Flashcards in Upper Limb Deck (81)
_____ is the only major nerve to cross the brachial artery.
The superior ulnar collateral artery travels in parallel with the _____ portion of the _____ nerve and passes _____ to the medial epicondyle.
Distal portion of the ulnar nerve, and passes posterior to the medial epicondyle.
Where is Lister's tubercle located?
What attaches there?
-Distal posterior radius.
-Extensor pollicis longus tendon.
The ________ is the most powerful supinator muscle.
Injury to the radial would result in weakened ______ and a characteristic _______.
Injury to the median nerve causes characteristic ______.
flattening of the thenar eminence.
Injury to the ______ cord can result in weakened flexion and supination in the forearm, and weakened adduction and medial rotation of the arm.
What are the medial rotators of the arm?
Pec major, subscapularis, teres major, (posterior head of deltoid?)
The anterior interosseous nerve arises from the _______ and supplies which muscles? (3)
the flexor digitorum profundus (1/2), flexor pollicis longus, and pronator quadratus.
A supracondylar fracture often results in injury to the ______ nerve.
The three chief contents of the cubital fossa are (lateral to medial)...
the biceps brachii tendon, brachial artery, and median nerve
Which nerve roots supply the musculocutaneous nerve?
What muscles (3) and cutaneous innervation does it supply?
Muscles of anterior compartment of arm (coracobrachialis, biceps brachii and brachialis); skin of lateral aspect of forearm.
Which nerve roots supply the axillary nerve?
What muscles (2) and cutaneous innervation does it supply?
Glenohumeral (shoulder) joint;
teres minor and deltoid muscles; skin of superolateral arm (over inferior part of deltoid)
Which nerve roots supply the median nerve?
What muscles (11.5) and cutaneous innervation does it supply?
Muscles of anterior forearm compartment (1st and 2nd lumbricals as well) *except for flexor carpi ulnaris and ulnar half of flexor digitorum profundus*, five intrinsic muscles in thenar half of palm and *palmar skin*
Which nerve roots supply the radial nerve?
What muscles (13) and cutaneous innervation does it supply?
All muscles of posterior compartments of arm and forearm; skin of posterior and inferolateral arm, posterior forearm, and dorsum of hand lateral to axial line of digit 4.
Which nerve roots supply the ulnar nerve?
What muscles (9) and cutaneous innervation does it supply?
flexor carpi ulnaris, flexor digitorum profundis, 3rd and 4th lumbrical muscles, opponens digiti minimi, flexor digiti minimi, abductor digiti minimi, interossei, adductor pollicis; *skin of hand medial to axial line of digit 4*
Injuries to superior parts of the brachial plexus (C5 and C6) usually result from what?
an excessive increase in the angle between the neck and shoulder.
What rotators of the arm are you left with in the instance of an injury to C5-6 (upper brachial plexus injury)?
Essentially only pectoralis major, thus, the arm is stuck in medial rotation. See "Erb-Duchenne palsy (p.730).
The superior angle of the scapula lies at what vertebral level?
Medial scapular spine lies at what vertebral level?
SP of T3
Inferior angle of the scapula lies at what vertebral and costal level?
T7, 7th rib and intercostal space.
The _______ accompanies the radial nerve along the radial groove as it passes ______ around the shaft of the humerus.
Which artery accompanies the ulnar nerve posterior to the medial epicondyle of the humerus?
Superior ulnar collateral
Give the boundaries of the cubital fossa (superior, medial, lateral, floor, roof)
Superiorly: Line connecting medial and lateral epicondyles.
Medial: Pronator teres
Floor: Brachialis and supinator muscles
Roof: Bicipital aponeurosis
Give the contents (5) of the cubital fossa (medial to lateral)
1. Median nerve
2. Brachial artery
3. Biceps tendon
4. Radial nerve
5. Posterior interosseous nerve
Name the branches of each of the three divisions of the axillary artery.
1.) Superior thoracic artery
2.) Thoraco-acromial artery, lateral thoracic
3.) Subscapular artery, anterior circumflex humeral artery, posterior circumflex humeral artery.
The thoracodorsal artery is a branch of which artery? Which, in turn, is a branch of which artery?
Thoracodorsal a. is a branch of the Subscapular a. – which is the last branch of Axillary a.
Trace the circumflex scapular artery back to its origin.
Circumflex scapular – Thoracodorsal – Subscapular – Axillary
Compression of the musculocutaneous nerve in the coracobrachialis will affect which muscles and actions?
