Upper Limb Part 2 Flashcards
What are the sections of the brachial pelux
Roots Trunks Divisions Cords Branches
What is a Root
the nerves
What is a Trunk
superior , middle, inferior
What is a Division
anterior and posterior
What is a Cord
lateral, posterior and medial
What is a branch
these are where the main nn. are coming off
dorsal scapular n.
c5, 4
rhomboid, levator
Long thoracic n
C5, 6, 7
serratus anterior
Suprascapular n
C4,5, 6,
supraspinatus and infaspinatus, should joints
subclavian n.
C4, 5, 6
subclavius and the sternoclaviular joint
Where is the erbs point of the brachial pelxus
the junction of C5 and C6
Lateral pectoral
C5,6,7
pec major
medial pectoral
C8, T1
pect minor, pec major
Medial cutaneous nerve of the arm
C8, T1
skin of meidla side of arm and proximal forearm
medial cutaneous nerve of forearm
C8, T1
skin of medial side of forearm as distal as wrist
Musculocutaneous
C5, 6, 7
coracobrachialis, biceps, brachialis, skin of lateral aspet of forearm
Median
Lateral root C6, 7
Medial root C8, T1
muscles of anterior forearm and five intrinsic muscles in thenar half of palm and palmar skin
what is the loop between the lat and medial pec n
this allow them to connect and send info back and forth
Ulnar
C7, 8, T1
flexor carpi ulnaris and ulnar half of flexor digitorum profundus ; most intrinsic muscles of hand; skin of hand medial to axial line of digit 4
Upper subscapular
c5
superior portion of subscapularis
lower subscapular
C6
inferior portion of subscapularis and teres major
thoracodorsal
C6, 7, 8
lats
axillary
C5, 6
glenohumeral joints, teres minor and delts; along with skin of superolateral arm
radial
C5-T1
all muscles of posterior campartment of arm and forearm; skin of posterior and inferolateral arm, posterior forearm and dorsum of hand lateral to axial line of digit 4
What is the arm
this extends from the shoulder to elbow
what are the two muscle groups of the arm
- anterior= flexor
- posterior = extension
what is the main action of the arm muscles
movement of the elbow and some action at the genohumeral joint
What is the of the arm
Humerus
what are some ascepts of the Proximal humerus
- anatomcial neck
- surgical neck
- deltoid tuberosity
- radial groove ( fractures may injure radial nerve)
what does the humerus articulate with
scapula ( glenohumeral joint)
radius
ulna
what are some aspects of the distal humerus
- 2 condyles
- epicondyles ( medial and lateral)
- conronoid fossa
- olecranon fossa
what are the 2 condyles of the humerus
- capitulum - articulates with radius
- trochlea- articulates with ulna
where can the coronoid fossa of humerus be found
anterior - receives ulnar coronoid process when elbow is bent
where can the olecranon fossa of humerus be found
posterior- receives ulnar olecranon process when elbow is straight
what pattern does the cutaneous innervation of he upper limbs follow
they follow at developmental pattern.
– the limbs lateral protrusion of the trunk with the 1st digit pointed in the cranail side ( thumb is directed superiorly)
what aspect of the upper limb is innervated by more cranial spinal cord segments?
