Upper Extremities (Bones, Axilla, Brachial Plexus) Flashcards
(114 cards)
1
Q
What bones make up the Shoulder Girdle? Are they part of the Appendicular or Axial Skeleton?
A
- Scapula
- Clavicle
Appendicular Skeleton
2
Q
What is the only Boney connection between the Appendicular Upper Limb Skeleton and the Axial Skeleton?
A
Connection between the Medial portion of the Clavicle and the Sternum
3
Q
What bones does the Clavicle attach to?
A
- Sternum on the Medial Side
2. Acromion Process of the Scapula on the Lateral Side
4
Q
What are the bones of the Upper Limb/Upper Extremity?
A
“RC HUMP”
- Radius (Forearm)
- Carpals (Wrist Bones)
- Humerus (Arm)
- Ulna (Forearm)
- Metacarpals (Hands)
- Phelanges (Fingers)
5
Q
Where on the Scapula does the Humerus articulate?
A
Glenoid Fossa
6
Q
Where on the Scapula does the Clavicle articulate?
A
Acromion Process (Lateral Anterior portion of Scapula)
7
Q
What muscle attaches to the Coracoid Process of the Scapula?
A
Pec Minor
8
Q
What are the articulations of the Humerus?
A
- Head articulates with the Glenoid Fossa of the Scapula
- Capitulum articulates LATERALLY with the Radius
- Trochlea articulates MEDIALLY with the Ulna
9
Q
What articulation of bones forms the Ball and Socket joint of the shoulder
A
- Head of the Humerus
2. Glenoid Fossa (Cavity) of the Scapula
10
Q
Where is the Greater Tubercle located?
A
- It is a projection on the LATERAL side of the Superior part of the Humerus
11
Q
Where is the Lesser Tubercle located?
A
- It is a projection on the ANTERO-MEDIAL side of the Superior part of the Humerus
12
Q
What is the Intertubercular Sulcus (Groove) and what purpose does it serve?
A
- It is groove located right between the Greater and Lesser Tubercles
- Bicep tendon runs through here
13
Q
What is the difference between the Anatomical Neck and Surgical Neck of the Humerus?
A
- Anatomical Neck is thicker and located right below the Head of the Humerus
- Surgical Neck is thinner and more proximal to the Head than the Anatomical Neck
14
Q
Where is the Humerus most likely to fracture?
A
SURGICAL NECK
-get it? you are more likely to get surgery on this
15
Q
What is the Deltoid Tuberosity?
A
A bump on the Lateral Side of the Humerus’s Shaft where the Deltoid inserts on the Humerus
16
Q
What are Condyles? Name the Condyles of the Humerus:
A
“Little Knobs” on the Distal end of the Humerus
- Medial Epicondyle (larger)
- Lateral Epicondyle
- Capitulum (circular)- lateral and connects to the Radius
- Trochlea (bowtie)- medial and connects to the Ulna
17
Q
Describe the location of the Radius bone of the Forearm:
A
It is on the same side as your thumb. In anatomical position, thumbs are out to the side so the RADIUS is LATERAL
18
Q
How to remember orientation of Radius and Ulna:
A
“TRL”
Thumb and Radius are Lateral
This means the Pinky and Ulna are Medial
19
Q
What is the Olecranon Process?
A
“Sharp part of your elbow” located on the Ulna that fits into the Olecranon Fossa of the Humerus like a hinge
20
Q
What is the Olecranon Fossa?
A
- A “big dip” on the Posterior Side of the Proximal End of the Humerus
- Right above the Trochlea so the Olecranon Process of the Ulna fits here and works like a hinge
21
Q
What is the Coronoid Fossa?
A
A dip on the Anterior where the Coronoid Process of the Ulna locks in preventing over-flexing of the elbow
22
Q
What are the joints of the shoulder?
A
- Glenohumeral Joint
- Acromioclavicular Joint
- Sternoclavicular Joint
ONLY Glenohumeral has movement
23
Q
What joint in the shoulder has the most mobility?
