Unit 1 Flashcards
OR: Clavicle, Sturnum, Costal cartilages, external oblique aponeurosis
IN: Lateral lip of the intertubercular groove of humerous
NS: Medial and lateral pectoral nerves
AC: Flexion, adduction, and medial rotation of the arm
Pectoralis Major
OR: 3rd, 4th and 5th ribs
IN: Scapula (Coracoid process)
NS: Medial pectoral nerve
AC: Pulls the shoulder downward and forward; elevates the ribs
Pectoralis minor
OR: First costal cartilage
IN: Clavicle (Inferior surface)
NS: Nerve to subclavius
AC: Depresses the clavicle, stabilizes the sternoclavicular joint
Subclavius
A sheet of fibrous tissue that envelopes the body beneath the skin and/or encloses muscles and groups of muscles
Fascia
Fascia that invests the pectoral muscle and is continuous with the abdominal wall fascia.
Pectoral fascia
Fascia that forms the axilla. The pectoral fascia and clavipectoral fascia leave join laterally to form this
Axillary fascia
Fascia that descends from the clavicle to surround the subclavian muscle and pectoralis minor
Clavipectoral fascia
The lower clavipectoral fascia forms this part of the axilla. It pulls the axillary fascia taught when the UE is abducted.
Suspensory ligament
Fascia that invests each muscle originating from the surface of the scapula, creating a tough fascia compartment.
Scapular fascia
Fascia that surrounds the arm and attaches inferiorly to the epicondyle and olecranon.
Brachial fascia
What extends to the medial and lateral surface of the humerus, and separates the arm into the anterior (flexor) and posterior (extensor) compartments?
Medial and lateral intermuscular septa
What isolates an anterior and posterior compartment in the forearm? (3 answers)
Antebrachial fascia
Interosseous membrane
Lateral intermuscular septa
Causes of compartment syndrome (4 answers)
An injury or procedure which causes bleeding or edema within the compartment
A muscle tear which also causes bleeding
Over use injury which also causes swelling
Inappropriate casting/splinting (too tight)
Symptoms of compartment syndrome
Pain, weakness, swelling
Intervention of compartment syndrom
RICE, or more severe cases my require fasciotomy to avoid myonecrosis.
Innervation landmarks Deltoid: Thumb: 3rd digit: 5th digit:
C5
C6
C7
C8
Superficial and deep veins communicate via:
Perforating veins
Veins begin in the ___ ____ ____ of the hand
dorsal venous plexus
Vein that forms on the radial side of venous plexus and courses proximal on the lateral arm crossing the arm to the delta-pectoral groove.
Cephalic vein
The cephalic vein pierces the _______ fascia to join the ______ vein.
Clavipectoral
Axillary
Vein the begins on the ulnar side of the venous plexus. Courses on the medial aspect of the forearm and arm piercing the brachial vein and form the axillary vein
Basilic vein
This vein crosses the antebrachial fossa to communicate between the cephalic and basilic veins
Medial cubital vein
Lymphatic nodes of the upper limb (4)
Cubital
Humeral
Subscapular
Axillary
Causes of lymphedema (4)
Breast cancer
Trauma
Infection
Decreased mobility
3 groups of shoulder muscles:
Anterior axioappendicular muscles
Posterior axioappendicular muscles
Scapulohumeral muscles
Group of 4 muscles that move the pectoral girdle. Name the muscles
Anterior axioappendicular muscles
pectoralis major
Pectoralis minor
Subclavius
Serratus anterior
Group of muscles that attach the upper limb to the skeleton of the trunk
Posterior axioappendicular muscles
Group of muscles (6) that act of the glenohumeral joint
Scapulohumeral muscles
OR: External surface of lateral 1st-8th/9th ribs
INS: Anterior surface of the medial border of the scapula
INN: Long thoracic nerve
AC: Strong protractor of the scapula. Rotates scapula to elevate glenoid fossa. Stabilized scapula so other muscles can act on UE.
Serratus anterior
Results of long thoracic nerve injury:
Winging and inability to raise arm past horizontal, due to inability to rotate the glenoid.
