UE: shoulder, bones, axilla and brachial plexus

Question 1

bones

Answer 1

shoulder girdle: scapula and clavicle

upper extremity: humerus, radius and ulna, carpals, metacarpals, phalanges

Question 2

Scapula

Answer 2

know theL

glenoid cavity

infraspinous and supraspinous and subscapular fossae

scapular spine

acromian process

coracoid prorcess

suprascapular notch

Question 3

Scapula pic

Answer 3

be sure to understand for the unit … look at it from Exam 1 material

Question 4

Describe the humerus parts

Answer 4

Head: attaches to glenoid cavity of scapula –

greater tubercle and lesser tubercle…intertubercular groove– biceps tendon

anatomical neck vs surgical neck

detoid tuberosity- deltoid attaches

condyles:

Question 5

Humerus pic

Answer 5

Question 6

tramau anatomical neck vs the surgical neck

Answer 6

any trauma applied to the humerus will like fracture at the surgical neck intead of the anatomical because it is much thinner

Question 7

deltoid tuberosity

Answer 7

deltoid attaches here…. where deltoid inserts on the humerus and pulls on it

Question 8

condyles

Answer 8

capitulum (lateral) –> radium

trochlea (medial) –> ulna

epicondlyes (lateral and medial)

coronoid fossa- anterior

olecranon fossa-posterior

Question 9

sternoclavicular

Answer 9

should joints

between clavicle and manubrium, only attachment between UE and axial skeleton

stabilized by ligaments… not a ton of movement

Question 10

acromioclavicular

Answer 10

between acromion of scapula and clavicle

Question 11

glenohumeral

Answer 11

ball and socket joint between head of humerus and glenoid cavity

glenoid cavity is lined by catilaginous glenoid labrum– joint is supported by ligaments, rotator cuff muscles, and bursae (both continuous and separated from joint capsule)

flexion, extension, abduction, adduction, medial/lateral rotation, circumduction …..

glenoid labrum with cup shape that allows for the head of humerous to plug into something

Question 12

bones of the forearm

Answer 12

radius and ulna

Question 13

radius

Answer 13

lateral forearm bone, thumb side

Head= capitulum

radial tuberosity

styloid process

Question 14

radial tuberosity

Answer 14

bicep muscle will attach… movement of the radius are different than movement of the ulna….

radius is able to pivot

The proximal end the radius is small and the ulna is kind of big… at the distal end, the radius is large and the ulna is small…

Question 15

ulna

Answer 15

medial forearm bone, pinky side

Trochlear notch

olecranon process –> olecranon fossa

coronoid process –> coronoid fossa

syloid process (looks like a pen)… these ends are where the wrist joint is going to form between the carpals and distal radius

Question 16

interosseous membrane

Answer 16

ligament that hold the radius and ulna together in between… helps to divide them into anterior and posterior muscle

Question 17

pivoting of the forearm

Answer 17

pivoting around the elbow… allows for flexion & extension and pronation & supination

radius is not locked in place so it can pivot

radius freely rotate along the capitulum (pivot joint) to allow for the frearm pronation and supination… in the pronated position the ulna and radius are crossed

radius and ulna attached to each other at distal and proximal ends

Question 18

3 joints of the elbow

Answer 18

1. TRochlear notch of ulna and trochlea of humerus
2. head of radius and capitulum of humerus
3. head of radius and radial notch of the ulna

Question 19

what joint allows for supination/pronation (pivot)

Answer 19

proximal radio-ulna joint

so head of radium and radial notch of the ulna

Question 20

what joints all for flexion and extension?

Answer 20

trachlear notch of ulna and trohclea of humerus

head of radius and capitulum of humerus

Question 21

anular ligament

Answer 21

ligaments that support the elbow joint that wraps around the radial head

Question 22

describe the hand bones

Answer 22

Carpals: (scaphoid, lunate, triquetrum, pisiform) *trapezium, trapezoid, capitate, hamate

metacarpals (5 on each hand

Phalanges: proximal, middle, distal (except thumb-proximal and distal only

Question 23

Carpal arch

Answer 23

capals form an arch… covered by the flexor retinaculum… tissue makes the carpal tunnel

Question 24

carpal bones arrangement

Answer 24

• *Thumb side — scaphoid, lunate, triquetrum and pisiform**
• (piriformis is a sesamoind bone = a bone embedded in a tendon…not attached to other bone … wrapped about a tendon)*
• *Next row… trapezium, trapezoid, capitate, and hamate**
• Hamate has a hook*
• TRapezium is for the thumb.. forms the attachment between the carpals and the metacarpals of the thumbs… special joint= saddle joints… make opposable thumbs*

