Week 1 Flashcards
(548 cards)
1
Q
What is Anatomical Position?
A
Standing up, eyes directly ahead, palms facing forward (supinated). This is how we will reference any body we discuss even if cadavers are not in this position.
2
Q
How does the coronal/frontal plane divide the body?
A
Anterior & posterior
3
Q
How does the horizontal/axial/transverse plane divide the body?
A
Superior & inferior
4
Q
How does the sagittal/longitudinal plane divide the body?
A
Right and left
5
Q
What is the median plane?
A
A subset of the sagittal/longitudinal plane that is right down the middle of the body part we are discussing.
6
Q
What is the parasagittal plane?
A
A subset of the sagittal/longitudinal plane that is off of the mid-line of the body part we are discussing.
7
Q
What is the Oblique Plane?
A
Diagonal in any way.
8
Q
What plane divides the body into right and left?
A
Sagittal or longitudinal
9
Q
What plane divides the body into superior and inferior?
A
Horizontal, axial, transverse plane.
10
Q
What plane divides the body into right and left?
A
Sagittal or longitudinal plane.
11
Q
What are the subset planes of sagittal plane?
A
Median (midsagittal) plane and parasagittal plane.
12
Q
In general, with flexion we observe an anterior angle decreasing. What is an exception to this?
A
Knee flexion is an exception as it involves posterior angle decreasing.
13
Q
What are the functions of the vertebral column?
A
-Protection for the spinal cord (contained within vertebral column)
-Support/attachment of the extremities
-Movement
-Stability (posture)
14
Q
What are the movements of the vertebral column?
A
Flexion, extension, lateral flexion, rotation.
15
Q
Name the 5 regions of the vertebral column and number of vertebrae in each. Think of meal times
A
7 cervical
12 thoracic
5 lumbar
5 sacral (fused)
3-5 coccygeal (fused after 30 yrs)
16
Q
Why are curvatures of the spine important?
A
They increase the resiliency of the spine.
17
Q
What are the primary curvatures of the spine and why are they called primary?
A
The thoracic and sacral curvatures. Called primary because they are present at birth, allowing us to fit in our mom’s tummy during pregnancy.
18
Q
What are the secondary curvatures of the spine and why are they called secondary?
A
Cervical and lumbar curvatures. Called secondary because they develop when babies begin to walk as their neck and back muscles develop. No baby could walk without these curvatures.
19
Q
What is Scoliosis?
A
An abnormal lateral curvature.
20
Q
What is Kyphosis?
A
An exaggerated thoracic curvature.
21
Q
What is Lordosis? When does this generally happen?
A
An accentuated lumbar curvature. Generally occurs during pregnancy or when a birth is obese as there is a lot of weight anteriorly.
22
Q
What part of the vertebrae takes the bulk of the body weight?
A
Vertebral body
23
Q
What makes up the vertebral arch?
A
Pedicle (pillars) and Lamina (arch)
24
Q
What part of an individual vertebrae does the spinal cord travel through?
A
Vertebral foramen.
25
What attaches to the spinous processes of the vertebrae?
Muscles and ligaments.
26
T/F: We can visualize intervertebral foramen just by looking at an individual vertebrae.
False! We can only see these when vertebrae are stacked on each other.
27
What connects at the articular processes of the vertebrae?
These are the places where vertebrae connect on the top and bottom of each vertebra.
28
How many total processes are on vertebrae? Name them.
7 total processes
-Spinous process
-2 transverse processes
-2 superior articular processes
-2 inferior articular processes
29
What is a Zygapophysial (Facet) Joint?
This is where the inferior articular processes of the vertebrae articulate with the superior articular processes of the vertebrae below.
30
What is the function of the vertebral body?
Support of body weight
31
What is the function of the vertebral arch?
Protection of spinal cord
32
What is the function of the articular processes of the vertebrae?
Restriction of movement.
33
What is the function of the spinous and transverse processes of the vertebrae?
Muscle/ligament attachment and movement
34
What is the C1 vertebrae called?
C1 = Atlas
35
What purpose do the lateral masses on C1 serve?
They are parts of the transverse process that articulate with the occipital condyles (head sits on here).
36
What is the C2 vertebrae called?
C2 = Axis
37
What purpose does the Dens on C2 serve? What is another name for it?
It fits right into C1. Another name for this is the Odontoid Process.
38
What is the C7 vertebrae called and why?
Vertebral prominens. Called so because it has a very large spinous process, which can be felt on the back of the neck.
39
What are the identifying characteristics of Cervical Vertebrae?
-Large vertebral foramina
-Transverse Foramen
-Bifid spinous process
-Small body
40
Why would the cervical vertebrae have a large vertebral foramina?
There is a lot traveling through this area, especially nerves traveling down the rest of the body since the extremities are below.
41
What travels through the transverse foramen of the cervical vertebrae?
Vertebral arteries for the brain travel through here. VERY IMPORTANT.
42
What are the 2 major groups of back muscles?
Extrinsic back muscles (superficial and intermediate) and Intrinsic back muscles (deep).
43
What is the function of the Superficial Extrinsic back muscles?
Functions primarily to produce and control limb movement.
44
What is the innervation of the Superficial Extrinsic back muscles?
All muscles are innervated by ventral rami, however, the trapezius is an exception and is innervated by CN XI (the spinal accessory nerve).
45
What is so special about the innervation of the trapezius by CN XI?
This is the only CN to innervate skeletal muscle that is not in the head.
46
Name the 5 Superficial Extrinsic back muscles.
Trapezius
Latissimus Dorsi
Levator Scapulae
Rhomboid Minor
Rhomboid Major
47
What is the function of the Intermediate Extrinsic back muscles?
Functions as superficial respiratory muscles.
48
What innervates the Intermediate Extrinsic back muscles?
Innervated by the intercostal nerves (ventral rami). These nerves come out in between the ribs.
49
Name the 2 Intermediate Extrinsic back muscles.
Serratus posterior inferior and serratus posterior superior.
50
T/F: It is generally easier to find the Intermediate Extrinsic back muscles in older populations.
False! It is actually more difficult to find serratus posterior inferior and serratus posterior superior in older populations as these muscles are generally smaller and thinner.
51
What is the function of the Intrinsic (Deep) back muscles?
Functions to maintain posture and controls the movements of the vertebral column.
52
What innervates the Intrinsic (Deep) Back Muscles?
Innervated by the dorsal rami of spinal nerves.
53
What encloses the Intrinsic (Deep) Back Muscles?
These muscles are enclosed by deep thoracolumbar fascia in the thoracic and lumbar regions.
54
Name the 3 groups of Intrinsic (Deep) Back Muscles.
Superficial, intermediate, and deep.
55
Name the Superficial Intrinsic Back Muscles.
Splenius Capitis and Splenius Cervicis
56
What is the medial attachment of the Splenius Capitis and Splenius Cervicis?
Nuchal ligament and spinous processes of C7-T3.
57
What is the lateral attachment of the Splenius Capitis and Splenius Cervicis?
Capitis: Mastoid process and occipital bone.
Cervicis: Transverse processes of C1-C3 (4).
58
What is the innervation of the Splenius Capitis and Splenius Cervicis?
Posterior/Dorsal rami of spinal nerves.
59
What is the function of the Splenius Capitis and Splenius Cervicis?
Extend the head and neck bilaterally and laterally flex neck and rotate head unilaterally (contralateral side needs to relax for this).
60
What is the blood supply to the Splenius Capitis and Splenius Cervicis?
Muscular branches of the aorta and the branches off of the posterior intercostal artery.
61
Name the Intermediate Intrinsic back muscles.
The erector spinae muscles, which consist of:
Iliocostalis (lateral)
Longissimus
Spinalus (medial)
62
What is the inferior attachment of the erector spinae muscles?
Broad tendon from the posterior surface of the sacrum.
63
What is the superior attachment of the erector spinae muscles?
Runs superiorly to superior ribs and transverse processes.
64
T/F: The erector spinae muscles have medial and lateral attachments.
False! There is no medial or lateral attachment as these muscles go down the vertebral column along the midline (just superior and inferior focus).
65
What is the innervation of the erector spinae muscles?
Posterior rami of spinal nerve.
66
What is the function of the erector spinae muscles?
Laterally flex vertebral column unilaterally and control spinal flexion by lengthening its fibers bilaterally.
67
What is the blood supply to the erector spinae muscles?
Branches off of the aorta.
68
What muscles reside deep to the erector spinae muscles?
Deep intrinsic back muscles
69
Where do the deep intrinsic back muscles lie between?
Lie between the spinous and transverse processes (super small).
70
Collectively, what are the deep intrinsic back muscles called?
