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Flashcards in Upper Extremities Deck (54):
1

BOUNDARIES OF THE AXILLA
Anterior/Pectoral: (3)
Posterior/Scapular: (3)
Medial/Costal: (2)
Lateral/Humeral: (4)
Apex: (3)
Base
- Skin, subcutaneous fascia, axillary fascia

BOUNDARIES OF THE AXILLA
Anterior/Pectoral: (3)
- Pectoralis major
- Pectoralis minor
- Subclavius
Posterior/Scapular: (3)
- Subscapular
- Teres major
- Latissimus dorsi
Medial/Costal: (2)
- 2nd to 6th rib and intercostal muscles
- Serratus anterior muscle
Lateral/Humeral: (4)
- Humerus
- Coracobrachialis
- Short head of biceps brachii
- Long head of biceps brachii
Apex
- Clavicle
- Scapula
- 1st rib
Base
- Skin, subcutaneous fascia, axillary fascia

2

CONTENTS OF THE AXILLA (3; covered by _____________, lateral prolongation of the _____________)

Axillary artery, axillary vein, brachial plexus
axillary fascia
prevertebral fascia

3

In doing the brachial plexus block:
The _________ part of the sheath is closed with finger pressure;
The syringe needle is inserted into the _________ part of the sheath and the anesthetic solution is injected;
Position is verified by feeling the pulsation of the ________ part of the _________ artery.

In doing the brachial plexus block:
the distal part of the sheath is closed with finger pressure;
the syringe needle is inserted into the proximal part of the sheath and the anesthetic solution is injected;
Position is verified by feeling the pulsation of the third part of the axillary artery.

4

Rotator Cuff Muscles: (4)

SITS:
Supraspinatus
Infraspinatus
Teres minor
Subscapularis

5

INTRINSIC MUSCLE(S) OF THE SHOULDER
Innervated by the suprascapular nerve

Infraspinatus, supraspinatus

6

INTRINSIC MUSCLE(S) OF THE SHOULDER
Innervated by the axillary nerve

Teres minor, deltoid

7

INTRINSIC MUSCLE(S) OF THE SHOULDER
Innervated by the upper subscapular nerve

Subscapularis

8

INTRINSIC MUSCLE(S) OF THE SHOULDER
Innervated by the lower subscapular nerve

Teres major

9

Initiator of abduction of the shoulder: ___________
Main abductor of the shoulder: __________

Supraspinatus
Deltoid

10

Nerve commonly injured in shoulder dislocation: __________
Actions compromised by the injury of this nerve: __________

Axillary nerve
Abduction, lateral rotation

11

Lateral rotators of the shoulder (2)

Infraspinatus, teres minor

12

Medial rotators of the shoulder (2)

Subscapularis, teres major

13

Weakest part of the shoulder: ___________
Dislocation of the shoulder joint when a sudden violence is applied to the humerus with joint fully abducted, tilting the humoral head downward into the weak part: _____________

Inferior (unprotected by muscles)
Anterior inferior dislocation

14

Most commonly inflamed tendon of the shoulder

Tendon of the supraspinatus

15

Boundaries of the QUADRANGULAR SPACE
Superior: __________
Inferior: _________
Medial: _________
Lateral: _________

Contents of the QUADRANGULAR SPACE: (2)

Boundaries of the QUADRANGULAR SPACE
Superior: Teres minor
Inferior: Teres major
Medial: Long head of triceps brachii
Lateral: Surgical neck of the humerus

Axillary nerve (circumflex nerve)
Posterior circumflex humeral vessels

16

BOUNDARIES of the TRIANGULAR SPACE
Superior: ___________
Inferior: __________
Lateral: __________

Content of TRIANGULAR SPACE:

BOUNDARIES of the TRIANGULAR SPACE
Superior: Teres minor
Inferior: Teres major
Lateral: Long head of the triceps brachii

