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Musculoskeletal > TBL13 > Flashcards

TBL13 Flashcards

1
Q

Pectoral muscles are derivatives of what?

A

parietal mesoderm

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2
Q

Pectoralis major attachments

A

sternocostal and clavicular heads of the pectoralis major attach to the sternum, superior six costal cartilages, and clavicle proximally and to the humerus distally

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3
Q

Pectoralis major function

A

simultaneous contraction of the two heads adducts the upper extremity and medially rotates the arm at the glenohumeral joint

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4
Q

Serratus anterior attachments

A

attaches to lateral portions of the 1st to 8th ribs proximally and to the medial border of the scapula distally

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5
Q

Serratus anterior function

A

protracts the scapula when reaching for something and recall the trapezius and rhomboids retract the protracted scapula

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6
Q

Pectoralis minor attachments

A

deep to the pectoralis major, attaches to the 3rd to 5th ribs proximally and to the coracoid process of the scapula distally

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7
Q

Pectoralis minor function

A

pectoralis minor stabilizes the scapula against the posterior thoracic wall during protraction

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8
Q

Serratus anterior with the superior and inferior parts of the trapezius synergistically?

A

rotate the scapula upward allowing the deltoid to fully abduct the upper extremity from the horizontal plane

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9
Q

Lateral pectoral nerve

A

innervates the clavicular head of the pectoralis major

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10
Q

Medial pectoral nerve

A

innervates both the sternocostal head and the pectoralis minor

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11
Q

Long thoracic nerve

A

innervates the serratus anterior

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12
Q

Which muscles are absent or partially lost in the Poland sequence defect?

A

absence of the pectoralis minor and partial loss of the pectoralis major (usually the sternal head) -> nipple and areola are absent of displaced, fused digits, short digits

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13
Q

Why is the long thoracic nerve vulnerable to injury and how are abduction and rotation at the glenohumeral joint hindered after its injury? How does the winged scapula deformation occur?

A

the long thoracic nerve courses on the superficial aspect of the serratus anterior; after injury, the medial border of the scapula moves laterally and posteriorly away from the thoracic wall -> winged scapula

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14
Q

Deep fascia

A

sheet of dense connective tissue named by the tissue it covers

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15
Q

Pectoral fascia

A

fascia leaves the lateral border of the pectoralis major to become the axillary fascia, which surrounds the neurovascular contents of the axilla

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16
Q

Boundaries of the axilla

A

subscapularis, serratus anterior, and pectoralis major form the posterior, medial, and anterior boundaries, respectively

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17
Q

Axilla connects what to where?

A

determine nerves and blood vessels pass from the root of the neck through the axilla into the upper extremity

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18
Q

Axillary artery

A

continues from the subclavian artery at the lateral border of the first rib and envision its proximal branches (ignore names) supply the pectoralis major and minor and the serratus anterior

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19
Q

Blood supply of the deltoids

A

posterior circumflex humeral and anterior circumflex humeral arteries arise from the axillary artery and anastomose around the humerus to supply the deltoid

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20
Q

Subscapular artery

A

arises from the axillary artery, is a very short artery, then divides into the thoracodorsal artery (latissimus dorsi) and the circumflex scapular artery (teres major and minor)

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21
Q

Circumflex scapular artery

A

supplies the teres major and minor, anastomoses on the posterior surface of the scapula with the suprascapular artery, a branch of the subclavian artery that supplies the supraspinatus and infraspinatus

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22
Q

Dorsal scapular artery

A

another branch of the subclavian artery, supplies the levator scapulae and rhomboids and contributes to the anastomoses on the posterior scapula

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23
Q

Brachial artery

A

axillary artery continues as the brachial artery at the inferior border of the teres major

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24
Q

Where can the axillary artery be ligated without stopping blood flow into the ipsilateral upper extremity?

A

ligated between the 1st rib and subscapular artery; subclavian to suprascapular artery to circumflex scapular artery bypasses

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25
Q

Axillary vein

A

receives venous tributaries corresponding to branches of the axillary artery

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26
Q

Lymphatic vessels of the upper extremity

A

accompany the axillary vein tributaries and drain into the axillary lymph nodes

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27
Q

Efferent lymph vessels from the axillary nodes drain into?

