Upper Limb Session 1 and 2 Flashcards Preview

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Flashcards in Upper Limb Session 1 and 2 Deck (115)
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1

What are the functions of the axilla?

The pyramidal space below the shoulder joint. It provides passageway for vessels and nerves going to and from the upper limb

2

Outline the anterior wall of the axilla

Formed by Pec. Major and Minor

3

Outline the posterior wall of the axilla

Scapularis, teres minor and lat. dorsi

4

Outline the medial wall of the axilla

Thoracic wall and serrates anterior muscles

5

Outline the lateral wall of the axilla

Intertubercular sulcus of the humerus

6

Where does the axillary artery originate?

Subclavian artery at the upper margin of the first rib

7

What does the axillary artery continue as and where does it end?

Continues as the brachial artery beyond the lower border of the teres major muscle

8

What is the brachial plexus?

A major network of nerves innervating the upper limb

9

Where does the brachial plexus begin?

Cervical region and extends into the axilla

10

What forms the brachial plexus?

Ventral rami of C5, C6, C7, C8, T1

11

Outline the division of the brachial plexus

Roots, trunks, divisions, cords and branches

12

Read That Damn Cadaver Book

Roots, trunks, divisions, cords and branches

13

Describe Erb's Point

Site of the superior trunk

Located about 2-3cm above the clavicle

14

Describe what happens when Erb's point is injured?

Erb's Palsy - characteristic waiters tip where shoulder is internally rotated and wrist is flexed

15

What is the common aetiology of Erb's Palsy?

Undue separation (hyperextension) of the head from the shoulder - often from birth, falling on shoulder or anaesthesia

16

What nerve roots form the lower trunk?

C8 and T1

17

What does injury to the lower trunk cause?

Klumpke's palsy

18

Describe Klumpke's palsy

Intrinsic muscle of the hand are affected and ulnar flexors of the wrist and fingers

19

What is the common aetiology go Klumpke's palsy?

Undue abdurction of the arm

20

How are the three cords of the brachial plexus named?

According to their relation to the axillary artery

21

What are the main branches of the lateral cord?

Lateral pectoral nerve
Lateral root of median nerve
Musculocutaneous nerve

22

What are the main branches of the medial cord?

Medial pectoral nerve
Median nerve
Ulnar nerve
Medial cut. nerve of the arm
Medial cut. nerve of the forearm

23

What are the main branches of the posterior cord?

Thoracodorsal nerve
Axillary nerve
Radial nerve
Subscapular nerve

24

In the upper arm the brachial artery immediately gives rise to what other artery?

Profunda brachii

25

Where does the profound brachii arise?

Just distal to the margin of the teres major

26

Where does the profound brachii travel?

Within the radial groove of the humerus

27

What other structures accompany the profound brachii in the radial groove?

Radial nerve

28

What does the profound brachii supply?

Structures on the posterior aspect of the arm (principally the triceps muscle)

29

How does the profounda brachii terminate?

In an anastomosing network of vessels at the elbow joint

30

The brachial artery descends down the arm immediately posterior to what?

the median nerve

31

As the brachial a. crosses the cubital fossa it passes under what muscle?

Brachialis

32

How does the brachial artery terminate?

Bifurcatin into the radial and ulnar arteries

33

What vein arises from the dorsal venous plexus of the hand on the medial side?

The basilic vein

34

What happens to the basilic vein at the border of the teres major?

The vein moves deep and coalesces with cephalic vein to form the axillary vein

35

What vein arises from the dorsal venous plexus of the hand on the anterolateral side?

Cephalic

36

Outline the course of the cephalic vein

Moves through the deltoid groove between the deltoid and pec. major muscles to join the axillary vein

37

What is the large communicating vein that shunts blood from the basilic to the cephalic?

Median cubital vein

38

Axillary lymph nodes are divided into 5-6 distinct groups; name them.

Lateral/axillary nodes
Apical/supraclavicular nodes
Central nodes
Interpectoral nodes
Anterior mammary nodes
Posterior/subscapular nodes

39

What is the pectoral girdle?

A set of bones which connect the upper limb to the axial skeleton on each side

40

What joint does the upper limb and the shoulder articulate at?

Glenohumeral joint

41

How do you determine the sternal end of the clavicle?

