Upper Extremity: Shoulder, Bones, Axilla and Brachial Plexus Flashcards

1
Q

What are the bones of the shoulder girdle?

A

Shoulder girdle: scapula, clavicle

*Shoulder girdle hold upper extremity in place

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2
Q

What are the bones of the upper extremity?

A

Humerus, radius, ulna, carpals, metacarpals, phalanges

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3
Q

What are the parts of the scapula?

A

glenoid cavity, infraspinous, supraspinous, subscapular fossae, scapular spine, acromion process, coracoid process, suprascapular notch

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4
Q

What are the major muscles, actions, innervations of the shoulder?

A
1. ROTATOR CUFF MUSCLES = "SITS": supraspinatous (abduction) + infraspinatus (ext rotation) = supracapular nerve
Subscapularis (int rot) = superior, inferior subscapular nerve
Teres Minor (ext rotation) = axillary nerve
  1. Teres Major (extend, addiction, int. rotation) = inferior subscapular nerve
  2. Deltoid (all actions but aBduction) = axillary nerve
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5
Q

What’s the only bony connection between the upper limb (part of appendicular skeleton) and axis skeleton?

A

sternoclavicular joint

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6
Q

Where would trauma fracture the humerus?

A

Surgical neck (bec/ thinner than anatomical neck)

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7
Q

Where does humerus articulate to form ball and socket joint?

A

Glenoid cavity

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8
Q

Which fossa is on anterior side of your scapula?

A

Subscapular fossa

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9
Q

Which fossae is on posterior side of scapula?

A

Supraspinus and infraspinus

separated by spine of scapula

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10
Q

Where does the lateral end of the clavicle attach?

A

acromion process of scapula

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11
Q

Where does the medial end of clavicle attach?

A

sternoclavicular joint

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12
Q

Where does pec minor attach on scapula?

A

coracoid process

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13
Q

What part of humerus attaches to glenoid cavity of scapula?

A

Head

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14
Q

Where does the biceps tendon run through?

A

Intertubercular groove/sulcus between greater and lesser tubercles

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15
Q

What attaches to tubercles?

A

muscles!

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16
Q

Where does deltoid attach to humerus?

A

deltoid tuberosity of humerus

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17
Q

What fossa is on anterior side of humerus?

A

coroNoid process

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18
Q

What fossa is on end of posterior side of humerus?

A

olecranon fossa

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19
Q

What 3 condyles are on the humerus and what attaches to them?

A

Capitulum (lateral) attaches to radius
Trochlea (medial) attaches to ulna
Epicondyles (lateral and medial)

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20
Q

The medial epicondyle is _________ than lateral epicondyle?

A

bigger

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21
Q

What are the 3 joints of the shoulder girdle and proximal humerus?

A
  1. Sternoclavicular - between MEDIAL end of clavicle and manubrium of sternum (only attachment betw/ upper extremity and axial skeleton)
  2. Acromioclavicular - between acromion of scapula and LATERAL end of clavicle
  3. Glenohumeral - between head of humerus and glenoid cavity (has the MOST mobility of all 3 joints!)
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22
Q

What actions can the glenohumeral (ball and socket) joint do? Does it have the most mobility of all 3 joints in the shoulder girdle and proximal humerus area?

A
Flexion
Extension
aBduction
aDduction
Medial rotation
Lateral rotation
Circumduction

Yes!

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23
Q

The Radius and Ulna both have ________ processes?

A

styloid

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24
Q

What is the lateral forearm bone? and the medial one?

A

FOREARM:
Lateral (thumb side) = radius
Medial (pinky side) = ulna

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25
Q

What muscle attaches to the radial tuberosity of the radius?

A

biceps inserts on radial tuberosity!

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26
Q

What can the radius do that the ulna can’t?

A

pivot! (it can pivot across ulna in “pronation” movement)

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27
Q

Which joint does the pivoting action?

A

Elbow joint = hinge joint

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28
Q

Where can you find the trochlear notch, coraNoid and olecranon processes?

A

on ULNA

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29
Q

What divides the forearm into anterior and posterior muscle compartments?

A

fibrous Interosseus membrane between the radius and ulna

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30
Q

What attaches to styloid processes of forearm bones?

A

wrist joint between carpals and distal radius

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31
Q

The elbow joint is what type of joint?

The shoulder joint is what type of joint?

A
elbow = Hinge
shoulder = Ball and socket
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32
Q

Where is the C-shaped hinge on the ulna?

