Anatomy- Thieme Chapter 14 (Functional of Upper Limb)

One of your patients ruptured the tendon of the long head of the biceps brachii. Although he is bothered by the unattractive bulge that formed in his anterior arm, he is surprised to find that he has lost little flexor strength. You confirm that the brachialis muscle has greater leverage at the joint and therefore is the more powerful flexor of the elbow. Where does the brachialis insert? A. Radial tuberosity B. Ulnar tuberosity C. Coronoid process D. Bicipital aponeurosis E. Olecranon

B The brachialis muscle inserts on the ulnar tuberosity of the ulna A The biceps brachii inserts on the radial tuberosity. C The coronoid process forms the anterior lip of the trochlear notch of the ulna and is the origin of the ulnar head of the pronator teres. D The bicipital aponeurosis is a fascial extension of the biceps brachii. E The olecranon of the ulna forms the posterior prominence of the elbow and is the insertion for the triceps brachii and anconeus muscles.

Which muscle provides strong adduction of the glenohumeral joint? A. Teres minor B. Pectoralis major C. Pectoralis minor D. Short head of the biceps brachii E. Subscapularis

B The broad origin of the pectoralis major on the anterior trunk wall allows it to strongly adduct the arm A As part of the rotator cuff, the teres minor supports the head of the humerus in the glenohumeral joint. It also weakly adducts and laterally rotates the arm. C The pectoralis minor draws the scapula forward and down, causing the scapula to rotate medially. D The short head of the biceps brachii provides some flexion, abduction, and internal rotation of the glenohumeral joint. E The subscapularis supports the head of the humerus in the glenohumeral joint and medially rotates the arm.

The deep palmar arch of the hand is formed mainly by the A. ulnar artery B. radial artery C. brachial artery D. palmar digital arteries E. palmar metacarpal arteries

B The deep palmar arch is formed mainly by the radial artery (Section 13.4a). A The ulnar artery forms the superficial palmar arch. C The brachial artery begins at the lateral border of the axilla and terminates in the cubital fossa. D The palmar digital arteries are branches of the superficial and deep palmar arches in the palm of the hand. E The palmar metacarpal arteries arise from the superficial and deep palmar

At a neighborhood block party several children engage in a tugof-war. Suddenly, Jason, a 5-year-old boy, hugs his right elbow and cries out in pain. The inconsolable child is eventually taken to the local clinic, where the pediatrician recognizes that Jason has subluxed (partially dislocated) his radial head. By gently supinating the flexed arm, the doctor restores it to its normal position. Which of the following is true regarding the proximal radioulnar joint? A. The radial head rotates within the annular ligament. B. It includes a hinge-type joint between the head of the radius and capitellum of the humerus. C. The biceps brachii pronates the joint. D. An articular disk separates the radius and ulna. E. The subluxation of the radial head results from a tear of the radial collateral ligament.

A The annular ligament forms a circular cuff around the radial head that allows the bone to rotate in the joint B The hinge-type joint between the radius and capitullum of the humerus is the humeroradial joint. C The biceps brachii inserts on the tuberosity of the radius and therefore supinates the joint when contracted. D In the proximal radioulnar joint the radius articulates at the radial notch of the ulna. An articular disk separates the radius and ulna in the distal radioulnar joint. E Subluxation of the radial head results from a laxity of the annular ligament.

The C4 anterior ramus is a component of A. the pre-fixed plexus B. the upper trunk C. the posterior cord D. the axillary nerve E. All the above

A The brachial plexus contains the anterior rami of C5 to T1. A prefixed plexus also contains the C4 anterior ramus B The upper trunk contains C5 and C6 anterior rami. C The posterior cord contains the anterior rami of C5 to T1. D The axillary nerve contains the anterior rami of C5 and C6. E B, C, and D are incorrect.

