Overview of Upper Extremity Flashcards
1
Q
What are the Divisions of the Upper Extremity
A
- Pectoral Girdle/Shoulder
- Axilla (Armpit)
- Arm (Brachium): between shoulder and elbow
- Cubital fossa: anterior aspect of elbow
- Forearm (Antebrachium): between elbow and wrist
- Wrist (Carpus)
- Hand (palmar and dorsal aspects) (Note: the thumb is lateral and the pinkie is medial)
2
Q
What is the Osteology of the Upper Extremity
A
Includes: clavicle, scapula, humerus, ulna (medial bone of forearm), radius (lateral bone of forearm), 8 carpals (proximal row: scaphoid, lunate, triquetrum, pisiform; distal row: trapezium, trapezoid, capitate, hamate), 5 metacarpals (proximal part is the base, distal part is the head), 14 phalanges (proximal, middle, distal; the pollex (thumb) has a proximal and distal phalanx only)
3
Q
Describe the Clavicle
A
- S-shaped bone that connects upper extremity to axial skeleton
- Acts as a strut to hold upper limb in a lateral position
4
Q
Describe the Scapula borders, angles, processes, and notches.
A
Borders: Superior, Medial, and Lateral Borders
Angles
- Superior angle (superomedial corner)
- Inferior angle (inferomedial corner)
Processes
- Coracoid process (anterior projection)
- Spine of the scapula (posterior ridge)
- Acromion process (projection at lateral end of scapular spine)
Suprascapular notch
- on superior border
- Superior transverse scapular ligament spans the notch to form a foramen for the passage of the suprascapular nerve
5
Q
Describe the Scapula fossae
A
- Supraspinous fossa (posterior surface, superior to spine of scapula)
- Infraspinous fossa (posterior surface, inferior to spine of scapula)
- Subscapular fossa (anterior surface, faces ribs)
- Glenoid cavity (lateral surface, articulates with head of humerus)
6
Q
Describe the Head, neck, and tubercles of the Humerus
A
Head (articulates with glenoid cavity of scapula)
Tubercles and associated structures
- Greater tubercle (lateral)
- Lesser tubercle (anterior)
- Intertubercular (bicipital) groove: Houses the tendon of the long head of biceps brachii
Necks
- Anatomical neck between head and tubercles
- Surgical neck between tubercles and shaft (body)
7
Q
Describe other features of the Humerus
A
- Deltoid tuberosity (lateral prominence on proximal humeral shaft)
- Medial Epicondyle (medial protuberance of distal humerus)
- Lateral Epicondyle (lateral protuberance of distal humerus)
- Capitulum (ball shaped structure on distal humerus; articulates with radial head)
- Trochlea (spool shaped structure on distal humerus; articulates with proximal ulna)
- Radial groove (on posterior shaft; oblique groove for radial nerve & deep artery of the arm)
8
Q
Describe the Radius & Ulna
A
Radius (lateral bone of forearm)
-Radial tuberosity (proximal end; anteromedial surface)
Ulna (medial bone of forearm)
- Olecranon process (most proximal part of bone)
- Ulnar tuberosity (proximal end; anterior surface)
9
Q
Describe the Sternoclavicular (SC) Joint
A
- Synovial joint between the clavicle and the manubrium of sternum
- Allows the clavicle to move anterior/posterior and superior/inferior
10
Q
Describe the Acromioclavicular (AC) Joint
A
- Synovial joint between the clavicle and the acromion of scapula
- Allows the acromion to rotate on the clavicle
11
Q
Describe the Scapulothoracic (ST) Joint
A
- Not a true anatomic joint (no synovial tissue, no osseous connection)
- It is a functional joint, permitting movement
- Refers to the movement of the scapula on the thoracic wall
12
Q
Describe the Movements of the Scapula
A
- Elevation moves the scapula superiorly
- Depression moves the scapula inferiorly
- Retraction draws the scapula posteriorly, such that the medial borders of the two scapulae are drawn together
- Protraction draws the scapula anteriorly, such that the medial borders of the two scapulae are pulled apart
- Upward rotation directs the surface of the glenoid cavity superiorly
- Downward rotation directs the surface of the glenoid cavity inferiorly
13
Q
Describe the Glenohumeral (GH) Joint
A
- Head of the humerus articulates with the glenoid cavity of the scapula
- Ball and socket synovial joint with a wide range of motion
- Flexion moves the upper extremity (UE) anteriorly
- Extension moves the UE posteriorly
- Abduction draws the UE away from the midline of the body
- Adduction draws the UE towards the midline of the body
- Medial and lateral rotation-humerus rotates around its long axis
14
Q
Describe the Scapulohumeral Rhythm
A
- Movements of the SC, AC, and ST joints are all coordinated with movements of the glenohumeral joint to produce a full range of motion.
- Every 2 degrees of glenohumeral motion is associated with 1 degree of scapulothoracic movement (occurring as combined actions of the SC, AC, & ST joints).