A

trochlear notch/trochlear fossa of proximal end of ulna = where it articulates with humerus

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33
Q

What is the cup shaped cartilage lining the glenoid cavity helping head of humerus to articulate with it?

A

glenoid labrum (sits within glenoid fossa)

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34
Q

Do ligaments hold radius and ulna together?

A

Yes. They are attached to each other at both proximal and distal ends

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35
Q

Proximal radio-ulnar joint (head of radius and radial notch of ulna) allows for what actions?
The other 2 joints allow for what actions?

A

forms PIVOT joint, allows forearm to do pronation and supination

Trochlear notch of ulna + trocheal of humerus AND head of radius + radial notch of ulna allow for FLEXION/EXTENSION = HINGE joint

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36
Q

What movement necessitates crossing of radius over ulna?

A

Pronation

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37
Q

What is the major ligament supporting the elbow joint?

A

Anular ligament (wraps around radial head)

38
Q

What are the 3 elbow joints enclosed by common synovial cavity?

A
  1. Trochlear notch of ulna + trochlea of humerus
  2. head of humerus + capitulum
  3. head of radius + radial notch of ulna
39
Q

What are the 8 carpal bones?

A

mnemonic: Some lovers try positions that they can’t handle:
1. scaphoid
2. lunate
3. triquetrum
4. pisiform

MEDIAL side:

  1. trapezium
  2. trapezoid
  3. capitate
  4. hamate
40
Q

How many metacarpals are in each hand?

A

5 in each!

10 total for 2 hands

41
Q

Which carpal bone is sesmoid?

A

pisiform (sesmoid = bone sitting in tendon)

42
Q

There are 3 phalanges (proximal, medial, distal) on each digit except for _________?

A

thumb (only has proximal, distal)

43
Q

The carpal arch is covered by what tissue that makes it into a tunnel?

A

FLEXOR RETINACULUM

44
Q

The carpo-metacarpal joint is what type of joint?

A

Saddle joint ( betw/ trapezium and first metacarpal of thumb)= contributes to opposable thumbs!

45
Q

Within digits, there are interphalangeal joints. How many do we have?

A

There are 2 joints (PROXIMAL interphalangeal joint = between proximal and middle phalanges AND DISTAL interphalangeal joint betw/ distal phalanges) for each digit? But, thumb only has 1 distal interphalangeal joint.

46
Q

What are our 5 joints in wrists and hands?

A
  1. Wrist joint = between radius and ulna (articular disc) with scaphoid, lunate, triquetrum of carpals
  2. Carpal joint
  3. Carpometacarpal joints
  4. Metacarpophalangeal joint
  5. Interphalangeal joints (Proximal IP + Distal IP)
47
Q

What bones form the carpal arch?

A

From thumb side: trapezium, trapezoid, capitate, hamate, triquetrum, pisiform

48
Q

What is the origin, insertion, innervation and action of Lat. dorsi?

A

O: spine T12-L5, sacrum, iliac crest, ribs 10-12
I: Intertubercular sulcus of humerus
N: Thoracodorsal nerve
A: Extend, adduct, medial rotation of humerus

49
Q

What is the origin, insertion, innervation and action of deltoid?

A

O: scapula and clavicle
I: humerus (deltoid tuberosity)
N: Axillary nerve
A: aBduction! (except for first 15 degrees which is done by supraspinatus)

50
Q

What is the origin, insertion, innervation and action of trapezius?

A

O: ext. occipital protuberance, ligamentum nuchae, spine (C7-T12)
I: Lateral 1/3rd clavicle, acromion, spine of scapula
N: accessory nerve
A: elevate, retract, depress scapula

51
Q

What is the origin, insertion, innervation and action of serratus anterior?

A

O:
I:
N:
A:

52
Q

What is the origin, insertion, innervation and action of pec major and pec minor?

A
O: Major:
     Minor:
I:   Major:
    Minor:
N: Major: medial and lateral pectoral nerve
Minor: medial pectoral nerve
A:
53
Q

What is the origin, insertion, innervation and action of rhomboid major and rhomboid minor?

A

O: Major: T2-T5
Minor: C7 and T1
I: Major: medial border of scapula below spine of scapula
Minor: medial border of scapula at spine of scapula
N: dorsal scapular nerve
A: Elevate and retract scapula

54
Q

What is the origin, insertion, innervation and action of levator scapulae?

