Chapter Four: The Upper Limb Flashcards
(159 cards)
1
Q
The axilla
A
-space between the upper rib cage and the humerus
-the armpit
2
Q
Inside the axilla
A
-blood vessels, nerves, and fat
3
Q
Walls of the axilla
A
-lateral wall
-medial wall
-posterior wall
-anterior wall
4
Q
Lateral wall of the axilla
A
-bicipital groove
5
Q
Medial wall of the axilla
A
-serratus muscle (sits over ribs)
6
Q
Posterior wall of the axilla
A
-subscapularis muscle
7
Q
Anterior wall of the axilla
A
-2 pectoralis muscles
8
Q
Labelling of axilla walls
A
9
Q
Arteries of the Axilla
A
-arterial trunk passes downward through axilla and name changes as it goes through
-subclavian artery: while passing under clavicle
-axillary artery: sends 3 branches to main axillary walls and supplies deltoid muscle via the posterior humeral circumflex artery
-brachial artery: when blood vessel leaves the axilla
10
Q
Branches of the axillary artery
A
-lateral thoracic artery (to medial wall)
-thoracoacromial artery (to anterior wall)
-subscapular artery (to posterior wall)
11
Q
Axillary artery labelling
A
12
Q
Veins and lymph nodes of the axilla
A
-venae comitantes (veins that accompany), empty in subclavian vein
-also several groups of interconnected lymph nodes (pathway in spread of cancer to upper limbs from the breast)
13
Q
The brachial plexus number of roots, trunks etc..
A
-roots: 5
-trunks: 3
-divisions: 6
-cords: 3
-branches: 5
14
Q
Brachial plexus roots
A
-c5, c6, c7, c8, t1
15
Q
Brachial plexus trunks
A
-upper, middle, lower
16
Q
Brachial plexus divisions
A
-strike and a spare
17
Q
Brachial plexus cords
A
-lateral, posterior, medial
18
Q
Brachial plexus branches (nerves)
A
-axillary
-radial
-musculocutaneous
-median
-ulnar
19
Q
Brachial plexus labelling
A
20
Q
Axillary nerve
A
-c5 and c6
-goes to top of arm (deltoid)
-abduction of shoulder
21
Q
Musculocutaneous nerve
A
-c5, c6, c7
-goes to top muscles in the arm
22
Q
Ulnar nerve
A
-c8 and t1
-goes to lower part of arm and hand
23
Q
Median nerve
A
-c5-8 and t1 (all roots)
24
Q
Radial nerve
A
-c5-8 and t1 (all roots)
-biggest one
25
Somatotopism
-upper, middle, and lower innervations usually stay consistent throughout whole arm
26
Dorsal scapular nerve (minor)
-c5
-to rhomboid major and minor
27
Suprascapular nerve (minor)
-c5 and c6
-to rotator cuff muscles
-abduction of shoulder
-suprapinatus
28
Upper and Lower subscapular nerve (minor)
-c5 and c6
-rotator cuff muscles
29
Lateral pectoral nerve (minor)
-c5, c6, and c7
-goes to pectoralis major
30
Long thoracic nerve
-c5, c6, and c7
-goes to serratus anterior
31
Thoracodorsal nerve (minor)
-c6, c7, and c8
-goes to latissimus dorsi
32
Medial pectoral nerve (minor)
-c8 and t1
-goes to pectoralis major and minor
33
Medial cutaneous nerve of the arm and forearm (minor)
-c8 and t1
-cutaneous sensation of the arm and forearm
34
The scapula position
-sits between t2 and t7
35
The scapula borders and angles
-superior border
-medial border
-lateral border
-superior angle
-inferior angle
-lateral angle
36
Glenoid fossa of scapula
-articulates with the head of the humerus
37
Suprascapular notch
-where blood vessels and nerves run through
38
Coracoid process
-in the lateral angle
39
Spine of the scapula
-posterior ridge
-turns into the acromion
40
Acromion
-forms the point of the shoulder
-forms acromioclavicular joint
41
Subscapular fossa
-anterior face (slightly concave)
-subscapularis muscle originates here
42
Infraspinous fossa
-below spine
-posterior face (slightly concave)
43
Supraspinous fossa
-depression above the spine
-posterior face (slightly concave)
44
Clavicle ends
-roundish end (articulates with sternum at sternoclavicular joint)
-flatish end (articulates with scapula at acromioclavicular joint)
-this connection is the only articular attachment of the upper limb to the axial skeleton
45
Proximal humerus head
-articulates with glenoid fossa forming the shoulder joint (glenohumeral joint)
46
Proximal humerus neck(s)
-anatomical neck: located right under the head
-surgical neck: located further down and is where most fractures occur
47
Proximal humerus labelling
48
Muscles attaching the axial skeleton to the scapula
-serratus anterior
-trapezius
-levator scapula
-the rhomboids (major and minor)
49
Serratus anterior
-origin: upper 9 ribs
-insertion: medial border of scapula
-protraction (pulls scapula forward) and upward rotation of glenoid fossa