the lateral aspect is innervated by more cranial spinal cords then the medial
what did keegan and garret make
they made the dermatome of the body that follows the developmental pattern
what cautaneous nerves of the upper limb are innervated by which nerves
the brachial pleux C5-T1 nerves
what nerves go to the shoulder
the cervical plexus
what did foerster develop
they came up with the idea of segmental dermatomal innervation which they came up with by clinical findings
what are the cutaneous nerves of the upper limb
- supraclavicular nerves
- superior lateral cutaneouse nerve of the arm
- inferior lateral cutaneous nerve of arm
- posterior cutaneous nerve of arm
- posterior cutaneous nerve of forearm
- lateral cutaneous nerve of forearm
- medial cutaneous nerve of forearm
- medial cutaneous nerve of arm
- intercostobrachial nerves
What are the spinal nerves of the supraclavicular nerves
C3, C4
What is the source of the supraclavicular nerves
cervical plexus
What is the course and distribution of the supraclavicular nerves
skin over clavicle, platysma and superolateral aspect of pectoralis major
What are the spinal nerves of the superior lateral cutaneouse nerve of the arm
C5, 6
What is the source of the superior lateral cutaneouse nerve of the arm
terminal branch of axillary nerve
What is the course and distribution of the superior lateral cutaneouse nerve of the arm
skin over lower part of deltoid m and on lateral side of midarm
What are the spinal nerves of the inferior lateral cutaneous nerve of arm
C5,6
What is the source of the inferior lateral cutaneous nerve of arm
radial nerve or posterior cutaneous nerve of arm
What is the course and distribution of the inferior lateral cutaneous nerve of arm
skin over inferolateral aspect of arm
What are the spinal nerves of the posterior cutaneous nerve of arm
C5-8
What is the source of the posterior cutaneous nerve of arm
radial nerve in axilla
What is the course and distribution of the posterior cutaneous nerve of arm
skin on posterior arm as far as colecranon
What are the spinal nerves of the posterior cutaneous nerve of forearm
C5-8
What is the source of the posterior cutaneous nerve of forearm
radial nerve with inferior lateral cutaneous nerve of arm
What is the course and distribution posterior cutaneous nerve of forearm
posterior forearm to wrist
What are the spinal nerves of the lateral cutaneous nerve of forearm
C6,7
What is the source of the lateral cutaneous nerve of forearm
musculocutaneous nerve terminal branch
What is the course and distribution lateral cutaneous nerve of forearm
skin of anterolateral forearm to wrist
What are the spinal nerves of the medial cutaneous nerve of forearm
C8, T1
What is the source of the medial cutaneous nerve of forearm
medial cord of brachial plexus in axilla
What is the course and distribution medial cutaneous nerve of forearm
skin of anteromedial aspect to wrist
What are the spinal nerves of the medial cutaneous nerve of arm
C8-T2
What is the source of the medial cutaneous nerve of arm
medial cord of brachial plexus in axilla
What is the course and distribution medial cutaneous nerve of arm
skin of medial aspect of distal arm
What are the spinal nerves of the intercostobrachial nerves
T2
What is the source of the intercostobrachial nerves
second intercostal nerve ( as its lateral cutaneous branch )
What is the course and distribution intercostobrachial nerves
skin of axilla and medial aspect of proximal arm
what is the atypical intercostal nerves
the 2nd and 3rd intercostal nn
Called interobrachial n look at the slide for name
what is so speical about the atypical intercostal n
that the 2nd intercostal lateral cutaneous branch does not divide into anterior and posterior branch. it emerges from intercostal space by piercing intercostal and serratus anterior mm.
what are the anterior muslces of the arm
- biceps brachii
- brachialis
- coracobrachialis
what do all the anterior arm mm. have in common
they are have the musculocutaneous n.
and its distal attachment marks nutrients foramen
what are the posterior muscles of the arm
triceps brachii
anconeus
what does all the posterior arm mm have in common
radial n.
what is the main artery of the arm
brachial artery
where does the brachial artery start
after the axillary a after the inferior border of T. major m
where does the brachail artery end
ends at the cubital fossa sopposite neck of radius
— where it becomes the radial and ulnar aa.
*** could also divide more proximally with the median n running between the radial and ulnar aa. in the arm
what nerves does the brachial artery run with
the median and ulnar n then with just the ulnar n.
what are artery found with brachial plexus
-anterior and posterior circumflex humeral aa and subscapular a
What are the division of the brachial artery
- deep art of the arm
- humeral nutrient a
- ulnar collateral aa
- unnamed muscular branches
- terminates into ulnar and radial aa
what does the deep brachial artery divide into
divides into the middle collateral a and the radial collateral a
where does the humeral nuterient a enter
aroudn the deltoid tuberosity
what does the ulnar collateral aa divide into
- superior ulnar collateral ( runs with ulnar n.)
- inferior ulnar collateral
what are the main superficial veins of the upper limb
- cephalic
- basilic
** both originate from dorsal venous network on dorsum of hand
where is the cephalic v. found
on the anterolateral surface
where does the cephalic V. emptie into
the axillary v
where is the bascilic v found
medial side
where does the basilic v empty into
joins the brachial v to form the axillary v.
where is the median antebrachial v. found
middle anterior forearm
runs into the basilic v.
Where does the brachial V start
begins at elbow by union of accompanying vv of ulnar and radial aa
where does the brachial v end
end by mergin with basilic v to form axillary v
*** alot of anatomic veration in the way the veins form
what are the nerves of the arm
- median n
- ulnar n
- musculocutaneous n
- Radial nerve
median n roots and info
C6,7,8,T1
- no branches to arm
- articular branches to elbow
Ulnar n roots and info
C7, 8, T1
- no branches to arm
- articular branches to elbow
- deep to medial epicondyle
Musculocutaneous n roots and info
C5,6, 7
- supplies all 3 m of anterior arm
- ** then continues as lateral cutaneous nerve of forearm
hits coracobrahialis then biceps brachii and then brachalis mm.
