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DPT 720 Gross Anatomy I > Exam 1 > Flashcards

Flashcards in Exam 1 Deck (59):
1

Lateral Cervical Muscles

-sternocleidomastoid: two heads from sternum and clavicle then comes up at an angle to mastoid process
-scalenes: anterior, middle, posterior

2

Thoracic Outlet

-anterior scalene in front, middle scalene in back of triangle
-first rib cuts across bottom which together with above makes a tight triangular shape where a whole bunch of nerves (esp nerve roots) come through this space
-big scalenes means this space will be smaller which won't allow enough space for nerves to come through which can lead to thoracic outlet syndrome
-tested by having them take a deep breath and take pulse, if pulse disappears then they have it
-stretch out scalenes and push down on first rib and symptoms of numbness and tingling in arm go away

3

Brachial Plexus

-nerve complex of upper extremity
-roots, trunks, divisions, cords, branches
-paresthesia: any sensory other than normal
-ischemia: lack of blood flow

4

Roots

-C5, C6, C7, C8, T1
-exit intervertebral foramen (hole in between vertebrae)
-between anterior and middle scalene muscles

5

Trunks

-superior C5, C6
-middle C7
-inferior C8, T1

6

Divisions

-each trunk divides into anterior and posterior division
-through cervicoaxillary canal
-anterior divisions tend to go to anterior muscles (flexors)
-posterior divisions tend to go to posterior muscles (extensors)

7

Cords

-anterior divisions of superior and middle trunks to lateral cord
-anterior division of inferior trunk becomes medial cord
-posterior division of all three trunks form posterior cord
-cords are named by position to axillary artery

8

Branches from Roots

-dorsal scapular nerve C5 to rhomboids and occasionally levator scapula (no sensory component)
-long thoracic C5, C6, C7 to serratus anterior (no sensory component)

9

Branches from Superior Trunk

-suprascapular nerve C5, C6 to supraspinatus, infraspinatus GH joint capsule (no sensory component)
-subclavian nerve C5, C6 to subclavius, SC joint

10

Branches from Lateral Cord

-side branch from lateral cord: lateral pectoral nerve C5, C6, C7n to pectoralis major and some to pectoralis minor via branch to medial pectoral nerve
-musculocutaneous nerve C5, C6, C7 to coracobrachialis,biceps brachii, brachialis, cutaneous to skin of lateral forearm to wrist
-half of lateral cord turns into musculocutaneous and the other half into median nerve
-lateral root to median nerve-merges with medial root to median nerve from medial cord to anterior forearm muscles

11

Side Branch of Posterior Cord

-upper subscapular nerve C5 to superior subscapularis
-thoracodorsal nerve (middle subscapular) C6, C7, C8 to latissimus dorsi
-lower subscapular nerve C6 lower subscapularis and teres major

12

Branches from Posterior Cord

-axillary nerve C5, C6 to deltoid, teres minor, GH joint capsule, skin of superior lateral arm (over deltoid) which runs through quadrangular space
-radial nerve C5-T1 runs through triangular interval (anything on posterior surface of forearm)

13

Side Branches from Medial Cord

-medial pectoral nerve C8, T1 to pectoralis minor and sternal part of pectoralis major
-medial cutaneous nerve to arm C8, T1 cutaneous to medial side of arm to epicondyle of humerus
-medial cutaneous nerve to forearm C8, T1 medial side of skin of forearm to distal wrist

14

Branches from Medial Cord

-medial root to median nerve nerves with lateral root to median nerve
-ulnar nerve C8, T1 (C7) to many muscles
-ulnar has sensory in ulnar side of hand from pinky and half of 4th finger to wrist

15

Anterior Muscles of Upper Arm

-coracobrachialis
-brachialis
-biceps brachii: tendon goes into joint capsule=intracapsular

16

Triceps Brachii

-what divides lateral and medial heads is where radial nerve sits (the "groove") the radial nerve lies right on the bone splitting the heads

17

Quadrangular Space

-above: subscapularis and teres minor
-below: teres major
-medially: triceps
-laterally: shaft of humerus
-passage of axillary nerve and posterior humeral circumflex artery

18

Triangular Interval

-below quadrangular space
-superior: teres major
-medial: long head of triceps
-lateral: lateral head of triceps and humerus
-contents: radial nerve and deep brachial artery
-fracture in midshaft of humerus would affect radial nerve

