Week 4 Flashcards
__________ __________ is the form of OMT in which patient’s muscles are actively used on request, forma precisely controlled position, in a specific direction, and against a distinctly executed physician counterforce
Muscle Energry
List 3 techniquest that involve patients active cooperation in muscle energy:
1.) Contract a muscle/muscles
2.) Inhale or exhale
3.) Move one bone of a joint in a specific direction relative to the adjacent bone
For example, if using a technique that begins in the position of ease and transitions to position of restriction, is this indirect or direct osteopathic tx?
Since STARTING at position of EASE, this is INDIRECT tx
Ex: if performing treatment that starts by engaging the restrictive barrier and moves towards position of ease, is this indirect or direct osteopathic treatment?
Direct
Define: concentric contraction
Contraction of a muscle resulting in the approximation of the origin and insertion
Define: concentric
Contraction of a muscle resulting in the approximation of the origin and insertion
_____________ _________ of a muscle resulting in the approximation of the origin and insertion. i.e. elbow flexion phase of bicep curls
Concentric contraction
Define Eccentric contraction
The muscle tension allow the origin and insertion to separate, in effect to lengthen
______________ _____________ is the muscle tension which allows the origin and insertion to separate, in effect to lengthen. i.e. elbow extension phase of bicep curls
Eccentric contrcation
Define: isolytic contraction
When external forces overcome the muscle contraction, causing muscle lengthening
___________ ___________ is when external forces overcome the muscle contraction, causing muscle lengthening
Isolytic contraction
___________ ____________ is when muscle tone stays the same but the length of the muscle changes
Isotonic
Define: isotonic contraction
When muscle tone stays the same but the length of the muscle changes
Define: isometric contraction
Distance between the origin and the insertion of the muscle is maintained at constant length
What is the difference between the binding site and catalytic site of an enzyme?
- Binding site is the area that holds the substrate in proper place
- Catalytic site is where the actual reaction occurs
What is the active site on an enzyme?
2 component pocket of an enzyme, is composed of the binding site and catalytic site
What is the difference between a cofactor and coenzyme?
- Cofactor is an inorganic
- Coenzyme is a nonprotein organic component needed for enzyme function
What is a Holoenzyme?
The protein plus its cofactor or coenzyme?
A __________________________ is an enzyme protein plus it cofactor/coenzyme
Holoenzyme
A ________________________ is an enzyme protein without its cofactor/coenzyme
Apoenzyme
What is an apoenzyme?
Enzyme protein without its cofactor/coenzyme
What is an example of a prosthetic group?
Heme
_______________ ______________ a component that’s very tightly (covalently or non-covalently) attached to the protein. It can be inorganic (metal ions), organic (vitamin B1, B2, B3 and so on) or mixed.
Prosthetic group
What is a prosthetic group?
a component that’s very tightly (covalently or non-covalently) attached to the protein. It can be inorganic (metal ions), organic (vitamin B1, B2, B3 and so on) or mixed.
What do enzymes do to a reaction?
- LOWERS THE ENERGY OF ACTIVATION
- it lowers the amount of energy needed for the reaction to take place
What is ΔG in an enzyme reaction?
- the free energy of the overall reaction
How can you calculate the free energy of a reaction?
Energy of reactants minus the energy of the products
What does an enzyme do to its substrate?
- Stabilizes the transition state
- By stabilizing the transition state the enzyme increases the concentration of the reactive intermediate that can be converted to product
List 5 factors that can affect reaction velocity
- Substrate concentration
- Temperature
- pH
- Cofactors
- Coenzymes
Enzymes following Michaelis-Menten kinetics show a ___________________ curve.
Hyperbolic
Allosteric enzymes show a ____________ curve.
Sigmoidal curve
_________________ ____________________ increases with substrate concentration until a maximum _____________________ is reached.
Reaction velocity
velocity
On an enzyme kinetics graph, what does the linear phase of a reaction equate to?
It is the change in reactant or product concentration as soon as enzyme and substrate are mixed.
Describe the model of Michaelis Menten Kinetics
the enzyme reversibly combines with its substrate to form an ES complex that subsequently breaks down to product, regenerating the free enzyme
The Michaelis-Menten equation says Vo =
Vmax [S] / Km + [S]
What is Km in enzyme kinetics?
- Km is the [SUBSTRATE CONCENTRATION] where velocity of the reaction is 1/2 Vmax
What does small Km reflect?
- Small Km indicates HIGH affinity of the enzyme for substrate because Vmax is reached at a sooner point
When [S] is much less than Km, the velocity of the reaction is approximately proportional to the substrate concentration which is what order of rate kinetics?
First order
Describe first order enzyme kinetics
At low concentrations of substrate where [S] < Km, the velocity of the reaction is proportional to substrate concentration
When [S] > Km, the velocity of the reaction is _________________ order, meaning the velocity is constant and independent of substrate concentration.
Zero order
Describe zero order enzyme kinetics
When [S] > Km, the velocity is almost constant and independent of substrate concentration
What does the Y intercept represent on a Lineweaver-Burk analysis?
