Anatomy Final

what tendon can you palpate the radial a?

Flex carpi radialis tendon you can palpate radial artery near the wrist medial to brachioradialis and lateral to flexor carpi radialis.

Location of the common flexor tendon (and muscles that originate here)

at the medial epicondyle of humerus Superficial layer of anterior forearm (pass, fail, pass, fail) -pronator teres -flexor carpi radialis -Palmaris longus - *not through carpal tunnel ->runs superficial to it -flexor carpi ulanris -FDS (intermediate muscle)

regions where vessels pass through

axilla (space) - connect vessels from neck to upper limb (armpit) axillary artery and vein brachial plexus muscles neck ->axilla-> upper limb cubital fossa: mediam n, tendon biceps brachii, brachial artery - vena puncture carpal tunnel - flexors of forearm, FDP, FDS tendons, flexor pollicis longus, medium n

Arteries of the hand and what they supply

ULNAR/RADIAL ARTERY superficial palmer arch --> ulnar a. deep palmer arch --> radial a. Radila artery: lateral half of index finger (digit 2) -radialis indicis a thumb -princeps pollicis

What is the cutaneous innervation of the hand?

Ulnar nerve Superficial branch innervates the skin of the palmar surface of the little finger and the medial half of the ring finger (DIGITS 4 AND 5) *deep branch is going to muscles Radial nerve Innervates the skin on the thumb, index and middle finger, and lateral side of the ring finger *radial n only does skin in hand no muscles Palmar digital nerves (from median n) innervates skin on the palmar surfaces of the lateral three and one-half digits and cutaneous region over the dorsal aspects of the distal phalanges (nail beds) of the same digits

ulnar (flexors of elbow/digits 4,5)

Ulnar:Branch from medial cord-->posterior medial epicondyle of humerus & b/w head of FCU-->passes inferiorly b/w FCU (supplying tendons of digit 4&5) and FDP-->superficial @ wrist-->flexor retinaculum-->hand-->skin on medial side *funny bone innervates FDU and half of FDP *dorsal and palmer of digits 4 and 5

Pathway of nerves from the brachial plexus to the hand (include spaces they travel through, muscles they go deep to)?

Quadrangular space (inferior to teres minor, superior to teres major) -axillary nerve to get to deltoid and teres Triangular Space (superior to teres major/medial to long head of triceps) Triangular Interval? -radial nerve (post cord) -> to get post

What is the extensor expansion?

Retinacular Ligament During flexion of the distal interphalangeal joint, this ligament becomes taut The taut ligament pulls the proximal interphalangeal joint into flexion Similarly, on extending the proximal joint, the distal joint is pulled by the retinacular ligament into nearly complete extension

Bones of the hand (fractures that can occur)?

Scaphoid bone (snuff box) - fall with abducted hand can fracture the scaphoid bone- radial a. Lunate Triquetrum Pisiform Trapezium Trapezius Capitate Hamate

Innervation of the anterior arm (flexors)

musculocutaneous nerve Flexor muscles -coracobrachialis -biceps brachii -brachialis

trapezius innervated by

spinal accessory n

infection of synovial sheath

synovial sheath only starts in the forearm in digits 1,5 *so if you get an infection of those digits it can spread to forearm - carpal tunnel *digits 2-4 have a break in sheath - not connected *on top of synovial sheath is fibrous digital sheath = hold tendons down

Axillary artery pathway from axilla to the wrist (include landmarks where name changes occur)

(lateral border fo 1st rib - continuation of subclavian you have Axiallry artery -> end at inferior border fo teres major -> brachial artery -> gives off profunda brachii or deep artery of arm (goes posterior arm) brachial artery divides into 2 arteries -radial artery -ulanr artery superficial and deep palmer arches

dorsal divisions of brachial plexus

- The dorsal divisions unite, posterior to the axillary artery, to form the posterior cord. -Branches of the posterior cord are responsible for innervating all muscles on the posterior and lateral sides of the upper limb. The terminal branches of the posterior cord are the axillary nerve and radial nerve.

ventral div of brachial plexus

- The ventral divisions recombine to form the lateral cord (C5 - C7) and medial cord (C8- T1) (named for their relationship to the 2nd part of the axillary artery). -The three major ventral division nerves of the brachial plexus are the median nerve, the ulnar nerve and the musculocutaneous nerve.

