Unit 3 Rehab Anatomy
Suboccipital triangle borders & contents.
Superior Medial border: Rectus Capitis Posterior Major Lateral border: Obliquus Capitis Superior Inferior border: Obliquus Capitis Inferior Contents: Posterior Rami Suboccipital Nerve C1 Vertebral Artery
The cords of the brachial plexus combine to form the:
Terminal Branches Musculocutaneous N- Lateral Cord Axillary N- Posterior Cord Radial N- Posterior Cord Median N- Lateral and Medial Cords Ulnar N- Medial Cord
Name all of the direct branches of the cords of the brachial plexus (before the terminal branches). Name the cord they branch from and what muscles they innervate.
The 7 direct branches that come off the cords before the naming of the terminal branches of the brachial plexus are as follows: Lateral Cord: The Lateral Pectoral Nerve innervates the pectoralis major. Posterior Cord: The Thoracodorsal Nerve innervates the latissimus dorsi. The Upper Subscapular Nerve innervates the subscalularis. The Lower Subscapular Nerve innervates the subscapularis and teres major. Medial Cord: The Medial Pectoral Nerve innervates the pectoralis major AND minor. The Medial Brachial Cutaneous Nerve innervates the skin of the medial arm. The Medial Antebrachial Cutaneous Nerve innervates the skin of the medial forearm.
The palmar carpal ligament is a thickening of what connective tissue of the forearm?
The Antebrachial fascia
Name all of the direct branches of the roots of the brachial plexus. Describe what nerve root contribution they have and what muscles they innervate.
The Dorsal Scapular Nerve (C5) branches directly off the C5 ventral rami and innervates the rhomboids and levator scapulae. The Long Thoracic Nerve (C5,6,7) branches off of the C5, C6, and C7 ventral rami and innervates the serratus anterior.
What connects the cephalic vein on the radial side of the forearm with the basilic vein on the ulnar side of the forearm?
The Median Cubital Vein
Name all of the direct branches of the trunks of the brachial plexus. Describe where they branch from and what muscles they innervate.
The Subclavian Nerve comes off the superior trunk and innervates the subclavius. The Suprascapular Nerve comes off the superior trunk and innervates the supraspinatus and infraspinatus.
The trunks of the brachial plexus divide to form:
The anterior and posterior divisions.
The superior and inferior ulnar collateral arteries are branches of:
The brachial artery. They come off on the medial side of the humerus and anastomose at the medial elbow with the anterior and posterior ulnar recurrent arteries.
Describe the relationship between the brachial plexus and the scalene muscles.
The brachial plexus (along with the subclavian artery) exits the cervical region between the anterior and middle scalene muscles. The brachial plexus then travels posterior to the clavicle and into the axillary region (accompanied by the axillary artery and vein).
Describe the position of the coracoclavicular ligaments.
The coracoclavicular ligaments span between the coracoid process of the scapula & the clavicle. The trapezoid ligament is medial to the coraco-acromial ligament and lateral to the conoid ligament.
What portions of the brachial plexus are considered "infraclavicular"?
The cords and the main terminal branches.
Which palmar arch is located more proximal in the hand?
The deep palmar arch
What two muscles does the cephalic vein travel between before draining into the axillary vein?
The deltoid and pectoralis major.
What structure is the "key to the cubital fossa"?
The distal biceps tendon (located in the center of the cubital fossa).
What is the function of the filum terminale?
The filum terminale is an extension of the pia mater. It comes off the conus medullaris and travels to the sacral hitaus and functions to tether down the distal end of the spinal cord.
Describe the position of the first section of the axillary artery and name the branch(es) that come off at this section.
The first section of the axillary artery is between the lateral border of the first rib and the superior border of the pectoralis minor. There is only one branch coming off this section which is the superior/supreme thoracic artery.
A patient presents with pain over the volar radial aspect of his wrist. The pain is increased with resisted volar flexion & radial deviation. What structure has been compromised?
The flexor carpi radialis is responsible for wrist volar flexion and radial deviation. Since there is pain and no weakness/numbness the pathology is most likely a tendonosis/itis.
The head of the radius is ______________ whereas the head of the ulna is located _______________ on the forearm.
The head of the radius is proximal whereas the head of the ulna is located dismally on the forearm. -This explains why the radius is the smaller bone at the elbow joint and the larger bone at the wrist joint.
Describe the scapulohumeral rhythm (aka scapulo-thoracic motion)
The humerus & scapula move into ABDuction with a 2:1 ratio (for every 2* of glenohumeral ABD, there is 1* of upward rotation of the scapula). Total ROM for shoulder ABD is 180*= 120* GH + 60* Scap
What separates the anterior and posterior compartments of the arm?
The humerus and the medial and lateral intermuscular septums
Name and describe the interosseous arteries of the upper extremity. What artery do they branch off of?
The interosseous arteries are branches of the ulnar artery. Common Interosseous branches off ulnar artery and splits into: Anterior Interosseous--> anterior forearm into hand Posterior Interosseous--> posterior forearm into hand Recurrent Interosseous--> CIRCLES BACK proximally to supply posterior elbow
The extensors of the forearm originate where?
The lateral epicondyle
What is the clinical significance of the origin of the long head of the biceps brachii tendon?
The long head of the biceps brachii originates off of the supraglenoid tubercle and is intimately attached to the superior glenoid labrum. Forceful eccentric contraction of the biceps can cause a SLAP tear of the glenoid labrum which results in an increased risk for anterior dislocation of the shoulder.
The flexors of the forearm originate where?
The medial epicondyle
DANGER A branch of which artery supplies the posterior compartment of the forearm?
The posterior interosseous artery supplies the posterior compartment of the forearm and is a branch of the ULNAR artery. (Labeled #2 in image)
The radial groove is a feature of what bone? What neurovascular structures can be found in the radial groove? What is the clinical significance of the radial groove?
The radial groove is a structure of the posterior humerus. The radial nerve and the deep brachial artery pass through triangular interval and into the radial groove. The origin of the lateral head of the triceps brachii is superior to the radial groove while the origin of the medial head of the the triceps brachii is inferior to the radial groove. The humerus is susceptible to fracture at this site (especially in patients with low bone mineral density).
The radial nerve is ___________ to the ______________ epicondyle whereas the ulnar nerve is _____________ to the _______________ epicondyle.
The radial nerve is anterior to the lateral epicondyle whereas the ulnar nerve is posterior to the medial epicondyle.
What portions of the brachial plexus are considered "supraclavicular"?
The roots and trunks. The divisions are behind the clavicle so technically they are neither supra or infra.
Describe the position of the second section of the axillary artery and name the branch(es) that come off at this section.
