What is a very important anchoring spot for the upper extremity?
Sternoclavicular joint
Where is a good place to listen for breath sounds?
Triangle of auscultation
Cephalic vein runs with biceps brachii and goes through ?
clavipectoral triangle
What is another name for the upper arm?
Brachium
What is another name for the forearm?
Antebrachium
What is the name of the notch between the superior angle and coracoid process?
suprascapular notch
What ligament covers the suprascapular notch?
Superior Transverse scapular ligament
What two structures are at the suprascapular notch and do they run above or below the ligament?
suprascapular artery goes over, suprascapular nerve goes under
Where does the biceps tendon attach proximally?
supraglenoid tubercle
Where does the triceps tendon attach proximally?
Infraglenoid tubercle
What muscle is responsible for holding the humerus in the socket?
Supraspinatus
Which ligament connects two structures on the same bone?
coracoacromial ligament
What are the bony structures of the shoulder?
Clavicle,scapula and proximal end of the humerus
What are the joints of the shoulder?
sternoclavicular, acromioclavicular, glenhumeral and scapulothoracic
What does the transverse humeral ligament cover
greater and lesser tubercles
What does the costoclavicular ligament connect?
rib and clavicle
Where does the interclavicular ligament run?
over sternal notch between clavicles
What are the static stabilizers of the GH joint?
joint capsule/labrum,joint cohesion,geometry of humerus,/glenoid, coracohumeral ligament and coracoacromial ligament
Do static stabilizers need neural innervation or muscular innervation to do their job?
NO
What are dynamic stabilizers of the GH?
SITS, Movers of GH joint: pec major lats LH biceps Triceps Delts Teres Major,
Do the dynamic stabilizers needs neural and muscular innervation to do their job?
YES
What is another name for the middle subscapular nerve?
Thoracodorsal nerve
What structures can you find in the quadilateral space?
axillary nerve and posterior circumflex humeral
What are the borders for the Quadlateral space?
Teres Minor, Teres Major, Long Head of triceps and Humerus
What can you find in the Triangular space?
Circumflex scapular artery
What are the borders for the triangular apace?
Teres major, teres minor and long head of triceps
What structures can be found in the triangular interval?
Radial nerve and profuna(deep) brachial artery
What are the borders for the triangular interval?
teres major, long head of triceps and lateral triceps
What is the name of the nerve, artery and vein that pops thru the costocoracoid membrane?
Lateral pectoral nerve, thoracoacromial artery and cephalic vein
How many branches does the thoracoacromial artery have and what are their names?
4; delto, pectoral, calvicular and acromial
Describe Scapular Movement
Keeps glenoid fossa and humeral head congruent, align the pull for shoulder muscles, increase ROM and reduce subluxation
What is the difference between the shoulder girdle and shoulder joint?
Girdle=shoulder structure
Joint=responsible for ROM
What are the bony structures of the shoulder?
Clavicle,Scapula and proximal head of humerus
What are the features of the SC joint?
Links between the upper limb and axial skeleton, ligaments(anterior/posterior SC, interclavicular and costoclavicular)
What are the motions of the SC joint?
Protaction/retaction, Elevation/depression
What is the articulation of AC joint?
acromion and lateral end of the clavicle
What are the ligaments of the AC joint
coracoacromial and coracoclavicular
What is the function of the AC joint?
keep glenoid fossa aligned with humeral head, suspends UE from the trunk
What is action of the AC joint?
Rotation in anterior and posterior direction, spin and glides
Describe the differences between a type 1,2,3 injury of AC and CC joints?
Type 1: sprain of AC
Type 2: Tear of AC ligament
Type 3: Tear of AC and sprain or strain of another structure
What are the components of the Shoulder joint?
Glenoid humeral labrum, fibrous capsule, synovial membrane
What are the ligaments of the Glenhumeral joint?
Glenhumeral(superior, middle and inferior), Transverse humeral, coracohumeral and coracoacromial
List 3 features of the glenhumeral joint?
glenoid fossa only covers 1/2 of humeral head, lbarum deepens glenoid fossa by 50% and there are static and dynamic stabilizers
What are static stabilizers of the shoulder?
Geometry, joint capsule ligaments of glenhumeral joint
What is tonic reflex and contraction
low grade contraction holding girdle together, tonic is a consistent firing
Name 2 arteries of the posterior shoulder
Anterior and posterior circumflex humeral, suprascapular
Which nerve projects medial to the pec minor muscle?
Lateral pectoral nerve
Name the three structures that pop out of the costocoracoid membrane
cephalic vein, thoracacromial artery and lateral pectoral nerve
What are the boundaries of the Axilla region
1st rib, armpit, superior border of the pec minor, subscapularis, teres major and lats
What are the boundaries for the axillary artery?
First Rib, Coracoid process, Pectoralis Minor ad teres major
What artery does the long thoracic nerve run with?
Lateral Thoracic artery
What are the roots that contribute to the brachial plexus?
C5-C8, T1
What rami forms the trunks of the brachial plexus?
Ventral Rami
The trunks divide to form what?
Divisions
How are the cords of the brachial plexus named and what are the names?
In relation to the axillary artery, lateral posterior and medial
What do the cords turn into?
Terminal Branches
What two nerve come off of the “roots” section of the brachial plexus?
Dorsal Scapular and Long thoracic
What two nerves radiate off the “trunks” section of the brachial plexus?
Suprascapular and nerve to subclavis
What comes off the “divisions” section of the brachial plexus?
Nothing
There are seven nerves that come off of the “cords” section, what are they?
