Upper Limb 1 Flashcards
What is the axilla?
Pyramidal space below the shoulder joint
Provides passage way for vessels and nerves
Has an apex, base and 4 walls
What forms the anterior wall of the axilla?
Pectoralis major and pectoralis minor muscle
What forms the posterior wall of the axilla?
Subscapularis, teres major and latissimus dorsi
What forms the medial wall of the axilla?
Thoracic wall and serratus anterior muscle
What forms the lateral wall of the axilla?
Intertubercular sulcus of the humerus
What makes up the apex of the axilla?
Lateral border of first rib, superior border of scapula and posterior border of clavicle
What are the contents of the axilla?
Axillary artery, axillary vein, brachial plexus, axillary lymph nodes, and biceps brachii + coracobrachialis
What is the axillary artery a continuation of?
Subclavian artery
At what anatomical point does the axillary artery begin?
Lateral border of the 1st rib
When does the axillary artery change to the brachial artery?
Inferior border of teres major
When are axillary lymph nodes enlarged?
Infection of upper limb and malignant processes involving breast tissue
What ventral rami make up the brachial plexus?
C5 to T1
What is the nerve roots of the upper, middle and lower trunk of the brachial plexus?
Upper - C5 and C6
Middle - Continuation of C7
Lower - C8 and T1
What is the sub-divisions of the brachial plexus?
5 roots
3 trunks
3 anterior and 3 posterior divisions
3 cords
Terminal branches
What are the cords of brachial plexus named after?
Their position in relation to axillary artery in the axilla
What does injury to the upper trunk of brachial plexus cause?
Erb’s palsy - waiters tip appearance
Medial rotation of the arm with wrist flexion
Caused by hyperextension injury if head from shoulder
What does injury of the lower trunk of brachial plexus cause?
Klumpke’s palsy
Mainly affects intrinsic muscles of hand, flexor muscles of wrist and flexor muscles of fingers
What are the 5 main terminal branches of the cords of brachial plexus?
Axillary nerve
Radial nerve
Musculocutaneous nerve
Ulnar nerve
Median nerve
What nerves come from the posterior cord of the branchial plexus?
Axillary and radial nerves
What nerve comes from the lateral cord of the brachial plexus?
Musculocutaneous
Median nerve from lateral and medial cord
What nerves come from the medial cord of the brachial plexus?
Ulnar and Median nerve
Median nerve from medial and lateral cord
What are the roots of the musculocutaneous nerve?
C5-7
What are the roots of the axillary nerve?
C5 and C6
What are the roots of the median nerve?
C6-T1
What are the roots of the radial nerve?
C5-T1
What are the roots of the ulnar nerve?
C8-T1
What artery is number 3?
Subclavian artery
What artery is number 6?
Axillary artery
What artery is number 7?
Brachial artery
What artery is number 9?
Radial artery
What artery is number 10?
Ulnar artery
What vein is number 10?
Cephalic vein
What vein is number 11?
Basilic vein
What is number 12?
Median cubital vein
What is the dorsal venous arch?
Complex network of veins lying at the distal aspect of upper limb
Where do superficial veins of upper limb lie?
Subcutaneous tissue - just under skin so easy access for some procedures
Where does the cephalic and basilic veins arise from?
Cephalic - lateral end of the dorsal venous arch
Basilic - medial end of the dorsal venous arch
Where is the median cubital vein situated?
Ante-cubital fossa
Describe the course of the cephalic vein
Ascends in lateral aspect of arm and pierces clavipectoral fascia draining into axillary vein
Describe the course of the basilic vein
Ascends on medial side of arm, passing deep at the mid-humeral level and becomes axillary vein at lower border of teres minor
What is a dermatome?
Area of skin supplied by one spinal segment
Where do all lymphatic vessels of upper limb drain into?
Axillary nodes
What are the 5 distinct groups of axillary lymph nodes?
Anterior or pectoral group
Posterior or subscapular group
Apical group
Central group
Lateral or brachial group
What is the pectoral gridle and what bones are included?
Connects the upper limb to the axial skeleton on each side
Scapula and clavicle with acromioclavicular and sternoclavicular joints
What is the joint connecting the pectoral gridle to the upper arm?
Glenohumeral joint
Name the features of the clavicle
Acromial end and Sternal end
Subclavian groove
Costal tuberosity
Trapezoid line
Conoid tubercle
What can help differentiate between the acromial end and sternal end of the clavicle?
Lateral aspect of clavicle is flatter than medial
Superior surface is smoother than inferior
Conoid tubercle is attachment for conoid ligament - inferior aspect of lateral portion
Which part of the clavicle is the weakest and breaks commonly during fall?
Middle as thinnest part of clavicle
What is A?
Acromion of scapula
What is B?
Coracoid process
What is C?
Glenoid cavity
What is D?
Subscapular fossa
What is E?
Supraspinous fossa
What is F?
Spine of the scapula
What is G?
Supraglenoid tubercle
What is H?
Infra-glenoid tubercle
What is I?
Infra-spinous fossa
What type of joint is the acromioclavicular joint?
Plane synovial joint
What type of joint is the sternoclavicular joint?
Saddle synovial joint
Describe the scapulo-humeral rhythm
First 30 degrees of abduction is caused by muscles acting on shoulder joint
After 30 degrees, relies on scapula being pulled upwards and laterally rotated on chest wall
Every 3 degrees of abduction after first 30 - 2 degrees occur at gleno-humeral joint and 1 at scapula thoracic movement
What are the main muscles involved in elevation of scapula?
Trapezius
Levator scapulae
What is the main muscle involved in depression of the scapula?
Trapezius
What are the main muscles involved in protraction of the scapula?
Pectoralis minor and serratus anterior
What are the main muscles involved in retraction of the scapula?
Trapezius and rhomboids
What main muscle is involved in the lateral rotation of the scapula?
Trapezius - upper and middle
What muscles are involved in the medial rotation of the scapula?
Gravity
Levator scapula
Rhomboid major and minor
Pectoralis minor
What is muscle 1?
Trapezius
What is muscle 2?
Levator scapula
What is muscle 3?
Rhomboid minor
What is muscle 4?
Rhomboid major
What is muscle 5?
Supraspinatus
What is muscle 6?
Infraspinatus
What is muscle 7?
Teres minor
What is muscle 8?
Teres major
What is muscle 9?
Latissimus dorsi
What are features of proximal humerus?
Head of humerus, greater + lesser tubercle, surgical neck, deltoid tuberosity and intertubercular groove
Describe the glenoid cavity
On scapula
Is synovial ball and socket joint with humerus
Rim of cartilage surrounding socket is the glenoid labrum
What is the function of the glenoid labrum?
Reduce disproportion
What is ligament 10?
Transverse ligament
What is ligament 8?
Glenohumeral ligaments - strengthen anterior aspect of joint capsule
What is ligament 13?
Coraco-acromial ligament
What is ligament 12?
Coracohumeral ligament - strengthens superior aspect of joint capsule
What is the coraco-acromial arch made up of?
Acromion, coracoid and coraco-acromial ligament
Prevents superior displacement of humeral head
What is the function of bursae?
Provide cushioning around joints via synovial fluid filled interior
What are the 2 main bursae of shoulder?
Subacromial (subdeltoid) and subscapular bursae
Which bursa communicates with the joint cavity?
Subacromial bursa
What is the role of the subacromial bursa?
Reduces friction of tendon on movement of shoulder joint
