Upper Limb Quiz 3 Flashcards
Draw Brachial Plexus: begins in the lateral cervical region and extends into the axilla.
draw
Superficial Vessels of Upper LImb:
- Primary Superficial VEINS:
a) ____ vein ascends from LATERAL aspect of dorsal venous network, along lateral border of wrist and anterolateral surface of forearm and arm, passes between the ____ and _____ muscles and enter the clavipectoral triangle and joins the terminal part of the axillary vein.
b) _____ vein ascend from _____ end of dorsal venous network, along medial side of forearm and inferior part of arm, pierces _____ fascia and merges with accompanying veins to form the axillary vein.
C) ____ antebrachial vein (MAV) - communication between the _____vein and _____ vein on anterior portion of forearm.
- Cephalic Vein, deltoid and pectoralis major
- Basilic , medial end, brachial fascia
- Median antebrachial , cephalic and basilic vein
Anterior Axioappendicular Muscles:
- Move the pectoral girdle : Name 4 of them?
- Pectoralis major
- pectoralis minor
- subclavius
- serratus anterior
Posterior Axioappendicular Muscles:
- Attach the superior appendicular skeleton limb to the axial skeleton trunk
- Superficial posterior axioappendicular muscles are: 2
- Deep posterior axioappenicular muscles: 2
- Scapulohumeral muscles, pass from scapula to humerus and act of ______ joint . what are the 3 of them?
- trapezius and latissimus dorsi
- levator scapulae and rhomboids
- glenohumeral joint: deltoid, teres major, and rotator cuff
List 4 the rotator cuff muscles
supraspinatus,
infraspinatus
teres minor
subscapularis
Axilla
- Pyramidal space inferior to the __GH__ join and superior to the ____ and ____fascia. Provides a passageway for vessels and nerves going to and from upper limb.
Apex? base? anterior wall? posterior wall? medial wall? lateral wall?
- GH, superior to the skin and axillary fascia
- Apex- cervicoaxillary canal
- Base- skin, subcutaneous tissue and axillary fascia forming armpit
A- pectoralis major, minor, pectoral and clavipectoral fascia, and Anterior axillary fold.
P- scapula, and subscapularis anteriorly and teres major and latissimus dorsi inferiorly. And Posterior axillary fold
M- Thoracic wall and serratus anterior
L- Interrubercular groove of humerus
Axillary Artery:
- Continuation of what artery?
- Begins at later border of what rib?
- Ends at inferior border of what muscle and becomes what artery?
- divided into 3 parts:
a) between lateral border of __-rib and medial border of ______muscle. One branch ______ artery.
b) posterior to _____muscle. Two branches: ____ and ___ artery.
C) From lateral border of ___muscle to inferior border of ____ muscle. 3 branches: ___,____,___ artery.
- subclavian artery
- 1st rib
- infeior- teres major, brachial artery
- first rib, medial border of pectoralis minor , superior thoracic artery.
- posterior to pectoralis minor, thoracoacrominal artery and lateral thoracic artery
- pectoralis minor , teres major.
subscapular, anterior circumflex humeral and posterior circumflex humeral artery.
Axillary Vein :
Formed by the union of accompanying ____veins and ____ vein at inferior border of _____ muscle.
Ends at lateral border of ____rib and becomes ____vein
brachial veins, basilic vein. teres major
first rib, subclavian vein
Axillary Lymph Nodes-
Pectoral nodes subscapular nodes humeral nodes- \_\_\_\_axilla central nodes- near \_\_\_ of axilla apical nodes- at \_\_\_ of axilla Subclavian lymphatic trunk: a) right side of body to right \_\_\_\_\_ trunk or right \_\_\_\_\_ angle B) Left side of body to \_\_\_\_
- lateral
- near base
- at apex
- right lymphatic trunk or right venous angle
- thoracic duct
Arteries of the Arm:
Brachial artery- Main arterial supply to arm, continuation of axillary artery at inferior border of ____ muscle.