A
Glenohumeral Joint (Flexion, Extension, aDduction, aBduction, medial rotation, lateral rotation, circumduction)
24
Q
Cup of the Glenoid Cavity is flat and not very deep, so…
A
A piece of cartilage called the Glenoid Labrum is shaped like a cup to help the head of the Humerus articulate into the Scapula
25
What is the Glenoid Labrum?
A piece of rounded cartilage that is shaped like a cup to allow the Humerus to articulate with the flat and shallow Glenoid Cavity of the Scapula
26
The Glenohumeral Joint is...
The Ball and Socket Joint of the shoulder with the most mobility allowing for flexion, extension, aDduction, aBduction, medial rotation, lateral rotation, and circumduction
27
What is the Acromioclavicular Joint?
Joint between the Acromion Process of the Scapula and the lateral end of the Clavicle
28
What is the Sternoclavicular Joint?
Joint between the Manubrium of the Sternum and the medial end of the Clavicle
29
What are the two bones of the Forearm?
1. Radius (lateral)
| 2. Ulna (medial)
30
What are the parts of the Ulna?
1. Trochlear Notch/Fossa
2. Olecranon Process
3. Coronoid Process
4. Styloid Process
31
What is the Trochlear Fossa?
"Hook" on the Anterior side of the Proximal End of the Ulna that articulates with the Trochlea of the Humerus
32
Where is the Olecranon Process located?
"Sharp part of your elbow " that is located on the Posterior Side of the Ulna and fits into the Olecranon Fossa on the Posterior side of the Humerus like a hinge
33
What are the parts of the Radius?
1. Head (circular and flat surface near proximal end)
2. Radial Tuberosity (near proximal end)
3. Styloid Process (Distal end)
34
What does the Head of the Radius articulate with?
Capitulum of the Humerus
They form a hinge
35
What is the function of the Radial Tuberosity
This is the insertion point of the Bicep
36
The Radius is SMALLER or LARGER than the Ulna
The Radius is SMALLER than the Ulna
37
Matching column:
1. The Radius
2. The Ulna
A. Can Pivot allowing for Supination and Pronation of the Forearm
B. Fixed and locked into place around the Humerus
Radius CAN Pivot allowing for Supination and Pronation of the Forearm
Ulna is Fixed and locked into place around the Humerus
38
What is the Styloid Process?
Distal end located on both the Radius and Ulna where the Wrist Joint is formed with the Carpals
39
Matching column:
1. The Radius
2. The Ulna
A. Big Proximal End and Small Distal End
B. Small Proximal End and Big Distal End
The Radius has a Small Proximal End and Big Distal End
The Ulna has a Big Proximal End and Small Distal End
40
What is the Interosseous Membrane?
A Fibrous sheet that holds the Radius and Ulna together and divides the forearm into anterior and posterior muscle compartments
41
Describe the position of the Radius and Ulna in the Pronated Position:
In the pronated position the Radius twists and crosses the Ulna
42
Describe the position of the Radius and Ulna in the Pronated Position:
The Radius and Ulna are parallel
43
The Elbow Joint is what kind of joint?
Hinge Joint enclosed in ligaments
44
What ligament helps to hold the Radius in place?
The Anular Ligament which starts at the Ulna and wraps circumferentially around the Radial Head
45
What are the joints of the Elbow?
1. Trochlear Notch of Ulna and Trochlea of Humerus
2. Head of Radius and Capitulum of the Humerus
3. Head of Radius and Radial Notch of the Ulna
46
The Proximal Radio-Ulnar joint allows for...
1. Supination
2. Pronation
3. Pivot
47
The Radio-Humeral Joint and Ulna-Humeral Joints allow for...
1. Flexion
2. Extension
3. Hinge
48
What are the groups of bones in the Hand?
1. Carpals (Wrist bones)
2. Metacarpals (5 bones in the palm)
3. Phalanges (Digits)
49
How are the Carpal bones organized?
Two sets of 4 bones (8 total) that combine form the curved Carpal Arch
50
What is the Carpal Arch?
Carpal Bones organized together that form an arch with an opening that faces Anteriorly
51
What forms the Carpal Tunnel?
The Carpal Arch (Carpal Bones organized together) into a curve covered by the Flexor Retinaculum
52
What are the names of the Carpal Bones?