The brachial plexus (including roots, trunks, division, cords, terminal branches)

- all from ventral rami (C5-T1) ROBIN THICK DRINKS COLD BEER MARMU

Superficial veins and their pathways

- in adipose tissue -starts on dorsum of hand (dorsal venous network) -> gives to 2 different veins medially and laterally 1. Cephalic (lateral) 2. Basilic (basilic) LATERAL SIDE: Cephalic (lateral dorsal venous network of hand) -> lateral forearm -> deltopectoral groove -> (can see this in gym when workout) -> drain into axillary vein MEDIAL SIDE: Basilic vein (dorsal venous arch) -> medial side of forearm -> pierces brachial facia -> form axillary vein Cephalic and Basilic vein are connected by the Median cubital vein *everything is draining into axially vein (deep NOT superficial) -> beings at inferior border of Teres Major ->subclavian ->brachiocephalic ->right atrium of heart

brachial plexus

-supplies upper limb -begins at neck and continues to axilla

The collateral ligaments of the elbow (radial and ulnar) • What they connect, when they are taught

-on medial(ulnar) and lateral(radial) sides -name depending on what they are connecting -thickening of joint capsule extending around

Palmar radiocarpal ligaments

-reinforcing the anterior surface of the palm -connecting distal radius to both rows of carpals -fiber orientation that hand follows forearm when latter is supinated

1st CMC ligaments

= distal row of carpals and base of metacarpals saddle type of synovial joint = lots of movement at thump level *allows for flexion, extension, abduction, adduction, rotation

Arteries of the forearm (what they are branching off of and where they distribute/where they can be palpated)?

@ cubital fossa will give radial artery on radial side and ulnar artery on ulnar side Anterior forearm arteries -Ulnar, radial, and anterior interosseous arteries -Ulnar nerve can be felt one the lateral side of the tendon of the flexor carpi ulnaris Posterior forearm arteries -Posterior interosseous artery and radial artery slide 13 on hand passing btw dorsal interossei -Radial artery can be felt on the anterior surface of the radius

*short answer- Identify 2 structures that surround the brachial plexus? slide 10 - Axilla

Apex - cervicoaxillary canal (communication between neck and axilla) Anterior - pectoralis major and minor Anterior axillary fold - formed by P. major m. Posterior - subscapularis (scapula), teres major, latissimus dorsi Posterior axillary fold - formed by Latissimus Dorsi & Teres major mm. Medial - Serratus anterior on the thoracic wallLateral - intertubercular groove (housing tendon of the long head of biceps brachii) Base - skin and axillary fascia between arm and thoracic wall

Axiallary vein runs with

Axiallry artery

Anatomical snuffbox contents and borders

Borders Medial boundary: extensor pollicis longus Lateral boundary: extensor pollicis brevis and abductor pollicis longus Floor: radial artery, scaphoid, and trapezium Contents Radial artery, scaphoid, and trapezium *if you fractured your scaphoid result from abducted hand rupture radial a.

musculocutaneous nerve (anterior flexors of arm/supinates)

Branch from lateral cord-->pierces coracobrachialis & con't distally b/w brachialis & biceps. Emerges lateral to biceps brachii-->(name changes) lateral cutaneous nerve -> innervate lateral side of skin of forearm *anterior flexors of shoulder plus elbow (Arm) and biceps supinates *damage to musculocutaneous n. = can't flex elbow

radial n (extension of posterior arm/forearm/digits)

Branch from posterior cord-->Travels with profunda brachii artery through triangular interval (go posterior) and enters @ elbow between brachioradialis and brachialis-->divides into superficial and deep branch-->travels deep to supinator m. and name changes-->posterior interosseous nerve (goes to deep extensors) *EXTENSION OF POSTERIOR ARM AND FORARM /digits *ARM = extension of shoulder/elbow = RADIAL N *FOREARM= extensions of elbow/digits/supinators =posterior interosseous n

Boundaries and contents of the carpal tunnel

Carpal Tunnel: into the carpal tunnel through which the flexor tendons and median nerve pass. -deep to flexor retinaculum (a.k.a. transverse carpal ligament) -> thickening of deep facia of ante-brachium - Lateral side= between tubercles of the scaphoid and the trapezium (LST) - Medial side= pisiform and the hook of hamate (MPH) roof = flexor retinaculum floor= carpal bones -allows for passage of the: -median n. -tendons of FDS (4), FDP (4), and FPL (1) = 9 total tendons *carpal tunnel syndrome you can have atrophy fo the thenar muscles bc medium n innervates those muscles*

What is carpal tunnel syndrome?