Circumflex scapular vessels

17

ANTERIOR COMPARTMENT of the ARM
Muscles: (3)
Innervation: __________
Main flexor of the forearm: ___________
Flexor and main supinator of the forearm: ____________
Adductor and flexor of the arm: ____________

Coracobrachialis
Biceps brachii
Brachialis

Musculocutaneous nerve

Main flexor of the forearm: Brachialis
Flexor and main supinator of the forearm: Biceps brachii
Adductor and flexor of the arm: Coracobrachialis

18

POSTERIOR COMPARTMENT of the ARM
Main extensor of the forearm: ____________
Innervation: ____________

POSTERIOR COMPARTMENT of the ARM
Main extensor of the forearm: Triceps brachii
Innervation: Radial nerve

19

FLEXOR MUSCLES of the FOREARM
All are innervated by the ___________ except
____________ and ____________ which are innervated by the ___________.
Common flexor tendon: _______________

median nerve
FCU (flexor carpi ulnaris) and FDP-medial (flexor digitorum profundus)
ulnar nerve
Medial epicondyle of the humerus

20

EXTENSOR MUSCLES of the FOREARM
All are innervated by the ___________.

Common extensor tendon: __________

radial nerve
Lateral epicondyle of the humerus

21

Golfer's elbow = ____________ epicondylitis
Tennis elbow = ____________ epicondylitis

Medial
Lateral

22

Inability to supinate the forearm could result from injury to which of the following nerves?
A. Musculocutaneous and median
B. Musculocutaneous and radial
C. Median and ulnar
D. Radial and median

Musculocutaneous and radial

23

If you are planning to draw sample of blood from the brachial artery, you should insert the needle:
A. Just lateral to the biceps tendon in the cubical fossa
B. Just medial to the biceps tendon in the cubical fossa

Just medial to the biceps tendon in the cubical fossa

24

CUBITAL FOSSA
Contents (from medial to lateral): 4

Boundaries
Lateral: __________
Medial: __________
Superior: __________
Floor: __________

Median nerve
Brachial artery
Biceps brachial tendon
Radial nerve

Boundaries
Lateral: Brachioradialis
Medial: Pronator teres
Superior: Horizontal line connecting the epicondyle of the humerus
Floor: Brachialis, supinator

25

THENAR MUSCLES: (3)
Innervated by the _____________

AFO:
Abductor policies brevis
Flexor pollicis brevis
Opponens pollicis

median nerve

26

HYPOTHENAR MUSCLES: (3)
Innervated by the _____________

AFO:
Abductor digiti minimi
Flexor digiti minimi
Opponens digiti minimi

ulnar nerve

27

INTRINSIC MUSCLES OF THE HAND
Adducts fingers: ___________
Abducts fingers: ___________
Flexes MCP joints: __________
Innervated by the radial nerve: ___________

INTRINSIC MUSCLES OF THE HAND
Adducts fingers: Palmar interossei
Abducts fingers: Dorsal interossei
Flexes MCP joints: Lumbricals
Innervated by the radial nerve: Extensor digitorum

28

EXTRINSIC MUSCLES OF THE HAND
Flexor digitorum superficialis - flexes the __________; innervated by the _____________
Flexor digitorum profundus - flexes the __________; innervated by the _____________

Proximal IP joints
median nerve

Distal IP joints
median and ulnar nerves

29

INNERVATIONS
Rhomboids: ____________
Serratus anterior: ____________
Supraspinatus, infraspinatus: _____________
Pectoralis major: ____________
Coracobrachialis, biceps brachial: _______________
Pectoralis minor: _____________
Subscapularis: _______________
Latissimus dorsi: ________________
Teres major: ___________
Deltoid, teres minor: ____________

Rhomboids: Dorsal scapular
Serratus anterior: Long thoracic (THINK: SALT)
Supraspinatus, infraspinatus: Suprascapular
Pectoralis major: Lateral pectoral
Coracobrachialis, biceps brachial: Musculocutaneous
Pectoralis minor: Medial pectoral
Subscapularis: Upper subscapular
Latissimus dorsi: Thoracodorsal
Teres major: Lower subscapular
Deltoid, teres minor: Axillary