-innervated by long thoracic nerve (c8 & t1)
50
Trapezius
-origin: occipital bone
-insertion: scapula (clavicle and acromion)
-there is an upper, middle and lower aspect
-upper and lower fibres elevate shoulder and rotate glenoid fossa upwards
-middle fibres depress shoulder and also rotate glenoid fossa upwards
-innervated by cranial nerve 9 (spinal accessory nerve)
51
Levator Scapula
-origin: transverse processes of c1-c4
-insertion: upper medial border of scapula
-elevation of scapula and depression of glenoid fossa
-innervated by branches of nerves c3 and c4
52
The rhomboids (major)
-origin: spinous processes of t2-t5
-insertion: lower third of medial scapular border
-elevate and retract the scapula and aid in depressing glenoid fossa
-innervated by dorsal scapular nerve (c5)
53
The rhomboids (minor)
-origin: ligamentum nuchae and spinous processes of c7 and t1
-insertion: middle of the medial border of the scapula
-elevate and retract the scapula and aid in depressing glenoid fossa
-innervated by dorsal scapular nerve (c5)
54
Muscles attaching the axial skeleton to the humerus
-latissimus dorsi
-pectoralis major
-pectoralis minor
55
Latissimus dorsi
-origin: ilium
-insertion: bicipital groove of the humerus
-powerful extensor, adductor and medial rotator
-innervated by thoracododorsal nerve
56
Pectoralis major
-origin: clavicular head (at clavicle) and costal head (at ribs)
-insertion: lateral lip of bicipital groove on humerus
-adducts, flexes and medially rotates the arm
-innervated by medial and lateral pectoral nerves
57
Pectoralis minor
-origin: ribs 3-5
-insertion: coracoid process of the scapula
-stabilize and pull upward and forward on the rib cage
-innervated by the medial pectoral nerve
58
Muscles attaching the girdle to the humerus
-deltoid
-teres major
-rotator cuff (subscapularis, supraspinatus, infraspinatus, teres minor)
59
Deltoid
-origin: on distal clavicle to acromion and spine of scapula
-insertion: deltoid tuberosity
-anterior fibres flex, middle fibres abduct and posterior fibres extend
-innervated by axillary nerve
60
Teres major
-origin: lower back
-insertion: medial lip of occipital groove
-extends, abducts and medially rotates the arm
-innervated by lower subscapular nerve
61
Rotator cuff muscles
-subscapularis
-infraspinatus
-supraspinatus
-teres minor
62
Subscapularis
-origin: subscapular fossa of scapula
-insertion: lesser tubercle of humerus
-medial rotator and adductor
-innervated by subscapular nerve
63
Supraspinatus
-origin: supraspinous fossa of scapula
-insertion: top facet of greater tubercle
-abduction
-innervated by suprascapular nerve
64
Infraspinatus
-origin: infraspinous fossa of scapula
-insertion: middle facet of greater tubercle
-laterally rotates the humerus
-innervated by suprascapular nerve
65
Teres minor
-origin: lower lateral border of scapula
-insertion: inferior facet of greater tubercle
-lateral rotator
-innervated by axillary nerve
66
Muscles attaching to bicipital groove
-lateral lip: pectoralis major
-medial lip: teres major
-floor: latissimus dorsi
67
Glenohumeral (shoulder) joint
-synovial, triaxial, ball and socket joint
-flexion/extension, abduction/adduction, medial/lateral rotation
-weak but mobile joint
68
Labrum
-lip of fibrocartilage around the perimeter of the glenoid fossa
69
Capsule and ligaments of the glenohumeral joint
-capsule: extremely loose
-coracoacromial ligament
-coracohumeral ligament: only strong one
-coracobrachialis
-biceps brachii
-pectoralis minor
-coracoclavicular ligament
70
Blood and nerve supply of the glenohumeral joint
-most of arteries come from the axillary artery
-brachial plexus
71
Scapulo-thoracic joint
-basically just the scapula moving around
-performs elevation, depression, protraction, and retraction of the scapula
72
Muscles that move the scapula
-elevators: rhomboids, levator scapula, upper trapezius
-depressors: lower trapezius
-upward rotation: upper trapezius, serratus anterior
-downward rotation: levator scapula, rhomboids
73
Sternoclavicular joint
-very strong joint (usually only damaged in car accident, fibrocartilage disc)
-synovial joint between the clavicle and manubrium
-only joint connecting the upper limbs to the rest of the skeleton
-contains costoclavicular and sternoclavicular ligament
-permits quite a range of circumduction
