Flashcards in Upper Extremity (Test II) Deck (95):
What is the difference between the anatomical and surgical neck of the humerus?
The anatomical neck is right around the head of the humerus; the surgical neck is farther down the shaft beneath the greater and lesser tubercles.
Which fossa is located on the anterior view of the scapula?
Are the epicondyles or the condyles of the humerus palatable?
Epicondyles. (The condlyes are the capitulum and trochlea)
What are the borders of the quadrangular space?
Superior= teres major
Inferior= teres minor
Medial= long head of triceps brachii
Lateral= Surgical neck of humerus
What are the contents of the quadrangular space?
Axillary nerve (C5-C6) and the posterior humeral circumflex artery.
What are the borders of the triangular space?
Superior= teres major
Inferior= teres minor
Lateral= long head of triceps brachii
What are the contents of the triangular space?
Circumflex scapular artery (also known as the circumflex branch of the subscapular artery).
The suprascapular artery and suprascapular nerve travel over and under what?
Which travels over the suprascapular ligament? What travels under it?
Suprascapular artery; supracscapular nerve.
What is the main function of the rotator cuff muscles?
What two rotator cuff muscles act in lateral rotation?
Teres minor and infraspinatus.
What rotator cuff muscle works in abduction?
What rotator cuff muscle works in medial rotation?
Subscapularis. (The teres major is also a medial rotator but it is not a rotator cuff muscle).
What are the four bursae of the GH joint?
Subacromial, subdeltoid, biciptial, and subscapular.
Which of the bursae of the GH joint communicates with the synovial cavity of the shoulder joint?
What type of joint is the glenohumeral joint?
Ball & socket synovial joint. It is multiaxial.
What type of joint is the acromioclavicular joint?
Plane (gliding) synovial joint. It is non-axial.
How many planes of motion occur at the GH joint? What motions are there?
How many glenohumeral ligaments (bands) are there? What do they strenthen?
3 (superior glenohumeral ligament, middle glenohumeral ligament, inferior glenohumeral ligament). The reinforce the anterior aspect of the joint capsule.
Where do the glenohumeral ligaments run?
From the glenoid labrum to the anatomical neck of humerus.
What ligament strengthens the joint capsule superiorly of the GH joint? Where does it run?
Coracohumeral ligament. From the base of coracoid process to greater tubercle of humerus.
What ligament holds the synovial sheath and tendon of the biceps brachii in place during mmovements of the GH joint? Where does it run?
Transverse humeral ligament. It runs across the bicipital grove from the greater tubercle to the lesser tubercle.
Where does the long head of the biceps brachii muscle run through and attach?
Through the GH joint and attaches at the supraglenoid tubercle.
What is the GH joint innervated by?
Articular branches of suprascapular nerve, axillary nerve, and lateral pectoral nerve coming off the posterior cord. (C5-C6 levels).
What is the blood supply to the GH joint?
From the articular branches of the suprascapular artery, and anterior & posterior humeral circumflex arteries.
What does the thyrocervical trunk branch off from?
What does the thryocervical trunk branch into? (x4)
Suprascapular artery, transverse cervical artery (branches into the superior and inferior branches), inferior thyroid artery, and ascending cervical artery.
What does the superior branch of the transverse cervical artery (coming from the thryocervical trunk) supply?
What does the deep branch of the transverse cervical artery (coming from the thryocervical trunk) supply?
What provides cutaneous innervation to the shoulder?
Supraclavicular nerve (C3-C4).
What provides cutaneous innervation to the brachium? (x5)
Upper lateral brachial cutaneous (C5-C6)
Lower lateral brachial cutaneous (C5-C6)
Medial brachial cutaneous (C8-T1)
Posterior brachial cutaneous (C5-T1)
What provides cutaneous innervation to the antebrachium? (x3)
Lateral antebrachial cutaneous (C5-C7)
Medial antebrachial cutaneous (C8-T1)
Posterior antebrachial cutaneous (C5-C7)
What does the upper lateral brachial cutaneous nerve branch off from? What are its cord levels?
What does the lower lateral brachial cutaneous nerve branch off of? What are its cord levels?
What does the medial brachial cutaneous nerve branch off of? What are its cord levels?
What does the posterior brachial cutaneous nerve branch off of? What are its cord levels?
What does the lateral antebrachial cutaneous nerve branch off of? What are its cord levels?
What does the medial antebrachial cutaneous nerve branch off of? What are its cord levels?
What does the posterior antebrachial cutaneous nerve branch off of? What are its cord levels?
What dermatome is mainly ventral?
What dermatome is mainly more medial?
C8 & T1
What dermatome is mainly more lateral?
What dermatome is mainly posterior?
True or false:
A dermatome may have several cutaneous nerves that supply it.
For example, the upper lateral brachial cutaneous and lower lateral brachial cutaneous both cross the C5 and C6 dermatome.
What are the two major veins of the brachium? What third vein is used to draw blood?
Cephalic vein & basilic vein; median cubital vein.
What vein of the brachium is located more medially?
What vein of the brachium is located more laterally?
What does the cephalic vein run between?
The biceps and triceps
What does the basilic vein run medial to?
The biceps brachii
In breast tissue, what is superficial to the pectoral fascia?
What supports the lobules (glandular tissue) of the breast?
What do the suspensory ligaments help the pectoral fascia attach to?
What type of lymph nodes are usually the first that are affected by breast cancer?