Transversospinalis (also referred to as paraspinal muscles)
71
What 3 muscles make up the Transversospinalis?
Semispinalis, rotatores, and multifidus
72
When we injure our backs and our muscles lock up/spasm, what muscles likely are spasming?
Transversospinalis muscles, aka, the paraspinal muscles.
73
Describe the location of the posterior median furrow.
Ends in the nuchal groove superiorly and intergluteal cleft inferiorly.
This is the line down the midback on surface anatomy, seen easier when someone has low body fat.
74
What back muscles border the posterior median furrow?
Erector spinae muscles
75
What does Surface Anatomy refer to?
Anatomy visualized through the skin on the outside of the body. Think of a lean person's muscles, you can look at the anatomy.
76
What importance does the Triangle of Auscultation serve on physical exams?
This is the site where breath sounds can be heard most clearly using a stethoscope.
77
What makes up the boundaries of the Triangle of Auscultation?
Lateral border of the trapezius.
Medial border of the scapula.
Superior border of the latissimus dorsi.
78
What is the Suboccipital Region/Triangle?
A muscle "compartment" deep to the superior part of the posterior cervical region.
79
Describe the location of the Suboccipital Region/Triangle.
Deep to the trapezius, sternocleidomastoid, splenius, and semispinalis muscle.
80
What 4 muscles makes up the boundaries of the Suboccipital Region/Triangle?
Superolateral boundary: Obliquus capitis superior
Inferolateral boundaru: Oliquus capitis inferior
Superomedial border: Rectus capitis posterior major and minor
81
If the muscles that make up the Suboccipital Region/Triangle get tight, what can be the effect?
Headaches
82
What innervates that muscles of the Suboccipital Region/Triangle?
All innervated by the suboccipital nerve.
83
What can be found within the Suboccipital Region/Triangle?
Vertebral artery and suboccipital nerve (ventral ramus coming off of C1)
84
How does the vertebral artery get to the brain?
Travels through the transverse foramina in the cervical vertebrae (really deep) to get to the brain.
85
What is the function of the Superficial Extrinsic back muscles?
Functions primarily to produce and control limb movement.
86
What innervates the Superficial Extrinsic back muscles?
All innervated by the ventral rami with the exception of the trapezius which is innervated by CN XI (spinal accessory nerve).
87
Name the 5 muscles that make up the Superficial Extrinsic back muscles.
Trapezius, latissimus dorsi, levator scapulae, rhomboid major, rhomboid minor.
88
T/F: Many of the superficial extrinsic back muscles are attached to part of the pectoral girdle.
True!
89
What innervates the Trapezius muscle?
CN XI (spinal accessory nerve)
90
What is so special about the Trapezius muscle innervation?
This is the only back muscle that is innervated by a cranial nerve!
91
What is the function of the Trapezius?
Elevation, depression, and retraction of the scapula.
92
What is the blood supply to the Trapezius?
Transverse cervical artery
93
What is the medial attachment for the Trapezius?
Posterior skull and medial spinal processes of C7-T12.
94
What is the insertion for the Trapezius?
Lateral 1/3 of clavicle, acromion, and spine of scapula.
95
What innervates the Latissimus Dorsi?
Thoracodorsal nerve.
96
What is the function of the Latissimus Dorsi?
Think of Butterfly Swim via Micheal Phelps
Adduction of the upper extremity, internal rotation, and extension of the upper extremity.
97
What is the blood supply to the Latissimus Dorsi?
Thoracodorsal artery
98
What is the origin of the Latissimus Dorsi?
Spinous processes of the mid-thoracic to sacral region.
99
What is the insertion of the Latissimus Dorsi?
Intertubercular groove/sulcus of the humerus.
This means the Latissimus Dorsi travels through the armpit to get on the anterior humerus.
100
What innervates the Levator Scapulae?
Dorsal scapular nerve
101
What is the function of the Levator Scapulae?
Elevation of the scapula.
102
What is the blood supply to the Levator Scapulae?
Dorsal scapular artery.
103
What is the medial attachment for the Levator Scapulae?
Posterior tubercles of C1-C4 (these are next to the transverse processes).
104
What is the lateral attachment for the Levator Scapulae?
Medial border of the scapula from superior angle to scapular spine.
105
What innervates the Rhomboid Major?
Dorsal scapular nerve
106
What is the function of Rhomboid Major?
Retract and rotate the scapula as well as fix the scapula to the thoracic wall.
Because it is fixed to the thoracic wall, this means that the Rhomboid Major is always working.
107
What is the blood supply for the Rhomboid Major?
Dorsal scapular artery
108
What is the medial attachment for the Rhomboid Major?
Spinous processes of T2-T5.
109
What is the lateral attachment for the Rhomboid Major?
Medial end border of scapula from spine to inferior angle.
110
What innervates the Rhomboid Minor?
Dorsal scapular nerve
111
What is the function of the Rhomboid Minor?
Retract and rotate the scapula as well as fix the scapula to the thoracic wall.
This means the muscle must always be working to fix the scapula to the thoracic wall.
112
What is the blood supply for Rhomboid Minor?
Dorsal scapular artery
113
What is the medial attachment for Rhomboid Minor?
Nuchal ligament and spinous processes of C7-T1.
114
What is the lateral attachment for Rhomboid Minor?
Medial end of and above the scapular spine.
115
Trapezius cause ___________ rotation of the scapula, whereas the rhomboids cause _____________ rotation of the scapula.
Superior; inferior
116
What sits deep to the Rhomboid Minor?
Serratus Posterior Superior.
117
What innervates the Serratus Posterior Superior?
2nd-5th intercostal nerve.
118
What is the function of the Serratus Posterior Superior?
Elevate the ribs to assist with breathing/respiration.
119
What is the origin of Serratus Posterior Superior?
C7-T3 vertebrae spinous process and nuchal ligament.
120
What is the insertion of Serratus Posterior Superior?
Upper border of the 2nd-5th ribs.
121
What sits deep to the Latissimus Dorsi?
Serratus Posterior Inferior
122
What innervates the Serratus Posterior Inferior?
9th-11th intercostal nerve and subcostal nerve (T12).
123
What is the function of Serratus Posterior Inferior?
Depresses ribs to assist with breathing/respiration.
124
What is the origin of Serratus Posterior Inferior?
T11-L2 vertebrae spinous processes
125
What is the insertion of Serratus Posterior Inferior?
Lower border of the 9th-12th ribs.
126
What is a Sprain?
An injury to the ligaments without dislocation or fracture. Overstretching but not tearing.
127
What would a back sprain involve?
Injury to the ALL, PLL, and/or sometimes the Ligamentum Flavum ligament.
128
How does a back sprain occur?
Occurs from excessive extension or rotation.
129
What is a Strain?
Stretching or tearing of a muscle.
130
Where does a back strain usually occur?
Usually in the lumbar region and involving the erector spinae muscles.
131
What is the MOST COMMON cause of low back pain (LBP)?
A back strain.
132
How is a back strain caused and what is the effect?
Unbalanced weight on the vertebral column pulls the muscles. Spasms then occur.
133
What is a Hangman's Fracture?
Severe whiplash or hyperextension injuries that cause a tear of the transverse ligament of the atlas or a fracture of the axis. This allows the dens of C2 to slide forward and compress the spinal cord.
134
What keeps the Dens of C2 locked into C1?
The transverse ligament of C1.
135
What is a Disc Herniation?
Occurs when nucleus pulposus bulges out of the anulus fibrosus and can compress spinal nerves, spinal cord, or cauda equina.
136
In what location do disc herniations most commonly occur? What percentage? Why?
95% occur at L4-5 or L5-S1
This is the area furthest down the spine where majority of the weight sits.
137
What tends to prevent anterior disc herniations?
Anterior Longitudinal Ligament of the spine (ALL)
138
What tends to prevent complete posterior disc herniations?
Posterior Longitudinal Ligament of the spina (PLL).
139
What is Spondylolysis?
Fracture of the vertebral lamina.
140
What level of the spine does Spondylolysis mostly occur at?
Occurs at L5 due to majority of weight here. Additionally, there are thought to be failures/problems during embryonic development that can lead to this.
141
What can Spondylolysis contribute to the development of?
Spondylolisthesis
142
T/F: Spondylolysis generally occurs bilaterally.
False! It usually only occurs on 1 side, not bilaterally.
143
What is Spondylolisthesis?
Displacement of the vertebral body due to bilateral fracturing of the lamina. The vertebral body then moves forward and puts pressure on both the spinal cord and nerves.
144
What happens if Spondylolisthesis occurs at L5-S1?
