Upper Limb 1 - Axilla, Neurovascular, Dermatomes, Pectoral Girdle & Rotator Cuff Muscles Flashcards by Martin Beattie

Which muscles make up the anterior wall of the axilla?

Pectoralis major

Pectoralis minor

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Which muscles make up the posterior wall of the axilla?

Subscapularis

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Which muscles make up the medial wall of the axilla?

Thoracic wall

Serratus anterior

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What forms the lateral wall of the axilla?

Intertubercular groove of Humerus

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What are the contents of the axilla?

Axillary artery

Axillary vein

Brachial plexus

Biceps brachii

Coracobrachialis

Axilliary lymph nodes

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Which artery is the axilla artery a continuation of?

Subclavian artery

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At what anatomical point does the axillary artery begin?

Edge of 1st rib

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What is the name of the axillary artery once is leaves the axilla and passes the teres major muscle?

Brachial artery

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At what anatomical point does the name of the brachial artery change?

Cubital fossa

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When there is an infection of the upper limb, what group of lymph nodes become enlarged?

Axillary lymph nodes

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The brachial plexus is formed from the ventral rami of which nerve roots?

C5,6,7,8 and T1

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Which nerve roots form the upper trunk?

C5 and C6

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Which nerve roots form the middle trunk?

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Which nerve roots form the lower trunk?

C8 and T1

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What is Erb’s point and what is its clinical relevance?

Erb’s point - a point found on the upper trunk of the brachial plexus, 2-3cm above the clavicle

Clinical relevance - Commonly damaged during chilbirth or falling onto the shoulder

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What condition does damage to Erb’s point/upper trunk cause?

Erb’s palsy/waiters tip appearance

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What muscles are affected in Erb’s palsy?

1 - Supraspinatus

2 - Infraspinatus

3 - Subclavius

4 - Biceps brachii

5 - Brachialis

6 - Coracobrachialis

7 - Deltoid

8 - Teres minor

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What clinical condition results from damage to the lower trunk of the brachial plexus?

Klumpke’s palsy

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What muscles are affected by Klumpke’s palsy?

Intrinsic muscle of hand

Ulnar flexors of wrist and fingers

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In relation to which vessel are the cords of the brachial plexus named?

Axillary artery

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What are the names of the cords of the brachial plexus?

Lateral

Posterior

Medial

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What divisions form the cords of the brachial plexus?

Lateral cord - anterior division of superior trunk and anterior division of median trunk

Posterior cord - posterior divisions of superior, middle and inferior trunks

Medial cord - anterior division of inferior trunk

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What are the major arteries of the upper arm?

Subclavian artery

Axillary artery

Brachial artery

Ulnar artery

Radial artery

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What are the major veins of the upper arm?

Cephalic vein

Basilic vein

Median cubital vein (connects cephalic and basilic veins)

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What is the clinical significance of the veins of the upper limb?

They are used for IV injections and drawing blood for testing

At their distal end, from which structure do the cephalic and basilic veins arise?

Dorsal venous arch

Between which 2 veins does the **median cubital vein** shunt blood?

Cephalic and basillic vein

Which dermatomal level innervates the thumb?

Which dermatomal level innervates the index and middle finger?

Which dermatomal level innervates the ring and little finger?

If an area of the upper limb becomes infected, to where is the most likely location the lymphatic fluid will drain?

Axillary lymph nodes

If there is an infection of the little finger of the upper limb, to which group of lymph nodes would the infection spread?

Axillary

If there is a boil on the scapular region, to which group of lymph nodes would the infection spread?

Axillary

If there was cancer in the medial part of the breast, to which group of lymph nodes would the cancer likely spread?

Internal thoracic (mammary)

If there was cancer in the lateral part of the breast, to which group of lymph nodes would the cancer most likely spread?

Axillary

If there was an infection of the skin just above the umbilicus, to which group of lymph nodes would the infection most likely spread to?

Axillary

If there was an infection of the skin just below the umbilicus, to which group of lymph nodes would the infection most likely spread to?

Superficial inguinal

At which joint does the upper limb articulate with the pectoral girdle?

Glenohumeral joint

On which end of the clavicle is the conoid tubercle located? Humeral or sternal end?

