Upper Extremity Flashcards
Upper extremity regions
shoulder, arm (brachium), forearm (antebrachium), and hand
Shoulder regions
pectoral region
scapular region
deltoid region
part of lateral neck
Arm regions
anterior region (flexor compartment) posterior region (extensor compartment)
Forearm regions
anterior region (flexor compartment) posterior region (extensor compartment)
Hand regions
wrist
palm
dorsum of hand
digits
Brachial plexus formed by ____
ventral rami
What are upper extremity nerves associated with?
individual regions or compartments of upper extremity
How many spinal cord levels feed into brachial plexus?
5 levels
roots of brachial plexus
C5-T1
top portion of brachial plexus
supraclavicular portion
bottom portion of brachial plexus
intraclavicular portion
Supraclavicular branches innervate
dorsal and medial scapula
infraclavicular branches innervate
pectoral region and ventral scapula
axillary n. innervates
proximal arm
radial n. innervates
posterior arm and posterior forearm
musculocutaneous n. innervates
anterior arm
median n. innervates
anterior forearm and hand
ulnar n. innervates
anterior forearm and hand
terminal branches of brachial plexus
axillary, radial , musculocutaneous, median, and ulnar
artery pattern
subclavian - axillary - brachial - brachial profunda artery - radial (then deep palmar arch) and ulnar (then superficial palmar arch) arteries
When does axillary artery start and end?
lateral border of 1st rib and ends at inferior border of teres major
When does brachial artery start?
inferior border of teres major
brachial profunda artery
deep artery of arm, major branch of brachial artery
superficial palmar arch anastomosize with _____
deep palmar arch
venous network dorsal or ventral?
dorsal
cephalic vein
superficial to meracarpus prolonged proximally on lateral side
Basilic vein
arise from medial side of venous network
Basilic vein
arise from medial side of venous network
venous drainage pattern arm
dorsal venous network - basilic and cephalic veins - median cubital vein (in cubital fossa) - axillary vein
brachial veins
deep vessels that course with brachial artery
borders of axillary vein
inferior border of teres major by union of brachia veins and basilic vein
joints of shoulder
Sternoclavicular
Acromioclavicular
Glenohumeral
Scapulothoracic
sternoclavicular joint articular components
round and prominent, Sternal end of the clavicle and manubrium of sternum
sternoclavicular joint type
biaxial Modified saddle synovial joint
sternoclavicular joint associated structure
fibrocartilage disc creates bed for end of clavicle and transmits force and pressure from extremity to axial skeleton
sternoclavicular joint movements
elevation/depression
protraction (scapula forward)/retraction (pull scapula back)
acromioclavicular joint articular components
Acromial end of the
clavicle and acromion
process of scapula
acromioclavicular joint type and associated structure
plane type synovial joint (no defined plane of movement), fibrocartilage disc
acromioclavicular joint movements
gliding between clavicle
and scapula
glenohumeral joint articular components and features
humeral head and glenoid fossa (fossa 1/3 size of humeral head)
glenohumeral joint type and movement
ball & socket synovial joint for Flexion/Extension
Abduction/Adduction
Internal and External Rotation
Both ____ and _____ structures enhance G-H stability
non-contractile and contractile structures
Glenoid labrum
fibrocartilaginous ring attaches to margin of glenoid fossa deepens the glenoid cavity and contributes to GH stability
Scapulothoracic joint
physiological joint iwith movement between musculoskeletal
structures (scapula
and associated muscles and the thoracic wall)
Scapulothoracic joint arthrokinematics
elevation, depression, adduction (retraction), abduction (protraction), upward rotation, downward rotation
What joints are responsible for shrugging?
scapulothoracic joint, SC joint, AC joint
medial (internal) and lateral (external) rotation in shoulder
spinning of humerus in glenoid fossa, elbow usually flexed
What planes can the shoulder undergo ab/adduction?
coronal and horizontal
is motion in should from glenohumeral joint alone?