The second section of the axillary artery is located directly posterior to the pectoralis minor. There are two branches coming off this section which are the thoracoacromial and the lateral thoracic arteries.
Describe the suprascapular notch and the neurovascular structures associated with it.
The supraspacular notch is a feature of the superior border of the scapula that is closed off by the superior transverse scapular ligament. The suprascapular nerve travels beneath the ligament whereas the suprascapular artery travels above the ligament.
Describe the position of the third section of the axillary artery and name the branch(es) that come off at this section.
The third section of the axillary artery is located between the inferior border of pectoralis minor and the inferior border of teres major. The branches coming off this section are the subscapular artery and the anterior and posterior humeral circumflex arteries.
The anterior and posterior ulnar recurrent arteries are branches of:
The ulnar artery. (REcurrent- the brachial artery has already split to become the ulnar artery and now it is CIRCLING BACK to anastomose with the ulnar collateral arteries to supply the medial elbow)
Describe the vertebral arteries.
The vertebral arteries travel through the transverse foramen of the cervical vertebrae from the subclavian artery toward the brain. Posteriorly they branch off to form inferior cerebellar arteries which branch again to give two posterior spinal arteries. Anteriorly they coalesce to form a single anterior spinal artery before right and left vertebral arteries join and form the basilar artery.
Describe the function of the vinculum.
The vinculum carry blood supply to the flexor digitorum superficialis and profundus tendons and help facilitate digital flexion.
A patient presents with numbness in the thumb, index, and long fingers for the past year along with atrophy of the thenar muscles. Name a thenar muscles and their innervation.
Thenar Muscles: Opponens Pollicis- Median nerve (recurrent motor branch) ABDuctor Pollicis Brevis- Median nerve (recurrent motor branch) Flexor Pollicis Brevis- Superficial Head: Median nerve (recurrent motor branch) Deep Head: Ulnar nerve (deep branch)
What is the purpose of the annular and cruciate fibrous digital sheaths?
They keep the flexor tendons close to the phalanges creating a biomechanical advantage for full flexion (fist)
What connective tissue structure stabilizes the biceps tendon within the intertubercular groove?
Transverse ligament of the humerus.
The facet joints of the cervical spine reside predominately in what plane? This allows for what movement?
Transverse/Axial Plane Rotation
The roots of the brachial plexus combine to form:
Trunks C5, C6- Superior Trunk C7- Middle Trunk C8, T1- Inferior Trunk
What nerve innervates MOST of the intrinsic muscles of the hand? (with exceptions)
Ulnar (C7, 8, T1) also innervates the skin of the 4-5 digits.
Main contributor to the superficial palmar arch:
Ulnar Artery Small contribution from superficial palmar branch of radial artery
What ligament is found on the medial elbow that is stretched with valgus force?
Ulnar Collateral Ligament
What are the principal muscles producing lateral cervical flexion?
Unilateral action of: Iliocostalis Cervicis Longissimus Capitus & Cervicis Splenius Capitus & Cervicis Intertransversarii Scalenes
What are the principal muscles producing cervical rotation?
Unilateral action of: Rotatores Semispinalis Capitis & Cervicis Multifidus Splenius Cervicis
Brachial Plexus Nerve Root Levels
C5-T1
Borders & Contents of Anatomical Snuffbox
"Brevis Sandwich" Lateral Border: APL-ABDuctor Pollicis Longus EPB-Extensor Pollicis Brevis Medial Border: EPL- Extensor Pollicis Longus Floor: Scaphoid Contents: Radial Artery Superficial Radial Nerve on top of snuffbox
Deep Anterior Compartment of Forearm: Pronator Quadratus Origin, Insertion, Action, Innervation
"Deepest Anterior Compartment Muscle" Origin: Distal 1/4 of anterior Ulna Insertion: Distal 1/4 of anterior Radius Action: accessory forearm pronator Innervation: Anterior Interosseous Nerve (from Median Nerve)
Superficial Anterior Compartment of the Forearm: Flexor Carpi Ulnaris Origin, Insertion, Action, Innervation
"Workhorse of the wrist" Origin: Olecranon Process & Posterior border of Ulna Insertion: Pisiform, hook of the hamate, 5th MC Action: Volar/Palmar Flex Wrist. Ulnar Deviation. Innervation: ULNAR NERVE
Describe the sensory innervation of the ulnar nerve and it's autonomous zone.
(Blue in image) Palmar Surface: Pinky & 1/2 of ring finger Dorsal Surface: Pinky, ring finger, 1/2 of middle finger Autonomous Zone: Pulp of pinky
Describe the sensory innervation of the median nerve and it's autonomous zone.
(Red in image) Palmar Surface: Thumb, index, middle, & 1/2 of ring finger Dorsal Surface: Distal phalanx of index, middle & 1/2 of ring finger Autonomous Zone: Pulp of index finger
Describe the sensory innervation of the radial nerve and it's autonomous zone.
(Yellow in image) Palmar Surface: Lateral edge of thumb Dorsal Surface (Superficial Radial Nerve): Thumb, index, & 1/2 of middle finger Autonomous zone (Superficial Radial Nerve): dorsal interdigital space between 1st & 2nd MC
Deep Anterior Compartment of Forearm: Flexor Digitorum Profundus Origin, Insertion, Action, Innervation
*DUAL INNERVATION* Origin: Proximal 3/4 of medial & anterior surfaces of ulna & interosseous membrane Insertion: Medial Part- Base of distal phalanx digits 4-5 Lateral Part- Base of distal phalanx digits 2-3 Action: Flex distal phalanges 2-5 at DIP joints Innervation: Medial Part- ULNAR NERVE Lateral Part- Anterior Interosseous Nerve (from median nerve)
Brachioradialis (innervated by the radial nerve) performs what motion at the elbow joint?
*EXCEPTION* Innervated by the radial nerve (extensor nerve) but it flexes the elbow in a mid-pronated position.
List the muscles in the hand innervated by the median nerve.
*Meat LOAF* 1st & 2nd Lumbricals Opponens Pollicis ABDuctor Pollicis Brevis Flexor Pollicis Brevis (superficial head) (Meat = median nerve)
Deep Posterior Compartment of the Forearm Extensor Indicis Origin, Insertion, Action, Innervation
*Most distal muscle in the posterior forearm* Origin: Posterior surface of distal 1/3 of ulna & interosseous membrane Insertion: Extensor expansion of 2nd digit Action: Extends 2nd digit. Assists with wrist extension. Innervation: Deep radial/posterior interosseous nerve
List the contents of the carpal tunnel.
