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Anatomy > Upper Limbs > Flashcards

Upper Limbs Flashcards

1
Q

Bones

A 
Per limb:
Clavicle
Scapula
Humerus
Radius (lateral in anatomical position - thumb side) 
Ulna (medial; pinky side) 
Carpals (8)
Metacarpals (5)
Phalanges (14)
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2
Q

Scapula

A

“shoulder blade”

It articulates with the humerus at the glenohumeral joint, and with the clavicle at the acromioclavicular joint. In doing so, the scapula connects the upper limb to the trunk.

It is a triangular, flat bone, which serves as a site for attachment for many muscles

side of the scapula is relatively unremarkable, with a concave depression over most of its surface, called the subscapular fossa. The subscapularis muscle, one of the rotator cuff muscles, originates from this side.

Originating from the superolateral surface of the costal scapula is the coracoid process. It is a hook-like projection, which lies just underneath the clavicle. The pectoralis minor attaches here, while the coracobrachialis and biceps brachii muscles originates from this projection.

Lateral Aspect, there is supraglenoid tubercle – A roughening immediately superior to the glenoid fossa, this is the place of attachment of the long head of the biceps brachii.

Infraglenoid tubercle – A roughening immediately inferior to the glenoid fossa, this is the place of attachment of the long head of the triceps brachii.

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3
Q

Movements of Humerus

A

Movements of Humerus

  • Flexion/ extension
  • Abduction/adduction
  • Medial and lateral rotation
  • Circumduction
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4
Q

Movements of Scapula

A
  • Rotation
  • Retraction/Protraction

very limit movement of arm occurs without the scapula, it is involved in abduction and adduction and also in extending forward and backward

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5
Q

movements of the elbow joint

A

• Humeroradial and humeroulnar are hinge
joints

• Proximal radioulnar joint is a pivot joint

two different kinds of movements occur art the elbow: one between the humerus and the radius (hinge joint) and one between the radious and the ulna (pivot joint to pronate/supanate)

Hinge movement is aided by the olecranon process fitting into olecranon fossa

Trochlea (like a pulley with specialized condyles) articulate with the head of the radius and the trochlea articulates with the trochlear notch of the ulna (hinge/pivot joint)

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6
Q

Supraspinatus m.

A

Origin:
located in the supraspinatous fossa of the scapula

Insertion: greater tubercle of the humerus (highest facet)

Action: abducts the arm (initiates abduction)

Innervation: Suprascapular nerve (C5,6) from the superior trunk of the brachial plexus

Blood supply:
suprascapular a.

NOTE initiates abduction of the arm, (up to 15 degrees) then the deltoid muscle completes the action; a member of the rotator cuff group

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7
Q

Trapezius

A

Origin: medial third of the superior nuchal line, external occipital protuberance, ligamentum nuchae, spinous processes of vertebrae C7-T12

Insertion: lateral third of the clavicle, medial side of the acromion and the upper crest of the scapular spine, tubercle of the scapular spine

Action: elevates and depresses the scapula (depending on which part of the muscle contracts); rotates the scapula superiorly; retracts scapula motor

Innervation: spinal accessory (XI)

Blood Supply: transverse cervical a.

named for its shape; trapezius is an example of a muscle that migrates during development from its level of origin (cervical) to its final position, pulling its nerve and artery along behind

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8
Q

Deltoid

A

Origin: Clavicle, acromion, spine of scapula

Insertion: deltoid tuberosity of humerus

Action: Abduction of arm beyond 15o, flexion,
extension, medial and lateral rotation

Innervation: Axillary n

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9
Q

Latissimus Dorsi

A

Origin: Spinous processes of T7-T12, inferior angle of
scapula

Insertion: intertubercular groove of humerus

Innervation: Thoracodorsal n

Action: Adduction, medial rotation, extension of arm

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10
Q

Ab- and Adductors

A
  • Supraspinatus
  • Trapezius
  • Deltoid
  • Latissimus dorsi
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11
Q

Rotator Cuff Muscles

A

Add to stability of shoulder joint
• Function as ligaments
• Arise from scapula and insert into upper
humerus and joint capsule
• Supraspinatus, infraspinatus, teres minor,
subscapularis

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12
Q

Infraspinatus

A

Origin infraspinatous fossa (scapula)

Insertion: greater tubercle of the humerus (middle facet)

Action: laterally rotates the arm

Nerve: suprascapular nerve

Blood supply: suprascapular a.