Some lovers try position that they can’t handle

Question 25

Wrist joints and joints in the hand

Answer 25

* wrist joints (radius and ulna-- with articular disc- wiht scaphoid, lunate and triquetrum of the carpals * capals joints; carpal have joints between themselves * carpometacarpal joints-- the saddle joint between the first metacarpals and the trapezium allow for special movement of the thumb * metacarpophalangeal joint (MCP)-- betwen metacarpals and proximal phalanges * interphalangeal joints: proximal (PIP) and distal (DIP)

Question 26

back muscle

Answer 26

* Latissimus dorsi: originated on the spine and inserted onto the front of humerus... adduction, extension and medial rotation * Trapezius: originate on the spine and the head and inserted on the side of the shouldner on the spine of acromin...move shoulder up and down and retraction of scapula * Rhomboid major and minor: retract scapula * Pectoralis major and minor: starts on the sternum and inserts on the front of the humerous, does adduction and medial rotion and flexion * serratus anterior: protraction

Question 27

deltoid

Answer 27

triangular muscle from scapula and clavicle to humerus at the deltoid tuberosity action: arm abduction (beyond supraspinatus motion) innervation: axillary nerve But can’t initiate abduction... it can’t do the first 15 degrees, it has to be helped first (by the supraspinatus) and then does the rest of abduction Ex. Flu shot in the deltoid... if you feel sore when you continue to abduct past 15 degree and then deltoid takes over for the rest of it

Question 28

Which one doens’t get innervation from the brachial plexus?

Answer 28

The trapezius is innervated by a spinal accessory nerve...cranial nerve that come from the head

Question 29

what are the muscles over the scapula

Answer 29

1. infraspinatus * originates on the infraspinatus fossa and inserts on the humerus * allows humerus to rotate laterally * innervation is from the suprascapular nerve off the bracial plexus 2. supraspinatus * originates on the supraspinatus fossa and inserts on the humerus * abducts the humerus--does the first 15 degrees * innervation is from the suprascapular nerve off the bracial plexus

Question 31

muscles over the scapula

Answer 31

posterior side: teres major and minor minor superior to major action: minor= lateral rotation fo the arm major= same as lat dorsi, same insertion....medial rotation, extension, adduction innervation: minor: axi

Question 32

teres major

Answer 32

action: same as lat dorsi.. same inserton - medial rotation, extension, adduction innervation: lower subscapular nerve origin is is the infraspinatus fossa but insertion front of humerus...allows adduction. medial rotatio nand extension

Question 33

teres minor

Answer 33

next to infrapinatus minor: lateral rotation of the arm innervation: axillary nerve

Question 34

muscle over the scapula: subscapularis

Answer 34

in the subscapular fossa on the anterior side of the scapula medial rotation of the arm innervated by the subscapular nerve

Question 35

Latissimus dorsi

Answer 35

between the two majors: between the pec major and teres major.....the la-di between the two majors

Question 36

muscles associated with the scapula chart

Answer 36

stars mean it's part of the rotator cup muscle...

Question 37

Blood supply to the axilla

Answer 37

axillary artery comes from the subclavan artery.. up through thoracic inlet over rib 1, ## Footnote curve around rib 1 under the clavical and go into axilla and change name to the axillary artery Axillary vein becomes subclavian vein goin in the opposite direction

Question 38

important structures that pass from the neck to the upper extremety

Answer 38

bracial plexus here comes from the neck and goes through the opening of the axilla and go down to the upper limb and innervates all the muscles that are in the upper limb and move the upper limb and the muscles in the back

Question 39

Brachial pl

Question 40

describe the axilla boundaries

Answer 40

inlet anterior wall medial wall lateral wall posterior wall floor

Question 41

describe the inlet of the axilla boundaries

Answer 41

defined by bone clavicle- anterior scrapula-posterir rib 1- medial

Question 42

describe the anterior wall of the axilla boundaries

Answer 42

clavipectoral fascia (subclavious and pectoralis minor) pectoralis major

Question 43

describe the medial wall of the axilla boundaries

Answer 43

toracic wall and serratus anterior ribs and the serrated muscle

Question 44

describe the later wall of the of the axilla boundaries

Answer 44

humerus

Question 45

describe the posterior wall of the axilla boundaries

Answer 45

muscle over the scapula and triceps muscle

Question 46

describe the floor of the axilla boundaries

Answer 46

lateral to the floor the axilla is continuous with the anterior compartment of the arm

Question 47

overall picture of the axilla boundary

Question 48

axillary artery

Answer 48

* the right subclavial artery passes under the clavical and lateral to rib 1==\> becomes axillary artery