A

drain into the supraclavicular nodes

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28
Q

Efferent lymph vessels from the supraclavicular lymph nodes drain into?

A

drain into the veins in the root of the neck

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29
Q

Which two nerves are at risk during surgical removal of pathologic axillary nodes? Why can removal result in lymphedema?

A

Long thoracic nerve and thoracodorsal nerve; removal of LNs result in lymphedema because lymphatic drainage is impeded

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30
Q

What comprise the roots of the brachial plexus?

A

anterior rami of spinal nerves C5-T1

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31
Q

Organization of brachial plexus starting from closest to vertebral column?

A

root, trunk, division, cord, branches

“Run To Drink Cold Beer”

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32
Q

What form the superior, middle, and inferior trunks of the brachial plexus?

A

C5-C6, C7, C8-T1; respectively

33
Q

What nerve orginates from C5?

A

dorsal scapular nerve

34
Q

What roots generate the long thoracic nerve?

A

C5-C7, “5,6,7 wings to heaven -> wing scapula”

35
Q

What generates the suprascapular nerve?

A

superior trunk

36
Q

What form the lateral, medial, and posterior cords?

A

anterior and posterior divisions of the trunks

37
Q

Deltoid, pectoral, and axillary fasciae continue inferiorly as?

A

brachial fascia that encloses the arm like a snug sleeve

38
Q

Head, neck, and tuberosity of the radius

A

radial tuberosity (biceps long and short heads attach distally)

39
Q

Coronoid process and tuberosity of the ulna

A

brachialis attach distally to both

40
Q

Long head of the biceps attachments

A

intertubercular sulcus guides the long head to its proximal attachment on the supraglenoid tubercle of the scapula and attaches to the radial tuberosity distally

41
Q

Short head of the biceps attachments

A

attaches to the coracoid process proximally and to the radial tuberosity distally

42
Q

Biceps function

A

flexes the forearm, and when walking or running the long head synergizes with the anterior part of the deltoid to flex the arm at the shoulder joint

43
Q

Where is the tendon of the long head of the biceps commonly ruptured and what deformity results?

A

Commonly ruptured in the intertubercular sulcus of the humerus (after wear and tear of an inflammed tendon) -> tears attachment to the supraglenoid tubercle, resulting in the detached muscle belly forming a ball near the center of the distal part of the anterior aspect of the arm (Popeye deformity)

44
Q

Supination and pronation of the forearm

A

Supination - palm up; pronation - palm down

45
Q

Biceps role in supination/pronation

A

flexes the forearm when it is supinated but the biceps becomes the main supinator of the forearm and hand when the forearm is pronated

46
Q

Brachialis attachments

A

attaches to the inferior half of the humerus proximally and to the coronoid process and tuberosity of the ulna distally

47
Q

Brachialis function

A

flexes the forearm when it is either pronated or supinated

48
Q

Coracobrachialis attachments

A

attaches to the coracoid process proximally (deep to the short biceps head) and to the middle third of the humerus distally (medial to the the brachialis proximal attachment)

49
Q

Coracobrachialis function

A

assists the anterior part of the deltoid and long head of the biceps during flexion of the arm at the shoulder joint

50
Q

Musculocutaneous nerve

A

arises from spinal cord segments C5 and C6, eventually branches off from the lateral cord of the brachial plexus -> innervates the biceps, brachialis, coracobrachialis

51
Q

Which spinal cord segments are tested by the biceps tendon reflex?

A

examiner’s thumb firmly on biceps tenon, tap at base of nail bed, positive if involuntary contraction of biceps; tests C5 and C6 spinal cord segments

52
Q

Posterior cord of the brachial plexus branches into what 2 nerves before bifurcating into the terminal branches?

A

thoracodorsal and subscapular nerves

53
Q

Posterior cord of the brachial plexus bifurcates into what 2 nerves?

A

radial nerve and axillary nerve

54
Q

Axillary nerves arises from which spinal cord segments?

A

C5 and C6

55
Q

How does avulsion of roots C5 and C6 typically occur in adults and newborns? How is an affected upper extremity positioned after the onset of Erb­Duchenne palsy?