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13
Q

Teres Minor

A

Origin: upper 2/3 of the lateral border of the scapula

Insertion: greater tubercle of the humerus (lowest facet)

Action: laterally rotates the arm; fixes the head of the humerus in the glenoid fossa during abduction & flexion of the arm; a member of the rotator cuff group

Innervation: axillary nerve (C5,6) from the posterior cord of the brachial plexus

Blood Supply: circumflex scapular a.

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14
Q

Subscapularis

A

Origin: medial two-thirds of the costal surface of the scapula (subscapular fossa)

Innsertion: lesser tubercle of the humerus

Action: medially rotates the arm; assists extention of the arm

Innervation: upper and lower subscapular nerves (C5,6)

Blood supply: subscapular a.

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15
Q

Serratus Anterior

A

Origin: ribs 1-8 or 9

Insertion: medial border of the scapula on its costal (deep) surface

Action: it draws the scapula forward; the inferior fibers rotate the scapula superiorly

Innervation: long thoracic nerve (from ventral rami C5-C7)

Blood supply:
lateral thoracic a.

NOTE
a lesion of long thoracic nerve will cause winging of the scapula (i.e., the medial border of the scapula falls away from the posterior chest wall and looks like an angel’s wing)

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16
Q

Arm Muscles

A

• Anterior Compartment
– Flexors
– Innervation: Musculocutaneous nerve

• Posterior Compartment
– Extensors
– Innervation: Radial nerve

17
Q

Anterior Compartment

A

Biceps brachii (long & short heads)
Origin: short head: tip of the coracoid process of the
scapula
Origin: long head: supraglenoid tubercle of the
scapula

Insertion: tuberosity of the radius

Actions: flexes the forearm, flexes arm (long head), supinates

Coracobrachialis:
Origin: coracoid process of the scapula
Insertion: medial side of the humerus at mid-shaft
Action flexes and adducts the arm

Brachialis (deep, not shown):
Origin: anterior surface of the lower one-half of the humerus and the associated intermuscular septa
Insertion: coronoid process of the ulna
Action: flexes the forearm

18
Q

Posterior Compartment

A

Posterior Compartment of Arm

Triceps muscle
— long head: infraglenoid tubercle of the scapula;

—lateral head: posterolateral humerus & lateral intermuscular septum;

— medial head: posteromedial surface of the inferior 1/2 of the humerus

Insertion: olecranon process of the ulna

Action: extends the forearm; the long head extends and adducts arm

Innervation: radial nerve

long head of the triceps separates the triangular and quadrangular spaces (teres major, teres minor and the humerus are the other boundaries); all three heads of origin insert by a common tendon

19
Q

Anterior/ Posterior Compartment of Forearm

A
  • Flexion of wrist and fingers
  • Pronation

Posterior Compartment
• Extension of wrist, fingers, and
thumb
• Supination

20
Q

Pronators/Supinators

A

Pronators
–Pronator teres:
Origin: common flexor tendon and (deep or ulnar head) from medial side of coronoid process of the ulna
Insertion: midpoint of the lateral side of the shaft of the radius
Action: pronates the forearm
Innervation: median nerve
median nerve passes between the two heads of origin of pronator teres*

–Pronator quadratus
Origin: medial side of the anterior surface of the distal one-fourth of the ulna
Insertion: anterior surface of the distal one-fourth of the radius
Action: pronates the forearm
Insertion: median nerve via the anterior interosseous nerve

pronator quadratus is the deepest muscle in the distal forearm; it works with pronator teres and has the same nerve supply

• Supinators
–Biceps brachii see other card

–Supinator
Origin: lateral epicondyle of the humerus, supinator crest & fossa of the ulna, radial collateral ligament, annular ligament
Insertion: lateral side of proximal one-third of the radius
Action: supinates the forearm
Insertion: deep radial nerve

deep radial nerve passes through the supinator to reach the posterior compartment of the forearm

21
Q

Hand Muscles

A

• Interossei
(dorsal and palmer)
- muscles between your metacarpals; responsible for the abduction and adduction (PAD and DAB)

• Lumbricals
 - Flex metacarpophalangeal
joints and extend
interphalangeal joints
(start on there palmar side but then they attach to the phalanges on the dorsal side

• Thenar muscles -
opposition of thumb to fingers and
delicate movements of thumb

22
Q

Axillary Artery

A
  • Subclavian a&raquo_space; axillary a&raquo_space; brachial a
  • Divided into 3 parts by pectoralis minor m

