Anatomy EXAM 2 Shoulder

Flexor mechanism components

- flexor tendons ( FDS, FDP) -synovial sheath -annular and cruciform ligaments Phalangoglenoid l.

Mechanisms of clavicle fracture

- happens when force is transmitted from fall on outstretched upper limb and direct fall on shoulder. can cause damage to neurovasculature within cervioaxillary canal

Extensor mechanism components

-extensor digitorum tendon (central slip and lateral bands) -interosseous m. -lumbrical m.

glenoid labrum

-fibrocarilaginous disc surrounding glenoid fossa. -helps stabilize humerus at GH joint because it deepens fossa ( increases contact surface) and prevents excessive movement of head. -poor blood supply and biceps brachii partially attaches here

What bones articulate at the midjoint?

-first row of carpal & distal row (mid carpal articulation)

distribution of median n.

-anterior forearm mm. -intrinsic hand mm. -palmar surface of hand/digits (sensory) C6-C7 (from lateral cord) C8-T1 (medial cord)

Distribution of axillary

-deltoid m. -teres minor m. sensory -GH joint -AC joint skin overlying middle and posterior deltoid m. (sensory) C5-C6

What are the different interphalangeal (IP) ligaments

-volar plates (palmar aspect) -cruciform l. -annular l. -collateral l.

Ranche of motion of the elbow mobility

0 full extension to 140 flexion ~70 pronation to 80 supination

What digit does the thenar muscles act on?

1

Give a general overview of the dorsal tunnel

6 tunnels, each tunnel in the tendon is wrapped in a sheath that gives them the ability to move smoothly. Extensor retinaculum is a band of fiber that holds tendon in place with movemement

What is intersesting about the palmaris longus?

It can be absent

Where does the n. to subclavius m. run after leaving the superior trunk?

It descends down posterior to clavicle and to muscle

what is the first branch of the ulnar artery?

It goes into a common interosseous a. where it then splits at the interosseous membrane into anterior and posterior interosseous a.

How do you know if you fractured the scaphoid bone?

It is difficult to see this on imaging. Pain and bruising but usually no visual deformity. Can be problematic, bone can die if not detected soon enough. Follow up x-rays are usually needed

distribution of medial pectoral n. and spinal cord levels

Pect major and minor C8-T1

What is scapular winging?

Protrusion of the medial border of the scapulae. caused by either muscle weakness of serratus anterior or It could be the the long thoracic n. was affected in some way causing the scapula to wing

AC joint movements

Flexion/extension abduction/adduction internal/external rotation

The innervation pattern of the lumbricals match the innervation of what other muscles?

Flexor digitorum profundas

If a peripheral nerve of the brachial plexus becomes injured, strength would be lost where?

associated muscles

If a root trunk of the brachial plexus becomes injured, strength would be lost where?

associated myotome

Why is there no attachment of a palmar interosseous muscle to the. 3rd digit?

The third digit is the line of axis for these muscles to ADD/ABD. It doesn't move during these actions therefore it doesnt need a muscle

describe the attachments of the levator scapulae m.

attaches to the transverse process of the upper cervical vertebrae and inserts on superior angle of scapula

innervation and primary actions of teres minor m.

axially n. and laterally/externally rotate arm stabilzes GH joint

what runs inside the quadrangular space?

axillary n. and posterior circumflex humeral a.

into which deep vein does the cephalic v. drain into directly?

axillary v.

Course of thoracodorsal n. from posterior cord

branches from posterior cord between upper and lower subscapular nn. and runs infrolaterally along posterior axillary wall to muscle.

Describe how Shania twain likes singing at parties can be used

branches of axillary a. S: superior thoracic a. T: thoracoacromial a. L: Lateral thoracic a. S:subscapular a. A: anterior circumflec humeral a. P: posterior circumflex humeral a.

Why is there no DAB muscle to the 1st and 5th digits?

We do not need the muscle to act on the thumb because we have the APL and APB to do so and pinky has ADM

Boutonniere deformity

Rupture of the ED tendon at the central slip. ( base of middle phalanx) lateral bands pull PIP into flexion and DIP into extension and inability to extend PIP joint or flex DIP joint

What is mallet finger?

