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CABS lm > Upper Extremity - Unit 2 > Flashcards

Upper Extremity - Unit 2 Flashcards

1
Q

Clinically Significant Superficial Veins

What is important about them?

A

Cephalic, Basilic, Median Cubital Veins

They are common sites for phlebotomy

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2
Q

Cephalic Vein Route and Drainage

A

Drains the dormsum of the hand and ascends along the lateral forearm.

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3
Q

What does the cephalic vein pass through to join with the axillary vein?

A

deltopectoral groove

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4
Q

Basilic Vein Route and Drainage

A

drains the dorm of the hand and ascends the medial forearm

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5
Q

What does the basilic vein join with to form the axillary vein?

A

Paired brachial veins

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6
Q

What is the significance of the median cubital vein?

A

interconnects the basilic and cephalic veins in the cubital fossa

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7
Q

Location of the cubital fossa

A

triangular space between the brachioradialis muscle (laterally) and the pronator teres muscle (medially)

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8
Q

Contents of the cubital fossa

A

from lateral to medial…

tendon of the biceps brachia, brachial artery, and median nerve

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9
Q

Brachial plexus

A

interlacing network of roots that will eventually form nerves to innervate the upper extremity muscles - pectoral girdle and upper limb

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10
Q

What roots derive the brachial plexus?

A

C5-T1

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11
Q

Anterior ramus

A

primary branch of spinal nerve that exits the vertebral canal and supplies lateral/ventral portions of the body, limbs, and perineum

Forms the major somatic plexuses of the body

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12
Q

What are the parts of the brachial plexus?

A

Roots, Trunks, Divisions, Cords, Branches

*Remember to drink cold beer

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13
Q

What are the brachial plexus roots?

A

C5-T1

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14
Q

Dermatomes

A

areas on the arm that are the cutaneous innervation derived from the brachial plexus roots

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15
Q

C6 distribution in the hands - dermatome

A

stick shooter

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16
Q

C7 distribution in the hands - dermatome

A

middle finger

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17
Q

C8 distribution in the hands - dermatome

A

Dr. evil, pinky finger

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18
Q

Name of the two dermatome maps

A

Foerster (segmented), Keegan & Garret (stripes)

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19
Q

Myotomes

A

muscle innervation from the brachial plexus roots

They have segmental distribution from proximal (C5-deltoid) to distal (C8, T1 - Interossei)

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20
Q

What are the trunks and their derivations?

A

Superior: C5-C6
Middle: C7
Inferior: C8-T1

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21
Q

Anterior division, what types of muscles do they innervate?

A

Innervate muscles in the anterior compartment of the arm and forearm
Includes flexors and pronators of the arm, forearm, and palmar surface of the hand

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22
Q

Posterior division, what types of muscles do they innervate?

A

innervate the extensor and supinator muscles of the posterior compartment of the arm, forearm, and dorsal surface of the hand

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23
Q

What are the cords of the brachial plexus?

A

Posterior, lateral, medial

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24
Q

Posterior cord
What is the derivation of this cord?
Where does it supply?

A

all three trunks combine to form this
Derived from the posterior division
Supply the posterior arm and forearm

