Unit 3: Upper Limb Flashcards
what is the axilla?
pyramidal space inferior to the glenohumeral joint (GHJ)
- passage way for neurovascular structures supplying the upper limb + anterior and posterior thorax
what makes up the anterior border of the axilla (deep to superficial)?
- pec major
- pec minor
what makes up the medial border of the axilla (deep to superficial)?
- serratus anterior
- 4th rib
what makes up the posterior border of the axilla (deep to superficial)?
- humerus
- teres major
- lat dorsi
- subscapularis
- scapula
where doe the axillary artery turn into the brachial artery?
inferior border of teres major
where does the brachial artery bifurcate and what does it turn into?
cubital fossa (elbow)
- radial artery (lateral)
- ulnar artery (medial)
what is the anatomical description of the axillary vein?
arises from the basilic vein (medial) at the inferior border of teres major, continues as subclavian vein at 1st rib
what are the branches of the axillary vein?
- brachial vein (medial)
- cephalic vein (lateral)
how do the lymphatics of the upper limb travel?
closely with the veins (shadow veins)
what links the lymphatic system with the venous system?
lymphatic ducts
what does the brachial artery supply?
- biceps brachii
- triceps brachii
- coracobrachialis
what does the radial artery supply?
posterolateral aspect of forearm
- lateral forearm muscles
- radial nerve
- carpal bones and joints
- thumb
- lateral side of index finger
what does the radial artery run through and supply?
snuffbox
- hand’s palmar arches
what does the ulnar artery supply?
- palmar arches
- ends as the superficial arch
what are dorsal (posterior) roots?
enter the dorsal (posterior) horn
- provide sensory information
what are the ventral (anterior) roots?
exit the ventral (anterior) horn
- provide motor info
what is a spinal nerve and where is it formed?
- mixed information, sensory and motor from ventral and dorsal roots
- distal to dorsal root ganglion
- shortly bifurcates into anterior and posterior rami
what rami does the brachial plexus arise from?
roots of plexus are ventral (anterior) rami
what are the 5 anatomical divisions of the plexus?
- roots (5)
- trunks (3)
- divisions (6)
- cords (3)
- branches (terminal) (5)
what is the relative position of the brachial plexus to surrounding structures?
- emerges between anterior and middle scalenes
- deep to clavicle and pec major
- superficial (overlying) subscapularis
what are the most relevant portions of the plexus in terms of injury?
- roots
- cords
- branches
what does the dorsal scapular nerve innervate?
- levator scapula
- rhomboid major
- rhomboid minor
what does the suprascapular nerve innervate?
- supraspinatus
- infraspinatus
what does the subclavius nerve innervate?
subclavius
what does the lateral pectoral nerve innervate?
- pectoralis major (clavicular part)
- pectoralis minor
what does the medial pectoral nerve innervate?
- pectoralis major (sternocostal part)
- pectoralis minor
what does the long thoracic nerve innervate?
serratus anterior
what does the lower subscapular nerve innervate?
- subscapularis
- teres major
what does the thoracodorsal nerve innervate?
latissimus dorsi
what does the upper subscapular nerve innervate?
subscapularis
what is thenar atrophy (ape hand)?
loss of bulk of skin at base of thumb caused by carpal tunnel syndrome (compression of median nerve within carpal tunnel)
what is interosseous atrophy (claw hand)?
caused by damage to ulnar nerve, creating claw like hands due to loss of muscle in hand
- hyperextension at the metacarpophalangeal joint
- hyperflexion at the interphalangeal joint
what is the superior (upper) pattern of injury to the brachial plexus?
lateral hyperextension of the neck due to falling or at birth when pulling head out of birth canal
what is the inferior (lower) pattern of injury to the brachial plexus?
arm pulled away from trunk by handing by hand or pulling arm out of birth canal at birth
what are the mechanisms of injury to the brachial plexus?
- avulsion: proximal, tears roots out of spinal cord (most dramatic case)
- stretch
- rupture: distal break in plexus
what is upper trunk (Erb’s) palsy?
C5 and C6 are affected
- waiter’s tip deformity (arm pronated, fingers flexed)
- due to loss of innervation to abductors and lateral rotators of arm, forearm flexors, and wrist extensors
what is lower trunk (Klumpke’s) palsy?
C8 and T1 are affected
- claw hand
- due to loss of innervation to the pronators and intrinsic hand muscles (especially distal digit extensors)
where are the proximal portions of the plexus?
axilla
how do terminal branches of the plexus exit the axilla?
in a medial bundle in the proximal arm
what are the major differences between the lower and upper limb?
