Upper Limb Flashcards
Ligaments of sternoclavicular joint
Acromioclavicular lig
Coracoclavicular lig
Costoclavicular lig
Pectoralis major origin & insertion
Clavicular head - medial 1/2 of ant surface of clavicle -> lateral lip of bicipital groove
Sternal - manubrium, body of sternum and upper 6 CC
Nerve supply of pec major
Lateral & medial pectoral nerves *from medial/lateral cords of plexus
Fx of pec major
Adductor
Medial rotator
Which nerve (medial/lateral) pierces claviopectoral fascia
Lateral pectoral nerv
Which nerve pierces pec minor
Medial pectoral N
Origin & insertion pec minor
3-5th ribs
Insert: medial border & upper surface of coracoid
Nerve supply of pec minor
Medial & lateral pectoral nerves
Fx pec minor
Assists serratus anterior in protraction of scapula
Subclavius origin & insertion
Costochondral jx of 1st rib
Inferior surface clavicle
Nerve supply of subclavius
N to subclavius *C5,6
Pectoral fascia
Thin lamina of deep fascia
Covers pec major
Continuous with axillary fascia
Clavipectoral fascia attachments
Coracoid process to ext intercostal membrane
What does clavicopectoral fascia split to enclose
Subclavius
What 4 structures pierce the clavipectoral fascia
Lymphatics
Cephalic V
Lateral pectoral N
Thoracoacromial A
What does the clavipectoral fascia become below pec minor
Suspensory lig of axilla
Trap origin & inset
1/3rd of nuchal line & all t12
Insert: lateral 1/3rd clavicle post border
Acromion & scapula spine
Nerve supply of traps
Spinal part of accessory N C1-5
Cervical plexus
Fx of traps
Retract scapula
Lat dorsi origin & insert
Spines of T7-12; posterior layer of lumbar fascia, lumbar and sacral spines, iliac crest
Insert: floor of intertubercular sulcus
Nerve supply of lat dorsi
Thoracodorsal N C6-8
Action of lat dorsi
Extend shoulder joint
Medially rotates humerus
Rhomboid major origin & insert
Arises from t2-5 spines
Insert: medial border of scapula
Rhomboid minor origin & insert
C7-T1Spines => medial border of svapula
N supply of rhomboids
Dorsal scapular N C5
Fx of rhomboids
Retract scapula
Levator scapulae origin &insert
TP of atlas, axis, posterior tubercles C3/4
Insert: medial border of scapula from superior angle to spine
Nerve supply to levator scapulae
Cervical plexus C3,4
Reinforced by dorsal scapulae
Fx of levator scapulae
Elevate scapula
Laterally flex neck
Serratus anterior origin & insert
R1-8
Insert; costal surface of scapula
Nerve supply to serratus anterior
Long thoracic N C5,6,7
Fx of serratus anterior
Pushing & punching
Rotate scapula lateral
Raising arm above shoulder
Origin & insert subscap
Medial 2/3rd costal surface scapula
Insert: LT of humerus
N of subscap
Upper & lower subscapular N
Fx of subscap
Stability
Medial rotator
SSP origin & insert
2/3rd medial supraspinous gossa
Upper part of GT
N of SSP
Suprascapular N C5,6
Origin & insert ISP
Medial 2/3rd of infraspinous fossa
Insert: GT
N of ISP
Suprascapular N C5,6
Fx of infraspinatous
Lateral rotator
Stability
Brace head against glenoid
Teres minor origin & insert
Edge to edge with infraspinatus (axillary border of scapula)
Insert: GT (lower facet)
N to teres minor
Posterior branch of axillary N C5,6
Fx of teres minor
Lateral rotator (weak)
Teres major origin & insert
Inferior angle of scapula, dorsal surface
Insert: medial lip of intertubercular groove
N to teres major
Lower subscapular N
Fx of teres minor
Medial rotator
Adductor
Deltoid origin & insert
Anterior border & upper surface of lateral 1/3rd of clavicle, acromion, inferior lip of scapula spine
Deltoid tuberosity
N to deltoid
Axillary N C5,6
Fx of deltoid
Multipennate
Anterior - flex, medial rotate
Post - extend, lateral rotate
What is covered in infraspinatus fascia
Infraspinatus
Teres minor
What makes up the scapular anastomosis
Dorsal scapular
Suprascapular
Subscpaular
Circumflex scapular
Where does dorsal scapular A arise
Transverse cervical A or directly off subclavian A (3rd part)
Where does suprascapular A arise
Thyrocervical trunk
Where does subscapular A arise
3rd part of axillary A
Where does circumflex scapular arise
Subscapular A (which is from 3rd part of axillary A)
Movements of shoulder
Flexion
Extension
Abduction
Adduction
Rotation
Circumduction
Axilla boundaries
Anterior - pec major, minor; subclavius & clavipectoral fascia
Post - subscap, teres major, tendon of lat dorsi
Medial - serratus anterior, lower limit is 4th rib
Floor - axillary fascia
Apex - clavicle, upper border of scapula
What divides axillary A
Pectoralis minor
Above ; behind ; below
Axillary A starts at
Outer border of 1st rib
What nerves pass IN FRONT of axillary A
Median root of median nerve (to reach lateral root of median N)
Where does axillary V lie in proximity
Anteromedial to all parts of the artery!