no, the humerus would come out
scapulohumeral rhythm
each shoulder joint making contributions in specific and consistent pattern
0-30 degree abduction uses ____
glenohumeral joint only (don’t need to move scapula)
30-180 degree abduction uses ____
2:1 GH/ST movement, for every 2 degrees GH moves, the scapula moves 1 degree
Extrinsic muscles of posterior shoulder
Superficial layer (trapezius and latissimus dorsi) and deeper layer (levator scapulae, rhomboid major, and rhomboid minor)
Trapezius muscle AIM
A:superior nuchal line, external occipital protuberance, spinous processes of C7-T12 - scapula spine, acromion, lateral 1/3 clavicle • M: upper: elevates and upwardly rotates scapula middle: adducts scapula lower: depresses and upwardly rotates scapula • I: CN XI
is your trapezius muscle innervated by cranial nerves or brachial plexus?
Cranial nerve
latissimus dorsi AIM
A:spinous process T7-T12, iliac crest, ribs 9-12 - intertubercular groove of humerus • M: shoulder extension, adduction and internal rotation (IR) • I: thoracodorsal n.
Levator scapulae AIM
A: transverse processes of C1-C4, superior medial border of scapula M: elevates and downwardly rotates scapula I: Dorsal scapular nerve
Rhomboid minor attachment
spinous processes C7 and T1, medial scapular border at the level of root of scapular spine
Rhomboid major attachments
spinous processes T2 - T5, medial scapular border from level of spine to inferior angle
Rhomboid major and minor IM
M: adduct/retract and
downwardly rotate scapula
I: dorsal scapular nerve
triangle of auscultation
site on the back where breath sounds may be most easily heard through a stethoscope
How do you widen triangle of auscultation?
protract scapula
Boundaries of triangle of asuscultation
Latissimus dorsi,
trapezius, medial
border of scapula
extrinsic muscles of anterior shoulder
Pectoralis Major
Pectoralis Minor
Serratus Anterior
Subclavius
Pectoralis major AIM
A:Clavicular head (Medial half of clavicle), Sternocostal head (anterior sternum, upper six costal cartilages), Intertubercular groove of humerus
M: Adducts and medially rotates humerus
• I:Lateral and Medial pectoral
nerves
Pectoralis minor AIM
A: Ribs 3-5, Coracoid process of scapula
M: Stabilizes scapula
I: Medial pectoral nerve
Serratus anterior AIM
A: External surfaces of lateral parts of ribs 1-8, Anterior surface of medial border of
scapula
M: protracts & upwardly rotates the scapula, holds scapula against thoracic wall
I: long thoracic n
Winging of scapula
at rest scapula is popped off posterior thoracic wall
Subclavius AIM
A: Junction of first rib and costal cartilage, inferior surface of medial third of clavicle M: anchors and depresses clavicle I: nerve to subclavius
intrinsic muscles of shoulder
Coracobrachialis Deltoid Teres Major Teres Minor Supraspinatus Infraspinatus Subscapularis
coracobrachialis AIM
A: tip of coracoid process, medial, middle 1/3 of humerus
M: flex and adducts shoulder
I: musculocutaneous nerve
deltoid AIM
A: scapula spine, acromion,
lateral 1/3 clavicle, deltoid tuberosity of humerus
M: anterior: shoulder flexion, middle: shoulder abduction, poster: shoulder extension
I:axillary n.
teres major AIM
A: inferior lateral aspect of poster surface of scapula, intertubercular groove of humerus M: shoulder medial/ internal rotation (IR) I: lower subscapular n.
rotator cuff muscles and anterior/posterior location
supraspinatus (posterior)
infraspinatus (posterior)
teres minor (posterior)
subscapularis (anterior)
Supraspinatus AIM
A: Supraspinous fossa and Greater tubercle
M: shoulder abduction
I: suprascapular n.
infraspinatus AIM
A: Infraspinous fossa and Greater tubercle
M: shoulder lateral/external rotation (ER)
I: suprascapular n.