Upper extremity bones
Clavicle Scapula Humerus Ulna Radius Carpals Metacarpals Phalanges
Bone than ossifies before any other bone in the body
Clavicle
Bones in the pectoral girdle
Clavicle
Scapula
Bones in the free upper limb
Humerus Radius Ulna Carpals (8) Metacarpals (5) Phalanges (14)
Bone that connects the UP appendicular skeleton to the axial skeleton
Clavicle
Sternal (medial) end of the clavicle articulates with ____ at _____ joint
Manubrium
Sternoclavicular
Acromial (lateral) end of the clavicle articulates with the acromion of the ______ at the ______ joint.
Scapula
Acromioclavicular
Only joint holding the UE to the axial skeleton
Sternoclavicular joint
Which side of the clavicle would be thicker on a right handed person?
The right clavicle
Anterior surface of the scapula:
Subscapular fossa
What is the greater scapular notch formed by?
Lateral extension of the acromion
Attachment of inferior part of the middle trapezius
Deltoid tubercle
Shallow, concave oval fossa for articulation of the humeral head
Glenoid cavity
Stout, beak-like process superior to the glenoid fossa
Coracoid process
What does the thickened lateral angle on the scapula support?
The scapular head which supports the glenoid fossa
Where does the humerus articulate?
Glenohemeral joint (scapula) Elbow joint (radius and ulna)
Where on the humerus allows maximum ROM?
Spherical head on the proximal end
Humerus anatomical neck is separated from the head by the _____ ___
Sucapital groove
End of the humerus where greater and lesser tubercles are located, distal extensions of tubercles forming crests, intertubercular groove for the tendon of the long head of biceps
Proximal end
Area of humerus where deltoid tuberosity is located, as well as radial (spiral) groove for the radial nerve and artery
Shaft
Area of the humerus that articulates with the ulna
Trochlea
Area of the humerus that articulates with the radius
Capitulum
What accommodates the olecranon of the ulna (full extension) on the humerus?
Olecranon fossa
What on the humerus accommodates the head of the radius (full flexion)
Radial fossa
Area of the humerus that accommodates the coronoid process of the ulna (full flexion)
Coronoid fossa
Medial condyle is for the ____ attachment
Lateral condyle is for the _____ attachment
Flexor
Extensor
Most common site of fracture on the humerus
Surgical neck
Where do proximal fractures of the humerus occur?
Surgical neck
Key concern of humerus fractures
Neurovascular status
Fractures of humerus- name the associated nerves Surgical neck: Radial groove: Distal end: Medial epicondyle:
Axillary nerve
Radial nerve
Median nerve
Ulnar nerve
Area there the biceps brachial tendon inserts
Radial tuberosity
Which styloid process is longer and larger than the other by approx. 1cm distal?
Radial styloid process
Only the distal ______ articulates with the carpal bones. Name which bones
Radius
Scaphoid and lunate
Massive proximal end of the ulna articulates with the: (2 answers)
Trochlea and head of radius
____ serves as a short, stout lever arm for extension in the ulna
Olecranon
These 2 form the trochlear notch
Coronoid process and olecranon process
Muscle that attaches to the tuberosity of the ulna
Brachialis muscle
Oblique cord proximal to neurovascular hiatus. Transverse the space between the radius and ulna
Interosseous membrane
Purpose of interosseous membrane
Acts to transmit force from the hand to the humerus
Most common site for radius fracture
Middle third
Type of fracture that is a transverse fracture of the distal radius.
Usually from forced dorsalflexion of the hand.
Usually an associated ulnar styloid avulsion fracture
Also known as the dinner fork deformity
Colle’s fracture
Fracture where there is a ventral displacement
Smith’s fracture
Isolated fracture of the radial styloid
Can result from forced ulnar deviation and supination of the wrist
Chauffeur’s fracture
Chauffer’s fracture is typically caused by:
Compression of the scaphoid bone of the hand against the styloid process of the distal radius
Name of carpal bones
Scaphoid Lunate Triquitrum Pisoform Trapezium Trapezoid Capitate Hamate
What does the triquetrum articulate with?