Carpal tunnel syndrome occurs when there is pressure on the median nerve and can create the sensation of tingling or numbness in the hands

EXTENSOR CARPI RADIALIS LONGUS

ORIGIN: Distal lateral supracondylar ridge INSERTION: Base of second metacarpal (dorsal surface)

extensor expansion

Distal end of the metacarpals and along the phalanges of tendons of extensor digitorum flatten to form the extensor expansion Each extensor expansion is a triangular tendinous aponeurosis that wraps around the dorsum and sides of a head of the metacarpal and base of the proximal phalanx Each extensor digitorum tendon divides into a: Median band Passes to the base of the middle phalanx Two lateral bands Pass to the base of the distal phalanx Tendons of the interosseous and lumbrical muscles of the hand join the lateral bands

Anconeus

ORIGIN: Lateral epicondyle of humerus INSERTION: Lateral surface of olecranon and superior part of posterior surface of ulna

What are the actions of the posterior forearm?

Extensors of the elbow and digits, wrist Supinators of the radioulnar joints

Extensor Digiti Minimi

ORIGIN: Lateral epicondyle of humerus via common extensor tendon INSERTION: Extensor expansion of digit 5

What is the O,I,A and innervation for the latissimus dorsi?

Latissimus Dorsi O: vertebral spines from T7 to the sacrum, posterior third of the iliac crest, lower 3 or 4 ribs, sometimes the inferior angle of the scapula I: floor of intertubercular groove of humerus A: extends the arm and rotates the arm medially, adducts IN: thoracodorsal nerve from the posterior cord of the brachial plexus

What is the innervations of the lumbricals?(palm surface)

Lumbrical muscles (4) 1 & 2 are innervated by the median nerve 3 & 4 are innervated by the ulnar nerve *Proximal attachment is to the flexor digitorum profundus m. Lumbricals link flexor tendons with extensor tendons. Through their insertion into the extensor hoods, ACTIONS 1) Flexing MCP joints 2) Extending IP joints of digits 2-5 (PIPs & DIPs)

median n (anterior forearm flexors digits 1,2,3, half 4 palmer surface AND dorsal fingertips 3.5 digits

Median: Branch from medial & lateral cord-->starts in axilla -enters forearm w/ brachial artery (deep to median cubital vein)-->leaves cubital fossa b/w heads of pronator teres, deep to FDS-->con't b/w FDS & FDP-->become superficial @ wrist b/w FDS & FCR deep to palmaris longus tendon-->anterior interosseous nerve

What is the origin and insertion of the extensors of the forearm?

Muscles that extend and abduct or adduct the hand at the wrist joint Extensor carpi radialis longus (ECRL) Extensor carpi radialis brevis (ECRB) Extensor carpi ulnaris Refer to muscle charts for O, I Common extensor origin (from lateral epicondyle of humerus): Anconeus Extensor carpi radialis brevis Extensor digitorum Extensor digiti minmi Extensor carpi ulnaris

branches (MARMU) -> superior to inferior

Musculocutaneous n = Lateral cord Axiallry = posterior cord Radial n = posterior cord Median nerve = medial and lateral cord Ulnar N. = Medial cord -forearm/palm, funny bone *anterior parts make the M of brachial plexus

Extensor Digitorum

ORIGIN: Lateral epicondyle of humerus via common extensor tendon INSERTION: Extensor expansion of digits 2-5 (onto middle and distal phalanges)

EXTENSOR CARPI RADIALIS BREVIS

ORIGIN: Lateral epicondyle of humerus via common extensor tendon INSERTION: Base of 2nd & 3rd metacarpal (dorsal surface)

What is the O,I,A of the anconeus?