What are the divisions of the axillary lymph nodes? (x5)
Subclavian, central, brachial/humeral, subscapular, & pectoral
What are the lymph nodes that are affected by breast cancer after the axillary lymph nodes?
Parasternal & intramammlary lymph nodes
What other parts of the body will breast cancer metastasize to?
Brain, liver, and or bones (sternum, skull, pelvis)
What are the current recommendations of the American Cancer Society in regards to breast cancer?
(1) baseline mammogram at age 35
(2) year mammograms beginning at age 40 (unless a family member is diagnoses--then ten years prior to the age of the family member at diagnosis)
Because women with breast cancer often have their affected lymph nodes removed, what condition do they oftentimes suffer from?
What are three components of the clavopectoral fascia?
Where does the axillary fascia run?
From the rib cage to the brachial fascia (anterior view).
Backwards to the latissiums dorsi fascia (lateral view).
Because pectoral fascia is investing, it means what:
It has two layers that envelop the pectoral muscle (superficial and deep)
What nerve pierces the pec minor muscle?
Medial pectoral nerve
What nerve runs lateral to the pec minor muscle?
Lateral pectoral nerve (it runs through the pec major muscle--it exits the muscle more medially)
What is the axilla?
A pyrimidal space inferior to the scapulohumeral joint and superior to the axillary fascia. It it the area that occurs at the junction of the brachium and thorax.
What does the axilla provide passage for?
The vessels and nerve that go to the upper extremity.
What structures make up the apex and base of the walls of the axilla?
Apex= 1st rib, clavicle, & superior edge of the subscapular muscle
Base= skin, telsubcutanea, and axillary fascia
What structures make up the anterior and posterior walls of the axilla?
Anterior wall= pectoral major and minor
Posterior wall= scapula and subscapularis muscle
What structures make up the medial and lateral walls of the axilla?
Medial wall= 1st - 4th ribs & serratus anteior
Lateral wall= intertubercular groove of humerus
What are the contents of the axilla? (x4)
Axillary artery & vein
Brachial plexus (cords and branches)
What are the branches of the subclavian?
What are the branches of the thyrocervical trunk?
What are the branches of the transverse cervical artery? What is the more specific name of one of the branches? Where does the transverse cervical artery come from?
Superficial (running to trapezius) and deep (running to rhomboids= dorsal scapular)
This artery comes off the thyrocervical trunk that comes off the subclavian
What are the branches of the costocervical trunk?
Deep cervical & supreme intercostal
Where does the supreme intercostal artery run to?
The 1st and 2nd ribs
What groove is on the posterior aspect of the clavicle? What runs in it?
Subclavian groove (the subclavian artery runs in it)
The rounded end of the clavicle is which end? What does it articulate with?
Acromial end (articulates with the acromion)
The flat end of the clavicle is which end? What does it articulate with?
Sternal end (articulates with the sternum)
What artery runs on either side of the sternum? What does it branch off of?
The internal thoracic (mamillary) artery. It branches off the subclavian.
What muscles divides the subclavian artery into three portions? What is contained within those three portions?
Anterior scalene muscle
internal thoracic (mamillary)
2nd= costocervical trunk
3rd= dorsal scapular artery (if present...this is just an additional place where the artery to the rhomboids can begin--it usually branches as the deep portion of the transverse cervical artery)
Describe the course of the subclavian artery.
It emerges out of of the thorax superior to the first rib underneath the clavicle. It arises from the aortic arch (on the left) or the brachiocephalic artery (on the right). It runs under the clavicle on the subclavian groove and after the clavicle and end of first rib, it becomes the axillary artery.The anterior scalene muscle divides it into three parts.
Klumpke's Palsy is a lesion of what?
The inferior trunk of the brachial plexus.
Erb-Duchenne's Palsy is a lesion of what?
The superior trunk of the brachial plexus.
Crutch Palsy or "Wrist Drip" is a lesion of what?
The posterior cord of the brachial plexus.
What causes an Erb-Duchenne's Palsy (or superior trunk lesion)?
A violent displacement of the head from the shoulder (such as falling from a bike or ladder or being pulled by the vaginal canal during childbirth.
What is the result of an Erb-Duchenne's Palsy?
Waiter's tip hand--the arm is medially rotated, adducted, and the wrist is flexed.
What cord level does Erb-Duchenne's Palsy affect?
What causes Klumpke's Palsy?
Difficult breech delivery (="birth or obstetric paralysis")
A cervical rib (="cervical rib syndrome")
Spasm of the anterior or middle scalene by hanging from a strap by the hand (=strap hanger's syndrome")
What is the result of Klumpke's Palsy?
Claw hand--there's a loss of extension form the dorsal hood expansion)
What is the cause of a posterior cord lesion?
Pressure of a crutch ("crutch palsy")
What happens with crutch palsy?
Weakness roo loss of the extensor muscles, producing "wrist drop"
What causes wrist drop? Where is sensation lost? At what joints is extension lost?
Radial nerve injury;
dorsal surface of digits 1, 2, and half of 3;
Wrist and MCP joints lose extension
What nerve is injured in ape hand?
Recurrent branch of the median--it causes atrophy of the thenar muscles
Loss of opposion (leaving the thumb adducted and lateraly rotated) is a sign of what?
Where does ape hand cause loss of sensation?
Palmar digits 1-3 and half of 4
Dorsal digits 2, 3, and half of 4