Rupture to ED tendon DIP is forces into hyperflexion and inability to extend DIP joint

SC Capsule and Ligaments vs coracoclavicular lig and disc

SC capsule naturally elevates clavicle while the coracoclavicular lig depresses it.

Which nerve roots make up the posterior cord and what makes up the posterior cord?

contains fibers from all spinal nerves. posterior divisions of superior, middle and inferior trunk

What muscles perform elbow flexion/extension? which muscles perform supination and pronation?

flexion: biceps brachii, brachioradialis, brachialis and coracobrachialis extension: triceps supination: supinator pronation: pronator teres and pronator quadratus

What structure pass near the carpal tunnel but ar not considered to be contents

flexor carpi radialis and ulnar n./a

What muscles do radial deviation?

flexor carpi radialis, extensor carpi radialis longus, extensor carpi radialis brevis

what muscles do ulnar deviation?

flexor carpi ulnaris and extensor carpi ulnaris

what is the intermediate flexor group?

flexor digitorum superficial m.

what muscle makes up the intermediate flexor group?

flexor digitorum superficial m.

What ligament of the hand is only seen on the palmar/anterior aspect of the hand?

flexor retinaculum, radial/ ulnar collateral l.

What does the median n. innervate?

flexors of the forearm and hand

What else does the radial a. give off?

gives off princeps pollicis to the thumb and that artery supplies the thumb.

Distribution of n. to subclavius m. and spinal level contributions

goes to subclavius (motor) and SC joint (Sensory) C5-C6

How many muscles of the rotator cuff attach onto the greater tubercle of the humerus vs lesser?

greater: 3/4 lesser; 1/4

label

grey: superior lateral brachial cutaneous pink toward scapula: posterior brachial cutaeous n. pink toward shoulder: inferior lateral brachial cutaneous n. pink last arrow: posterior antebrachial cutaneous n. pink hand: superficial brach of radial n. purple: medial antebrachial cutaneous green: lateral antebrachial cutaneous n. yellow: superficial palmar branch of median n.

What is a dislocation of the Gh joint?

head of humerus is displaced from glenoid fossa and is 90% anterior dislocation.

What is the radio ulnar articulation at the proximal end?

head of radius articulates with radial notch of ulna and helps to pronate and supinate

what is compartment syndrome?

increase in pressure in compartment which is caused by swelling/internal bleeding. Pain, weakness and numbness

Describe each tunnel of the dorsal tunnel

Styloid process of radius tunnel 1: 2 tendons, Abductor pollicis longus and extensor pollicis brevis tunnel 2: 2 tendons, extensor carpi radialis longus and brevis Dorsal tubercle of radius tunnel 3: one tendon, extensor pollicis longus tunnel 4: 5 tendons, tendon sheath of extensor digitorum and extensor indicis tunnel 5: extensor digiti minimi tunnel 6: extensor carpi ulnaris

What are the three different bands of the ulnar collateral ligament?

anterior: primary restraint against extension and resists valgus force through ROM posterior: primary restraint against extension and restrains valgus force from 65-149 degree transverse band: reinforces medial joint and deepens socket

innervation of pectoralis major m. and primary actions

innervation: medial and lateral pectoral nn. primary actions: -adducts humerus -medially/internally rotates humerus -horizontally adducts humerus -clavicular head: flex humerus

innervatios and primary actions of pectoralis minor m.

innervation: medial pectoral & lateral pectoral n. primary actions: -stabilize scapula -pull scapula inferiorly, protract, and anteriorly against thoracic wall. -anterior tils scapula

innervation and actions of coracobrachialis m.

innervation: musculocutaneous n. actions: flex, adduct and internally rotate the humerus

innervation and primary actions of the biceps brachii

innervation: musculocutaneous n. primary actions: elbow: flexion; when flexed supination is very powerful. shoulder: stabilize GH joint, abduct and internally/medially rotate the humerus (weak)

innervation and primary actions of the subclavius m.