Causes pressure on the spinal nerves of the cauda equina.
145
What does Spondylolisthesis reduce the opening of?
Reduces the opening of the pelvic inlet.
146
What is Spina Bifida?
An embryonic spinal anomaly present at birth.
147
What are the 2 types of Spina Bifida?
Spina Occulta and Spina Cystica.
148
What is Spina Occulta? What percentage of people have this?
Failure of the laminae to develop and fuse. Around 24% of people have this, and this ranges in severity and symptoms.
149
What is Spina Cystica?
Herniation of the meninges (meningocele) or herniation of the spinal cord (meningomyelocele). VERY DANGEROUS!
150
In Spina Bifida Occulta, what protects the spinal cord?
Just connective tissue, skin, and muscle. There are no laminae developed.
151
Where are Lumbar Punctures/Epidurals generally performed? Why?
Generally performed between L3/L4 or L4/L5. At this point, the spinal cord has ended and it is just nerves.
152
When performing a lumbar puncture/epidural, where do we penetrate to?
Penetrate to the subarachnoid space.
153
At what level does the spinal cord end?
Around L2.
154
What parts does the upper limb consist of?
Arm (brachium), forearm, and hand.
155
The upper limb can be split into the ______ ________ and the _______ ________.
Pectoral Girdle; Upper Limbs
156
Name the parts of the pectoral girdle.
Clavicle and scapula
157
Name the parts of the upper limbs.
Humerus, radius, ulna, carpals, metacarpals, and phalanges.
158
What does the Pectoral Girdle do?
Attaches the upper limb to the axial skeleton via the sternoclavicular joint.
159
T/F: The pectoral girdle is a complete, bony ring.
False! The pectoral girdle is an incomplete, bony ring. This is because the clavicles do not connect anteriorly, and the scapulae do not connect posteriorly.
160
Name the two ends of the clavicle.
Sternal end and acromial end.
161
What does the sternal end of the clavicle articulate with?
Articulates with the manubrium at the sternoclavicular (SC) joint.
162
What does the acromial end of the clavicle articulate with?
Articulates with the acromion process of the scapula at the acromioclavicular (AC) joint.
163
What part of the scapula articulates with the humerus?
Glenoid cavity
164
Where is the scapular spine on the scapula? What attaches here?
Posterior side, many muscles attach here.
165
What part of the scapula articulates with the clavicle?
Acromion process; this forms the AC joint.
166
What is the Coracoid Process on the scapula?
It is a more anterior process (relative to the acromion process) that functions as a site for muscle attachment.
167
What is the suprascapular notch of the scapula?
A groove in the superior border of the scapula.
168
What 2 major parts is the shoulder joint made up of?
** Think other than the glenoid and humerus**
Pectoral girdle + upper limb
169
Where is the scapulothoracic joint?
Muscles gliding on each other between the scapula and the ribs.
170
Where is the sternoclavicular joint?
Between the clavicle and manubrium of the sternum.
171
Where is the acromioclavicular joint?
Between the acromion and acromial end of the clavicle.
172
Where is the glenohumeral joint?
Between the glenoid fossa and head of the humerus.
173
Is the Scapulothoracic Joint a true joint? Explain.
It is NOT a true joint. This is because there are no ligaments involved, just muscles.
174
What is the function of the scapular sling muscles?
To hold the scapulothoracic joint in place and provide scapular ROM.
175
What 7 muscles make up the scapular sling?
Trapezius
Levator scapulae
Rhomboid minor
Rhomboid major
Serratus anterior
Pectoralis major
Subclavius.
176
T/F: The scapular sling will aid in moving the upper limb.
False! None of the scapular sling muscles attach to the humerus, thus, they cannot move the upper limb.
177
Name the 6 main scapulothoracic joint movements.
Elevation, depression, abduction (protraction), adduction (retraction), upward rotation, and downward rotation (see slide for picture).
178
What joint serves as the only attachment between the upper limb and the axial skeleton?
Sternoclavicular joint
179
What type of joint is the sternoclavicular joint? What type does it function as?
Saddle joint, however, it functions as a ball-and-socket joint.
180
Name the 4 ligaments of the Sternoclavicular Joint.
Anterior SC ligament
Posterior SC ligament
Interclavicular ligament
Costoclavicular ligament
181
What is special about the Costoclavicular ligament and what is its function?
It is an Extrinsic ligament, meaning it is not a part of the joint itself, however, it functions to limit elevation of the clavicle.
182
What type of joint is the Acromioclavicular Joint?
Plane joint with many strong ligaments.
183
Name the ligaments of the Acromioclavicular Joint.
Acromioclavicular ligament
Coracoclavicular ligament
184
Where does the Acromioclavicular ligament span?
Extends from the acromion of the scapula to the acromial end of the clavicle.
185
Where does the Coracoclavicular ligament span?
Extends from the coracoid process to the clavicle.
186
The Coracoclavicular ligament is a pair of ligaments; the ________ & ___________.
conoid; trapezoid
187
What type of joint is the glenohumeral joint?
Ball-and-socket joint, which allows for a lot of movement.
188
How is stability increased in the glenohumeral joint?
Stability is increased by the glenoid labrum and tonus of rotator cuff muscles.
189
What makes up the glenohumeral joint?
Glenoid cavity + the head of the humerus
190
Given the size of the articulation points of the glenohumeral joint, how does this allow for increased mobility of the joint?
Only 1/3 of the humeral head generally fits into the glenoid cavity, thus, there is increased mobility. Unfortunately, this also means the joint is less stable.
191
What is the Glenoid Labrum?
A fibrocartilaginous ring located within the glenoid cavity that increases the depth and surface area of the socket.
192
Where are the intrinsic ligaments of the glenohumeral joint located?
They are part of the fibrous layer of the joint capsule.
193
Name the intrinsic ligaments of the glenohumeral joint.
Glenohumeral ligament
Coracohumeral ligament
194
Name the extrinsic ligaments of the glenohumeral joint.
Transverse humeral ligament
Coracoacromial ligament
Coracoclavicular ligament
195
What is the function of the glenohumeral ligament?
3 fibrous bands that reinforce the anterior part of the joint capsule. These bands go in different directions, which increases stability of the ligament.
196
What is the function of the axillary fold/recess on the glenohumeral ligament? Why can this be bad?
This fold/recess is lax, which allows for movement of the shoulder. This can put us at a higher risk for anteroinferior shoulder dislocations.
197
Where does the Coracohumeral ligament span?
Stretches from the base of the coracoid to the anterior aspects of the greater and lesser tubercles.
198
Where does the Transverse Humeral ligament span?
Stretches from the greater to the lesser tubercle.
199
Where does the Coracoacromial ligament span?
Stretches from the coracoid to the acromion.
200
What is the function of the Coracoacromial ligament?
This helps to prevent anteroinferior shoulder dislocations (even though it has nothing to do with the humerus).
201
What is the function of the Transverse Humeral ligament?
This helps to hold the biceps tendon in place while allowing it to pass through the bicipital groove.
202
What does Scapulohumeral Rhythm entail?
The glenohumeral joint moves in a 1:2 ratio after 30 degrees of abduction. For every 2 degrees the humerus moves, the scapula rotates 1 degree as well.
203
T/F: Scapulohumeral Rhythm is occurring within the first 30 degrees of abduction.
False! The first 30 degrees of abduction range are humeral movement, primarily due to humeral rotation at the glenohumeral joint.
204
At the end abduction range, is the humerus or scapula primarily responsible for movement? What does this avoid?
End abduction range is primarily due to scapular rotation at the scapulothoracic joint.
This avoids limiting acromion and humeral interaction.
205
When does the Subclavian artery become the Axillary artery?
At the 1st rib.
206
When does the Axillary artery become the Brachial artery?
At the medial border of the teres major (or the lats, which can be easier to see in the cadaver lab).
207
What are the 4 main arteries of the posterior shoulder?
Suprascapular artery
Circumflex scapular artery
Thoracodorsal artery
Dorsal scapular artery
208
When performing shoulder shoulder surgery, we can ligate the axillary artery and blood will still get to the upper limb. Why is this?
The arteries anastomose with each other, allowing them to form several routes where they connect with each other. Even if the axillary artery is ligated, blood has other routes to get to the upper limb.
209
What is an Axioappendicular Muscle?
A muscle attaching to the axial and appendicular skeleton.
210
Name the 4 Anterior Axioappendicular Muscles.
Serratus anterior
Subclavius
Pectoralis Minor
Pectoralis Major
211
What is the proximal attachment for the Pectoralis Major?
Clavicular head: anterior surface of medial half of clavicle.
