Upper Extremity, Snell Flashcards
Base of the breast extends from which ribs
2nd to 6th
Base of the breast extends from which lines
Margin of sternum to midaxillary line
Superficial vs deep fascia: Greater part of mammary gland
Superficial
Part of mammary gland that pierces the deep fascia
Axillary tail
Mammary glands are separated from deep fascia by loose areolar tissue called
Retromammary space
Each mammary gland consists of ___ lobes
15-20
Acts as a small reservoir for secreted milk
Lactiferous sinus
Blood supply of breast (2)
1) Lateral thoracic and thoracoacromial from axillary artery
2) Perforating branches of the internal thoracic and intercostal arteries
Breast lymphatics: Lateral quadrants
Anterior axillary or pectoral nodes
Breast lymphatics: Medial quadrants
Internal thoracic nodes
Bones of the shoulder girdle (2)
1) Scapula
2) Clavicle
Most common fractured bone in the body
Clavicle
Clavicular fracture is MOST COMMONLY due to
Fall on the shoulder or outstretched hand
Clavicle: Articulates medially with (2)
1) Sternum
2) First costal cartilage
Clavicle: Articulates laterally with
Scapula
Clavicle: Convex forward
Medial 2/3
Clavicle: Concave forward
Lateral 1/3
Scapula: Articulates with the clavicle
Acromion
Scapula: Articulates with the head of humerus
Glenoid fossa
Scapula: Medial to the base of the coracoid process
Suprascapular notch
Scapula: Concave anterior surface
Subscapular fossa
Humerus: Articulates with glenoid fossa
Head
Humerus: Immediately below the head
Anatomical neck
Humerus: Below the anatomic neck
Greater and lesser tuberosities
Humerus: Greater and lesser tuberosities are separated from each other by
Bicipital groove
Humerus: Distal to the tuberosities
Surgical neck
Humerus: Roughened area approximately halfway down the lateral aspect of shaft
Deltoid tuberosity
Humerus: Behind and below the deltoid tuberosity
Spiral groove for the radial nerve
Humerus: Articulates with head of radius
Capitulum
Humerus: Articulates with ulna
Trochlea
Humerus: Lies above the capitulum and receives the head of the radius in full flexion of elbow joint
Radial fossa
Humerus: Above the trochlea anteriorly, this receives the ulna during full flexion of elbow joint
Coronoid fossa
Humerus: Above the trochlea posteriorly, this receives the ulna when elbow is fully extended
Olecranon fossa
Upper end vs lower end: Head of radius
Upper
Radius: Articulates with the capitulum of humerus
Upper concave surface of head
Radius: Articulates with the radial notch of ulna
Circumference of head
Radius: Below the neck
Bicipital tuberosity
Radius: Inserts at the bicipital tuberosity
Biceps brachii
Radius: Attaches to the sharp interosseous border at the shaft
Interosseous membrane
Lateral vs medial: Styloid process of radius
Lateral
Radius: Articulates with head of ulna
Ulnar notch
Radius: Inferior surface of lower end articulates with (2)
1) Scaphoid
2) Lunate
Radius: Posterior surface of the lower end
Dorsal tubercle
Radius: Dorsal tubercle is grooved on its medial side by the tendon of
ExPoLo
Ulna: Large upper end that forms the prominence of the elbow
Olecranon process
Ulna: Lies on the anterior surface of the olecranon process
Trochlear notch
Ulna: Below the trochlear notch
Coronoid process
Ulna: On the lateral surface of the coronoid process
Radial notch
Upper vs lower end: Head of ulna
Lower
Medial vs lateral: Styloid process of ulna
Medial
Carpal bones: #
8
Carpal bones: Name in order (lat-med; proximal-distal)
Some Lovers Try Positions That They Can’t Handle
1) Scaphoid (navicular)
2) Lunate
3) Triquetral
4) Pisiform
5) Trapezium
6) Trapezoid
