Upper Limb Flashcards
Name 1-15
Clavicle: The Conoid (Medial) and Trapezoid (Lateral) Ligaments form which ligament?
Coracoclavicular ligament (Corocoid process - Lateral Clavicle)
Which 3 Rotator Cuff Muscles attach to the Greater Tubercle?
And Which muscles attach to the intertubercular groove (Between greater and lesser tubercles)?
Greater Tubercle: Supraspinatus, Infrapinatus, Teres Minor
Lesser Tubercle: Subscapularis
What runs in the radial groove?
Radial nerve and profunda brachii artery.
(Mid-shaft fracture could damage both - leading to wrist drop and sensory loss over dorsal hand and lateral 3.5 fingers dorsally)
Which muscles attach to the shaft of the humerus?
Anterior: Coracobrachialis, Deltoid (Deltoid tuberosity), brachialis, brachioradialis
Posterior: Medial and lateral heads of tricep
What does the capitulum and trochlea articulare with?
*Where does the ulnar nerve pass
Trochlea - Ulna
Capitulum - Radius
*Ulnar nerve passes along the posterior side of the medial epicondyle
Name the 4 Areas
What muscle attaches to the radial tuberosity?
Biceps brachii muscle
Name the carpal bones
Ligaments of the glenohumeral joint
- Joint capsule (Glenoid cavity - neck of humerus)
- Glenohumeral ligament (Supraglenoid tubercle - blend w joint capsule)
- Coracohumeral (Coracoid - Greater tubercle humerus)
- Transverse humeral (Bridges intertubercular groove between greater and lesser tubercles)
- Coracoacromial
What is the clavipectoral fascia and what structures peirce it?
Membrane between clavicle and pectoralis minor.
Lateral: Coracoid process
Medial: fuses with external intercostal membrane of upper two spaces
Encloses subclavius
Forms costocoracoid ligament
Peirced by:
2 passing inwards - 1) Lymphatics from the infraclavicular nodes to the apical nodes of the axilla. 2) Cephalic vein
2 passing outwards - 1) Thoracoacromial vessels (Clavicular, humeral, acromial, pectoral a.). 2) Lateral pectoral nerve
Pectoralis Major:
- Origin
- Attachment
- Innervation
- Action
Origin:
Sterocostal Head - Anterior surface of manubrium+sternum, superior 6 costal scartilages and aponeurosis of external oblique muscle
Clavicular Head - Anterior surface of medial clavicle
Attachment:
Tendon into the lateral lip of intertubercular groove, into the anterior lip of the deltoid tuberosity and into deep fascia of arm
Innervation:
Medial and Lateral pectoral nerve (All 5 segments of brachial plexus - C5,6 clavicular head and C7-T1 sternocostal part)
Action:
Abdduction of arm. Medial rotation of arm
Sternocostal head in main adductor of arm.
Clavicular head assists in flexion.
Pectoralis Minor:
- Origin
- Attachment
- Innervation
- Action
Origin:
- 3rd-5th Ribs
Attachment:
- Short thick tendon in coracoid process
Innervation:
Medial pectoral nerve
Action:
Assists serratus anterior in protraction of scapule
*Axillary artery and brachial plexus cords lie underneith it
What structures do the medial and lateral pectoral nerves peirce?
Medial pectoral nerve peirces the pectoralis minor (and supplies it)
Lateral pectoral nerve peirces the clavipectoral fascia
Subclavius:
- Origin
- Attachment
- Innervation
- Action
Origin:
Costochondral junction of the first rib
Attachment:
Inferior sruface of middle clavicle
Innervation:
Nerve to subclavius (C5,6)
Action:
Stabilises clavicle. Prevents fracture damaging subclavian vein.