1/ V max
What does the slope of a Lineweaver Burk analysis represent?
Km / Vmax
What does the X intercept represent on a Lineweaver Burk analysis?
1/[S]
What types of bonds do reversible enzyme inhibition form?
Inhibitor forms noncovalent bonds that readily dissociate from an enzyme
What types of bonds are formed between inhibitor and enzyme in Reversible inhibition?
What about in irreversible inhibition?
Reversible: noncovalent bonds
Irreversible: covalent bonds
In _______________________ inhibition the enzyme is only inactive when the inhibitor is present
Reversible
Where is the site of attack in irreversible inhibition?
the amino acid group that participates in the normal enzymatic reaction
What are Km and Vmax in competitive inhibition?
- Km is decreased because the affinity for the substrate is decreased
- Vmax stays the same
Vmax is directly proportional to:
The number of enzymes available
In enzyme inhibition, Vmax reduces in all types EXCEPT:
Why?
V max does not change in Competitive inhibition because can add more substrate
What are Km and Vmax in noncompetitive inhibition?
- Vmax lowered
- Km unchanged because the substrate still binds to the enzyme and the inhibitor is bound to the allosteric site
What are Km and Vmax in uncompetitive inhibition?
- Vmax lowered
- Km LOWERED, because the allosteric inhibitor disallows the enzyme/substrate to disassociate which raises their affinity for one another
___________ ____ ___ is what type of inhibitor of citrate Synthase
- Succinyl CoA
- Uncompetitive
What are three examples of covalent modification as a form on enzyme regulation?
- Phosphorylation
- ADP Ribosylation
- Methylation
What is sequestration as a form of enzyme regulation?
The enzyme is taken away and not available for substrate use
What are induction and repression as forms of enzyme regulation?
Is this a fast or slow change? Why?
- Increase or decrease gene expression such that it increases or decreases the amount of enzyme
- Slow as in hours to days due to delays of expression
- Examples of covalent modification as a form of enzyme regulation, include phosphorylation and ADP ribosylation. The action is completed by:
- Impacts _______ and/or ______
- Time required for change: immediate to minutes
- Another enzyme
- Change in Vmax and/or Km
Converting a zymogen to its activated form is what type of enzyme regulation?
Proteolytic cleavage
Phosphorylation as a type of covalent enzyme modification will act on what 3 AA?
Ser
Thr
Tyr
ADP ribosylation as a type of covalent enzyme modification will normally act on what Amino acid?
Arg
Methylation as a form of covalent enzyme modification will normal act on what amino acids?
Lys
Arg
_____________________ is a type of covalent enzyme modification that acts on the amino acids: Ser, Thr, and Tyr. What are three examples?
- Phosphorylation
2a. GS
2b. GP
2c. PK
____-_______________________ is a form of covalent enzyme modification that acts on Arg. What are two examples of this?
- ADP-Ribosylation
2a. G proteins
2b. eEF-2
_______________________ is a form of covalent enzyme modification that acts on Lysine and Arg. What is an example of this type of modification?
Methylation
Histone
Phosphorylation as a form of enzyme regulation occurs at Serine, Threonine and tyrosine, why?
What enzymes normally catalyze this reaction?
What enzyme can reverse this reaction?
- They have -OH groups in their side chain
- Protein kinases
- Protein phosphatases
The enzyme, ART initiates ADP-ribosylation on Arginine. The enzyme ARH removes the ribose nucleotide from Arg. What two clinical correlations does this relate to?
- Cholera
- Pertussis
Cholera is a bacterial infection of the small intestine by the bacterium Vibro cholerae. The classic symptom is watery diarrhea. What is the toxin doing on the cellular level?
Cholera toxin ADP-ribosylates the G protein Gαi
- Covalent enzyme regulation
Infection by the bacterium Bordetella pertussis is a form of covalent enzyme modification. What is occurring on the cellular level?
Pertussis toxin ADP-ribosylates G protein Gαi
Allosteric regulation occurs in allosteric enzymes. Why?
Because allosteric enzymes have two or more subunits and active sites
Allosteric enzymes exhibit cooperativity. How does substrate concentration impact their kinetics?
These enzymes are regulated by:
At high [S], more enzymes are found in the R state
- regulated by effectors
- Describe the displacement of the curve for allosteric enzyme kinetics for POSITIVE EFFECTORS
- Describe the displacement of the curve for allosteric enzyme kinetics for NEGATIVE EFFECTORS
- positive effectors will stabilize the relaxed from and curve will shift left, indicating less [S] needed to reach V max
- Negative effectors: stabilize the Tense form and curve will shift right indicating need for more substrate to achieve V max
Enzyme nomenclature:
EC 1
What does this enzyme do?
- Oxidoreductase
- Loss of H+ and electron
Enzyme nomenclature:
EC 2
What does this enzyme do?
- Transferases
- Transfer group(s) containing C-, N-, or P-
Enzyme nomenclature:
EC 3
What does this enzyme do?