- 9 flexor tendons (4 x FDP, 4 x FDS, 1 x FPL) - median nerve
Five categories of structures that receive innervation in the back and can be sources of pain:
1. Fibroskeletal structures: periosteum, ligaments, & annular fibrosis of IVD 2. Meninges 3. Synovial Joints: Facet joints 4. Muscles (intrinsics) 5. Nervous tissue: spinal nerves/nerve roots exiting the IV foramina.
Name and describe the branches of the subscapular artery.
1. Thoracodorsal Artery- travels with the thoracodorsal nerve to supply the latissimus dorsi. 2. Circumflex Scapular Artery- travels posteriorly through the triangular space to help supply the scapula and surrounding musculature.
There are _____________ thoracic vertebrae and ____________ thoracic nerves.
12 vertebrae 12 nerves
The Palmaris Longus Tendon is absent in approximately what percent of the population?
20%
What branches of of the superficial palmar arch?
3 Common Palmar Digital Arteries (between MC 2-5)
Palmar Interossei Origin, Insertion, Action, Innervation
3 PAD Origin: Palmar surfaces of 2nd, 4th, & 5th MC Insertion: Bases of proximal phalanges; extensor expansion Action: ADDuct 2nd, 4th, & 5th digits towards 3rd ray. Assist Lumbricals Innervation: Deep branch of the ulnar nerve
Dorsal Interossei Origin, Insertion, Action, Innervation
4 DAB Origin: Adjacent sides of two MC Insertion: Bases of proximal phalanges; extensor expansion. Action: ABDuct digits 2-4 away from 3rd ray. Assist Lumbricals Innervation: Deep branch of Ulnar nerve
There are __________ sacral vertebrae and __________ sacral nerves.
5 fused vertebrae 5 nerves
There are __________ lumbar vertebrae and __________ lumbar nerves.
5 vertebrae 5 nerves
There are _________ cervical vertebrae and ___________ cervical nerves.
7 vertebrae 8 nerves
The median artery ( when present) is a continuation of
A persistent median artery is present in 35% of the population and is a continuation of the Anterior Interosseous Artery. Will travel with median nerve and can cause carpal tunnel syndrome.
What muscle is the main opposer of the thumb?
ABDuctor Pollicis Brevis explanation: main action involved in opposition is abduction.
List the tendons contained in the 1st extensor compartment of the wrist.
APL- ABDuctor Pollicis Longus EPB- Extensor Pollicis Brevis
Superficial Anterior Compartment of the Forearm: Palmaris Longus Origin, Insertion, Action, Innervation
Absent in approximately 20% of the population Origin: Medial Epicondyle of Humerus (Common Flexor Origin) Insertion: Distal 1/2 of flexor Retinaculum & Apex of Palmar Fascia Action: Weak Volar/Palmar Flexor of the Wrist Innervation: Median Nerve
A patient presents with persistent numbness in the small finger, atrophy of the 1st dorsal interosseous muscle, & wasting of the volar interossei muscles. What is your diagnosis?
According to the sensory distribution of the hand, the ulnar nerve is responsible for sensation of the 5th digit. The ulnar nerve also innervates the interosseous muscles of the hand. There has been compression of the ulnar nerve (cubital tunnel syndrome). The ulnar nerve is the major terminal branch of the medial cord of the brachial plexus.
Which joint has a greater range of motion: Sternoclavicular Acromioclavicular
Acromioclavicular (45*) Sternoclavicular (10-15*)
What connective tissue structures support the acromioclavicular (AC) joint?
Acromioclavicular Capsule (comprised of superior & inferior ligaments) Coraco-acromial Ligament Coracoclavicular ligaments (Trapezoid & Conoid) Articular disc
Levatores Costarum Action & Innervation
Action: Elevates the ribs to aide in inspiration Innervation: Posterior Rami
Which nerves relay signals from the receptors to the brain/spinal cord regarding sensory input?
Afferent Fibers
L4 Myotome Movement
Ankle Dorsiflexon
S1 Myotome Movement
Ankle Plantarflexion
Compartments of the arm
Anterior & Posterior
In what two directions does the SC joint typically dislocate? Which direction requires immediate medical attention?
Anterior & Posterior A posterior dislocation would require immediate medical attention as it could compromise structures such as the subclavian artery/vein, brachial plexus, and apex of the lung.
Compartments of the Forearm
Anterior & Posterior Separated by the Radius, Ulna, and Interosseous Membrane
Where does the brachial plexus come from?
Anterior (Ventral) rami of C5-T1
Name the muscles innervated by the ulnar nerve.
Anterior Forearm: FLEXOR CARPI ULNARIS Flexor Digitorum Profundus (digits 4-5) Intrinsic Hand: Abductor Digiti Minimi Flexor Digiti Minimi Opponens Digiti Minimi Palmaris Brevis Lumbricals (4-5) 3PAD 4DAB Adductor Pollicis *Deep head Flexor Pollicis Brevis
Name the muscles innervated by the median nerve.
Anterior Forearm: Pronator Teres Flexor Carpi Radialis Palmaris Longus Flexor Digitorum Superficialis Intrinsic Hand: Abductor Pollicis Brevis Flexor Pollicis Brevis (superficial head) Opponens Pollicis Lumbricals 2-3
What artery supplies the deep anterior compartment of the forearm?
Anterior Interosseous Artery- branch of the common interosseous off the ulnar artery ( labeled #3 in image)
What prevents IVD material from extruding anteriorly?
Anterior longitudinal ligament
Where are spinal cord strokes most likely to occur?
Anterior spinal artery
Separation of the AC joint requires rupture of what tissues?
Articular Capsule Coraco-acromial Ligament Coracoclavicular Ligaments
What is the most commonly injured nerve with an anterior shoulder dislocation? (non-surgical)
Axillary Nerve
Synovial joint with the greatest freedom of movement. Flexion/Extension, ABD/ADD, ER/IR
Ball & Socket Joint Ex: Hip & shoulder
What superficial vein is located on the ulnar side of the forearm?
Basilic Vein
What are the principal muscles producing cervical flexion?
Bilateral action of : longus colli (anterior neck) Scalenes SCM
A 40 year old female presents with a laceration in the antecubital fossa. She has extensive bleeding that cannot be stopped and an inability to dorsiflex (extend) her wrist as well as extend the MCP joints. What structures have been injured?
Brachial artery is likely the source of the bleed. The radial nerve being a content of the cubital fossa and the nerve of the extensors has also likely been injured.
What forms the Dorsal Carpal Arch?
Branches from both the radial and ulnar arteries. The Dorsal Carpal Arch contributes to the Dorsal Metacarpal Arteries.
Cervical Plexus Nerve Root Levels
C1-C5
pre-plexus nerve root
C4
What superficial vein is located on the radial side of the forearm?