Sternocostal head: anterior surface of sternum, superior 6 costal cartilages, aponeurosis (tendonis sheath) of external oblique muscles.
212
What is the distal attachment for the Pectoralis Major?
Lateral lip of the intertubercular sulcus.
213
What is the action of the Pectoralis Major?
Adducts, medial/internal rotation, flexion, and inspiration (when the shoulder is fixed).
214
What is the action of the clavicular head of the Pectoralis Major?
Flexes the humerus joint.
215
What is the action of the sternocostal head of the Pectoralis Major?
Extends the humerus from a flexed position (coming back down from a flexed position).
216
What innervates the Pectoralis Major?
Lateral and medial pectoral nerve.
217
What is the proximal attachment for Pectoralis Minor?
3rd-5th ribs near the costal cartilages.
218
What is the distal attachment for Pectoralis Minor?
Medial and superior surface of coracoid process.
219
What is the action of the Pectoralis Minor?
Stabilizes the scapula by drawing it inferiorly and anteriorly against the thoracic wall.
220
What innervates the Pectoralis Minor?
Medial pectoral nerve.
221
What is the proximal attachment of the Serratus Anterior?
**Think differently than normal proximal idea**
Lateral parts of ribs 1-9
222
What is the distal attachment of the Serratus Anterior?
**Think differently than normal proximal idea**
Anterior surface of the medial border of the scapula.
223
What is the action of Serratus Anterior?
Protracts scapula and anchors scapula to thoracic wall.
224
What innervates the Serratus Anterior?
Long thoracic nerve
225
What is the proximal attachment of the Subclavius?
Junction of 1st rib and its costal cartilages.
226
What is the distal attachment of the Subclavius?
Inferior surface of middle third of the clavicle.
227
What is the action of the Subclavius?
Anchors and depresses the clavicle.
228
What innervates the subclavius?
Subclavian nerve
229
What are the superficial posterior axioappendicular muscles?
Trapezius and Latissimus Dorsi
230
What are the deep posterior axioappendicular muscles?
Levator scapulae, rhomboid major, and rhomboid minor.
231
Definition-wise, what are the scapulohumeral muscles?
A group of 6 short muscles that stretch from the scapula to the humerus and act on the glenohumeral joint.
232
Name the 6 scapulohumeral muscles.
Deltoid
Teres major
Teres minor
Infraspinatus
Supraspinatus
Subscapularis
233
What is the proximal attachment of the anterior deltoid?
Lateral 1/3 of the clavicle
234
What is the proximal attachment of the middle/lateral deltoid?
Acromion
235
What is the proximal attachment of the posterior/rear deltoid?
Spine of scapula
236
What is the distal attachment of the deltoid?
Deltoid tuberosity, which is a rough bump on the lateral aspect of the humerus
237
How do bones, specifically tuberosities, change as our muscles grow?
Bones get bigger, rougher, and thicker as our muscles grow.
238
What is the action of the anterior deltoid?
Flexes and medially rotates the arm.
239
What is the action of the middle/lateral deltoid?
Abducts arm PAST 15 degrees.
240
What is the action of the posterior/rear deltoid?
Extends and laterally rotates the arm.
241
What innervates the deltoid?
Axillary nerve
242
What is the proximal attachment of the Teres Major?
Posterior surface of inferior angle of the scapula.
243
What is the distal attachment of the Teres Major?
Medial lip of the intertubercular sulcus of the humerus (this is anteriorly).
244
What is the action of Teres Major?
Adducts and medially rotates the arm.
245
What innervates Teres Major?
Lower subscapular nerve
246
Name the 4 muscles of the rotator cuff.
Supraspinatus, subscapularis, infraspinatus, and teres minor
247
T/F: All of the rotator cuff muscles rotate the arm.
False! All rotator cuff muscles EXCEPT the supraspinatus rotate the arm.
248
What is the function of the rotator cuff muscles?
To provide stability and protection for the glenohumeral joint.
249
In a rotator cuff tear, what muscle is most likely injured?
Supraspinatus tendon
250
What is the proximal attachment of the Supraspinatus?
Supraspinous fossa of the scapula
251
What is the distal attachment of the Supraspinatus?
Greater tubercle of the humerus.
252
What is the action of the Supraspinatus?
Initiates the first 15 degrees of abduction, then works with the deltoid for full abduction of the arm.
253
What innervates the Supraspinatus?
Suprascapular nerve
254
What is the proximal attachment of the Infraspinatus?
Infraspinous fossa of the scapula
255
What is the distal attachment of the Infraspinatus?
Greater tubercle of the humerus
256
What is the action of the Infraspinatus?
Laterally rotates the humerus
257
What innervates the Infraspinatus?
Suprascapular nerve
258
Describe the pathway of the suprascapular nerve.
The suprascapular nerve runs through the suprascapular notch. It is in close proximity to the suprascapular artery and vein, which run atop the suprascapular notch.
259
Why would it be best for the suprascapular nerve to be running through the notch while the artery and vein run on top? Is this always the case?
The nerve will not be crowded.
There can be variation in some people, in which some may have the artery and vein running through the notch, which can present as either symptomatic or asymptomatic
260
What is the proximal attachment of the Teres Minor?
Lateral border of the scapula.
261
What is the distal attachment of the Teres Minor?
Greater tubercle of the humerus
262
What is the action of the Teres Minor?
Laterally rotates the arm (external rotation).
263
What innervates Teres Minor?
Axillary nerve
264
What is the proximal attachment of the Subscapularis?
Subscapular fossa of the scapula.
265
What is the distal attachment of the Subscapularis?
Lesser tubercle of the humerus
266
What is the action of the Subscapularis?
Medially rotates the arm (internal rotation).
267
What innervates the Subscapularis?
Upper and lower subscapular nerve.
268
What are the 3 spaces of the shoulder?
Quadrangular space, triangular space, and triangular hiatus/interval.
269
Name the borders of the Quadrangular Space of the shoulder.
Superior: Teres minor
Lateral: Surgical neck of the humerus
Inferior: Teres major
Medial: Long head of the triceps
270
What is contained within the Quadrangular Space of the shoulder?
Posterior circumflex humeral artery and the axillary nerve
271
Name the borders of the triangular space of the shoulder.
Superior: Teres minor
Inferior: Teres major
Lateral: Long head of triceps brachii
272
What is contained within the Triangular Space of the shoulder?
Circumflex scapular artery
273
Name the borders of the triangular hiatus of the shoulder.
Superior: Teres major
Medial: Long head of triceps brachii
Lateral: Humerus
274
What is contained within the Triangular Hiatus of the shoulder?
Radial nerve and the deep (profunda) brachial artery
275
What type of injury do clavicular fractures generally come from?
FOOSH
Fall on an outstretched hand.
276
At what part of the clavicle do the highest percentage of clavicular fractures occur? What about the lowest percentage?
80% of clavicle fractures occur in the middle 1/3.
15% at the lateral 1/3
5% at the medial 1/3.
277
After a clavicular fracture, what can happen to the humerus?
The clavicle is pulled up, separating the upper limb from the pectoral girdle. Pectoralis Major then pulls the humerus anteroinferiorly.
278
Do dislocations of the sternoclavicular joint generally occur anteriorly or posteriorly?
Mostly anterior dislocations of the clavicle at the SC joint.
279
Why would a posterior sternoclavicular joint dislocation be very dangerous?
The clavicle dislocates posteriorly and can injury underlying structures, such as the trachea and esophagus causing shortness of breath or choking. This type of dislocation of the SC joint is RARE.
280
In an AC joint injury, what exactly gets injured?
Injuries can be to the AC ligament, coracoclavicular ligament, or both.
281
What is the result if both the acromioclavicular ligament and coracoclavicular ligament get injured?
Shoulder separation or AC joint dislocation.
282
When a patient has a shoulder separation/AC joint dislocation, how would the upper limb appear?
The clavicle elevates while the upper limb droops.
283
What nerve travels superficially along Serratus Anterior?
Long thoracic nerve
284
What protects the Long Thoracic Nerve?
Our arms at our sides.
285
What nerve roots does the long thoracic nerve come from?
C5, 6, 7 (spread your wings & fly to heaven)
286
What happens if the long thoracic nerve is damaged?
The serratus anterior cannot work because it is paralyzed, resulting in medial scapular winging.
287
How do we test for medial scapular winging?
Pushing against a wall with outstretched hands and observing the surface anatomy of the scapula.
288
What is the result of Trapezius Paralysis?
Lateral winging of the scapula due to damage of the spinal accessory nerve (CN XI).
289
What nerve has to be damaged for paralysis of the trapezius muscle?
CN XI (spinal accessory nerve).
