Upper Limb Lecture Flashcards
what connects the trunk and upper limb?
the SC joint
what do all structures that pass b/w the neck and arm go through?
the axilla
what goes through the cubital fossa?
median nerve and brachial artery
tendon of biceps brachii
what is the cubital fossa?
formed by brachioradialis and pronator teres
where brachial artery branches into radial and ulnar arteries
BP measurement
what goes through the carpal tunnel (transverse carpal ligament)?
median nerve, flexor tendons, and flexor retinaculum
brachial
arm
antibrachial
forearm
what muscles connect the scapula and clavicle to the trunk?
traps, rhomboids (major and minor), and levator scap
what connects the clavicle, scap, and body wall to the proximal humerus?
pec major, pec minor, lats, teres major, deltoid, and rotator cuff muscles
what are the rotator cuff muscles?
SITS:
- supraspinatus
- infraspinatus
- teres minor
- subscapularis
anterior compartment
flexors
posterior compartment
extensors
what separates the posterior and anterior compartments?
intermuscular septa, bones, and ligaments (interosseous membrane in the forearm)
what are the hand intrinsics?
thenar and hypothenar muscles
thenar muscles
move thumb independent of other muscles
soft tissue mound called thenar eminence on palmar aspect of metacarpal 1
opponents pollicus
flexor pollicus brevis
abductor pollicis brevis
innervated by recurrent branch of median nerve
adductor compartment: adductor pollicus innervated by deep branch of ulnar nerve
hypothenar muscles
soft tissue mound on palmar side of metacarpal 5
act on digit 5
form hypothenar eminence
innervated by deep branch of ulnar nerve
what makes up the axilla inlet?
medial margin: lateral border of rib 1
anterior margin: posterior surface of the clavicle
posterior margin: superior border of the scapula
what makes up the anterior wall of the axilla?
lateral pec major, pec minor, and subclavius
clavipectoral fascia (deep to pec minor, encloses subclavius and pec minor)
what goes through the clavipectoral fascia?
cephalic vein
what makes up the medial wall of the axilla?
ribs and intercostal muscles
serratus anterior
what makes up the lateral wall?
intertubercular sulcus of humerus
what muscle connects to lateral lip of intertubercular sulcus?
pec major
what muscle connects to the floor of the intertubercular sulcus?
lats
what muscle connects to the medial lip of the intertubercular sulcus?
teres major
what makes up the posterior wall of the axilla?
subscapularis, lats, teres major, long head of triceps brachii
what makes up the floor of the axilla?
fascia and dome of the skin supported by clavipectoral fascia
is the anterior or posterior fold of the axilla more superior?
the anterior fold is more superior than the posterior fold
what are the boundaries of the quadrangular space?
teres major, surgical neck of humerus, teres minor, long head of triceps brachii
what passes through the quadrangular space?
axillary nerve, and posterior circumflex humeral artery and vein
what are the boundaries of the triangular space?
long head of triceps brachii, teres major, and teres minor
what passes through the triangular space?
circumflex scapular artery and vein
what are the boundaries of the triangular interval?
long head of triceps brachii, shaft of humerus, and teres major
what passes through the triangular interval?
radial nerve, profunda brachii (deep artery of arm), and vein
what makes up the suprascapular foramen?
suprascapular notch and superior transverse scapular ligament
what passes through the suprascapular foramen?
suprascapular nerve
branching of the subclavian artery
subclavian artery becomes the axillary artery at the lateral margin of rib 1
the axillary artery becomes the brachial artery at the inferior margin of the teres major
what are the 3 parts of the axillary artery?