```
Named as if you are looking at the back of your hand:
Bottom Row (Thumb to Pinky):
1. Scaphoid
2. Lunate
3. Triquetrum
4. Pisiform
```
Top Row (Thumb to Pinky):
1. Trapezium
2. Trapezoid
3. Capitate
4. Hamate
53
What is unique about the Pisiform bone?
It is a Sesamoid Bone which is a bone within a tendon not attached to the other bones
54
"Trapezium is for the Thumb"
Trapezium forms the attachment between the Carpals and the Metacarpal of the Thumb
55
What is unique about the Trapezium?
It forms the only Saddle Joint in the body with the Metacarpal of the Thumb which makes Opposable Thumbs
56
What is the Pneumonic for the Carpals?
Listed Bottom Row Thumb to Pinky then Top Row Thumb to Pink
```
Some (Scaphoid)
Lovers (Lunate)
Try (Triquetrum)
Positions (Pisiform)
That (Trapezium)
They (Trapezoid)
Can't (Capitate)
Handle (Hamate)
```
57
Each digit has how many Phalanges?
Digits 2-5 have 3 Phalanges:
1. Proximal
2. Middle
3. Distal (finger tip)
Thumb has 2 Phalanges:
1. Proximal
2. Distal
58
What are the Wrist Joints?
1. Radius and Ulna connect to Scaphoid, Lunate, and Triquetrum (NOT Pisiform)
2. Carpal Joints (between themselves)
3. Carpometacarpal Joints (Trapezium and First Metacarpal is special, allows opposable thumbs)
4. Metacarpophalangeal Joint [MCP] (between Metacarpals and Phalanges)
5. Interphalangeal Joints (Between the Phalanges, there is Proximal [PIP] and Distal [DIP])
NOTE: there is no PIP or DIP for thumb
59
What are the Interphalangeal Joints?
Digits
1. Proximal Interphalangeal Joints (PIP)- between the Proximal and Middle Phalanges
2. Distal Interphalangeal Joints (DIP)- between the Distal and Middle Phalanges
SPECIAL CASE:
3. Thumb has Interphalangeal Joint (not named)
60
Latissimus Dorsi:
1. Origin
2. Insertion
3. Action
4. Innervation
1. Spinous Processes T12- L5 and the Sacrum, the Iliac Crest, and Ribs 10-12
2. Intertubercular Sulcus of Humerus (Anterior)
3. Extension, aDduction, Medial Rotation of Humerus
4. Innervation: Thoracodorsal Nerve (from Brachial Plexus)
61
Upper Trapezius:
1. Origin
2. Insertion
3. Action
4. Innervation
1. External Occipital Protuberance (base of skull)
2. Lateral 1/3 of the Clavicle
3. Elevates the Scapula
4. Accessory Nerve (Cranial Nerve XI)
62
Middle Trapezius:
1. Origin
2. Insertion
3. Action
4. Innervation
1. Ligamentum Nuchae (triangular sheet of Ligament attaching skull and the Cervical Spinous Processes)
2. Acromion Process (Scapula)
3. Retracts the Scapulae (direct opposition to Serratus Anterior)
4. Accessory Nerve (Cranial Nerve XI)
63
Lower Trapezius:
1. Origin
2. Insertion
3. Action
4. Innervation
1. Spinous Processes C7-T12
2. Spine of the Scapula
3. Depresses (pulls down) Scapulae
4. Accessory Nerve (Cranial Nerve XI)
64
Levator Scapulae:
1. Origin
2. Insertion
3. Action
4. Innervation
1. C1-C4 Transverse Processes
2. Upper Medial Border of Scapula (above Spine of the Scapula)
3. Elevates the Scapulae
4. Dorsal Scapular Nerve (from Brachial Plexus)
65
Rhomboid Major:
1. Origin
2. Insertion
3. Action
4. Innervation
1. T2-T5 Spinous Processes (inferior to Rhomboid Major)
2. Medial Border of Scapula (below the Spine of the Scapula)
3. Retract and Elevate Scapula
4. Dorsal Scapular Nerve (from Brachial Plexus)