Branches of the axillary A
“Screw The Lawyer, Save A Patient)
Superior thoracic A
Thoracoacromial (4 subsbranches)
Lateral thoracic
Subscapular
Anterior humeral circumflex A
Posterior humeral circumflex A
4 branches of thoracoacromial A
Clavicular
Deltoid
Acromial
Pectoral
What passes through quadrangular space
Axillary N
Posterior circumflex humeral A
What passes through lower triangular space
Deep A of arm
Radial N
Where does axillary V start
Lower border of teres major
What does axillary V become & where
Subclavian V
Passes infront of anterior scalene
What are the roots of the brachial plexus
C5-T1
Where do the roots of brachial plexus FORM
Behind anterior scalene muscle
What are the branches of the ROOTS
Dorsal scapular
Long thoracic
N to subclavius
What are the lateral cord branches
Lateral pectoral
Lateral root of median N
MSC
What are the medial cord branches
Medial pectoral
Medial cutaneous N of the arm
Medial cutaneous N of forearm
Ulna n
Medial root of median N
Posterior cord branches
Upper subscapular
Lower subscapular
Thoracodorsal
Radial
Axillary
Where do the trunks emerge
B/w the anterior and middle scalene muscle
Dorsal scapular N supplies & n root
C5
Rhomboids
Levator scapulae
Long thoracic N root & supplies
C5,6,7
Serratus anterior
N to subclavius root & supplies
C5,6
Subclavius M
Suprascapular N root & supplies
SSP, ISP
C5,6
Travels beneath transverse scapular lig
Lateral pectoral N root & supplies
C5,6,7
Pec major
MSC nerve root & supplies
C5,6,7
Coracobrachialis
Brachialis
Biceps brachii
Becomes lateral cutaneous N of forearm
Upper subscapular N root & supplies
C5,6
Subscapular N upper partl
Lower subscapular N root & supplies
C5,6
Subscapularis (lower part)
Teres major
Thoracodorsal nerve root & supplies
C6,7,8
Latissimus dorsi
Radial nerve root & supplies
C5-T1
Triceps, supinator, anconeus
Extensors of forearm
Brachioradialis
Becomes posterior cut n of arm
Axillary n root & supplies
C5,6
Deltoid
Teres minor
Becomes upper lateral cutaneous n of arm
Medial pectoral N roots & supplies
C8,T1
Pec major & minor
Ulnar nerve root & supplies
C8,T1
FCU, medial 2 FDP
Most of small muscles of hand (2LOAF exception)
Base of breast
Sternal edge to Mid axillary line 2nd-6th ribs
How many lactiferous ducts open into the niple
15-20
Blood supply of the breast
Lateral thoracic A
Internal thoracic A
Posterior IC A
Venous drainage of breast
Deep veins that run with main arteries
Posterior IC for metastatic spread
LN drainage of breast
75% to axillary LNs
Parasternal LNS
Coracobrachialis origin & insert
Coracoid process
Into medial border of humerus
Supply of coracobrachialis
MSC n C5,6
Fx of coracobrachialis
Weak flexor & adductor
Biceps origin & insert
LH from supraglenoid tubercle & labrum of scapula
SH apex of coracoid, lateral to coracobrachialis
Insert: tuberosity of radius (posterior border)
N to biceps brachii
MSC n c5,6
Fx of biceps
Flex elbow
Supinate forearm
Brachialis origin & insert
Lower half of humerus & medial intermuscular septum
Insert: coracoid process of ulna tuberosity
Nerve to brachialis
MSC n & radial N
Fx of brachialis
Elbow flexor
Medial intermuscular septum
Medial supracondylar ridge and fades out over coracobrachialis
Gives origin to brachialis & medial head of triceps
What pierces the medial intermuscular septum