• Branches of axillary
– 1st Part: Superior thoracic
– 2nd Part: Thoraco-acromial, lateral thoracic
– 3rd Part: Subscapular, anterior circumflex humeral, posterior circumflex humeral

“Screw The Lawyer, Save A Patient”

23
Q

Arterial Anastomoses

A

Arterial anastomoses around scapula

• Many arterial
anastomoses (communication between arteries) occur around the
scapula

• Anastomoses make
collateral circulation
possible in case of ligation or occlusion due to disease or trauma

24
Q

Brachial Artery

A

Continuation of axillary a. (after it passes inferior border of teres major muscle)

ends at elbow

• Branches
–Deep brachial (aka profunda brachii, deep artery of the arm)
–Ulnar a (terminal branch)
–Radial a (terminal branch)

Once they get to the hand, radial and ulnar provide all the blood to the deep palmar arch and superficial palmer arch respectively

25
Q

Veins

A

Veins going with arteries (subclavian vein, axillary vein, brachial vein = deep veins)

Superficial are not paired with arteries and can been seen through skin

Superficial and deep veins communicate

• Vigorous muscular contraction
compresses deep veins and shunts blood
to superficial veins

Superficial veins
• Cephalic and basilic veins originate
on dorsal venous network
(cephalic on thumb side, basilic on pinky side)

  • Basilic v (along with brachial vv) becomes axillary v, and runs medially
  • Cephalic v drains into axillary v

• Median cubital v connects basilic
and cephalic v

Cephalic vein passes
over anatomical snuff box: site of access for replacement of blood or fluid

NOTE that there is a cubital fossa in the superior part of the elbow joint and then there you
will always have communication between
the cephalic and basilic veins. This is a very
common place for blood to be taken. The connection
between cephalic and basilic veins is medial
cubital vein aka intermediate vein.

26
Q

Anatomical Snuff Box

A

Between extensor tendons of thumb

Extend thumb to see it

Radial artery crosses it. Pulse can be taken here.

27
Q

Deltopectoral Triangle

A

Deltoid, Pectoralis major, clavicle

Cephalic vein drains into axillary vein

28
Q

Axillary Lymph Nodes

A

Entire upper limb

Lateral part of breast

Thoracoabdominal wall
above umbilicus

In limbs, superficial lymphatics follow superficial veins, deeper lymphatics follow deep arteries and veins but
superficial for both lymph and blood will drain into the deep. For example, the lymph following the cephalic vein will then go deep and drain into the lymph nodes
around the axillary vein. So superficial drains into deep and not vice versa.

All deep veins have lymph nodes accompanying them –

Axillary lymph nodes are important because the lymph from the entire upper limb drains here and even more important from the lateral part of the breast (important to understand the spread of breast cancer to the axillary
region) and the whole thoracoabdominal wall above the umbilicus.

So the lymph from this region goes into these deep lymph nodes. So superficial for both lymph and
blood will drain into the deep. So here, for example, the lymph following the cephalic vein will then go deep and drain into the lymph nodes
around the axillary vein. So superficial drains into deep and not vice versa.

29
Q

Brachial Plexus

A
  • Ventral rami of spinal nerves C5-T1
  • Motor and sensory to upper limb

**ROOTS****
the beginning of the brachial plexus.
formed by the anterior divisions of spinal nerves C5, C6, C7, C8 and T1.(the posterior divisions go on to innervate the skin and musculature of the trunk).

leave the spinal cord via the intervertebral foramina of the vertebral column then divides into anterior and posterior nerve fibres

nerves pass between the anterior and medial scalene muscles to enter the base of the neck.

Coming off the root C5 is also the DORSAL SCAPULAR n. (to the rhomboids and levator scapulae), as well as the LONG THORACIC N. to Serratus Anterior (C5, C6, C7) and the 1st intercostal n. from T1

**TRUNKS****
base of the neck,
the roots of the brachial plexus converge, forming three trunks.

  1. Superior trunk: C5 and C6
    (coming off superior is also the n. to subclavius and suprascular n. to supra/infraspinatus m.)
  2. Middle trunk: C7
  3. Inferior trunk: C8 and T1

The trunks begin to move laterally, crossing the posterior triangle of the neck.

**CORDS****

Once the anterior and posterior divisions have entered the axilla, they combine together to form three nerves. These nerves are named by their position relative to the second part of the axillary artery.