7) Capitate
8) Hamate
Concavity vs convexity: Formed by carpal bones on anterior surface
Concavity
Carpal bones: Attached to the lateral and medial edges anteriorly
Flexor retinaculum
Contents of carpal tunnel (2)
1) Median nerve
2) Long flexor tendons of the fingers
Compressed in carpal tunnel syndrome
Median nerve
Flexor muscle that does not pass beneath the flexor retinaculum
Palmaris longus
Metacarpal bones: Form the knuckles
Heads
Metacarpal bones: Heads articulate with
Proximal phalanges
Phalanges: # per finger
3 except thumb (2)
Shoulder joint: Fibrocartilaginous rim that deepens the glenoid cavity
Glenoid labrum
Shoulder joint: Type of joint
Synovial ball-and-socket
Shoulder joint: Capsule strengthened by tendons of
1) Supraspinatus superiorly
2) Infraspinatus and Teres minor posteriorly
3) Subscapularis anteriorly
Shoulder joint: Stabilizers
Rotator cuff muscles
Shoulder joint: Rotator cuff muscles
SITS
1) Supraspinatus
2) Infraspinatus
3) Teres minor
4) Subscapularis
Shoulder joint, ligament: Strengthen the anterior part of the capsule
Glenohumeral ligaments
Shoulder joint, ligament: Bridges the gap between the greater and lesser tuberosities of humerus and holds tendon of long head of biceps in place
Transverse humeral ligament
Shoulder joint, ligament: Strengthens superior part of the capsule
Coracohumeral ligament
Shoulder joint, ligament: Protects the superior aspect of the joint
Coracoacromial ligament
Shoulder joint: The synovial membrane surrounds the tendon of
Biceps muscle
Shoulder joint: Synovial membrane protrudes forward through the capsule forming a bursa beneath
Subscapularis muscle
Shoulder joint: Weakest part
Inferior
Shoulder joint: Subglenoid dislocation into the quadrangular space can cause damage to what structure
Axillary nerve
Shoulder joint: Axillary nerve injury causes (2)
1) Paralysis of deltoid
2) Loss of skin sensation over lower half of deltoid
3) Weak lateral rotation (teres minor)
Shoulder joint: The quadrangular space contains (2)
1) Posterior humeral circumflex artery
2) Axillary nerve
Shoulder joint relations: Anterior (2)
1) Brachial plexus
2) Axillary vessels
Shoulder joint relations: Inferior
1) Axillary nerve
2) Posterior circumflex humeral vessels
Elbow: Type of joint
Synovial hinge
Elbow, medial vs lateral collateral ligament: Closely related to ulnar nerve
Medial
Elbow: Fracture/dislocation damages what nerve/vessel
Ulnar nerve
Elbow: Muscles that produce flexion
1) Biceps
2) Brachialis
3) Brachioradialis
4) Pronator teres
Elbow: Muscles that produce extension
1) Triceps
2) Anconeus
Elbow: Angle seen when elbow joint is extended and lies between arm and forearm
Carrying angle
Elbow: Carrying angle in males
170
Elbow: Carrying angle in females
167
Elbow relations: Anterior (2)
1) Median nerve
2) Brachial artery
Elbow relations: Medial
Ulnar nerve as it passes behind the medial epicondyle of the humerus
Superior radioulnar joint: Consists of
1) Circumference of radial head
2) Radial notch
3) Annular ligament
Superior radioulnar joint: Forms a collar around the radial head of radius
Annular ligament
Superior radioulnar joint: Pronation (2)
1) Pronator teres
2) Pronator quadratus
Superior radioulnar joint: Supination
1) Supinator muscles
2) Biceps
Supination vs pronation: More powerful
Supination
Inferior radioulnar joint: Components
1) Ulnar head
2) Ulnar notch
Inferior radioulnar joint: Type of joint
Synovial pivot
Inferior radioulnar joint: Shuts off the joint from wrist joint
Articular disc
Wrist joint/Radiocarpal joint: Type
Synovial condyloid
Wrist joint/Radiocarpal joint: Ligament/s that connect/s the styloid process of ulna to triquetral
