A2 - Upper Arm & Elbow Flashcards
(94 cards)
1
Q
What makes up the anterior border of the axilla?
A
pectoralis major and minor
2
Q
What makes up the posterior border of the axilla?
A
subscapularis, teres major, latissimus dorsi
3
Q
What makes up the medial border of the axilla?
A
serratus anterior and the thoracic wall
4
Q
What makes up the lateral border of the axilla?
A
intertubercular sulcus
5
Q
Label the structures that make up the borders of the axilla
A
6
Q
What is contained within the neurovascular bundle of the axilla?
A
- the axillary vein
- the axillary artery
- lateral, medial and posterior cords of the brachial plexus
7
Q
Label the structures that pass through the apex of the axilla and into the upper limb
A
8
Q
What is the function of the axillary lymph nodes?
What is their relationship to breast cancer?
A
There are 4 groups of nodes which drain 75% of the lymph from the breast
They are the first place that breast cancer spreads to
9
Q
How does infection affect the axillary lymph nodes?
A
It causes them to become enlarged
10
Q
What is the function of the brachial plexus?
A
it gives rise to nerves which provide sensory and motor innervation to the WHOLE upper limb
this is provided by 5 major nerves that are formed in the axilla
11
Q
Label the 4 divisions of the brachial plexus
A
- roots
- trunks
- divisions
- cords
12
Q
What are the roots of the brachial plexus formed by?
A
- anterior rami of C5 to C8
- the most anterior ramus of T1
these are spinal nerves
13
Q
What are the 3 trunks of the brachial plexus and what are they formed by?
A
- superior trunk - formed by the union of the C5 and C6 roots
- middle trunk - continuation of C7 root
- inferior trunk - formed by the union of C8 and T1 root
14
Q
How do the trunks of the brachial plexus divide?
A
Each trunk splits into an anterior and posterior division
15
Q
What is the difference between the anterior and posterior divisions of the brachial plexus?
A
the 3 anterior divisions give rise to nerves associated with the anterior compartments of the arm
the 3 posterior divisions give rise to nerves associated with the posterior compartments of the arm
16
Q
What divisions form the lateral cord?
What contributions does it contain?
A
the union of the anterior divisions of the superior and middle trunk
contributions from C5 - C7
17
Q
What are the 3 cords of the brachial plexus?
How are they named?
A
- lateral
- medial
- posterior
They are named relative to their position around the 2nd part of the axillary artery
18
Q
What divisions come together to form the medial cord?
What contributions does it contain?
A
The medial cord is the continuation of the anterior division of the inferior trunk
It has contributions from C8 and T1
19
Q
What divisions come together to form the posterior cord?
What contributions does it contain?
A
It is formed from the union of ALL 3 posterior divisions
It contains contributions from ALL roots of the brachial plexus (C5 - T1)
20
Q
Label the trunks and cords of the brachial plexus
A
21
Q
What are the 5 major terminal branches of the brachial plexus?
A
- musculocutaneous
- axillary
- median
- radial
- ulnar
22
Q
Which cords form the axillary and musculocutaneous nerves?
A
axillary - posterior cord
musculocutaneous - lateral cord
23
Q
Which cords form the median nerve?
A
lateral and medial cords
24
Q
Which cords form the radial and ulnar nerves?
A
radial - posterior cord
ulnar - medial cord
25
Label the terminal branches of the brachial plexus
26
What muscles are innervated by the musculocutaneous nerve?
ALL muscles in the **ANTERIOR** compartment of the arm
1. greater part of brachialis
2. coracobrachialis
3. biceps brachii
27
What skin is innervated by the musculocutaneous nerve?
skin on the lateral side of the forearm
28
What muscles are innervated by the axillary nerve?
deltoid and teres minor
29
What skin is innervated by the axillary nerve?
skin over the upper lateral part of the arm
30
What muscles are innervated by the median nerve?
1. all muscles in the anterior compartment of the forearm (except FCU and medial 1/2 of FDP)
2. thenar eminence muscles
3. two lateral lumbrical muscles
31
What skin is innervated by the median nerve?
skin over the palmar surface of the lateral 3 ½ digits
skin over the lateral side of the palm and middle of the wrist
32
What muscles are innervated by the radial nerve?
all muscles in the posterior compartments of the arm and forearm
33
What skin is innervated by the radial nerve?