Large facet
Oval shaped impression on inferior surface (attachement for the costoclavicular ligament)

42

How do you determine the acromial end of the clavicle?

Small facet for articulation with the acromial processs of the scapula

Coronoid tubercle - insertion for the coronoid ligament (medial part of the CC ligament)

43

How is the clavicle divided up?

Thirds (middle third being most susceptible to fracture)

44

What type of joint is the AC and SC joints?

AC - planar synovial
SC - synovial saddle

45

What is the function of the subscapular fossa?

Attachment for the subscapularis (rotator cuff)

46

What is the function of the coracoid process?

Attchement for the short head of the biceps brachii, coracobrachialis and pec. minor

47

What is the function of the glenoid fossa?

Shallow cavity that articulates with the head of the humerus

48

What is the function of the supraglenoid tubercle?

A roughening immediately superior to the glenoid fossa which serves the origin for the long head of the biceps brachii

49

What is the function of the infraglenoid tubercle?

A roughening immediately inferior to the glenoid fossa which serves as the origin to the long head of the triceps brachii

50

What is the function of the acromion?

Projection of the spine that arcehs of the GH joint and articulates with the clavicle

51

What is the function of the infraspinous fossa?

Slightly convex shape and serves as insertion for the infraspinatous

52

What is the function of the supraspinous fossa?

More convex shape and serves as the insertion for the supraspinous muscle

53

What muscles cause elevation of the scapula?

Levator scapulae , upper fibres of the trapezius

54

What muscles cause depression of the scapula?

Pec. minor, lower fibres of the traps, subscapularis, lat. dorsi

55

What muscles cause protraction of the scapula?

Serratus anterior

56

What muscles cause retraction of the scapula?

Trapezius (middle fibres)

57

What muscles cause lateral rotation of the scapula?

Upper and middle traps

58

What muscles cause medial rotation of the scapula?

Gravity, rhomboids, pec. minor

59

What is the rim of cartilarge around the GH joint called?

Glenoid labrum

60

What is the function of the Glenoid labrum?

Deepens the joint adn provides more stability

61

Describe the joint capsule of the GH joint

Thickened to form definable ligaments (superior, middle and inferior)

62

What true ligaments of the shoulder are there?

Coracoacromial ligament - forms arch from acrominon to the coracoid process and protects the shoulder from superior dislocation

Corcaohumeral ligament - supports superior joint capsule

63

Describe the bursae of the shoulder

1. Subacrominal - superficial to the supraspinatous tendon and joint capsule and promotes free movement

2. Subscapular - located deep to supscapularis tendon, this bursa freely communicates with the joint capsule

64

What muscles form the rotator cuff?

Superspinatous, infraspinatous, supscauplaris, teres minor

65

What is the insertion of the supraspinatous?

Greater tubercle of the humerus

66

What is the innervation of the supra-infraspinatousa?

Supraclavicluar nerve

67

What is the only rotator cuff muscle to not insert on the greater tubercle?

Subscapularis (attaches to the lesser tubercle)

68

What nerve supplies the deltoid muscle?

Axillary nerve

69

What is the triangular space between the deltoid and pec. major called? What is its significance?

Deltoid triangle - for placement of central lines into subclavian vein

70

What nerve supplies the serrates anterior?

Long thoracic nerve

71

Injury of the long thoracic nerve causes what? What can cause injury of the LT nerve?

Winging of the scapula; breast surgery

72

What are the function fo the trapezius

Superior fibres -- elevate and rotate the scapula
Middle fibres - retract scapula
Infeior fibres - depress scapula

73

What is the action of the teres major muscle?

Medially rotate and adduct the arm (as does the lat. dorsi which also extends the arm)

74

Where does the intertubercular groove run?

Between the greater and lesser tubercles

75

What is the relevance of the surgical neck of the humerus?

It is a common site of fracture and can lead to injury of the axillary nerve and posterior circumflex artery

76

What is the insertion fo the deltoid muscle

The deltoid tuberosity

77

Describe the trochlear of the distal humerus

More medial the the capitulum

Serves as attachment for the ulnar bone

78

What are the three fossae at the distal part of the humerus?

Olecranon, coronoid and radial fossae

79

What are the two compartments of the arm?