290
How would trapezius paralysis present in clinic on surface anatomy?
Affected shoulder would have drooping of entire shoulder girdle with loss of shoulder contour due to trapezius not working. Affected shoulder would appear longer than healthier one.
291
How is a shoulder separation different from a glenohumeral joint dislocation?
Shoulder separation = AC joint dislocation
Glenohumeral dislocation is a shoulder dislocation.
292
How is a glenohumeral joint dislocation generally caused?
Commonly caused by direct or indirect blunt force trauma and extreme arm rotation (plus forced abduction).
293
During a glenohumeral joint dislocation, describe what happens in the joint itself.
The humeral head is driven inferiorly and anteriorly. The fibrous layer of the joint capsule and glenoid labrum may be stripped from the anterior aspect of the glenoid cavity in the process.
294
What is the frequency of anterior versus posterior glenohumeral joint dislocations?
98% anterior (extension and lateral rotation)
2% posterior
295
What nerve can be damaged during a glenohumeral joint dislocation?
The axillary nerve can be injured because of its close relation to the inferior part of the glenohumeral joint capsule.
296
What is a Sulcus sign?
When a patient presents with a lateral + inferior dip in their shoulder, this indicates a glenohumeral joint dislocation.
297
What is the result of axillary nerve damage?
Loss of sensation and motor function over the deltoid resulting in atrophy of the muscle.
298
When a humeral fracture occurs, what do the muscles surrounding the humerus do?
Pull the humerus in different directions at the break.
299
What is the breast made up of?
Glandular (mammary) tissue, fat, and other connective tissue (suspensory ligaments).
300
What is the Areola?
The darkened area surrounding the nipple.
301
What benefit does the Areola serve during breastfeeding?
Babies eyesight are really bad. During breastfeeding, the areola gets darker, which makes it easier for babies to determine where to latch onto.
302
What are the borders of the breast?
2nd rib (superior)
6th rib (inferior)
Lateral sternal border (medial)
Midaxillary line (lateral)
303
What is the midaxillary line?
A line down the side of the body.
304
Is every female going to have the same superior and inferior borders of the breast?
No! This changes based on size, age, and other factors.
305
T/F: The pec major and serratus anterior lie superficial to the breast.
False! The breast lies superficial to the pec major and serratus anterior.
306
Where is the retromammary space located?
This is located between the breast and the pectoral fascia.
307
What is the retromammary space?
It is a potential space (not really there) that is lubricated to prevent friction between layers of the breast and pectoral major.
308
What is the Axillary Process?
An extension of mammary tissue that goes into the superolateral armpit (aka tail of spense).
309
What attaches mammary glands firmly to the dermis?
Suspensory ligaments
310
What are suspensory ligaments of the breasts?
Fibrous connective tissue that helps support the lobes and lobules of the mammary gland.
311
T/F: The suspensory ligaments divide the breasts into compartments.
True!
312
T/F: The suspensory ligaments are actually prone to spreading infection.
False! The suspensory ligaments can prevent the spread of infection.
313
As we age or acquire certain diseases, what can our suspensory ligaments cause?
They can cause dimpling and morphological changes with disease/age.
314
Describe how the lobules of the mammary glands change with breast milk production.
When the lobules of the mammary gland are at rest, they are not producing breast milk and are smaller.
However, when they actively produce breast milk, the size increases, which accounts for the breast size increase that occurs during pregnancy.
315
During puberty, what gives rise to the lobules of the mammary gland?
Lactiferous ducts give rise to buds that develop into 15-20 lobules of the mammary gland.
316
Per lobule, how many lactiferous ducts are there?
1-20
317
What is a Lactiferous Sinus?
A space within the lactiferous duct deep to the areola where breast milk collects until it comes out.
318
Describe how lymph drainage of the breast works.
Most lymph from the superficial thoracic wall drains into 5 groups of axillary lymph notes.
Medial parts of the breast may drain into parasternal nodes and cross the midline.
319
Most lymph from the superficial thoracic wall drains into 5 groups of axillary lymph notes. Name these lymph nodes.
Central
Lateral/Humeral
Apical
Subscapular/Postrior-axillary
Pectoral/Anterior axillary
320
Medial parts of the breast may drain into parasternal nodes and cross the midline. Why could this be bad?
This could be bad, because breast cancer can spread to the lymph nodes on the contralateral side of the body.
321
What is the proximal attachment for the Pectoralis Major?
Clavicular head: anterior surface of the medial half of clavicle.
Sternocostal head: anterior surface of sternum, superior 6 costal cartilages, and aponeurosis of external oblique muscles.
322
What is the distal attachment for the Pectoralis Major?
Lateral lip of intertubercular sulcus
323
What is the action of the Pectoralis Major?
Adduction, internal/medial rotation, flexion, and inspiration (when the shoulder is fixed).
324
Describe the Pecotralis Major contraction with inspiration when the shoulder is fixed. Why is this an exception to the norm?
When the shoulder is fixed, the muscles of the shoulder are holding tight. The Pectoralis Major attaches over here, thus, the shoulder muscles on top are bearing down on it. As a result, during inspiration, the proximal attachment will contract and move towards the distal attachment. This is an exception, because the distal attachment is generally thought to move towards the proximal attachment with contraction.
325
What is the innervation of the Pectoralis Major?
Lateral and medial pectoral nerve.
326
What is the blood supply for the Pectoralis Major?
Pectoral branch of the thoracoacromial artery.
327
What is the proximal attachment for the Pectoralis Minor?
3rd-5th ribs near the costal cartilages.
328
What is the distal attachment for the Pectoralis Minor?
Medial and superior surface of coracoid process.
329
What is the action of the Pectoralis Minor?
Stabilizes the scapula by drawing it inferiorly and anteriorly against the thoracic wall.
330
What innervates the Pectoralis Minor?
Medial pectoral nerve (Medial does MORE aka both pec major and minor).
331
How are the pectoral nerves named?
They are named based on the cord of the brachial plexus from which they arise. Thus, the lateral pectoral nerve arises from the lateral cord. The medial pectoral nerve arises from the medial cord.
332
What is the proximal attachment for Serratus Anterior?
Lateral parts of ribs 1-9.
333
What is the distal attachment for Serratus Anterior?
Anterior surface of the medial border of the scapula.
334
What is the action of Serratus Anterior?
Protracts scapula and anchors scapula to the thoracic wall.
335
What innervates Serratus Anterior?
Long thoracic nerve (C5-7).
336
What nerve roots does the long thoracic nerve come from?
C5, 6, 7, spread your wings and fly to heaven.
337
Describe the location of the Long Thoracic Nerve.
Descends along the superficial surface of serratus anterior. Your arms at rest on the sides cover the nerve.
338
Define the Axilla.
A pyramidal space deep to the axillary fossa (armpit). It is a fat-filled pyramid that transmits neurovasculature from the thorax and neck to the upper limb.
339
What makes up the Apex triangular opening/Cervicoaxillary canal of the Axilla?
Anterior: clavicle
Medial: 1st rib
Posterior: superior border of the scapula
340
What passes through the Apex triangular opening/Cervicoaxillary canal of the Axilla?
Neurovasculature between the neck and upper extremities.
If this is tinier, there is a chance of pinching, which can cause problems.
341
What makes up the Base of the Axilla?
Axillary fascia underlying the armpit, which stretches between axillary folds.
342
What make up the walls of the Axilla?
Anterior: Pectoral major/minor
Posterior: Scapula, subscapularis, and latissimus dorsi
Medial: Ribs 1-4, serratus anterior
Lateral: Intertubercular groove of humerus
343
How does the Axilla serve as a connection?
It is an important connection between the root of the neck, pectoral region, scapular region, and upper extremity.
344
When does the subclavian artery become the axillary artery?
At the lateral border of the 1st rib.
345
What wraps around the Axillary artery?
The brachial plexus
346
What do the branches of the axillary artery supply?
The entire upper limb
347
How many different parts of the Axillary Artery are there?
3 different parts
348
What are arteries and nerves named after? What is the exception to this?
Named for what they are going to. It is the course and not the source which is important in naming arteries.
EXCEPTION: Lateral and medial pectoral nerve.
349
Where does the 1st part of the Axillary Artery span?
Lateral border of rib 1 to the medial border of pec minor.
350
What branches off of the 1st part of the Axillary Artery?
Superior thoracic artery
351
What does the superior thoracic artery supply?
Supplies 1st and 2nd intercostal spaces.
352
Where does the 2nd part of the Axillary Artery span?
Posterior (deep) to the pec minor.
353
What 2 arteries branch off of the 2nd part of the Axillary Artery?