On your first day of shadowing in your preceptor's office, you are asked to get some baseline information on each patient. You start by taking their pulse. The radial artery is easiest to palpate in the wrist where it lies immediately lateral to the tendon of the A. flexor carpi radialis B. flexor digitorum C. flexor pollicis longus D. palmaris longus E. extensor carpi radialis

A The radial artery descends on the lateral side of the forearm and at the wrist lies immediately lateral to the tendon of the flexor carpi radialis B The tendons of the flexor digitorum lie in the middle of the wrist, medial to the radial artery. C The tendon of the flexor pollicis longus lies lateral to the median nerve and medial to the tendon of the flexor carpi radialis and to the radial artery. D The palmaris longus runs superficial to the flexor retinaculum and medial to the flexor pollicis longus. E The radial artery lies medial (palmar) to the extensor carpi radialis tendon.

The axillary artery A. begins at the lateral border of the 1st rib B. lies anterior to the axillary vein C. ends by dividing into brachial and deep brachial arteries D. passes through the axilla between the pectoralis major and pectoralis minor muscles E. branches include the thyrocervical trunk

A The subclavian artery continues as the axillary artery at the lateral border of the 1st rib B The axillary artery lies posterior to the axillary vein. C The brachial artery is a continuation of the axillary artery in the axilla. The deep brachial artery is one of the branches of the brachial artery. D The axillary artery passes through the axilla posterior to the pectoralis minor muscle.

sternoclavicular joint

Articulation between the clavicle and the sternum

You examine a 14-year-old girl in the emergency department. She has a puncture wound from a dog bite in the flesh over the middle phalange of her 5th digit. The incident occurred 2 days ago, and the finger is inflamed and likely infected. What are your thoughts regarding possible spread of the infection via the synovial sheath? A. It will spread into the superficial space on the dorsum of the hand. B. It will spread to the common flexor sheath in the wrist. C. It will spread to the adjacent finger. D. It will remain confined to the sheath of the infected finger. E. A and B are correct.

B The synovial sheath of the 5th digit normally communicates with the common synovial sheath A The synovial sheath of the 5th digit communicates with the common synovial sheath and with that of the thumb, but it does not normally communicate with the superficial space on the dorsum of the hand. C The synovial sheaths of the 2nd, 3rd, and 4th digits do not normally communicate with any other tendon sheaths. It is unlikely the infection will spread to these fingers. D Although the infection may remain confined to the infected finger, the synovial sheath of the 5th digit communicates with that of the thumb and with the common tendon sheath. Therefore, the concern is that it will spread via this route to the thumb, wrist, and forearm. E The synovial sheath of the 5th digit normally communicates with the common flexor sheath at the wrist but not with the superficial space on the dorsum of the hand.

Axillary lymph nodes that lie medial to the pectoralis minor include A. pectoral nodes B. humeral nodes C. apical nodes D. central nodes E. subscapular nodes

C The apical nodes are the nodes of the upper infraclavicular group. These lie medial to the pectoralis minor muscle along the axillary vein and adjacent to the proximal part of the axillary artery A Pectoral nodes are part of the lower axillary group that lies lateral to the pectoralis minor. B Interpectoral nodes are part of the middle axillary group that lies between the pectoralis major and pectoralis minor muscles. D Central nodes are part of the lower axillary group that lies lateral to the pectoralis minor. E The subscapular nodes are part of the lower axillary group that lies lateral to the pectoralis minor.

In the anatomy lab you are fascinated by the deep dissection of the hand because as a professional violinist you appreciate that the intrinsic muscles of the palm are important for the fine movements of the hand. Which of the following is true for both the lumbricals and the interossei muscles? A. All are innervated by the median nerve. B. All are innervated by the ulnar nerve. C. They flex the metacarpophalangeal joints. D. They arise from the tendons of the flexor digitorum profundus. E. They abduct or adduct the fingers.

