial side
- pathway up through forearm/arm
radioulnar joint injury
- common in children
- head of radius can slip through
Extensor digiti minimi
attachments:
- Lateral epicondyle of humerus
- Extensor hood of the digit 5
innervation:
-Radial nerve
action:
Extension of the little finger
Upper plexus injury (erb’s palsy)
- Forcibly increased angle between neck and shoulder
- common injury during delivery
- stretches upper trunk and/or C5/C6 spinal nerves
- symptoms: adducted and medially rotated arm; extended elbow, flexed wrist, sensory loss on lateral arm, forearm and hand (waiter’s tip posture going backwards)
pectoral nerves
“Lateral is less, medial is more”
Lateral pectoral nerve goes through pectoralis major, while medial pectoral nerve goes though both pectoralis major and minor.
Carpals
Straight Line To Pinky, Here Comes The Thumb -proximal to wrist scaphoid lunate triquetrum pisiform -distal to wrist hamate capitate trapezoid trapezium
Superficial palmer arch
parent: ulnar artery
dorsal venous arch of the hand
- superficial
- runs across one side of the hand to the other
brachialis
attachments:
- Anterior humerus
- Coronoid process of ulna
innervation:
-Musculocutaneous nerve
Action:
-Flexion of forearm
Supraclavicular branches
Supraclavicular branches
Extensor pollicis brevis
attachments:
- Radius and interosseous membrane
- Proximal phalanx of the thumb
innervation:
-Radial nerve
action:
Extension of the thumb
Intrinsic muscles of the hand
Intrinsic muscles of the hand
Unicorn
ulnar: c8, t1
lateral thoracic
parent: axillary artery
Abductor digiti minimi
attachments:
- Pisiform
- Proximal phalanx of digit 5
innervation:
-Deep branch of ulnar nerve
action: Abducts digit 5
Lateral Cord Branches mnemonic
LLM “Lucy Loves Me” - the lateral pectoral, lateral root of the median nerve, musculocutaneous
quadratus femoris
attachments:
- Ischial tuberosity
- Greater trochanter of the femur
innervation:
- Nerve to quadratus femoris
action:
-Lateral rotation of the thigh
rhomboid major
attachments:
- T2-T5 vertebrae
- Medial border of scapula
innervation:
- Dorsal scapular nerve
Action:
-Elevation and retraction the scapula
which branches of brachial plexus are purely muscular?
answer
medial cutaneous of arm
origin:
spinal segments: t1
cutaneous: medical side of distal one-third of arm
synovial sheaths
- minimizes friction where long tendons contact other structures (think carpal tunnel)
- Ulnar bursa: ulnar/medial portion of metacarpals down to digit V; follows FDS and FDP as the crowd the wrist
- radial bursa: radial portion; follows flexor policies longus
- separate finger sheaths for phalanges for digits II-IV
Colle’s fracture
- a break of the distal radius
- fall on outreached hand
- dinner folk deformity, hand cups upward
Muscles inserting into humerus
“A lady between two majors”
Pectoralis major attaches to lateral lip of bicipital groove, the teres major attaches to medial lip of bicipital groove, and the latissimus dorsi attaches to the floor of bicipital groove. The “lati” is between two “majors”
Spinal level of Radial
C5, C6, C7, C8, T1
Rotator cuff muscles
Rotator cuff muscles
lacteral pectoral
origin:
spinal segments: c5 to c7
motor: pectoralis major, pectoralis minor
palmaris longus
attachments:
- Medial epicondyle of humerus
- Palmar aponeurosis of hand
innervation:
-median nerve
Action:
- Flexion of hand
- Tenses palmar aponeurosis when gripping
inability to turn right palm upward against resistance (supination); limited ability to flex his elbow. which nerve is most likely injured?
- musculocutaneous nerve: innervates biceps which flex elbow and does supination
- in pronation, radial bone flips over
branches of brachial plexus
Branches of brachial plexus
acromioclavicular ligament
- between the distal end of clavicle and acromion processes of the scapula
- strengthens the acromioclaviscular joint superiorly
- dislocation = shoulder separation
Median Nerve
- Muscular and cutaneous components
- goes through carpal tunnel
- Palmer branch: branches off before carpal tunnel so should not be affected by any carpal tunnel injuries
- Common digital branches go from thumb to the radial side of the ring finger
- recurrent branch serves the thenar muscles
Coracoclavicular ligament
- trapezoid ligament and conoid ligament
- anchors the clavicle to the coracoid process
- tear of ligament = separation of coracoid and clavicle
medial antebrachial cutaneous nerve
medial forearm from elbow to wrist
gluteus medius
attachments:
- Ilium
- Greater trochanter
innervation:
-Superior gluteal nerve
action:
- Abduction and medial rotation of the thigh
- prevents pelvic drop when leg is raised
Thoracodorsal
parent: subscapular
teres minor
attachments:
- Lateral border of the scapula
- Greater tubercle of the humerus
innervation:
-Axillary nerve
Action:
-Lateral rotation of arm
gluteus maximus
attachments:
- IIium, sacrum and sacrotuberous ligament
- Iliotibial tract of fascia lata and gluteal tuberosity
innervation:
-Inferior gluteal nerve
action:
-Extension and lateral rotation of the thigh
shoulder extension
C6, C7, C8
shoulder flexion
C5
motor and sensory deficits consistent with an axillary nerve injury; which motor defects will be most evident?