1. skin on posterior aspects of arm and forearm
2. skin on lateral surface of the arm
3. skin on the dorsal lateral surface of the hand
34
What muscles are innervated by the ulnar nerve?
ALL the intrinsic muscles of the hand
(except 3 thenar muscles and 2 lateral lumbricals)
Flexor carpi ulnaris
Medial half of flexor digitorum profundus
35
What skin is innervated by the ulnar nerve?
skin over the palmar surface of the median 1½ digits and associated palm and wrist
skin over dorsal surface of medial 1 ½ digits
36
Where does the axillary artery originate from?
Where does it terminate?
it is a continuation of the **subclavian artery** after it passes under the clavicle at the lateral margin of rib I
the axillary artery becomes the **brachial artery** at the inferior margin of teres major
37
Label the arteries and landmarks:
38
What are the branches of the axillary artery that arise inferior to pectoralis minor?
the anterior and posterior circumflex humeral arteries
they form an anastomosis around the surgical neck of the humerus
39
What is the alternative name for the profunda brachii?
What is significant about this artery?
also called the deep artery of the arm
it is the main supplier of blood to the upper arm
40
How does the posterior circumflex humeral artery reach the posterior aspect of the humerus?
It travels backwards through the axilla and through the quadrangular space
the axillary nerve also passes through the quadrangular space
41
Label the arteries and branches
42
Where does the profunda brachii travel?
What nerve accompanies it?
It runs down the posterior aspect of the humerus in the radial groove
The radial nerve also runs in the radial groove
43
Where does the brachial artery bifurcate?
What is the result of this?
It runs down the anterior arm and bifurcates at the level of the elbow joint
It bifurcates in the **_radial and ulnar arteries_**
44
Where does the axillary vein commence?
At which point does it become the subclavian vein?
It commences at the lower border of teres major
It becomes the subclavian vein at the lateral border of the first rib
45
What are the 2 main superficial veins in the arm?
What do they form?
the cephalic and basilic veins
they travel up the arm and form the axillary vein
46
What are the 3 superficial veins in the upper limb that are used for venepuncture and cannulation?
1. basilic vein
2. cephalic vein
3. median cubital vein
47
Label the veins of the upper limb
48
What is the median cubital vein?
it connects the cephalic and basilic veins in the antecubital fossa
this is the region anterior to the elbow joint
49
What are the 2 compartments of the arm and their relationship to the humerus?
the flexor compartment lies anterior to the humerus
the extensor compartment lies posterior to the humerus
50
What are the main muscles in the anterior and posterior compartments of the arm?
How are they separated from each other?
anterior - biceps and brachialis
posterior - triceps
they are separated from each other by the intermuscular septum
51
Label the muscles and the nerves in the arm
52
What are the 3 muscles within the flexor compartment (anterior) of the arm?
What is their blood and nerve supply?
1. brachialis
2. biceps brachii
3. coracobrachialis
they are innervated by the **musculocutaneous nerve** and supplied by branches of the **brachial artery**
53
Label the muscles of the flexor compartment
54
What are the proximal and distal attachments of biceps brachii?
**Proximal:**
Short head - apex of coracoid process
Long head - supraglenoid tubercle of scapula
**Distal:**
Radial tuberosity
55
What are the 3 main actions of biceps brachii?
1. powerful flexor of the forearm at elbow joint
2. supinator of the forearm
3. accessory flexor of the arm at glenohumeral joint
56
What are the proximal and distal attachments of brachialis?
**Proximal:**
anterior aspect of the humerus
**Distal:**
tuberosity of the ulna
57
What are the proximal and distal attachments of the coracobrachialis muscle?
**Proximal:**
apex of coracoid process
**Distal:**
linear roughening on midshaft of medial side of humerus
58
What are the functions of brachialis and coracobrachialis?
**Brachialis:**
flexor of the forearm at the elbow joint
**Coracobrachialis:**
flexor of the arm at the glenohumeral joint
59
What are the steps involved in performing a biceps reflex test?
1. patient's arm rests on their lap with the elbow slightly flexed
2. examiner palpates biceps tendon in cubital fossa
3. place forefinger/thumb over biceps tendon
4. swing the head of the tendon hammer onto the position of the thumb/finger
60
What is the biceps reflex test testing?
