The upper extremity Flashcards
Extrinsic muscles of shoulder
Trapezius
Latissimus Dorsi
Levator Scapulae
Rhomboid Major and Minor
Trapezius function and innervation
Spinal Accessory Nerve (Cranial nerve 11)
elevates, depresses and retracts the scapula.
rotate the glenoid cavity superiorly
Lat dorsi function and innervation
To extend, adduct and medially rotate the arm Thoracodorsal nerve (C6-C8)
Levator Scapulae function and innervation
Elevates the scapula
Dorsal Scapular nerve, cervical nerves C3 C4
Rhomboid major/minor function and innervation
Retract scapula and rotate it to depress glenoid cavity
Dorsal Scapular Nerve (C4-C5)
Intrinsic Muscles of Shoulder
Deltoid Supraspinatus Infraspinatus Teres Minor Teres Major Subscapularis
Deltoid function and innervation
anterior part: Flexes and medially rotates,
middle part: abducts
posterior part: Extends and lateral rotates
Axillary nerve (C5, C6)
Supraspinatus function and innervation
Inserts into greater tubercle of humerus, initiates abduction. IS NOT a rotator even though labelled a rotator cuff muscle. Suprascapular nerve (C5-C6)
Infraspinatus function and innervation
Inserts into greater tubercle of humerus, laterally rotates arm. Suprascapular nerve (C5-C6)
Teres Minor function and innervation
Inserts into greater tubercle of humerus Laterally rotates arm Axillary Nerve (C5, C6)
Teres Major function and innervation
Inserts into intertubercular groove of humerus.
Adducts and medially rotates arm
Lower Subscapular nerve (C5, C6)
Subscapularis function and innervation
Upper and lower subscapular nerve (C5-C6)
Inserts into lesser tubercle of humerus
Medially rotates and adducts arm
Rotator Cuff Muscles
Supraspinatus –> Superior to scapula
Infraspinatus –> Posterior to scapula
Teres Minor –> Posterior to scapula
Subscapularis –> Anterior to scapula
Shoulder (glenohumeral) ligaments
Coracoacromial ligament –> creates a vault for the head of the humerus
Three glenohumeral ligament –> between glenoid fossa of scapula and humerus
Coracohumeral ligament
Glenoidal labrum
Sacroacromial bursa location
Under acromion, above supraspinatus ligament. Can communicate with joint cavity if the ligaments break down.
Possible movements of arm
abduction, adduction, flexion, extension, medial rotation, lateral rotation
What passes through quadrangular space
Axillary Nerve
Posterior Circumflex Humeral Artery
What passes through triangular interval
radial nerve and deep artery of arm
What does the long head of the biceps pass under?
Transverse humeral ligament
anatomical vs. surgical head of humerus
Anatomical head is above surgical head (narrower here)
What does the axillary sheath contain?
cords of brachial plexus, axillary vein(medial) and artery
Anterior compartment of arm
Biceps brachii Brachialis Coracobrachialis All flexors All innervated by musculocutaneous nerve (C5-C7)
Posterior compartment of arm
Triceps brachii (main extensor)
Anconeus (assists in extension)
Extension of elbow
Innervated by Radial Nerve (C5-T1)
Biceps Brachii function
Supinates forearm and flexes elbow.
Insertion is the radius via the bicipital aponeurosis.
Coracobrachialis function
Flexes and adducts the shoulder. Insertion is humerus
Brachialis function
Main flexor of the elbow. Insertion on ulna.
Anterior Fore-arm muscles lateral to medial, innervation
All flexors Receive median nerve innervation Superficial (lateral to medial): Pronator Teres Flexor Carpe Radialis Palmaris Longus Flexor Carpe Ulnaris Flexor digitorum superficialis (actually deep to top four) Deep: Flexor Pollicis Longus Flexor digitorum Profundus Pronator Quadratus (deep to flexor pollicis longus)
Deep anterior fore-arm muscles
Flexor Pollicis Longus (lateral)
Flexor digitorum Profundus (medial)
Pronator Quadratus (deep to flexor pollicis longus)
Superficial anterior fore-arm muscles
lateral –>medial
Pronator Teres Flexor Carpe Radialis Palmaris Longus Flexor Carpe Ulnaris Flexor digitorum superficialis (actually deep to top four)
Common Flexor Tendon function
Attaches all superficial fore-arm flexors to medial epicondyle of humerus
Pronator Teres function
pronates and flexes forearm, attaches to radius
Flexor Carpe Radialis function
Flexes wrist, abducts wrist
Palmaris Longus function
holds plantar aponeurosis tight, flexes hand
Flexor Carpe Ulnaris function and innervation
Flexes wrist, adducts wrist
Innervated by ulnar nerve, exception to median nerve rule of anterior fore-arm
Flexor Digitorum Superficialis function
flexes proximal IP joint
Flexor Pollicis Longus function
Flexes both phalanges of thumb
Flexor Digitorum Profundus function and innervation
Flexes distal IP joint, also flexes wrist and metacarpal joint
Lateral part median nerve, Medial part ulnar nerve.