74
Costoclavicular ligament
-reinforces the sternoclavicular joint
-runs up from first rib to proximal clavicle
75
Sternoclavicular ligament
-reinforces the sternoclavicular joint
76
Acromioclavicular joint
-easily damaged joint (separated shoulder)
-contains a small fibrocartilage disc
-reinforced with coracoclavicular ligament
-coracoacromial ligament limits the movement of the shoulder joint
77
Distal humerus labelling
-look in book on page 62
78
Radial nerve (proximal humerus)
-occupies spiral groove as it passes distally to the arm
79
Radius and ulna labelling
-look in book on page 63
80
Radial tubercle
-insertion for biceps brachii
81
Radial notch
-contains hyaline cartilage
82
Anterior compartment of the arm
-coracobrachialis
-brachialis
-biceps brachii
-all these muscles are innervated by the musculocutaneous nerve
83
Coracobrachialis
-origin: coracoid process
-insertion: half way down the medial side of the humerus
-minor adductor
-innervated by musculocutaneous nerve
84
Brachialis
-origin: flat surface of distal humerus
-insertion: ulnar tubercle
-powerful elbow flexor
-innervated by musculocutaneous nerve
85
Biceps Brachii
-2 heads (2 origins): long head and a short head
-long head origin: supraglenoid tubercle
-short head origin: coracoid process
-insertion: radial tubercle
-innervated by musculocutaneous nerve
-powerful flexor and supinator
86
Radial aponeurosis
-thin tendon that fans out over biceps and does not attach to bone
87
Posterior compartment of the arm
-triceps brachii
-innervated by radial nerve
88
Triceps brachii
-3 heads(3 origins): long, medial and lateral head
-long head origin: infraglenoid tubercle
-medial head origin (deep): lower part of shaft of humerus
-lateral head origin: proximal humerus
-insertion: connect into aponeurosis which insert on olecranon of ulna
-innervated by radial nerve
-extensor of elbow joint
89
The elbow joint
-classification: synovial, uniaxial and hinge
-movements: flexion and extension only
90
Bones involved in the elbow joint
-proximal head of radius articulates with capitulum of the humerus
-trochlear notch of ulna articulates with trochlea of the humerus
91
Muscles acting on the elbow joint
-flexors: brachialis, biceps brachii, and brachioradialis
-extensor: triceps brachii
92
Capsule of the elbow joint
-joint capsule covers elbow joint and proximoradioulnar joint
-fibrous capsule extends just a bit further than the synovial capsule
93
Ligaments of the elbow joint
-annular ligament: holds radius and ulna together
-medial collateral (ulnar) ligament: fan shaped, runs from medial epicondyle and fans out onto ulna
-lateral collateral (radial) ligament: thiner and cord like, comes from lateral epicondyle and goes into annular ligament
-both ligaments prevent adduction and abduction of the elbow
94
Blood and nerve supply of the elbow joint
-radial and ulnar arteries
-ulnar nerve (funny bone) and brachial plexus passes in front of it
95
Bursae
-small synovial, fluid filling capsules that are found in areas where there could be friction
96
Forearm bones
-between the borders of the radius and ulna, there is a interosseous membrane which divides the forearm into an anterior (flexor) compartment and a posterior (extensor) compartment
97
Labelling of forearm
-on page 72
98
Styloid process
-distal projection from ulna and radius
99
Ulnar notch
-on the distal radius
100
Pronation and supination of the forearm
-the ulna cannot rotate, so the head of the radius rotates in the annular ligament, causing the distal radius to rotate around the head of the ulna
101
Carpal bones
-pisiform
-triquetral
-lunate
-scaphoid
-hamate
-capitate
-trapezoid
-trapezium
102
Labelling of the carpal bones
-on page 73
103
Carpal tunnel
-the carpal bones are not flat
-they form an anterior concavity
-this forms the posterior and side walls of the carpal tunnel through which pass tendons and nerves to the palm of the hand
104
Metacarpals
-bones of the palm of the hand
-they are labelled 1-5 starting at the thumb
-base of each metacarpal articulates with wrist or carpal bones
-head of each articulates with the proximal phalanges resulting in the metacarpophalangeal joints
105
Phalanx
-each finger has a proximal, middle and distal phalanx
-they articulate at the knuckles with the metacarpals and with eachother at the interphalangeal