C The interossei and lumbricals flex the metacarpophalangeal joints and extend the interphalangeal joints (Section 14.6c). A Only the lateral two lumbricals are innervated by the median nerve. The medial lumbricals and all of the interossei are innervated by the ulnar nerve. B The ulnar nerve innervates all of the interossei and the medial two lumbricals. The lateral two lumbricals are innervated by the median nerve. D Only the lumbricals arise from the flexor tendons. The interossei arise from the shafts of the metacarpal bones. E The palmar interossei adduct the fingers, the dorsal interossei abduct the fingers. The lumbricals have no effect on these movements.

Which part(s) of the triceps brachii crosses/cross the glenohumeral joint? A. Medial head B. Lateral head C. Long head D. Lateral and medial heads E. Lateral and long heads

C The long head of the triceps brachii crosses the glenohumeral joint to attach to the infraglenoid tubercle, where it contributes to extension of the joint (Section 14.2c). A The medial head arises from the medial aspect of the humeral shaft. It joins with the lateral and long heads to insert on the olecranon of the ulna. B The lateral head arises from the lateral aspect of the humeral shaft. It joins with the medial and long heads to insert on the olecranon of the ulna. D The medial and lateral heads arise from the humeral shaft and cross only the elbow joint. E The lateral head arises from the shaft of the humerus and crosses the elbow joint. The long head originates on the infraglenoid tubercle of the scapula and crosses the glenohumeral and elbow joints.

Nerves often pair with arteries to travel as neurovascular bundles. Which of the following is not an accurate pairing? A. Axillary nerve and posterior circumflex humeral artery B. Median nerve and brachial artery C. Musculocutaneous nerve and circumflex scapular artery D. Radial nerve and deep brachial artery E. Long thoracic nerve and lateral thoracic artery

C The musculocutaneous nerve passes from the axilla to pierce the coracobrachialis of the anterior arm. The circumflex scapular artery passes through the triangular space into the scapular region (Section 14.2d). A The axillary artery and posterior circumflex humeral artery pass through the quadrangular space to the deltoid region. B The median nerve and brachial artery descend on the medial side of the biceps brachii and enter the cubital fossa. D The radial nerve and deep brachial artery wind around the posterior humerus through the triceps hiatus. E The long thoracic nerve and lateral thoracic artery descend on the medial wall of the axilla to supply the serratus anterior muscle.

Structures that pass through the quadrangular space of the upper limb include the A. radial nerve B. suprascapular nerve C. posterior humeral circumflex artery D. anterior humeral circumflex artery E. deep brachial artery

C The posterior humeral circumflex artery and the axillary nerve pass through the quadrangular space (Section 14.2d). A The radial nerve passes through the triceps hiatus. B The suprascapular nerve passes through the scapular notch. D The anterior humeral circumflex artery runs horizontally beneath the coracobrachialis and the short head of the biceps brachii to encircle the neck of the humerus. E The deep brachial artery passes through the triceps hiatus with the radial nerve.

A professional rodeo cowboy fell off his horse and fractured his humerus at the anatomic neck and the lesser tubercle. Which of the following muscles inserts on this tubercle? A. Supraspinatus B. Infraspinatus C. Subscapularis D. Coracobrachialis E. Teres major

C The subscapularis inserts on the lesser tubercle of the humerus and fibrous capsule of the glenohumeral joint (Section 14.2c). A The supraspinatus inserts on the greater tubercle of the humerus. B The infraspinatus inserts on the greater tubercle of the humerus. D The coracobrachialis inserts on the shaft of the middle part of the humerus. E The teres

During your first training session as a phlebotomist, you are relieved to find that your "patient" is a 24-year-old weight lifter whose superficial veins stand out dramatically against his overdeveloped muscles. Superficial veins of the upper limb A. include a basilic vein that runs in the deltopectoral groove B. include a cephalic vein that joins the brachial veins in the arm C. drain into the veins of the deep venous system via perforating veins D. course with the arteries as paired accompanying veins E. have bidirectional valves that allow flow in either direction.