Ulna N
Superior Ulna collateral A
Axillary branch of radial N (to MH of triceps)
Lateral intermuscular septum attachments
Brachioradlis & ECRL & medial head of triceps
What pierces the lateral intermuscular septum
Radial N
Profunda rachii A (radial collateral A(
Brachial A & relation to median N
Median N passes from lateral to medial
Ulnar nerve and relation to brachial A
Ulnar nerve is posterior to the artery then leaves the arm medially through medial intermuscular septum
Branches of brachial A
Profunda brachii
Radial
Inferior ulna collateral
Ulna
Superior ulna collateral
Where does profunda brachii travel & what are its branches
In radial groove with radial N
Gives off medial & radial collateral A
Basilic vein course
Perforates deep fascia of middle arm
Becomes axillary V
Cephalic V course
Lies b/w deltoid & Pec major
Pierces clavipectoral fascia
Empties into axillary V
Where is median found in the elbow
MEDIAL
What is the intercostobrachial N a brach of
Lateral cutaneous branch of 2nd IC nerve
Triceps origin & insert
LH - infraglenoid tubercle
Lateral - back of surgical neck & above radial groove
Medial - arises from whole of back of humerus, below radial groove
Insert - posterior surface of olecranon
LH triceps
Infraglenoid tubercle
Lateral head triceps
Back of humerus to surgical neck
Above radial groove
Medial head of triceps
Back of humerus
Below radial groove
Medial & lateral intermuscualr septumsn
Nerve to triceps
Radial C7,8
Fx of triceps
Extend elbow
Course of radial N
Runs in radial groove
Pierces lateral intermuscular septum, entering anterior compartment
Passes with brachialis medial, brachioradialis lateral
Gives off lower lateral cutaneous n of the arm & post cutaneous n of forearm
Passes ANTERIOR to lateral epicondyle
How does ulna n enter the forearm
Lies in contact with groove behind medial epicondyle
B/w humeral & ulnar heads of FCU
Features of the humerus in the elbow joint
Medial TROCHLEA
Lateral CAPITULUM
What articulates with trochlea
Coronoid process & head of ulna bone
What articulates with capitulum
Head of radius
Anterior compartment of forearm, broad groups
Superifical
Deep
Superficial group of muscles in forearm
Pronator teres
FCR
FDS
Palmaris Longus
FCU
Origin & insert pronator teres & and what passes through
Humeral head - medial supracondylar ridge
Ulnar - coronoid process
Median nerve passes through the heads
Insert into shaft of radius
N of pronator teres
Median N (highest muscular branch)) C6,7
Fx of pronator teres
Pronate
Weak flexor
FCR origin & insert
Medial epicondyle of humerus
Base 2/3rd metacarpals
Radial A & median N in relation to FCR
Radial A is LATERAL to tendon
Median N is medial
Nerve to FCRq
Median N C6,7
Fx of FCR
Flex & radial abduct wrist
FDS origin & insert
Medial epicondyle, medial lig of elbow, coronoid process, radial head
Insert: palmar surface of base of middle phalanx
Nerve of FDS
Median N C7,8
Fx of FDS
Flex prox IP
FCU origin & insert
Medial epicondyle and medial border of olecranon & upper 2/3rds of ulna
(Ulna n passes between)
Insert into pisiform & hamate & 5th Metacarpal bone
N to FCU
Ulnar N C7,8
What accompanies UlnaN In forearm
Posterior ulnar recurrent A
FDP origin & insert
Medial surface of olecranon, upper anterior and medial surfacers of ulna