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25
Lateral cord What is the derivation of this cord? Where does it supply?
anterior of superior and middle trunks combine derived from the anterior division Innervate the anterior arm/forearm
26
Medial cord What is the derivation of this cord? Where does it supply?
anterior division of the inferior trunk derived from the anterior division Innervate the anterior arm/forearm
27
What are the brachial plexus cords named in relation to?
the axillary artery
28
What are the major terminal branches of the brachial plexus? | What are the other terminal branches he mentioned in lecture?
``` Radial and axillary nerves Ulnar nerve Musculocutaneous nerve Median nerve ----------------- Long thoracic nerve Suprascapular nerve Thoracodorsal nerve Dorsal Scapular nerve ```
29
What are the derivation of the 9 terminal branches?
``` Radial nerve - posterior cord Axillary nerve - posterior cord Ulnar nerve - medial cord Musculocutaneous nerve - lateral cord Median nerve - lateral and medial cords Long thoracic nerve - proximal C5-C7 Suprascapular nerve - superior trunk Thoracodorsal nerve - posterior cord Dorsal scapular nerve - C5 ```
30
What does injury in the superior roots result in?
Erb-Duchenne Palsy - "Waiter's Tip" position
31
What nerves are affected with Erb-Duchenne Palsy?
Suprascapular, axillary, and musculocutaneous nerves
32
What muscles are impacted with Erb-Duchenne Palsy?
paralysis of the rotator cuff muscles (supraspinatus, infraspinatus, teres minor, NOT SUBSCAPULARIS), biceps brachii, brachial, coracobrachialis, deltoid
33
Nerve innervation and action of Supraspinatus muscle
supra scapular nerve, abduct arm
34
Nerve innervation and action of Infraspinatus
supra scapular nerve, laterally rotate the arm
35
Nerve innervation and action of Teres minor
axillary nerve, externally rotates
36
Nerve innervation and action of deltoid
axillary nerve, comprised of three sets of fiber to do abduction (middle), assist with flexion (anterior), and extension (posterior)
37
Nerve innervation and action of biceps brachii
*also known as beer drinker's muscle | musculocutaneous nerve, forearm flexion and supination
38
Nerve innervation and action of brachialis
musculocutaneous nerve, forearm flexion
39
Nerve innervation and action of coracobrachialis
musculocutaneous nerve, assisting with adduction, flexion
40
What does the Waiter's Tip position look like?
Upper extremity hanging limply (loss of abduction from supraspinatus and deltoid) in medial rotation (due to intact subscapularis), and pronation (loss of biceps brachii)
41
what does injury to the inferior roots of the brachial plexus result in?
Klumpke's palsy - "clawed hand"
42
What nerves are damaged in Klumpke's palsy?
Ulnar and some median nerve damage
43
What is Klumpke's palsy result in for muscles?
hyperextension often metacarpophalangeal joints, digit flexion unopposed by the interossei muscles
44
What are the interossei muscles of the hand
intrinsic muscles of the hands Palmar: adduct, using middle finger as reference (PAD) Dorsal, abduct, using middle finger as reference (DAB) MCP: extension of the hand
45
Clinical testing of Myotomes and Neurologic Level C5
Myotomes: resist abduction of arm (deltoid) &/or flexion of the biceps brachii Reflex: bicipital reflex, results in flexion Sensation: top of the bicep muscle
46
Clinical testing of Myotomes and Neurologic Level C6
Myotome: break the OK sign &/or resist wrist extension or bicep Reflex: brachial radialis reflex, causes wrist to flex Sensation: stick shooter
47
Clinical testing of Myotomes and Neurologic Level C7
Myotome: resist digit extension &/or forearm extension, wrist flexion Reflex: triceps reflex, extension Sensation: middle finger
48
Clinical testing of Myotomes and Neurologic Level C8
Myotome: break interlocking grip of fingers Reflex: none Sensation: pinky finger
49
Clinical testing of Myotomes and Neurologic Level T1
Myotome: resist digit abduction or adduction
50
What artery supplies most of the upper extremity but changes names based on it's location
subclavian artery
51
Subclavian artery - location and name of new arteries
Axillary artery: crosses first rib Brachial artery: passes inferior border of teres major Brachial artery bifurcates at the distal end of the cubital fossa into radial and ulnar arteries
52
What is an anatomical significance of radial artery?
Position of the radial artery in forearm divides the muscles into extensor group lateral to the radial artery, and a flexor group medial to the radial artery
53
What is the significance of the ulnar and radial arteries
they are anastomose in the superficial and deep palmar arches in the hand --> creates collateral circulation
54
Anatomical Snuff Box
Triangular depression at the base of the thumb anteriorly
55
Boundaries of Anatomical Snuff Box
Posteriorly: tendons of abductor policies longs and extensor policis brevis Tendon of extensor policis longs ``` Scaphoid bone (carpal bone) forms the floor The radial artery lies in the base as it passes from ventral wrist to dorsal hand ```
56
What is the most commonly fractured carpal bone?
Scaphoid
57
What is the concern with a proximal fracture of the scaphoid
most at risk for non-union healing because the only blood supply to the bone is from the distal end
58
What does the median nerve travel along with? What is it's location compared to it?
Brachial Artery Initially lateral to the brachial artery and then becomes medial to the brachial artery in the cubital fossa
59
Median Nerve - Muscle Innervation
Thenar muscles - abductor policis brevis, flexor pollicis brevis, Opponens pollicis Superficial layer of the anterior compartment of the forearm (3/4 muscles) - pronator teres, flexor carpi radialis, palmaris longus Intermediate layer of the anterior compartment of the forearm - flexor digitorum superficialis Deep layer of the anterior compartment of the forearm - flexor digitorum profundus, flexor policis longus, pronator quadratus To remember the anterior compartment muscles *Fred Parks Pulled Frankie Fitz From (the) Pool
60
Median Nerve - Sensory Distribution
lateral 3.5 digits on the palmar surface Posterior surface includes the tips of the lateral 3.5 digits fingers to the interphalangeal joints
61
Injuries Associated with Median Nerve
Hand of Benediction: proximal injury- supracondylar fracture Ape Hand: wrist injury Carpal Tunnel Syndrome
62
What cord(s) and root(s) the ulnar nerve originate from?
Medial Cord | C8-T1 Roots
63
Ulnar Nerve - Muscle Innervation
Superficial layer of the anterior compartment of the forearm (1/4 muscles) - Flexor Carpi Ulnaris Half of the flexor digitorum profundus Intrisic muscles of the Hand - interossei muscles (PAD and DAB), 3-4 lumbricals, adductor policis muscle
64
Ulnar Nerve - Sensory Distribution
medial 1/3 palm and 1 1/2 of the digits Same distribution in the posterior view
65
What tunnel does the ulnar nerve travel through?
Guyon's Tunnel
66
What injuries are associated with the ulnar nerve?
Cubital Tunnel Syndrome, Kulmpke's Palsy, Pulled elbow
67
Cubital Tunnel Syndrome
when the ulnar nerve passes through the two heads of the flexor carpi ulnaris and becomes pinched
68
What is a "Pulled Elbow"
Head of the radius is dislocated inferiorly out of the annular ligament and radial notch of the ulna Occurs when the hand/forearm is pulled suddenly, immediate pain just distal to the lateral epicondyle
69
What population most commonly has "pulled elbow"
pre-school children because the radial head is small relative to the size of the annular ligament
70
"Tennis Elbow"
inflammation of the common extensor tendon at the lateral epicondyle, occurs in tennis and produces lateral epicondylitis
71
"Golfer's Elbow"
Inflammation of the common flexor tendon at the medial epicondyle of the humerus, occurs as in golf, produces medial epicondylitis
72
Where is the common flexor tendon in the elbow?
On the medial epicondyle
73
Bony landmarks of the elbow
olecranon process of the ulna Lateral/medial epicondyles of the hummers Head of the radius Head of the radius is help within the radial notch of the ulna by the annual ligament -- allows for free rotation father radius during pronation and supination
74
Musculocutaneous Nerve Muscle Innervation
biceps brachii, brachialis, coracobrachialis
75
Axillary Nerve Muscle Innervation
Deltoid, teres minor
76
Suprascapular Nerve Muscle Innervation
Supraspinatus, infraspinatus

CABS lm (5 decks)

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