A

O: C1-C4 Transverse processes
I: Upper medial border of scapula
N: Dorsal Scapular nerve
A: Elevate scapulae

55
Q

What muscle does the first 15 degrees of abduction of the shoulder?

A

Supraspinatus

56
Q

Can the deltoid muscle initiate abduction?

A

NO!

57
Q

Which muscle initiates abduction of the shoulder?

A

Supraspinatus!

58
Q

Which muscle is not innervated by brachial plexus?

A

Trapezius (innervated by cranial accessory nerve)

59
Q

What are the muscles over scapula?

A

1.supraspinatus (above scapular spine) = initiation of abduction
2.infraspinatus (below scapular spine) = arm lateral rotation
innervated by suprascapular nerve
Posteriorly: 3. teres major which goes to front (same as lat dorsi o and i, lower subscapular nerve) does medial rotation, adduction, extension and 4. teres minor (lat rotation of arm, axillary nerve)
5. subscapularis

60
Q

Which muscle of the shoulder do medial rotation of arm?

A

Subscapularis (same action as pec major! but opposes infraspinatus action)

61
Q

What is the origin, insertion, innervation and action of Supraspinatus?

A

O: supraspinous fossa of scapula
I: humerus (superior part of greater tubercle)
N: suprascapular nerve
A: initiation of abduction (15 degrees), stabilizes shoulder joint, helps prevent downward dislocation of humerus e.g. when carrying heavy suitcase

*Named for scapular location, located on posterior part of scapula. DEEP to trapezius

62
Q

What is the origin, insertion, innervation, action of Infraspinatus?

A

O: infraspinous fossa
I: humerus (greater tubercle posterior to where supraspinatus inserts )
N: Suprascapular nerve runs in suprascapular foramen
A: rotates humerus laterally, helps hold head of humerus in glenoid cavity stabilizing shoulder joint

*Named for scapular location, partly covered by deltoid and trapezius

63
Q

What is the origin, insertion, innervation action of Teres minor?

A

O: lateral border of dorsal scapular surface
I: greater tubercle of humerus inferior to infraspinatus insertion
N: Axillary nerve
A: same action as infraspinatus muscle

*Small elongated muscle inferior to inferiospinatus, may not be able to separate it from that muscle

64
Q

What is the origin, insertion, innervation, action of Teres major?

A

O: posterior surface of scapula at inferior angle
I: crest of lesser tubercle on anterior humerus, insertion tendon fused with that of Lat. dorsi
N: lower subscapular nerve (C6,C7)
A: Extends, medially rotates and adducts humerus, synergist of lat. dorsi
*thick, rounded muscle, located inferior to tres minor, helps form posterior wall of axilla (with Lat. dorsi and subscapularis)

65
Q

What is origin, insertion, innervation, action of subscapularis?

A

O: subscapular fossa of scapula
I: lesser tubercle of humerus
N: subscapular nerve (C5-C7)
A: chief medial rotator of humerus, assisted by pec major, helps hold head of humerus in glenoid cavity, stabilizing shoulder joint

*forms part of posterior wall of axilla, tendon of insertion passes in front of shoulder joint

66
Q

What is the axilla?

A

armpit region where structures from neck pass to upper extremity:

  1. where subclavian artery becomes axillary artery and where axillary vein becomes subclavian vein
  2. has brachial plexus
  3. lymphatics, lymph nodes
  4. axillary tail of breast (critical to feel for breast exam)
  5. upper part of some arm muscles cross axilla: biceps and coracobrachialis
67
Q

What are the boundaries for axilla?

A
  1. Superior boundary defined by bones: axillary inlet (anterior = clavicle, posterior = scapula, medial = rib 1)
  2. Anterior Wall: clavipectorial fascia (subclavius, pec minor), pec major
  3. Medial Wall: thoracic wall, serratus anterior
  4. Lateral Wall: humerus
  5. Posterior Wall: muscles over scapula and triceps muscle
  6. Floor: dome skin and fascia, lateral to floor axilla is continuous with anterior part of arm

*Axilla = NOT well protected

68
Q

What divides the axillary artery into 3 parts?

A

Pec minor:

  1. before/PROXIMAL to pec minor = gives off 1 branch called SUPERIOR THORACIC
  2. behind/POSTERIOR to pec minor = gives off 2 branches called Thoraco-acromial, lateral thoracic
  3. after/DISTAL to pec minor = gives off 3 branches: SUBSCAPULAR, ANTERIOR & POSTERIOR CIRCUMFLEX HUMERAL (go around humerus, meeting in middle)
69
Q

When does subclavian artery become axillary artery?