66
Rhomboid Minor:
1. Origin
2. Insertion
3. Action
4. Innervation
1. C7 and T1 Spinous Processes
2. Medial Border of Scapula at Spine of the Scapula
3. Retract and Elevate Scapula
4. Dorsal Scapular Nerve (from Brachial Plexus)
67
Pectoralis Major:
1. Origin
2. Insertion
3. Action
4. Innervation
1. Sternum and Medial ½ of Clavicle
2. Intertubercular Groove of Humerus
3. aDduction, Medial Rotation, and Flexion (forward)
4. Medial and Lateral Pectoral Nerve
68
Pectoralis Minor:
1. Origin
2. Insertion
3. Action
4. Innervation
1. Ribs III-V (deep to Pec Major)
2. Coracoid Process (Scapula)
3. Protraction (moving it forward)
4. Medial Pectoral Nerve
69
Serratus Anterior:
1. Origin
2. Insertion
3. Action
4. Innervation
1. Lateral surfaces of Upper Ribs (Ribs 1-9)
2. Anterior Medial Surface of Scapula
3. Protraction, Rotation, Maintains good posture
4. Long Thoracic Nerve
70
Deltoid:
1. Origin
2. Insertion
3. Action
4. Innervation
1. Scapula (Spine) and Clavicle
2. Deltoid Tuberosity on Humerus
3. Arm aBduction (past 15*)
4. Axillary Nerve
71
What is the only Upper Extremity Muscle that is NOT innervated by a branch of the Brachial Plexus?
Trapezius
Innervated by Accessory Nerve (Cranial Nerve XI)
72
Back Muscle Overview
1. Latissimus Dorsi- EDM (Extension, aDduction, Medial Rotation of Humerus)
2. Trapezius- DERS (Depress, Elevate, Relax Scapula)
3. Levator scapulae (Elevate Scapula)
4. Rhomboid major and minor (Retract Scapula)
5. Pec Major and Minor- DMF (aDduction, Medial Rotation of Humerus, Flexion)
6. Serratus Anterior- PRP (Protraction, Rotation, Posture)
73
What are the muscles that originate on the Scapula?
1. Infraspinatus Muscle
2. Supraspinatus Muscle
3. Teres Major
4. Teres Minor
5. Subscapularis
6. Deltoid
74
Infraspinatus Muscle:
1. Origin
2. Insertion
3. Action
4. Innervation
"Comes from back of Scapula"
1. Infraspinous Fossa (Scapula)
2. Greater Tubercle (Humerus) POSTERIORLY
3. Lateral Rotation of Humerus (rotates out)
4. Suprascapular Nerve
75
Supraspinatus Muscle:
1. Origin
2. Insertion
3. Action
4. Innervation
"Comes from the top"
1. Supraspinous Fossa (Scapula)
2. Superior Part of Greater Tubercle (Humerus)
3. aBduction of the Humerus up to 15* (then Deltoid takes over)
4. Suprascapular Nerve
76
Teres Major Muscle:
1. Origin
2. Insertion
3. Action
4. Innervation
"Synergist of Lat Dorsi"
1. Inferior Angle of Dorsal Scapula
2. Lesser Tubercle (Anterior Humerus)
3. Extension, aDduction, Medial Rotation of Humerus
4. Lower Subscapular Nerve
77
Teres Minor Muscle:
1. Origin
2. Insertion
3. Action
4. Innervation
Adjacent to Infraspinatus Muscle
1. Lateral Border of Dorsal Scapula
2. Greater Tubercle of Humerus POSTERIORLY (inferior to Infraspinatus insertion)
3. Lateral Rotation of Humerus (rotates out)
4. Axillary Nerve
78
Subscapularis Muscle:
1. Origin
2. Insertion
3. Action
4. Innervation
1. Subscapular Fossa (Anterior Scapula)
2. Lesser Tubercle (Anterior Humerus)
3. Medial Rotation of Humerus
4. Subscapular Nerves
79
What are the Rotator Cuff Muscles?
"SITS"
Stabilize Humerus in the Glenohumeral Joint
1. Infraspinatus Muscle
2. Supraspinatus Muscle
3. Teres Minor
4. Subscapularis
80
Where does the Suprascapular Artery travel?