innervation: n. to subclavius primary actions: anchor and depress clavicle, assists in stabilizing AC and SC joint

innervation and primary actions of the triceps brachii m.

innervation: radial n. primary actions: elbow extension and shoulder (long head): extension, adduction

innervation and primary actions of the infraspinatus m.

innervation: suprascapular n. actions: laterally/externally rotate arm stabilize GH joint

innervation and primary actions of the supraspinatous m.

innervation: suprascapular n. primary actions: abducts humuers for 15 degrees and middle delt does the rest stabilize GH joint

innervation and actions of latissimus dorsi m.

innervation: thoracodorsal n. actions: extend and adduct humerus and rotate humerus medially

innervation and primary actions of the subscapular m.

innervation: upper and lower subscapular nn. actions: medially/internally rotate arm and stabilize GH joint

insertion, innervation and actions of deltoid muscle

insertion: deltoid tuberosity of humerus innervation:axillary n. actions: anterior: flex, adduct and medially/internally rotate arm middle: abducts arm posterior:extends, abducts and laterally rotates arm

insertion, innervation and actions of rhomboids

insertion: medial border of scap.minor(abovespine)major(belowspine) innervation: dorsal scap actions: retract scapula and rotate scapula inferiorly

what is unique about the palmaris longus muscle?

it does not insert on a bone, it inserts on palmar aponeurosis and not everyone has one

what is the function of the anular ligament? which movements does it involve

it forms CT around radial head so when it supinates or pronates the radial head stayed in tact.

what is unique about the brachioradialis

it is considered a forearm extensor but it flexes elbow

What happens if the subscapular trunk is closed off?

it is much harder to reroute blood

What is the scapulothoracic joint?

it is not a true joint, it is the contact between scapula and thorax. allows for full elevation of upper limb @ GH joint and maintains GH articulation

What is the Anular ligament?

it is on the coronoid process to olecranon that holds radial head in place

Course of dorsal scapular n. once it leaves the spinal level

it pierces middle scalene m. posteriorly and descends to mm.

why is it important for the supraspinatous m. to perform only the initial 15 degrees of abduction?

it pushes the humeral head down so the deltoid can come up and over in abduction

What shape is the clavicle?

its flat, S-shaped and a superficial bone ( only link between thorax and upper limb) Superior surface of clavicle is smooth and inferior surface is roughened

Lateral ulnar collateral ligament

its on the lateral epicondyle to olecranon. It resists varus forces and supports radial head

describe the course of the lateral slips

join togethers over the middle phalanx and inserts at base distal phalanx (

the periosteum covering the humerus reaches the elbow/cubital fossa region and turns into the ______

joint capsule of the elbow joint and continues distally as periosteum one again

Describe the course of the median n.

leaves brachial plexus and does not give off any innervations until it passes the elbow. It crosses the supracondylar ridge of the humerus and gives off motor branches to forearm flexors and anterior interoeous membrane between radius and ulna. The gives rise to palmar cutaneous branch that innervates palm/thumb then goes through carpal tunnel to give off recurrent median n. that innervates thenar and lumbrical muscles and lastly it gives off cutanoues n. to supply the rest of the hand

most medial to lateral TFCC

meniscus homologue, ulnotriquetral & ulnounate l., dorsal/palmar radio-ulnar l, Triangular fibrocartilage

What is the radio ulnar articulation at the middle?

mid-shaft via interosseous membrane and that keeps bones stuck together

origin and inertion of the biceps brachii m. long and short head

long head: supraglenoid tubercle short head:coracoid process of scapula insertion: radial tuberosity, bicipital aponeurosis

what muscles help to stabilize and control during superior and upward rotation

middle traps and rhomboid mm.

origin of rhomboid major and minor

minor: spinous process C7-T1 & nuchal l. major: T2-T5

Surgical neck of humerus fracture

most common and usually from a fall on outstretched arm. damage to quadrangular space structures

Deep branch of radial n.

motor. pierces through supinator m. and as it leaves it changes names into posterior interosseous nerve.

