Upper Extremity Flashcards
What is the anatomical position?
Face up, palms forward, feet flexed
Name the (3) planes the in which the body can be divided
Sagittal Plane
Transverse Plane
Coronal/Frontal Plane
What are the 4 types bones and give an example of each.
Long bone (humerus), short bone (talus), flat bone (sternum), irregular bone (vertebra)
What is an epiphysis?
End of a long bone, sponges bone
What covers the epiphysis?
Articular cartilage
What is a diaphysis?
The shaft of the bone, compact bone, encloses medullary cavity
What does an osteoclasts do?
Resorbs old bone tissue
What does an osteoblasts do?
Forms new bone cells
What are 3 types of cartilage?
Hyaline, Elastic, fibrocartilage
What is the most abundant cartilage in the body?
Hyaline cartilage
What type of cartilage can tolerate repeated bending?
Elastic cartilage (example ear)
What cartilage resists strong compression and tension?
Fibrocartilage (example inter-vertebral discs)
What are the three main types of joints?
Synovial Joint
Cartilaginous joint
Fibrous joint
What is the most mobile type of synovial joint?
Ball & socket
What are the two types of cartilaginous joints?
Synchondroses
Symphyses
What type of cartilage is in synchondroses joints?
Hylaine cartilage (not much movement)
What type of cartilage is in symphyses joints?
Fibrocartilage (good with impact, in vertebrae and pubic symphysis)
What are the three types of fibrous joints?
Suture
Syndesmosis
Gomphosis (don’t need to know this one)
How many pairs of spinal nerves are there?
31 pairs of spinal nerves
How many pairs of cranial nerves are there?
12 pairs of cranial nerves
How many vertebrae are there? How many per section?
33 total 7 cervical 12 thoracic 5 lumbar 5 segments of sacrum m (fused) 4 segments of coccyx
Where do the spinal nerves leave the spinal column?
In the intervertebral foramen
What type of nerve(s) are in the dorsal root?
Sensory axon and cell bodies
What type of nerve(s) are in the ventral root?
Motor neuron axons
What type of nerve(s) are in the dorsal ramus?
Both sensory and motor neurons
What type of nerve(s) are in the ventral ramus?
Both sensory and motor neurons
What is the difference between dermatomes and myotomes?
Derma= skin Myo= muscle
How may (spinal) dermatomes are there in the body?
31 (# of spinal nerve pairs)
If somebody lost feeling in their thumb, what nerve was affected?
C6
What dermatome includes the pinky finger?
C8
What dermatome includes the middle finger?
C7
What dermatome includes the nipples?
T4
What dermatome includes the belly button?
T10
What nerves innervate the anterior lower extremity?
L1-L5
What nerves innervate the posterior lower extremity?
S1-S5
What nerves innervate the bottom of the foot?
L4 & L5
What type of muscle fibre directions provide the most force?
Multipennate
What is the direction of the fibres in pectoralis major?
Convergent
Between Parallel fibres and pinnate fibres which allow for a large range of motion and which allows maximal force?
Parallel: large range of motion
Pennate: maximal force
What is an isometric contraction?
Muscle remains the same length but the tension increases.
No movement but there is more tension. Think holding a glass and adding water.
What is an isotonic contraction?
Muscle changes in length and the tension stays the same.
What is the difference between concentric and eccentric isotonic contractions?
Concentric: muscle shortens
Eccentric: muscle lengthens
How are muscles attached to bones?
By tendons
What is the insertion/distal end?
The movable portion of the attachment
What is the origin/proximal end?
The less movable attachment
What is fascia?
Connective tissue that binds dustless to overlying skin or binds groups of muscles together.
What are the movements of the scapula? (3 opposing)
Elevation & Depression
Protraction & Retraction
Medial rotation (downward rotation) & Lateral rotation (upward rotation)
Trapezius origin(proximal)
External occipital protuberance (‘hole’ in base of skull)
Medial 1/3 of Superior Nuchal line (line along base of skull)
Ligamentum Nuchae (along spine)
Spinous processes & Supraspinous ligaments of C7-T12 vertebrae
Trapezius insertion(distal)
Lateral third of Clavicle
Acromion & Spine of Scapula
Trapezius actions
Retract, elevate & depress the scapula
Lateral rotation of the scapula during abduction of arm
Trapezius nerve supply
Spinal part of accessory nerve (Cranial nerve 11)
C3 & C4
What muscles are used for rotation of the scapula?
