Upper Limb

Question 1

Name the muscles that connect the upper limb to the thoracic wall

Answer 1

Pectoralis major
Pectoralis minor
Subcalvius
Serratus anterior

Question 2

Origin and insertion of the pectoralis major muscle

Answer 2

Origin: two heads claviclular head from medial half of the front of the clavicle and sternocostal head from sternum upper six costal cartilages and apponeurosis of external oblique muscle.

Insertion: lateral lip of bicepital groove of the humerus.

Question 3

NS and NR of perctoralis major muscle

Answer 3

NS medial and lateral pectoral nerve

NR c5 c6 c7 c8 and t1

Question 4

Action of pectoralis major muscle

Answer 4

Addiction and medial rotation of the arm

Clavicular head helps in flex ion of the arm (shoulder)

Question 5

Pectoralis minor origin and insertion

Answer 5

Origin: from 3rd 4th and 5th ribs close to their costal cartilages.
Insertion: Coracoid process of the scapula

Question 6

NS and NR of pectoralis minor

Answer 6

NS medial pectoral nerve from brachial plexus

NR c6 c7 c8

Question 7

Action of pectoralis minor

Answer 7

Depression of the shoulder

Draws the ribs upwards and outwards during deep inspiration.

Question 8

Origin and insertion of subclavius

Answer 8

Origin: first costal cartilage
Insertion: subcalvian groove in the middle 1/3 of the inferior surface of clavicle.

Question 9

NS of subclavius

Answer 9

Nerve to sublclavius from upper trunk of brachial plexus

Question 10

Action of subclavius

Answer 10

Fixes the clavicle during movement of the shoulder joint.

Question 11

Serratus anterior origin and insertion

Answer 11

Origin: upper eight ribs
Insertion: anterior aspect of the medial border and inferior angle of scapula.

Question 12

Serratus anterior NS

Answer 12

Long thoracic nerve.

Question 13

Serratus anterior action

Answer 13

Draws the scapula forward in boxing (protrusion)

Rotates the scapula outwards in raising the arm above 90*

Question 14

What is the clavipectoral fascia

Answer 14

It is a thickened membrane of deep fascia between the subclavius and perctoralis minor 
It is pierced by 
Lateral pectoral nerve 
Thoraco-acromial artery 
Cephalic vein 
Few lymph vessels

Question 15

The root of brachial plexus

Answer 15

Formed by the anterior rami (branch) of c5, c6, c7, c8 and t1

Question 16

Trunks of brachial plexus in details and divisions

Answer 16

Upper (superior) trunk: formed by the union of the anterior rami of c5 and c6

Middle trunk: anterior ramus of c7

Lower (inferior) trunk: formed by the union of the anterior rami of c8 and t1.

Division: each trunk is divided into anterior and posterior divisions.

Question 17

Cords of brachial plexus in details

Answer 17

Lateral cord: formed by the union of the anterior divisions of the upper and middle trunk

Posterior cord: formed by the union of the posterior division of all trunks.

Medial cord: formed by the anterior division of the lower trunk

Question 18

Describe the axilla in general

Answer 18

Known as the armpit a pyramid shape space between the upper part of the arm and the side of the chest. It’s a communication between the upper limb and the root of the neck.
Has an apex (inlet) base and four walls: anterior posterior medial and lateral.

Question 19

The folds of the axilla are formed by

Answer 19

The anterior fold of the axilla is formed by the folded fibers of the pectoralis major muscle

The posterior fold of the axilla is formed by the folding of the latissimus dorsi over teres major muscle.

The anterior fold is higher than the posterior fold

Question 20

The anterior wall of the axilla is formed by the

Answer 20

Pectoralis major
Pectoralis minor
Subclavius
Clavipectoral fascia

Question 21

The posterior wall of the axilla is formed by the

Answer 21

Subscapularis
Teres major
Lattissimus dorsi
Proximal part of the long head of triceps

Question 22

Openings in the posterior wall of the axilla the quadrangular space is bounded by… and transmits

Answer 22

Subscapularis
Surgical neck of the humerus
Teres major
Long head of triceps

And transmits the axillary nerve and posterior circumflex humeral artery.

Question 23

Openings in the posterior wall of the axilla the triangular space is bounded by … and transmits

Answer 23

Long head of triceps
Subscapularis
Teres major

Transmits circumflex scapular artery and vein.

Question 24

The medial wall of the axilla is formed by

Answer 24

Upper 4-5 ribs

Upper 4-5 intercostal spaces covered by the upper digitations of the Serratus anterior muscle.

Question 25

The lateral wall of the axilla is formed by

Answer 25

It is the narrowest wall Biciputal groove Coracobrachialis Biceps brachii

Question 26

What are the contents of the axilla (7)

Answer 26

Axillary artery and it’s branches Axillary vein and it’s tributaries Axillary tail of the breast Cords and terminal branches of the brachial plexus Axillary lymph vessels and lymph nodes Axillary fat Lateral cutaneous branches of the upper intercostal nerves.