What is a normal observation?
it tests the function of the C5 and C6 spinal nerves and musculocutaneous nerve
a jerk of the forearm should be observed
61
What is the only muscle within the posterior (extensor) compartment of the arm?
triceps brachii
it has 3 muscle bellies which converge distally onto one common tendon
62
Where do the 3 heads of triceps brachii originate from?
**Long head:**
Originates from infraglenoid tubercle of scapula
**Lateral head:**
originates from posterior surface of the humerus
**Medial head:**
originates from the posterior surface of the humerus
63
Label the components of triceps brachii
64
Where do all 3 muscle bellies of triceps brachii insert?
the olecranon
65
What is the function of triceps brachii?
extension of the forearm at the elbow joint
the long head is also involved in extension and adduction at the shoulder joint
66
What is the nerve supply and arterial supply to triceps brachii?
it is innervated by the radial nerve
it is supplied by the radial artery
67
What are the stages involved in testing the triceps reflex?
1. patient's arm is held across their body and the weight of the limb supported
2. examiner palpates the triceps tendon superior to its insertion on the olecranon
3. the tendon is tapped with a tendon hammer
68
What is the triceps reflex test testing?
What is a normal response?
it tests the function of spinal nerve C7 and the radial nerve
normal triceps reflex shows sudden extension of the arm
69
What are the 4 borders of the quadrangular space?
superior - teres minor
inferior - teres major
medial - long head of triceps brachii
lateral - surgical neck of humerus
70
What point marks the location of the quadrilateral space?
where the tendon of the long head of triceps brachii crosses teres major and teres minor at right angles
71
What artery and nerve pass through the quadrangular space?
the axillary nerve
the posterior humeral circumflex artery
72
Label the nerves, vessels and muscles
73
What articulations are involved in formation of the elbow joint?
1. distal end of the humerus
2. proximal end of the radius
3. proximal end of the ulna
74
What joints in the elbow are involved in flexion and extension of the forearm?
1. a joint between the trochlea of the humerus and the trochlear notch of the ulna
2. a joint between the head of the radius and the capitulum of the humerus
75
What is the joint in the elbow that is involved in pronation and supination of the forearm?
the proximal radio-ulnar joint
this is between the head of the radius and the radial notch of the ulna
76
Label the features of the radius, ulna and humerus
77
What are the following movements of the elbow joint?
78
What is the condyle made up of?
What does it articulate with?
the condyle consists of the capitulum and the trochlea
the capitulum articulates with the radius
the trochea articulates with the ulna
79
What are the 3 fossae on the distal end of the humerus?
1. radial fossa
2. coronoid fossa
3. olecranon fossa (posterior surface of humerus)
80
Label the features of the distal end of the humerus
81
What are the 3 features of the proximal end of the radius?
1. head
2. neck
3. radial tuberosity
82
What does the head of the radius articulate with?
the capitulum of the humerus
the thick medial margin of the head articulates with the radial notch on the proximal end of the ulna
83
Which muscle attaches to the radial tuberosity?
the biceps brachii tendon
84
Identify the features of the radius and the humerus
85
What are the 5 features of the proximal end of the ulna?
1. olecranon
2. coronoid process
3. trochlear notch
4. radial notch
5. tuberosity of the ulna
86
What muscle attaches to the olecranon of the ulna?
triceps brachii muscle
87
What do the trochlear notch and the radial notch of the ulna articulate with?
the trochlear notch articulates with the trochlea of the humerus
the radial notch articulates with the head of the radius
88
Label the features of the proximal end of the ulna
89
What is the role of collateral ligaments of the elbow joint?
they strengthen the medial and lateral aspects of the joint
the anular ligament of the radius holds the head of the radius in place
90
What causes 'pulled elbow'?
the head of the radius dislocates from the anular ligament
91
Label the ligaments of the elbow joint
92
What nerves are at risk in a dislocation/fracture of the elbow?
1. radial nerve
2. ulnar nerve
3. median nerve
93
94
What is the name of the fibro-osseous tunnel in which the ulnar nerve is contained within?
the cubital tunnel
this runs behind the medial epicondyle