- Hydrolase
- Break substrate using H2O
Enzyme nomenclature:
EC 4
What does this enzyme do?
- Lyases
- Catalyze cleave of C-C or C-S bonds and certain C-N bonds
Enzyme nomenclature:
EC 5
What does this enzyme do?
- Isomerases
- Relocates a group within the SAME molecules
Enzyme nomenclature:
EC 6
What does this enzyme do?
- Ligases
- Formation of bonds b/t Carbon & -N, -O, -S
Peptide bonds are between what terminus of Amino acids?
B/t Carboxyl terminus and Amino terminus
What direction are peptide bonds read and written?
N terminus to C terminus
What type of bonds are key in stabilizing secondary protein structures?
Hydrogen bonds between the carbonyl oxygen from one amino acid to an α nitrogen of a distant amino acid
What two amino acids disrupt α helix? Why is this the case?
- Proline and Glycine
- They have no side chain
β sheets involve peptides side by side in a parallel or antiparallel orientation. How can you discern their direction?
Are the N terminus of the chain on the SAME SIDE OR OPPOSITE SIDE ?
Opposite = ANTIPARALLEL
Same sided = PARALLEL
Amyloid deposits in the brain make ____-______________ more likely to aggregate and implicated in Alzheimer’s disease
β pleated sheets
________________________ disease is caused by protein aggregation through β pleated sheets; aggregation of polyglutamine β-strands of the __________________ protein
- Huntington
- Huntingtin
How do amyloid plaques form in Alzheimer’s disease?
Aggregation of amyloid β, a peptide derived from amyloid precursor protein through sequential cleave by β-secretase and γ-secretase
What causes Creutzfeldt-Jakob disease?
Prion protein in a misfolded form by inducing the formation of an amyloid fold
What creates the turns in β pleated sheets?
Amino acids Proline and Glycine
What are Porins/what do they do?
Proteins found on outer-membrane of Gram - and Gram+ bacteria. They transport molecules across the membrane and act as a channel
Mutations in porin protein contribute to ABX resistance
List 4 forces involved in maintaining tertiary structure
Hydrogen bonds
Disulfide bonds
Hydrophobic interactions
Electrostatic interactions
Electrostatic interactions are synonymous to:
Ionic interactions and dipole dipole interactions
After tertiary structures are denatured they cannot revert to their original tertiary structure with the exception:
Ribonuclease which can refold on its own
What hold quaternary protein structures together?
Noncovalent interactions
- Hydrogen bonds
- Hydrophobic interactions
- Electrostatic interactions
In Sickle Cell disease what two Amino Acids are involved?
Glutamic acid is replaced with nonpolar Valine
What structure in the axilla divides the Axillary artery into three parts?
Pectoralis minor
- The lateral border of the 1st rib and the medial border of pectoralis minor is what portion of the axillary artery?
- What branches come off the artery?
1.) 1st division of the axillary artery
2.) Superior thoracic artery
1.) The portion of the axillary artery that passes beneath the pectoralis minor is:
2.) What branches off this artery?
1.) 2nd division of the axillary artery
2.) Thoracoacromial artery & Lateral thoracic
- The thoracoacromial artery is distal or proximal to the 1st rib?
- The lateral thoracic artery is proximal or distal to the 1st rib?
- Where do these two branches come from?
1.) Thoracoacromial artery is proximal
2.) Lateral thoracic A is distal
3.) 2nd division of the Axillary artery
1.) The lateral border of pectoralis minor to the inferior border of teres major is what portion of the axillary artery?
2.) What branches come off this division of the axillary artery?
1.) 3rd division of axillary A
2. ) Subscapular , Post. Circumflex Humeral A., Ant. Circumflex Humeral A.
This artery arises inferior the subclavius and runs inferomedially to supply the subclavius muscle & muscles in the 1st and 2nd intercostal spaces
Superior thoracic A
The superior thoracic A. in the textbook arises from the 1st division of ________________________. In reality, it may come from somewhere else. What is another way to discern you are looking at the superior thoracic A.?
1.) Axillary artery
2.) See where it is supplying, should supply the 1st & 2nd intercostal spaces and the subclavius muscle
This artery branches off the second division of the axillary artery. It gives rise to 4 more branches (acromial, deltoid, pectoral and clavicular artery) and is deep to the clavicular head of the pectoralis major muscle
Thoracoacromial A.
What are the four branches coming off of the throacoacromial A.?
Clavicular
Acromial
Pectoral
Deltoid
This artery branches off the second division of the axillary artery and supplies pectoral, serratus anterior, intercostal muscles, axillary lymph nodes, and the lateral aspect of the breast
Lateral thoracic artery
This artery is the largest artery coming off the axillary artery. It descends along the lateral border of the subscapularis muscle of the posterior axillary wall, terminating by dividing into the circumflex scapular A and thoracodorsal A. In textbooks, this artery is in the 3rd division of the axillary artery
Subscapular Artery
1.) What branches off the subscapular Artery?
2.) Where does the the subscapular artery supply?