Cephalic Vein
Name the branches of the thoracoacromial artery. (Not all- just the ones highlighted in lecture)
Clavicular branch Pectoral Branch
Most common compression neuropathy in the upper extremity:
Compression of the Suprascapular nerve. Can result in weakness of supraspinatus (shoulder ABD) and infraspinatus (shoulder ER).
Biaxial synovial joint that allows for motion in the sagittal (FLEX/EX) and frontal (ABD/ADD) planes.
Condyloid (Oval) Joint Ex: Wrist, MCP joints of the fingers
What structures comprise the coraco-acromial arch?
Coracoid process Coraco-acromial Ligament Acromion Process The Coraco-acromial arch is the "roof" of the rotator cuff.
The divisions of the brachial plexus combine to form:
Cords Lateral cord: Anterior fibers from Superior and Middle Trunk Posterior cord: Posterior fibers from Superior, Middle, and Inferior Trunks Medial cord: Anterior fibers from Inferior Trunk
The most superficial muscle of the posterior forearm, the extensor digitorum, is innervated by what nerve?
DANGER the most superficial muscle is innervated by the deep radial nerve
List the muscles involved in shoulder ABDuction.
DELTOID Supraspinatus
List the muscles involved in shoulder extension.
DELTOID Teres Major Latissimus Dorsi Triceps Brachii (long head)
A patient presents with pain over the radial aspect of the wrist. The pain is increased when she wrings out diapers. She reports no numbness or tingling in the digits. What is your diagnosis?
DeQuervain's Tenosynovitis is associated with repetitive gripping, clenching, pinching, and/or wringing (ulnar deviation) motions. The involved structures are the ABDuctor pollicis longus and the extensor pollicis brevis which are the contents of the first dorsal compartment of the wrist.
Patient present with inability to extend fingers and inability to extend and abduct thumb. Patient is able to extend (dorsiflex) wrist but it moves into a radially deviated position. What neurovascular structure has most likely been compromised?
Deep Radial Nerve/Posterior Interosseous Nerve
Dermatomes: C4
Deltoid Region
Geographic distribution of named nerves: Superior Lateral Cutaneous Nerve of the arm
Deltoid region
Superficial Posterior Compartment of Forearm: Brachioradialis Origin, Insertion, Action, Innervation
Does NOT cross the wrist! Origin: lateral supracondylar ridge of the humerus Insertion: lateral distal radius proximal to radial styloid process. Action: Accessory elbow flexor with wrist in neutral (pronation/supination) Innervation: Radial Nerve
Lister's Tubercle is a feature of what bone?
Dorsal Radius Lister's Tubercle= Dorsal Tubercle of the Radius
List the tendons contained in the 2nd extensor compartment of the wrist.
ECRL- Extensor Carpi Radialis Longus ECRB- Extensor Carpi Radialis Brevis
List the tendon contained in the 6th extensor compartment of the wrist.
ECU- Extensor Carpi Ulnaris
List the tendon contained in the 5th extensor compartment of the wrist.
EDM- Extensor Digiti Minimi
List the tendon contained in the 3rd extensor compartment of the wrist.
EPL- Extensor Pollicis Longus
Lister's Tubercle acts as a pulley for what muscle tendon?
EPL- Extensor Pollicis Longus
Which nerves have relay signals from the brain/spinal cord to the body regarding motor function?
Efferent Fibers
C7 Myotome Movement
Elbow Extension
C5 Myotome Movement
Elbow Flexion
Pronator Teres Syndrome:
Entrapment or compression of the median nerve between the two heads of the pronator teres.
Describe the denticulate ligaments.
Extensions of the pia mater that separate the ventral and dorsal nerve rootlets.
Name the muscles innervated by the deep radial nerve (posterior interosseous).
Extensor Carpi Radialis Brevis Supinator Extensor Carpi Ulnaris Extensor Digiti Minimi Extensor Digitorum Extensor Pollicis Longus Extensor Pollicis Brevis Abductor Pollicis Longus Extensor Indicis
List the tendons contained in the 4th extensor compartment of the wrist.
Extensor Digitorum Extensor Indicis
True or False The valveless basivertebral veins surround the vertebral bodies but do not enter them.
FALSE
True or False The annular ligament has a robust attachment to the head of the radius.
FALSE The annular ligament wraps around the radial head and has robust attachments to the ulna. This creates a sling around the radius that allows for the rotation of pronation and supination.
True or False The dens articulates with the posterior arch of C1.
FASLE The dens articulates with the anterior arch of C1.
Describe the orientation of the interosseous membrane of the forearm.
Fibers travel from proximal radius to distal ulna at an angle of 22*. Space between radius and ulna maintained by the interosseous membrane allows for pronation and supination. Anterior Interosseous Artery travels on top of Interosseous membrane in the anterior compartment of the forearm & Posterior Interosseous Artery travels beneath membrane in posterior compartment.
Histologically, the 3 types of joints in the body are:
Fibrous Cartilaginous Synovial
T1 Myotome Movement
Finger ABDuction
Opposition is a combination of what 3 movements?
Flexion ABDuction Pronation
C8 Myotome Movement
Flexion of DIP of middle finger
At the wrist the radial pulse can be palpated between which two tendons?
Flexor Carpi Radialis Brachioradialis
Name the muscles innervated by the anterior interosseous nerve.
Flexor Digitorum Profundus (Digits 2-3) Flexor Pollicis Longus Pronator Quadratus
Describe the relationship between the proper palmar neurovascular structures in the finger.
From superficial to deep: Nerve Artery Vein
The facet joints of the thoracic spine reside predominately in what plane? This allows for what movement?
Frontal/Coronal Plane Lateral Flexion
Uniaxial synovial joint that allows for movement in one plane (Sagittal plane- Flexion & Extension)
Hinge Joint Ex: Elbow & IP joints of the digits
L2 Myotome Movement
Hip Flexion
List the muscles involved in shoulder external (lateral) rotation.
INFRASPINATUS Teres Minor Deltoid
Thoracic nerves exit superior or inferior to the vertebrae of the same number?
Inferior
Name the connective tissues that supports the Sternoclavicular (SC) joint.
Interclavicular ligament Articular Capsule (comprised of anterior and posterior ligaments) Articular Disc Costoclavicular Ligament
What ligament is between the spinous processes of adjacent vertebrae?
Interspinous Ligament
Posterior Rami Spinal Nerves C3-7
Intrinsic muscles of the back and overlying skin (adjacent to vertebral column)
L3 Myotome Movement
Knee Extension
L5 Myotome Movement
Knee Flexion, Great Toe Extension
Lumbar Plexus Nerve Root Levels
L1-L4
At what level is the conus medullaris located?
L2 is where the spinal cord ends.
Where is a safe location for spinal injections?