C The veins of the superficial venous system drain into the deep veins via perforating veins (Section 13.4b). A The cephalic vein courses along the deltopectoral groove before terminating in the axillary vein. B The basilic vein joins with the paired brachial veins to form the axillary vein. D Veins of the deep venous system travel with the arteries as paired accompanying veins. There is no superficial arterial system that accompanies the superficial veins. E Veins of the limbs have unidirectional valves that prevent pooling of blood and facilitate flow back toward the heart.

A young man suffered a crushing injury to his right arm, fracturing his humerus at midshaft and damaging the nerve that runs in the posterior compartment. What functional loss would you expect from this injury? A. Inability to extend the elbow B. Inability to supinate the hand C. Inability to abduct the thumb D. Inability to extend the wrist E. All of the above

D Damage to the radial nerve from a midhumeral fracture results in loss of innervation to the extensor carpi radialis and extensor carpi ulnaris A The branches of the radial nerve to the triceps brachii arise high in the arm, so a midhumeral lesion of the nerve would not affect the function of this muscle. B The radial nerve innervates only one of the muscles that supinate the hand, the supinator. The biceps brachii, also a supinator, is innervated by the musculocutaneous nerve. C Abduction of the thumb is weakened by damage to the radial nerve. E A, B, and C are incorrect.

Each cord of the brachial plexus A. contains nerve fibers from C5 to T1 levels of the spinal cord B. is formed from the junction of one anterior and one posterior division C. gives a branch to the median nerve D. lies within the axilla E. gives rise to a subscapular nerve (upper, middle, and lower)

D Each cord of the brachial plexus lies within the axilla (Section 13.4d). A The posterior cord contains fibers from C5 to T1; the medial cord contains fibers from C8 and T1; the lateral cord contains fibers from C5 to C7. B The posterior divisions form the posterior cord; only anterior divisions form the medial and the lateral cords. C The median nerve is formed from the medial and lateral cords

An elderly man had injured his wrist in a fall and is now experiencing tingling in his fingers and a weakened grip. A lateral X-ray of the wrist shows that his lunate has dislocated and is pressing on the structures within the carpal tunnel. Which of the following structures pass through the carpal tunnel? A. Ulnar artery B. Radial artery C. Flexor carpi radialis D. Flexor pollicis longus E. Palmaris longus

D The flexor pollicis longus passes through the carpal tunnel with the flexor digitorum superficialis, flexor digitorum profundus, and median nerve A The ulnar artery and ulnar nerve pass through the ulnar canal at the wrist. B At the wrist the radial artery turns dorsally to run through the floor of the anatomic snuffbox. C The flexor carpi radialis crosses the wrist lateral to the carpal tunnel and inserts on the base of the 1st metacarpal. E The palmaris longus passes superficial to the flexor retinaculum to insert into the palmar aponeurosis.

A young woman riding a 10-speed bicycle accidentally engaged the front brake, was thrown over the handlebars, and landed on her outstretched hands. In the emergency department, imaging of the elbow revealed a subtle fracture of the radial neck that allowed proximal movement of the radius relative to the ulna, which also suggested a tear in the interosseous membrane. Which movements were most impaired by this injury? A. Flexion of the wrist B. Extension of the elbow C. Extension of the digits D. Abduction of the thumb E. Adduction of the thumb

D The function of the abductor pollicis muscle, the primary abductor of the thumb, would be greatly impaired because it originates on the interosseous membrane A The flexor carpi radialis and flexor carpi ulnaris originate from the medial epicondyle of the humerus and olecranon of the ulna and would be unaffected by this injury. B The triceps brachii, which extends the elbow, inserts on the olecranon. It would not be impaired by this injury. C The extensor digitorum originates from the humerus and ulna and would be unaffected by this injury. E The adductor of the thumb, adductor pollicis, attaches to the 2nd and 3rd metacarpals and the capitate. It would not be affected by this injury.