Medial
Wrist joint/Radiocarpal joint: Ligament/s that connect/s the styloid process of the radius to the scaphoid bone
Lateral
Wrist joint/Radiocarpal joint: Nerve supply
1) Anterior interosseous nerve from median nerve
2) Deep branches of radial and ulnar nerves
Wrist joint/Radiocarpal joint, T/F: Rotation is possible
F
Wrist joint/Radiocarpal joint: Flexion (6)
1) Palmaris longus
2) Flexor carpi radialis
3) Flexor carpi ulnaris
4) Flexor digitorum superficialis
5) Flexor digitorum profundus
6) Flexor pollicis longus
Wrist joint/Radiocarpal joint: Extension (7)
1) Extensor carpi radialis longus
2) Extensor carpi radialis brevis
3) Extensor carpi ulnaris
4) Extensor digitorum
5) Extensor pollicis longus
6) Extensor indicis
7) Extensor digiti minimi
Wrist joint/Radiocarpal joint: Adduction (2)
1) Flexor carpi ulnaris
2) Extensor carpi ulnaris
Wrist joint/Radiocarpal joint relations: Anterior (2)
1) Median nerve
2) Ulnar nerve
Wrist joint/Radiocarpal joint relations: Lateral
Radial artery
Carpometacarpal joints: Type of joint
Synovial gliding
Carpometacarpal joints: Thumb, type of joint
Synovial saddle
Carpometacarpal joint of thumb: Flexion (2)
1) Flexor pollicis longus and brevis
2) Opponens pollicis
Carpometacarpal joint of thumb: Extension
Expolo and expobre
Carpometacarpal joint of thumb: Abduction
Abpolo and abpobre
Carpometacarpal joint of thumb: Adduction
Adductor pollicis
Carpometacarpal joint of thumb: Rotation/opposition
Opponens pollicis
Metacarpophalangeal joints: Type of joint
Synovial condyloid
Metacarpophalangeal joints: Ligaments
Palmar
Metacarpophalangeal joints: Flexion (4)
1) Interossei
2) Lumbricals
3) Flexor digitorum superficialis
4) Flexor digitorum profundus
Metacarpophalangeal joints: Extension
1) Extensor digitorum
2) Extensor indicis
3) Extensor digiti minimi
Metacarpophalangeal joints: Abduction (away from midline of 3rd finger)
Dorsal interossei
Metacarpophalangeal joints: Adduction (toward midline of 3rd finger)
Palmar interossei
Interphalangeal joints: Type of joint
Synovial hinge
Muscles connecting the upper limb to the vertebral column (5)
1) Trapezius
2) Latissimus dorsi
3) Levator scapula
4) Rhomboid minor
5) Rhomboid major
Muscles connecting the upper limb to the thoracic wall (4)
1) Pectoralis major
2) Pectoralis minor
3) Subclavius
4) Serratus anterior
Muscles connecting the scapula to the humerus (6)
1) Supraspinatus
2) Infraspinatus
3) Teres minor
4) Teres major
5) Subscapularis
6) Deltoid
Axilla, base: Anterior
Anterior axillary fold (inferior border of pectoralis major)
1) Pectoralis major
2) Pectoralis minor
3) Subclavius
Axilla, base: Posterior
Posterior axillary fold (tendon of latissimus dorsi and teres major)
Axilla, base: Medial
Chest wall
Axilla: Contents (3)
1) Axillary vessels
2) Brachial plexus
3) Lymph nodes
Axillary sheath: Contents
1) Axillary vessels
2) Brachial plexus
Axillary sheath: Continuous above with
Prevertebral layer of deep cervical fascia
Nerve supply: Latissimus dorsi
Thoracodorsal nerve
Nerve supply: Rhomboids
Dorsal scapular nerve
Action: Latissimus dorsi
1) Extends
2) Adducts
3) Medially rotates the arm
Action: Raises medial border of scapula
Levator scapula
Nerve supply: Serratus anterior
Long thoracic nerve
Nerve supply: Deltoid
Axillary nerve
Nerve supply: Teres minor
Axillary nerve
Action: Supraspinatus
Abducts arm
Action: Infraspinatus
Laterally rotates arm
Action: Teres minor
Laterally rotates arm
Action: Subscapularis
Medially rotates arm
Boundaries of quadrangular space: Superior
Subscapularis
Boundaries of quadrangular space: Inferior