O: lateral epicondyle of the humerus I: lateral side of the olecranon and the upper ¼ of the ulna A: extends the forearm IN: nerve to anconeus from the radial nerve

What is the innervation of the muscles of the posterior forearm?

Posterior interosseous nerve off of the radial nerve

What are the rotator cuff muscles and what is their actions?

Rotator cuff muscles: (SITS) -Supraspinatus m. - abducts the arm (initiates abduction) -Infraspinatus m. - laterally rotates the arm -Teres minor m. - laterally rotates the arm -Subscapularis m. - medially rotates the arm; assists with extension of the arm *Called rotator cuff muscles because they form a musculotendinous rotator cuff around the glenohumeral joint. *Acts on the glenohumeral joint *all except supraspinatus are rotators of humerus

O, I, A of muscles of the forearm

Superficial Layer: Pronator Teres O: common flexor tendon and (deep or ulnar head) from medial side of coronoid process of ulna I: midpoint of lateral side of the shaft of the radius A: pronates the forearm IN: median nerve Flexor carpi radialis O: common flexor tendon from the medial epicondyle of the humerus I: based of the second and third metacarpal A: flexes the wrist, abducts the hand IN: median nerve Palmaris longus O: common flexor tendon from the medial epicondyle of the humerus I: palmar aponeurosis A: flexes the wrist IN: median nerve Flexor carpi ulnaris O: common flexor tendon and (ulnar head) from medial border of olecranon and upper ⅔ of the posterior border of the ulna I: pisiform, hook of hamate, and base of 5th metacarpal A: flexes wrist, adducts hand IN: ulnar nerve Intermediate Layer: Flexors digitorum superficialis O: humeroulnar head: common flexor tendon; radial head: middle ⅓ of radius I: shafts of middle phalanges of digits 2-5 A: flexes the metacarpophalangeal joints and proximal interphalangeal joints IN: median nerve Deep Layer: Flexor digitorum profundus O: posterior border of the ulna; proximal ⅔ of medial border of the ulna; interosseous membrane I: base of distal phalanx of digits 2-5 A: flexes the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints IN: median nerve (radial ½); ulnar nerve (ulnar ½) Deep Layer (Continued...) Flexor pollicis longus O: anterior surface of radius and interosseous membrane I: base of distal phalanx of the thumb A: flexes metacarpophalangeal joints and interphalangeal joints of the thumb IN: median nerve Pronator quadratus O: medial side of anterior surface of the distal ¼ of the ulna I: anterior surface of the distal ¼ of the radius A: pronates the forearm IN: median nerve via anterior interosseous nerve

Ulnar nerve injuries (short answer question)

The ulnar nerve is most commonly injured at two sites: the elbow and the wrist. ▪ At the elbow, the nerve lies posterior to the medial epicondyle. ▪ At the wrist, the ulnar nerve passes superficial to the flexor retinaculum and lies lateral to the pisiform bone. Injuries of the ulnar nerve (common at the elbow and the wrist) Ulnar nerve lesions are characterized by "clawing" of the hand. The metacarpophalangeal joints of the fingers are hyperextended and the interphalangeal joints are flexed because of the function of most of the intrinsic muscles of the hand is lost. ulnar nerve is injured here, what muscles or nerves will be affected or anything distal - forearm - short answer Q ANSWER: funny bone, medial epicondyle-ulnar n. FOREARM: -flexor carpi ulnaris -->flexion and adduction of wrist -flexor digitorum profundus -> flexes DIP of digits 2-5-medial half HAND: -Lumbricals 3 and 4 - flex MCP, extending digits 2-5 - hypothenar compartment (digit 5) -interossei muscles - adduction/abduction (all innervated by ulnar n)

Divisions

anterior and posterior (ventral an dorsal) --> to axially artery (direction) *dorsal/post div unite to form posterior cord *ventral/ant div form medial and lateral cords

Which of the following ligaments prevents inferior dislocation of the radius?

annular ligament

A woman sustains trauma to her thoracodorsal nerve. Which of the following arm movements is most likely affected?

