Practical #2

Drooped shoulder is caused by injury to what muscle and which nerves

- Trapezius (spinal accessory n.)

MM of posterior arm and what is innervatation and blood supply

- triceps brachii -Radial n. -Deep brachial a./v.

Elbow joint complex includes what?

1.Humeroulnar (HU) joint 2.Humeroradial (HR) joint 3.Proximal radioulnar (pRU) joint

Bones of the wrist proximal row:

1.Some (Scaphoid) 2.Lovers (Lunate) 3.Try (Triquetral) 4.Positions (Pisiform—Pinky side)

Shoulder joint complex includes?

1.Sternoclavicular (SC) joint 2.Acromioclavicular (AC) joint 3.Glenohumeral joint ("shoulder") 4. Scapulothoracic joint §Not a synovial joint

Innervate pectoral mm. _______________ is more lateral & ________________is more medial—they are named for their origin pt. on brachial plexus cords...

Medial pectoral n. lateral pectoral n.

Action for lesser tubercle attachments

Medial rotation

Underneath abductor pollicis brevis?

Opponens pollicis

§Clavicular fibers attach most distal on lateral crest of bicipital groove. Lower abdominal portion/fibers attach most proximal.

Pectoralis major

§Can lead to scapular winging §Can impinge large vessels & nn. in axilla causing shoulder impingement and thoracic outlet syndrome

Pectoralis minor m tightness

§Supraglenoid tubercle-> anatomical neck just superior to lesser tubercle

Superior glenohumeral ligament

Trapeziums innervation and blood supply

Spinal accessory nerve and transverse cervical artery

how you hold yourself when you are not moving (i.e., sitting, standing, sleeping...); coordination and interaction of muscle groups working statically to counteract gravity or other forces.

Static posture

§Sternal/medial end of clavicle articulates with the manubrium & 1st rib WHAT TYPE OF JOINT? §Fibrous capsule §Articular disc §fibrocartilaginous pad between articulating surfaces of the clavicle & manubrium §Anterior & posterior sternoclavicular ligaments §Interclavicular ligament §Costoclavicular ligament

Sternoclavicular joint Complex saddle joint

§_________________- is the ONLY boney joint connecting the upper extremity to the axial skeleton! § §How does the limb stay on? §

Sternoclavicular joint §Scapular sling mm.

(connected, but named by location) serve to protect this tendon- Serve to protect tendon of supraspinatus m

Subacromial bursa & subdeltoid bursa

Trauma to Sternoclavicular joint could affect what major blood vessels

Subclavian artery and internal jugular vein

§Acromial/lateral end of clavicle articulates with the acromion process §Planar surfaces § §Acromial side—faces medial/superior §Clavicular side—faces lateral/inferior § §Fibrous capsule §Articular disc §Superior & inferior acromioclavicular ligaments §Coracoclavicular ligament §Trapezoid ligament §Conoid ligament WHAT TYPE OF JOINT?

Acromioclavicular joint Planar joint

Pyramidal passageway between the lateral surface of the thorax and the arm. AND Borders AND CONTENTS

Axilla or armpit region §Borders: §Medial: serratus anterior m. §Anterior: pectoral mm. §Lateral: bicipital groove (humerus) §Posterior: latissimus dorsi, teres major, subscapularis §Floor: axillary fascia §Apex: opening/gap between clavicle & 1st rib §Axillary contents: §Axillary artery & vein §Branches of the brachial plexus

§ it's not designed to be leaned on or compressed §Path for major blood vessels & nerves §Impedes blood flow §Can compress & injure nn.

Axilla passageway §Axillary contents: §Axillary artery & vein §Branches of the brachial plexus

________artery is a continuation of subclavian a. It extends from the lateral border of 1st rib to inferior border of teres major. In the arm, it changes name to _______- artery.