L4 Below conus medullaris in the area of the cauda equina
Sacral Plexus Nerve Root Levels
L4-S4
Dermatomes: C6
Lateral Antebrachial & Thumb
Most common neurovascular structure injured with distal biceps tendon rupture:
Lateral Antebrachial Cutaneous Nerve
What nerve innervated the skin of the lateral forearm?
Lateral Antebrachial Cutaneous Nerve (4 & 16 in image- light green)
Dermatomes: C5
Lateral Brachial
Cubital Fossa: Borders & Contents
Lateral border: Brachioradialis Medial border: Pronator Teres Contents: "Key to the cubital fossa is the Biceps Tendon" Radial Nerve Brachial Artery Median Nerve MEDIAN NERVE IS MEDIAL TO THE BRACHIAL ARTERY AT THE LEVEL OF THE CUBITAL FOSSA.
What are the principal muscles producing cervical extension?
Layer 1- Semispinalis Cervicis Iliocostalis Cericis Layer 2- Splenius Cervicis Levator Scapulae Layer 3- Splenius Capitis Layer 4- Multifidus Layer 5- Longissiumus Capitis Layer 6- Semispinalis Extrinsic- Trapezius
What is the posterior boundary of the vertebral canal?
Ligamentum Flavum
What intrinsic muscles of the hand originate and insert on tendons?
Lumbricals
Describe the mechanism of injury, classic symptoms, and muscles involved with an upper brachial plexus injury (Erb's Palsy)
MOI: Excessive lateral cervical flexion either from falling on the shoulder or from pulling on the head during birth. Classic symptoms: waiter's tip deformity. Shoulder internal rotation, elbow extension, forearm pronation, and wrist extension. Muscles: biceps brachii, brachialis, and deltoid (along with several others). (C5,6)
Describe the mechanism of injury, classic symptoms, and muscles involved with a lower brachial plexus injury (Klumpke's Palsy)
MOI: Hyperabduction of the shoulder as the result holding on to something while falling or when the arm is pulled during birth. Classic symptoms: (global) claw hand deformity. Forearm supination, wrist extension, MCP hyperextended, IP flexed. Muscles: intrinsic muscles of the hand. (C8,T1)
What nerve innervates the skin of the medial forearm?
Medial Antebrachial Cutaneous Nerve (10 in image- light purple)
Dermatomes: T1
Medial Antebrachium
Dermatomes: T2
Medial Brachium
The ulnar nerve is the direct continuation of which cord?
Medial Cord
What nerve innervates the anterior compartment of the forearm? (EXCEPT FCU)
Median (C6,7,8, T1) also innervates the thenar muscles and parts of the skin of the hand.
What connects the cephalic and basilic veins?
Median Cubital Vein
Inability to oppose the thumb indicates injury to which nerve?
Median Nerve
What nerves are at risk of injury with a supracondylar fracture of the humerus?
Median, Ulnar, and Radial Nerves
Dermatomes: C7
Middle finger
What nerve innervates the anterior compartment of the arm?
Musculocutaneous (C5,6,7) Runs between :Biceps Brachii & Brachialis Pierces: Coracobrachialis
What are the main terminal branches of the brachial plexus?
Musculocutaneous Nerve (C5,6,7)-becomes lateral antebrachial cutaneous nerve Axillary Nerve (C5,6) Radial Nerve (EVERYTHING- C5,6,7,8,T1) Median (C6,7,8,T1)- "the M in the brachial plexus" Ulnar (C7,8,T1)
What is the most commonly injured nerve with an anterior shoulder dislocation that requires surgical intervention?
Musculocutaneous nerve because it pierces the coracobrachialis and gets stretched when that muscle is moved during surgery.
What neurovascular structure can be found between the biceps brachii and brachialis muscles in the anterior compartment of the arm?
Musculocutaneous nerve. Upon its exit from between these two muscles it becomes the lateral antebrachial cutaneous nerve and supplies sensation to the skin of the lateral forearm.
Name all of the direct branches of the divisions of the brachial plexus. Describe what nerve root contribution they have and what muscles they innervate.
NO DIRECT BRANCHES
Dermatomes: T4
Nipple Line
List the 3 Hypothenar Muscles
Opponens Digiti Minimi ABDuctor Digiti Minimi Flexor Digiti Minimi Brevis
List the 3 Thenar Muscles
Opponens Pollicis ABDuctor Pollicis Brevis Flexor Pollicis Brevis
Deep Anterior Compartment of Forearm: Flexor Pollicis Longus Origin, Insertion, Action, Innervation
Origin: Anterior surface of radius and adjacent interosseous membrane Insertion: Base of distal phalanx of thumb Action: Flexion of phalanges of first digit (thumb) Innervation: Anterior Interosseous Nerve (from Median Nerve)
Multifidus Origin, Insertion, Action, Innervation
Origin: Broad origin from sacrum, lumbar vertebrae, ilium, & aponeurosis of erector spinae Insertion: Cervical & thoracic spinous processes Action: extension, lateral flexion, & rotation TOWARD ACTIVE SIDE Innervation: Posterior Rami
Iliocostalis Origin, Insertion, Action, Innervation
Origin: Broad tendon from part of iliac crest, posterior sacrum, sacral & inferior lumbar spinous processes, & supraspinous ligament Insertion: angles of lower ribs and to transverse processes cervical vertebrae Action: Unilateral- lateral flexion Bilateral- extension Innervation: Posterior Rami
Longissimus Origin, Insertion, Action, Innervation
Origin: Broad tendon from part of iliac crest, posterior sacrum, sacral & inferior lumbar spinous processes, & supraspinous ligament Insertion: transverse processes in thoracic & cervical regions & to mastoid process Action: Unilateral- lateral flexion Bilateral- extension Innervation: Posterior Rami
Spinalis Origin, Insertion, Action, Innervation
Origin: Broad tendon from part of iliac crest, posterior sacrum, sacral & inferior lumbar spinous processes, & supraspinous ligament Insertion:spinous processes in upper thoracic region to cranium Action: Unilateral- lateral flexion Bilateral- extension Innervation: Posterior Rami
Anterior Compartment of the Arm: Coracobrachialis Origin, Insertion, Action, Innervation
Origin: Coracoid Process Insertion: Middle third of medial humerus Action: Flex and ADD shoulder Innervation: Musculocutaneous
Opponens Pollicis Origin, Insertion, Action, Innervation
Origin: Flexor Retinaculum & tubercles of scaphoid & trapezium Insertion: Lateral side 1st MC Action: oppose thumb Innervation: Median Nerve
ABDuctor Pollicis Brevis Origin, Insertion, Action, Innervation
Origin: Flexor Retinaculum & tubercles of scaphoid & trapezium Insertion: Lateral side of base of proximal phalanx of thumb Action: ABDucts thumb Innervation: Median Nerve