Brachialis and portions of biceps brachii, thereby weakening flexion and perhaps supination.
What nerve roots does the triceps reflex test?
What muscle does teres major share a common insertion and action with?
Pectoralis major: Insertion at the intertubercular sulcus and medial rotation.
Explain the cutaneous innervation of the musculocutaneous nerve.
It innervates ≈ 1/2 of the lateral anterior forearm, and ≈ 1/3 of the lateral posterior forearm (only up to the distal radius for both).
Explain the cutaneous innervation of the median nerve on the hand.
Palmar surface: ≈ 2/3 of the palm starting laterally at the thumb (including the thenar eminence, but not the absolute most lateral portion overlying the 1st metacarpal) and ending medially at a sagittal plane drawn through midline of the 4th digit.
Dorsal surface: Medial surface of the thumb and distal to the PIP joint. Distal to the 2nd and 3rd PIPs. Lateral 1/2 of the 4th digit distal to the PIP.
Explain the cutaneous innervation of the ulnar nerve on the hand.
Palmar surface: Starting at the medial most portion and extending laterally to a line drawn through a sagittal plane at the midline of the 4th digit.
Dorsal surface: Starting at the medial most portion (entire 5th digit) and extending to a laterally to a line drawn through a sagittal plane through the midline of the dorsum of the hand. DORSAL DIGITS: Entire dorsal 4th digit extending distally until the PIP, then only the medial half of the 4th digit to the DIP. Proximal medial half of the dorsum of the 3rd digit up to the PIP.
Where is the common extensor tendon and which muscles attach there?
Four of the six superficial extensors attach there: ECRB, ED, EDM, ECU.
Where is the proximal attachment for the superficial extensors that don't attach to the common extensor tendon? What are the muscles?
-Lateral supracondylar ridge.
The deep extensors of the forearm act on the _______ and the ______.
Thumb and index finger.
What is the proximal attachment for the common extensor tendon?
What forms that lateral border of the cubital fossa?
What are the borders and contents of the triangular interval?
Superior: Teres major
Medial: Long head of triceps
Lateral: Lateral head of triceps/humerus
Contents: Radial nerve, profunda brachii
p.292 BRS 8th
The common extensor tendon arises from the ________.
Lateral epicondyle. #75 Gray's
1. Pushing against an immovable object tests the ______ muscle and the _______ nerve.
2. This muscle is known as the ________ muscle because it is the strongest _______.
1. serratus anterior muscle, long thoracic nerve (C5-7)
2. Boxer's muscle, strongest PROTRACTOR of scapula (also stabilizes scapula)
The interossei and lumbricals are responsible for ______ of the _______ joints.
The interossei and lumbricals are responsible for extension of the interphalangeal joints. #78 Gray's.
Which structure passes through the supinator muscle? Track its course
Deep branch of radial nerve - Radial nerve passes through the cubital fossa just anterior to the lateral epicondyle. Just distal to the cubital fossa, it branches into Deep branch and superficial branch, the former passing through the heads of supinator muscle to enter the extensor compartment of the forearm, where it meets with posterior interosseous artery.
The radial artery may be palpated on the anterior forearm just lateral to which tendon?
Flexor carpi radialis
Which nerve provides sensation to the dorsum of the hand proximal to the thumb and index finger?
the superficial branch of the radial nerve.
Which nerve supplies a strip of skin on the back of the forearm and the wrist extensors?
The posterior interosseous nerve (branch of radial)
The lateral antebrachial cutaneous nerve is a continuation of the _______ nerve and supplies the ________.
lateral side of the forearm.
The ______ cervical nerve makes a major contribution to the radial nerve, and this nerve is the prime mover in wrist extension. Injury to which spinal nerve would cause paraesthesia on the back of the arm and forearm.
The _____ artery passes beneath the flexor carpi ulnaris to reach Guyon’s canal between the _____ bone and the flexor retinaculum.
The deep palmar branch of the ulnar artery passes between the two heads of ______ to anastomose with the radial artery in the palm.
the adductor pollicis
Teres major is responsible for ______ and ______ of the humerus.
adduction and medial rotation
The conus medullaris is located at the _____ vertebral level.
What does the carpal trapezium articulate with?
What muscles/tendons attach here? (4)
-Scaphoid, trapezoid, 1st and 2nd metacarpal.
-AbPB, FPB, OP, Transverse carpal ligament
The common palmar digital arteries arise from where?
The superficial palmar arch
The ulnar artery enters the hand ____ to the flexor retinaculum, between the ______ and the _______ via the ________.