Insert: bases of distal phalanges of medial 4 digits
Nerve to FDP
AIN & Ulnar N
Fx of FDP
Flex distal IP joint
FPL origin & insert
Anterior surface of radius
Some from ulna side
Insert into base of distal phalanx on THUMB
Nerve to FPL
AIN C7,8
Fx of FPL
Only flexor of the interphalangeal of thumb
Pronator quadratus origin & insert
Anteriomedial aspect of distal ulnar
Insert into anterior surface of lower 4th of radius
N to pronator quadratus
AIN C7,8
Fx of pronator quadratus
Pronator
Hold ulna & radius together
Boundaries of cubital fossa
Sup = intercondylar line *b/w medial & lateral epicondyles of humerus
Med = pronator teres m
Lat = brachioradialis
Apex (directed inferiorly)
Roof - skin, superficial fascia, deep fascia
Floor - brachialis & supinator
Contents of cubital fossa
“People really believe bob marley”
Posterior Interosseous N
radial N
Biceps tendon
Brachial A
Median N
Course of radial A in forearm
Distal to biceps tendon
Crosses supinator
Over tendon of pronator teres
Radial origin of FDS
FPL
Disappears into anatomical snuff box
Deep to Abductor Pollicis Longus & EPL
Course of Ulnar A in forearm
Disappears in cubital fossa under pronator teres
Runs beneath FDS& Median nerve
Runs on FDP
Lies on top of flexor retinaculum
Superficial palmar Arch
How does median nerve enter forearm
B/w two heads of pronator teres
How does median nerve leave cubital fossa
B.w pronator teres (the two heads)
Where does median n run in forearm
Beneath FDS
Then behind &Lateral to palmaris longus
Gives off AIN
AIN supplies
FDP (1/2)
FPL
Pronator quadratus
Inferior radioulnar joints
Wrist ^ carpal joints
How does ulnar nerve exits cubital fossa
B/w FCU heads
How does ulnar nerve travel in forearm
Under cover of flattened aponeurosis of FCU
Where does the ulnar A run in relation to ulna N in forearm
Lies RADIAL side along the distal 2/3 of forearm
What does ulnar N supply in the forarm
FCU
FDP 1/2
What is the lateral cutaneous n of the forearm an ext of
Ext of MSC n
What type of joint is the proximal radioulnar joint
Pivot, synovial. Joint
What type of joint is the distal radioulnar joint
Synovial pivot joint
What are the muscles of extensor component of forearm
Anconeus
Supinator
Brachioradlias
ECRL
ECRB
Extensor digitorum
Digiti minimi
ECU
Abductor pollicis longus
Extensor pollicis longus
Extensor pollicis brevis
Extensor indicis
What are the 2 upper muscles of ext compartment of forearm
Anconeus
Supinator
3 muscles that arise from lateral humerus to radial side
Brachioradialis
ECRL
ECRB
Lateral part of humerus 3 muscles to POSTERIOR surface of forearm
Extensor digitorum
Digiti Minimi
ECU
What are the 3 muscles that emerge deep & form the boundaries of anatomical snuffbox
Abductor pollicis longus
Extensor pollicis longus
Extensor pollicis brevis
How many extensor compartments are there
6
What are the extensor compartments
1: Abductor pollicis longus; extensor pollicis brevis
2: ECRB, ECRL
3: EPL
4: Extensor digitorum; extensor indicis
5: extensor digiti minimi
6: ECU
Anconeus origin & insert
Arises from posterior surface of lateral epicondyle
Insert: olecranon
Nerve to anconeus
Radial C7,8
Action of anconeus
Small amount of posterolateral movement of ulnar that occurs during pronation
Supinator origin & insert