The disc of the radioulnar joint
Fracture most commonly associated from a fall on an open palm
Scaphoid fracture
Fracture associated with injury to the distal ulnar nerve and artery
Hamate
X-ray should be repeated ______ weeks later to confirm scaphoid fracture. Will see _____ ____ .
2
Bone growth
Types of bones in the hand
Carpals Metacarpals Proximal phalanges Intermediate phalanges Distal phalanges
Origin, insertion, innervation action of TRAPS
OR: Medial 1/2 of superior nuchal line, external occipital protuberance, nuchal ligament, spinous sprockets of C7-T12
IN: Spine of scapula, acromion, lateral 1/3 of clavicle
NS: Cranial new XI (spinal accessory), C3-C4
AC: Superior- Elevates and rotates scapula
Middle: Retracts scapula
Inf- Depresses and rotates
OR, INS, NS, AC or Levator scap
OR: TVP of C1-C4 INS: Sup. Medial scapula NS: Dorsal scapular nerve, C3-C4 AC: Elevates scapula Assists in downward rotation of scapula Bilaterally extends neck Unilateral action flexes neck
OR INS NS AC of Rhomboid major and minor
OR: Major- SP of T2-T5
Minor- SP of C7-T1
INS: Maj- Medial border of scapula below the spine
Min- Medial scapula, root of spine
NS: Dorsal scapular nerve
AC: Rectrats scapula, rotates glenoid tubercle down, fixes scapula against thoracic wall
Test of rhomboids
Place hands post. On hips and push elbows back against resistance.
Muscles that serve to position and fix the base o the UE so the limb can function
Post. Axioappendicular muscles
Post. Axioappendicular muscles function in antagonistis and synergistic groups to position the:
Scapuloclavicular unit
Independent innervation of synergistic groups in post. Axioappendicular muscles results in:
Little diminution of function in the face of an isolated nerve injury
Exception of post. Axioappendicular muscles:
Superior trapezius by CN XI- upward rotation of the lateral angle of the scapula
OR, INS, NS, AC of Deltoid
OR: Lateral 1/3 of clavicle, acromion, spine of scapula
INS: Deltoid tuberosity
NS: Axillary nerve (Passes around the surgical neck of humerus and is at risk in fractures of this location, dislocations and traction injuries!**)
AC: Ant- flexes and medically rotates are
Middle: Abducts arm after first 15 degrees
Post- extends and laterally rotates arm
Resists inferior displacement of the humeral head from glenoid fossa
Muscle that does FIRST 15 degrees of arm abduction
Supraspinous
Test for deltoid:
Resist abduction at >15 degrees
Muscle forms the post. Inferior border of the axilla
Teres major
OR, INS, INN, AC of Teres major
OR: Post, inf. Angle of scapula
INS: Medial lip of the intertubercular groove of humerus
INN: Lower subscapular nerve
AC: Adducts arm, medically rotates arm
Test for Teres Major
Palpation of muscle during abduction of the abducted arm
Intrinsic shoulder muscles that form a musculotendinous cuff. There are 4 of these muscles
Rotator cuff muscles (scapulohumeral muscles)
Muscles of the Rotator Cuff muscles (4)
Supraspinatus
Infraspinatus
Subscapularis
Teres minor
Tonic contraction of the rotator cuff muscles help keep the _______ _____ in the _____ ______
Humeral head in the glenoid cavity
OR, INS, NS, AC of supraspinatus
OR: supraspinus fossa
INS: Sup. Facet of the greater tubercle of humerus
NS: Suprascapular nerve
AC: Abducts arm first 15 degrees
OR, INS, NS, AC of infraspinatus
OR: Infraspinus fossa
INS: Middle facet of greater tubercle of humerus
NS: Suprascapular nerve
AC: Lateral rotation of the arm
Test of infraspinatus
Flex at the elbow, adductor arm and laterally rotate against resistance
OR, INS, NS, AC of Teres minor
OR: Lateral border of scapula
INS: Inf. Facet of greater tubercle of humerus
NS: Axillary nerve
AC: Lateral rotation of the arm
Teres minor is mostly hidden by the:
Deltoid
T/F:
Muscles acting on the humerus move the scapula
False
OR, INS, NS, AC of Subscapularis
OR: Subscapular fossa
INS: Lesser tubercle of humerus
NS: Upper subscapular nerve, Lower subscapular nerve
AC: Medial rotation of the arm
Rotator cuff wear and tear is especially in the:
Supraspinatus
Rotator cuff is most often found in:
Throwing athletes
Uneducated, ill-informed, weekend athletes, body builders, weight lifters who neglects the RCs.