Flexor Pollicis Brevis Origin, Insertion, Action, Innervation
Origin: Flexor Retinaculum & tubercles of scaphoid & trapezium Insertion: Lateral side of base of proximal phalanx of thumb Action: Flex Thumb Innervation: Superficial Head- Median Nerve Deep Head- Deep branch of the ulnar nerve
Flexor Digit Minimi Brevis Origin, Insertion, Action, Innervation
Origin: Hook of hamate & flexor retinaculum Insertion: Medial border of 5th MC Action: Flex proximal phalanx of pinky Innervation: Deep branch of the ulnar nerve
Opponens Digiti Minimi Origin, Insertion, Action, Innervation
Origin: Hook of hamate & flexor retinaculum Insertion: Medial border of 5th MC Action: brings pinky into opposition Innervation: deep branch of the ulnar nerve
INTERMEDIATE Anterior Compartment of the Forearm: Flexor Digitorum Superficialis Origin, Insertion, Action, Innervation
Origin: Humero-ulnar Head- Medial Epicondyle & Coronoid Process Radial Head- Superior half of anterior border (of radius) Insertion: Middle phalanx digits 2-5 Action: Flexion of middle phalanges at proximal interphalangeal joints digits 2-5. Also flexes MCP joints digits 2-5. Innervation: Median Nerve
Posterior Compartment of the Arm: Anconeus Origin, Insertion, Action, Innervation
Origin: Lateral Epicondyle Insertion: Lateral olecranon and posterior ulna Action: Accessory elbow extensor Innervation: Radial Nerve
Superficial Posterior Compartment of the Forearm Extensor Carpi Radialis Brevis Origin, Insertion, Action, Innervation
Origin: Lateral epicondyle of humerus (common extensor origin) Insertion: Dorsal aspect of base of 3rd MC 🖕 Action: Wrist extension & radial deviation Innervation: Deep radial/posterior interosseous nerve
Superficial Posterior Compartment of the Forearm Extensor Digiti Minimi Origin, Insertion, Action, Innervation
Origin: Lateral epicondyle of humerus (common extensor origin) Insertion: Extensor expansion of 5th digit (pinky) Action: Extends 5th digit primarily at MCP joint & secondarily at interphalangeal joint Innervation: Deep radial/posterior interosseous nerve
Superficial Posterior Compartment of the Forearm Extensor Digitorum (Communis) Origin, Insertion, Action, Innervation
Origin: Lateral epicondyle of humerus (common extensor origin) Insertion: Extensor expansion of digits 2-5 Action: Extends digits 2-5 primarily at MCP joints & secondarily at interphalangeal joints Innervation: Deep radial/posterior interosseous nerve
Deep Posterior Compartment of the Forearm Supinator Origin, Insertion, Action, Innervation
Origin: Lateral epicondyle of humerus, radial collateral & annular ligaments, supinator fossa, crest of ulna Insertion: Lateral, posterior, & anterior surfaces of proximal 1/3 of radius Action: Accessory supinator Innervation: Deep radial/posterior interosseous nerve
Superficial Posterior Compartment of the Forearm Extensor Carpi Ulnaris Origin, Insertion, Action, Innervation
Origin: Lateral epicondyle of humerus. Posterior border of ulna via shared aponeurosis. Insertion: Dorsal aspect of base of 5th MC Action: wrist extension. Ulnar deviation. Innervation: Deep radial/posterior interosseous nerve
Superficial Posterior Compartment of the Forearm Extensor Carpi Radialis Longus Origin, Insertion, Action, Innervation
Origin: Lateral supracondylar ridge of humerus (immediately distal to Brachioradialis) Insertion: dorsal aspect of base of 2nd MC Action: Wrist extension and radial deviation Innervation: Radial Nerve
Posterior Compartment of the Arm: Triceps Brachii Origin, Insertion, Action, Innervation
Origin: Long Head- Infraglenoid Tubercle Lateral Head- Posterior surface of the humerus (superior to radial groove) Medial Head- Posterior surface of the humerus (inferior to radial groove) Insertion: Olecranon of Ulna and fascia of forearm Action: Main elbow Extensor. Innervation: RADIAL NERVE FOR ALL HEADS IN THIS COURSE
Anterior Compartment of the Arm: Biceps Brachii Origin, Insertion, Action, Innervation
Origin: Long Head- Supraglenoid tubercle & glenoid labrum Short Head- Coracoid Process Insertion: Tuberosity of radius and fascia of forearm via bicipital aponeurosis Action: Main Supinator of the forearm. Flexes elbow. Innervation: Musculocutaneous
Superficial Anterior Compartment of the Forearm: Flexor Carpi Radialis Origin, Insertion, Action, Innervation
Origin: Medial Epicondyle of Humerus (Common Flexor Origin) Insertion: Base of 2nd MC Action: Wrist palmar/volar flexion and radial deviation. Innervation: Median Nerve
Lumbricals 3 & 4 Origin, Insertion, Action, Innervation
Origin: Medial three tendons of FDP (flexor digitorum profundus) Insertion: Lateral sides of extensor expansion digits 4-5 Action: Flex MCP joints & Extend IP joints Innervation: Deep branch of the ulnar nerve
Spelnius Capitus Origin, Insertion, Action, Innervation
Origin: Nuchal ligament & spinous processes of cervical & thoracic vertebrae Insertion: mastoid process & lateral portion of superior nuchal line Action: Unliateral- lateral fexion & rotation TOWARD ACTIVE SIDE Bilateral- extend Innervation: Posterior rami C1
Splenius Cervicis (Splenius Colli) Origin, Insertion, Action, Innervation
Origin: Nuchal ligament & spinous processes of cervical & thoracic vertebrae Insertion: transverse processes of superior cervical vertebrae Action: Unliateral- lateral fexion & rotation TOWARD ACTIVE SIDE Bilateral- extend Innervation: Posterior rami C1
ADDuctor Pollicis Origin, Insertion, Action, Innervation
Origin: Oblique Head- Bases of 2nd & 3rd MC, capitate, & adjacent carpals Transverse Head- Anterior surface of 3rd MC Insertion: Medial side of base of proximal phalanx of thumb Action: ADDucts thumb toward lateral border of palm Innervation: Deep branch of the ulnar nerve
ABDuctor Digiti Minimi Origin, Insertion, Action, Innervation
Origin: Pisiform Insertion: Medial side of base of proximal phalanx of pinky Action: ABDucts the pinky. Assists with flexion. Innervation: deep branch of the ulnar nerve
Deep Posterior Compartment of the Forearm Extensor Pollicis Brevis Origin, Insertion, Action, Innervation
Origin: Posterior distal surface of ulna & interosseous membrane Insertion: dorsal aspect of base of proximal phalanx of thumb Action: Extend MCP & CMC joints of thumb Innervation: Deep radial/posterior interosseous nerve
Deep Posterior Compartment of the Forearm Extensor Pollicis Longus Origin, Insertion, Action, Innervation