Radial n roots and info
C5-T1
- enters arms posterior to brachial artery and runs with deep brachail artery and winds aroudn the radial groove
- then will branch off under the brachioradialis m.
what are the branches of the radial n.
superifical and deep branches
- they form near the lateral epicondyle
superficial branch of radial n.
( sensory )
- runs with radial a
- lateral branch to the radial side of thumb
- medial branch divides into for digital nerves to the medail 3 digits
deep branch of the radial n
( motor)
- becomes posterior interosseous n
when does the deep brach of the raidal n become the posterior interosseous n.
when it crosses over the supinator m.
look at slide 40 in upper limb part 2
this give a good example of what the names shoudl be of the hand
what is the cubital fossa
this is a triangular depression on anterior side of elbow
what are the cubital fossas boundries
Superior- imaginary line connecting medial and latera epicondyles
Medial - pronator teres
Lateral- brachioradialis
what are the cubital fossas contents
Dont Break My Radial Bone on Cubital fossa
- Brachial a end ( into raidal and ulnar aa.)
- deep accompnaying veins of arteries
- biceps brachii tendon
- medain n.
- radial n divides ( super, and deep )
What is the median cubital vein
forms the communication between basilic and cephalic veins in cubital fossa
what is the variation of the superficial brachial artery
may branch of the 2nd part of the axillary artery and pass between the tow roots of the median nerve and run supericial to the median nerve ( which can cause problems when trying to take blood)
What is the forearm
antebrachium
OR
elbow to wrist
what are the bones of the forearm
radius and ulna
plus interosseous membrane
what does the interosseous membrane divide into
the anterior and posterior compartments
- which acts as a site for muscle attachments
- transgers forces from the radius to the ulna, to humerus
how does the interosseous membrance changes as it moves from supinaiton to pronation
pronation= relaxed state supination = tense state
what is on the distal end of the radius
ulnar notch
lateral styloid process attach site for wirst ligaments
what carpals bones does the interior surfaces of the radius articulate with
Scaphoid
lunate
triquetrium
what is on the distal end of the ulna
- head articulates with radius and wrist bones
- styloid process attach site for muscles
- convex articular surface for atritculation with the ulnar notch
what is on the proximal end of the ulna
radial notch
what is in the anterior compartment of the forearm
flexors and pronators
– median n
** tendons held in place by palmar carpal ligament and flexor retinaculum
what is in the posterior compartment of the forearm
extensors and supinators
–radial nerve
** extensor tendosn held in place by extensor retinaculum and the tendons passing over wrist dorsum are covered with synovial tendon sheaths
what are the layers of the anterior forearm m.
Superficial
intermediate
deep
what is in the superificial layer of the anterior forearm m.
- they cross the the elbow joint
- originate from medial side of humerus
- innervation of: median and ulnar n.
- pronator teres
- flexor carpi radialis ( radial a lies just lateral to tendon)
- plamaris longus ( median n pass lateral to tendon and is absent on one ( left or both sides) 14% of people)
- flexor carpi ulnaris
what is is the intermediate layer of the anterior forearm m.
*they cross the the elbow joint
flexor digitorm superficialis
what is in the deep layer of the anterior forearm m.