1.) Circumflex scapular artery & Thoracodorsal A
2.) Subscapular Artery
What muscle is supplied by Thoracodorsal Artery?
Latissimus artery
This artery is the smaller A of an anastomosing counterpart. It passes laterally and deep to the coracobrachialis muscle and biceps brachii.
Anterior circumflex humeral artery
What muscle is superficial to the anterior circumflex humeral artery?
1.) Coracobrachialis
2.) Biceps brachii
This artery is the larger of the pair anastomoses in the axillary region. It passes medially through the posterior wall of the axilla and supplies the deltoid, teres major/minor, and long head of triceps brachii
Posterior circumflex humeral artery
What is the largest artery branch coming off the axillary artery?
What branches off this artery?
Subscapular Artery
1.) Circumflex scapular artery
2.) Thoracodorsal artery supplying Latissmus dorsi
This artery is found deep to the rhomboids major and minor:
Dorsal scapular Artery
What are two anatomical markers for the Dorsal scapular Artery?
Inferior to Rhomboid M/m
Along the medial border of the scapula
1.) The suprascapular artery comes from:
2.) It forms an anastomoses with:
1.) Subclavian artery
2.) Dorsal scapular artery, circumflex scapular artery
Other than supplying the latissimuss dorsi, this artery can be found bordering the inferior angle of the scapula. This artery branched off:
Thoracodorsal Artery
Came from subscapular artery
Repetitive trauma like chronic crutch use or athletic activities involving repeated abduction or external rotation of the shoulder may lead to:
1.)
2.)
1.) Aneurysmal degeneration of the axillary artery
2.) Compress the trunks of the brachial plexus
What are the three kinds of fibers which constitute the Brachial plexus?
1.) Motor
2.) Sensory
3.) Sympathetic
Dorsal roots contain ______________ fibers.
Ventral roots contain ______________ fibers.
1.) Sensory fibers
2.) Motor fibers
This nerve pierces the through Pectoralis minor and Pectoralis major muscle. This nerve is a branch of the medial cord of the brachial plexus
Medial pectoral nerve
1.) Where can the medial pectoral nerve be found?
2.) What branch of the brachial plexus does this nerve come from?
1.) Pierces through the Pectoralis major and minor
2.) Comes from the medial cord of the brachial plexus
What arteries branch off the thoracoacromial artery?
1.) Acromial branch
2.) Clavicular branch
3.) Deltoid branch
4.) Pectoral branch
What does the serratus anterior do?
Stabilize, protract, and rotate the scapula upward
This muscle is attached to the coracoid process of the scapula. Its actions stabilize the scapula and draws it anteriorly and inferiorly against the posterior thoracic wall.
Pectoralis minor
What are the actions of the Pectoralis minor muscle?
Stabilizes the scapula and draws anteriorly and inferiorly against the posterior thoracic wall
Name three actions of the pectoralis major muscle?
1.) Flex
2.) Adduct
3.) Medially rotate the humerus
This nerve is a branch of the lateral cord of the brachial plexus, deriving from cervical spinal nerves C5, C6, C7. Its primary innervation if pectoralis Major muscle
Lateral pectoral nerve
1.) Where does the lateral pectoral nerve come from?
2.) What muscle does this nerve innervate?
1.) Lateral cord of the brachial plexus
2.) Innervates pectoralis major
This nerve is a branch of the medial cord of the brachial plexus, derving for C8 and T1. This nerve pierces through the pectoralis minor muscle to provide motor innervation to the pectoralis M/m
Medial pectoral nerve
Where might you find a bifid spinous process?
Cervical vertebrae, exception is C1
What is special about the spinous processes of the cervical disks?
Their spinous processes are bifid
Where is the pedicle on a vertebrae?
Forms the intervertebral foramen by joining the transverse process to the body of the vertebrae
What is the purpose of a demi-facet and where are they located?
Located on the vertebrae
Demi-facet are where the head of the rib articulates with the body of the vertebrae
What is the purpose of transverse costal facets?
They are the location of articulation between transverse spinous process and the tubercle of ribs
Where are sacral cornua found? What is their purpose structurally?
- They surround the sacral hiatus of the posterior side of the sacrum. Little knobs
- They represent the inferior articular processes of S5 vertebra
What are ala? Where are they found?
They are the wings of the sacrum on the anterior side
Is the sacral promontory on the anterior or posterior side of the sacrum?
What forms this structures
Anterior side
Formed by projecting edge of the body of the S1 vertebrae
Is the cononoid fossa on the anterior or posterior side of the humerus?
What is its purpose?
On the posterior
- small depression in the humerus bond that hold the coronoid process of the ulna when the elbow flexes
How many nerves come off the brachial plexus?
17 total
The clavicle divides 17 peripheral nerves into two categories. What are the two categories and how many nerves reside in each region?