Thoracoacromial artery/trunk and lateral thoracic artery
354
What does the Thoracoacromial artery/trunk divide into?
**Mnemonic: Cadavers Are Dead People**.
Clavicular branch, acromial branch, pectoral branch, and deltoid branch.
355
What does the lateral thoracic artery supply?
Supplies the lateral thoracic wall of the trunk (serratus anterior).
356
Where does the 3rd part of the Axillary Artery span?
Lateral border of pec minor to lateral border of teres major.
357
What 3 branches come off of the 3rd part of the Axillary Artery?
Anterior circumflex humeral artery, posterior circumflex humeral artery, and subscapular artery.
358
Describe the anterior circumflex humeral artery.
Small branch which winds around the anterior aspect of the surgical neck of the humerus.
359
Describe the posterior circumflex humeral artery.
Larger branch which passes posteriorly through quadrangular space (with the axillary nerve) and winds around the posterior aspect of the surgical neck of the humerus.
360
Which structures would be at risk with a surgical neck fracture of the humerus?
Anterior circumflex humeral artery, posterior circumflex humeral artery, and axillary nerve.
361
What does the posterior circumflex humeral artery supply? What does it anastomose with?
Supplies the deltoid muscle and shoulder joint.
Anastomoses with the anterior circumflex humeral artery, which provides for multiple routes of blood flow to the humerus.
362
What is the largest branch off of the Axillary Artery?
Subscapular artery
363
What does the subscapular artery supply?
Supples muscles of posterior wall of axilla.
364
What does the subscapular artery divide into?
Circumflex scapular artery and thoracodorsal artery.
365
Describe the location of the circumflex scapular artery.
It winds around the lateral border of the scapula to reach infraspinous fossa where it participates in scapular anastomosis.
366
What nerve does the thoracodorsal artery run with to the latissimus dorsi?
Thoracodorsal nerve
367
What is the function of Anastomoses in the shoulder?
These provide alternative routes for blood flow to the shoulder and upper limb.
368
Where is ligation of an artery at the shoulder critical? Explain.
Subscapular artery.
If you ligate above the subscapular artery (at the axillary artery), there is still circulation.
If you ligate below the subscapular artery, there is no circulation to the upper limb (there are no branches to get blood down to the rest of the limb).
369
What are the 3 "spaces" of the shouder?
Quadrangular space, triangular space, and triangular hiatus.
370
What is found within the Quadrangular Space of the shoulder?
Posterior circumflex humeral artery
Axillary nerve
371
What is found within the Triangular Space of the shoulder?
Circumflex scapular artery
372
What is found within the Triangular Hiatus of the shoulder?
Radial nerve
Deep (profunda) brachial artery
373
Relative to the axillary artery, where does the axillary vein run?
Runs inferior to the axillary artery. The artery will appear thicker than the vein.
374
Where does the axillary vein begin and what is it a continuation of?
The axillary vein begins at the lateral border of Teres Major as a continuation of the Basilic vein.
375
What veins contribute to the axillary vein?
Basilic vein
Cephalic vein
Brachial vein
376
Describe the location of the Cephalic Vein.
Runs superficial up the arm then lies in the groove between the deltoid and pec major before diving deep to reach the axillary vein.
377
In what space would you find the Cephalic Vein?
Clavipectoral or Deltopectoral triangle/groove.
378
Deep arteries typically have a ______ _____ running with them.
deep vein
379
T/F: Arterial distribution is always more variable compared to venous distribution.
False! Venous distribution is almost always more variable than arterial patterns.
380
T/F: Superficial veins also parallel arteries similar to how deep arteries parallel deep veins.
False! In the skin, there is another circuit of superficial veins that DO NOT parallel arteries.
381
In the upper limb, what veins serve as cutaneous drainage?
Cephalic vein, basilic vein, and median cubital vein act as the cutaneous drainage.
382
T/F: We are unable to see the Cephalic vein, basilic vein, and median cubital vein, because these lie so deep.
False! These are superficial veins, thus, we can see these under the skin.
383
T/F: The superficial veins have widely varying patterns.
True!
384
What is the Brachial Plexus?
A set of nerves that run from the spinal cord to the shoulder, arm, and hand.
385
From what vertebral roots does the brachial plexus come from?
C5 - T1.
386
Starting from the spinal cord and going to the distal part of the upper limb, name the parts of the brachial plexus.
**Randy Travis Drinks Cold Beer**
Roots (off the spinal cord)
Trunks
Divisions
Cords
Branches/Terminal Branches (named nerves)
387
What are the Divisions and Cords of the brachial plexus named based on?
They are named based on their relation to the axillary artery.
388
Name the 5 terminal branches of the brachial plexus.
Musculocutaneous, axillary, median, radial, and ulnar.
389
What is the one cord of the Brachial Plexus that contains nerves from every single nerve root? How does this happen?
The posterior cord contains nerves from every single nerve root (C5-T1). This is due to the branching that occurs prior.
390
What motor function does the axillary nerve provide?
Provides motor function to the deltoid and teres minor muscles.
391
What sensory function does the axillary nerve provide?
Sensation to the skin over the deltoid muscle.
392
In what quadrant of the breast does the highest percentage of breast cancer arise from?
60% of breast cancer occurs in the superolateral quadrant near the axillary tail.
393
In what quadrant of the breast does the lowest percentage of breast cancer arise from?
5% of breast cancer occurs in the inferomedial quadrant.
394
If there is edema surrounding the areola of the breast, what can we assume is wrong?
There is likely not good lymphatic drainage of the breast occurring.
395
What could skin dimpling or abnormal contours of the breast indicate?
Masses (tumors) and/or changes in suspensory ligaments.
396
In the simplest terms, what is Erb's Palsy and what does it result from?
Erb's Palsy is an injury to the Superior Brachial Plexus (C5-6) that results from an excessive increase in angle between the head and shoulder, literally stretching the C5-6 nerve roots.
397
If a patient has Erb's Palsy, how would they clinically present?
** Think position and what this looks like **
Waiter's tip position:
-Adduction of the shoulder
-Medial/internal rotation of the arm
-Extension of the elbow
398
Why do patients with Erb's Palsy present in Waiter's tip position?
-Paralysis of shoulder abductors (deltoid & supraspinatus)
-Paralysis of lateral rotators (teres minor & infraspinatus
-Paralysis of elbow flexors (biceps brachii, brachialis, and brachioradialis)
399
What is Thoracic Outlet Syndrome?
A group of entrapment syndromes of the brachial plexus and/or axillary artery and vein as they pass from the trunk into the axilla. This results in less blood flow to the upper limb or irritation of the nerves traveling to the upper limb.
400
Where are common sites of entrapment with Thoracic Outlet Syndrome?
-Interscalene triangle
-Costoclavicular space
-Intrapectoral space
401
Where is the interscalene triangle?
Between anterior and middle scalene muscle.
402
Where is the costoclavicular space?
Between the 1st rib and clavicle.
403
Where is the intrapectoral space?
Under the pec minor tendon and coracoid process.
404
Where does the Long Thoracic Nerve originate from?
Nerve roots C5, 6, 7 (spread your wings and fly to heaven).
405
What would be the result of repeated stress to the pectoral nerves causing injury?
Pectoralis major atrophy
406
T/F: Outside of repetitive stress, isolated injury to the pectoral nerve is quite common.
False! Other than repetitive stress, isolated injury to the pectoral nerve is actually quite rare!
407
What could be other causes of pectoral nerve injury outside of repetitive stress?
-Surgical accident (ligation or cautery)
-Avulsion fracture of scapular coracoid process
408
When there are variations in the Brachial Plexus, how do we determine which nerves are which?
Figure out where the nerves are going to in order to find out which nerve is what.
409
What do Brachial Plexus Nerve Blocks entail?
Anesthetic may be administered near the cords or branches of the brachial plexus to numb the upper limb for surgical procedure.
410
If we wanted to numb the upper limb entirely, where should we administer anesthetic?
Administer supraclavicularly as this will get all branches of the brachial plexus.
411
What 3 nerves innervate the skin of the arm?
**Remember what the arm entails**
Posterior cutaneous nerve
Medial cutaneous nerve
Lateral cutaneous nerve
412
What does a cutaneous nerve mean?
A cutaneous nerve is a nerve going directly to the skin to provide sensation.
413
What is a Dermatome?
A strip of skin innervated by a single spinal nerve.
414
In the context of a heart attack (myocardial infarction), why are dermatomes important?
When a person experiences a heart attack, they often also experience pain in their left arm. This is due to referred pain from thoracic nerves, which can be visualized from a dermatome.
415
What nerve is the region of the thumb?