A

when it goes under clavicle, lateral to rib 1

70
Q

Axillary artery continues as the ____________ artery into arm?

A

brachial artery (axillary becomes brachial artery when it crosses teres major)

71
Q

Brachial artery travels in the ___________ compartment and divides into which 2 arteries near the elbow?

A

Brachial artery travels in the ANTERIOR compartment, divides into radial (lateral) and ulnar artery (medial)

72
Q

What is the major branch of the brachial artery that supplies the POSTERIOR arm?

A

Profunda brachii

73
Q

Does profunda brachii run with the radial nerve?

A

YES!

74
Q

What artery is used to measure blood pressure?

A

Brachial artery

75
Q

What are the 2 major superficial brachial veins that run along the brachial artery to drain superficial structures?

A

Basilic (medial)= forms most of brachial vein

Cephalic (lateral) = travels in deltopectoral groove

76
Q

What are the SUPERFICIAL and DEEP brachial veins?

A

SUPERFICIAL: basilic, cephalic (cephalic vein drains posterior side of Upper Extremity)
DEEP: smaller brachial veins

77
Q

What is the deltopectoral groove and what nerve runs through it?

A

space between deltoid and pec major

*Cephalic vein runs through deltopectoral groove before it enters axillary vein

78
Q

When does axillary vein become subclavian vein?

A

after passing rib 1

79
Q

Are axillary lymphatic nodes divided into groups based on location in axilla?

A

YES!

80
Q

What areas do axillary lymph nodes drain?

A

Upper Extremity, parts of upper back, shoulders, neck and most of breast, other things of thoracic wall

81
Q

Where does all lymph drain into?

A

top of axilla (at junction of subclavian and internal jugular vein = where brachiocephalic vein forms)

82
Q

What spinal nerves form the brachial plexus?

A

anterior (ventral) rami (ROOTS) of C5-T1 spinal cord nerves travelling through neck and axilla to innervate muscles and skin in upper extremity

83
Q

Which muscle does NOT get innervated by brachial plexus?

A

Trapezius (bec/ its innervated by cranial accessory nerve)

84
Q

What is the brachial plexus divided into?

A

arranged from proximal to distal: ROOTS (C5-T1) organized into TRUNKS (pass from neck to axilla = Superior, middle, inferior) organized into DIVISIONS (anterior division supplies anterior compartment, posterior division supplies posterior compartment) organized into CORDS (Lateral, Medial, Posterior)

*remember, axillary artery goes in between anterior and posterior division

85
Q

Which cords are associated with the anterior division of brachial plexus?

A

lateral and medial cords

86
Q

Which part of the brachial plexus do most major nerves for upper extremity branch off of?

A

CORDS

87
Q

What do ROOTS of brachial plexus branch into? What do they innervate?

A

dorsal scapular (innervates rhomboids), long thoracic nerve (innervates Serratus Anterior)

88
Q

What do TRUNKS branch into?

A

suprascapular nerve (innervates infraspinatus, supraspinatus)

89
Q

What does the LATERAL CORD branch into? What is its TERMINAL NERVE?

A

Lateral pectoral nerve (innervates pec major) and 1/2 of median nerve

Terminal nerve = Musculocutaneous nerve (innervates anterior arm compartment)

90
Q

What does the LATERAL CORD branch into? What is its TERMINAL NERVE?

A
  1. Lateral pectoral nerve (innervates pec major)
  2. 1/2 of median nerve
  3. Musculocutaneous nerve (innervates anterior arm compartment) = (remember this is a terminal nerve)
91
Q

What does the POSTERIOR CORD of brachial plexus branch into?

A

Superior subscapular, Thoracodorsal (for Lats), Inferior subscapular (Teres Major), Axillary (for Deltoid, Teres Minor), Radial nerve (posterior compartment of arm, forearm)

92
Q

What branches off the MEDIAL CORD of brachial plexus?

A

medial cutaneous nerve of arm
medial cutaneous nerve of forearm
medial pectoral nerve (innervates pec major, pec minor)
1/2 of median nerve (innervates most of anterior compartment of FOREARM, few HAND muscles)
ulnar nerve (innervates most HAND muscles, few forearm muscles)