What bones and bony landmarks articulate to make up the hinge joint of the elbow?

movement flexion and extension. trochlear articulates with the trochlear notch of ulna capitulum articulates with the radial head.

what specific peripheral nerve is involved with elbow flexion?

musculocutaneous n.

What 5 components of the brachial plexus form the M shaped structure?

musculocutaneous n., lateral cord, median n., medial cord and ulnar n.

compare and contract the origin and insertion of the trapezius muscle

origin: external occipital tuberence and attaches laterally along the scapula to tip of acromion

Describe the attachments of the lumbrical muscles

origin: flexor digitorum profundas tendons ( palmar surface) insertion: back of digits. ( posterior surface )

Origin and insertion of the Flexor pollicis brevis m.

origin: flexor retinaculum, capitate, trapezium insertion: base of thumb innervation: superficial head-median n deep head- ulnar n.

Origin and insertion of the abductor pollicis brevis

origin: flexor retinaculum, scaphoid and trapezium bone. insertion: base of proximal thumb phalange median n. (c8-t1)

Origin and insertion of the opponens pollicis m.

origin: flexor retinaculum, trapezium insertion: lateral side of 1st metacarpal median n.

Origin and insertion of the flexor digiti minimi m.

origin: hook of hamate, flexor retinaculum insertion: base of 5th phalange action: MCP flexion ulnar n.

Origin and insertion of the opponens digiti minimi m.

origin: hook of hamate, flexor retinaculum insertion: medial 5th metacarpal

origin and insertion of teres major m.

origin: inferior angle and lateral border of scapula (posterior surface) insertion: medial lip of bicipital groove of humerus

origin and insertion of the infraspinatus m.

origin: infraspinous fossa insertion: greater tubercle of humerus

origin and insertion of teres minor m.

origin: lateral border of infraspinous fossa insertion: greater tubercle of humerus

Origin and insertion of extensor carpi radialis longus m.

origin: lateral epicondyle insertion: 2nd meta carpal wrist extension

Origin and insertion of extensor carpi radialis brevis m.

origin: lateral epicondyle insertion: base of 3rd carpal wrist extension

Origin and insertion of anconeus

origin: lateral epicondyle insertion: olecranon extends forearm at elbow

Origin and insertion of extensor digiti minimi m.

origin: lateral epicondyle insertion: pinky extends pinky

Origin and insertion of supinator

origin: lateral epicondyle of humerus insertion: radius supinates

Origin, insertion, innervation and actions of flexor carpi ulnaris m.

origin: medial epicondyle insertion: carpus innervation: ulnar n. actions: flex wrist

Origin, insertion, innervation and actions of flexor carpi radialis m.

origin: medial epicondyle insertion: carpus 2nd-3rd carpal innervation: median n. actions: flex wrist

origin and insertion of pronator teres m.

origin: medial epicondyle insertion: lateral radius

Origin, insertion, innervation and actions of palmar longus m.

origin: medial epicondyle insertion: palmar aponeurosis innervation: median n. actions: flex wrist

Origin, insertion, innervation and actions of flexor digitorum superficial m.

origin: medial epicondyle and radius insertion: distal fingers (2-5) innervation: median n. actions:flexes wrist, flex index middle and ring fingers acts on pip because it does not cross the dip

Origin and insertion of the palmaris brevis

origin: medial palmar aponeurosis insertion: skin of hypothenar eminence action: tightens the palmar aponeurosis ulnar n.

Origin and insertion of the abductor digiti minimi m.

origin: pisiform insertion: base of 5th proximal phalange action: abduction & flexion of MCP PIP & DIP = extension ulnar n.