C6
416
What nerves are the region of digits 2-4?
C7-8
417
What nerve is the region of the pinky finger?
C8
418
Describe the ends of the humerus bone relative to their articulations with the surrounding bones.
Proximal end articulates with the glenoid cavity at the shoulder.
Distal end articulates with the radius and ulna at the elbow.
419
What part of the humerus articulates with the radius?
Capitulum
420
What part of the humerus articulates with the ulna?
Trochlea
421
T/F: The elbow joint is a joint between the humerus and radius.
False! The radius does not articulate with the humerus. The humerus and ulna articulate, which is what forms the elbow joint.
422
What is a tuberosity?
A roughened bump on a bone where muscles attach.
423
What attaches at the radial tuberosity?
Biceps brachii
424
What attaches at the ulnar tuberosity?
Brachialis attachment
425
What attaches at the medial and lateral epicondyles of the humerus?
Forearm muscles
426
What part of the humerus and what part of the radius "articulate" with each other?
Capitulum of the humerus articulates with the head of the radius.
427
What part of the humerus and what part of the ulna articulate with each other?
Trochlea of the humerus articulates with trochlear notch of ulna.
428
What makes up the bony part of the elbow that we can feel with our fingers?
Olecranon
429
What 3 parts of the ulna prevent free rotation of the ulna during pronation/supination?
Trochlear notch, coranoid process, and radial notch.
430
What 3 muscles are responsible for elbow flexion/extension?
Biceps brachii
Brachioradialis
Triceps brachii
431
What 4 muscles are responsible for supination/pronation?
Biceps brachii
Supinator teres
Pronator teres
Pronator quadratus
432
In relation to the radius and ulna, what happens as we move from supinated to pronated?
Radius rotates and crosses over the ulna distally.
433
What type of joint is the elbow?
Hinge type synovial joint
434
What surrounds the elbow joint?
**Think simple, not several structures**
Fibrous layer of joint capsule surround the elbow joint.
435
Name the 3 ligaments of the elbow joint.
Radial collateral ligament
Anular ligament
Ulnar collateral ligament
436
What is the Radial Collateral Ligament?
Thickened lateral ligament from the lateral epicondyle of the humerus that blends with the anular ligament.
437
What is the Anular Ligament? What does this ligament allow for?
Encircles and holds the head of the radius in the radial notch.
This allows the head of the radius to complete pronation and supination.
438
What is the Ulnar Collateral Ligament? How many bands does it consist of?
Extends from the medial epicondyle to the coronoid process and olecranon of ulna.
It consists of 3 bands.
439
Describe the movement of the proximal radio-ulnar joint during supination.
The head of the radius rotates in the cup-like anular ligament during supination.
440
What are Bursa?
Small, fluid-filled lubricating sacs that reduce friction between moving parts in your body's joints.
441
Name the 3 clinically relevant elbow bursa.
Intratendinous olecranon bursa
Subtendinous olecranon bursa
Subcutaneous olecranon bursa
442
Where is the intratendinous olecranon bursa found?
Within the tendon of the triceps brachii at the elbow joint.
443
Where is the subtendinous olecranon bursa found?
Located between the olecranon and the triceps tendon at the elbow joint.
444
Where is the subcutaneous olecranon bursa found?
Located in the subcutaneous (below the skin) connective tissue over the olecranon.
445
How are compartments of the upper limb organized?
These compartments group together muscles that do the same actions/have the same innervations.
446
Name the upper limb compartments. What separates them?
In the upper limb, there is an anterior (flexion) and posterior (extension) compartment.
These compartments are separated by intermuscular septum (connective tissue fascia).
447
What muscles are found in the anterior compartment of the arm?
Biceps brachii
Brachialis
Coracobrachialis
448
What innervates the anterior compartment of the arm? What other nerves are found here?
The musculocutaneous nerve from the lateral cord of brachial plexus.
The ulnar and median nerve are also found in the anterior compartment of the arm, however, they are just passing through, not functioning.
449
What artery/vein is found in the anterior compartment of the arm?
Brachial artery/vein
450
What muscles are found in the posterior compartment of the arm?
Triceps brachii
Anconeus
451
What innervates the posterior compartment of the arm?
The radial nerve from the posterior cord of the brachial plexus.
452
What artery/vein can be found in the posterior compartment of the arm?
Deep brachial artery/vein.
453
What two things run next to each other in the triangular hiatus/interval?
Deep brachial artery/vein and radial nerve.
454
The nerves, arteries, and veins of the anterior compartment of the arm are located medially. Why is this good?
On the medial side, these are protected when our arms are down.
455
T/F: When we are discussing limbs, we use the terms proximal and distal attachments.
True!
456
What are the proximal attachments of the biceps brachii?
Short Head: Coracoid process of scapula
Long Head: Supraglenoid tubercle
457
What are the distal attachments of the biceps brachii?
Radial tuberosity and the fascia of the forearm via the bicipital aponeurosis.
458
What actions does the biceps brachii produce?
Flexion
Supination of forearm
Shoulder flexion (due to the attachment at the coracoid process).
459
T/F: The long head of the biceps brachii is responsible for the biceps ability to produce shoulder flexion.
False! The short head of the biceps is what originates at the coracoid process. Because this head crosses over the shoulder joint, it is able to act on the shoulder.
460
What innervates the biceps brachii?
Musculocutaneous nerve
461
What is the proximal attachment of the brachialis?
Distal half of the humeral shaft
462
What is the distal attachment of the brachialis?
Ulnar tuberosity
463
What action does the brachialis produce?
Elbow flexion
464
What innervates the brachialis?
Musculocutaneous nerve
465
What is the proximal attachment of the coracobrachialis?
Coracoid process
466
What is the distal attachment of the coracobrachialis?
Humeral shaft
467
What action does the coracobrachialis produce?
Flexes and adducts the shoulder.
468
What innervates the coracobrachialis muscle?
Musculocutaneous nerve
469
What is so special about the relation of the corachobrachialis to the musculocutaneous nerve?
The musculocutaneous nerve directly pierces the coracobrachialis as it exits the axilla.
470
What is the only nerve in the brachial plexus that comes from every nerve root?
Radial nerve, which comes from the posterior cord where every nerve root meets.
471
What is the proximal attachment of the lateral head of the triceps brachii?
Humerus, above the radial groove
472
What is the proximal attachment for the long head of the triceps brachii?
Infraglenoid tubercle of scapula.
473
What is the proximal attachment for the medial head of the triceps brachii?
Humerus, inferior to the radial groove
474
What is the distal attachment for all 3 heads of the triceps brachii?
Olecranon of the ulna.
475
What action do all heads of the triceps brachii produce?
Elbow extension
476
Which head of the triceps brachii produces actions beyond elbow extension? What are the actions? Why can this head do that?
The long head of the triceps brachii also extends the shoulder joint and resists humeral dislocation.
This is because the long head of the triceps brachii crosses the shoulder joint to attach at the infraglenoid tubercle of the scapula.
477
What innervates the triceps brachii?
Radial nerve
478
What is the proximal attachment of the Anconeus muscle?
Lateral epicondyle of the humerus
479
What is the distal attachment of the Anconeus muscle?
Lateral surface of olecranon.
480
What action does the Anconeus muscle produce?
Assists the triceps in elbow joint extension.
481
What innervates the Anconeus muscle?
Radial nerve
482
What nerve roots does the radial nerve come from?
C5-T1 (entire brachial plexus converges on posterior cord, which gives rise to the radial nerve).
483
Describe the location of the Musculocutaneous nerve as it goes down the arm and past the elbow.
The musculocutaneous nerve pierces coracobrachialis then runs between the biceps and brachialis. It emerges at the lateral side of the elbow as the lateral cutaneous nerve of the forearm.
484
After piercing the coracobrachialis muscle, what does the musculocutaneous nerve run between?
Runs between the biceps and brachialis
485
What does the musculocutaneous nerve become once it emerges at the lateral side of the elbow?
Lateral cutaneous nerve of the forearm.
486
T/F: The median nerve produces several functions in the arm.
False! The median nerve produces no functions in the arm.
487
Describe the location of the Median nerve as it runs through the arm and to the elbow.
The Median nerve runs along the medial side of the anterior compartment with the ulnar nerve and brachial artery. It passes ANTERIOR to the medial epicondyle to enter the cubital fossa.
488
What does the Median Nerve run along with on the medial side of the anterior compartment?
Ulnar nerve
Brachial artery
489
T/F: The ulnar nerve produces several functions in the arm.
False! The ulnar nerve does not produce functions in the arm.
490
Describe the location of the Ulnar nerve as it moves down the arm and to the elbow.