Teres major
Boundaries of quadrangular space: Lateral
Surgical neck of humerus
Boundaries of quadrangular space: Medial
Long head of triceps
Cubital fossa: Shape
Triangular
Cubital fossa boundaries: Lateral
Brachioradialis
Cubital fossa boundaries: Medial
Pronator teres
Cubital fossa boundaries: Base
Imaginary line between two epicondyles of humerus
Cubital fossa contents: Superficial fascia (2)
1) Basilic
2) Cephalic
Forearm: Compartments
1) Anterior
2) Posterior
3) Lateral
Forearm: Position in function (most stable position)
Midprone
Forearm: Muscles of anterior compartment (8)
1) Pronator teres
2) Pronator quadratus
3) Flexor carpi radialis
4) Flexor carpi ulnaris
5) Flexor digitorum superficialis
6) Flexor digitorum profundus
7) Flexor pollicis longus
8) Palmaris longus
Forearm: Muscle often absent in anterior compartment
Palmaris longus
Forearm: Muscles of posterior compartment (10)
1) Anconeus
2) Abductor pollicis longus
3) Supinator
4) Extensor carpi radialis brevis
5) Extensor carpi ulnaris
6) Extensor digitorum
7) Extensor pollicis longus
8) Extensor pollicis brevis
9) Extensor indicis
10) Extensor digiti minimi
Forearm: Muscles of lateral compartment (2)
1) Brachioradialis
2) Extensor carpi radialis longus
Forearm, nerve supply: Lateral compartment
Radial nerve
Forearm, nerve supply: Posterior compartment
Deep branch of radial nerve
Forearm, nerve supply: Flexor carpi ulnaris
Ulnar nerve
Carpal tunnel: Median nerve lies between (2)
1) Flexor carpi radialis
2) Flexor digitorum superficialis
Hand: Palmar aponeurosis is continuous proximally with
Plamaris longus tendon
Hand: T/F Palmaris longus is attached to flexor retinaculum
T
Hand, lumbricals: #
4
Hand, palmar interossei: #
4
Hand, dorsal interossei: #
4
Hand, origin: Lumbricals
Tendon of flexor digitorum profundus
Hand, origin: Palmar interossei
1st, 2nd, 4th, and 5th metacarpals
Hand, origin: Dorsal interossei
Contiguous sides of 5 metacarpals
Hand: Muscle that inserts to the skin of the palm
Palmaris brevis
Hand, nerve supply: Palmar interossei
Deep branch of ulnar nerve
Axillary artery: Begins at
Lateral border of first rib
Axillary artery: Continuation of
Subclavian artery
Axillary artery: Becomes the ___ artery at the lower border of teres MAJOR
Brachial
Axillary artery: Divided into 3 parts by
Pectoralis minor
Axillary artery: Branches per part (#)
1,2,3
Axillary artery: Branch of first part
Highest thoracic
Axillary artery: Branches of 2nd part
1) Thoracoacromial
2) Lateral thoracic
Axillary artery: Branches of 3rd part
1) Subscapular
2) Anterior circumflex
3) Posterior circumflex
Brachial artery: End
Radial neck
Brachial artery: Branch to bone
Nutrient artery to humerus
Brachial artery: Branch that accompanies radial nerve at spiral groove
Profunda artery
Brachial artery: Smaller branch
Radial artery
Radial artery: Compartments of forearm supplied
Anterior and lateral
Radial artery: Joins the deep branch of ulnar artery at the palm to form the
Deep palmar arch
Radial artery: Superficial palmar branch joins the ulnar artery to form the
Superficial palmar arch
Radial artery: Branch that takes part in the arterial anastomosis around the elbow joint
Recurrent
Radial artery: Pulse taken between
1) Brachioradialis laterally
2) Flexor carpi radialis medially
Ulnar artery: Pulse
Anterior to the flexor retinaculum, lateral to the pisiform
Ulnar artery: Branch that takes part in the arterial anastomosis around elbow joint
Recurrent
Ulnar artery: Divides at the interosseous membrane
Common interosseous artery
Ulnar artery: Branch that joins the radial artery forming a palmar arch
