Upper Extremity: Overview Flashcards
Layers of the skin
- Skin
- Superficial fascia
- Deep fascia
Deep fascia of upper limb
- Pectoral fascia
- Axillary fascia
- Clavipectoral fascia
- Deltoid fascia
- Brachial fascia
- Antebrachial fascia
Deep fascia of upper limb function
- Can attach to bone
- Covers muscle
- Form intermuscular septa
Arterial supply/venous drainage
- Deep to the deep fascia
- Arteries and deep veins have the same name
- Veins are next to artery (vena comitans)
- Often duplicated (venae comitantes)
Arteries of upper limb
- Subclavian
- Axillary
- Brachial
- Radial
- Ulnar
Superficial veins of upper limb
- External to deep fascia: drain superficial structures
- Arise from dorsal venous network (hand)
Superficial veins of upper limb names
- Cephalic vein
- Basilic vein
- Median cubital vein
Cephalic vein
- Lateral side of forearm/arm
- Leltopectoral groove
- Pierces clavipectoral fascia in the deltopectoral triangle
- Drains into the axillary vein
Basilic vein
- Medial side of forearm/lower arm
- Pierces brachial fascia around mid-arm
- Joins brachial vein to form axillary vein
Median cubital vein
- Connects cephalic and basilic veins
Superficial lymph drainage of upper limb
- Most drain into lateral (humeral) axillary lymph nodes directly
- Medial side of hand/forearm drains into the cubital lymph nodes
- Lateral side can drain into deltopectoral and apical nodes bypassing humeral axillary nodes
Deep lymph drainage of upper limb
- Drain into lateral (humeral) axillary lymph nodes
Scapular region lymph drainage
- Posterior (subscapular) axillary lymph nodes
Pectoral region lymph drainage
- Anterior (pectoral) axillary lymph nodes
C4 dermatome
- Base of neck, superior shoulder
C5 dermatome
- Upper lateral arm
C6 dermatome
- Planar thumb pad (lateral forearm)
C7 dermatome
- Middle finger pad (some sources say index also)
C8 dermatome
- Little finger pad (medial forearm)
T1 dermatome
- Medial elbow
- Upper forearm
- Lower arm
T2 dermatome
- Upper arm
- Axilla
C5 myotome
- Arm abduction
C6 myotome
- Elbow flexion
- Wrist extension
- *C6 biker chicks**
C7 myotome
- Elbow extension
- Wrist flexion
- Finger extension
C8 myotome
- Finger flexion
T1 myotome
- Finger abduction/adduction
C4 myotome
- Major contributor to motor innervation of the diaphragm
C5,6 tendon reflex
- Biceps reflex
- Brachioradialis reflex
C7 tendon reflex
- Triceps reflex
Major nerves of the upper extremity
- Radian nerve
- Ulnar nerve
- Median
Peripheral nerve cutaneous innervation
- Axillary nerve
- Radial nerve
- Musculocutaneous nerve
- Ulnar nerve
- Median nerve
Pectoral region muscles
- Connect the pectoral girdle and humerus to the axial skeleton
- Primarily function in moving the pectoral girdle and humerus
Anterior axio-appendicular muscles
- Pectoralis major
- Pectoralis minor
- Subclavius
- Serratus anterior
Deltopectoral groove
- Between pectoralis major and deltoid
- Cepahlic vein
- Deltoid branch of thoracoacromial artery
Pectoral fascia
- Covers anterior and posterior of pectoralis major
- Becomes axillary fascia (floor of axilla)
Clavipectoral fascia
- Deep to pectoral fascia
- Attaches to clavicle and envelopes subclavius and pectoralis minor muscles
- Pierced by cephalic vein, thoracoacromial artery, pectoral nerves
- Costocoracoid ligament
- Suspensory ligament of axilla below pec minor
Costocoracoid ligament
- Thickening between coracoid and 1st costochondral junction
Suspensory ligament of axilla below pec minor
- Connects to and supports axillary fascia
Pectoralis major
- 2 heads
- Forms anterior axillary fold