During a radical mastectomy on a 50-year-old woman, the surgeon does a careful but thorough axillary node dissection. What nerve lies along the medial wall of the axilla and is particularly vulnerable during this procedure? A. Lateral branch of posterior intercostal B. Musculocutaneous C. Lateral pectoral D. Long thoracic E. Dorsal scapular

D The long thoracic nerve runs superficial to, and innervates, the serratus anterior, which forms the medial wall of the axilla. Injury to this nerve can result in a "winged" scapula (Section 14.1a). A In the axilla the intercostal nerves run deep to the serratus anterior and external intercostal muscles and are not vulnerable to injury. B The musculocutaneous nerve leaves the axilla just inferior to the glenohumeral joint where it enters the coracobrachialis muscle. C The lateral pectoral nerve passes anteriorly to penetrate the pectoralis major muscle. E The dorsal scapular nerve descends posteriorly from the upper

17. Damage to which nerve would most affect elbow flexion? A. Radial nerve B. Ulnar nerve C. Median nerve D. Musculocutaneous nerve E. Axillary nerve

D The musculocutaneous nerve innervates the biceps brachii and brachialis muscles, the primary flexors of the elbow. There would also be loss of sensation to the skin of the lateral forearm (Sections 14.2c and 14.3a). A Damage to the radial nerve results in wrist drop and loss of sensation to the dorsum of the hand and the proximal segments of the 1st through 3rd digits and half of the 4th digit. B Damage to the ulnar nerve may cause paresthesia (numbness and tingling) in the forearm, 4th and 5th fingers, or paralysis of the intrinsic muscles of the hand (so-called claw hand deformity). C Damage to the median nerve above the cubital fossa will cause the inability to flex the proximal interphalangeal joint of the 1st to 3rd digits and the inability to flex the distal interphalangeal joints of the 2nd and 3rd digits. This results in "benediction hand" (2nd and 3rd finger are partially extended) when trying to form a fist. It also causes the inability to flex the terminal phalanx of the thumb (due to damage of flexor pollicis longus) and loss of sensation over the lateral aspect of the hand. E Damage to the axillary nerve causes paralysis of the deltoid muscle resulting in weakened flexion and extension

While moonlighting in the emergency department one night, you treat a 14- year-old gang member who was stabbed in the supraclavicular region of the neck 2 cm above the middle third of the clavicle. A chest X-ray confirms that he has a pneumothorax. What other structure could be injured in this area? A. Axillary nerve B. Pectoralis minor C. Subscapular artery D. Posterior cord of the brachial plexus E. Cephalic vein

D The posterior cord is part of the supraclavicular brachial plexus and could be injured in the area (Section 13.4d). A The terminal nerves of the brachial plexus form below the clavicle. Although damage to the supraclavicular plexus could affect the axillary nerve, the stab wound would not directly damage the nerve itself. B The pectoralis minor attaches to the coracoid process, which lies below the middle part of the clavicle. C The subscapular artery is a branch of the distal part of the axillary artery, which is infraclavicular. E The cephalic vein drains into the axillary vein below the clavicle and most likely would not be affected by this injury.

As a second-year resident doing a pediatric surgery rotation, you set up an arterial line on your 6-year-old patient prior to surgery. You choose the radial artery of her left (nondominant) hand. Because you know that the procedure can result in occlusion of the artery, you verify that the collateral circulation to the hand is patent. The radial artery A. forms the superficial arch of the hand B. passes superficial to the anatomic snuffbox C. supplies the muscles of the posterior compartment through its posterior interosseous branch D. supplies the princeps pollicis artery of the thumb E. lies medial to the tendon of the flexor carpi radialis in the wrist

D The princeps pollicis arises from the radial artery at the base of the 1st metacarpal and divides into two digital arteries of the thumb (Section 13.4a). A The ulnar artery forms the superficial palmar arch. The radial artery forms the deep palmar arch. B The radial artery courses along the floor of the anatomic snuffbox. C The posterior interosseous artery, which supplies muscles of the posterior forearm compartment, arises from the common interosseous artery, a branch of the ulnar artery in the cubital fossa. E The radial artery lies lateral to the tendon of the flexor carpi radialis at the wrist.