The lateral cord is formed by:
- The anterior division of the superior trunk
-The anterior division of the middle trunk
(Gives off lateral pectoral n. - pectoralis major)

The posterior cord is formed by:
- The posterior division of the superior trunk
-The posterior division of the middle trunk
- The posterior division of the inferior trunk
(Gives off branches of upper/lower subscapular n. and thoracodorsal n.)

The medial cord is formed by:
- The anterior division of the inferior trunk.
(Gives off medial pectoral and medial cutaneous n to arm and medial cutaneous n. to forearm)

The cords give rise to the major branches of the brachial plexus.

BRANCHES

  • Musculocutaneous (C5-C7)
  • Axillary (C5/C6)
  • Radial (C5-T1)
  • Median (C5-T1)
  • Ulnar (C8/T1
30
Q

Brachial Plexus Branches

A

LATERAL CORD
1) Lateral Pectoral

2) Musculocutaneus
- Motor to muscles of anterior compartment of arm
– Pierces coracobrachialis
– Sensory to skin of lateral forearm

3) Median

POSTERIOR CORD 
1) Upper Subscapular 
2) Lower Subscapular 
3) Thoracodorsal 
4) Radial 
- From posterior cord
- Motor to muscles of posterior compartment of arm
- Runs in radial groove between medial and lateral
heads of triceps
- also supplies the muscles of
the posterior compartment of the forearm – including
brachioradialis

5) Axillary
Motor to deltoid and teres minor

MEDIAL CORD 
Median Pectoral 
Ulnar 
Medial Cutaneous Arm
Medial Cutaneous Forearm 
Median
31
Q

Brachioradialis

A

Considered part of posterior comp because

innervated by RADIAL nerve, but FLEXOR of forearm

32
Q

Median Nerve

A 
- From medial and lateral cords
– Motor to most muscles of anterior compartment of forearm
• Except 1 1⁄2
muscles: flexor
carpi ulnaris, half
of flexor digitorum
profundus)

– Motor to the thenar
muscles in hand, and thumb!

Also note the cutaneous innervation if we look at
the lateral 3 and half fingers of the hand and the palm

everything that is not innervated by the radial nerve is innervated by the median nerve.

Median nerve that loops around the tips and innervates the distal phalanges on the dorsal side.

33
Q

Ulnar Nerve

A

– From medial cord
– Motor to 1 1⁄2 muscles in forearm
– Motor to most
muscles in hand

Note sensory innervation of
hand:
• Ulnar - skin of hand medial to line bisecting 4th digit
• Median - skin of hand medial to line bisecting 4th digit

34
Q

Areas of Transition

A

Axilla (armpit)
-Contains the nerves and vessels that supply upper limb
-Contains lymph nodes
Pectoralis major and minor connecting anteriorly to the head of the humerus then you have your serratus anterior and the ribs and you have the muscles trees major and subscapularis on the ventral surface and all of these are the borders of the axilla. Within that you can have your brachial plexus and your axillary artery and vein.

Cubital fossa

Carpal Tunnel

35
Q

Neurovascular compression syndrome

“thoracic inlet syndrome” or “thoracic outlet syndrome”

A

• Excess pressure on structures passing between
anterior and middle scalenes at the thoracic
inlet (T1, 1st rib, manubrium)
– Subclavian artery is compressed crossing 1st rib
! pallor, coldness, cyanosis
– Inferior truck is compressed causing numbness
and tingling of digits

• From trauma, injury, tumor/growth, congenital
abnormality (e.g. cervical rib), etc.

36
Q

Cubital Fossa

A 
Transition between arm and forearm
• Anterior to elbow joint
• Borders
– Imaginary line between medial and lateral
epicondyles
– Brachioradialis m
– Pronator teres m
– Floor: Brachialis m
– Roof: Superficial
fascia and skin

CONTENTS

• Tendon of biceps brachii
• Brachial artery
– Blood pressure is taken by placing
stethoscope over brachial artery in cubital
fossa

• Median nerve
• Median cubital vein
– Median cubital vein is often used for
venipuncture

37
Q

Carpal Tunnel

A
  • Tunnel of carpal bones and ligament
  • Contains tendons and median nerve

Carpal Tunnel Syndrome

Pressure on median nerve within carpal
tunnel
May be caused by swelling of tendons and
tendon sheaths
Tinel’s sign: Tapping on nerve produces
pain and “pins and needles”

Anatomy (14 decks)

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