Trapezius:
- Origin
- Attachment
- Innervation
- Action
Origin:
Skull, Nuchal ligament, spinous processes C7-T12
Attachment:
- Lateral 1/3 clavicle, medial border of acromion, superior lip of crest of scapular spine
Innervation:
Accessory nerve (C1-5) and branches from the cervical plexus (C3/4)
Action:
All fibres: Retract scapula
Upper fibres: elevate scapula and rotates it during abduction
Lower fibres - pull scapula inferiorly
Latissiumus Dorsi:
- Origin
- Attachment
- Innervation
- Action
Origin:
Spinous processes T7-12, supraspinous ligaments of lumbar and sacral vertebrae, posterior liac crest, thoracolumbar fascia and inferior 3 ribs
Attatch:
Tendon in intertubercular sulcus of humerus
Innervation:
Thoracodorsal nerve (C6,7,8)
Action:
Extends, adducts and medially rotates arm
Triangle of Auscultation Borders
Lateral Border of Trapezius
Vertebral border of scapula
Upper horizontal border of latissimus dorsi
Importance: Relative thinning of the musculature of the back, situated along the medial border of the scapula which allows for improved listening to the lungs.
Rhomboid Major and Minor
Rhomboid Major Origin:
Spinous processes of T2-5 vertebrae
Rhomboid Minor Origin:
Spinour provess C7-T1 vertebrae
Attach: Major: Inferior angle and Medial border of scapula. Minor: Medial border.
Innervation: Dorsal Scapula Nerve (from C5 root, passes through scalenus medius, runs down to the levator scapulae (supplies it) and lies on the serratus posterior
Action: Draw scapula medially and upwards
Test: With the hand on the hip or behind the back the patient pushes the elbow backwards against resis tance and braces the shoulder back. The muscles are palpated at the vertebral border of the scapula; being deep to trapezius they are not always visible. If the rhomboids of one side are paralysed the scapula of the affected side remains farther from the midline than that of the normal side.
Levator scapulae
- Origin
- Attachment
- Innervation
- Action
Origin:
- Transverse processes of C1-4 vertebrae
Attach:
- Medial border scapula
Innervation:
Dorsal scapula nerve (C5) + Cervical plexus C3,4
Function:
Elevates Scapula, rotates neck
Serratus anterior
- Origin
- Attachment
- Innervation
- Function
Origin:
Lateral aspects of ribs 1-8
Attach:
costal surface of medial border of scapula
Innervation:
Long thoracic nerve (C5,6,7)
Action: Protracts scapula and laterally rotates scapula
Describe the sternoclavicular joint. Why is it an atypical synovial joint?
Synovial joint between clavicle, manubrium of sternum and part of the 1st costal cartilage
Atypical synovial joint as the articulating surfaces covered with fibrocartilage not hyaline cartilage
Seperated into 2 cavities by a Fibrocartilaginous articular disc
Ligaments and innervation of the sternoclavicular joint
Ligaments:
- Anterior + Posterior sternoclavicular ligaments
- Interclavicular ligament
- costoclavicular ligaments
Innervation:
Medial supraclavicular nerve (C3,4)
Action:
- Elevation and depression (Shrugging)
- protraction and retraction
- rotation (When arm elevated)
The Axilla Region Borders and Contents
Apex - Lateral 1st rib, clavicle, superior border of scapula
Lateral - Intertubercular groove of humerus
Medial - upper: Serratus anterior, lower: 4th rib
Anterior - pectoralis major, minor, subclavius, clavipectoral fascia
Posterior - Subscapularis, teres major, latissimus dorsi
Contents:
- Axillary vein (medial to artery)
- Axillary artery
- Brachial Plexus (Cords)
- Biceps brachii and coracobrachialis
- Axillary lymph nodes
Acromioclavicular joint
- Ligaments
- innervation
- action
Similar to the sternoclavicular joint, the articulating surfaces covered by fibrocartilage
Ligaments:
- Coracoclavicular ligament (Conoid and trapezoid)
- Acromioclavicular ligament
Nerve supply
- Lateral supraclavicular nerves (C4)
What are the rotator cuff muscles?
Describe there innervation, origin and attachments, function
What is the quadrangular and triangular space in the shoulder?
Quadrangular Space:
Lies between the subscapularis and teres major
Transmits the axillary nerve, with the posterior circumflex humeral artery and vein
Triangular space:
Below the teres major and between the humerus and long head of triceps
Transmits the radial nerve and profunda brachii vessels
Axillary artery:
- When does the subclavian artery become the axillary artery
- Whats the fascia that covers the axillary artery called?
- At the lower border of what muscle does it become the brachial artery?