- Lies ____ to the humerus , palpable in bicipital groove
- lies anterior to _____ and ______muscles.
- Main branches : list 3
Ends in ____ fossa opposite the neck of the radius under cover of bicipital aponeurosis and divides into ___ and ___arteries
- teres major
- medial to the humerus
- triceps and brachialis
- deep artery of arm, superior ulnar collateral artery, and inferior ulnar collateral artery.
- cubital fossa, radial and ulnar arteries.
Superficial veins: cephalic and basilic vein .
Pair DEEP veins, collectively constituting the BRACHIAL veins, acomapny the brachial artery. The Brachial vein begins at the elbow by union of accompanying veins of the ___ and ___arteries. End by merging with basilic vein to form the ____ vein.
ulnar and radial arteries. axillary vein.
NERVES OF THE ARM:
Median Nerve: Formed in axilla by union of medial and lateral roots form the ___ and ____ cords of the brachial plexus.
- Initially on lateral side of ____artery until it reaches middle of arm and crosses to medial side.
- Descends in ___ fossa
Median Nerve Injury:
- most common site is ?
- Motor result: paralysis of ___muscles and first two ____ . Loss of ______ of thumb.
- Sensation Result: loss of sensation over_____and adjacent ____ fingers.
- injury in elbow region: Results in ____ hand, deformity in which thumb movements are limited to ____and ____ of thumb.
- medial and lateral cords
- brachial artery
- descends in cubital fossa
carpal tunnel
- thenar muscles and first two lumbricals,
- loss of opposition of thumb
- loss of sensation over thumb and 2.5 fingers
- result in Ape hand, limited to extension/flexion of thumb.
Ulnar Nerve:
- Arises from ____ cord of brachial plexus
- passes anterior to insertion of ____ muscle and pierces medial intermuscular septum in middles of arm.
- passes posterior to medial humeral epicondyle to enter forearm.
Injury: Occurs in 4 places
- Posterior to medial epicondyle of humerus (1 degree spot): Results in ______hand, atrophy of ____muscles of hand and unopposed action of _____and FDP. No opposition, MCP joints _____, No ____ of IP joints, no ____ of 4th and 5th fingers at DIP joints.
- In ____ fossa
- at the _____
- In the ____
- medial cord
- teres major
- epicondyle
- claw hand, atrophy of interosseous muscles, extensors. No opposition, MCP joints HYPEREXTENDS; No EXTENSION of IP joints, No FLEXION of 4th-5th fingers at DIP.
- cubital
- wrist
- hand
Musculocutaneous Nerve
- From ___ cord of brachial plexus
- Pierces ______ muscle and continues distally between ___ and ____ muscles.
- Supplies muscles and emerges lateral to the____ muscle as the _____ nerve of the forearm.
lateral
- coracobrachialis , brachialis and biceps
- biceps, lateral cutaneous nerve of the forearm.
Radial Nerve
- Enters arm posterior to ___l artery, medial to humerus, and anterior to ______muscle.
- Curves around humeral shaft in the radial groove
- Pierces lateral intermuscular septum and continues inferiorly in the anterior compartment between ____ and ____ muscles.
- Divides in ____ fossa into deep and superficial branches.
- supplies muscles in the ___ compartment of the arm and forearm and the overlying skin.
Injury:
- Fracture by ____
- Results in a condition: _____ ____ , loss of wrist and finger ____; hand is ____ at wrist and lies flaccid.
- posterior, brachial artery, medial to the humerus, anterior to long head of triceps
- Radial groove
- anterior compartment, brachialis and brachioradialis
- cubital fossa
- posterior compartment
- fracture by humeral shaft
- Results- wrist drop, loss of wrist/finger extension; hand is flexed
FRACTURES of Ulna and Radius: Associated with dislocation of the nearest joint.
____fracture is a fracture of distal 2 cm of radius.
The distal fragment of the radius is displaced ____and often comminuted. The fracture results from forced______of the hand, usually as the result of trying to ease a fall by outstretching the upper limb. Often, the ___ ____ is avulsed (broken off).