Axillary artery brachial

___________is the central structure. •_______________is anterior •Lateral cord of brachial plexus is lateral; medial cord is medial •Posterior cord of brachial plexus is posterior

Axillary artery Axillary vein

________________ goes through quadrangular space (innervates _______________________)

Axillary n. deltoid and teres minor

extra slack in capsule §Space within capsule ~2x size of humeral head (pouched)

Axillary pouch (inferior)

Names for arm and forearm

Brachium = arm Antebrachium = forearm

The superficial fascia of the abdomen is composes of two layers; the fatty outer layer is _________ and the membranous inner layer is _____

Campers fascia Scarpa's fascia

This one related to a motor problem, involving the lumbricals and interossei mm. So nerve issue (Ex. ulnar nerve) where the lumbricals/interossei can't help maintain the position of the hand. Stroke patients may also have this deformity. Hyperextend at MCP joint and flex at PIP and DIP joints.

Claw hand

anterior elbow CONTENTS, BORDERS, FLOOR

Cubital fossa T.A.N. (lateral to medial) 1. Tendon (biceps brachii) 2.Artery (brachial a./v.) 3. Nerve (median) Floor: brachialis m. Radial n. lateral (deep to brachioradialis m.)

A gap located at the base of the hypothenar mass; located at the distal end of the Tunnel of Guyon is where you find what nerve?

Deep branch of ulnar n

mm most commonly affected by tennis elbow ?

Extensor carpi radials longus (digit 2) and brevis (digit 3)

§Thickening of antebrachial fascia (like wrist sweat band); across posterior wrist

Extensor retinaculum

Hands in pockets Hands on tits Horizontal fibers

External oblique Internal oblique Transervsus abdominis

§proximal attachment outside of the wrist and distal attachment within the wrist (on carpal(s))... §Fibrous joint capsule §Dorsal radiocarpal ligaments §Radial collateral ligament (***Need to be specific, one of these at elbow too...) §Palmar radiocarpal ligaments §Ulnocarpal complex (triangular fibrocartilage complex)

Extrinsic ligaments

§Thickening of antebrachial fascia (like wrist sweat band); across the anterior aspect of the carpal arch §Roof of the "carpal tunnel" §Scaphoid to pisiform (proximal) §Trapezium to hamate (distal)

Flexor Retinaculum (transverse carpal ligament)

sends to the DIP/distal phalanges of digits 2-5.

Flexor digitorum profundus

to the thumb—deeper m. on the thumb side then (coming off the radius) and goes to distal phalanx of thumb

Flexor pollicis longus

1.fibrocartilaginous ring attaching along the glenoid fossa & contributes ~50% depth of the glenoid cavity.

Gelnoid Labrum

§Classic idea of "shoulder joint" § §Overview: §Positioning of the scapula §Positioning of the clavicle §Glenoid fossa §Angle of the humerus §Fibrous capsule §Ligaments §Coracoacromial arch & space

Glenohumeral joint

Goal of the shoulder joint complex

Goal: position the upper extremity to facilitate function of the hand

Elbow joint capsule & capsular ligaments: Typically, thin, lined with synovial membrane and envelops _________________joints

HU, HR, and pRU

§Anterior/inferior to posterior/inferior glenoid rim & labrum -> anterior/inferior to posterior/inferior anatomical neck

Inferior glenohumeral ligament

Action for great tubercle attachments

Lateral rotation

all limit lateral rotation of the arm

Ligaments of the GH joint including: 1. Superior glenohumeral ligament 2. Middle glenohumeral ligament 3. Inferior glenohumeral ligament 4. coracohumeral ligament

____________is "lonely," goes solo to form the medial cord

Lower (anterior)

§Shares fascia with infraspinatus; once open this fascia, a thin white line of tissue divides the two...

Teres minor

-_________ most often gives off common interosseous a. (splits into anterior & posterior interosseous aa.) -_____________a. provides blood to posterior forearm. -_______________ aa. combine to form superficial & deep palmar branches in the hand -_______a. primarily forms superficial arch (follow into the hand); _______will primarily form deep—will re-emerge by MC1 after its trek through the anatomical snuffbox.