Trapezius (twist the spine of scapula) and serrated anterior (pulls of inferior angle)
Levator Scapulae origin(proximal)
Posterior tubercles of transverse processes of C1-C4 vertebrae
Levator Scapulae insertion(distal)
Medial border of scapula above the spine (next to superior angle)
Levator Scapulae actions
Elevates and medically rotates scapula
Levator Scapulae nerve supply
Dorsal scapular nerve
Rhomboid minor origin(proximal)
Nuchal ligament & spinous processes of C7-T1
Rhomboids minor insertion(distal)
Medial border of scapula at the root of the spine
Rhomboid minor actions
Retract & medially rotate scapula
Rhomboid minor nerve supply
Dorsal scapular nerve
Rhomboid major origin(proximal)
Spinous processes of T2-T5 vertebrae
Rhomboid major insertion(distal)
Medial border of scapula below the spine
Rhomboid major actions
Retract & medially rotate scapula
Rhomboid major nerve supply
Dorsal scapular nerve
Serratus anterior origin(proximal)
External surfaces of ribs 1-8
Serratus anterior insertion(distal)
Anterior surface of medial border of scapula
Serratus anterior actions
Protracts scapula
Rotates scapula
Holds the scapula against the thoracic wall
Serratus anterior nerve supply
Long thoracic nerve
What is winging of the scapula caused by?
Weakness or paralysis of the long thoracic nerve which supplies the Serratus anterior muscle.
Pectoralis major origin(proximal)
Medial half of clavicle
Sternum
First 6 costal cartilages
Aponeurosis of external oblique
Pectoralis major insertion(distal)
Lateral lip of intertubercular groove of humerus
Pectoralis major actions
Adducts arm
Flexes arm
Rotates arm medially
Pectoralis major nerve supply
Medial & lateral pectoral nerves
Pectoralis minor origin(proximal)
External surfaces of ribs 3, 4, 5
Pectoralis minor insertion(distal)
Coracoid process of the scapula
Pectoralis minor actions
Stabilizes the scapula, it is a fixator
Pectoralis minor nerve supply
Medial pectoral nerve
Latissimus Dorsi origin(proximal)
Spinous processes of T6-T12 vertebrae
Thoracolumbar fascia
Iliac crest
Inferior 3 or 4 ribs
Latissimus Dorsi insertion(distal)
Floor of intertubercular sulcus of humerus
Latissimus Dorsi actions
Extends, adducts and medially rotates arm
Accessory muscle of respiration
Latissimus Dorsi nerve supply
Thoracodosal nerve
What muscles help elevate the scapula? (4)
Trapezius
Levator scapulae
Rhomboid major
Rhomboid minor
What muscles help depress the scapula? (5)
Trapezius Serratus anterior Pectoralis major Pectoralis minor Latissimus dorsi (And gravity)
What muscles help retract the scapula? (4)
Trapezius
Rhomboid major
Rhomboid minor
Latissimus dorsi
What muscles help protract the scapula? (3)
Serratus anterior
Pectoralis major
Pectoralis minor
What muscles help medially rotate (Downward rotation) the scapula? (6)
Levator scapulae Rhomboid major Rhomboid minor Pectoralis major Pectoralis minor (And gravity)
What muscles help laterally rotate (upward rotation) the scapula? (2)
Trapezius
Serratus anterior
What are the (3) joints in the pectoral girdle?
Sternoclavicular joint
Acromioclavicular joint
Scapulohumeral joint
What is the only articulation between the upper extremity and axial skeleton?
The sternoclavicular joint
What type of cartilage is the intraarticular disc of the sternoclavicular joint?
Fibrocartilage
When the clavicle is fractured, what pulls on the separated parts that make it worse?
