Upper ext Flashcards
the clavicle is made up of?
1.Sternal end articulates with the manubrium of the sternum at the sternoclavicular joint
2.Acromial end articulates with the acromion of the scapula at the acromioclavicular joint
Elongated S curvature increases resilience
Boundary for cervico-axillary canal providing protection to neurovascular bundle of the upper extremity
The function of parts of the Clavicle
- Clavicle- connects the upper limb to the axial skeleton
- Elongated S curvature increases resilience
- Boundary for cervico-axillary canal providing protection to neurovascular bundle of the upper extremity.
Where is the scapula is located?
located between the 2nd and the 7th rib
The scapula is made up of what parts?
Suprascapular notch3
Subscapular fossa 7
Supraspinous fossa 9
Infraspinous fossa 10
Spine of scapular 8
Medial border 5
Lateral border 4
Glenoid cavity 6
Acromion 1
Coracoid process 2
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Which border is the thickest in the scapular and what articulates with the head of the Humerus
The lateral border is thickest
Glenoid cavity articulates with the head of the humerus at the glenohumeral joint.
What are the parts of the Humerus
Head of humerus Greater tubercle Lesser tubercle Surgical neck Radial groove Medial and lateral epicondyles Capatulum Trochlear Coronoid fossa Olecranon fossa
Important Landmarks of the humerus
- Largest bone in upper limb
2. Radial groove for the radial nerve and profunda brachii artery
Compoonents of the Ulna bone
Olecranon Process
coronoid process
Styloid process
Important landmarks of the Ulna bone
Medial
Stabilizing bone of the forearm
Shaft is thick but tapers distally
Coronoid process of ulna fits to Trochlear of Humerus
Components of the Radius bone
Head of radius
styloid process
Important landmarks of the radius
Lateral to ulna and shorter
Shaft gradually enlarges as it passes distally
With pronation of forearm radius crosses ulna
NAme the Anterior axio-Appendicular muscles
Pectoralis Major
Pectoralis Minor
Serratus Anterior
Subclavius
Action of pectoralis major
Adducts/medially rotate the shoulder
Innervation of pectoralis Major
lateral and medial pectoral nerves
Action of pec minor
Stabilizes the scapular
Innervation of Pec Minor
Medial pectoral nerve
Serattius anterior
Holds scapular to the thoracic wall
Serratus anterior innervated by?
Long thoracic nerve
*only nerve that runs on top of the muscle that it innervates!
TRapezius(Shrugging muscle)
Superior portion- elevates; inferior portion-depresses; middle portion
retracts scapula
TRapezius Innervation
Spinal Accessory nerve
Latissimus dorsi
Extends (arm), adducts and medially rotates shoulder joint
Levator Scapulae/action/Innervation
Elevates scapula/Dorsal scapular nerve
Rhomboid Minor, Rhomboid Major action and innervation
Retract and fix scapular to thoracic wall /Dorsal scapular nerve
Deltoid (3 parts)
action and innervation
Flexes, medially rotates shoulder; abducts shoulder joint; extends and laterally rotates shoulder
axillary nerve
Supraspinatus action and innervation
Abduction of the shoulder, rotator cuff muscle
suprascapular nerve
Infraspinatus action and innervation
Laterally rotates shoulder joint, rotator cuff muscle
Suprascapular nerve
Teres Minor action and innervtion
Laterally rotates shoulder cuff, rotator cuff muscle
Axillary nerve
Teres major act and inn
Adducts and medially rotates the shoulder joint
Inferior subscapular nerve
Subscapularis act and inn
Medially rotates and adducts shoulder joint, rotator cuff muscle
Superior and inferior subscapular nerves