A

In adults, shoulder hits something and stop while the head and trunk continue to move, leading to an excessive increase in the angle between the neck and shoulder; in newborns, excessive stretching of the neck during delivery; after Erb-Duchenne palsy, upper limb with an adducted shoulder, medially rotated arm, and extended elbow due to paralysis of the deltoids, biceps, and brachialis

56
Q

Lateral cord of brachial plexus generates what nerve and root of the median nerve?

A

lateral pectoral nerve, lateral root of the median nerve

57
Q

Medial cord of brachial plexus generates what nerve and root of the median nerve?

A

medial pectoral nerve, medial root of the median nerve

58
Q

Medial cord continues as what?

A

ulnar nerve

59
Q

Musculocutaneous nerve, median nerve, its lateral and medial roots, and the ulnar nerve create the letter M over the axillary artery

A

Visualize the axillary deep to the ‘M’

60
Q

Brachial artery supplies what muscles?

A

anterior arm; biceps, brachialis, coracobrachialis

61
Q

Deep artery of the arm (profunda brachii) location and supplies?

A

first and largest branch of the brachial artery; accompanies the radial nerve along the radial groove of the humerus to supply the triceps

62
Q

Brachial artery bifurcates where and into what arteries?

A

near the elbow, into the radial and ulnar arteries that supply the forearm and the hand

63
Q

Anastomosis in the arm and elbow

A

collateral branches of the brachial and profunda brachii arteries amastomose with recurrent branches of the radial and ulnar arteries

64
Q

Why is laceration or occlusion of the brachial artery proximal to the profunda brachii artery a surgical emergency?

A

because paralyis of muscles results from ischemia of the elbow and forearm within a few hours

65
Q

Why can the brachial artery be blocked at any level distal to the deep artery of the arm without stopping blood flow to the forearm and hand?

A

because the arterial anastomoses around the elbow provide collateral circulation sufficient for the ulnar and radial arteries

66
Q

What is the normal role of the collateral circulation around the elbow?

A

to allow blood to reach the forearm when flexion of the elbow compromises flow through the terminal part of the brachial artery

67
Q

Capitulum and trochlea

A

capitulum = articulates with the cupshaped depression on the head of the radius, and is limited to the front and lower part of the bone; humeral trochlea = medial portion of the articular surface of the elbow joint which articulates with the trochlear notch on the ulna in the forearm

68
Q

Lateral and medial epicondyles

A

at or above the condyle (round prominence at the end of a bone)

69
Q

Coronoid and olecranon fossae

A

coronoid fossa (anterior); olecranon fossa (posterior)

70
Q

What forms the trochlear notch of the ulna?

A

olecranon and coronoid process

71
Q

Trochlear notch articulates with what?

A

articulates with the trochlea of the humerus

72
Q

Radial head articulates with what?

A

articulates with the capitulum of the humerus

73
Q

When the forearm is flexed, where does the coronoid process move to?

A

coronoid fossa (anterior of humerus)

74
Q

When the forearm is extended, where does the olecranon move to?

A

olecarnon fossa (posterior of humerus)

75
Q

Purpose of radial and ulnar collateral ligments

A

strengthen the lateral and medial sides of the capsule of the elbow joint

76
Q

Anular ligament

A

encircles and holds the head of the radius against the ulna; supports the proximal radioulnar joint that enables supination and pronation of the forearm and hand

77
Q

How does posterior dislocation of the elbow joint typically occur and why is the distal humerus driven anteriorly? Which nerve may be damaged?

A

blow that drives the ulna posterior (fall on their hands with their elbows flexed), distal end of humerus is dirven through the weak anterior part of the fibrous layer of the joint capsule; ulnar nerve may be injuried

78
Q

What is the most common cause of subluxation of the radial head in preschool children? Which ligament is commonly damaged and how is the injury treated?

A

child is suddenly lifted (jerked) by the upper limb while the forearm is pronated (lifting a child); tears the distal attachment of the anular ligament; treat by supination of the child’s forearm while the elbow the flexed, 2 weeks for anular ligament to heal

Musculoskeletal (11 decks)

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