- axillary nerve innervates the teres minor (lateral rotation) and deltoid muscle (abduction)
- leads to diminished abduction and lateral rotation of the arm
levator scapulae
attachments:
- C1-C4 vertebrae
- Superior angle of the scapula
innervation:
- Dorsal scapular nerve
Action:
-Elevation of the scapula
posterior interosseous
parent: common interosseous
Infraspinatus
attachments:
- Infraspinous fossa of the scapula
- Greater tubercle of the humerus
innervation:
- Suprascapular nerve
Action:
-Lateral rotation of arm
Extensor carpi ulnaris
attachments:
- Lateral epicondyle of humerus and ulna
- Base of 5th metacarpal
innervation:
-Radial nerve
action:
Extension and adduction of wrist
shoulder abduction
C5
Spinal level of Long thoracic
C5, C6, C7
supraspinatus
attachments:
- Supra-spinous fossa of the scapula
- Greater tubercle of the humerus
innervation:
-Suprascapular nerve
Action:
-Initiation of abduction of arm to 15°
coracobrachialis
attachments:
- Coracoid process
- Mid-shaft of humerus
innervation:
-Musculocutaneous nerve
Action:
-Flexion of arm
radial nerve
- from posterior cord
- C5-T1
- serves the posterior (extensor) compartment of the arm and forearm
- runs along radial groove of humerus
- supplies triceps, anconeus, brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris, extensor digitorum, extensor digiti minimi, extensor indicts, abductor pollicis longus, extensor pollicis longus, extensor pollicis brevis, and supinator
- superficial branch is cutaneous only
- deep branch = posterior interosseous nerve is muscular only
- extensive cutaneous field in the posterior arm, forearm, and hand
Shoulder joint
Shoulder joint:
nerve fields and injuries
-deficits that overlap several dermatomes then the problem is probably ij the lower plexus or in a particular nerve branch
medial brachial nerve
medial upper/axillary arm
common interosseous
parent: ulnar artery
long thoracic
origin: c5 to c7 central rami
spinal segments: c5 to c7
motor: serrates anterior
Transverse scapular ligament
Army over (bridge) Navy under (bridge)
Artery goes over and Nerve goes under the ligament
branches from the medial cord
branches from the medial cord
Medial Cord Branches mnemonic
MMMUM “Most Medical Men Use Morphine” - medial pectoral, medial cutaneous nerve of arm, medial cutaneous nerve of forearm, ulnar, the medial root of the median nerve
Arm muscles
Arm muscles
Lonely Three Musketeers
long thoracic: c5, c6, c7
musculocutaneous: c5, c6, c7
Other shoulder muscles:
Other shoulder muscles:
latissimus dorsi (thoracolumbar fascia
attachments:
- Thoracolumbar fascia to lower thoracic vertebra and iliac crest
- Intertubercular sulcus of the humerus
innervation:
-Thoracodorsal nerve
Action:
-Adduction, medial rotation, and extension of the arm
finger abduction/adduction
T1
Brachioradialis
attachments:
- Supracondylar ridge of humerus
- Distal radius
innervation:
-Radial nerve
action: Flexion of forearm when forearm is mid-pronated
baby hand is pulled while existing the womb; nerve deficient does not improve w/age. Describe muscle findings:
- elevation of scapula: normal
- abduction of arm: normal
- flexion of the forearm: normal
the above three are innervated by muscular cutaneous nerve
- opposition of thumb= decreased
- abduction of fingers= decreased
musculocutaneous nerve
- from lateral cord
- C5, C6, and C7
- serves the flexor compartment of the arm
- supplies: biceps brachii, coracobrachialis, and brachialis
- ends as the cutaneous nerve of the forearm
Abductor pollicis longus
attachments:
- Ulna, radius and interosseous membrane
- Base of 1st metacarpal
innervation:
-Radial nerve
action:
Abduction and extension of the thumb
deltoid
attachments:
- Spine and acromion of the scapula; lateral clavicle
- Deltoid tuberosity of humerus
innervation:
- Axillary nerve
Action:
- Abduction of arm (from 15° to 90°)
- Flexion of arm (anterior fibers)
- Extension of arm (posterior fibers)
thoracodorsal
origin:
spinal segments: c6 to c8
motor: latissimus dorsi
Abductor pollicis brevis
attachments:
- Carpals and flexor retinaculum
- Proximal phalanx and extensor hood of thumb
innervation:
-Recurrent branch of median nerve
action: Abduction of thumb
anular ligament
- attached to the radial notch of the ulna
- loops around the head and neck of the radius