Tutorial 1: Upper Limb, Wet Lab Flashcards
What is the axilla?
The pyramidal space below the shoulder joint
It provides a passageway for vessels going to the upper limb
What forms the 4 walls of the axilla?
Anterior wall - Pectoralis major and minor muscles
Posterior wall - Subscapularis, teres major and latissimus dorsi muscles
Medial wall - Serrates anterior muscle and thoracic wall
Lateral wall - Intertubercular groove of the humerus
What structures exist in the axilla?
Axillary artery Axillary vein Brachial plexus Biceps brachii Coracobrachialis Axillary lymph nodes
What is the axillary artery a continuation of?
Subclavicular artery
What anatomically marks the change from the subclavian to the axillary artery?
The lateral border of the 1st rib
What follows on from the axillary artery?
Brachial artery
What anatomically marks the change from the axillary to the brachial artery?
Lower border of the teres major muscle
When may compression of the axillary artery be necessary?
When profuse bleeding occurs
What spinal nerve roots supply the brachial plexus?
C5. C6, C7, C8, T1
Which nerve roots form the upper trunk of the brachial plexus?
C5, C6
What is Erb’s point and what is it’s relevance?
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Which group of muscles are affected by Erb’s palsy (injury to upper trunk)?
Paralysis of: Biceps brachialis Brachialis Coracobrachialis Brachioradialis Deltoid
What segmental roots of the brachial plexus contribute to he lower trunk?
C8, T1
See brachial plexus pg 9 of anatomy book
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What is Klumpke’s palsy?
Injury to the lower trunk of the brachial plexus
Intrinsic muscles of the hand and ulnar flexors or the wrist and fingers
Injury can be caused by undue abduction of the arm
What are the cords of the brachial plexus?
Lateral cord
Medial cord
Posterior cord
What are the branches of the lateral cord of the brachial plexus?
Lateral pectoral nerve
Lateral root of the median nerve
Musculocutaneous nerve
What are the branches of the medial cord of the brachial plexus?
Medial pectoral nerve Ulnar nerve Medial root of the median nerve Medial cutaneous nerve of the arm Medial cutaneous nerve of the forearm
What are the branches of the posterior cord of the brachial plexus?
Thoracodorsal nerve Axillary nerve Superior subscapular nerve Inferior sub scapular nerve Radial nerve
Look at diagram on pg 10 for arterial supply to arm
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Look at the diagram on pg 11 for the venous drainage of the arm
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What veins arise from each side of the dorsal venous arch?
Lateral side - cephalic
Medial - basilic
What does the median cubital vein do?
Shunts blood from the cephalic to the basilic vein
Where is the clavicle at it’s weakest and why?
Junction of the medial 2/3 and lateral 1/3
Weight is displaced inferiorly at the lateral end due to the pectorals major
What kind of joint is the acromioclavicular joint?
Synovial plane
What kind of joint is the sternoclavicular joint?
Saddle synovial
What is scapohumeral rhythm?
Simultaneous movement of the glenohumeral joint and scapula to provide a smooth extension to the range of movement
What muscles cause elevation of the scapula?
Upper trapezius
Levator scapulae
Rhomboids
What muscles cause depression of the scapula?
Lower trapezius
Pectoralis major
Pectoralis minor
What muscles cause protraction of the scapula?
Serratus anterior
Pectoralis major
Pectoralis minor
What muscles cause protraction of the scapula?
Serratus anterior
Pectoralis major
Pectoralis minor
What muscles cause retraction of the scapula?
Middle trapezius
Rhomboids
What muscles cause rotation of the scapula elevating the glenoid cavity?
Superior trapezius
Pectoralis minor
Superior serratus anterior
What muscles cause rotation of the scapula depressing the glenoid cavity?
Inferior trapezius
Inferior serratus anterior
See page 19 of booklet for muscles which act to move the scapula
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See page 19 of booklet for muscles which act to move the scapula
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What kind of joint is the glenohumeral joint?
Synovial ball and socket
What is the function of the glenoid labrum?
It is a cartilage that deepens the glenoid fossa
What ligaments support the glenohumeral joint?
Coracoacromial ligament
Coracohumeral ligament
Glenohumeral ligaments
What aspect of the glenohumeral joint is strengthened by the coracohumeral ligament?
Superior
What aspect of the glenohumeral joint is strengthened by the glenohumeral ligament?
Anterior
What aspect of the glenohumeral joint is strengthened by the glenohumeral ligament?
Anterior
What makes up the coraco-acromial arch and what is it’s function?
Acromion
Coracoid process of the scapula
It prevents superior displacement of the humeral head
What is the function of bursae?
To provide cushioning around a joint
Rotator cuff muscle diagram pg 23 of booklet
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What are the actions of the rotator cuff muscles?
Abduction, lateral and medial rotation
What is the action of the anterior fibres of the deltoid?
Medial rotation and flexion of the shoulder joint
What is the action of the middle fibres of the deltoid?
Abduction of the at the shoulder joint
What is the action of the posterior fibres of the deltoid?
Extension and lateral rotation of the shoulder joint
What nerve supplies the deltoid muscle?
Axillary nerve
What is the action of the pectorals major on the shoulder joint?
Adduction and medial rotation
What is the deltopectoral triangle and what can be found in that space?
Triangle formed by the clavicle, deltoid and pectorals major
Subclavian vein
What is the nerve supply for the serratus anterior?
Long thoracic nerve
What clinical sign occurs as a result of injury to the long thoracic nerve?
Winged scapula
How is the long thoracic nerve often injured?
Insertion of chest drain
What effect does contraction of the superior fibres of the trapezius have on the scapula?
Elevation
What effect does contraction of the middle fibres of the trapezius have on the scapula?
Retraction
What effect does contraction of the inferior fibres of the trapezius have on the scapula?
Depression
What innervates the trapezius muscle?
Accessory nerve (CNXI)
What action does the teres major have on the shoulder joint?
Adducts and medially rotates
What is the action of the latissimus dorsi on the shoulder joint?
Extension
Adduction
Medial rotation
What muscles cause flexion of the shoulder joint?
Biceps brachii
Pectoralis major
Anterior deltoid
Coracobrachialis
What muscles cause extension of the shoulder joint?
Posterior deltoid
Latissimus dorsi
Teres major
What muscles cause adduction of the shoulder joint?
Pectoralis major
Latissimus dorsi
Teres major
What muscles cause abduction of the shoulder joint?
Middle part of the deltoid
Supraspinatus
Trapezius
Serratus anterior
What muscles cause medial/internal rotation of the shoulder joint?
Subscapularis
Lattisimus dorsi
Pectoralis major
Teres major
What muscles cause lateral/external of the shoulder joint?
Teres minor
Infraspinatus