The Ulnar nerve runs along the medial side of the anterior compartment of the arm with the median nerve and brachial artery. It passes POSTERIOR to the medial epicondyle to enter the cubital fossa.
491
What does the ulnar nerve run along with on the medial side of the anterior compartment of the arm?
Median nerve
Brachial artery
492
T/F: Because the ulnar nerve passes posterior to the medial epicondyle, it is very protected.
False! It is actually not very protected, hence why we smack it so many times.
493
The _________ nerve innervates the posterior/extensor compartment of the arm.
Radial
494
Describe the location of the Radial nerve as it travels down the arm and towards the elbow.
The Radial nerve wraps POSTERIORLY around the humerus and runs deep with the brachial artery. It passes ANTERIOR to the lateral epicondyle before splitting into superficial and deep branches.
495
What does the Radial nerve run deep with posteriorly?
The deep brachial artery.
496
What are the main branches of the brachial artery?
Deep brachial (profunda brachia), superior ulnar collateral arteries, and inferior ulnar collateral arteries.
497
When we flex our elbow for a prolonged period, what artery gets constricted? How does blood flow get to the forearm?
Deep brachial (profunda brachia).
The superior and inferior ulnar collateral arteries keep blood flow going to the forearm.
498
What does the brachial artery turn into? Where does this happen?
The brachial artery becomes the radial and ulnar arteries at the elbow.
499
Describe the anastomosis of the arteries of the arm at the elbow.
The ulnar collateral artery anastomose with the ulnar recurrent artery below to provide collateral circulation around the medial side of the elbow.
The radial collateral artery anastomose with the radial recurrent artery on the lateral side of the elbow.
500
What are recurrent arteries in the elbow? Why are they important?
These are the arteries distal to the elbow that connect up to the collateral arteries. This is what helps to keep blood flow going.
501
What are the superficial veins of the arm?
The cephalic and basilic veins of the arm, which join at the elbow to form the medial cubital vein.
502
What makes up the medial cubital vein? Where do they join at?
The cephalic and basilic vein make up the medial cubital vein at the elbow.
503
How do we name the deep veins?
The deep veins travel with and are named the same as the major artery of the arm.
504
Deep arteries typically have a ______ running with them.
vein
505
T/F: Artery distributions are always more variable than veinous patterns.
False! Venous distribution is almost always more variable than arterial patterns.
506
T/F: All veins parallel arteries.
False! In the skin, there is another circuit of superficial veins that DO NOT parallel arteries.
507
In the upper limb, what serves as the cutaneous drainage?
In the upper limb, cephalic, basilic, and median cubital veins act as the cutaneous drainage.
508
Name the boundaries of the cubital fossa.
Medial: Lateral border of pronator teres.
Lateral: Medial border of brachioradialis
Base: Imaginary line through epicondyles
Roof: Deep fascia reinforced by bicipital aponeurosis, superficial fascia, and skin
509
Name the contents of the cubital fossa from medial to lateral.
Medial to Lateral:
1. Median nerve
2. Brachial artery (and bifurcation)
3. Tendon of biceps brachii
4. Radial nerve
510
What is an extra-articular fracture?
A fracture that occurs outside of the joint (where the bones articulate).
511
What is an intra-articular fracture?
A fracture that occurs within the joint (within the capsule).
512
What is a comminuted fracture?
This is when there are breaks in several directions throughout the bone, both within the joint and extra-articularly.
513
With a surgical neck fracture of the humerus, what nerve is at risk?
Axillary nerve
514
With a radial groove fracture of the humerus, what nerve is at risk?
Radial nerve
515
With a distal humerus fracture, what nerve is at risk?
Median nerve
516
With a medial epicondlye fracture of the humerus, what nerve is at risk?
Ulnar nerve
517
What causes subcutaneous bursitis of the elbow?
Falls on the elbow or repeated excessive pressure and friction.
518
What causes subtendinous olecranon bursitis?
Excessive friction between the triceps tendon and the olecranon from repeated flexion-extension of the forearm.
519
How would a patient with subtendinous olecranon bursitis present?
Presents with severe pain during flexion of the forearm. This pain is present because of pressure exerted on the inflamed subtendinous olecranon bursa by the triceps tendon.
520
What is the treatment for elbow bursitis?
Rest, ice, compression.
521
What does Tommy John Surgery entail?
Reconstruction of the ulnar collateral ligament (UCL).
522
What type of athlete is likely to have Tommy John Surgery? Why?
Baseball players, specifically pitchers, are likely to have this surgery because of the way they throw the ball and the frequency of throwing.
523
What is Tennis Elbow?
Lateral epicondylitis
524
What is Lateral Epicondylitis?
This is inflammation of the lateral epicondyle of the humerus, which is where the wrist extensors mainly originate. Overuse or overloading of the wrist extensors can cause this.
525
What is a Golfer's Elbow?
Medial epicondylitis
526
What is Medial Epicondylitis?
This is inflammation of the medial epicondyle of the humerus, which is where the wrist flexors mainly originate on. Overuse or overloading of the wrist flexors can cause this.
527
What is the MOST common epicondyle fracture?
Avulsion fracture of the medial epicondyle.
528
In what age group do medial epicondyle avulsion fractures usually occur in? Why?
Medial epicondyle avulsion fractures usually occur in children because the epiphysis (growth plate) for the medial epicondyle has not yet fused to the humerus.
529
What is at risk for damage with a medial epicondyle avulsion fracture?
Potential damage to the ulnar nerve (remember the medial epicondyle is where the ulnar nerve passes).
530
What is "Nursemaid's Elbow"?
Radial head dislocation in which the head of the radius is pulled distally out of the anular ligament.
531
How does a proximal biceps tendon rupture (specifically long head) usually happen?
Rupture of the long head usually results from wear and tear of the inflamed tendon (biceps tendinitis).
532
What happens in a long head proximal biceps tendon rupture?
The tendon is torn from its attachment to the supraglenoid tubercle of the scapula. The rupture is associated with a snap or pop.
533
How does a distal biceps tendon rupture generally happen?
The main cause of a distal biceps tendon tear is a sudden injury.
534
What is the difference in how a proximal versus distal biceps tendon rupture occurs?
Proximal likely occurs from wear and tear of inflamed tendon (biceps tendinitis).
Distal tends to occur from a sudden injury.
535
If a patient presents with a Popeye Deformity, what would be a likely diagnosis?
Biceps tendon rupture (distal or proximal)
536
What is a Popeye Deformity?
A bulge in the upper part of the arm that results from a distal biceps tendon rupture.
537
When we measure blood pressure, how is the brachial artery playing a part?
A blood pressure cuff will occlude the brachial artery so no blood flows. As we begin to relieve some pressure from the brachial artery, blood flow becomes audible (sounds of turbulent flow) and this is what is measured as the point of systolic pressure. Once the sounds of turbulent flow turn to silence, this is when the artery is no longer compressed and we mark this as diastolic pressure.
538
T/F: Deep veins are common sites of venipuncture for blood samples and IV injections.
False! Superficial veins of the cubital region are common sites of venipuncture for blood samples and IV injections.
539
What is a possible complication to venipuncture of the cubital region?
Injury to superficial cutaneous nerve accompanying veins.
540
Relative to the bicipital aponeurosis, where are the brachial artery and median nerve? Why is this good?
The brachial artery and median nerve lie deep to the bicipital aponeurosis.
This is good as it protects these structures from puncture during a blood draw or IV injection.
541
T/F: Everyone has a median cubital vein.
False! About 20% of people have a median vein of the forearm, which divides into the median cephalic vein and median basilic vein. There is NO median cubital vein for these people.
542
The biceps reflex is a ______ __________ reflex, routinely tested during physical examination.
deep tendon
543
What does a positive response of the biceps reflex confirm?
A positive response confirms the integrity of the musculocutaneous nerve and C5-6 spinal cord segments.
544
What would excessive, diminished, or prolonged responses of the biceps reflex indicate?
May indicate CNS or PNS system disease.
545
If a needle is inserted at the intrascalene region for a nerve block, which nerves would be affected?
What region of the body is numbed?
Radial, musculocutaneous, and axillary.
Anesthetizes the shoulder and humerus region.
546
If a needle is inserted above the clavicle for a nerve block, which nerves would be affected?
What would this result in?
All of the brachial plexus would be impacted.
Majority of upper limb should be anesthetized.
547
If a needle is inserted below the clavicle for a nerve block, which nerves would be affected?
All nerves of the brachial plexus EXCEPT for the axillary nerve.
548
If a needle is inserted in the armpit for a nerve block, which nerves would be affected?
Median and ulnar nerves.