1.) Supraclavicular nerves
2.) Infraclavicular nerves
The supraclavicular nerves of the brachial plexus have 4 coming off this region. 2 nerves arise from:
2 nerves arise from:
1.) 2 nerves arise from the roots of the BP
2.) 2 arise from the trunk
Name the two supraclavicular nerves coming off the roots of the brachial plexus
1.) Dorsal scapular nerve
2.) Long thoracic nerve
Name the two supraclavicular nerves coming off the trunkS of the brachial plexus
1.) Nerve to the subclavius
2.) Suprascapular nerve
What trunk do both the subclavius and suprascapular nerve come off of?
Superior trunk
What muscle does the Long thoracic nerve innervate?
Serratus anterior
Which of the 4 nerves coming off the supraclavicular region of the brachial plexus arise from only 1 cervical root?
Which root does it arise from?
Dorsal scapular nerve arises from C5 Root ONLY
This nerve arises from the supraclavicular region of the brachial plexus. It comes of C5-C7 roots and innervates the serratus anterior muscle
Long thoracic nerve
These nerves arises from the supraclavicular region of the brachial plexus. They comes from the superior trunk and arises from C__ & C__ roots.
Nerve to the subclavius & Suprascapular nerve
C5 & C6
What trunk and roots gives rise to the nerve to the subclavius?
Comes off the superior trunk and the thus C5-C6 roots
What trunk and roots give rise to the suprascapular nerve?
Comes off the superior trunk and the thus C5-C6 roots
How many branches does the lateral pectoral have?
3 branches come off the lateral cord
____ number of branches arise from the medial cord
5
____ number of branches arise from the medial cord
5
T1 fibers innervate:
Intrinsic muscles of the hand
____ & _____ fibers primarily innervate muscles that:
1.
2.
1,) Act at the shoulder
2.) Flex the elbow
____ & _____ fibers innervate muscles that:
1.) Extend the elbow
2.) Act at the forearm
What nerve originates from C5-C7 roots, passes through the cervicoaxillary canal, running inferiorly on the superficial surface of the serratus anterior, which it supplies?
Long thoracic N
Which nerve originates from C5 anterior ramus , pierces the middle scalene, and supplies the rhomboids and levator scapulae?
Dorsal scapular nerve
Which nerve originates from the superior trunk (C5-C6), passes laterally across the posterior triangle of the neck through the scapular notch to supply the supraspinatus and infraspinatus
Suprascapular N
Which nerve originates from the superior trunk (C5-C6), descends posterior to the clavicle, often giving an accessory root to the clavicle, often giving an accessory root to the phrenic nerve, then supplying the subclavius
Nerve to Subclavius
After innervating the muscles of the upper arm, what does the musculocutaneous nerve become?
Lateral cutaneous antebrachial nerve
What nerve consists of C5-C7 fibers and runs medial to the pectoralis minor to pierce the deep surface of the pectoral major?
Lateral pectoral nerve
Why are the lateral and medial cord backwards from their anatomic position?
They are named based on which cord supplies them
What nerve is expected to pierce the pectoralis minor muscle?
Medial pectoral nerve
What nerve innervates the majority of the hand?
Ulnar nerve
How many branches are coming off the medial cord?
Name them:
5
If this nerve was impaired, the extension of elbow and wrist would be disturbed thereby making reaching for things difficult
Radial nerve
What actions might be impaired if the radial nerve is damaged?
Extension of the elbow and wrist, unable to extend elbow and thereby unable to reach for things
The hand of Benediction is indicative of damage of what nerve?
Median nerve
Where does the dorsal scapular nerve come from?
C5 root of the brachial plexus
Where does the long thoracic nerve come from?
C5-C7 brachial plexus roots
- Injury to this nerve coming off the C5-C7 nerve roots of the brachial plexus could cause medial winging of the scapula.
- Why?
- Long thoracic nerve
- Long thoracic innervates the serratus anterior which normally protracts the scapula
There is only one trunk of the brachial plexus that gives rise to a nerve.
Which trunk?
What nerve comes off this trunk?
- Upper trunk
- Suprascapular N & Subclavius N
What nerves come off the division region of the brachial plexus?
NO nerves come off this area
List the nerves that come off the lateral cord of the brachial plexus?
1.) Lateral pectoral N
2.) Musculocutaneous
3) Lateral branch of median nerve
List the 5 nerves that come of the posterior cord of the brachial plexus
1.) Upper subscapular N
2.) Thoracodorsal N
3.) Lower subscapular N
4.) Radial N
5) Axillary N
What is an acronym to remember what the Axillary nerve innervates?
DAT M as in DAT minor
Deltoid Axillary Teres Minor!
What does the radial nerve innervate?
Muscles of the posterior arm and forearm
What acronym can help remember what nerves come off the Posterior cord of the brachial plexus?
S T A R S
Upper subscapular
Thoracodorsal
Axillary
Radial
Lower Subscapular
List the 5 nerves that come off the medial cord of the brachial plexus
1.) Medial pectoral
2.) Medial cutaneous N
3.) Medial antebrachial nerve
4.) Medial branch of the median N
5.) Ulnar N
This nerve has roots from C5 fibers, supplies the subscapularis muscle and comes of f the posterior cord of the brachial plexus
Upper subscapular N
What brachial plexus nerve roots does the upper subscapular N have?