Question 49

tell me about the divisions of the axillary arteyr

Answer 49

1. proximal to pectoralis minor * superior thoracic 2. posteiror to pec minor * thoraco-acromial * lateral thoracic 3. distal to pec minor * subscapular * anterior and posteral cicumflex humeral (go around humerous and meet in the middle) the axillary artery continues as the brachial artery in the arm

Question 50

the brachial artery

Answer 50

as the axillary artery passes the borader of teres major, it becomes the brachial arty.....travels down the front of the arm...anterir compartment near the elbow it divides into the radial and ulna arteries has to give a branch to supply the back of the arm (profunda brachii) which supplies the posterior arm... runs with the radial nerve used for blood pressure measurements note that the branches of the bracial artery suppy the elbow in addition to other branches

Question 51

axillary viens

Answer 51

axillary vein accompanies the axillary artery and becomes subclavian vein after passing rib 1 -- deep veins are the bracial vein that accompany the brachial artery-- **Cephalic vein** drains posterior later side of UE and passes in the **deltopectoral groove** between the deltoid and pectoralis major muscle before it enter the axillary vein small brachial veins accompany brachial arty, but superfical structures are drained by cephalic (lateral) and basilic (medial veins) *veins originate near the hand and travel up the forearm.. cephalic vein and basilic vein make up most of the axillary artery*

Question 52

axillary nodes

Answer 52

present in the axilla region... have many different groups that drain different things... Drains the UE and parts of the upper back, shoulders, neck and most of breast divided into groups based on location in the axilla *all drain up to the top of the axilla and drain up to the neck... all lymph ends up at the junction subclavian and internal jugular*

Question 54

Bracial Plexus

Answer 54

complex collection of nerves from the spinal cord traveling through the neck and axilla to innervate muscles and skin in the UE... formed from anterior (ventral) rami of C5-T1 spnal segments divides ito prximal to distal: roots trunks divisions cords

Question 55

brachial plexus... more info just read

Answer 55

comes from cervical outflow.. C5-T1 ... starts in the neck and travels to the upper limbs into the axillary inlet between the clavical and scapula and the first rib and then go through the axilla and then through the axilla and then it's going to branc and give different branches that are going to supply all the muscle in the upper limb that move the upper limb in the upper limb but also on the chest wall and that in the upper back expect for trapezius which gets the spinal accessory nerve

Question 56

Brachial plexus.. cords and roots

Answer 56

roots: C5 -T1.. exit from the spinal cord and contributes to the brachial plexus or anterir rami of the 5 outflow segmens that make the roots... trunk: superior, middle, inferior ... passes from neck to axilla division: anterior and posterior ... post (supply the posterior compartments), ant (medial and lateral cords) cords: lateral, posterior, medial most major nerves of the UE branch off the cords

Question 57

Nerves of the brachial plexus

Answer 57

Nerves off the roots= dorsal scapular and long thoracic nerve off of the trunks= supracscapular and nerve to subclavious t**there are no nerves off the divisions**

Question 58

long thoracic nerve

Answer 58

off the roots... from multples of these and travels on the throacic wall and innervates serratus anterior

Question 59

dorsal scapular

Answer 59

nerve off the roots innervates the rhombids

Question 60

nerve to subclavious

Answer 60

under clavical...

Question 61

suprascapular nerve

Answer 61

no direct branches from the division in trunk have inforior and superior ... which does anterior side of scapula and the lower one does the terese major

Question 62

lateral cord

Answer 62

lateral pectoral nerve that innervates the pectoralis major...from the lateral cord we have the terminal nerve so the musculocutanous cord comes from the lateral cord lateral cord contributes to 1/2 of the innervation to the median nerve

Question 63

medial cord

Answer 63

has medial pectoral nerve... innervate pec major and minor has 2 cutaneous nerve (sensory for skin) ... medial cutaneous of the arm and medial cutaneous of the forearm .. medial side of arm and foreamr contributes the ulna nerve and 1/2 median nerve

Question 64

posterior cord

Answer 64

gives axillary nerve to innervate the deltoid and teres minor so the axillary nerve is going to travel to the back of the scapula where teres minor is located and then we have tthe thoracordosl never to innervate the lats in the back

Question 66

nerves off of the cords

Answer 66

* lateral: * lateral pectoral * musculocutaneous * median * posterior * thoracodorsal * superior and inferior subscapular * **axillary** * **radial** * ​Medial * **​****median** * **​**medial pectoral * medial cutaneous nerves ofthe arm and forearm * **ulnar**

Question 67

chart

Answer 67

Question 68

identifying the braches

Answer 68

axillary runs between the anterior and poseterior division of the brachial plexus Find the M of the bracial plexus from lateral to medial: Musculocutanous, median , ulna posterior cord behind axillary artery... radial nerve

Question 69

cutaneous innervation of the upper limb

Answer 69