Ulnar a. Posterior interosseous Radial & ulnar Ulnar....Radial

What nerve passes through the cubital tunnel, behind medial epicondyle?

Ulnar n

§most medial—thicker & found wrapping posterior to medial epicondyle §Cutaneous nn. for arm & forearm found traveling near/with ulnar n. but are thinner. Cutaneous n. for arm will give off branches to skin in arm.

Ulnar n

Medial side of arm Courses behind medial epicondyle into forearm (cubital tunnel) (provides motor branches to ulnar side) Continues into the hand as the main motor nerve to hand (does NOT travel through the carpal tunnel; instead, tunnel of Guyon)

Ulnar n.

Medial side of arm Courses behind medial epicondyle into forearm (cubital tunnel) (provides motor branches to ulnar side) Continues into the hand as the main motor nerve to hand (does NOT travel through the carpal tunnel; instead,_________________)

Ulnar n. tunnel of Guyon

(Like their arteries, will send out common and proper digital branches into the digits for cutaneous innervation)

Ulnar n. and median n.

Subclavian a./v. & brachial plexus roots/trunks will emerge between the _____________________. of the neck

anterior and middle scalene mm

Subclavian a./v. & brachial plexus roots/trunks will emerge between the ____________- of the neck

anterior and middle scalene mm.

The ________ is a continuation of subclavian a. It extends from the lateral border of 1st rib to inferior border of teres major. In the arm, it changes name to _______________

axillary artery brachial artery

Cords are named for their relationship to the_____________-

axillary artery.

•On either side of the linea alba, you will find a _____________(When people say they want the "11-pack" abs or whatever, this is the line that would create the 11 appearance).

linea semilunaris.

we have significantly greater ______ at the glenohumeral joint than _________.

mobility stability

When the latissimus dorsi is reflected, the ____________. can be seen entering the lat., while the _______________-. adheres to the rib cage along the serratus anterior m._______________ is often easier to see when the cadaver is supine.

thoracodorsal n long thoracic n Long thoracic

In general, the _______ nerve is the primary nerve of the hand (with the deep branch doing motor innervation). _________ n. was the primary nerve in the anterior forearm.

ulnar Median

Origins of the brachial plexus are from the __________ of C5-T1 and include both _________

ventral rami Sensory & motor

Roots include

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

Origins of the brachial plexus are from the WHAT?

ventral rami of C5-T1 (sensory & motor)

________ fibers are connective tissue fibers that are serving to hold the tendons in place...

vinculum

tightest in full radial deviation—strains/tenses ulnar side

wUCL (wrist ulnar collateral ligament)

Order of brachial plexus parts:

"Randy Travis Drinks Cold Beverages" (Medial) Roots > Trunks > Divisions > Cords > Branches (lateral)

Muscles of the thenar

-Abductor pollicis brevis -Flexor pollicis brevis -Opponens pollicis

Cords include what?

-Lateral cord Anterior divisions from upper & middle trunks -Posterior cord All the posterior divisions from all trunks -Medial cord Anterior division from lower trunk

How many branches are there off of each component of brachial plexus?

-Roots (2) -Trunks (2) -Divisions (0) -Cords (12)

The tunnel of Guyon (ulnar tunnel) includes what ? And what is the floor?

-Ulnar n. and a. -Flexor retinaculum if the floor

Trunks include what?

-Upper trunk (C5,6) -Middle trunk (C7) -Lower trunk (C8, T1)

De Quervain's Syndrome •De Quervain's tenosynovitis—It's an inflammation of these synovial/tendon sheaths around the ____________ tendons as they pass under through the extensor retinaculum.

1 = abductor pollicis longus & extensor pollicis brevis 1st compartment

Hypothenar eminence/mass mm.?