adduction *thoracodorsal nerve innervates latissimus dorsi

branches

brachial artery splits at cubital fossa (radial and ulanr) -ulnar artery travels with the ulnar nerve/median n (deep to flexor carpi ulnaris) branches to: Common interosseous divides to -> brach pff ulnar a. -anterior interosseous a (ant) -posterior interosseous a (deep post) -goes to to superficial palmer arch *directional to interosseous membrane Radial artery -travels length of forearm medial to brachialradialis (extensor comp) -wrist anterior surface (pulse here) ***you can palpate radial artery near the wrist medial to brachioradialis and lateral to flexor carpi radialis. *dorsum of hand -> deep palmer and superficial

roots - starts

dermatone testing ? C5- upper/lateral arm C6 - pollex- thumb C7 - 3rd digit C8 - 5th digit - pinky T1- medial aspect of elbow

IP joints are also called

hinge joints -flexion/extension

branches of axillary a.

iSubscapular Anterior Circumflex humeral Posterior circumflex humeral (quadrangular space)

Which nerves of the brachial plexus are responsible for the actions of the upper limb

know the compartments here what actions would they lose if a nerve was damaged slide #7 of axilla lecture know this chart! slide 8 has compartments

Cords

lateral - posterior - innervate all muscles of posterior/lateral sides of upper limb medial

pectoralis major innervated by

lateral pectoral nerve AND medial pectoral n

pectoralis minor

medial pectoral n

A man fractures his radius in a fall. At the hospital he is unable to extend digits 2-5 This problem is most likely the result of an injury to which of the following nerves?

median (does lumb 1,2) lumbricals (primary extenders) for digits 2-5 helpt o extend interphalangeal lumbricals, dorsal interossei, palmer interossei

Innervation of the anterior forearm (flexors)

median (mostly) -anterior interosseous branch -ulnar nerve *flexors of elbow, wrist, digits and pronator muscles, adduction/abduction of wrist

Specific names of the regions of the upper limb?

neck -> coming form cervical spinal nerves (ventral rami) shoulder-> glenohumeral joint, multiaxial, head of humerus to rotate over scapula arm -> shoulder to elbow (brachium) elbow -> connects to forearm bones (hinge joint) Forearm- elbow to wrist - pronation nd supination (ante-brachium) wrist joint -> radius and carpal bones brachium arm anti branchium forarm slide 3

axillary n travels with what artery

posterior circumflex humeral a

If an individual falls on an outstretched hand and fractures their scaphoid bone, which of the following arteries may be lacerated?

radial artery snuff box (scaphoid bone + radial artery )

radial collateral lig *saying bones is fine for exam

radial/lateral -connecting humerus to radius -extends from lateral (extensor m) epicondyle blends inferiorly w/annular ligament of radius - is taught in adduction of forearm - help w/VARUS FORCE = medial force) *helps keep forearm in place

Location of the radiocarpal ligaments?

radiocarpal wrist joint radius articulates w/ lunate and scaphoid bones = wrist joint, **ulna NOT contributing to wrist joint

The acromioclavicular joint

scapula (posterior part) + acrmoial end of clavicle -has fluid, synovial joint -connected by the acromioclavicular ligament (passing btw clavicle and acromion- not strong) movements -anteroposterior and vertical planes together w/some axial rotation (slight) *can be torn A/C tear - different grades, leaves large bump in scapular region *not a strong ligament coracoclavicular ligament (very large) - 2 parts for stabilizing -anchoring clavicle to coracoid process (anterior on scap, finger like projection) of scapula 2 accessory ligaments: trapezoid ligament -> corocoid process conoid ligament -> corocoid process

long thoracic nerve innervates

serratus anterior

trunks - pass through the Cervicoaxillary canal to form div

superior -C5 + C6 middle - C7 inferior - C8 + T1

ulnar collateral lig *saying bones is fine for exam

ulna/medial -humerus to ulna -extends form medial epicondyle (superficial flexors) to coronoid + olecranon process of ulna-different strength bands -taught in abduction - help w/VALGUS -LATERAL FORCE 1.Anterior band (strongest) 2.Posterior band (weakest) 3.Oblique/Transverse band (increases depth of socket)