19

Vascular Supply Upper Arm

-brachial artery: medial to humerus and biceps and brachialis along with median nerve
-deep artery of arm (profunda)-of brachial artery and runs posterior to humerus with radial nerve along radial groove
-humeral nutrient artery: off brachial artery and into humerus
-superior and inferior ulnar collateral arteries-off ulnar side of brachial

20

Nerves in Upper Arm

-musculocutaneous: off lateral cord, under pectoralis minor, pierces coracobrachialis to biceps, brachialis, then cutaneous to lateral forearm
-radial nerve: off posterior cord, behind humerus, along radial groove, into triceps, anconeus, anterior to elbow on lateral side and all muscles in posterior forearm (posterior upper, anterior to joint, posterior again)

21

Distal Humerus

-capitulum
-trochlea, trochlea notch
-medial condyle and epicondyle
-lateral condyle and epicondyle
-medial and lateral supracondylar ridges
-coronoid f0ssa
-olecranon fossa
-groove for ulnar nerve

22

Proximal Ulna

-coronoid process
-ulna tuberosity (brachialis insertion)
-olecranon process triceps insertion)
-radial notch of ulna (articulation with radial head)

23

Proximal Radius

-radial head
-radial neck
-radial tuberosity (biceps insertion)

24

Elbow Joint Complex

-3 joints in one joint capsule
-humeral ulnar joint
-humeral radial joint
-radial ulnar joint

25

Elbow Joint Capsule and Ligaments

-capsule surrounds all 3 joints
-anterior ligament: restricts hyperextension
-medial collateral ligament: restricts valgus force
-lateral collateral ligament: restricts varus force; lateral epicondyle to ulna and annular ligament
-annular ligament: surrounds radial head but does not attach; ulna, around radial head and attaches back to ulna; just holds radius down; restricts radial head from separating from ulna

26

Radial Notch of Ulna

-for radial head
-concavity in proximal part of ulna because convex part of radial head sits in there

27

Valgus vs. Varus Forces

-valgus: the part of the body distal to the deformed part is deviated away from the body/midline (i.e. is more lateral) (ulnar collateral ligament tension)
-varus:the part of the body distal to the deformed part is deviated toward the body/midline (i.e. is more medial) (radial collateral ligament tension)

28

Anterior Forearm Muscles

-flexors or pronators
-most muscles are either wrist flexors, forearm pronators or both
-exception is brachioradialis

29

Posterior Forearm

-extensors or supinators or both
-all muscles are radial nerve or branches of radial nerve innervated

30

Forearm Bones

-humerus
-radius
-ulna
-interosseous membrane: superior radius inferior and medial to ulna; thick CT that doesn't give much
-oblique cord: from ulna inferior and lateral to radius

31

Interosseus Membrane

-fibers mostly run inferior and medial to radius or superior and lateral to ulna
-helps to transfer forces to opposite sides (compression to bone to tension; tensile=pulling) through membrane to compression on the other bone again

32

Forearm Motions

-supination: palm up
-pronation: palm down
-occurs at proximal and distal radioulnar joints simultaneously (synovial joints, both must move simultaneously, if one doesn't move the other can't)
-always radius moving on ulna

33

Forearm Arteries

-brachial splits into radial and ulnar arteries
-common interosseous artery off ulnar artery
-splits into anterior and posterior interosseous arteries that lie on interosseous membrane
-IMPORTANT SLIDE

34

Anterior Forearm Veins

-superficial: basilic (medial vein of forearm, ulnar side, superficial, have no artery match), cephalic (radial side, superficial, have no artery match)
-deep: radial vein and ulnar vein

35

Anterior Forearm Nerves

-median: anterior interosseous nerve
-ulnar
-medial antebrachial cutaneous nerve (cutaneous means sensory only; comes off medial cord directly as do medial pectoral and medial cutaneous of upper arm)
-lateral antebrachial cutaneous nerve from musculocutaneous nerve
-test question: will suggest that fingers 4 and 5 of superficialis are innervated by ulnar nerve-->they're NOT it's radial nerve
-flexor carpi ulnaris and flexor digitorum profundus to fingers 4 and 5 are only muscles in anterior forearm that are ulnar nerve
-only one is radial nerve-->brachialis
-everything else is median nerve (covers fingers 1-3 and half of 4 in sensory palmar side as well as the tips of these fingers on the dorsal side)

36

PICTURES

-review pictures, especially innervation sensory schematics from notes
-pay special attention to slide 17 on forearm, extensor surface powerpoint