1. Abductor digiti minim 2. Flexor digiti minimi brevis 3. Opponens digiti minimi

What 4 mm. originate at the Lateral Epicondyle?

1. Extensor carpi radialis brevis 2. Extensor Digitorum 3. Extensor digiti minimi 4. Extensor carpi ulnaris

Branches from the lateral cord

1. Lateral pectoral n.—pec major (typ. not pec minor) 2. Musculocutaneous n.—will go through coracobrachialis—anterior arm 3. Lateral contribution to the median n.

Branches from the roots

1. Long thoracic n.—to serratus anterior 2. Dorsal scapular n. -to levator scapulae & both rhomboids

Branches from the medial cord

1. Medial pectoral n.—will pierce through pec minor into pec major 2. Ulnar n.—will wrap around medial epicondyle (humerus) 3. Cutaneous n. to arm (medial brachial) 4. Cutaneous n. to forearm (medial antebrachial) 5. Medial contribution to the median n.

What does the "M" formation include?

1. Musculocutaneous n. 2. Median n. 3. Ulnar n.

Branches from the trunks

1. Nerve to subclavius 2. Suprascapular n.—to supraspinatus & infraspinatus

Rotator cuff muscles

1. Supraspinatus §Greater tubercle—superior facet 2. Infraspinatus §Greater tubercle—middle facet 3. Teres minor §Greater tubercle—inferior facet 4. Subscapularis §Lesser tubercle

Bones of the wrist distal row

5.That (Trapezium—sounds like thumb) 6.They (Trapezoid) 7.Can't (Capitate) 8.Handle (Hamate)

Action for dorsal interossei How many?

Abductors- DABS 4 DABS abduct the digits away from the 3rd digit plan

§O: §Transverse head: shaft 3rd MC (ventral) §Oblique head: base MC 1-3 & floor of carpal tunnel § §I: base of proximal phalanx of thumb (ulnar side) § §N: deep branch of ulnar n. § §A: primarily adduction 1st MC

Adductor pollicis m

§Ring-like fibrous band that attaches to the edges of the radial notch (ulna) and encircles the periphery of the radial head §Holds radial head against radial notch §Lined by articular cartilage §Attached to joint capsule, radial component of LCL, & supinator m.

Annular ligament

reinforce anterior & posterior aspects of fibrous capsule--within joint capsule

Anterior & posterior sternoclavicular ligaments

Division names and what are they from ? AND Combine to form what?

Anterior Division -From upper and middle --combine to lateral cord Posterior Division-- All 3 posteriors are "pals"—combine to form posterior cord

§Extends from thoracic cage (costal cartilage of ribs 7-10 & xiphoid process) to pelvis and inguinal ligament. § §Fascia layers §Superficial fascia (Camper's fascia) §Membranous layer (Scarpa's fascia) §External oblique §Internal oblique §Tranversus abdominis § §(Rectus abdominis is midline)

Anterolateral abdominal wall

From shoulder to elbow

Arm or brachium

Borders and contents of the quadrangular space

Borders: -Superior—teres minor -Medial—long head of triceps -Lateral—shaft of humerus Contents: -Axillary n. -Posterior circumflex humeral a.

Central slip goes and probably triangular membrane too. Lateral bands go too far forward. Flexed PIP and extended at DIP.

Boutonniere deformity

Roots include what?

C5, C6, C&, C8, T1

looks like the snakes that make up Medusa's hair. Inportal hypertension, blood must find alternative routes back to the heart because it is unable to make it fully through the hepatic portal system.