Deep palmar branch
T/F: Ligation of arteries of upper limb causes gangrene
F
Pulse: Axillary artery
3rd part anterior to teres major
Pulse: Brachial artery
Anterior to the brachialis muscle, medial to the biceps brachii tendon
Superficial veins of upper limb: Drained on the lateral side by
Cephalic vein
Superficial veins of upper limb: Drained on medial side by
Basilic vein
Cephalic vein: Pierces deep fascia to join
Axillary vein
Basilic vein: Pierces deep fascia to join
2 venae comitantes of brachial artery to form the axillary vein
Superficial veins of upper limb: Connects cephalic and basilic vein
Median cubital vein
Median cubital vein: Location
Anterior to the bicipital aponeurosis
Superficial veins of upper limb: Commonly used for central venous catheterization
Basilic vein
Deep veins of upper limb
Venae comitantes
Lymphatic drainage of upper limb: All vessels ultimately drain into
Axillary nodes
Axillary LN: Lower border of pectoralis minor and behind pectoralis major
Anterior/pectoral
Lymphatic drainage of upper limb: Anterior/pectoral nodes receive lymph from
1) Lateral breast
2) Thoracoabdominal wall above umbilicus
Lymphatic drainage of upper limb: In front of subscapularis
Posterior/subscapular
Lymphatic drainage of upper limb: Posterior/subscapular nodes receive lymph from
Superficial back as far as iliac crest
Lymphatic drainage of upper limb: Along axillary vein
Lateral
Lymphatic drainage of upper limb: Lateral nodes receive lymph from
Most of the upper limb except superficial lateral side
Lymphatic drainage of upper limb: Center of axilla
Central
Lymphatic drainage of upper limb: Central nodes receive lymph from
All that drain into anterior, posterior, and lateral nodes
Lymphatic drainage of upper limb: Outside the axilla, between the deltoid and pectoralis major
Infraclavicular/deltopectoral
Lymphatic drainage of upper limb: Infraclavicular/deltopectoral nodes receive lymph from
1) Lateral side of hand
2) Forearm
3) Arm
4) Vessels that accompany the cephalic vein
Lymphatic drainage of upper limb: Apex of axilla
Apical
Lymphatic drainage of upper limb: Apical nodes receive lymph from
All other axillary nodes
Lymphatic drainage of upper limb: Apical nodes drain into
Subclavian trunk
Lymphatic drainage of upper limb: Superficial fascia in the cubital fossa
Supratrochlear/cubital
Lymphatic drainage of upper limb: Supratrochlear/cubital node receives lymph from
1) Medial fingers
2) Medial hand
3) Medial forearm
Brachial plexus: Roots enter the base of neck between
Scalenus anterior and scalenus medius
Brachial plexus: Trunks and division cross the
Posterior triangle of the neck
Brachial plexus: Cords are arranged around the
Axillary artery
Brachial plexus: Divided into
1) Roots
2) Trunks
3) Divisions
4) Cords
Posterior cords of C5,6 and 7 form
Long thoracic nerve
Brachial plexus: Trunks
1) Superior
2) Middle
3) Inferior
Brachial plexus: Divisions
1) Anterior
2) Posterior
Brachial plexus: Cords
1) Lateral
2) Posterior
3) Medial
Brachial plexus: Branches
1) Musculocutaneous
2) Axillary
3) Median
4) Radial
5) Ulnar
Brachial plexus: Superior trunk is formed by
C5,6
Brachial plexus: Middle trunk is formed by
C7
Brachial plexus: Inferior trunk is formed by
C8, T1
Brachial plexus: Lateral cord is formed by
Anterior divisions of superior and middle trunks
Brachial plexus: Posterior cord is formed by
Posterior divisions of superior, middle, and inferior trunks
Brachial plexus: Medial cord is formed by
Anterior division of inferior trunk
Brachial plexus: Branches of lateral cord (3)
1) Musculocutaneous
2) Lateral pectoral
3) Median (as it joins with medial cord)