-these joints only allow flexion and extension
106
Anterior forearm muscles (flexor division)
-superficial group
-intermediate group
-deep group
107
Superficial group (anterior)
-pronator teres
-flexor carpi radialis
-palmaris longus
-flexor carpi ulnaris
108
Intermediate group (anterior)
-flexor digitorum superficialis
109
Deep group (anterior)
-flexor pollicis longus
-flexor digitorum profundus
-pronator quadratus
110
Pronator teres (superficial)
-origin: CFO
-insertion: about halfway down down on lateral side of the shaft of the radius
-innervated by median nerve
-pronates the forearm and flexes the elbow
111
Flexor carpi radialis (superficial)
-origin: CFO
-insertion: bases of metacarpals 2 and 3
-innervated by median nerve
-wrist flexor and abductor
112
Palmaris longus (superficial)
-pretty useless
-origin: CFO
-insertion: thick superficial fascia in the palm
-innervated by median nerve
-weak wrist flexor
113
Flexor carpi ulnaris (superficial)
-origin: CFO
-insertion: pisiform
-innervated by the ulnar nerve
-flexes and adducts the wrist
114
Flexor retinaculum
-fibrous bridge that crosses from the medial to lateral side of the wrist bones
-form the roof of the carpal tunnel
115
Flexor digitorum superficialis (intermediate)
-comprised of 4 tendons, one for each finger
-origin: line running from the medial epicondyle, across the coronoid process of the ulna and to a line on the anterior radius
-insertion: middle phalanx of each finger
-innervated by the median nerve
-flexion of the wrist, flexion of the metacarpal-phalangeal joint, and flexion of the proximal-interphalangeal joint
116
Flexor pollicis longus (deep)
-origin: middle part of the radius and interosseous membrane
-insertion: base of distal phalanx of the thumb
-flexes the thumb
117
Flexor digitorum profundus (deep)
-origin: proximal third quarter of the ulnar shaft and interosseous membrane
-insertion: distal interphalangeal joints of each finger (goes through split of superficial tendons that run here)
-deep muscle that flexes fingers
118
Pronator Quadratus (deep)
-rectangular muscle
-origin: on the ulna
-insertion: on the radius
-innervated by both median and ulnar nerve
-pronates and supinates the wrist
119
The carpal tunnel
-formed by the concavity of the wrist bones and by the flexor retinaculum bridging across the top
-structures that do not pass through: palmaris longus tendon, flexor carpi ulnaris tendon, ulnar nerve and artery, radial artery, and flexor carpi radialis tendon
-structures that do pass through: flexor digitorum superficialis tendons (4), flexor digitorum profundus tendons (4), flexor pollicis longus tendon, median nerve
120
Carpal tunnel labelling
-on page 79
121
Posterior forearm muscles (extensor group)
-superficial group
-deep group
122
Superficial group (posterior)
-brachioradialis
-extensor carpi radialis longus
-extensor carpi radialis brevis
-extensor digitorum and extensor digiti minimi
123
Brachioradialis (superficial)
-origin: supracondylar ridge
-insertion: styloid process of the radius
-innervated by the radial nerve
-flexes the elbow joint (exception of the group)
124
Extensor carpi radialis longus (superficial)
-origin: CEO
-insertion: base of the second metacarpal
-innervated by the radial nerve
-extends the wrist on radial side
125
Extensor carpi radialis brevis (superficial)
-origin: CEO
-insertion: base of third metacarpal
-innervated by radial nerve
-extend and abducts the wrist
126
Extensor digitorum and extensor digiti minimi (superficial)
-origin: CEO
-insertion: back of each distal phalanx
-innervated by radial nerve
-extensor of all 4 fingers
127
Common extensor hoods
-run along the posterior of each finger and all of the extensor muscles insert onto them
-extension is all or nothing
128
Extensor carpi ulnaris (superficial)
-origin: CEO
-insertion: base of fifth metacarpal
-innervated by radial nerve
-extends and adducts the wrist
129
Deep group (posterior)
-supinator
-the outcropping muscles (abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, extensor indicis)
130
Supinator (deep)
-origin: back of the radial notch of the ulna and the lateral epicondyle
-insertion: lateral side of the radius
-low resistance supination
131
Abductor pollicis longus (outcropping)
-origin: ?
-insertion: base of first metacarpal
-abducts
132
Extensor pollicis brevis (outcropping)
-origin: ?