Origin and insertion of abductor pollicis longus m.

origin: radius insertion: base of 1st metacarpal abducts thumb

Origin, insertion, innervation and actions of flexor pollicis longus m.

origin: radius insertion: distal phalanx of thumb innervation: median n. actions: flex thumb

Origin and insertion of extensor pollicis brevis m.

origin: raidus/interosseous membrane insertion: proximal phalanx extend thumb

origin and insertion of subclavius m.

origin: rib 1 insertion: inferior surface of clavicle

Pectoralis minor m. origin and insertion

origin: ribs 3-5 insertion: coracoid process of scapula

origin and insertion of middle transverse trapezius

origin: spinous process C7-T3 insertion: acromion and spine of scapula primary actions: retract scap

origin and insertion of lower ascending trapezius

origin: spinous process T3-T12 insertion: spine of scapula actions: depress scap and rotate scap superiorly

origin and insertion of Latissimus dorsi m.

origin: spinous processes T6- 12, iliac crest, thoracolumbar fascia and ribs 8-12 insertion: floor of bicipital groove

origin and insertion of subscapularis m.

origin: subscapular fossa insertion: lesser tubercle of humerus

Origin and insertion of Brachioradialis

origin: superior lateral supracondylar ridge insertion: lasteral aspect of distal radius flexes elbow

origin and insertion of upper descending trapezius

origin: superior nuchal line, external occipital protuberance insertion: lateral 1/3 of clavicle actions: elevate scapula and superior rotate scap.

Insertion and origin of the supraspinatous m.

origin: supraspinous fossa of scapula insertion: superior facet of greater tubercle of humerus

Origin and insertion of levator scapulae m.

origin: transverse process C1-C4 insertion: superior angle and medial border of scapula

Origin, insertion, innervation and actions of flexor digitorum profundus m.

origin: ulna insertion: base os distal phalnges 5,4,3,2 innervation: median n. (index/middle) /ulnar n. (pinky and ring) actions: flex hand except thumb

Origin and insertion of extensor pollicis longus m.

origin: ulna insertion: distal phalanx extend thumb

Origin and insertion of extensor indices m.

origin: ulna insertion: distal phalanx of index extends index finger

Origin, insertion, innervation and actions of pronator quadratus m.

origin: ulna insertion: radius innervation: median n. actions: pronates forearm

triceps brachii m. origin and insertion of long, lateral and medial head.

origins: long head: infraglenoid tubercle of scapula lateral head: proximal posterior humerus medial head: mid-shaft posterior humerus insertion: olecranon of ulna

Describe the scapula

overlies ribs 2-7 glides over rib cage during movement of upper limb (ST movment) muscle attachments 20

lines of defense

skin is a physical barrier, mucosa and secretions and immune cells and nodes

Distribution of medial antebrachial cutaneous n.

skin of medial antebrachium to wrist (sensory)

what nerve innervates the trapezius muscle?

spinal accessory nerve

From Proximal to Distal, what are the five major organizational components of the brachial plexus?

spinal nerve - trunks - divisions- cords- nerves

where do both the suprascapular a. and n. pass through?

spinoglenoid foramen under inferior tansverse I. of scapula which is another risk for entrapment

What bones and bony landmarks articulate to make up the pivot joint of the elbow?

supination and pronation radial head articulates with radial notch on ulna ulna head articulates with ulnar notch on radius

what forearm muscle is pierced by the radial nerve

supinator

What does the suprascapular a. supply?

supra and infra muscles

what structures pass through the spinoglenoid notch?

suprascapular a. and n.

what nerve innervates the muscles that occupy the supraspinatus and infraspinatus fossa?

suprascapular n.

Distribution of suprascapular n. and spinal level contributions

supraspinatous m. infraspinatus m. GH joint (sensory) C5-C6

what is the most common tendon affected in a rotator cuff impingments

supraspinatous m. and can lead to a tear of this tendon

what does the middle deltoid work with to produce abduction of the humerus?

supraspinatus m.

which muscle travels inerior to the acromion process and coracoarcromial arch?

supraspinatus m.

At what anatomical landmarks are fractures most common in the humerus?

surgical neck

What is the function of the synovial tendon sheath?

surrounds tendons and allows for smooth movement

where is the synovial sheath located with respect to the flexor digitorum superficialis tendon, flexor digitorum tendons, anular l., and cruciform l.?

surrounds these structures and tendons travel together

describe the typical causes of Guyon canal syndrome?

synovial cysts, hook of hamate fracture, repetitive trauma This can causes purely motor or purely sensory or both

What is the radio-carpal joint?

synovial joint (condyloid), proper wrist joint distal end of radius articulates with the first row of carpals expect the pisiform.