30

BRANCHES
____________ - deltoid and teres minor
____________ - anterior/flexor compartment of the arm
____________ - posterior/extensor compartment of the forearm
____________ - anterior/flexor compartment of forearm except FCU and FDP-medial
____________ - hypothenar muscles, interossei

Axillary nerve
Musculocutaneous nerve
Radial nerve
Median nerve
Ulnar nerve

31

TENDON REFLEXES and ROOTS tested
Biceps brachii: C5 (and C6)
Brachioradialis: C6 (and C5, C7)
Triceps brachii: C7 (and C6, C8)

Biceps brachii: C5 (and C6)
Brachioradialis: C6 (and C5, C7)
Triceps brachii: C7 (and C6, C8)

32

____________ Syndrome
- C5, C6 injured
- proximal musculature in the upper limb mainly affected
- "__________" position; arm is adducted, extended and medially rotated, forearm pronated, carpal flexors flex the hand at the wrist
- altered sensation in ____________ arm, forearm, thumb, and index finger

Erb-Duchenne
waiter's tip
lateral

33

Each trunk of the brachial plexus divides into anterior and posterior divisions. The posterior cord is formed from the union of what structures?

Posterior divisions of all three trunks

34

Klumpke's paralysis
- results form compression of ________
- distal MUSCLES of the upper limb affected
- altered sensation of the _______ hand, ring, and little finger
- weakness of the intrinsic muscles of the hand -- combination of an "ape hand" and "claw hand"

C8, T1
medial

35

Contents of Carpal Tunnel: (10)
Symptoms of Carpal Tunnel Syndrome:
NOTE: There is no paresthesia over the thenar eminence because because this area is supplied by the palmar cutaneous branch of the median nerve which passes superficially to the flexor retinaculum.

4 tendons of the FDS (flexor digitorum superficialis)
4 tendons of the FDP (flexor digitorum profundus)
tendon of the FPL (flexor pollicis longus)
median nerve

Burning pain or "pins and needles" along the distribution of the median nerve to the lateral three and a half fingers and weakness of the thenar muscles

36

MUSCLES CONNECTING THE UPPER EXTREMITIES TO THE THORAX
Muscle -- Innervation -- Action
Pectoralis major -- _________ -- _________
Pectoralis minor -- _________ -- _________
Subclavius -- _________ -- _________
Serratus anterior -- __________ -- _________

Muscle -- Innervation -- Action
Pectoralis major -- Medial and lateral pectoral nerves -- Adducts arm and rotates it medially
Pectoralis minor -- Medial pectoral nerve -- Depresses point of shoulder
Subclavius -- Nerve to subclavius -- Depresses the clavicle
Serratus anterior -- Long thoracic nerve -- Draws the scapula forward

37

The axillary artery is the continuation of the __________ artery from the first rib to the lower border of the teres major.
The tendon of the ________ divides the axillary artery into three parts:
- 1st part: ________ - supplies muscles of the first two intercostal spaces
- 2nd part:
---- Lateral pectoral nerve
---- Thoracoacromial - branches: (4)
- 3rd part: _______- supplies subscapularis, teres major, and latissimus dorsi
---- branches: thoracodorsal artery, circumflex scapular artery, anterior circumflex humeral, posterior circumflex humeral

subclavian
pectoralis minor

pectoral, acromial, deltoid, clavicular

superior thoracic artery

38

The radial artery begins in the cubital fossa at the level of the _____________.
Site for taking the radial pulse:
____________ on its lateral side
____________ on its medial side

radial neck
tendon of brachioradialis
tendon of FCR (flexor carpi radialis)