C5 Nerve Roots
This nerve receives C6 fibers and passes inferolaterally, deep to the subscapular artery & vein to supply the subscapularis and Teres major
Lower subscapular
What brachial plexus nerve roots does the lower subscapular Nerve recieve?
C6
Which nerve receives fibers from C6-C8, arises between the lower and upper subscapular nerves and runs inferolaterally to supply Latissimus dorsi?
Thoracodorsal N
What brachial plexus nerve roots does the Thoracodorsal N recieve?
C6-C8
This nerve receives C5-C6 fibers, exits the axilla posteriorly through the quadrangular space with the posterior circumflex humeral artery to enter the deep surface of the deltoid as well as sending a branch to teres minor muscle
Axillary nerve
What brachial plexus nerve roots does the Axillary nerve receive?.
C5-C6
Where does the thoracodorsal muscle attach?
The intertubecular groove of the Humerus
This nerve recieves C5-T1 fibers and passes posterior to the humerus in the radial groove wit the deep brachial artery. After passing anteriorly at the cubital fossa it divides into the superficial and deep branches.
Radial nerve
The radial nerve has brachial plexus roots:
C5-T1
Injuries to the superior trunk or C__ and C_ usually result from an excessive increase in the angle between the neck and the shoulder.
Give 3 examples of how that could happen
1.) C5 & C6
2.a) Motorcycle or horse accident
2b.) Excessive pulling of the head during childbirth
2c.) Carrying heavy backpack for too long
What is Erb-Duchenne palsy?
What might happen?
Injury to the superior trunk or C5/C6 roots of the Brachial Palsy
- Weakness, paralysis and loss of sensation of muscles which are supplied by these nerves
What nerve innervates the muscles of the anterior compartment of the upper arm?
Musculocutaneous
What does the musculocutaneous nerve turn into in the forearm?
Transitions into the lateral antebrachial cutaneous N
- Injuries to the inferior parts of the brachial plexus occur most commonly at which trunks of the brachial plexus?
2.) Where/how might they occur?
1.) C8 & T1
2.) Grasping something to break a fall or pulling a baby’s upper limb excessively during delivery
- Klumpke paralysis or palsy is injury to:
- They are usually due to stretch injury and may result in claw hand:
- Inferior turnk or C8-T1 roots to the brachial plexus
2.) Ulnar nerve injury causing flexion of the 4th and 5th fingers
What is the hallmark symptom of acute brachial plexus neuritis?
Sudden, severe, burning pain in the shoulder and upper arm of the superior trunk of the brachial plexus
- pain beings at night followed by muscle weakness and muscular atrophy
What is hyperabduction syndrome AKA thoracic outlet syndrome?
Axillary artery and vein are compressed causing pain radiating down the arm, paresthesia, numbness, erythema, weakness of the hands
The C5 & C6 fibers primarily innervate muscles that:
1.)
2.)
- Act at the shoulder
- Flex the elbow
The C7 & C8 Fibers innervate muscles that:
1.
2.
- Extend the elbow
- Act at the forearm
T1 fibers innervate:
Intrinsic muscles of the hand
- The majority of Clavicle fractures occur at which segment?
- What is a common cause of injury to this bone?
The middle segment
2.) Force from a fall on an outstretch hand can be propagated up the limb and break the clavicle
If there is fracture of the clavicle hemorrhage can occur from which artery?
Subclavian A
In the fracture of the clavicle, the medial fragment is often pulled upward. What muscle attaches to the clavicle and contributes to this?
Sternocleidomastoid muscle
What two muscles may contribute to the downward motion of the lateral portion of a fractured clavice?
Deltoid may pull the clavicle down as well as the pectoralis major
The sternoclavicular joint and acromioclavicular joint enable _____________________ ________________. While the sternoclavicular joint also aids in ___________________
1.) Shoulder elevation
2.) Shoulder rotation
Is the radial groove on the posterior or anterior portion of the humerus?
Posterior portion
The head of the humerus has the greater and lesser tubercle. With what anatomical feature between them?
Intertubercular sulcus
The greater tubercle is the attachment point for what 3 muscles and which tendon(s)
1.) Supraspinatus
2.) Infraspinatus
3.) Teres minor
4.) Rotator cuff tendons
Fracture of the surgical neck of the humerus can cause injury to what nerve and which Artery/vein?
Axillary artery
Posterior circumflex humeral A & V
A midhumeral fracture might injure:
Radial nerve and deep brachial artery
The _________________ muscles of the forearm are responsible for flexion
Anterior
The ____________________ muscles of the forearm are responsible for extension
Posterior
What membrane connects the radius and ulna?
Interosseous membrane
The olecranon is located on which bone of the forearm?
Ulna
Where is the tubercle on the ulna called near the olecranon?
Coronoid
The posterior muscles of the forearm are innervated by:
Radial nerve
All anterior muscles of the forearm are innervated by:
With the exception of the 1 & 1/2 muscles that are innervated by the:
Median nerve
Ulnar nerve
Wrist flexors are primarily found on the _______________ side of the forearm. They allow for ____________ & ________________ objects.