Origin: Posterior middle surface of ulna & interosseous membrane Insertion: dorsal aspect of base of distal phalanx Action: Extend IP, MCP, & CMC joints of thumb Innervation: Deep radial/posterior interosseous nerve
Deep Posterior Compartment of the Forearm Abductor Pollicis Longus Origin, Insertion, Action, Innervation
Origin: Posterior surface of proximal halves of ulna, radius, & interosseous membrane Insertion: Base of 1st MC Action: Abduct thumb & extends it at CMC joint Innervation: Deep radial/posterior interosseous nerve
Superficial Anterior Compartment of the Forearm: Pronator Teres Origin, Insertion, Action, Innervation
Origin: Ulnar Head- Coronoid Process of Ulna Humeral Head- Medial Epicondyle of Humerus (Common Flexor Origin) Insertion: Middle of convexity of lateral radius Action: Primary forearm pronator. Flexes Elbow Innervation: Median Nerve
Anterior Compartment of the Arm: Brachialis Origin, Insertion, Action, Innervation
Origin: distal half of anterior humerus Insertion: Coronoid process and tuberosity of ulna Action: Main Flexor of the elbow. DUAL INNERVATION: Musculocutaneous & Radial
Lumbricals 1 & 2 Origin, Insertion, Action, Innervation
Origin: lateral two tendons of FDP (flexor digitorum profundus) Insertion: Lateral sides of extensor expansion digits 2-3 Action: Flex MCP joints & Extend IP joints Innervation: Median Nerve
Rotatores Origin, Insertion, Action, Innervation
Origin: thoracic transverse process Insertion: adjacent thoracic transverse process Action: extension & rotation TOWARD ACTIVE SIDE Innervation: Posterior Rami
Semispinalis Origin, Insertion, Action, Innervation
Origin: transverse processes of cervical & thoracic vertebrae Insertion: occipital bone, spinous process of superior cervical & thoracic vertebrae Action: extension. ROTATION AWAY FROM ACTIVE SIDE* (contralateral rotation) Innervation: Posterior Rami
Name and describe the parts of the intervertebral disc.
Outer annular fibrousus- tough concentric layers provide structural support. Inner nucleus pulposus- gelatinous substance provides shock absorption.
List the muscles involved in shoulder flexion.
PECTORALIS MAJOR DELTOID Coracobrachialis Biceps Brachii
List the muscles involves in shoulder ADDuction.
PECTORALIS MAJOR LATISSIMUS DORSI Teres Major Triceps Brachii (Long Head)
What ligament can be found on the anterior portion of the vertebral canal?
POSTERIOR longitudinal ligament Named for its relation to the vertebral bodies.
What branches off of the deep palmar arch?
Palmar Metacarpal Arteries Dorsal Metacarpal Arteries
What is considered the roof of the carpal tunnel?
Palmar carpal ligament or transverse carpal ligament.
What is the only muscle innervated by the superficial branch of the ulnar nerve?
Palmaris Brevis
The three sections of the axillary artery are defined according to their position relative to:
Pectoralis Minor
Dermatomes: C8
Pinky
Which carpal is a sesamoid bone?
Pisiform
Synovial joint that is constructed for rotation around a longitudinal axis.
Pivot Joint Ex: Atlantoaxial joint (C1-C2), proximal radio-ulnar joint
Synovial joint with the least amount of movement. Limited to gliding and sliding movements.
Plane (Gliding) Joint Ex: Intercarpal joints & Carpometacarpal joints
Name the muscles innervated by the radial nerve.
Posterior Arm: Triceps Brachii (ALL HEADS FOR THIS COURSE) Posterior Forearm: Brachioradialis Anconeus Extensor Carpi Radialis Longus
Describe the normal curvatures of the spine.
Primary kyphotic curve 1* seen in the thoracic and sacral regions of the spine in adults. Posteriorly these curves are convex. Secondary lordotic curve 2* seen in the cervical and lumbar regions of the spine in adults. Posteriorly these curves are concave.
What are the two branches coming off the deep palmar arch?
Princeps Pollicis Artery (supplies medial thumb) Radialis Indicis Artery (supplies lateral index finger)
What are the terminal branches of the common palmar digital arteries?
Proper Palmar Digital Arteries
Main contributor to the deep palmar arch:
Radial Artery Small contribution from deep branch of ulnar artery
What ligament is found on the lateral elbow that is stretched with varus force?
Radial Collateral Ligament
What is the largest terminal branch of the brachial plexus?
Radial Nerve
Within the Cubital fossa the brachial artery splits and gives rise to what two arteries?
Radial and Ulnar Arteries
What neurovascular structure can be found between the brachialis and brachioradialis muscles?
Radial nerve traveling from the posterior compartment of the arm, anterior to the lateral epicondyle of the humerus, to the anteriolateral forearm.
Rotation of what bone allows for pronation/supination?
Radius
What neurovascular structure needs to be moved or cauterized if damaged with a distal biceps tendon rupture?
Recurrent radial artery
Describe the lumbar arteries.
Right and left branches that wrap around and sends off nutrient arteries within. The right branch is longer than the left because the descending aorta is shifted to the left side of the vertebral body.
A 40 year old male was lifting a 200lb TV set with another person when they suddenly they let go. The patient experienced immediate pain in the antecubital fossa. What structure has been compromised?
Rupture of the distal biceps tendon. The biceps brachii is innervated by the musculocutaneous nerve (C5,6,7) which is the major terminal branch of the lateral cord of the brachial plexus.
List the muscles involved in shoulder internal (medial) rotation.
SUBSCAPULARIS Pectoralis Major Deltoid Latissimus Dorsi Teres Major
Synovial joint that allows for the unique opposition movement of the thumb.
Saddle (Sellar) Joint
The facet joints of the lumbar spine reside predominately in what plane? This allows for what movement?
Sagittal Plane Flexion/Extension
Which carpal bone is most commonly fractured?
Scaphoid
The distal radius articulates directly with which carpal bone(s)?
Scaphoid & Lunate
CSF can be found where?
Subarcahnoid space
3 Layers of the Anterior Compartment of the Forearm
Superficial Layer: Pronator Teres, Flexor Carpi Radialis, Palmaris Longus, Flexor Carpi Ulnaris Intermediate Layer: Flexor Digitorum Superficialis Deep Layer: Flexor Pollicis Longus, Flexor Digitorum Profundis
Cervical nerves exit superior or inferior to the vertebrae of the same number?