Caput Medusa

Travels laterally down the arm to drain into the axillary vein in this region

Cephalic vein through deltopectoral groove

Conoid tubercle of clavicle to coracoid (medial)

Conoid ligament of the acromioclavicular joint

-Bridge—goes past the joint capsule/anatomical neck of the humerus -Functions similar to superior GH ligament (limiting lateral rotation and tightest in doing so when arm hanging at side) Lateral coracoid to greater tubercle

Coracohumeral ligament

from 1st costal cartilage to inferior surface of the proximal aspect of the clavicle (depression for the costoclavicular ligament)

Costaclavicular ligament

-Functions together with the proximal RU joint -Convex periphery of ulnar head with the concave ulnar notch (radius)

Distal radioulnar joint

Which row of carpals is more firmly bound (stable/rigid base for MCs)

Distal row

Distal attachment of the flexor retinaculum

Distal—2nd row of carpals (Trapezium through hamate)

tightest in full flexion

Dorsal radoiocarpal ligament

§Progressive fibrosis of the palmar aponeurosis §Causes thickening and shortening of the digital bands §Produces a flexed posture of digits 4 & 5 (most frequently) §Frequently bilateral §Men > women

Dupuytren contracture

§how you hold yourself when you are moving (i.e., walking, running, bending over...); your body must adapt to changing circumstances. §

Dynamic posture

Movements of the scapula

Elevation & depressionProtraction & retractionUpward rotation & downward rotation

From elbow to wrist

Forearm or antebrachium

6 compartments of extensor retinaculum —keeps the tendons gliding and on course for their destination

From thumb side (lateral) to pinky side (medial): 1. 1st = 2 tendons (abductor pollicis longus & extensor pollicis brevis) 2. 2nd = 2 tendons (extensor carpi radialis longus & extensor carpi radialis brevis) 3. 3rd = 1 tendon (extensor pollicis longus; wraps around dorsal tubercle, radius) 4. 4th = 4 tendons of extensor digitorum + 1 tendon (extensor indicis) 5. 5th = 1 tendon (extensor digiti minimi) 6. 6th = 1 tendon (extensor carpi ulnaris)

attaches sternal ends of clavicles, passes over superior surface of jugular notch.

Interclavicular ligament

Spinal nerves leave the spinal cord through the _______

Intervertebral foramen

carpal to carpal (short, intermediate, and long)...

Intrinsic ligaments

§From lateral epicondyle (humerus) and splits into 2 bands: §Radial component: fibers blend with annular ligament §Ulnar component: fibers attach to supinator crest §All fibers: resist varus force

Lateral (radial) collateral ligament

Lateral bands torn. The digit is forced into flexion. Lose ability to extend DIP.

Mallet finger

§Has anterior, posterior, and transverse fibers—main goal, resist valgus forces §Anterior fibers: anterior side, medial epicondyle to medial side coronoid process §Strongest, stiffest band of eMCL §Resists valgus force (for anterior fibers, primarily when arm flexed at 90) §Posterior fibers tightest in extreme elbow flexion; transverse fibers do little for stability (ulna-ulna connection)

Medial (ulnar) collateral ligament

Travels in a fascial sheath with the brachial a./v. Crosses the cubital fossa Motor innervation to muscles in superficial/intermediate anterior forearm In forearm, it travels between flexor digitorum profundus & flexor digitorum superficialis. It gives off 2 branches: anterior interosseous n. (deep anterior forearm mm.) & palmar cutaneous n. (see next slide) Median n. continues through carpal tunnel (flexor retinaculum) & into the hand

Median N.

Travels in a fascial sheath with the brachial a./v. Crosses the cubital fossa Motor innervation to muscles in superficial/intermediate anterior forearm In forearm, it travels between flexor digitorum profundus & flexor digitorum superficialis. It gives off 2 branches: anterior interosseous n. (deep anterior forearm mm.) & palmar cutaneous n. (see next slide)

Median n

§runs in fascial sheath with brachial a. & v. midline §Cubital fossa = T.A.N. §Lateral to medial: Tendon (biceps), Artery (brachial), Nerve (Median)

Median n

Carpal tunnel syndrome is caused by compression of what nerve? Mechanisms?