1.) Anterior side
2.) Gripping and holding objects
What is the major function of the intrinsic muscles of the wrists?
Adjust fine motor movements & provide stability to allow for intricate motions
Wrist extensors are found on the _______________ side of the forearm. They allow for: ____________________ & _____________________
1.) Posterior
2.) Pushing and lifting
What do intrinsic muscles of the hand do?
What do extrinsic muscles of the hand do?
1.) Intrinsic: Control fine motor movements, gripping and coordination
2.) Extrinsic: Gross motor movement, include flexor and extensor groups
- The muscles of the hand are all innervated by:
- Except for the thenar muscle and 2 lateral lumbrical muscles innervated by:
- Ulnar
- Median
Injury to the ulnar nerve can cause what problem in the hand?
The ulnar nerve innervates the ______________ muscles and the skin of the fourth and fifth fingers.
1.) Loss of grip strength
2.) Intrinsic muscles
This nerve controls fine motor skills in the hand. It innervates the intrinsic muscles and the skin of the 4th & 5th fingers. Injury to this nerve can lead to loss of grip strength
Ulnar nerve
At the elbow, what happens to the brachial artery?
It divides into the radial and ulnar arteries
The basilic and cephalic veins originate from where?
Dorsal venous arch on the hand
These veins originate from the dorsal venous arch of the hand. They are common sites for venipuncture and are part of the superficial venous network
Basilic and cephalic
Wrist drop would indicate damage to what nerve?
Radial nerve
What are the shoulder adductors?
1.) Pectoralis major
2.) Latissimus dorsi
3.) Teres major
The rotator cuff muscles are responsible for:
External shoulder rotation
What two muscles of the rotator cuff are responsible for lateral rotation of the shoulder?
What about the external shoulder rotation?
Lateral rotation: Infraspinatus & Teres minor
Medial rotation: Subscapularis
What are the primary ABductors of the arm?
Supraspinatus
Deltoid
Trapezius
Serratus anterior
Describe Jobe’s test AKA Empty Can test
Patient stands with arms abducted 90 degrees and internally rotated so the thumbs point toward the floor
The examiner applies a downward force to the arms while patient resists
Pain or weakness indicates a positive test
A positive Jobe’s test AKA Empty Can test indicates:
Supraspinatus tendinopathy or tear
Where does the suprascapular artery come from?
Thyrocervical trunk of the subclavian artery
Where does the dorsal scapular artery come from?
Subclavian artery
What is adhesive capsulitis?
Frozen shoulder
Describe adhesive capsulitis
Progressive stiffness and loss of shoulder motion. Progresses through freezing, frozen, and thawing stages, with varying degrees of pain and limitation
Excessive movement of the humeral head within the glenoid fossa may lead to subluxation. This can result from trauma, repetitive stress, or congenital laxity of the joint capsule and ligaments. What is subluxation?
Partial dislocation
There are 5 actions of the pectoralis major muscle:
- Adduction of the humerus
- Medial rotation of the humerus
- Flexion of the humerus
- Extension of the flexed humerus
- Depression of the shoulder girdle
What is Poland syndrome?
A congenital absence of the pectoralis major, often accompanied by hand abnormalities
What are the borders of the clavipectoral triangle?
What’s its purpose?
1.) Clavicle superiorly, Lateral border of the pectoralis major medially & anterior border of the deltoid laterally
2.) Landmark for central venous catheterization by providing access to the axillary vessels
T/F: The lateral thoracic artery supplies the pectoralis minor muscle
True, the pectoral branches of the thoracoacromial artery
This fascial layer is deep to pectoralis major. It is pierced by the Cephalic vein, thoracoacromial artery branches, lateral pectoral nerve and lymphatics
Clavipectoral fascia
This ligament is found in the clavipectoral fascia inferior to the pectoralis minor. It supports the axillary fascia and pulls it and the overlying skin upward during abduction of the arm, forming the axillary fossa
Suspensory ligament of the axilla
What is the suspensory ligament of the axilla?
Where is it found?
1.) found in the clavipectoral fascia inferior to the pectoralis minor
2.) It supports the axillary fascia and pulls it and the overlying skin upward during abduction of the arm, forming the axillary fossa
What is the function of the pectoralis minor?
- Stabilizes the scapula by drawing it inferiorly and anteriorly against the thoracic wall
- Elevates ribs when the scapula is fixed
- Assists in protraction and downward rotation of the scapula
Where does the axillary vein terminate?
Lateral border of the first rib where it continues as the subclavian vein
This artery supplies the lateral aspect of the breast
Lateral thoracic
Aside from supplying the serratus anterior and pectoralis minor, what other structure does the axillary artery supply?
Lateral blood supply of the breast
What are the nerves and arteries that can be damaged during breast surgery?
Long thoracic nerve and Lateral thoracic artery
List 4 actions of the serratus anterior muscle
1.) Protracts scapula
2.) Holds scapula against wall
3.) Rotates scapula upward during abduction
4.) Assists in forced inspiration
Medial winging of the scapula would indicate damage to what nerve?