Superior
What compromises the zygapophysial (facet) joints?
Superior & Inferior facets
Geographic distribution of named nerves: Trigeminal Nerve (CN V)
V1, V2, & V3 sensory face
C6 Myotome Movement
Wrist extension
What is the strongest portion of the ulnar collateral ligament? a)Anterior Band b) Superior Band c)Posterior Band d) Inferior Band
a) Anterior Band
Where are the glenohumeral ligaments located? a) Anterior shoulder b) Posterior Shoulder c) Superior Shoulder d) Inferior Shoulder
a) Anterior Shoulder Superior, Middle, and Inferior GH Ligaments prevent excessive shoulder extension and ER
The head of the radius articulates with what bone(s)? Select all that apply. a)Humerus b)Scaphoid c) Ulna d) Lunate
a) Humerus b) Ulna
Spinal nerves traveling through the intervertebral foramen are located: a)Superiorly within the foramen b)Inferiorly within the foramen c) Middle of the foramen
a) Superiorly within the foramen
Facet are innervated by how many nerve levels? a) 1 b) 2 c) 3 d) 4
b) 2 (posterior rami)
Primary supinator of the forearm:
biceps brachii
Capitate articulates with which metacarpal(s)? Select all that apply. a) 1st Metacarpal b) 2nd Metacarpal c) 3rd Metacarpal d) 4th Metacarpal e) 5th Metacarpal
c) 3rd Metacarpal
What connective tissue structure stabilizes the distal radio-ulnar joint? a)Annular Ligament b) Ulnar Collateral Ligament c) Triangular Fibrocartilage Complex (articular disc) d)Flexor Retinaculum
c) TFCC interosseous membrane also stabilizes distal radio-ulnar joint
What is the function of the ligamentum flavum?
connects lamina to lamina in adjacent vertebrae
Thickenings of what connective tissue form the intrinsic ligaments of a synovial joint? a) Articular Cartilage b) Collateral Ligaments c) Synovial Membrane d) Articular Capsule
d) Articular Capsule
Spinal nerves exit the spinal column via: a) Vertebral Foramen b) Transverse Foramen c) Foramen Magnum d) Intervertebral Foramen
d) Intervertebral Foramen
What motion occurs at the atlanto-occipital joint?
flexion/extension "shake head yes"
The distal ulna articulates directly with which carpal bone(s)?
gotcha! technically does not directly articulate with any of the carpals
Where are unmyelinated cell bodies found in the spinal cord?
gray matter
What muscles comprise the erector spinae group?
lateral --> medial I Like Spinach Iliocostalis: Lumbar, Thoracic, & Cervical parts Longissimus: Thoracic, Cervical, & Capitus parts Spinalis: Thoracic, Cervical, & Capitus parts
Geographic distribution of named nerves: Inferior Lateral Cutaneous nerve of the arm
lateral brachium
Geographic distribution of named nerves: Medial Cutaneous nerve of the arm
medial brachium
Posterior Ramus Suboccipital Nerve (C1) innervates
muscles of suboccipital triangle
The long head of the triceps brachii muscle: a) passes between the humerus and the medial head of the triceps b) passes between the teres major and teres minor muscles c) flexes the arm d) flexes the forearm e) supinates the forearm
passes between the teres major and teres minor muscles
Geographic distribution of named nerves: Posterior Cutaneous Nerve of the arm
posterior arm
Geographic distribution of named nerves: Posterior Cutaneous nerve of the forearm
posterior forearm
Primary pronator of the forearm:
pronator teres
Geographic distribution of named nerves: Lateral Cutaneous nerve of the forearm
radial forearm
What motion occurs at the atlanto-axial joint?
rotation "shake head no"
Medial brachial cutaneous nerve innervates:
skin on medial side of arm (11 in image- orange)
Posterior Ramus Greater Occipital Nerve (C2) innervates
skin over back of head
What muscles comprise the transverospinalis group?
superficial --> deep Smell More Roses Semispinalis Multifidus Rotatores
The cords of the brachial plexus are named for their relationship to:
the axillary artery.
What causes Dupuytren's contracture?
thickening/scarring of the palmar fascia/aponeurosis
What protects the vertebral arteries as they travel from the subclavian arteries toward the brain?
transverse foramen of the cervical spine
Geographic distribution of named nerves: Medial Cutaneous nerve of the forearm
ulnar forearm
Geographic distribution of named nerves: Supraclavicular Nerves
upper trapezius region
Where are myelinated axons found in the spinal cord?
white matter
What artery provides the main blood supply to the humeral head and neck?
Posterior Humeral Circumflex
Intervertebral disc herniations typically occur in what direction?
Posterior lateral
What prevents IVD material from extruding centrally posteriorly?
Posterior longitudinal ligament
Which two intermediate extrinsic muscles of the back that aid in respiration are innervated by anterior rami?
Serratus posterior superior. O: upper thoracic vertebra I: upper ribs A: elevate ribs Serratus posterior inferior- O: lower thoracic vertebra I: lower ribs A: depress ribs innervated my intercostal nerves from anterior rami
Posterior Antebrachial Cutaneous Nerve Innervates:
Skin of posterior forearm (17 in image- dark purple)
ANTERIOR Rami Lesser Occipital Nerve (C2-3) innervates
Skin of superior posterolateral neck and scalp to external ear
List the structures pierced when performing an epidural anesthetic.
Skin, subQ/superficial fascia, deep fascia, muscle, ligamentum flavum, STOP.
List the structures pierced when performing a spinal anesthetic.
Skin, subQ/superficial fascia, deep fascia, muscle, ligamentum flavum, dura mater, STOP.
What joint is the attachment of the appendicular skeleton to the axial skeleton in the upper extremity?
Sternoclavicular joint
Deep radial nerve pierces what muscle?
Supinator
Suprascapular notch syndrome is expected to cause neurological pain from the _________________ and disability of the _____________________ muscle. a) dorsal scapular nerve/supraspinatus b) subscapular nerve/infraspinatus c) suprascapular nerve/supraspinatus d) subscapular nerve/subscapularis e) suprascapular nerve/subscapularis
Suprascapular nerve/supraspinatus
What muscle initiates ABDuction of the arm?
Supraspinatus (Suprascapular Nerve)
post-plexus nerve root
T2
Describe the position of the median nerve in relation to the brachial artery at the level of the cubital fossa.
THE MEDIAN NERVE IS MEDIAL TO THE BRACHIAL ARTERY AT THE LEVEL OF THE CUBITAL FOSSA
True or False The median nerve runs deep to the superficial palmar arch.
TRUE