1st part: proximal to pec minor
2nd part: posterior to pec minor
3rd part: distal to pec minor
branching of the axillary vein
the basilic vein becomes the axillary vein at the lower margin of the teres major
the axillary vein becomes the subclavian vein as it crosses superior of rib 1
what does the cephalic vein pass through?
the clavipectoral fascia at the clavipectoral triangle
what are the borders of the clavipectoral triangle?
superior: clavicle
medial: lateral border of pec major
lateral: medial border of delta
what is the site to palpate the coracoid process?
the clavipectoral triangle
axillary nerve
quadrangular space
deltoid and teres minor
passes around surgical neck of humerus
motor: teres minor and deltoids
sensory: superior lateral brachial cutaneous nerve
radial nerve
triangular interval
posterior (extensor) compartment
diagonally around the posterior humerus in the radial groove
motor: triceps, anconeus, brachioradialis, extensor carpi radialis longus
deep branch of radial nerve (post interosseous nerve): supinator, extensor carpi radialis brevis, extensor digitorum, extensor carpi ulnaris, extensor pollicis longus, extensor pollicis brevis, extensor indicis, abductor pollicis longus
sensory: inferior lateral brachial cutaneous nerve, posterior brachial cutaneous nerve, posterior antibrachial cutaneous nerve, superficial branch (post, dorsal hand; dorsal digital branch of radial nerve)
ulnar nerve
intrinsic hand muscles
posterior to medial epicondyle of humerus
flexors in the forearm: flexor carpi ulnaris and medial side of flexor digitorum
musculocutaneous nerve
motor: corocobrachialis, biceps brachii, brachialis
sensory: lateral antibrachial cutaneous nerve (lateral forearm)
median nerve
motor: pronator teres, flexor carpi radialis, palmaris Longus, flexor digitorum superficialis
anterior interosseous nerve: flexor pollicis longus, flexor digitorum profundus (lateral side only), pronator quadratus
palmar digital nerves: 1st and 2nd lumbricals
recurrent branch (muscles of thenar eminence): abductor pollicis brevis, flexor pollicis brevis, and opponents pollicis
sensory: cutaneous branch (proximal thumb) and palmar digital nerves (lateral aspect of head)
superficial veins
superficial fascia
access to patients’s vascular system
dorsal venous network of hand (dorsal metacarpal and dorsal digital veins)
branches of superficial veins
cephalic, basilic, and median cubital veins
what are the arteries of the axilla?
axillary artery: superior thoracic artery, thoraco-acromial artery, lateral thoracic artery, subscapular artery, anterior circumflex humeral artery, and posterior circumflex artery
brachial artery (continuation of axillary artery then into radial and ulnar arteries)
profunda brachii artery (branch of brachial)
arteries of the anterior compartment
brachial artery into radial and ulnar arteries
what is the only attachment b/w the trunk and upper limb?
the clavicle
infraglenoid tubercle
attachment of triceps brachii
supraglenoid tubercle
attachment of long head of biceps brachii
spinoglenoid notch
connects supra/infraspinous fossa
suprascapular artery and nerve
suprascapular notch
converted to foramen by superior transverse scapular ligament
suprascapular nerves and vessels
costal surface of the scapula
subscapular fossa and subscapular muscle
makes scapulothoracic joint
attachments of the coracoid process
pec minor, coracobrachialis, short head of biceps brachii, and coracoclavicular ligament
attachments of the greater tubercle
supraspinatus (superior facet), infraspinous (middle facet), and teres minor (inferior facet)
attachments of the lesser tubercle
subscapularis
attachment of the lateral lip of the bicipital groove
pec major
attachment of the medial lip of the bicipital groove
teres major
attachment of the floor of the bicipital groove
lats
surgical neck of the humerus
weak point-common fracture
axillary nerve, and posterior circumflex humeral artery pass around
capitulum
lateral
articulates with the radius
not viewable posterior
trochlea
medial
articulates with the ulna
pulley shaped
extends to posterior side
medial epicondyle
flexors attachment (anterior forearm compartment)
ulnar nerve passes around posterior surface
lateral epicondyle
attachment of extensors (posterior compartment of forearm)
less pronounced than medial epicondyle
radial fossa
superior of capitulum
head of radius when elbow is flexed
coronoid fossa
anterior superior of trochlea
coronoid process of ulna when elbow is flexed
olecranon fossa
posterior superior of trochlea
olecranon during elbow extension
radial head
proximal
ulnar head
distal
radial notch
articulates with radial head
trochlear notch
articulates with trochlea
coronoid process
inferior part of trochlear notch
lateral side of radial notch
supinator crest
origin of supinator muscle of lateral side
posterior border of supinator fossa
tuberosity of the ulna
attachment of the brachialis muscle
radius shaft
narrow proximally and broad distally
is the radial or ulnar styloid process more distal?