Humeral/acromial end

What type of joint is the acromioclavicular joint?

Plane

What type of joint is the sternoclavicular joint?

Saddle

Which joints are involved in the movement of the pectoral girdle?

Acromioclavicular Sternoclavicular Glenohumeral

What is the scapulo-humeral rhythm?

2:1 After the first 30 degrees of abduction of the arm, 2 degrees of movement occurs at the shoulder joint and 1 degree at the scapula-thoracic joint

Which muscles are involved in elevation of the scapula?

Trapezius Levator Scapulae Serratus Anterior

Which muscles are involved in depression of the scapula?

Latissimus dorsi Pectoralis Major Pectoralis Minor

Which muscles are involved in protraction of the scapula?

Levator scapulae Serratus Anterior

Which muscles are involved in retraction of the scapula?

Trapezius Rhomboids Latissimus Dorsi

What type of joint is the gleno-humeral joint?

Ball and socket synovial joint

What are the components of the gleno-humeral joint?

Head of Humerus Glenoid cavity of Scapula

What is the name of the cartilage surrounding the joint?

Glenoid labrum

What is the function of the glenoid labrum?

It deepens the glenoid cavity, therefore reducing the chances of shoulder dislocation

What are the ligaments that stabilise the shoulder joint?

Coracohumeral ligament Coracoacromial ligament Glenohumeral ligament

What structures provide cushioning to joints?

Bursae

What common sporting injury damages the subacromial bursa?

Bursitis

What are the 4 rotator cuff muscles?

Infraspinatus Supraspinatus Subscapularis Teres Minor

What movements of the glenohumeral joint do the rotator cuff muscles perform?

Abduction Lateral + medial rotation

What is the most important role of the rotator cuff muscles?

To keep the humerus head within the glenoid fossa

What action do the anterior fibres of the deltoid perform?

Flex at Shoulder

What action do the middle fibres of the deltoid perform?

Abduction at shoulder joint

What action do the posterior fibres of the deltoid perform?

Extend of the arm at the shoulder

What nerve supplies the deltoid muscle?

Axillary nerve

What common injury results in the axillary nerve becoming trapped and damaged?

Dislocation of the shoulder

If the axillary nerve became damaged due to shoulder dislocation, where would you test for loss of sensation?

Test for loss of sensation over the deltoid muscle

Where do the fibres of pectoralis major originate from?

- Medial 1/3 of clavicle - Sternum - Ribs

What are the actions of pectoralis major on the shoulder joint?

Adduct and medially rotate the humerus at glenohumeral joint

Which vein (important for placement of central lines) is found within the deltopectoral triangle between deltoid and pectoralis major?

Cephalic vein

What is the nerve supply of serratus anterior?

Long thoracic nerve

What clinical sign is observed when the long thoracic nerve is damaged?

Winging of the Scapula

During which procedure is the long thoracic nerve most commonly injured?

Lymph node biopsy

What action do the superior fibres of the trapezius perform on the scapula?

Elevate and rotate Scapula

What action do the middle fibres of the trapezius have on the scapula?

Retract scapula

What action do the inferior fibres of the trapezius have on the scapula?

Depress the scapula

Which nerve innervates the trapezius muscle?

Accessory nerve

What are the actions of Teres Major on the shoulder joint?

Adducts shoulder and medially rotates arm

What are the actions of latissimus dorsi on the shoulder joint?

Extends, adducts and medially rotates shoulder joint

Which muscles perform flexion at the shoulder joint?

Pectoralis major Anterior deltoid Coracobrachialis

Which muscles perform extension at the shoulder joint?

Posterior deltoid Latissimus dorsi

Which muscles perform adduction at the shoulder joint?

Pectoralis major Lattisimus dorsi Teres Major

Which muscles perform abduction of the shoulder joint?

Supraspinatus (0-15 degrees) Middle deltoid (15-90 degrees) Trapezius and Serratus Anterior (\>90 degrees)

Which muscles perform internal rotation of the shoulder joint?

Subscapularis Latissimus Dorsi Pec major Teres Major

Which muscles perform lateral rotation at the shoulder joint?

Teres minor and infraspinatus