Anterior to the flexor retinaculum, between the pisiform and the hook of the hamate via ulnar/Guyon canal.
The ulnar nerve becomes superficial where?
It then passes ______ to the flexor retinaculum to enter the hand.
-Superficial to the flexor retinaculum to enter the hand.
The weakest part of the clavicle is the _______.
junction of its middle and lateral thirds
After fracture of the clavicle, the ________ muscle elevates the ______ fragment of bone, and ecause of the subcutaneous position of the clavicle, the end of the _____ directed fragment is prominent—readily palpable and/or apparent
- superiorly directed fragment
What can cause carpal tunnel syndrome?
-Any lesion that significantly reduces the size of the carpal tunnel or, more commonly, increase the size of some of the nine structures or their coverings that pass through it (e.g. inflammation of the synovial sheaths).
-Fluid retention, infection, and excessive exercise of the fingers may cause swelling of the tendons or their synovial sheaths.
The _______ branch of the median nerve arises proximal to, and does not pass through, the carpal tunnel; thus sensation in the ______ remains unaffected.
To relieve both the compression and the resulting symptoms of carpal tunnel syndrome, partial or complete __________, a procedure called carpal tunnel release, may be necessary. The incision for carpal tunnel release is made toward the _____ side of the wrist and ______ to avoid possible injury to the ________.
-surgical division of the flexor retinaculum
-medial side, flexor retinaculum
-recurrent branch of the median nerve.
The first branch of the _______ nerve is typically the only source of motor supply to the clavicular head of the pectoralis major. If it is injured (as in this case of an iatrogenic injury when the ______ nodes were removed), this part of the muscle undergoes atrophy, leaving an ______ cosmetic deficit.
1. Which spinal nerve is being tested in the brachioradialis reflex?
2. Biceps brachii?
If the triangular cartilage at the distal end of the ulna were disrupted, which carpal bone(s) would the ulna articulate with?
Triquetrum and pisiform
The ulnar nerve passes ______ to the cubital fossa between the heads of the _______.
-flexor carpi ulnaris (not between the heads of the flexor digitorum superficialis).
The ______ are the most important muscles in extension of the interphalangeal (IP) joints because of the manner of their insertion into the _______, which passes ______ to the ______ axes of these joints.
-extensor expansion of the fingers
-dorsal to the transverse axes of these joints.
The lumbrical muscles assist in _____ extension, in addition to flexing the ________.
If the ulnar nerve is cut at the wrist, describe the effects on cutaneous sensation of the dorsal medial palm.
Nothing. The dorsal cutaneous branch to the dorsum of the hand is unaffected.
What are the radial and ulnar attachments for the flexor retinaculum?
Ulnar: Pisiform and hook of hamate
Radial: Scaphoid and trapezium
What muscles are involved in flexion and extension of the wrist joint?
Flexion: FCU + FCR
Extension: ECRL and ECRB + ECU
What muscles are involved in AB- and ADduction of the wrist joint?
ABduction: FCR + ECRL and ECRB
ADduction: ECU + FCU
What is the most lateral of the forearm flexors?
Which muscles extend the the flexed humerus (against resistance) to the side of the trunk?
Lats, Teres major, Pec Major (sternocostal head – Lateral pectoral nerve)
Through what muscles does the Cephalic vein pass to access the axillary vein? What course does it take?
Deltoid and pectoralis major – Runs along the delto-pectoral groove (clavicular head of pec major), and enters through the clavipectoral triangle.
Excessives extension and lateral rotation drives the humerus ______-______, putting two structures at risk, which ones?
Drives humerus INFERO-ANTERIORLY, putting the fibrous layer of the joint capsule and the glenoid labrum at risk of being stripped from the anterior surface of the glenoid cavity.
In the event of a glenoid labrum tear (e.g. in ball-throwing athletes), what is the most common location and symptom?
Anterosuperior part of labrum (because of those who throw balls).
Symptoms: Pain during acceleration phase of throw.
Popping or snapping felt when it glenoid cavity when during ABduction and LATERAL ROTATION.
What is the main flexor(s) of the arm?
Is there a synergist?
Pec major (clavicular part), deltoid (clavicular and anterior acromial part)
Synergist – Coracobrachialis
What muscle most strongly resists downward motion on the shoulder joint (e.g. when carrying heavy objects)?
What joint allows for protraction and retraction of the scapula? What is the movement and what type of joint is it?
Sternoclavicular joint (SC): Saddle-joint – Rotation and, thus. circumduction.