teres minor AIM
A: Middle part of lateral border of scapula and Greater tubercle
M: shoulder lateral/external rotation (ER)
I: axillary n.
subscapularis AIM
A: Subscapular fossa and Lesser tubercle
M: shoulder medial/internal rotation (IR)
I: upper subscapular nerve &
lower subscapular nerve
Rotator cuff muscles are important for maintaining humerus ____
centered within glenoid fossa
elbow articulations
humeroulnar, humeroradial, proximal radioulnar, and distal radioulnar
humeroulnar joint type and movements
hinge, flexion/extension
Humeroradial joint type and movements
Modified Hinge, Flexion/extension and
Supination/pronation
proximal radioulnar joint type and movement
Pivot, Supination/pronation
distal radioulnar joint type and movement
Pivot, Supination/pronation
annular ligament: where it is, what it does, and what is protects
Encircles head of radius, Holds the head of the radius
against the ulna, Protects against distal
dislocation of the radius
lateral (or radial) collateral ligament: where it is, what it does, and what is protects
Lateral epicondyle to annular ligament of radius, Protects against medial
deviation of forearm, Taut in full extension
medial (ulnar) collateral ligament: where it is, what it does, and what is protects
Medial epicondyle of humerus to coronoid process and olecranon process, Protects against lateral deviation of forearm
ulnar collateral ligament (UCL) reconstruction
UCL is replaced with a
tendon from elsewhere in the body common among sports, mostly baseball
elbow extension arthrokinematics
olecranon process
is in close approximation to the distal humerus in olecranon fossa
elbow flexion arthrokinematics
olecranon process pulls away from distal humerus, as coronoid process and radius approach their respective fossae
elbow supination/pronation arthrokinematics
Supination occurs as
the radial head spins
on the capitulum (only radius moves)
Joints involves in supination/pronation of elbow
Humeroradial joint, Proximal and distal radioulnar joints
anterior compartment of arm muscles with elbow and innervation
Biceps Brachii
Brachialis
I: musculocutaneous n.
posterior compartment of arm muscles with elbow and innervation
Triceps Brachii
Anconeus
Brachioradialis
I: radial n.
Biceps brachii AIM
A: Short head: coracoid process of the scapula Long head: supraglenoid tubercle Both heads: radius via bicipital aponeurosis M: (weak shoulder flexion) elbow flexion, forearm supination I: musculocutaneous n.
Brachialis AIM
A:distal, anterior humerus, coronoid process of the ulna
M: flexes the forearm
I: musculocutaneous n.
triceps brachii AIM
Attachments: Long head: infraglenoid tubercle Lateral head: posterior sup. humerus Medial head (deep): posterior inf. humerus All Heads: olecranon of the ulna M: Extend elbow(LH-ext, shoulder) I: radial n.
anoconeus AIM
A:lateral epicondyle of humerus, olecranon of the ulna
M: extends the forearm (weaker than triceps)
I: radial n.
brachioradialis AIM
A: Lateral portion of
distal humerus, lateral and distal radius
M: flexes elbow
I: radial nerve
Brachioradialis originates in ____ but action is in ___
originates in posterior, but action is in anterior compartment
supinator AIM
A:lateral epicondyle of humerus and proximal ulna, proximal radius
M: supinates forearm
I: radial nerve
muscles acting on radioulnar joint
supinator, biceps brachii, pronator teres, pronator quadratus
pronator teres AIM
A: coronoid process and
medial epicondyle, lateral surface of radius
M: pronates and flexes forearm
I: median n.
pronator quadratus AIM
A: Distal anterior ulna, distal anterior radius
M: pronates forearm
I: median n.