Brachial plexus: Branches of superior trunk (2)
1) Suprascapular nerve
2) Nerve to subclavius
Brachial plexus: Branches of posterior cord (5)
1) Radial nerve
2) Axillary nerve
3) Upper subscapular
4) Lower subscapular
5) Thoracodorsal
Brachial plexus: Branches of medial cord
1) Ulnar nerve
2) Medial pectoral
3) Medial cutaneous of arm
4) Medial cutaneous of forearm
Brachial plexus, supplies: Long thoracic
Serratus anterior
Brachial plexus, supplies: Dorsal scapular
1) Rhomboids
2) Levator scapula
Brachial plexus, supplies: Suprascapular
1) Supraspinatus
2) Infraspinatus
Brachial plexus, supplies: Lateral pectoral
Pectoralis major
Brachial plexus, supplies: Upper subscapular
Subscapularis
Brachial plexus, supplies: Lower subscapular
Subscapularis and teres major
Brachial plexus, supplies: Thoracodorsal
Latissimus dorsi
Brachial plexus, supplies: Axillary nerve
1) Deltoid
2) Teres minor
3) Skin over lower half of deltoid
Brachial plexus, supplies: Radial nerve
1) Posterior compartment of arm
2) Posterior compartment of forearm (Deep radial branch)
3) Skin on lateral side of dorsum of hand and dorsal surface of lateral 3 1/2 fingers
Brachial plexus, supplies: Medial pectoral nerve
Pectoralis major and minor
Brachial plexus, supplies: Ulnar nerve
1) Interossei
2) Hypothenar eminence
3) 3rd and 4th lumbricals
4) Skin of medial half of dorsum and palm
5) Skin of dorsal and palmar surfaces of medial 1 1/2 fingers
Brachial plexus, supplies: Median nerve
1) Pronators
2) 3 thenar
3) First 2 lumbricals
4) Skin of lateral half of palm and palmar surface of lateral 3 1/2 fingers
Brachial plexus: Ulnar nerve in the upper arm (compartment)
Anterior
Brachial plexus: Ulnar nerve pierces
Medial intermuscular septum of arm
Brachial plexus: Ulnar nerve relation to ulnar artery in the forearm
Medial to the ulnar artery
Brachial plexus: Radial nerve pierces
Lateral intermuscular septum
Brachial plexus lesions: Displacement of head to opposite side and depression of shoulder on same side
Superior trunk lesion aka Erb-Duchenne Palsy aka Waiter’s tip hand
Brachial plexus lesions: Traction injury as in excessive abduction
Inferior trunk lesion aka Klumpke Palsy aka Claw hand
Brachial plexus lesions: Blow or surgical injury to this nerve at the axilla
Long thoracic nerve lesion aka serratus anterior paralysis or Winged scapula aka Difficulty of raising arm above head
Brachial plexus lesions: Inferior dislocation of shoulder of fracture of surgical neck of humerus
Axillary nerve lesion aka deltoid paralysis and loss of sensation at skin over lower half of deltoid
Brachial plexus lesions: Fracture of midshaft of humerus
Radial nerve lesion aka wrist drop
Brachial plexus lesions: Supracondylar fracture of humerus or wounds proximal to flexor retinaculum
Median nerve lesion aka thenar paralysis aka apelike hand
Brachial plexus lesions: Claw deformity
Ulnar nerve lesion
Radial nerve: First branch
Recurrent branch
Radial nerve: Recurrent branch anastomoses with
Radial collateral artery
Cubital fossa contents: Medial to lateral (4)
1) Median nerve
2) Bifurcation of brachial artery into ulnar and radial
3) Biceps tendon
4) Radial nerve
Ulnar artery: Supplies which forearm compartment
Anterior
Cephalic vein: Fairly constant location
Posterior to styloid process of radius
Brachial plexus: Formed by
Anterior rami of C5,6,7,8 and T1
Brachial plexus, supplies: Musculocutaneous
1) Anterior compartment of upper arm
2) Skin along lateral border of forearm (lateral cutaneous nerve of forearm)
Brachial plexus: Musculocutaneous nerve pierces
Coracobrachialis muscle and deep fascia