- stability of lower limb
- mobility of upper limb
why is the lower limb more stable?
iliac bones are anatomically connected posteriorly (at the sacroiliac joint)
- causes movement of one lower limb to cause movement of the other
what is the upper limb more stable?
scapulae are not connected posteriorly
- uppers limbs can move independently
what is a displaced clavicular fracture?
breaking of clavicle, makes bones out of alignment
what is a non-displaced clavicular fracture?
tearing of coracoclavicular ligaments
where does the humerus typically break?
surgical neck
what surrounds the structures of the arm proximal to the elbow?
brachial fascia
what surrounds the structures of the forearm?
antebrachial fascia
what divides the brachial fascia into anterior and posterior compartments?
- lateral and medial intermuscular septa
- humerus
what divides the antebrachial fascia into anterior and posterior compartments?
- interosseous membrane
- radius
- ulna
what does the antebrachial fascia specialize into?
anterior:
- palmar carpal ligament (anatomical thickening)
- flexor retinaculum
posterior:
- extensor retinaculum
what is the flexor retinaculum/transverse carpal ligament?
forms the roof of the carpal tunnel
- covers the distal row of carpal bones
- deep to palmar aponeurosis
what is the carpal tunnel?
- bound by the carpal bones and overlying flexor retinaculum
- contains 9 tendons (flexor pollicis longus, flexor digitorum superficialis, flexor digitorum profundus) and the median nerve
what causes carpal tunnel syndrome?
compression of the median nerve
what 3 articulations make up the elbow joint?
- humeroulnar joint
- humeroradial joint
- proximal radioulnar joint
what makes up the humeroulnar joint?
trochlear notch of the ulna and the trochlea of the humerus
- hinge joint
- medial
what makes up the humeroradial joint?
head of the radius and the capitulum of the humerus
- ball and socket joint
- lateral
what makes up the proximal radioulnar joint?
head of radius and radial notch of ulna
- held in place by annular ligament
what muscles are involved in pronation?
- pronator teres
- pronator quadratus
- brachioradialis
what muscles are involved in supination?
- supinator
- biceps brachii
what forms the distal radioulnar joint?
articulation between the head of the ulna and the ulnar notch of the radius
what structures/joints mediate pronation/supination?
- proximal radioulnar joint
- distal radioulnar joint
- interosseous membrane
how are the tendons of the extensor muscles structured?
flatten out into extensor hoods (aponeuroses that form the insertions)
- central slip over middle phalanx
- lateral bands attach to distal phalanx
what side of the hand has the protruding pisifrom?
ventral (anterior) side
what parts of the brachial plexus are supraclavicular?
- roots
- trunks
- divisions
what parts of the brachial plexus are infraclavicular?
- cords
- terminal branches
C5 characteristics
- branches into long thoracic nerve
- branches into dorsal scapular nerve
- branches into phrenic nerve
- sensory info about shoulder
C6 characteristics
- branches into long thoracic nerve
- sensory info about elbow
C7 characterisitcs
- branches into long thoracic nerve
- sensory info about wrist
C8 characteristics
- sensory info about hand
what forms the superior trunk and what does it branch into?
- formed by C5 and C6
- branches into suprascapular nerve
- branches into subclavius nerve
what forms the middle trunk?
C7
what forms the inferior trunk?
C8 and T1
what divisions form the lateral cord?
- anterior division of superior trunk
- anterior division of middle trunk
what divisions form the posterior cord?
- posterior division of superior trunk
- posterior division of middle trunk
- posterior division of inferior trunk
what divisions form the medial cord?
- anterior division of middle trunk
- anterior division of inferior trunk
what does the lateral cord branch into and give rise to?
- gives rise to lateral pectoral nerve
- branches into musculocutaneous nerve and median nerve
what does the posterior cord branch into and give rise to?
- gives rise to lower and upper subscapular nerves + thoracodorsal nerve
- branches into axillary nerve and radial nerve
what does the medial cord branch into and give rise to?
- gives rise to medial pectoral nerve
- branches into median nerve and ulnar nerve
what roots make up the long thoracic nerve?
C5, C6, C7
what roots make up the phrenic nerve?
C3, C4, C5
what roots make up the dorsal scapular nerve?
C5
what roots make up the suprascapular nerve?
C5, C6
what roots make up the subclavius nerve?
C5, C6
what roots make up the lateral pectoral nerve?
C5, C6, C7
what roots make up the lower and upper subscapular nerves?
C5, C6
what roots make up the thoracodorsal nerve?
C6, C7, C8