Distal surface of lateral epicondyle, lateral lig of elbow, annular lig of radius, supinator crest of ulna & fossa
Insert: lateral surface of radius
N to supinator
PIN C6,7
Fx of supinator
Supinate while elbow is straight
(Biceps more powerful)
Brachioradialis origin & insert
Lower 2/3rd of lateral supracondylar ridge
Insert: radial styloid base
*forms lateral border of cubital fossa
Nerve to brachioradialis
Radial n C5,6
Fx of brachioradialis
Flex elbow joint
What lies below brachioradialis muscle
Radial N & A
ECRL origin & insert
Lower 1/3rd of lateral supracondylar ridge
2nd metacarpal
Nerve to ECRL
Radial N C6,7
Fx of ECRL
Extend & abduct wrist
What arises from common extensory origin
ECRB
ED
EDM
ECU
What is the common extensor origin
Front of lateral epicondyle (anterior surface)
ECRB origin & insert
Common extensor origin
Base of 3rd metacarpal
Nerve to ECRB
PIN C7,8
Fx of ECRB
Wrist extensor
Extensor digitorum origin & insert
Common extensor origin
Into extensor hood
N to extensor digitorum
PIN C7,8
Fx of extensor digitorum
Wrist, MCP, IP extensor
Extensor digiti minimi origin & insert
Common extensor origin
To extensor hood of lil finger
N to extensor digiti minimi
PIN C7,8
ECU origin & insert
Common extensor origin
To 5th metacarpal
N to ECU
PIN C7,8
Abductor pollicis longus origin & insert
From back of radius, ulna & interosseous membrane
Into base of 1st MC & trapezium
N to abductor pollicis longus
PIN C7,8
Fx of abductor pollicis longus
Extend thumb & lateral displacement
Abduct & flex wrist
EPL origin & insert
Ulna to base of distal phalanx of thumb
N to EPL
PIN C7,8
EPB origin & insert
Radius & interosseous membrane
Base of proximal phalanx
EPB n
PIN C7,8
Extensor indicis origin & insert
Ulna
Shares synovial sheath with ED
Dorsal expansion of index finger
N to extensor indicis
PIN C7,8
PIN emerges where
From supinator & radial n
What is the post interosseous A a branch of
Common interosseous A from Ulna A
Boundaries of anatomical snuffbox
Radial side: Abductor pollicis Longus, EPB
ulnar: EPL
Roof: cephalic V
Floor: radial A (Deep to tendons
Extensor retinaculum attachments
Anterolateral border of radius
Pisiform & triquetral bones
What type of joint is the wrist joint
Biaxial synovial joint
N to wrist joint
PIN
AIN
Wrist movements & what muscle(s) allow for this
Flex; FCR + FCU (palmaris longus)
Ext: ECRL, ECRB, ECU
Abduct: FCR, ECRL, ECRB, abductor pollicis longus
Adduct: FCU and ECU
What is the venous drainage of dorsum of hand
Radial side: cephalic
Ulnar side: basilic
What forms the dorsal carpal arch
Arterial anastomosis b/w
Radial, ulnar * Anterior interosseous A
How do the dorsal metacarpal arteries reach the intermetacarpal space
Deep to the long tendons
What provides cutaneous innervation to palm
Median nerve & palmer branch
Superificial & palmer branches of ulnar N
What is the palmar aponeurosis continuous with
Tendon of palmaris longus
Deeper transverse fibres
Flexor retinaculum
Flexor retinaculum attachments
Medial: pisiform, hook of hamate
Lateral: scaphoid, trapezium
Contents of carpal tunnel
“Silly people pay continuous money”
FCS
FDP
FPL
FCR
Median N
What is the canal of guyon
The ulnar N and artery travelling lateral to pisiform bone covered by a band of fascia
What is the superificial palmar A a direct continuation of ?