Median n 1. Decrease in size of carpal tunnel 2. Disease state augmenting carpal tunnel contents

§Superior/middle aspect of glenoid fossa (blends with subscapularis tendon, so reinforced by it) -> anterior aspect of anatomical neck

Middle glenohumeral ligament

Muscles of anterior compartment of arm Innervation Actions

Mm: Coracobrachialis Biceps Brachii Brachialis Musculocutaneous Actions: Flexion (Shoulder and or elbow flexion)

Anterior & continuation of lateral cord—into coracobrachialis...usually)

Musculocutaneous n

§pierces through coracobrachialis §Found again between biceps brachii m. belly & brachialis

Musculocutaneous n

Goes through coracobrachialis Between biceps brachii & brachialis Continues as lateral cutaneous n. of forearm

Musculocutaneous n.

_____________ Goes through coracobrachialis Between biceps brachii & brachialis Continues as____________ of forearm

Musculocutaneous n. lateral cutaneous n.

Forms "M" formation

Musculocutaneous, median, and ulnar n

Most superficial structure in the hand: §Deep fascia; dense & aponeurotic like tissue covering the palm §Sends slips to each finger §Splits near the MCP joints & wraps around the flexor tendons §Slips attach to deep transverse metacarpal ligament and the fibrous tendon sheaths

Palmar aponeurosis

deep fascia, but in the hand what m. blends into this?

Palmar aponeurosis Palmaris longus blends into the palmar aponeurosis

tightest in full extension (thicker/stronger than dorsal versions)

Palmar radoiocarpal ligaments

Positioning of scapula

Plane of the scapula -35 degrees anterior to the frontal plane Clavicle -20 degrees posterior to the frontal plane

Radius & ulna forcefully driven posterior to humerus In children < 10 yrs, PED most common type of joint dislocation In adults, 2nd most dislocated joint (proceeded by shoulder joint) Typically, from traumatic fall onto an outstretched hand resulting in a hyperextension injury Often, anterior capsule also torn/damaged

Posterior elbow dislocation (PED)

§attitude assumed by the body either with support during muscular activity or as a result of the coordinated action performed by a group of muscles working to maintain stability.

Posture

Proximal attachment of the flexor retinaculum

Proximal—1st row of carpals (Scaphoid through pisiform)

A strenuous pull on the forearm through the hand can cause the radial head to slip through the distal end of the annular ligament. Young children more susceptible: Ligament laxity Unfused radial head (epiphysis) Reduced strength & slowed reflexes

Pulled elbow syndrome

§between the lateral surface of the thorax and the arm. Borders:WHAT?

Pyramidal passageway §Borders: §Medial: serratus anterior m. §Anterior: pectoral mm. §Lateral: bicipital groove (humerus) §Posterior: latissimus dorsi, teres major, subscapularis §Floor: axillary fascia §Apex: opening/gap between clavicle & 1st rib

Medial to lateral of brachial plexus

RANDY TRAVIS DRINKS COLD BEVERAGES (Medial) Roots > Trunks > Divisions > Cords > Branches (lateral)

•Tightest in ulnar deviation with wrist extension (so tension on radial side of joint capsule)

Radial collateral ligament

groove under the deltoid tuberosity, wraps from posterior to lateral side of the humerus. It's honestly very faint...

Radial groove or radial sulcus for radial n. to pass through

(primary posterior arm n.) will move anterior (between brachialis and brachioradialis—a muscle that crosses the elbow and extends down the radial side forearm).

Radial n

Posterior arm Comes anterior as it courses deep to brachioradialis (lateral arm into forearm) and anterior to lateral epicondyle Splits into superficial & deep branches... Deep travels through supinator m. to enter posterior arm as posterior interosseous n.—innervating posterior forearm mm. Superficial continues as cutaneous innervation for dorsal hand & digits (sensory).