The sternocleidomastoid pulls up on medial end
Gravity pulls the arm down which pulls the lateral end down
The Pectoralis major pulls the humerus medially which pulls the lateral end of the clavicle medially which could cause overriding of the fractured ends of the clavicle
What way does the clavicle rotate when the arm is flexed or abducted?
Posterior rotation
What (3) ligaments are associated with the acromioclavicular joint?
Acromioclavicular ligament
Coraco-acromial ligament (connects two parts of the clavicle)
Coracoclavicular ligament - divides into trapezoid ligament and conoid ligament
What is the difference between shoulder separation and dislocation?
Separation: the dislocation of the acromioclavicular joint. The acromioclavicular ligament ruptures, this can be accompanied by rupture of the coracoclavicular ligament as well but not always
Shoulder dislocation: head of humerus displaced from the glenoid cavity
What is the glenoid labrum?
A fibrocartilaginous rim of the glenoid that helps to increase the depth of the glenoid.
What are the (4) muscles that form the rotator cuff?
Supraspinatus Infraspinatus Teres minor Subscapularis (SITS muscles)
Subscapularis origin(proximal)
Subscapular fossa on anterior surface of scapula
Subscapularis insertion(distal)
Lesser tuberosity of the humerus
Subscapularis action
Medial rotation (of the arm?)
Subscapularis nerve supply
Upper and lower subscapular nerves
Supraspinatus origin(proximal)
Supraspinous fossa of scapula
Supraspinatus insertion(distal)
Upper part of the greater tuberosity of the humerus
Capsule of the shoulder joint
Supraspinatus action
Abduction of arm
Draws humerus toward the glenoid fossa (keeps it in place)
Weak lateral rotator and flexor
Supraspinatus nerve supply
Suprascapular nerve (C5)
Infraspinatus origin(proximal)
Infraspinous fossa of the scapula
Infraspinatus insertion(distal)
Middle facet of the greater tuberosity of the humerus
Infraspinatus actions
Laterally rotates the arm
Abducts arm
Adducts arm
Draws humerus toward the glenoid fossa (keeps it in place)
Infraspinatus nerve supply
Suprascapular nerve (C5, C6)
Teres minor origin(proximal)
Upper two-thirds of the dorsal surface of the axillary border of the scapula
Teres minor insertion(distal)
Laterally rotates arm
Weakly adducts arm
Draws humerus toward glenoid fossa (keeps in place)
Teres minor nerve supply
Axillary nerve (C5)
What are the (3) bursae around the shoulder joint?
Subacromial bursa
Tendon sheath (sleeve of bursa)
Subscapular bursa
What muscle does the first 15 degrees of abduction?
Supraspinatus
Which is more common, anterior or posterior shoulder dislocation?
Anterior shoulder dislocation is more common
Why is a shoulder dislocation always inferior and never superior?
The acromion blocks the humerus from dislocating superiorly
Teres Major origin(proximal)
Posterior surface of inferior angle of scapula
Teres Major insertion(distal)
Medial lip of intertubercular sulcus
Teres Major actions
Adducts and medially rotates arm
Teres Major nerve supply
Lower subscapular nerve
Deltoid origin(proximal)
Lateral third of clavicle
Acromion
Lower lip of spine of scapula
Deltoid insertion(distal)
Deltoid tuberosity of the humerus
Deltoid actions
Flexion & Extension
Medial & Lateral rotation
Abduction (15-90 degrees)
Deltoid nerve supply
Axillary nerve
What part of the Deltoid does flexion?
Clavicular (anterior) part of deltoid
What part of the Deltoid does abduction?
Middle part of deltoid
What part of the Deltoid does extension?
Spinal (posterior) part of deltoid
What needs to happen to abduct >90 degrees?
Lateral rotation of humerus is required
What muscles help flex the arm?
Deltoid
Pectoralis major
What muscles help extend the arm?
Deltoid
Latissimus Dorsi
What muscles help adduct the arm?
Infraspinatus Teres Minor Teres Major Pectoralis major Latissimus Dorsi
What muscles help abduct the arm?
Deltoid (15-90 degrees)
Supraspinatus (0-15 degrees)