- This fracture is often referred to as a dinner fork (silver
fork) deformity because a _____ angulation occurs in the
forearm just proximal to the wrist 2 degree to posterior displacement and tilt of the _distal__ fragment of the radius - what degree angle between radius and ulna, decreased what degree to shortening of radius?.
Colles
- dorsally
- dorsiflexion
- ulnar styloid
- dinner fork deformity:
posterior angulation
15 degree angle between radius and ulna, decreased 2 degree to shortening of radius.
METACARPAL FX:
Ofte due to severe crushing injury of the hand. AKA ____ fractures.
PROXIMAL AND DISTAL PHALANX FX:
- Due to crushing or _____ injuries
Distal Phalanx Fracture
- Usually comminuted, paintul hematoma develops.
boxer’s fracture
- hyperextension
FX of CARPAL BONES:
Results from fall on the palm with the hand ____. Pain on lateral side of the wrist that increases with ____ and abduction of the hand. Takes several months to heal. Possible avascular necrosis, possible degenerative joint disease.
abducted.
dorsiflexion
Cubital Fossa, shallow triangular depression on the anterior surface of the elbow.
Boundaries: Superiorly medial lateral floor roof
Contents; terminal part of \_\_\_\_ accompanying veins of the arteries \_\_\_\_ tendon \_\_\_nerve and \_\_\_\_ nerve (dividing into superficial/deep branches
subcutaneous tissue over cubital fossa:
List 3 nerve.
S- imaginary line between medial and lateral epicondyles
m- pronator teres
l- brachioradialis
floor- brachialis and supinator muscles
roof- continuity of brachial and antebrachial fascia, reinforced by bicipital aponeurosis
Contents: terminal part of brachial artery accompanying veins of the arteries bicpes brachii tendon median nerve/ radial nerve
- median cubital nerve, medial /lateral cutaneous nerve of the forearm
Anatomical Snuff Box
bound by tendons of 2 muscles laterally? and 1 medially?
what artery lies on floor of snuff box
what can be palpated proximally?
what can be palpated distally?
two bones can be felt in the floor between the radial styloid and 1st metacarpal ?
- laterally: APL, EPB; medially: EPL
- radial artery , floor
- radial styloid, proximally
- base of 1st metacarpal, distally
- scaphoid and trapezium
Median nerve of the FOREARM:
principal nerve of _ant/post__ compartment of forearm. Enters forearm with ___ artery and lies medial to it. Leaves cubital fossa between heads of ____ muscles.
Two major branches:
1
2
Anterior compartment
brachial artery
Two major branches:
Anterior interosseous nerve
Palmar cutaneous branch of median nerve
Ulnar Nerve:
Passes posterior to ____ of humerus between heads of flexor carpi ulnaris.
Two major branches:
medial epicondyle of humerus
- palmar cutaneous branch of ulnar nerve
- Dorsal cutaneous branch of ulnar nerve
Radial Nerve:
In cubital fossa, divides into:
1. ___ branch of radial nerve (sensory)
2. ___ branch of radial /posterior interosseious nerve (motor)
superficial branch of radial nerve (sensory)
deep branch (motor)
Lateral Cutaneous Nerve of Foreaarm:
Continuation of ____ nerve distal to muscular branches
Musculoutaneous nerve
Medial Cutaneous Nerve of Forearm:
Medial cord of ____, receiving C8 and T1 fibers.
brachial plexus
List Ulnar Artery:
Ulnar Artery: Anterior Ulnar recurrent artery Posterior Ulnar Recurrent artery common interosseious Artery, Anterior/posterior Interosseous Artery Recurrent interosseous artery Palmar carpal branch, anastamoses with palmar carpal branch of RADIAL artery to form palmar carpal arch Dorsal carpal branch, anastamoses with DORSAL CARPAL branch of RADIAL artery to form dorsal carpal arch.