Pectoralis major proximal attachment
- Medial ½ clavicle
- Anterior sternum
- Upper 6 costal cartilages
- Aponeurosis of external oblique muscle
Pectoralis major distal attachment
- Lateral lip of intertubercular sulcus
Pectoralis major innervation
- Lateral (C5-7) and medial pectoral nerves (C8-T1)
Pectoralis major function
- Adduction
- Medial rotation
- Flexion
Pectoralis minor
- Deep to pec major
- Important landmark (axillary artery, brachial plexus)
- Subcoracoid space
Pectoralis minor proximal attachment
- Ribs 3-5
Pectoralis minor distal attachment
- Coracoid process
Pectoralis minor innervation
- Medial pectoral nerve (C8-T1)
Pectoralis minor function
- Stabilize scapula
- Pulls against thoracic wall (lateral angle moves inferiorly)
- Accessory muscle of respiration
Subclavius proximal attachment
- 1st rib/costal cartilage jxn
Subclavius distal attachment
- Inferior, middle 1/3 of clavicle
Subclavius innervation
- Nerve to subclavius (C5)
Subclavius function
- Stabilize SC joint
- Depress clavicle
Serratus anterior
- Serrated appearance
- Boxer’s muscle
Serratus anterior proximal attachment
- Lateral aspect of ribs 1-8(9)
Serratus anterior distal attachment
- Distal attachment: anterior surface of medial scapular border
Serratus anterior innervation
- Long thoracic nerve (C5,6,7)
Serratus anterior function
- Scapular protraction and rotation
- Stabilizes against thorax
Long thoracic nerve
- Branch of the brachial plexus
- Has a superficial location
- Injured in: mastectomy, knife injury, chest tube
Long thoracic nerve injury
- Causes weakness or paralysis of serratus anterior
- Results in winging of the scapula, and difficulty with arm elevation (abduction)
Trapezius
- Named based on shape
- 3 divisions based on muscle fiber direction
Divisions of trapezius
- Superior (descending): elevation, rotation
- Middle: retraction
- Inferior (ascending): depression, rotation
Trapezius proximal attachment
- Medial 1/3 of superior nuchal line
- EOP (external occipital protuberance)
- Nuchal ligament
- SPs of C7-T12
Trapezius distal attachment
- Lateral 1/3 of clavicle
- Acromion
- Scapular spine
Trapezius innervation
- Spinal accessory nerve (motor)
- C3,4 spinal nerves (pain and proprioception)
Weakness or CN XI injury
- Shoulder drooping
- Weakness in shrugging
- Impaired abduction
Latissimus dorsi
- Expansive muscle
- Forms posterior axillary fold
Latissimus dorsi proximal attachment
- SPs of T7-L5
- Thoracolumbar fascia
- Iliac crest
- Ribs 10 to 12 (inferior 3 or 4 ribs)
- Scapula (inferior angle)
Latissimus dorsi distal attachment
- Humerus (floor of intertubercular sulcus)
Latissimus dorsi innervation
- Thoracodorsal nerve (C6-8)
Latissimus dorsi function
- Extends
- Adducts
- Medial rotation of humerus
- Pull-up type motions
Levator scapulae proximal attachment
- Posterior tubercles of C1-4 TPs
Levator scapulae distal attachment
- Medial border of scapula (above scapular spine base)
Levator scapulae innervation
- Dorsal scapular nerve (C4,5): motor
- C3,4: proprioception
Rhomboid major/minor
- 2 muscles: rhombus shaped
Rhomboid major proximal attachment
- T2-5 SPs
Rhomboid minor proximal attachment
- Nuchal ligament
- C7 and T1 SPs
Rhomboid major distal attachment
- Medial border of scapula
- Spine to inferior angle of scapula
Rhomboid minor distal attachment
- Medial border of scapula
- Base of scapular spine
Rhomboid major/minor innervation
- Dorsal scapular nerve (C4,5): motor
- C3,4: proprioception
Rhomboid major/minor function
- Retract and rotate scapula
- Fix against thoracic wall