-insertion: base of the proximal phalynx of the thumb
-extends
133
Extensor pollicis longus (outcropping)
-origin: distal to abductor pollicis
-insertion: posterior distal phalanx of the thumb
-extends
134
Extensor indicis (outcropping)
-origin: next to the short extensor of the thumb
-insertion: extensor expansion of the index finger
-extends
135
Anatomical snuff box
-when u pull back thumb into hitchhiker position, there is a hollow space between the tendons of the extensor pollicis longus and brevis
136
The joints of the forearm
-proximal
-middle
-distal
137
Proximal joint of the forearm
-the synovial joint between head of the radius and the radial notch of the ulna
-head of radius rotates in radial notch
-held in place by the annular ligament
-this allows pronation and supination
138
Middle joint of the forearm
-the interosseous membrane
-holds radius to the ulna
139
Distal joint of the forearm
-synovial joint that pivots when the head of the ulna rotates in the ulna notch of the radius
-this is held in place by an articular disc
-this allows for pronation and supination
140
The wrist joint
-biaxial, synovial joint
-flexion, extension, abduction, adduction and circumduction
-distal radius articulates with the scaphoid and lunate bones
-ulna is separated from the carpal bones via a disc
-medial and lateral collateral ligaments and palmar and dorsal radiocarpal ligaments hold it together
-innervated by the median, ulnar and radial nerves
141
Muscles of the hand
-thenar muscles
-hypothenar muscles
-lumbrical muscles
-interossei and adductor pollicis
142
Thenar muscles
-abductor pollicis brevis
-flexor pollicis brevis
-opponens pollicis
143
Abductor pollicis brevis (thenar)
-origin: scaphoid bone and flexor retinaculum
-insertion: outside of the proximal phalanx of the thumb
-innervated by median nerve
-abducts
144
Flexor pollicis brevis (thenar)
-origin: flexor retinaculum and trapezium
-insertion: base of the proximal phalanx
-innervated by median nerve
-flexes
145
Opponens pollicis
-origin: distal flexor retinaculum and trapezium
-insertion: side of the metacarpal (thumb)
-innervated by median nerve
-opposition (touch each finger tip with your thumb)
146
Hypothenar muscles
-abductor digiti minimi
-flexor digiti minimi brevis
-opponens digiti minimi brevis
147
Abductor digiti minimi
-origin: pisiform and the hook of the hamate
-insertion: medial side of the proximal phalanx
-innervated by ulnar nerve
-abducts
148
Flexor digiti minimi brevis
-origin: pisiform and the hook of the hamate
-insertion: lateral to the abductor digiti minimi
-innervated by the ulnar nerve
-flexes
149
Opponens digiti minimi brevis
-origin: flexor retinaculum and the hook of the hamate
-insertion: medial side of metacarpal 5
-innervated by the ulnar nerve
-does not perform opposition
150
Lumbrical muscles
-origin: thumb (lateral) side of all 4 tendons
-insertion: pass around lateral side of each finger and joins extensor expansion as it runs along the proximal phalanx
-medial 2 lumbricals are innervated by the ulnar nerve and the lateral 2 are innervated by the median nerve
-they flex the metacarpophalangeal joints and extend the interphalangeal joints
151
Adductor pollicis
-has an oblique head and a transverse head
-oblique head origin: capitate, trapezoid and adjoining metacarpals 2&3
-transverse head origin: shaft of the middle metacarpal
-insertions: medial sesamoid bone on the base of the proximal phalanx of the thumb
-innervated by the ulnar nerve
-adducts the thumb
152
Palmar interossei (3)
-origin: axial side of metacarpals 2, 4 and 5
-insertion: extensor expansion of their own digits
-innervated by ulnar nerve
-flex the MP joints and extend the IP joints
153
Dorsal interossei (4)
-origin: in the 4 spaces between the 5 metacarpals
-insertion: the 2 outer ones insert on index and ring fingers by the way of extensor expansion, and the middle 2 insert on each side of the middle finger (also on extensor expansion)
-innervated by the ulnar nerve
-abduct the fingers and flex the MP joints and extend the IP joints
154
Blood supply to the hand
-comes from radial and ulnar arteries
-superficial and deep palmar arches connect the 2 arteries together
155
Innervation of the hand
-labelling on page 95
156
Carpal joints of the hand
-carpal bones are joined to each other by synovial joints
157
Carpometacarpal joints of the hand
-only the articulation between the joint at the base of the thumb permits much movement (saddle joint between trapezium and metacarpal 1)
158
Metacarpal-phalangeal joints of the hand
-MP joint
-only permits flexion and extension
-each joint has a pair of collateral ligaments
159
Interphalangeal joints of the hand
-IP joints
-there are 9, 4 pairs in the fingers and 1 in the thumb
-have strong collateral ligaments preventing abduction and adduction