Flexors (anterior) and extensors (posterior)

80

Describe the anterior compartment of the arm and it innervation

Three muscles (BBC)

All supplied by the musclulocutaneous nerve

81

Outline the functions of the biceps brachii

Attaches form the supraglenoid tubercle (long head) and the coracoid process (short head) and both insert into the radial tuberosity

Functions to supinate the forearm and flex at the elbow and shoulder

82

Outline the functions of the coracobrachialis

Originates from the coracoid process and inserts on the medial aspect of the shaft at the level of the deltoid tuberosity

Acts to flex the arm at the shoulder and its a weak adductor

83

Outline the functions of the brachialis

Originates on the medial/lateral surfaces of the humeral shaft and attaches to the ulnar tuberosity distal to the elbow

Flexes the elbow

84

Describe the posterior compartment of the arm

COntains the triceps brachii and the radial nerve

Three heads:

Ling head - originates from the infraglenoid tubercle
Medial head - originates from the humerus, inferior to the radial groove
Lateral head - originates from superior to the radial groove (covers the medial head)

85

Where does the MC nerve arise from?

Lateral cord of the brachial plexus

86

How does the MC nerve enter the arm?

Pierces the coracobrachialis and descends between the biceps and the brachilalis

87

After supplying the muscles of the arm what is the fate of the MC nerve?

Contrinues as the lateral cutaneous nerve of the forearm

88

What are the segmental roots of the MC nerve?

C5-C7

89

Where does the median nerve arise from?

Two roots - one from the medial cord and one from the lateral cord

90

What is the course of the median nerve?

Descends along the lateral side of the axillary nerve and upper brachial artery, crossing over the arm to the medial side of the brachial artery in the mid-arm and enters the cubital fossa giving no branches in the axilla or upper arm

91

What does the median nerve innervate?

All flexors and pronators of the forearm (except FCU and FDP) and also innervates thenar muscles and the lateral two lumbricals

92

Where does the ulnar nerve arise?

From the medial cord

93

What is the course of the ulnar nerve?

Descends along the medial side of the brachial artery and enters the posterior compartment throught the inter-muscular septum; then running along the medial head of the triceps and behind the medial epicondyle

94

What does the ulnar nerve innervate ?

Nothing in the arm

FCU and medial half go FDP and intrinsic muscles of the hand (bar those innervated by the median nerve)

95

There are three common sites for nerve injury in the arm: what are they?

Radial nerve - radial groove
Ulnar nerve - medial epicondyle
Axillary nerve - surgical neck

96

What are the borders of the cubital fossa?

Medial - lateral borders of the pronator teres
Lateral - medial border of the brachioradialis
Superior - imaginary line between the epicondyles

97

What are the contents of the cubital fossa?

(Aid: Really Need Beer To Be At My Nicest)

Radial Nerve, Biceps Tendon, Brachial Artery, Median Nerve

98

The common tendon of the triceps inserts where?

The olecranon process

99

The olecranon process and the coronoid process are both features of what bone?

Ulnar

100

How does the radial nerve are arise?

It is the terminal branch of the posterior cord of the brachial plexus

101

What does the radial nerve innervate?

The extensor compartment of the upper arm and forearm

102

Describe the course of the radial nerve

Enters the arm to the long head of the triceps and runs with the profound brachii, it then curves around the mid-shaft in the radial groove

103

What are the segmental roots of the radial nerve?

C5-T1

104

What is the characteristic feature of radial nerve injury

Wrist drop

105

Describe the ligaments of the elbow

Fibrous capsule is thickened on the lateral and medial sides forming the medial (ulnar) collateral ligament and the lateral collateral (radial) ligament

There is also the annular ligament

106

What ligament hold the head of the radius in place?

Annular ligament

107

Outline the flexors of the elbow joint

Biceps brachii
Brachialis
Brachioradialis

108

Outline the extensors of the elbow joint

Triceps brachii (+ anconeus)

109

What type of joint are the radio-ulnar joints?

Synovial pivots

110

How is pronation/supination allowed?

The head o the radius rotates within the annular ligament

111

Oultine pronator muscles

Pronator teres and pronator quadratus

112

Outline supinator muscles

Supinator and biceps brachii

113

What other muscles assist with pronation?

FCR, PL and brachioradialis

114

What other muscles assist with supination?

EPL, ECR

115

What is the most powerful supinator/pronator?

Supination - biceps brachii
Pronation - pronator teres