AC joint

synovial joint (plane) relatively weak joint and AC l. is reinforced by coracoclavicular l. but strengthen by descending superior part of trapezius m.

Describe the structure of a synovial joint

synovial joint is covered by joint capsule. this capsule is surrounded by fibrous tissue, a synovial membrane, hyaline cartilage and synovial fluid.

What type of joint is the sternoclavicular joint

synovial joint, acts as ball and socket joint. only connection between axial skeleton and upper limb. very strong and mobile joint

Characteristics of the GH joint

synovial joint, ball and socket and most mobile joint in the body.

what type of joint is most mobile, least stable and united by a joint capsule?

synovial joints

Describe the location and function of the palmar/volar plates

palmar aspect that blend with fibrous sheath so flexor tendons can move smoothly.

differences between palmar branch and recurrent branch

palmar branch is superficial and cutanoues. Comes off before carpal tunnel. The recurrent branch is motor and go to thenar mm.

What are the two branches of the median n.

palmar branch: sensory recurrent branch: motor

Where is the cervicoaxillary canal located?

passageway that extends between the neck and the upper extremities through which the long thoracic nerve and other structures pass. the clavicle acts as its border.

where does the suprascapular A. pass?

passes over superior transverse l. of scapula (less risk of entrapment)

mechanisms of rotator cuff impingement

tendinopathy/tendonitis excessive fluid within subacromial bursae and subacromial bone spurs

What kind of joint is the distal radio-unlar joint?

pivot, radius moves around ulna.

force coupling for downward rotation

rhomboid mm. and levator scapulae m. doesn't need as many muscles because of gravity does most of the work.

What does the arch of the aorta give off?

right side: Brachiocephalic trunk left middle: common carotid A. left: subclavian A.

clinical implications

risk of injury to axillary n./radial n., fibrous joint capsule, glenoid labrum and SITS more prone to instability and recurrent dislocations.

what structures form the roof and floor of the carpal tunnel?

roof: flexor retinaculum floor: carpal bones

What are the borders of the tunnel of guyon?

roof: volar carpal l. floor: transverse carpal l. flexor reticulum ulnar border: pisiform and abductor digiti minimi m. radial border: hook of hamate

which two muscles are found deep to the posterior deltoid m.?

infraspinatous and teres minor m.

innervation and primary actions of teres major m.

inneravtion: lower subscapular n. action:adduct arm, medially internally rotate arm. and extend arm

How would an infection in one digit spread to the carpal tunnel or other digits? what structures provide the connection for infection to spread?

tendon sheaths are continous with carpal tendon sheath. If there is an infection the tendon sheath in thumb it can spread to carpal tunnel

Where does the radial collateral a./ middle collateral a./ radial reccurent a. / interosseous a branch from?

the radial collateral a. and middle branches directly from profunda brachii. radial recurrent a. branches directly from radial a. and the interosseous branches from posterior interosseous a.

Where are fractures on the clavicle most likely to occur?

the s shape on the shaft and where the S curves

How are the 3 sections divided?

the second section is from the start of the pectoralis minor and the third section starts at the end of it.

describe the middle deltoid and supraspinatous mm. producing abduction of the humerus

the supraspinatous does the first 15 degrees of abduction and the deltoid m. does the rest

describe the function of the rotator cuff as a whole

to keep the humeral head in the glenoid fossa during movement. stabilizes the GH joint

Adductor pollicis muscles

transverse head oblique head both come from 3rd metacarpal and carpal bones and go to the proximal phalanx of the thumb. adducts thumb

Where does the long thoracic n. travel after leaving spinal root level?

travels posterior to other BP roots and descends through cervico-axillary canal into acilla

What is the anatomical snuff box?

triangular depression on lateral side of wrist, the boundaries are the EPL and EPB and APL

what is the muscle of the posterior arm (brachium)? what is its function and what is it innervated by?

triceps brachii and extends muscle innervated by radial n.