Pronator quadratus function
Initiates pronation of fore-arm, holds radius and ulna together
Flexor Retinaculum function
Creates roof of carpal tunnel
Contents of carpal tunnel
9 tendons + nerve
Flexor digitorum superficialis and profundus
Flexor pollicis longus
median nerve
What does the lateral cutaneous nerve of the forearm branch off of
Off of the Musculocutaneous nerve, it becomes cutaneous in the forearm
Brachioradialis innervation, function, location
Innervation: Radial Nerve
Location: Posterior compartment
Function: Flexor
Evolutionarily might have been an extensor, which explains its innervation
position of ulnar nerve at elbow
Very superficial, just posterior to medial epicondyle –> what causes the funny bone sensation
Posterior compartment of forearm, lateral to medial
Radial nerve innervation Mostly extensors of wrist Superficial: Brachioradialis (actually flexor of forearm) Extensor Carpe Radialis longus Extensor Carpe Radialis brevis Extensor digitorum Extensor Digiti Minimi Extensor Carpe Ulnaris Anconeus Deep: Supinator Abductor Pollicis Longus Extensor Pollicis Brevis Extensor Pollicis Longus Extensor Indicis
Superficial posterior fore-arm
Extensor carpe radialis longus Extensor carpe radialis brevis Extensor digitorum Extensor digiti minimi Extensor carpe ulnaris
Deep posterior fore-arm
Supinator Abductor pollicis longus Extensor pollicis brevis Extensor pollicis longus Extensor Indicis
Extensor carpi radialis longus (ECRL)
Extends/abducts wrist
Extensor carpi radialis brevis (ECRB)
Extends/abducts wrist
Extensor digitorum (ED)
Extends the proximal phalanges of the four fingers
Extensor digiti minimi (EDM)
Extends metacarpals, secondarily at proximal IP
Extensor carpi ulnaris (ECU)
Extends hand w/ extensor carpe radialis longus/brevis
Adducts hand w/ FCU
Supinator
Prime mover for slow, unopposed supination, esp. w/ forearm extended
Abductor pollicis longus (APL)
Acts w/ abductor pollicis brevis
Extensor pollicis brevis (EPB)
Extends MCP joint (+ also carpometacarpal joint)
Extensor pollicis longus (EPL)
Extends interphalangeal joint (+ also other 2 thumb joints)
Extensor indicis
Extends proximal interphalangeal joint
Three radio-ulnar joints names and types
Proximal and Distal are synovial
Middle is syndesmosis
Carpal Bones
Scaphoid Lunate Triquitrium Pisiform Hamate Capitate Trapezium Trapezoid So Long To Pinky Here Comes The Thumb
What bone is Pisiform associated with
Triquitrium
What bones do the radius articulate with
The Scaphoid and Lunate
Joints between the carpal bones
anterior, posterior, interosseus ligaments
Thenar muscles and innervation
On the thumb side, innervated by the median nerve
Abductor pollicis brevis (lateral)
Flexor Pollicis brevis (medial)
Opponens pollicis (deep)
Hypothenar muscles and innervation
On the pinky side, innervated by the ulnar nerve
Abductor digiti minimi (medial)
Flexor digiti minimi (lateral)
Opponens digiti minimi (deep)
Adductor compartment
Adductor pollicis, has two heads
ulnar nerve
Deep to abductor and flexor pollicis brevis
Lumbrical muscle innervation and function
Bye-bye motion, flex metacarpals
1-2 are median, 3-4 are ulnar
Interosseous muscles
All ulnar nerve
Dorsal ABduct –> Abduct digits 2-5
Palm ADduct –> Adduct digits 2, 4, 5. Digit 3 cannot be adducted because it is in the middle.
PAD DAB
Anatomical Snuffbox boundaries
Anterior (towards palm) –> Abductor Pollicis Longus , Extensor Pollicis Brevis (both posterior fore-arm)
Posterior (towards dorsum of hand) –> Extensor Pollicis Longus (also posterior fore-arm)
Contains radial artery, radial styloid process, base of 1st metacarpal, scaphoid, trapezium
Three parts of elbow joint
trochlea of humerus to trochlear notch of ulna –> hinge joint
Capitulum of humerus to head of radius –> gliding joint
Head of radius to radial notch in ulna –> rotation joint
Ligaments of elbow joint
Annular ligament of radius (goes all the way around the radius, holds it in place)
Ulnar collateral ligament
Radial Collateral ligament
Collateral ligaments attach each bone to the humerus
Wrist joint
Radius articulates with scaphoid and lunate
Branches of axillary artery
Superior Thoracic
Thoracoacromial
Lateral Thoracic
Subscapular –> which turns into thoracodorsal
anterior and posterior circumflex humeral arteries
When does the axillary artery turn into the brachial artery
After the teres major
Three exceptions to brachial plexus root values
All exceptions off posterior cord
Axillary Nerve C5, C6
Thoracodorsal Nerve C6-C8
Upper and Lower subscapular nerve C5-C6
What does the axillary nerve become in the arm
The lateral cutaneous nerve of the arm
What does the radial nerve become in the fore-arm
The posterior cutaneous nerve of the fore-arm
What does the musculocutaneous nerve become in the forearm
The lateral cutaneous nerve of the fore-arm
What muscles in hand are innervated by median nerve
1st and 2nd lumbricle Opponens pollicis Abductor pollicis brevis Flexor pollicis brevis Meat LOAF
Lateral femoral cutaneous
L2-L3
Genitofemoral
L1-L2
Iliohypogastric
T12-L1
Ilioinguinal
L1
Pudendal
S2-S4
Common peroneal
L4-S2
Tibial
L4-S3
Inferior gluteal
L5-S2
Superior gluteal
L4-S1
Femoral
L2-L4
Obdurator nerve
L2-L4
Deep peroneal
L4-S2
Superficial peroneal
L5-S2