15
Q
Describe the Elbow Joint
A
- Distal humerus articulates with the proximal radius and ulna
- Hinge synovial joint
- Flexion brings the forearm closer to the anterior aspect of the arm
- Extension draws the forearm away from the anterior aspect of the arm
16
Q
Describe the Proximal and Distal Radioulnar Joints
A
- Synovial joints (ulna is stable, the radius rotates)
- Supination directs the palmar surface of the hand anteriorly (palm anterior; anatomical position)
- Pronation directs the palmar surface of the hand posteriorly (palm posterior)
17
Q
Describe the Wrist (Radiocarpal) Joint
A
- Synovial joint between the distal radius, articular disc, and 3 out of the 4 proximal carpals (scaphoid, lunate, and triquetrum); the distal ulna does not contribute to this joint; the fibrocartilaginous articular disc lies between the distal ulna and the proximal row of carpals
- Flexion brings the palm of the hand closer to the anterior aspect of the forearm
- Extension draws the palm away from the anterior aspect of the forearm
- Abduction (radial deviation) draws the hand away from the midline of the body
- Adduction (ulnar deviation) draws the hand towards the midline of the body
18
Q
Describe the Carpometacarpal (CMC) Joints
A
- Synovial joints between the carpals and the metacarpals
- Movement of the thumb primarily occurs at this joint
- Extension of thumb (draws thumb lateral to the palmar surface of the hand)
- Flexion of thumb (draws thumb medially across the palmar surface of the hand)
- Abduction of the thumb (draws thumb anterior to the palmar surface of the hand)
- Adduction of the thumb (draws thumb back from abduction)
- Opposition of the thumb (draws thumb to bring the tip toward tip of the pinkie)
- Reposition of the thumb (returns to anatomical position)
19
Q
Describe the Metacarpophalangeal (MCP) Joints
A
- Synovial joints between the metacarpals and the proximal phalanges
- Extension of fingers (away from the palmar surface of the hand)
- Flexion of fingers (towards the palmar surface of the hand)
- Abduction of the fingers (away from a line passing through the third digit)
- Adduction of the fingers (towards a line passing through the third digit)
20
Q
Describe the Interphalangeal (IP) Joints
A
- Hinge synovial joints between the phalanges
- Proximal interphalangeal joints (PIPs): between proximal & middle phalanges
- Distal interphalangeal joints (DIPs): between middle & distal phalanges
- The pollex has a single IP joint between its proximal & distal phalanges
- Flexion of fingers (towards the palmar surface of the hand)
- Extension of fingers (away from the palmar surface of the hand)
21
Q
What are the Fascia of the Upper Extremity?
A
- Superficial fascia: Contains: fat, cutaneous nerves, superficial veins, lymphatic vessels, lymph nodes
- Deep fascia: Dense connective tissue (very strong)
22
Q
Describe the Deep fascia of the Upper Extremity
A
- Dense connective tissue (very strong)
- Includes the following subdivisions: pectoral fascia, deltoid fascia, axillary fascia, brachial fascia, antebrachial fascia, palmar fascia (with central thickening called the palmar aponeurosis)
- In the arm, the brachial fascia gives rise to two septa that divide the arm into 2 compartments: anterior and posterior
- In the forearm, the antebrachial fascia gives rise to a septum; this septum and the interosseous membrane divide the forearm into 2 compartments: anterior and posterior
- Near the wrist joint, the antebrachial fascia forms flexor and extensor retinacula; these bands keep the tendons in place
23
Q
Describe Veins of the Upper Extremity
A
- There are superficial and deep veins in the upper extremity
- The deep veins parallel the arteries, and we will study these in subsequent labs
- There are perforating veins connecting the superficial and deep veins
24
Q
What are the Superficial veins of the Upper Extremity?
A
- Dorsal venous network (on dorsal aspect of the hand)
- Cephalic vein
- Basilic vein
- Median cubital vein (site of venipuncture)
25
Describe the Cephalic vein
- Arises from the lateral aspect of the dorsal venous network
- Travels along the lateral aspect of the forearm and arm
- Enters the deltopectoral triangle (space between deltoid, pectoralis major, and the clavicle) and drains into the axillary vein
26
Describe the Basilic vein
- Arises from medial aspect of the dorsal venous network
- Courses along the medial aspect of the forearm and arm
- Joins the brachial veins to form the axillary vein
27
Describe the Median cubital vein (site of venipuncture)
- Arises from the cephalic vein
- Crosses superficial in the cubital fossa
- Empties into the basilic vein
- A common variation: median antebrachial vein, which divides into median cephalic and median basilic veins (important to know about this variation as venipuncture is common in this region)
28
Describe Superficial Lymphatics of the Upper Extremity
- Superficial lymphatic vessels accompanying the cephalic vein first drain into deltopectoral or axillary lymph nodes (note: if drainage is first to the deltopectoral nodes, the lymph then drains to the axillary nodes)
- Superficial lymphatic vessels accompanying the basilic vein first drain into the cubital lymph nodes, then drain into the axillary lymph nodes
29
Describe Deep Lymphatics of the Upper Extremity
- Deep lymphatic vessels accompany deep veins & drain into the axillary lymph nodes
- Inflammation of the axillary lymph nodes may indicate infections/pathologies in the upper extremity, but they are also a site for metastasis of breast cancer (recall that superficial tissues superior to the umbilicus drain towards the axillary lymph nodes)
30
Describe the Brachial Plexus
- Network of nerves in the neck and axilla that gives rise to the motor and sensory nerves of the upper extremity (including the pectoral region)
- Formed by the ventral rami of C5-T1
- We will study the brachial plexus in more detail during the Axilla/Arm lab
31
Describe Dermatomes of the Upper Extremity
Note the distribution of the dermatomes associated with the upper extremity (although there are two dermatome maps in use, note the general trend: superior cervical levels (e.g., C4-C5) near shoulder and inferior cervical levels (e.g., C6-C8) in hand)