Radial n

runs similar course to musculocutaneous n, but larger, posterior, and goes behind humerus)

Radial n

Posterior arm Comes anterior as it courses deep to brachioradialis (lateral arm into forearm) and anterior to lateral epicondyle Splits into superficial & deep branches... Deep travels through supinator m. to enter posterior arm as posterior interosseous n.—innervating posterior forearm mm. Superficial continues as cutaneous innervation for dorsal hand & digits (sensory).

Radial n.

Saturday night palsy results in what and what nerve is compressed?

Radial n. and wrist drop

Underneath the brachioradialis m you will encounter what nerve

Radial nerve

2 rows of carpals (proximal and distal) create

Radiocarpal joint Midcarpal joint

Reinforces glenohumeral joint stability?

Rotator cuff mm.

§Glenoid labrum deepens socket by ~50%--so labral tears can be a big deal § §Superior Labral tear from Anterior to Posterior § §Biceps brachii LH pulls on labrum & can tear

SLAP lesion/tear

§coupled with the radius forms a direct line of force transmission through the wrist §Most frequently fractured carpal (esp. from falls with a radially deviated wrist)

Scaphoid

Not a synovial joint

Scapulothoracic joint

§= Fascial connection between scapula & ribs § §"Floating scapula"

Scapulothoracic joint

§= Fascial connection between scapula & ribs § §"Floating scapula" § __________________________-is the ONLY boney joint connecting the upper extremity to the axial skeleton! § §How does the limb stay on? § §___________________

Scapulothoracic joint Scapular sling mm.

§Sprain to some degree of the acromioclavicular joint

Separated shoulder

Scapular winging is due to injury to what m and nerves

Serratus anterior m with long thoracic n. ALSO spinal accessory nerve, or, less commonly, the dorsal scapular nerve.

PATH of what nerve? §Through suprascapular notch (nerve under ligament; artery above) §Superior transverse scapular ligament §To supraspinatus m. §Around/lateral to spinoglenoid notch §To infraspinatus m.

Suprascapular n. and a.

Intitatiats abduction of the arm

Supraspinatus

Muscle involved most in rotator cuff injuries -Clinical term ?

Supraspinatus m. Subacromial impingement syndrome

truly what creates that upward rotation of the scapula (and thus glenohumeral joint).

Trapezius (descending & ascending) + serratus anterior

Upward rotation--relates to raising arms overhead

Trapezius (descending & ascending) + serratus anterior—truly what creates that upward rotation of the scapula (and thus glenohumeral joint).

Together—they form the coracoclavicular ligament

Trapezoid and conoid ligament

Trapezoid line of clavicle to coracoid (lateral)

Trapezoid ligament of acromioclavicular joint

only posterior m to attach to scapula, so this one can act on both the elbow joint & the glenohumeral joint!

Triceps brachii (long head)

-Similar in appearance to Dupuytren's contracture; however, not a problem of the palmar aponeurosis. Instead, a problem of the fibro-osseous tunnel -May have narrowing of the tunnel or scar tissue that builds up -Can't push through the tunnel with the FDS/FDP tendons and "gets stuck" in flexion

Trigger finger or stenosing tenosynovitis

§Joint displaced medially where distal end of limb is displaced laterally relative to the position of the joint § §Would strain MCL of elbow if too much

Valgus force

§Joint displaced laterally where distal end of limb is displaced medially relative to the position of the joint § §Would strain LCL of elbow if too much

Varus force

Straps tendons down in place

Vinicula

_________covers the ulnar n. and artery--top right picture above, top right side--ulnar n. & a.

Volar ligament

Action of palmar interossei HOW MANy

adductors -PADS 3 PADS pull digits toward 3rd digit plane Digits 2, 4, and 5

Cords are named for their relationship to the ________ artery.

axillary

Deep fascia of the arm

brachial fascia

Movement of digits 2-5 are considered separately from the thumb. Reference digit is digit_____ ONLY does what action?