Damage to the Long Thoracic Nerve as the serratus anterior can no longer hold the scapula against the thoracic wall
Lateral winging of the scapula would indicate damage to what nerve?
Spinal accessory nerve as it innervates the trapezius. If this muscle did not medially retract the scapula, the bone would rotate laterally
Where does the axillary vein start?
Lower border of the teres major
Where does the cephalic vein join the axillary vein?
Near the clavicle
This vein joins the axillary vein near the clavicle
Cephalic vein
The cephalic bein originates from:
The lateral aspect of the dorsal venous network of the hand
Aside from the axillary nerve, this nerve can also be damaged during mastectomy or lymph node dissection. Damage would lead to numbness in the upper inner arm
Intercostobrachial N
The grandular tissue of the breast consists of:
15 - 20 lobes
Each lobe of the breast is drained by a:
Lactiferous duct
The nipple contains:
The areola contains:
Lactiferous ducts
Montgomery’s tubercles aka Sebaceous glands
What is Spence’s tail?
An “axillary tail” of breast tissue that extends towards the axilla
These ligaments attach the mammary gland to the dermis. They provide structure and support the glandular lobules within the breast
Suspensory ligaments (Cooper’s Ligaments)
What are Suspensory Ligaments of the breast?
Ligaments which attach the mammary gland to the dermis
Provide structure and support to to the glandular lobules within the breast
Mammary gland lobules form ___________________. Each has a _________________ _____________ that drains its secretions. They converge toward the nipple. Near the nipple, each widens to form a ____________ ________________.
Lobes
Lactiferous duct
Lactiferous sinus
What structure allows for drainage of lymph fluid from the breast into the axillary lymph nodes?
Axillary process
What structure allows the breast to be mobile and moveable within the chest wall?
Retromammary space
What is the axillary process of the breast?
Structure of the breast that allows for drainage of lymph fluid from the breast into the lymph nodes
What is the difference between lactiferous ducts vs. sinuses?
- Ducts drain lobe secretions towards the sinuses
- Anatomically the ducts precede the sinuses
What is the retromammary space?
Space which contains a small amount of fatty tissue that allows for some degree of movement of the breast gland over the underlying muscles
What is the lateral blood supply of the breast?
What is the medial blood supply of the breast?
Lateral: Lateral thoracic artery, axillary artery
Medial supply: Internal thoracic artery
What are the common tumors of the breast called which reside within the grandular tissue and arise from the epitherial cells of the lactiferous ducts in the mammary gland lobules?
Adenocarcinoma
Dimpling of the nipple and skin of the breast may involve:
Why?
Suspensory ligaments, the tumor of the breast may invade and distort the ligaments which causes the skin to pull
____________ _______________ nerve can be damaged during radical mastectomy
What is the origin of levator scapulae?
C1-C4
What is the insertion of levator scapulae?
Insert at superior angle and medial border of scapula
The dural sac and subarachnoid space end at which vertebral level?
S2
The ______ _________ _______ is the location of the cell bodies of the somatic sensory neurons.
Dorsal root ganglion
What are the three ligaments that must be passed through when performing a CSF collection
1.) Supraspinous ligament
2.) Interspinous ligament
3.) Interspinous ligament
What are the three ligaments that must be passed through when performing a CSF collection
1.) Supraspinous ligament
2.) Interspinous ligament
3.) Ligamentum flava
Where are the cell bodies of the motor neurons found in the spinal cord?
Ventral horn
Where are the cell bodies of the motor neurons found in the spinal cord?
Dorsal horn
Which of these ligaments is the strongest:
Acromioclavicular ligament
Coracoclavicular ligament
Coracoacromial ligament
Coracoclavicular ligament
The coracoclavicular ligament consists of: 1.)
2.)
Conoid ligament
Trapezoid ligament
The ____________ horn of the spinal cord contains the cell bodies that the afferent sensory neurons synapse on before the neural signal ascends the spinal cord
Dorsal
Which head of the biceps brachii inserts into the intertubecular groove?
Long head
Is pronator teres medial or lateral?
Medial
1.) Supination of the hand and forearm would be diminished by loss of radial nerve function. But one very powerful supinator would remain intact and unaffected:
2.) Why would the brachialis NOT be effected?
1.) Biceps Brachii
2.) Because the Brachialis is a FLEXOR muscle
Which head of the triceps originates on the scapula?
Which head originates from the shaft of the humerus?
Long head originates on the scapula
Lateral head and medial head originates on the shaft of the humerus
What type of tissue creates the hornlike structure through the spinal cord?
Grey matter
What two muscles are lateral rotators of the arm?
Infraspinatus and teres minor
Teres major rotates the arm medially or laterally?
Medially
Do teres minor and infraspinatus rotate the arm laterally or medially?
Laterally
Which tendon of the rotator cuff muscles is the most commonly damaged, typically due to its close proximity to the corcoacromial arch?
Supraspinatus