Stage 1 of RC injuries
Edema and hemorrhage, most common people younger than 15
Stage 2 of RC injuries
Fibrosis and tendinitis, most common in people aged 25-40
Stage 3 of RC injuries
Tears of cuff, most common in people over 50
Truncated pyramidal space located medial and interior to the glenohumeral joint and superior to the axillary fascia located at the junction of the arm and thorax
Axilla
Axilla serves as:
A passage way for neurovascular structures from the trunk to the upper extremity
Axilla passageway is brotected by:
Musculofascial and boy structures
-the mobility of the upper extremity exposes the axilla and its contents to injury
Axillary borders
Apex (roof)
Base (floor)
Four walls- 3 muscular and 1 bony
AKA thoracic outlet
Serves as passageway between the neck and axilla
Cervicoaxillary canal
The cervicoaxillary canal is bounded by:
Clavicle
1st rib
Scapula
Cervicoaxillary canal conducts: (4)
Arteries
Nerves
Veins
Lymphatics to the upper extremity
Base of axilla is formed by:
Skin, subcutaneous tissue and fascia extending from the upper extremity to the lower thorax
Location of the base of axilla
Level of the 4th rib
Depending on the position of the limb, the floor of the axilla is somewhat:
Mobile
Axilla wall formed by the pect major and minor and the clavicopectoral fascia
Anterior wall
Wall of axilla formed mainly by the scapula and subscapularis on the anterior surface, inferiorly by teres major and altissimo Doris
Posterior wall
What is the medial wall of the axilla formed by?
Lateral thoracic wall (4th and 5th ribs) and serratus anterior
What is the lateral wall of the axilla formed by?
(Bony wall) by the interbercular groove of the humerus
Contents of the axilla
Axillary sheath (nerve, artery, vein) Lymphatics
Connective tissue that wraps around the nerve artery and vein in the axilla
Axillary sheath
Things packed into the axilla (16)
Axillary sheath (Nerves, veins, artery) Medial cord of brachial plexus Post. Cord of brachial plexus Long thoracic nerve Serratus anterior Subscapularis Infraspinatus Scapula Deltoid Lymph nodes Head of humerus Intertubercular groove Biceps brachial Coracobrachialis Pectoralis major and minor Lateral cord of brachial plexus
Axillary artery is an extension of:
Subclavian artery as it passes the lateral border of the 1st rib
Axillary changes to the:
Brachial artery at the interior border of the teres major
Key to the axillary artery:- insertion point
Pectoralis minor
3 parts divided by pectoralis minor- part 1
superior to pec minor, branch is the superior thoracic artery - supplies first 2 intercostal spaces
Part two of axillary artery and its branches
Deep to pec minor
Branches:
Thoracoacromial trunk - then acromial, deltoid, pectoral, clavicular
Lateral thoracic artery: to serratus anterior, runs with long thoracic nerve
Part 3 of axillary artery and its branches
Distal/inf to pec minor
Branches- Subscapular artery, splits into circumflex scapular artery and Thoracodorsal artery below that
Anterior humeral circumflex
Posterior humeral circumflex
Collateral curculation around the scapula- slide 20 - review
3rd segment of axillary artery branches form periscapular collateral circulation system 2 distal subclavian branches
Occlusion of the axillary artery proximal to the subscapular artery or distal to the thyrocervical trunk- can be tolerated due to this anastomotic network
Axillary vein lays:
Anteromedial to the artery
Axillary vein is formed by
Union of the brachial vein and basicilic vein at the inf. Border of the teres major
Axillary vein becomes
Subclavian vein at the inf border of the 1st rib
Axillary lymph nodes in order
Humeral, subscapular and pectoral to:
Central
Apical
Supraclavicular
