Upper Extremity Flashcards
What composes pectoral girdle?
Scapulae, clavicle, manubrium of sternum
What composes superior appendicular skeleton
pectoral girdle and free part of upper limb
Where does the superior appendicular skeleton articulate?
Sternoclavicular joint— this allows great mobility
What shape is the clavicle in?
S shape with sternal end and acromial end
Where does sternal end of clavicle connect?
Sternoclavicular joint
Where does acromial end of clavicle articulate?
Acromioclavicular joint
What does the boundary for cervico-axillary canal do?
Provide protection to neurovascular bundle for upper extremity
What is the benefit to the s shape of the clavicle?
Allow bumps and bruises without breaking
Where does the scapula lie in the body?
2nd-7th ribs
Which border of scapula is thickest?
Lateral
Where does the scapula articulate with head of humerus?
Glenohumeral joint
2 important facts for humerus?
Largest bone in upper limb
Radial groove is for radial nerve and profunda brachii artery
3 facts ulna
Main part of arm- medial
Stabilizing bone of forearm
Shaft is thick but tapers distally
Radius in comparison to ulna
Lateral to ulna and shorter.
Shaft gradually enlarges as it passes distally
Pronation of arm– radius crosses ulna
What is action and innervation of pectoralis major?
Action: adducts and medially rotates shoulder joint
Innervation: Lateral and medial pectoral nerves
What is action and innervation of pectoralis minor?
Action: Stabilizes scapula inferioraly and anteriorly
Innervation: Medial pectoral nerve
What is action and innervation of subclavius muscle?
Action: anchors clavicle
Innervation- subclavian nerve
What is action and innervation of serratus anterior?
Action: Holds scapula to thoracic wall
Innervation: Long thoracic nerve
What is action and innervation for trapezius
Action: Superior portion- elevated; inferior portion- depresses; middle- retracts
Innervation: Spinal Accessory Nerve (CN XI)
What is action and innervation of latissimus dorsi
Action: extends, adducts and medially rotates shoulder joint
Innervation: Thoracodorsal nerve
What is action and innervation for levator scapulae
Action: Elevates scapula
Innervation: Dorsal scapular nerve
What is action and innervation of rhomboid minor and major?
Action: retracts scapula and fix scapula to thoracic wall
Innervation: Dorsal scapular nerve
What is action and innervation of deltoid?
Action: flexes, medially rotates shoulder; abducts shoulder joint; extends and leterally rotates shoulder
Innervation: axillary nerve
What is action and innervation of supraspinatus?
Action: abduction of shoulder, rotator cuff muscle
Innervation: suprascapular nerve
What is action and innervation of infraspinatus?
Action: laterally rotates shoulder joint, rotator cuff muscle
Innervation: suprascapular nerve
What is action and innervation of teres minor?
Laterally rotates shoulder cuff, rotator cuff muscle
Innervation: Axillary nerve
What is action and innervation of teres major?
Action: Adducts and medially rotates shoulder joint
Innervation: Inferior subscapular nerve
What is action and innervation of subscapularis?
Action: Medially rotates and adducts shoulder joint, rotator cuff muscle
Innervation: superior and inferior subscapular nerve
What muscles make up the rotator cuff?
Supraspinatus, Infraspinatus, teres minor, subscapularis
What is action and innervation of biceps brachii?
Action: Supinates forearm and flexes elbow join
Innervation: Musculocutaneous nerve
What is action and innervation of brachialis?
Action: Flexes elbow
Innervation: musculocutaneous nerve
What is action and innervation of coracobrachialis
Action: Flex and adduct shoulder joint
Innervation: Musculocutaneous nerve
What is action and innervation of triceps brachii?
Action: extends elbow join
Innervation: Radial nerve
What is action and innervation of anconeus muscle>?
Action: Assists triceps
Innervation: Radial nerve
What are the anterior axio-appendicular muscles?
Pectoralis major, pectoralis minor, subclavius, serratus anterior
What are the posterior axio-appendicular muscles?
Trapezius, Latissimus dorsi, Levator scapulae, Rhomboid minor, rhomboid major
What are the scapulohumeral muscles?
Deltoid, supraspinatus, infraspinatus, teres minor, teres major, subscapularis
What are the muscles of the anterior arm compartment?
Biceps brachii
Brachialis
Coracobrachialis
What are muscles of the posterior arm compartment
Triceps brachii
Anconeus
What are the superficial muscles of the forearm in the anterior compartment?
Pronator teres
Flexor Carpi radialis
Palmaris longus
Flexor carpi ulnaris
What is action/innervation of pronator teres
Action: pronates and flexes forearm
Innervation: Median nerve
What is action/innervation of flexor carpi radialis
Action: flexes and abducts hand at wrist
Innervation: median nerve
Action/innervation of palmaris longus?