Biceps brachii act and inn
Supinates forearm and flexes elbow joint
Musculocutaneous nerve
Brachialis act and inn
Flexes elbow
Musculocutaneous nerve
Coracobrachialis act and inn
Flex and adduct shoulder joint
Musculocutaneous nerve
Triceps brachii act and Inn
Extends elbow Joint
Radial Nerve
Pronator Teres act and Inn
Pronates and Flexes forearm/
Median nerve
Flexor Capi Radialis act and inn
Flexes and abducts hand at wrist/
Median nerve
Palmaris Longus act and inn
Flexes hand at wrist/
Median nerves
Flexor carpi ulnaris act/inn
Flexes and adducts hand at wrist/
Ulnar nerve
Flexor digitorum superficialis act/inn
Intermediate anterior
Flexes wrist joint; flexes proximal phalanges at metacarpophalangeal joints
Median nerve
Flexor digitorum profundus act/inn
deep anterior
Flexes wrist joint, flexes distal interphalangeal joints (2nd-5th)
Median nerve
Ulnar nerve
Flexor pollicis longus
deep anterior
Flexes wrist; flexes thumb/Median nerve
Pronator quadratus
deep anterior
Pronates forearm
Median nerve
Brachioradialis
superficial posterior
Weak flexion of elbow joint
Radial nerve
Extensor carpi radialis longus
superficial posterior
Extend and abduct wrist joint
Radial nerve
Extensor carpi radialis brevis
superficial posterior
Extend and abduct wrist joint
Radial nerve
Extensor digitorum
superficial posterior
Extend wrist joint; extend medial 4 fingers
Radial nerve
Extensor digiti minimi
superficial posterior
Extends wrist joint; extends 5th finger
Radial nerve
Extensor carpi ulnaris
superficial posterior
Extends and adducts wrist joint
Radial nerve
Supinator
Deep posterior forearm
Supinates forearm
radial nerve
Abductor pollicis longus
Extends wrist; abducts and extends the thumb
Radial; nerves
Extensor pollicis longus
Extends wrist, extends thumbs
Radial nerve
Extensor pollicis brevis
Extends wrist; extends thumb
Radial nerve
Extensor Indices
Extends wrist joint; extends 2nd finger
Radial; nerve
Median Nerve
Hand
Abducts thumb
Opposes thumb
Flexes thumb
Flexes metacarpophalangeal joints of the 2nd-4th fingers
Ulnar Nerve
Hand
Adducts thumb
Abducts 5th finger
Flexes 5th finger
Opposes 5th finger towards thumb
Radial Nerve
Hand
Extends fingers and thumb
For the effect of muscle relaxant, what should you watch for
Watch for thumb adduction
FYI
Ulnar nerve is medial to ulnar artery
Roots comprise of?
anterior rami of C5-T1; pass between anterior and middle scalene muscles
Trunks
Named in relation to each other
Divisions
: anterior divisions supply the anterior (flexor) compartments of the upper limb. Posterior division supply the posterior (extensor) compartments of the upper limb.
Cords
: named for their position in relation to the axillary artery
Branches From Roots and innervation
Brachial plexus
Dorsal Scapular Nerve (C5)—Rhomboid major/minor; levator scapulae muscles
Long Thoracic Nerve (C5-C7)__Serratus anterior muscle
Branches from the Trunk and innervation
Brachial plexus
Suprascapular Nerve (Superior trunk/ C5-C6)——Supraspinatus and infraspinatus muscles
Nerve to Subclavius (Superior trunk/ C5)—Subclavius muscle
branches from the lateral cord and innervation
Brachial plexus
Lateral Pectoral Nerve (C5-C7)–Pectoralis major muscle
branches from medial cord and innervation
brachial plexus
Medial Pectoral Nerve (C8-T1)—Pectoralis major and minor muscles
Medial Brachial Cutaneous Nerve (C8-T1)—-Sensory to the medial side of the arm
Medial Antebrachial Cutaneous Nerve (C8-T1)—Sensory to the medial side of the forearm
Branches from the posterior cord and innervation
Brachial Plex
Superior Subscapular Nerve (C5-C6)…..Subscapularis muscle.