Question 27

Begging course and termination of the axillary artery

Answer 27

Beginning: at the outer (lateral) border of the first rib as a continuation of the subclavian artery. Corse: passes downwards in the axilla from the apex to the base. Termination: ends at the lower border of the teres major muscle where it continuous as the brachial artery.

Question 28

Parts of the axillary artery

Answer 28

Divided by pectoralis minor into three parts First part: lies above the pectoralis minor Second part: lies behind the pectoralis minor Third part: lies below the pectoralis minor.

Question 29

Relations o father first part of the axillary artery

Answer 29

The first part lies above the pectoralis minor Anteriorly: the clavicular part of the pectoralis major the clavipectoral fascia and vessels and nerves superficial to it. Posteriorly: first intercostal space, first digitation of the Serratus anterior and medial cord the brachial plexus. Laterally: lateral and posterior cords of the brachial plexus. Medially: axillary vein.

Question 30

Relations of the second part of the axillary artery

Answer 30

The second part of the axillary artery lies behind the pectoralis minor Anteriorly: the pectoralis minor and major Posteriorly: the posterior cord of the brachial plexus and the Subscapularis muscle. Laterally: the lateral cord of the brachial plexus. Medially: the medial cord of the brachial plexus, medial pectoral nerve and axillary vein.

Question 31

Relations of the third part of the axillary artery

Answer 31

The third part of the axillary artery lies below the pectoralis minor. Anteriorly: upper part is covered by pectoralis major but it’s lower part is covered by skin, superficial and deep fascia. It’s crossed by the medial root of the median nerve. Posteriorly: the Subscapularis, the lattismus dorsi and the teres major. The axillary and radial nerves also lies behind the artery. Laterally: the coracobrachialis p, the biceps and the humerus. The lateral root of the median and musculocutaneous nerves also lie in the lateral side. Medially: the ulnar nerve, axillary vein and the medial cutaneous nerve of the arm and the forearm.

Question 32

Branches of the axillary artery in the first part

Answer 32

The superior thoracic artery.

Question 33

Branches of the axillary artery in the second part

Answer 33

The thoracoacromial trunk | The lateral thoracic artery

Question 34

The branches of the axillary artery in the third part

Answer 34

The Subscapular artery The anterior circumflex humeral artery The posterior circumflex humeral artery

Question 35

The beginning and end of the axillary vein

Answer 35

Beginning: at the lower border of teres major as a continuation of basilic vein. End: the outer border of the first rib where it becomes subclavian vein. It lies on the medial side of the axillary artery.

Question 36

The tributaries of the axillary vein

Answer 36

Two vanae comitantes of brachial artery, cephalic vein and other tributaries follow the axillary arterial branches.

Question 37

Muscles that connect the scapula to the humerus (6)

Answer 37

``` Deltoid Supraspinatus Infraspinatus Teres major Teres minor Subscapulrais ```

Question 38

Superficial muscles of the shoulder are

Answer 38

Trapezius and deltoid muscles. Together they provide the characteristic contour of the shoulder. The trapezius attaches the scapula and clavicle to the trunk. The deltoid attaches the scapula and clavicle to the humerus.

Question 39

Deltoid muscle, origin insertion and NS, NR

Answer 39

Large and triangular in shape, with its base attached to the scapula and clavicle and it’s apex attached to the humerus. Origin: lateral third of clavicle, acromion and spine of the scapula (U shaped). Insertion: middle of the lateral surface of shaft of humerus (deltoid tuberosity). NS: axillary nerve c5 and c6 (branch of posterior cord of the brachial plexus).

Question 40

Action of deltoid muscle

Answer 40

Performs three functions because of the direction of its fibers - posterior fibers extend and laterally rotate the arm (shoulder) - middle fibers abducts arm 15 to 90 - Anterior fibers flex and Medially rotate arm 

Question 41

Structures under cover of the deltoid muscle

Answer 41

``` Bone: Upper part of humerus Coracoid process Greater tuberosity Lesser tuberosity Intertuberculus sulcus (groove) ``` Bursa: subdeltoid Subacromial bursa Muscles: teres minor Teres major Lattismus dorsi Triceps long head Vessels: anterior and posterior circumflex humeral vessel. Nerves: axillary nerve.

Question 42

Trapezius origin, insertion and nerve supply

Answer 42

``` Origin: external occipital protuberance Superior nuchal line Ligamentum nuchae Spine of the 7th cervical vertebra Spines of all thoracic vertebrae and their supraspinous ligament ``` Insertion: U shaped insertion opposite to the origin of the deltoid. Upper fiber into the posterior border of lateral third of clavicle. Middle fibers, medial border of acromion and upper lip of the crest of the spine Lower fibers, pass upward and laterally insert on medial end of the spine of the scapula. Nerve supply: spinal part of accessory nerve (motor) XI Ventral rami of C3 and c4 (sensory- proprioceptive)

Question 43

Action of the trapezius muscle

Answer 43

Upper fibers along with lavator ‏scapulae elevate the scapula Middle fibers with rhomboids pull scapula Medially (retracts) Lower fibers pull medial border of scapula downward, so upper and lower fibers acting together rotate scapula glenoid cavity face upward assisted by lower five digitations of Serratus anterior.