Suprascapular Artery travels superficially to Suprascapular Ligament
81
Where does the Suprascapular Artery travel?
Suprascapular Artery travels superficially to Suprascapular Ligament
82
What muscles INSERT on the Anterior Portion of the Humerus?
"The La-Di between 2 Majors"
1. Teres Major
2. Latissimus Dorsi
3. Pec Major
83
What is the Axilla?
"Armpit"
Important structure that passes structures from the neck to the upper extremity
84
What structures pass through the Axilla?
1. Axillary Artery
2. Axillary Vein
3. Brachial Plexus (jumble of nerves from cervical spinal cord)
4, Axillary Lymph Nodes
5. Tail of Breast
6. Portions of some arm muscles (Biceps and Coracobrachialis)
85
List pathway of blood on its way to the Upper Extremities:
1. Brachiocephalic Trunk (Right side) or Aortic Arch (Left side)
2. Subclavian Artery (Exits Thoracic Inlet lateral to Rib 1 and beneath Clavicle)
3. Axillary Artery (gives off 6 branches around the Pec Minor)
4. Brachial Artery (continuation of Axillary Artery that starts where Teres Major and Latissimus Dorsi cross paths)
86
What are the boundaries of the Axilla?
Feel around armpit for the 6 borders
1. Inlet (Bones)- Superior Border
2. Anterior Wall (Pec Major and Fascia)
3. Medial Wall (Thoracic Wall and Ser Ant)
4. Lateral Wall (Humerus)
5. Posterior Wall (Scapula Muscles and Triceps)
6. Floor (dome of skin and fascia that continue down the arm partially)- Inferior Border
87
What bones make up the Axillary Inlet?
"Little Triangle" created by bones:
1. Clavicle (Anterior)
2. Scapula (Posterior)
3. Rib 1 (Medial)
88
What are the Divisions of the Axillary Artery?
6 TOTAL
1. Proximal to Pec Minor
a. Superior Thoracic Artery
2. Posterior to Pec Minor
a. Thoraco-acromial Artery
b. Lateral Thoracic Artery
3. Distal to Pec Minor
a. Subscapular Artery
b. Anterior Circumflex Humeral (connects to Posterior)
c. Posterior Circumflex Humeral (connects to Anterior)
89
What is the exit point of the Axilla?
Where the Teres Major and Latissimus Dorsi cross paths
90
What artery provides blood to the posterior portion of the arm? Where does it originate?
1. Profunda Brachii
2. Branches from the Brachial Artery
3. Runs with the Radial Nerve (off of Brachial Plexus)
91
The Brachial Artery:
1. Where does it come from
2. Where does it travel
3. What does it branch into
4. What is its function
1. Arises from the Axillary Artery after it passes the Teres Major muscle
2. Travels in Anterior Compartment
3. Branches
a. Profunda Brachii (posterior branch)
b. Radial Artery
c. Ulnar Artery
4. Blood supply to arm and BP measurement
92
What are the Superficial and Deep Veins of the Upper Extremity?
Superficial (Big Two):
1. Cephalic Vein (drains posterior lateral side)
2. Basilic Vein (drains medial side and forms BULK of Axillary Vein)
Deep (Small Two):
1. Pair of Small Brachial Veins that travel on either side of the Brachial Artery
93
Where does the Cephalic Vein travel?
Deltopectoral Groove which is between the Deltoid and Pec Major before it ultimately empties into Axillary Vein
94
What body parts does the Axillary Lymph Nodes drain?
1. Upper Extremities
2. Parts of Upper Back
3. Shoulders
4. Neck
5. Most of breast
95
Where do the Axillary Lymph Nodes drain into?
Junction of Subclavian and Internal Jugular Vein
96
Where does the Brachial Plexus come from?
"Mostly Cervical"
Ventral/Anterior Rami of C5,C6,C7,C8, and T1 (5 total)
97
What is the purpose of the Brachial Plexus?