*they DO NOT cross the the elbow joint BUT attach to the radius or ulna
- flexor digitorum profundus
- flexor pollicis longus
- pronator quadratus
Posterior compartment GROUP 1 muscles that extend and abduct or adduct the hand at wrist
- extensor carpis radialis longus
- extensor carpi radialis brevis
- extensor carpi ulnaris
Posterior compartment GROUP 2 muscles that extend the medial four digits
- extensor digitorum
- extnesor indicis
- extensor digit minimi
posterior compartment GROUP 3 muscles that extend or abuct the thumb
- abductor pollicis longus
- extensor pollicics brevis
- extensor pollicis longus
what muscle might the extensor digitis minimi fuse with
the extensor diitorum
what creates the anatomic snuff box
Lateral: tendons of the Abductor pollicis longus and extensor pollicis brevis
Medial: tendon of the Extensor pollicis longus
Floor: scaphoid, trapezium
Proximal: radial styloid
Distally: base of 1st metacarpal
what is contained in the anatomic snuff box
- radial a ( floor)
- terminal brs superficial radial nerve ( roof)
- cephalic v begins ( subcutaneously)
where can the scaphoid carpal bone be palpated
in the anatomica snuff box
what are the arteries of the forearm
radial a and the ulnar a
– which branch off the brachial a. from the arm
what are the radial a divisions
- radial recurrent a
- palmar carpal branch
- superficial palmar branch
- dorsal carpal branch
what does the palmar carpal branch contribute to
the palmar carpal arch
what are the ulnar a divisions
- anterior ulnar recurrent a
- posterior ulnar recurrenta
- common interosseous a ( ant and post)
- palmer carpal branch
- dorsal carpal branch
what are the veins of the forearm
- deep and superifcial palmar arches
- ulnar v
- radial v
what are the nerves of the forearm
-median
-ulnar
radial
what does the median n supply
the motor to the flexor muscles of the forearm ( minus the crapi ulnaris and 1/2 of the profundus ) and the muscles of the thenar compartment and the lateral 2 lumbricals
Where does the median n enter the forearm
entes with the brachial artery between 2 head of the pronator teres and giving them branches
where does the articular branches of the median n go
to the elbow joint
where does the anterior interosseous nerve go
runs with the anterior interosseous branch of theulnar artery
what does the anterior interosseous nerve supply
- motor to the flexor pollicis long and pronator quad
what does the anterior interosseous nerve end
at wrist joint sending articualr branches
where does the palmar cutaneous branch of the medain nerve go
to the skin of the central part of palm
what does the ulnar n do in general
motor to muscles of the hand
where does the ulnar n enter the forearm
between the head of flexor carpi ulnaris
what are the borders of the ulanr n
posterior humerus in the cubital tunnel
- medial epicondyle
- olecranaon pr
- ulnar head of flexor carpi ulnaris
where does the articular branches of the ulnar n go
to the elbow joint
where does dorsal and palmer cutaneous branches of the ulnar n go to
the medial part of the hand
what are the division of the palmer of the cutaneous
superficial
deep
what does the superficial branch of the palmer branch to the cutaneous branch of the ulnar n supply
motor to palmaris brevis m
skin on ulnar side of hand
***direct continuation of the ulnar n.
what does the deep branch of the palmer branch to the cutaneous branch of the ulnar n supply
motor to dorsal interossei, palmar interossei, lumbrical 3 & 4
in general what does the radial n do
supplies all the muscles on posterior side of arm and forearm
What are the 2 branches of the radial n
superficial and deep
where does the superificial branch of the radial n go
sensory to the dorusm of hand
where does the deep branch of the radial n go
motor
winds around lateral neck of radius enters posterior compartment then enters supinator and inferior to supinaor it becomes the posterior interosseous n
** runs with the posterior interosseous artery
what is the posterior interosseous
motor to most of the posterior forearm muscles
what does volar mean
relating ot palmar or sole of foot
What are the carpal bones
So Long To Pinky Here Comes The Thumb
- trapeziUM supports the thUMb
- trapeZIOD is on the inZOID
What make up the wirst
the carpal groove ad the carpal tunnel
what makes the carpal tunnel
the flexor retinaculum attached to scahpoind and trapezium to the pisiform and hook of hamate
what is the carpal tunnel filled with
tendons and the median nerve
**compression of the ner produces carpal tunnel syndorme
What are mini long bones
metacarpus and phalanges
What is visible in the dorsum of the hand
- extensor tendons
- heads of metacarpals
- superficial dorasl veins
What is unquie of the palmar hand
- thicker skin
- flexion crease
- thenar eminence
- hpothenar eminence
What makes up of the palm fascia
this is a continuation of antebrachial fascia
where is the palm fascia thicker and thinner
thicker onthe central palm
thinner on the thenar and hypothenar areas
what is the palmar aponeurosis
triangular layer of heavy and dense deep fascia in middle of palm
how many compartment of the hand
5
what is in the thenar compartment
abductor pollicis brevis
- flexor pollicis brevis
- opponens pollicis
what is in the hypothenar compartment
- abductor digiti minim
- flexor digiti minimi brevis
- opponens digiti minimi
what would damage to the median n. cause
atrophy of thenar eminence
what would damage to ulnar nerve cause
atrophy of hypothenar eminence
what muscle put our hand into writing position
lubricals
what interosseous muscles abduct
the 4 dorsal m.
what interosseous muscles adduct
the 3 palmar m.
palmaris brevis
- covers ulnar n and a.