Lateral Pectoral, Upper Subscapular, middle subscapular, lower subscapular, medial pectoral, medial brachial cutaneous and medial ante-brachial cutaneous
Name the terminal branches of the Brachial Plexus?
Musculocutaneous, axillary nerve, Radial Nerve, Median Nerve and Ulnar Nerve
What are supraclavicular nerves?
Dorsal scapular, long thoracic, nerve to subclavius and suprascapular
What are the nerves that are considered infraclavicular?
Lateral Cord, Medial Cord and posterior cord
What nerve roots contribute to the lateral cord?
C5-C7
What are the nerve roots for the Medial Cord?
C8-T1
What are the nerve roots for the posterior cord?
C5-T1
What nerves come off of the lateral cord?
Lateral Pectoral nerve, Musculocutaneous and Lateral root to median nerve
What nerves come off of the posterior cord?
Upper subscapular, middle subscapular, lower subscapular, axillary nerve and radial nerve
What nerves come off of the medial cord?
Medial root of the median nerve, Medial pectoral, medial brachial cutaneous, medial antebrachial cutaneous and ulnar nerve
What is the nerve called that connects the lateral and medial pectoral nerves?
Communicating branch
What nerves are affected is someone is said to have Waiters tip position?
Suprascapular, axillary and musculocutaneous
Describe the nerve path of the axillary nerve?
comes off the posterior cord travels through the Quadrilateral space and innervates the deltoid and trees minor muscles and the innervates superficially at the regimental badge
Describe the nerve path of the Radial Nerve
Comes of the posterior cord travels down the posterior arm can be seen in the triangular interval. Innervates the tricep muscles, brachioradialis, ECRL,ECRB,Supinator,APL, EPB,EPL,Anconeus,ED,EDM,ECU,Ext Indicis. Then goes to the dorsum of the hand to thumb, 2nd digit, 3rd digit and half of 4h digit
Does the radial nerve branch anywhere? If so where and what are the branches names?
Yes, At the supinator muscle, superficial radial and deep radial(which after supinator is posterior interosseuos)
What is the name of the groove that the radial nerve runs thru?
Radial groove
Describe the path of the Musculocutaneous nerve
Comes off the lateral cord and dives into the coracobrachialis. Innervates the coracobrachilais, biceps brachii and the brachialis. Crosses the elbow and becomes the lateral anterbrachial cutaneous nerve.
Describe the Nerve pathway of the Ulnar nerve
Ulnar nerve comes off the medial cord, travels posterior medially down the arm and goes through the cubital tunnel. Does not do anything in arm, passes down the ulnar side of the arm, innervates the FDP and FCU, continues down to the hand under the palmer carpal ligament and over the flexor retinaculum travels between the pisiform and hook of hamate under pisohamate ligament, feeds 1/2 of 4th and 5th digits down plamer side and dorsal sides. In the Hand it also innervates the Palmer and dorsal interossei, 3&4 lumbricals, hypothenar muscles and adductor pollicis, flexor pollicis brevis deep.
Describe the pathway for the Median nerve
Median nerve comes off of the lateral and medial cords, it travels down the anterior arm next to the brachial artery, it doesn’t do anything in the arm except smpathetic innervation of the brachial artery, crosses through the cubital fossa then dives between the 2 heads of pronator teres where it splits into the median and anterior interosseus. The anterior interosseus ends at pronator quadratus and the median nerve continues down the arm into the wrist and hand.At wrist it flosses under flexor retinaculum with exception to the palmer branch that goes over the palmer carpal ligament. In the hand it innervates the lumbricals of digits 2,3(lumbricals 1&2), thenar muscles and the palm of the hand cutaneously.
Names the 3 veins of the arm
Cephalic, Basilic and median cubital
Which vein does the median cubital feed into?
Basilic
What does the cephalic and basilic feed into?
Axillary vein
What are the structures you can find in the cubital fossa?
Biceps brachii tendon, median nerve, Brachial artery, Medial and lateral cutaneous nerves and radial nerve
What is pronator teres syndrome?
Compression of the median nerve at the pronator teres
What nerve is affected with Carpal tunnel syndrome?
Median nerve
What functions or structures are affected with Carpal Tunnel?
weak flexion with Thumb digits 2&3, Lumbricals 1,2, thenar muscles and cutaneous innervation of the palm of the hand
What would you lose with pronator teres syndrome?
Pronation as well as lumbricals 1,2 thenar muscles and cutaneous innervation of the palm of the hand
What happens if you have compression of the median nerve at the shoulder?
unable to regulate temperature because there would not be innervation of the brachial artery
What are the bones of the hand?
Scaphoid, lunate, triquetrum, pisiform, hamate, capitate, Trapizoid and trapezium
In what structure can you see the cephalic vein and Radial Artery?
Anatomical Snuff box
Where do all the ligaments of the hand attach?
Capitate bone
What is the name of the ligament that runs from the pisiform to the hook of the hamate
pisohamate ligament
What is the roof of the carpal tunnel?
Flexor Retinaculum
What is the floor of the carpal tunnel?
Carpal bones
What happens with carpal tunnel?
the median nerve gets compressed because of a muscle imbalance(flexors strong, extensors weak), the flexors swell lessening the space causing compression of median nerve.
What is Guyon tunnel?
compression of the ulnar nerve between the pisiform and hamate bones
What would you lose with guyon tunnel?
lose cutaneous of hypothenars, 1/2 4 digit and 5th digit, dorsal and palmer interossei, adductor pollicis and compromised grasp