Action: flexes hand at wrist
Innervation: median nerve
A/I Flexor carpi ulnaris
Action: flexes and adducts hand at wrist
Innervation: ulnar nerve
A/I Flexor digitorum superficialis
Action: flexes wrist join; flexes proximal phalnages at metacarpophalangeal join
Innervation: median nerve
What are the deep muscles of the forearm?
Flexor digitorum profundus
Flexor pollicis longus
pronator guadratus
A/I Flexor digitorum profundus
Action: flexes wrist joint, flexes distal interphalangeal joints (2-5th)
Innervation: Median nerve (lateral part) ; Ulnar nerve (medial part)
A/I Flexor pollicis longus
Action: flexes wrist; flexes thumb
Innervation: Median nerve
A/I Pronator quadratus
Action: pronates forearm
Innervation: ,median nerve
A/I brachioradialis
Action: Weak flexion of elbow
Innervation: Radial nerve
A/I Extensor carpi radialis longus
Action: extend and abduct wrist joint
Innervation: radial nerve
A/I Extensor carpi radialis brevis
Aciton: extend and abduct wrist joint
Innervation: Radial nerve
A/I Extensor digitorum
Action: extend wrist joint; extend medial 4 fingers
Innervation: radial nerve
A/I Extensor digiti minimi
Action: extend wrist joint; extends 5th finger
Innervation: Radial nerve
A/I Extensor carpi ulnaris
Action: extends and adducts wrist joint
Innervation: Radial nerve
A/I supinator?
Action: supinates forearm
Innervation: Radial nerve
A/i abductor pollicis longus
Action: extends wrist; abducts and extends the thumb
Innervation: radial nerve
A/I Extensor pollicis longus
Action: extends wrist; extends thumb
Innervation: radial nerve
a/i Extensor pollicis brevis
Action: extends wrist; extends thumb
Innervation: radial nerve
A/I Extensor indicis
Action: extends wrist joint; extends 2nd finger
Innervation: Radial nerve
Median nerve actions for hand
Abducts thumb
Opposes thumb
flexes thumb
flexes metacarpophalangeal joints of 2nd-4th finger
Ulnar nerve actions for hand
Adducts thumb
Abducts 5th finger
Flexes 5th finger
Opposes 5th finger towards thumb
Radial nerve actions for hand
Extends fingers and thumb
What are the roots of the brachial plexus?
Anterior rami of C5-T1; pass between anterior and middle sclalene muscles
Division: Inferior part of neck-> lateral border of the scalenes
What are the trunks of the brachial plexus
Named in relation to each other. Superior, middle, inferior
Division: Cervico-axillary canal posterior to clavicle/1st rib
What are the divisons of brachial plexus?
Anterior divisions supply the anterior (flexor) compartments of upper limb. Posterior division supply posterior (extensor) compartment of upper limb
Division: first rib–>pectoral minor muscle
What are the cords in brachial plexus?
Named for position in relation to axillary artery (Lateral, posterior, medial)
Divison: calvicle acromial end–> ends at axilla
What are branches of brachial plexus?
Terminal nerves of brachial plexus: Musculocutaneous, Axillary, Radial, Median, Ulnar
Divison: after axilla
Where does the brachial plexus divide the various secitons?
Roots–> Trunks: inferior part of neck, lateral border of scalenes
Trunks–> division: cervico-axillary canal posterior to clavicle/1st rib
Divison–> Cords: pectoral minor muscle
Cords–> terminal branches: axilla
Dorsal Scapular nerve innervation? Where does it branch from?
Branches from ROOTS (C5)
Innervation: Rhomboid major/minor; levator scapulae muscles
Long thoracic Nerve innervation? Where does it branch from?
Branches from ROOTS (C5-C7)
Innervation: Serratus Anterior muscle
Suprascapular nerve innervation? Where does it branch from?
Branches from TRUNKS ( Superior trunk/C5-C6)
Innervation: Supraspinatous and infraspinatous muscle
Nerve to subclaivus innervation? Where does it branch from
Branches from TRUNKS (Superior trunk C5)
Innervation: subclavius muscle
Lateral pectoral nerve innervation? Where does it branch from?
Branches from LATERAL CORD (c5-c7)
Innervation: Pectoralis major muscle
Medial Pectoral nerve innervation? Where does it branch from?
Branches from MEDIAL CORD (C8-T1)
Innervation: Pectoralis major and minor muscle
Medial Brachial cutaneous nerve? Where does it branch from?