wrist articulations
radiocarpal, midcarpal, and distal radioulnar joints
radiocarpal joint type and movement
between distal radius and
proximal carpals, condyloid type
M: wrist flexion/extension, wrist AB (radial deviation)/AD (ulnar deviation)
midcarpal joint type and movement
between proximal and distal row of carpal bones, plane synovial joint
M: gliding motions between
carpals
distal radioulnar joint type and movement
between distal end of radius and ulna, pivot synovial joint
M: supination/pronation
Colles fracture
dorsal displacement of distal fragment from fall on outstretched arm
Most common people to get colles fracture?
post-menopausal women
Stabilizing ligaments in wrist
extensor retinaculum, flexor retinaculum (anterior)
carpal tunnel
on flexor surface from curve of carpals and flexor retinaculum
joints involved in wrist flexion/ extension
radiocarpal & midcarpal joints (motion at both joints for both movements)
joints involved in wrist abduction/ adduction
radiocarpal &
midcarpal joints
wrist extensors AIM
A:Lateral epicondyle of humerus, Base of metacarpals
M:Wrist extension
I: radial n.
lateral epicondylitis
Repeated forceful flexion and extension of the wrist
strain attachment of common extensor tendon
producing inflammation
wrist flexors AIM
A:Medial epicondyle of humerus, Base of metacarpals
M: Wrist flexion
I: median and ulnar nerves
Palmaris longus AIM
A:Medial epicondyle of humerus to fascia of palm
M: Tenses fascia of palm
I: Median n.
wrist abduction (radial deviation)
result of contraction of both the flexor and extensors on the radial side of the forearm
wrist adduction (ulnar deviation)
result of contraction of both the flexor and extensors on the ulnar side of the forearm
are there dedicated muscles for wrist ab/adduction?
NO
articulations of digits
carpometacarpal (CMC), metacarpophalangeal (MP), proximal interphalangeal (PIP), distal interphalangeal (DIP)
Joints in thumb
CMC, MP, and IP (not PIP and DIP)
Digit 2-5 flexion/ extension joints
MP joints
PIP joints
DIP joints
digits 2-5 ab/adduction joints
MP joints
movements of thumb
add/abduction (CMC), flexion/extension (CMC/MP/IP), and opposition (CMC)
opposition movement of thumb
combo of abduction and flexion
non-manipulative prehension patterns
cylindrical grip, hook grip, spherical grip
manipulative prehension grip
palmar pinch, lateral pinch, tip-to-tip pinch
flexor digitorum superficialis AIM
A: medial epicondyle, bifurcates and inserts on middle phalanx
M: flexes PIP
I: median and ulnar n.
Flexor digitorum profundus AIM
A: proximal ulna attaches on distal phalanx 2-5
M: flexes DIP
I: ulnar n.
extrinsic digit flexor muscles
flexor digitorum superficialis and flexor digitorum profundus
what does the carpal tunner contain?
extrinsic tendons of the extrinsic digit flexors as well as the main branch of the median nerve
What gets compressed upon inflammation inside carpal tunnel?
Median n.
Extrinsic digit extensors and innervation
Extensor digitorum (common), extensor indicis proprius (Finger 2), and extensor digiti minimi (finger 5) I: radial n.
extrinsic thumb muscle
Flexor pollicis longus Extensor Pollicis Longus and Brevis Abductor Pollicis Longus
anatomical snuff box
formed by tendons of extrinsic muscles of thumb at base of scaphoid
intrinsic hand muscles and innervation
hypothenar group on pinkie side (ulnar n.), and thenar group (median n.) on thumb side
Lumbricals AIM
A:Flexor tendons in palm, Dorsum of proximal phalanges
(cross anterior side of MP joints)
M: Flex at MP & Extend at PIP/DIP
I: Median and Ulnar N.
dorsal interossei AIM and how many muscles
A:Metacarpals to proximal phalanges
- 4 muscles
M: ABduction
I: Ulnar N.
palmar interossei AIM and how many muscles
A: metacarpals to proximal phalanges
- 3 muscles
M: ADduction
I: Ulnar N.
what nerves innervate skin of hand?
ulnar, median, and radial nerves