Ulnar A
What does NOT receive blood supply from superficial palmar branch
Thumb & thumb side of index finger
When does the ulnar n divide into superfiical & deep branches
On the flexor retinaculum
Where does the radial A lie in the hand
Cross anatomical snuffbox over trapezium
Runs deeply b/w 2 heads of first dorsal interosseous m
What does the deep branch of ulnar n go on to supply
Motor to 3 hypothenar M
2 lumbricals on ulnar side
All interossei
Both heads of adductor pollicis
Muscles of thenar eminence
Abductor pollicis brevis
Flexor pollicis brevis
Opponens pollicis
Nerve to m of thenar muscles
Muscular *recurrent) branch of median N T1
Origin &insert of thenar muscles
All from flexor retinaculum
Insert:
Abductor pollicis brevis - radial side of prox phalanx
Flex pollicis brevis - radial sesamoid
Opponens pollicis - whole radial border of prox phalanx
M of hypothenar eminence
Abductor digiti minimi
Flexor digiti minini brevis
Opponens digiti minimi
Nerve to muscle of hypothenar eminence
Deep branch of ulnar N T1
Origin &insert hypothenar M
Abductor DM
- from pisiform & FCU tendon
- base of prox phalanx into extensor expansion
Flex DMB
- flexor retinaculum & hook of hamate
- ulnar side of prox phalanx base
O DM
- flexor retinaculum & hook of hamate
- ulnar side of 5th MC bone base
Adductor pollicis origin & insert
Whole 3rd Metacarpal
Bases of 2nd & 3rd metacarpal & capitates
Insert: ulnar sesamoid of thumb
N to adductor pollicis
Deep branch of ulnar N C8,T1
Where do the lumbricals origin & insert
4 FDP tendons
Extensor expansions on dorsum of prox phalanges
N of lumbricals
Median & ulna
Interosseous muscles TYPES & NERVE
Palmar - ADDUCT
Dosral - ABDUCT
All by deep branch of Ulnar N C8,T1
What lies within the fibrous flexor sheaths of the fingers & thumbs
FPL in thumb
FDP & FDS in the fingers
What are the palmar spaces within the hand & what separates them
The septum of palmar aponeurosis
3 spaces
- thenar, hypothenar, mid-palmar spaces
What lies bw the web spaces of the hand *palmar & dorsal layers of the skin
Superficial & deep transverse ligs
Digital N + Vessels
Tendons of interossei & lumbricals
Loose fibrofatty tissue
What attaches ot the deep transverse metacarpal ligaments
Lumbricals are on palmar side
Interossei on dorsal side
What does the vincula do
Provide blood supply to flexor tendons
What are the long tendons of the thumb
FPL
EPB & EPL
Action of lumbricals
Only attached to extensor expansions
Extend BOTH IP joints
Features of clavicle
Medial 2/3rd round & convex forward
Lateral 1/3rd flat & curved back to scapula
Acromial & sternal edges
Attachments to clavicle
SCM
Pec Major
Deltoid lateral 1/3rd
Trapezius
Subcalvius
Ligs: costoclavicular; conoid; trapezoid
Features of scapula
Triangular, flat bone
Costal surface
Dorsal surface - spinous process, infra&supraspinous fossa
Acromion
Glenoid fossa
Supra and infraglenoid tubercles
Coracoid process
Attachments to scapula
Costal - serratus anterior; subscapularis
Medial border: levator scapulae, rhomboids major & minor
SSP, ISP
Teres major; teres minor
Trapezius
Deltoid
LH of biceps
LH of triceps
What are the muscles that attach to coracoid process
Pectoralis Minor
Biceps SH
Coracobrachialis
Ligaments attached to coracoid process
Coracoclavicular ligs
Coracoacromial lig
Coracohumeral lig
Features of humerus
Head
Surgical & anatomical neck
Lesser tubercle
Bicipital groove
Greater subercle
Deltoid tuberosity
Radial groove
Capitulum for head of radius
Trochlea for ulna
What attaches onto lesser tubercle
Subscapularis
Continues as medial lig = teres major
Intertubercular sulcus bridged by
Transverse humeral lig (biceps LH tendon passes beneath)
greater tubercle attachments
Supraspinatus
Infraspinatus
Teres minor
Radial groove gives from to
Lateral lip to LH of triceps
Medial head of triceps
Radial n lies here
What does capitulum articulate with
Radial head
What does trochlea articulate with
Ulna
Radius features
Cylindrical head (communicates with capitulum)
Radial tuberosity
Interosseous membrane
Styloid process
Dorsal tubercle
Where does biceps attach on radius
Onto posterior lip
What attaches to anterior oblique line of radius
FDS
FPL
Pronator quadratus
What attaches to posterior oblique line on radius
Abductor pollicis longus
Abductor pollicis brevis
What attaches to radius styloid process
Radial collateral lig
Brachioradialis
Extensor retinaculum
Colles fracture
Distal radius - dorsal rotation & displacement
Ulna bony features
Upper end - olecranon, coronoid process
Ulnar tuberosity
Trochlear notche
Shaft
Head of ulna (distal)
Ulna styloid
What arises from olecranon & attaches
Tricep tendons attach
FDP arises
Anconeus
Coronoid process attachments
FDS
Pronator teres
(Sublime tubercle)
What inserts on ulna tuberosity
Brachialis
Largest carpal bone
Capitate
Which carpal bone makes contact with deep branch of ulnar N
Hook of hamate