The serratus anterior muscle A. forms a scapulothoracic joint with the external intercostal muscles B. is innervated by a branch of the posterior cord C. elevates the scapula off the thoracic wall D. rotates the scapula laterally during abduction of the arm above the horizontal plane E. originates from the subscapular fossa

D The serratus anterior pulls the inferior angle of the scapula laterally when the glenohumeral joint is abducted above the horizontal plane (Sections 14.1a and 14.1b). A The scapulothoracic joint is a functional relationship between the serratus anterior and subscapularis muscles. B The long thoracic nerve, which innervates the serratus anterior muscle, arises directly from the C5-C7 roots of the brachial plexus. C The serratus anterior supports the scapula against the thoracic wall. Denervation of the muscle allows the scapula to lift away from the thoracic wall, a condition known as a "winged" scapula. E The serratus anterior originates from the entire medial border of the scapula.

One of your orthopedic colleagues introduces you, an anatomist, to his patient, a famous baseball pitcher, who suffers from chronic rotator cuff pain. He asks you to demonstrate the rotator cuff on a cadaver specimen and explain the anatomy of this type of injury. You tell him the following: A. Tendons of the rotator cuff muscles insert onto the capsule of the glenohumeral joint. B. The supraspinatus tendon passes through the subacromial space between the shoulder joint and the coracoacromial arch. C. An abnormal communication between the subacromial bursa and glenohumeral joint cavity can result from rupture of the supraspinatus tendon. D. Rupture of the supraspinatus tendon will impair the patient's ability to initiate abduction of the arm. E. All the above

E All of the rotator cuff muscles insert on the fibrous capsule of the glenohumeral joint. The supraspinatus muscle, the most frequently involved in rotator cuff tears, passes through the narrow subacromial space and, with repetitive use, becomes frayed. Rupture of the tendon allows the overlying bursa to communicate with the joint cavity and impairs the initial phase of abduction. Later phases of abduction remain intact through the action of the deltoid muscle (Sections 14.2b and 14.2c). A The tendons of the rotator cuff muscles insert on, and reinforce, the fibrous capsule of the joint. B through D are also correct (E). B The supraspinatus tendon and subacromial bursa pass through the narrow subacromial space between the capsule of the shoulder joint and the coracoacromial arch. A, C, and D are also correct (E). C The supraspinatus tendon separates the subacromial and subdeltoid bursae from the joint cavity. With rupture of the tendon, a communication between the bursae and joint cavity may result. A, B, and D are also correct (E). D The deltoid is the primary abductor of the glenohumeral joint, but the supraspinatus assists in the first 15 degrees of abduction. A through C are also correct (E).

The flexor retinaculum A. forms the floor of the ulnar tunnel B. forms the roof of the carpal tunnel C. is continuous with the palmar aponeurosis D. is continuous with the palmaris longus E. All the above

E The flexor retinaculum forms the roof of the carpal tunnel and floor of the ulnar tunnel. As a thickening of the deep fascia of the palm, it is continuous with the palmar aponeurosis, palmaris longus, transverse metacarpal ligament, and fibrous digital sheaths (Sections 14.5b and 14.6c). A The flexor retinaculum forms the floor of the ulnar tunnel; the palmar carpal ligament form its roof. B through D are also correct (E). B The carpal tunnel is a fascio-osseous tunnel. Carpal bones form the floor and sides; the flexor retinaculum forms the roof. A, C, and D are also correct (E). C The flexor retinaculum is continuous with the tough palmar aponeurosis of the hand. A, B, and D are also correct (E). D The palmaris longus passes over the carpal tunnel and inserts on the flexor

Which of the following bones articulates with the radius at the wrist? A. Pisiform B. Hamate C. Capitate D. Trapezium E. Scaphoid

E The radius articulates distally with the scaphoid and lunate bones of the wrist (Section 14.5a). A The pisiform on the medial side of the wrist articulates with the triquetrum. B The hamate articulates with the capitate, lunate, triquetrum, and 4th and 5th metacarpal bones. C The capitate articulates with the hamate, trapezoid, scaphoid, lunate, and 3rd metacarpal. D The trapezium articulates with the trapezoid, scaphoid, and 1st metacarpal.