Radial Artery of the FOREARM included:
Radial recurrent artery
palmar carpal branch
dorsal carpal branch
The Hand: Skleton consits of : carpals in the wrist metacarpals in the hand proper phalanges in the fingers
Metacarpals and phalanges numbered 1-5 starting with the thumb. Palmar aspect of hand has two eminences:
- Thenar eminence, lateral prominent at base of thumb.
- Hypothenar eminence, medial , smaller proximal to base of 5th finger.
READ
Fascia:
Continuous with antebrachial fasica and fascia of the dorsum of the hand, thin over thena and hypothenar eminences.
1) Thick: ____ aponeurosis, overlies long flexor tendons in hand.
2) ____ ____ sheaths, ligamentous tubes that enclose the flexor tendons and the synovial sheaths that surround them as they pass along the _____ aspect of their respective digit.
Fascia divides hand into compartment:
List 5-
Central Compartment: contains flexor tendons and their sheaths, lumbrical muscles, superficial palmar arterial arch, and digital vessels and nerves.
Interosseous compartment: contains _____ and interossei muscles.
- palmar aponeurosis
- fibrous digital sheaths, palmar
5:
Hypothenar, thenar, central, adductor, interosseous
metacarpal
Refer to Muscles of hand
refer to document
Flexor TEndons of Extrinsic Muscles:
Tendons of FDS and FDP enter common ____ ___deep to flexor retinaculum. Enter central compartment of hand and enter their respective _____ ____ sheaths. FDS splits and surround tendon of FDP near base of proximal phalanx.
flexor sheath
digital synovial sheaths
Ulnar Artery:
Enters hand between ___ and hook of hamtae via the Guyon canal. Divides into : 2 arches
Superficial palmar arch, gives rise to 3 common palmar digital arteries
Deep palmar arch
Radial Artery:
Curves dorsally around the ___ and ___carpal bone in the floor of the snuff box. Ends by anstamosing with deep branch of the ulnar artery to form the deep ____ arch.
Deep palmar arch gives rise to : 2 arteries
scaphoid and trapezium
palmar arch
Three palmar metacarpal arteries
princeps pollicis artery
NERVES of the HAND:
Median nerve enters hand through carpal tunnel with tendons of FDS, FDP, FPL. Supplies 2.5 ____muscles and first two ____. Sensory to skin on entire palmar surface, sides of first three digits, lateral half of___th digit and dorsum of the distal halves of these digits.
_____cutaneous branch does not pass through carapal tunnel
thenar, lumbricals.
4th digit
Palmar cutaneous branch
NErves: ULNAR NERVE
_____ cutaneous branch supplies skin on medial side of the palm.
____cutaneous branch suppplies medial half of dorsum of hand, 5th finger, and medial half of 4th finger
Palmar
dorsal
Radial NERVE
supplies _____hand muscles.
______ branch (sensory)enters hand.
supplies kin over lateral 2/3 of the dorsum of the hand, dorsum of the thumb, and proximal parts of the lateral one and a half digits.
No
Superficial branch
Sternoclavicular Joint: refer to pic
between sternal end of clavicle and manubrium of sternum.
Reinforced anteriorly and posteriorly by ant/post SC ligaments.
_____ligament reinforces joint superiorly
_____ligament anchors inferior, sternal end of clavicle to 1st rib and its costal cartilage
interclavicular ligament
costoclavicular
acromioclavicular joint: refer to pic
plan synovial articulation, strengthened by AC ligament.
pic
glenohumeral joint: least stable
wide range of movement, instable
Movements: f/e, abd/add, inter/ext rotation, circumduction
Blood supply: 3 arteries? look at pic
innervatoin: 3 nerve??
ligaments of GH joint: strengthen the anterior aspect of the capsule.
1: _____ ligament: from base of coracoid process to anterior greater tubercle
2- ___humeral ligament, from greater to lesser tubercle over the intertubercular groove, creates a canal for tendon of long head of _____
3- ___ligament from acromion to coracoid process , overlies head of humerus limiting superior dislocation.