37

Superficial Posterior Forearm Muscles

-extensor carpi radialis longus off lateral supracondylar ridge
-all others off the lateral epicondyle of humerus
-what muscle attaches anteriorly on the greater tubercle of humerus--->none

38

Anatomical Snuffbox

-extensor pollicis longus, extensor pollicis brevis, and abductor pollicis tendons make up borders
-contents: scaphoid, trapezium, distal radius and base of first metacarpal are in base
-radial artery also inside
-sensory branch of radial nerve

39

Distal Radius and Ulna

-biconcave
-articulates with scaphoid laterally and lunate medially
-radial styloid on lateral side
-covered by TFCC
-distal ulna also has styloid on medial side
-triquetrum would sit right over ulna, but TFCC is in the way

40

TFCC

-triangular fibrocartilaginous complex
-ligament and central meniscus
-holds ulna to radius
-fibro part acts as shock absorber/cushion
-attaches to lateral side of ulna styloid and ulna side of radius
-also acts as a spacer

41

Distal Radioulnar Joint

-synovial
-concave distal radius moves on convex distal ulna
-held together by anterior and posterior distal radioulnar ligaments
-further stabilized by interosseous membrane and TFCC
-very hard to disrupt

42

Ulnomeniscal Triquetral Joint

-triangular fibrocartilaginous complex
-synovial joint

43

Wrist

-multiple joints in one joint complex
-proximal row on radius
-distal row on proximal row
-flexion/extension
-ulnar/radial deviation

44

Wrist Ligaments

-palmar complex: ligaments all over palmar side; taut with extension
-dorsal complex: ligaments going all over dorsal side; taut with flexion
-radial collateral taut with radial deviation
-ulnar collateral taut with ulnar deviation

45

Palmar Side Retinaculums

-palmar carpal ligament
-flexor retinaculum

46

Palmar Carpal Ligament

-superficial covering all the flexor tendons of wrist and hand, vascular supply and nerves on palmar side of wrist (superficial flexor tendons go under this except palmaris longus tendon)

47

Flexor Retinaculum

-thicker deeper ligament forming roof of carpal tunnel
-much tighter and deeper anchored on both sides than palmar carpal ligament
-anchored by pisiform, hook of hamate, scaphoid and trapezium
-carpal bones are arch shaped
-contents: tendons of flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus, median nerve
-note 2, 2, 4 configuration as these tendons go through tunnel; synovial sheath standard around FPL tendon but between other ones has 4 folds-->invagination (synovial invagination of the wrist)

48

Synovial Sheaths at Wrist

-two: radial and ulnar side sheaths (bursas)
-radial surrounds flexor pollicis longus tendon
-ulnar side folds around (invagination) flexor digitorum superficialis and flexor digitorum profundus tendons

49

Tunnel of Guyon

-ulnar nerve and artery goes through between pisiform and hook of hamate
-roof is flexor carpal ligament that goes over top

50

Extensor Compartments at Wrist

-extensor tendons held in place in compartments by extensor retinaculum
-each compartment surrounded by synovial sheath
-6 compartments numbered from radial to ulnar

51

Extensor Compartment 1

-abductor pollicis longus
-extensor pollicis brevis

52

Extensor Compartment 2

-extensor carpi radialis longus
-extensor carpi radialis brevis
-along radial side of lister's tubercle

53

Extensor Compartment 3

-extensor pollicis longus
-crosses compartment 2 but is on ulnar side of lister's tubercle

54

Extensor Compartment 4

-extensor digitorum (5 tendons)
-extensor indicis
-so 6 tendons in one sheath

55

Extensor Compartment 5

-extensor digiti minimi
-just to radial side of ulnar styloid

56

Extensor Compartment 6

-extensor carpi ulnaris
-just to ulnar side of ulnar styloid

57

Bones of the Hand

-sesamoid bones of hand
-numbers vary by individual
-most commonly found in tendons of adductor pollicis and flexor pollicis brevis
-much smaller and inconsistent

58

Ligaments of MCP and IP Joints

-ulnar and radial collateral ligaments; on each side of joints (resist varus and valgus forces)
-palmar ligaments: at all MCP (more lax because can abduct fingers) and IP joints, covered on palmar side by articular cartilage so flexor tendons can slide easily

59

Volar Plate of MCP and IP

-palmar ligaments that resist hyperextension
-covered in articular cartilage that lets tendons slide
-found in MCP and IP joints to reinforce capsules, enhances stability and limit hyperextension
-most MCP and IP ligaments are primarily irregular type 1 collagen