Which of the following muscles has no attachment on the humerus? A. Deltoid B. Coracobrachialis C. Flexor digitorum superficialis D. Pronator teres E. Biceps brachii

E The two heads of the biceps brachii originate on the supraglenoid tubercle and coracoid process of the scapula and insert on the radial tuberosity of the radius (Sections 14.2c and 14.3a). A The deltoid originates along the scapular spine and clavicle and inserts on the deltoid tuberosity of the humerus. B The coracobrachialis originates on the coracoid process of the scapula and inserts on the shaft of the humerus. C The flexor digitorum superficialis originates on the medial epicondyle of the humerus and upper part of the radius and inserts on the middle phalanx of the 2nd through 4th digits. D The pronator teres originates on the medial epicondyle of the humerus and coronoid process of the ulna and inserts on the lateral radius.

An injury to the lower brachial plexus (Klumpke's palsy) would affect A. sensation in the nail bed of the 5th digit B. abduction of the 2nd through 5th digits C. adduction of the thumb D. adduction of the wrist E. All of the above

E The ulnar nerve arises from the lower part of the plexus. Its dorsal cutaneous branch in the hand supplies the palmar and dorsal surfaces of the 4th (half) and 5th digits, and its deep branch supplies the dorsal interossei muscles that abduct the fingers and the adductor pollicis that adducts the thumb. It also innervates the flexor carpi ulnaris that assists in adduction of the wrist (Section 13.4d). A The ulnar nerve's (C8-T1) dorsal cutaneous branch in the hand supplies the palmar and dorsal surfaces of the 4th (half) and 5th digits. B through D are also correct (E). B The ulnar nerve's (C8-T1) deep branch in the hand supplies the dorsal interossei muscles that abduct the fingers. A, C, and D are also correct (E). C The ulnar nerve's (C8-T1) deep branch in the hand supplies the adductor pollicis muscle that adducts the thumb. A, B, and D are also correct (E). D The ulnar nerve (C8-T1) innervates the flexor carpi ulnaris that assists the extensor carpi ulnaris (radial nerve) in adduction of the wrist. A through C are also correct (E).

lateral epicondylitis

Inflammation of the muscle attachment to the lateral epicondyle of the elbow. pain radiates along extensor forearm. Often caused by strongly gripping. Commonly called tennis elbow.

A patient complains of tingling and pain in the upper arm. Upon further examination and additional tests, you determine that the axillary artery has been occluded by atherosclerosis. The patient, however, still has a radial pulse at the wrist. Which of the following arteries could provide a collateral circulation around the occlusion? A. Suprascapular and circumflex scapular arteries B. Suprascapular and lateral thoracic arteries C. Posterior circumflex humeral and anterior circumflex humeral arteries D. Superior thoracic and lateral thoracic arteries E. Posterior intercostals and lateral thoracic arteries

The suprascapular and transverse cervical branches of the subclavian artery and the thoracodorsal and circumflex scapular branches of the distal segment of the axillary artery participate in a scapular arcade that provides a collateral circulation that would circumvent the occlusion B The lateral thoracic artery does not supply the scapula, nor does it anastomose with the suprascapular artery. C The anterior and posterior humeral circumflex arteries anastomose around the neck of the humerus but do not anastomose with arteries proximal to the occlusion. D Neither the superior thoracic artery nor the lateral thoracic artery supplies the scapular region. E Posterior intercostal arteries supply the medial scapular region, but they do not anastomose with the lateral thoracic artery.

supraspinatus

abducts arm

acromiocalvicular joint

acromion of scap and acromial end of clavicle

teres major function

adduct and internally rotate arm

triceps brachii

adduction and extension

axilla

armpit. 4 sided pyramid region btw upper parts of arm and lateral thoracic wall.