digit #3 Only Abducts

1.main digit extender for the forearm (with indicis and digiti minimi having minimal effect on overall appearance of our digits at rest). primarily acts at the MCP joint and is ineffective at extending the interphalangeal joints.

extensor digitorum

§Painful inflammation of _____ & ____tendons at thumb side wrist. §Tendinous sheaths surround these tendons as they pass through the fibro-osseous tunnel near styloid process (radius) § §Crossing tendons can lead to irritation. § §Pain gets worse with abduction of thumb, grasping action of hand, and ulnar deviation of the wrist.

intersection syndrome or De Quervain'sTenosynovitis EPB and APL

Nerves you will encounter when dissecting the anterior compartment...

musculocutaneous, median, ulna, cutaneous nn. for arm & forearm

Nerves you will encounter when dissecting the anterior compartment... ___________-

musculocutaneous, median, ulna, cutaneous nn. for arm & forearm

anatomical snuff box contains

radial artery

Nerve in posterior forearm/extensor compartment— (& deep branch which becomes the "_________________." once it passes through supinator & enters a posterior compartment again.

radial n. posterior interosseous n

The rectus abdominis m. lies within the _____________and is divided at the midline by the ______________-.

rectus sheath Linea alba

Arterial supply to upper extremity comes from the ________

subclavian into axillary aa.

Deep radial n. -> goes through __________ (anterior) -> exits posterior as _____________________

supinator posterior interosseous n.

Once the rectus sheath is opened, you can see _____________ that divide the rectus abdominis into segments (creating the "6-pack" appearance). These serve as attachment sites for rectus m. to the overlying sheath.

tendinous intersections

When the latissimus dorsi is reflected, the _____________. can be seen entering the lat., while the _______________. adheres to the rib cage along the serratus anterior m.

thoracodorsal n long thoracic n

Positioning of glenoid fossa

§Angled 5 degrees superior (relative to medial border of scapula)

Borders and contents of the quadrangular space

§Borders: §Superior—teres minor §Medial—long head of triceps §Lateral—shaft of humerus §Contents: §Axillary n. §Posterior circumflex humeral a.

Branches from the lateral cord

§Lateral pectoral n.—pec major (typ. not pec minor) §Musculocutaneous n.—will go through coracobrachialis—anterior arm §Lateral contribution to the median n.

Branches from the roots

§Long thoracic n.—to serratus anterior §Dorsal scapular n. -to levator scapulae & both rhomboids

Branches from medial cord

§Medial pectoral n.—will pierce through pec minor into pec major §Ulnar n.—will wrap around medial epicondyle (humerus) §Cutaneous n. to arm (medial brachial) §Cutaneous n. to forearm (medial antebrachial) §Medial contribution to the median n.

Branches from the trunks

§Nerve to subclavius §Suprascapular n.—to supraspinatus & infraspinatus

Fascia layers of anterolateral abdominal wall

§Superficial fascia (Camper's fascia) §Membranous layer (Scarpa's fascia) §External oblique §Internal oblique §Tranversus abdominis § §(Rectus abdominis is midline)

Path of the supra scapular n and artery

§Through suprascapular notch (nerve under ligament; artery above) §Superior transverse scapular ligament §To supraspinatus m. §Around/lateral to spinoglenoid notch §To infraspinatus m. § § §Will need to reflect supraspinatus & infraspinatus mm. off spine to locate the n.

Branches from posterior cord

§Upper subscapular n.—upper fibers subscapularis §Thoracodorsal n.—latissimus dorsi §Lower subscapular n.—lower fibers subscapularis & teres major §Axillary n.—deltoid & teres minor §Radial n. -posterior arm

Trunks Include

§Upper trunk (C5,6) §Middle trunk (C7) §Lower trunk (C8, T1)

Whats in the carpal tunnel

•FDS and FDP going to digits 2-5; something for pollicis--FPL. •Only other thing going through here--median nerve. •Makes for 9 tendons within the tunnel... (4 FDP, 4 FDS, 1 FPL)