Bursae around the GH humeral joint:
1- _____l bursa, between acromion , coracoacromial ligament, and deltoid muscle superiorly and the GH joint inferiorly. Facilitates movement of supraspinous tendon under coraacromial arch
2- ___bursa, between the tendon of subscapularis and the neck of the scapula.
supplies:
anterior/posterior circumflex humeral artery, and branches from suprascapular artery
- coracohumeral ligament
- transverse humeral ligaemnt
- coracoacromial
subacromial bursa
subscapular bursa
Elbow Joint: hinge type of synovial joint
carrying angle btw 10-15 degree.
Articulations:
____- trochelear articulates with trochlear notch
____- capitulum articulates with head of radius
MOvement: f/e, p/supination
Ligaments:
1- ____ collateral ligament AKA LCL, from lateral epicondyle it blends with anular ligament of radius
2- ____ ligament of the radius, encircles and holds the head of the radius in the ____notch. Forms proximal _____ joint. Permits what ? ____and ____ of forearm.
3- ____collateral ligament AKA UCL, from medial epicondyle to coronoid process.
Bursae of the Elbow:
Intratendinous olecranon bursa
subtendinous olecranon bursa
subcutaneous olecranon bursa
humeroulnar
humeroradial
ligaments:
radial rollateral ligament
anular ligament of the radius
medial collateral ligament
Proximal Radioulnar Joint:
____ type of synovial joint.
Allows movement of the head of the radius on the ulna. Head of radius articulates with _____notch of ____
Ligament: _____ ligament of radius
Movement: sup/pro
nerve supply: Musculocutanous, radial, and ulnar nerve
pivot type
- with radial notch of ulna
- anular ligament of radius
DIstal Radioulnar joint:
head of ulna articulates with ____notch on medial side of distal _____. Articulating parts bound by articular disc of the distal _____joint.
Ligaments: anterior/posterior ligaments (weak transverse bands
movements: distal end of ____ rotates around head of ulna during pronation/supination
Arterial supply: ant/post interosseous arteries
Nerve: Ant/post inter nerves
ulnar notch, distal radius
radioulnar joint
distal end of radius
Radiocarpal JOINTs:
what type of synovial joint?
between distal end of radius and proximal row of carpal bones except ____ bone.
Movements: fle/ext, abd/add, circumduction
Ligaments: 3
- Anterior and posterior ligaments
- ulnar collateral ligament, between styloid process and ___bone
- radial collateral ligament- between styloid process and ___ bone
blood supply:
- 2
condyloid
pisiform
- triquetrum
- scaphoid
- dorsal and palmar carpal arches
Intercarpal joints
what type?
ligaments: anterior, posterior, and interosseus ligaments
same blood supply as radiocarpal joints
plane
carpometacarpal and intermetacarpal joints , except CMC of thumb
what type?
between carpals and metacarpals. Movements “
2-3 digits:
4th digit
5th digit=
ligaments: anter, posterior, and interosseous ligaments
blood supply: 4
dorsal/palmar ____arteries
deep carpal and deep____ arches
plane
almost no movemet
slightly mobile
very mobile
metacarpal arteries
deep carpal and deep palmar arches
CMC of thumb:
type?
between trapezium and base of 1st metacarpal
movements: flexion, ext, adb, add
saddle
MCP joints
type?
between heads of metacarpals and base of proximal phalanges
movements; flex, ext, abd, add limitited in thumb, circumduction
ligaments:
___ligaments between metacarpal and phalange on palmar side
__-metacarpal ligaments, hold heads of 2-5th metacarpals together.
___ligaments , from heads of metacarpals to bases of phalanges.
blood supply:
____ digital arteries arising from superfial palmar arches
Nerve:
digital nerves from median and ulnar nerves
Skier’s thumb:
rupture ____ ligament of the 1st MCP joint. results from ___ of the thumb
condyloid
palmar ligaments
transverse metacarpal ligaments
collateral ligaments
- deep
–
collateral ligament , hyperEXtension
Interphalangeal Joints (DIP and PIP)
type?
blood supply?
nerve supply?
hinge
digital arteries
digital nerves from ulnar and median nerves