the radial styloid process is more distal than the ulnar styloid process
distal facets of the radius articulate with what?
the scaphoid and lunate
ulnar shaft
broad proximally and narrow distally
what provides stability of the GH joint?
rotator cuff muscles
long head of biceps brachii
ligaments
subtendinous bursa of the subscap (subscapular bursa)
b/w subscap and fibrous membrane
the fibrous membrane thickens to form what?
superior, middle, and inferior GH ligaments
coracohumeral ligament
transverse humeral ligament
medial and lateral collateral ligaments
3 articulations at the elbow
trochlear notch and trochlea (flexion/extension)
head of radius and capitulum (flexion/extension)
head of radius and radial notch (pronation/supination)
fat pads separate what?
the synovial membrane from the fibrous membrane
what moves fat pads out of the way during flexion/extension?
the tendons of the brachialis and triceps brachii
superficial/subcutaneous olecranon bursa
b/w olecranon and subcutaneous tissue
what is the sacciform recess?
pocket of synovial membrane that protrudes from the inferior joint capsule
facilitates rotation of head of radius during pronation/supination
distal radioulnar joint
head of ulna and ulnar notch of radius and fibrous articular disc separating RU joint from wrist
what makes up the lateral carpal arch?
tubercles of trapezium and scaphoid
what makes up the medial carpal arch?
pisiform and hood of hamate
what makes up the anterior carpal arch?
flexor retinaculum attaches to and spans b/w lateral and medial sides
CMC joints
b/w carpals and base of metacarpals
plane joints
1 trapeziometacarpal joint-saddle joint b/w trapezium and metacarpal 1 (allows opposition)
MCP joints
b/w head of metacarpals and base of proximal phalanges
condylar joints
flex/extend, add/abduct, circumduction
PIP joints
b/w head of proximal phalanges and base of middle phalanges
DIP joints
b/w head of middle phalanges and base of distal phalanges
can the hand adduct or abduct more?
the hand can adduct (ulnar deviate) more than abduct (radial deviate)
radial collateral ligament
b/w radial styloid process and scaphoid and trapezium
ulnar collateral ligament
b/w ulnar styloid process and triquetrum and pisiform
carpal tunnel
anterior wrist
carpal bones and flexor retinaculum
lateral base: tubercles of schaphoid and trapezium
medial base: pisiform and hood of hamate
what converts the carpal arch into the carpal tunnel?
the flexor retinaculum
what goes through the carpal tunnel?
median nerve
tendon of flexor pollicis longus
4 tendons of flexor digitorum superficialis
4 tendons of flexor digitorum profundus
the palmaris brevis overlies what set of muscles?
the hypothenar muscles
anatomical snuffbox
lateral: tendons of abductor pollicis longus and extensor pollicis brevis
medial: tendon of extensor pollicis longus
floor: schaphoid and trapezium
radial artery passes through
muscles of the anterior compartment of the forearm
flexors
musculocutaneous nerve
coracobrachialis pierced by musculocutaneous nerve
biceps brachii
deep layer mostly innervated by anterior interosseous nerve (branch of median nerve)
flexor digitorum superficialis
deep layer of muscles in posterior compartment of forearm
innervated by posterior interosseous nerve
mostly originate on interosseous membrane
superficial layer of muscles in posterior compartment of forearm
extension
lateral epicondyle and supercondylar ridge
extensor retinaculum
radial nerve-posterior interosseous branch
what are the intrinsic hand muscles?
hypothenar muscles, thenar muscles, lumbricals, and interossei compartments
what are the lumbricals?
lateral 2: innervated by dorsal digital branch of median nerve
medial 2: innervated by ulnar nerve
interossei compartments
DAB: dorsal abduct digits 2-4
PAD: palmar adduct all digits except 3
innervated by deep branch of ulnar nerve