Complex Collection of nerves from Ventral/Anterior Rami C5-T1 (5 total) that travel through neck, Axillary Inlet, and Axilla to branch and innervate muscles and skin of chest wall, back, upper extremities
98
Brachial Plexus is divided into? (List from Proximal to Distal)
1. Roots (Ventral/Anterior Rami of C5-T1)
2. Trunks (Superior, Middle, Inferior)
3. Divisions (Anterior and Posterior situated around Axillary Artery)
4. Cords (Lateral, Posterior, and Medial)
5. 4 Terminal Nerves (End nerves)
99
In reference to the Brachial Plexus, how are the Cords of the Brachial Plexus situated?
1. Lateral travels laterally to the Brachial Plexus (supplied by Anterior Divisions)
2. Posterior travels posteriorly to the Brachial Plexus (supplied by Posterior Divisions)
3. Medial travels medially to the Brachial Plexus (supplied by Anterior Divisions)
100
What part of the Brachial Plexus do most of the nerves of the Upper Extremities branch from?
```
A. Roots
B. Trunks
C. Divisions
D. Cords
E. Terminal Nerves
```
CORDS
101
What nerves branch off of the Roots of the Brachial Plexus?
1. Dorsal Scapular Nerve (Rhomboids)
| 2. Long Thoracic Nerve (takes root from C5-C7 and provides Serratus Anterior)
102
What nerves branch off of the Trunks of the Brachial Plexus?
ONLY BRANCHES COME FROM SUPERIOR TRUNK!!!
1. Suprascapular Nerve (Supraspinatus and Infraspinatus
2. Nerve to Subclavius (not important)
103
What nerves branch off of the Divisions of the Brachial Plexus?
NONE
104
What nerves branch off of the Lateral Cord of the Brachial Plexus?
"Lateral to the Axillary Artery"
1. Lateral Pectoral Nerve (Pec Major)
2. Musculocutaneous Nerve (Terminal Nerve)
3. 1/2 of the Median Nerve (Terminal Nerve)
105
What nerves branch off of the Posterior Cord of the Brachial Plexus?
"Behind the Axillary Artery"
106
What nerves branch off of the Medial Cord of the Brachial Plexus?
"Medial to the Axillary Artery"
1. 1/2 Median Nerve (Terminal Nerve)
2. Medial Pectoral (Pec Major and Minor)
3. Medial Cutaneous Nerve of Arm (skin of medial side of Arm)
4. Medial Cutaneous Nerve of Forearm (skin of medial side of Forearm)
5. Ulnar Nerve (Terminal Nerve)
107
What Cords give rise to the Terminal Median Nerve?
The two that run alongside the Axillary Artery:
1. Lateral Cord
2. Medial Cord
108
What nerves branch off of the Posterior Cord of the Brachial Plexus?
1. Thoracodorsal (Lat Dorsi)
2. Superior Subscapular (Subscapularis Muscle)
3. Inferior Subscapular (Subscapularis and Teres Major)
4. Axillary (Deltoid and Teres Minor)
5. Radial (Terminal Nerve)
109
Where does the Radial Nerve travel and what does it do?
1. Travels with Profunda Brachii
| 2. Innervates Posterior Muscles of the Arm and Forearm
110
What are the 4 Terminal Nerves of the Brachial Plexus?
"RUMM"
1. Radial Nerve (Posterior Arm and Forearm AND cutaneous hand)
2. Ulnar Nerve (Some Anterior Forearm and MOST of Hand)
3. Musculocutaneous Nerve (Anterior Arm muscles and lateral skin)
4. Median Nerve (Most Anterior Forearm and SOME of Hand)
111
What does the Axillary Nerve innervate?
1. Deltoid
| 2. Teres Minor
112
What reference point is formed because the Axillary Artery runs between the Anterior and Posterior Divisions of the Brachial Plexus?
An "M" that is made up of MCMUnday:
(named Laterally to Medially)
1. The Musculocutaneous Nerve
2. The Median Nerve
3. The Ulnar Nerve
113
Where is the Radial Nerve in reference to the "M" reference point?
Radial Nerve would be BEHIND the Axillary Artery
114
What are the only 2 Nerves of the Bracheal Plexus are only Cutaneous?
1. Medial Cutaneous Nerve of the Arm (C8 and T1)
| 2. Medial Cutaneous Nerve of the Forearm (C8 and T1)