Thoracodorsal Nerve (C7-C8)…….Latissimus dorsi
Inferior Subscapular Nerve (C5-C6)….Subscapularis and teres major muscles
Nerve)Terminal Branches anterior compartment of arm
Musculocutaneous:pierces the coracobrachialis muscle, supplies innervation to brachialis and biceps brachii then continues as purely sensory nerve as the lateral cutaneous nerve of the forearm.
Median:follows the brachial artery, distal branch of the axillary artery
Ulnar:Courses behind the medial epicondyle of the humerus bone.
Nerve)Terminal branches posterior compartment of arm
Axillary Nerve: Enters posterior compartment through the quadrangular space formed by the teres minor, teres major, humerus and long head of the triceps brachii.
Radial Nerve: Enters posterior compartment through the triangular interval formed by the teres major, humerus, long head and lateral head of the triceps brachii.
Nerve)Terminal Branches anterior compartment Forearm
Radial Nerve: joins up and follows the radial artery along lateral aspect forearm
Ulnar Nerve: joins up with ulnar artery along medial anterior aspect forearm
Median Nerve: follows course of common interosseous artery (branch of ulnar artery
Terminal branches posterior compartment forearm
Radial Nerve: Deep branch of the radial nerve becomes posterior interosseous nerve
Long thoracic nerve injury(Terminal Branches of Brachial plexus)
sensory and motor
Paralysis of serratus anterior results in medial border of scapula to protrude away from body “winged scapula
Musculocutaneous nerve injury(Terminal Branches of Brachial plexus)
Sensory/motor
Lateral surface of forearm/
Paralysis of coracobrachialis, biceps, brachialis impaired flexion and supination of forearm
Axillary nerve injury(Terminal Branches of Brachial plexus)
sensory/motor
Lateral surface of shoulder/
Shoulder weakness, especially with abduction
Radial nerve injury(Terminal Branches of Brachial plexus)
sensory and motor
Posterior surface of forearm, posterior thumb and first 2 ½ fingers (not distal joint)/
Paralysis of triceps, brachioradialis, supinator, extensors of the wrist and fingers “wrist drop” (unopposed flexors)
Median nerve injury(Terminal Branches of Brachial plexus)ensory and motor
Anterior thumb, palmer surface, anterior first 2 ½ fingers, posterior distal joint of first 2 ½ fingers
Loss of thumb opposition, decreased abduction of thumb, loss of flexion of proximal and distal interphalangeal joints “pope’s blessing” or “ape hand”
Ulnar nerve injury(Terminal Branches of Brachial plexus)
sensory and motor
Medial surface of hand/palm. Medial 1 ½ fingers.
Loss of flexion at 4th and 5th fingers, loss of thumb adduction, loss ability to oppose and abduct 5th finger “claw hand”
Artery supply upper ext
Subclavian artery axillary artery brachial artery
four terminal branches(Subclavian artery goes through and end in brachial (SAB)
Ulnar artery
Radial Artery
Anterior interosseous artery
Posterior interosseous artery
when does the Subclavian artery become the brachial artery
AFter the Teres Major to the distal portion of the cubital fossa
What does the Dorsal scapular artery branch from
Direct branch of the subclavian artery.
What location is the Profunda Brachii
Branches off the Axillary artery
Ulnar,Radial arteries
Ulnar and Radial arteries provide collateral blood supply to hand (palmar arch)
Anterior and Posterior Interosseous arteries
provide blood supply to anterior and posterior divisions of the interosseous membrane
location of arteries in relation to nerves are
Note location of arteries in relation to nerves:
Radial artery radial nerve
Ulnar artery ulnar nerve
Anterior interosseous artery median nerve
Posterior interosseous artery posterior interosseous nerve (deep branch of the radial nerve)
What is the venous System setup upper ext
Palmer and dorsal venous networks basilic (medial) and cephalic (lateral) veins
Median cubital vein
Basilic vein becomes axillary vein
Cephalic vein empties into axillary vein
Axillary vein subclavian vein