- Subclavian artery
- Axillary sheath
- Teres Major
Outline the surgical approach to the axillary artery
First part of the artery exposed by splitting clavicular head of pectoralis major and incising the clavipectoral fascia
The rest of the artery is approached through the axilla, in the groove between coracobrachialis and long head of triceps
Branches of the axillary artery
- First part: Superior thoracic artery (supplies both pectoral muscles)
- Second part:
- Thoracoacromial artery (peirces clavipectoral fascia then seperates into clavicular, deltoid, acromial, pectoral branches)
- Lateral thoracic artery (breast and pectoral muscles) - Third Part: Subscapular (largest branch, runs down posterior axillary wall giving off circumflex scapula artery) and anterior/posterior circumflex humeral arteries (circle humerus and supply shoulder region)
DRAW THE BRACHIAL PLEXUS
The five roots lie behind scalenus anterior muscle and emerge between it and scalenus medius to form the trunks which cross the lower part of the posterior triangle of the neck. Each of the three trunks divides into an anterior and a posterior division behind the clavicle. Here, at the outer border of the first rib, the upper two anterior divisions unite to form the lateral cord, the anterior division of the lower trunk runs on as the medial cord, while all three posterior divisions unite to form the posterior cord. These three cords enter the axilla above the first part of the artery, approach and embrace its second part, and give off their branches around its third part.
How many groups of lymph nodes in axilla
- Average number 35, may be over 50
i) Anterior (pectoral group)
ii) Posterior (Subscapular group)
iii) Lateral group
iv) Central group
v) Apical group
Breast anatomy: What is the blood supply to the breast?
- Internal thoracic (mammary) artery
- Lateral thoracic artery
- Thoracoacromial artery
Breast Anatomy: Mammary glands are modified sweat glands. They consists of a series of ducts and secretory lobules (15-20). What are these ducts called?
Lactiferous ducts
Breast anatomy: The fibrous stroma condenses to form what ligament?
Suspensory ligaments of cooper.
Function is to secure the breast to the dermis and underlying pectoral fascia
seperate secretory lobules of the breast
What nodes does lymph from the breast drain?
Axillary nodes (75%)
Parasternal nodes (20%)
Posterior Intercostal nodes (5%)
Deltoid:
- Origin
- Attachment
- Innervation
- Function
Origin:
Scapula (Acomion and crest of scapula spine), lateral 1/3 clavicle
Attach:
Deltoid tuberosity on lateral humerus
Innervation:
Axillary nerve
Function:
Anterior: flexion
Posterior: extend
Middle: Major abductor (Takes over from suprispinatus after 15 degrees)
Describe the scapular anastamosis
The dorsal scapular and suprascapular arteries arise from the third and first parts of the subclavian, and the subscapular from the third part of the axillary artery. They and the circumflex scapular anastomose on both surfaces of the scapula.
Describe the brachial plexus roots, subclavian artery and vein in relation to the scalene muscles
Subclavian vein runs infront of anterior scalene
Subclavian artery and roots of brachial plexus run behind anterior scalane and infront of middle scalene muscle
Course of the cephalic vein
No accomanying artery
Between anterior deltoid and pectoralis major then under pectoralis major
joins other veins to become subclavien vein
Subclavian vein relative to pectoralis minor, anterior scalene and clavicle
Passes beneath pectoralis minor, over scalene anterior and under subclavius muscle and clavicle
Joins Internal jugular vein to become braciocephalic vein
Describe the shoulder joint and ligements involved
Synovial joint
Between humeral head and glenooid fossa (4:1 ratio)
Stabilised by the glenoid labrum
Covered in a joint capsule (Surrounds glenoid labrum and surgical neck of humerus)
Synovium covers attaches around the labrum and lines the capsule and humerus. It herniates through a hole to communicate with the subscapularis bursa and invests the long head of biceps tendon
Ligaments:
- Glenohumeral ligemnts
- Coracohumeral ligament
- Transverse humeral ligament
- Coracoacromial ligament
Important shoulder bursae
Subacromial bursae: located inferiorly to the deltoid and acromion and superior to the suprispinatus tendon and joint capsule
Subscapular bursae: located between subscapularis tendon and scapula
Infraspinatus bursae
Subdeltoid bursae
Subcutaneous acromial bursa
Coracobrachial bursa
Subtendinous bursa of subscapularis