- originates fromt eh pamar aponeurosis and flexor retinaculum
- attaches to the dermis on the medial margin of the hand
- draws skin to center of palm
What is the common flexor sheath
this is deep to the flexor retinaculum and the tendons of the FDS and FDP enter this
What is the digital synovial sheath
these are found in the fingers and the FDS and FDP tendons enter here.
what does the digital sheaths enable the tendon do
they allow them to slide freely over each other during movements of the fingers
What are the fibrous digital sheaths
they are strong ligamentous tunnels that contain the flexor tendons and their synovial sheaths
Where does the fibrous digital sheaths extend to and from
extend from the metacarpal heads to bases of distal phalanges
what are the osseofibrous tunnels
the lumen of the fibrous digital sheaths
what is the tendinous chiasm
this is when there is a crossing of tendons such as the crossing of FDS and the FDP
what are the tendinoys vincula
there is a long and breva they hold the superficialis and profundus in place
-AND the flexor tendons receive blood through small blood vessels from here ( from the digtal aa.)
what forms the extensor expansions
the extensor digitorum tendons flatten to become this
what does each expansion is triangular have
they are tendionus aponeruosis or hood that wraps aroudn the head of the metacarpal and base of proximal phalanx and attach to the deep fascia
what are the three bands of the extensor expansions
1 median- ED tendon to middle phalanx
2 lateral bands to distal phalanx
what are the branches of the radial a. of the hand
- palmar carpal a
- superificial palmar branch a.
- deep palmar branch a.
- dorals carpal branch a.
- principis pollicis a.
- radial indicis a.
where does the radial a of the hand end
by anastomosing with deep branch of ulnar a form deep palmar arch
where does the pamar carpal branch and ulnar aa form
the palmar carpal arch
what does the dorsla carpal brancha and the ulnar aa form
the dorsal carpal arch
first dorsal metacarpal artery
where does the radial indicis a arises
they usually arise from the radial artery but it may originate from the princeps pollicis a
where does the ulnar a. of the hand enter
via the ulnar canal between the pisiform and hood of hamate WHICH is superficial to carpal tunnel
**ulnar nerve entrapment can occur ( handlebar palsy)
what are the terminal branches of the ulnar a. of the hand
- superficial palmar arch
- deep palmer arch via deep branch of ulnar a.
- dorsal carpal branch
- palmar carpal branch
what are branches off of the superficial palmar arch of the ulnar a. divide into
common palmar digital aa. and anastomeose with palmar metacarpal aa
what does the common palmer a of the superficial palmar arch divide into
the proper palmar digital aa
what are the veins of the hand PALMAR side
- ulanr veins
- deep palmar venous arch
- superficial palmar venous
what are the veins of the hand DORSAL side
- basilic vein
- cephalic vein
- dorsal venous network
what are the nerves of the hand
- ulnar n
- median n
- radial n
how does the ulnar n enter the hand
enters through ulnar canal superficial to the flexor rentinaculum
what are the branches of the ulnar n of the hand
- palmar cutaneuous branch
- dorsal branch
- superificial branch
- deep branch
how does the median n enter the hand
enters through carpal tunnel
what are the branches of the median n of the hand
- recurrent thenar branch
- lateral branch
- medial branch
- palmar cutaneous branch
what does the palmar cutaneuous branch of the ulnar n of the hand supply
skin base of palm over medial carpals
what does the dorsal branch of the ulnar n of the hand supply
skin medial dorsum and proximal portion of 5th and medial medial 1/2 of 4th digits ( so about dorsla medial 1-1/2 digits )
what does the superificial branch of the ulnar n of the hand supply
motor ( palmar brevism ) aslo sensory to palmar and dorsal digit 5 and medial side fo digit 4
— common and proper digital nerves
what does the deep branch of the ulnar n of the hand supply
motor
what does the recurrent thenar branch of the median n of the hand supply
Motor - thenar muscles
what does the lateral branch of the median n of the hand supply
Motor- 1st lumbrical
Sensory- skin of palmar and sital dorsal thumb and radial half of 2nd digit
what does the medial branch of the median n of the hand supply
Motor- 2nd lubrical
Sensory- skin of palmar and dosal adjacent sides of 2nd-4th digits
**common and proper digital nn.
what does the palmar cutaneous branch of the median n of the hand supply
skin of central palm
what are the radial n branches of the hand
-superficial branch
what does the deep branch of the radial n of the hand supply
motor- in the arm
and supplies no muscles in the hand
what does the superficial branch of the radial n of the hand supply
skin of the posterolateral wrist and hand; dorsum of the lateral 3 1/2 digits
