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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
Q

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

A

anterior of superior and middle trunks combine
derived from the anterior division
Innervate the anterior arm/forearm

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26
Q

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

A

anterior division of the inferior trunk
derived from the anterior division
Innervate the anterior arm/forearm

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27
Q

What are the brachial plexus cords named in relation to?

A

the axillary artery

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28
Q

What are the major terminal branches of the brachial plexus?

What are the other terminal branches he mentioned in lecture?

A 
Radial and axillary nerves
Ulnar nerve 
Musculocutaneous nerve 
Median nerve 
-----------------
Long thoracic nerve 
Suprascapular nerve
Thoracodorsal nerve
Dorsal Scapular nerve
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29
Q

What are the derivation of the 9 terminal branches?

A 
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
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30
Q

What does injury in the superior roots result in?

A

Erb-Duchenne Palsy - “Waiter’s Tip” position

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31
Q

What nerves are affected with Erb-Duchenne Palsy?

A

Suprascapular, axillary, and musculocutaneous nerves

32
Q

What muscles are impacted with Erb-Duchenne Palsy?

A

paralysis of the rotator cuff muscles (supraspinatus, infraspinatus, teres minor, NOT SUBSCAPULARIS), biceps brachii, brachial, coracobrachialis, deltoid

33
Q

Nerve innervation and action of Supraspinatus muscle

A

supra scapular nerve, abduct arm

34
Q

Nerve innervation and action of Infraspinatus

A

supra scapular nerve, laterally rotate the arm

35
Q

Nerve innervation and action of Teres minor

A

axillary nerve, externally rotates

36
Q

Nerve innervation and action of deltoid

A

axillary nerve, comprised of three sets of fiber to do abduction (middle), assist with flexion (anterior), and extension (posterior)

37
Q

Nerve innervation and action of biceps brachii

A

*also known as beer drinker’s muscle

musculocutaneous nerve, forearm flexion and supination

38
Q

Nerve innervation and action of brachialis

A

musculocutaneous nerve, forearm flexion

39
Q

Nerve innervation and action of coracobrachialis

A

musculocutaneous nerve, assisting with adduction, flexion

40
Q

What does the Waiter’s Tip position look like?

A

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
Q

what does injury to the inferior roots of the brachial plexus result in?

A

Klumpke’s palsy - “clawed hand”

42
Q

What nerves are damaged in Klumpke’s palsy?

A

Ulnar and some median nerve damage

43
Q

What is Klumpke’s palsy result in for muscles?

A

hyperextension often metacarpophalangeal joints, digit flexion unopposed by the interossei muscles

44
Q

What are the interossei muscles of the hand

A

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
Q

Clinical testing of Myotomes and Neurologic Level C5

A

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
Q

Clinical testing of Myotomes and Neurologic Level C6

A

Myotome: break the OK sign &/or resist wrist extension or bicep

Reflex: brachial radialis reflex, causes wrist to flex

Sensation: stick shooter

47
Q

Clinical testing of Myotomes and Neurologic Level C7

A

Myotome: resist digit extension &/or forearm extension, wrist flexion

Reflex: triceps reflex, extension

Sensation: middle finger

48
Q

Clinical testing of Myotomes and Neurologic Level C8

A

Myotome: break interlocking grip of fingers

Reflex: none

Sensation: pinky finger

49
Q

Clinical testing of Myotomes and Neurologic Level T1

A

Myotome: resist digit abduction or adduction

50
Q

What artery supplies most of the upper extremity but changes names based on it’s location

A

subclavian artery

51
Q

Subclavian artery - location and name of new arteries

A

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
Q

What is an anatomical significance of radial artery?

A

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
Q

What is the significance of the ulnar and radial arteries

A

they are anastomose in the superficial and deep palmar arches in the hand –> creates collateral circulation

54
Q

Anatomical Snuff Box

A

Triangular depression at the base of the thumb anteriorly

55
Q

Boundaries of Anatomical Snuff Box

A

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
Q

What is the most commonly fractured carpal bone?

A

Scaphoid

57
Q

What is the concern with a proximal fracture of the scaphoid

A

most at risk for non-union healing because the only blood supply to the bone is from the distal end

58
Q

What does the median nerve travel along with? What is it’s location compared to it?

A

Brachial Artery

Initially lateral to the brachial artery and then becomes medial to the brachial artery in the cubital fossa

59
Q

Median Nerve - Muscle Innervation

A

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
Q

Median Nerve - Sensory Distribution

A

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
Q

Injuries Associated with Median Nerve

A

Hand of Benediction: proximal injury- supracondylar fracture

Ape Hand: wrist injury

Carpal Tunnel Syndrome

62
Q

What cord(s) and root(s) the ulnar nerve originate from?

A

Medial Cord

C8-T1 Roots

63
Q

Ulnar Nerve - Muscle Innervation

A

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
Q

Ulnar Nerve - Sensory Distribution

A

medial 1/3 palm and 1 1/2 of the digits

Same distribution in the posterior view

65
Q

What tunnel does the ulnar nerve travel through?

A

Guyon’s Tunnel

66
Q

What injuries are associated with the ulnar nerve?

A

Cubital Tunnel Syndrome, Kulmpke’s Palsy, Pulled elbow

67
Q

Cubital Tunnel Syndrome

A

when the ulnar nerve passes through the two heads of the flexor carpi ulnaris and becomes pinched

68
Q

What is a “Pulled Elbow”

A

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
Q

What population most commonly has “pulled elbow”

A

pre-school children because the radial head is small relative to the size of the annular ligament

70
Q

“Tennis Elbow”

A

inflammation of the common extensor tendon at the lateral epicondyle, occurs in tennis and produces lateral epicondylitis

71
Q

“Golfer’s Elbow”

A

Inflammation of the common flexor tendon at the medial epicondyle of the humerus, occurs as in golf, produces medial epicondylitis

72
Q

Where is the common flexor tendon in the elbow?

A

On the medial epicondyle

73
Q

Bony landmarks of the elbow

A

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
Q

Musculocutaneous Nerve Muscle Innervation

A

biceps brachii, brachialis, coracobrachialis

75
Q

Axillary Nerve Muscle Innervation

A

Deltoid, teres minor

76
Q

Suprascapular Nerve Muscle Innervation

A

Supraspinatus, infraspinatus

CABS lm (5 decks)

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