scapulothoracic joint

articulation between the anterior scapula and the thoracic wall

quadrangular space

axillary and posterior humeral circumflex

radioulnar joints connect

bones of forearm proximally at elbow and distally at wrist. cause supination and pronation.

musculocutaneous nerve innervates

brachialis, biceps brachii, coracobrachialis

narrow space btw clavicle and 1st rib, forms apex of axilla

cervicoaxillary canal

triangular space

circumflex scapular art

coracoacromial ligament

coracoid process to acromion. prevents superior disloc of humerus

coracohumeral ligament

coracoid process to lesser tuberosity of humerus . superior to glenohumeral ligament

adduction

deltoid pec major latissimus teres major triceps brachii

abduction

deltoid (acromial) supraspinatus

flexion

deltoid (clavicular) pec major coracobrachialis biceps brachii

extension

deltoid (spinal) latissimus dorsi teres major triceps brachii

axillary nerve innervates

deltoid and teres minor

biceps brachii tendon prevents

dislocation of humerus during abduction and flexion

levator scapulae

elevates scapula

teres major

extends, adducts, and medially rotates arm

latissimus dorsi

extensor of arm. Extends, adducts, and medially rotates the arm; draws the shoulder downward and backward

teres minor function

externally rotates arm

coracoclavicular ligament

extrinsic ligament, anchors clavicle to coracoid process

glenoid labrum

fibrocartilage ring that deepens glenoid cavity

Coracobrachialis

flexes and adducts arm

Brachioradialis

flexes forearm

pectoralis major

flexor of arm. Adducts and flexes humerus

posterior axillary fold

formed by the latissimus dorsi and the teres major muscles

anterior axillary fold

formed by the pectoralis major

subluxation of radial head "nursemaid's elbow"

in children, immature radial head can be dislocated when arm jerked upward, tearing annular ligament around radius neck and allows distal displacement of radial head. supination of flexed elbow returns joint to normal.

long thoracic nerve

innervates serratus anterior

teres major

internal rotation

rotator cuff tears

involve supraspinatus tendon. subacromial and subdeltoid bursae tear in conjunction with ruptured tendon, they become continuous with cavity of glenohumeral joint

injury to long thoracic nerve

is caused by a stab wound or during radical mastectomy or thoracic surgery. It results in paralysis of the serratus anterior muscle and inability to elevate the arm above the horizontal. It produces a "WINGED" scapula in which the vertebral (medial) border of the scapula protrudes away from the thorax.

glenohumeral dislocation

joint is most mobile but least stable joint. inferior support by rotator cuff muscles is weak- called anterior dislocation= damage axillary nerve, flattened shoulder. posterior dislocations rare and associated w seizures/electrocutions.

subscapularis

medially rotates arm

posterior compartment

muscles extend glenohumeral, radial, deep brachial art and vein

median and ulnar nerves do not innervate

muscles of arm

anterior compartment

musculocutaneous n, brachial art and vein, muscles flex glenohumeral

muscles that extend from axial skeleton to humerus and adduct and rotate arm

pectoralis major and latissimus dorsi

form anterior axillary wall and anterior axillary fold

pectoralis minor and major

pronation

pronator teres, pronator quadratus

serratus anterior function

protracts scapula

proximal radioulnar joint is a synovial joint that allows rotation of the

radial head in cuff. elbow joint capsule.

triceps hiatus

radial n and deep brachial art

triceps brachii innervated by

radial nerve

bicipital aponeurosis

roof of cubital fossa

infraspinatus

rotates arm externally

pectoral girdle is formed by

scapula and clavicle

cubital fossa

shallow depression anterior to elbow

glenohumeral joint

shoulder joint

anterior muscles of pectoral girdle

subclavius, pectoralis minor, serratus anterior

supination

supinator, biceps brachii

posterior muscles of pectoral girdle (superficial muscles)

trapezius, levator scapulae, rhomboid major & minor