39

PALPATION OF THE ARTERIES OF THE UPPER LIMB
Subclavian artery - can be palpated in the root of the posterior triangle of the neck as it crosses the ___________
Axillary artery (3rd part) - can be palpated in the axilla as it lies in front of the ___________
Brachial artery - can be palpated in the arm it lies on the __________ and is overlapped from the lateral side by the __________

first rib
teres major
brachialis
biceps brachii

40

The first bone to begin ossification during fetal development but the last one to complete ossification at about age 21.
Most commonly fractured bone
Its medial 2/3 is convex forward, lateral 1/3 is flattened.
Weakest point: Junction of middle 2/3 and lateral 1/3 (junction between 2 curvatures) and hence is the most vulnerable part to fracture.
Medial segment is pulled by the _______.
Lateral segment displaced downward by gravity and pull of _________ and ________.

Clavicle
SCM
deltoid, pectoralis major

41

HUMERAL FRACTURES and injured NERVES/ARTERIES
Surgical neck of the humerus: ________, posterior circumflex artery
Supracondylar ridge: ________
Midshaft / Spiral groove: _________, profundus brachial artery
Medial epicondyle: _________

Surgical neck of the humerus: axillary nerve, posterior circumflex artery
Supracondylar ridge: median nerve
Midshaft / Spiral groove: radial nerve, profundus brachial artery
Medial epicondyle: ulnar nerve

42

Fall on an outstretched hand
Fracture?
Displacement?

Fall on the back of hand
Fracture?
Displacement?

Colles / dinner / silver fork fracture
Distal segment displaced posteriorly and superiorly, distal radial radial fracture; fragment dorsally placed

Smith's fracture
Distal segment displaced anteriorly

43

Most commonly fractured carpal bone

Scaphoid

44

Most commonly displaced carpal bone (typically displaced anteriorly)

Lunate

45

ANATOMICAL SNUFFBOX
Lateral: ________
Medial: ________
Floor: ________
Trapezium

Lateral: tendons of the EPB and abductor PL
Medial: tendon of EPL
Floor: scaphoid
Trapezium

46

_______________ contracture
- localized thickening and contracture of the ______________
- ring finger draws into the palm then little finger
- flexion of ______ interphalangeal joints

Dupuytren's
palmar aponeurosis
proximal

47

Fracture when the thumb is forcefully abducted.
Fracture of the base of the _____________

Bennett's fracture
first metacarpal bone

48

Boxer's fracture
- oblique fracture of the necks of the ________________

fourth or fifth metacarpals

49

_____________ Nerve
- Supracondylar fractures
- Hand of benediction
- Carpal Tunnel syndrome

Median

50

__________ Nerve
- Medial epicondyle fractures
- Wrist abduction during wrist flexion
- Medial "clawing"

Ulnar

51

DERMATOMES
Back of head:
Tip of shoulder:
Thumb:
Middle finger:
Small finger:
Nipple:
Umbilicus:
Inguinal:
Knee, medial leg:
Lateral leg, big toe:
Small toe:
Perineum:

DERMATOMES
Back of head: C2
Tip of shoulder: C5
Thumb: C6
Middle finger: C7
Small finger: C8
Nipple: T4
Umbilicus: T10
Inguinal: L1
Knee, medial leg: L4
Lateral leg, big toe: L5
Small toe: S1
Perineum: S5

52

Landmark for the axillary lymphatic vessels: _______
Level I - anterior/pectoral LN, posterior/scapular LN, lateral/humeral LN
Level II - central LN
Level III - apical LN

Lymphatic vessels drain into the:
- Thoracic duct
- Right lymphatic duct (R side of the head and neck, R side of the thorax, R upper limb)

Pectoralis minor

53

If deep tissue of the hand are infected, which of the following group of lymph nodes will commonly be the first to react to lymphatic dissemination of the infection?
A. Anterior axillary
B. Lateral axillary

Lateral axillary

54

Brachial artery is the main arterial supply of the arm, it begins at the __________________________ and divides to become ulnar and radial artery at the level of the ________________ in the antecubital fossa. Source: Moore Clinically Oriented Anatomy 4th ed.

inferior border of teres major
neck of radius