Branches from MEDIAL CORD (C8-T1)
Innervation: Sensory to medial side of arm
Medial antebrachial cutaneous nerve? Where does it branch from?
Branches from MEDIAL CORD (C8-T1)
Innervation: Sensory to medial side of forearm
Superior subscapular nerve innervation? Where does it branch from?
Branches from POSTERIOR CORD (C5-C6)
Innervation: subscapularis muscle
Thoracodorsal nerve innervation? Branches from?
Branches from POSTERIOR CORD (C7-C8)
Innervation: Latissimus dorsi muscle
Inferior subscapular nerve innervation? Branches from?
Branches from POSTERIOR CORD (C5-C6)
Innervation: Subscapularis and teres major muscles
Pathway of musculocutaneous nerve anterior compartment of arm?
Terminal branch of brachial plexus. Pierces coracobrachialis muscle, supplies innervation to brachialis and biceps brachii. Continues as purely sensory nerve as the lateral cutaneous muscle of forearm.
Pathway of median nerve in anterior compatment of arm?
Terminal branch of brachial plexus. Follows brachial artery, distal branch of axillary artery
Pathway of ulnar nerve in anterior compartment of arm?
Terminal branch of brachial plexus. Courses behind the medial epicondyle of the humerus bone.
Pathway of axillary nerve in posterior compartment of arm?
Enters posterior comparment though guadrangular space formed by teres minor, teres major, humerus and long head of triceps brachii.
Pathway of radial nerve in posterior compartment of arm?
Enters posterior compartment though triangular interval formed by teres major, humerus, long head and lateral head of triceps brachii.
Pathway of radial nerve in anterior compartment of forearm?
Joins up and follow sradial artery along lateral aspect of forearm
Pathway of ulnar nerve in anterior comparmtent of forearm?
Joins up with ulnar artery along medial anterior aspct of forearm
Pathway of median nerve in anterior compartment of forearm?
Follows course of common interosseus artery (branch of ulnar artery)
Parthway of radial nerve in posterior compartment of forearm?
Deep branch of radial nerve bcomes posterior interosseous nerve.
Injury to long thoracic nerve causes?
“Winged scapula” Paralysis of serratus anterior results in medial border of scapula to protrude away from body
Injury to musculocutaneous nerve?
Sensory impairment- lateral surface of forearm
Paralysis of coracobrachialis, biceps, brachialis–> impaired flexion and supination of forearm
Injury to axillary nerve?
Sensory impariemnt: lateral surface of shoulder
Motor: Shoulder weakness, especially abduction
Injury to radial nerve?
“Waiter’s tip hand”
Sensory: posterior surface of forearm, posterior thumb and first 2 1/2 fingers (not distal join)
Motor: paralysis of triceps, brachioradialis, supinator, extensors of wrist and fingers–> wrist drop
Injury to median nerve?
“Pope hand”– think pope is “median”
Sensory deficits: anterior thumb, palmer surface, ant first 2 1/2 fingers, posterior distal joint of first 2 1/2 fingers
Motor deficit: loss of thumb opposition, decreased abduction of thumb, loss of flexion of proximal and distal interphalnageal joints
Injury to ulnar nerve?
Snesory: medial surface ofhand/palm. Medial 1 1/2 fingers
Motor: loss of flexion at 4th and 5th finger, loss of thumb adduciton, loss of ability to oppose and abduct 5th fingers “claw hand”
Pathway of arterial supply of upper extremity?
Subclavian artery–> axillary artery–> brachial artery–> four terminal branches
4 terminal branches of UE arterial supply?
1) Ulnar artery
2) Radial artery
3) anterior interosseous artery
4) posterior interosseous artery
Where does axillary artery start?
Lateral margin of 1st rib to the intferior border of teres major muscle
The dorsal scapular artery is a direct branch of which artery?
Subclavian artery
Where does the brachial artery start?
Inferior border teres major to distal portion of cubital fossa
Ulnar and radial arteries provide collateral blood supply to hand through the ____
Palmar arch
Where do the anterior and posterior interosseous arteries provide blood supply to?
The anterior and posterior divisions of interosseous membrane
What does the radial artery follow?
Radial nerve
What does the ulnar artery follow?
Ulnar nerve
Where does the anterior interosseous artery follow?
Median nerve
Where does the posterior interosseous artery follow?
posterior interosseous nerve (deep branch of radial nerve)
What do the palmar and dorsal venous networks drain to?
Basilic (medial) and cephalic (lateral) veins
What bridges the cephalic and basilic veins?
Median cubital veins
What does the basilic vein become?
Axillary vein
Where does the cephalic vein empty into?
Axillary vein
Axillary vein turns into the ____
subclavian vein