Describe the difference between all types of the AC joint injury?

type 1: AC ligaments disrupted but intact and CC ligs is in tact Type 2: AC ligaments completely torn; CC ligs in tact Type 3: AC and CC ligs are completely torn

If you were to radial deviate your wrist, what muscles would be stretched?

ulanr deviation muscles ( flexor carpi ulanris and extensor carpi ulnaris)

Klumpkes palsy: cause, mechanism and presentation

* lower brachial plexus cause: rupture at C8-T1 mechanism: sudden, forceful pull on arm presentation: paralysis of intrinsic hand mm. supplied by C8-T1 loss of sensation along medial aspect of arm, forearm and hand -claw hand deformity ( difficult to make a vist)

What is the function of the clavicle?

-allows for increases range of motion of upper limb -shock absorption -muscle attachments

describe what a anatomoses is?

*communications arteries talk to each other to enable distributions of blood. If there is a blockage, they will detour blood so the muscles still get blood.

What do the teres major and latissimus dorsi have in common?

*frenemies* they have the same actions, have similar origin/insertion and have same blood supply

What bones articulate at the carpometacarpal joint

- articulations of distal carpal bones with 5 metacarpals

What bones articulate at the wrist joint?

- distal end of radius and first row carpal bones (not pisiform)

Radial pulse

- lies on the anterior surface of the distal end of the radius and is lateral to the FCR tendon but medial to the APL

Label on other side

- top arrow palmar l. (volar plate) - deep transverse metacarpal l.

Course of suprascapular n. once it leaves the superior trunk

- travels laterally/posteriorly in neck -descends and travels through suprascapular foramen and goes through spinoglenoid notch

what arteries do these two trunks give off and where?

-Thyrocervical gives off 1. dorsal scapular a.( medial side) and 2. suprascapular a. ( spine of scapula) -subscapular trunk gives off 1. thoracodorsal a. ( inferior angle and lateral side) and 2. circumflex scapular a. ( goes in the middle of the scapula)

if the ventral ramus of c6 was injured, what would most likely happen?

-abolition of the c6 neurological level -loss of sensation in the c6 dermatome -reduction in elbow flexion -loss of brachioradilias reflex

Distributions of musculocutaneous n. and spinal level distributions

-biceps brachii m. -coracobrachialis m. -brachialis m. -skin of lateral forearm (sensory) C5-C7

What type of joint are the metacarpophalangeal joints joints? (MCP)

-condyloid type synovial joints -movements occurs in 2 planes (flexion/extension) (abduction/adduction)

Label the red box

-flexor retinaculum (red box) ulnar collateral l on ulna side and radial collateral l. on thumb side

what motions does the GH joint do?

-glides and translates -flexion and extension -abductions and adduction -internal/external rotation

what are the three joints in the elbow and what are their actions?

-humeroulnar joint ( flexion/extension) -humeroradial joint ( flexion/extension) -proxmial radioulnar joint (supination/pronation)

What branches off the thyrocervical trunk?

-inferior thyroid artery -ascending cervical a. -transverse cervical a., superficial branch -dorsal scapular a. ( transverse cervical a.) -suprascapular a.

Distribution of dorsal scapular n. and spinal level contributions

-levator scapulae m. -rhomboid minor and major m. c5

distribution of upper and lower subscapular nn. and spinal cord levels

-subscapularis m. (both) and teres major m ( just lower) C5-C6

Distribution of ulnar n.

-most intrinsic hand mm. -1 1/2 anterior forearm mm. (flexor) -medial hand ( sensory) C8-T1

Course of the medial pectoral n. after it leaves the medial cord

-passes between axillary a./v. and pierces pectoralis minor m. and continues down deep to pect major

what are the distributions and spinal level contributions of the lateral pectoral n.

-pectoralis major and minor m. -AC joint (sensory) GH joint (sensory) C5,C6,C7

distribution of radial n.

-posterior arm and forearm mm. -posterior and inferolateral arm (sensory) -posterior forearm (sensory) -dorsum of hand (sensory)

Metacarpophalangeal (MCP) ligaments

-radial collateral l. and ulnar collateral l. of finger -palmar l. ( volar plate) - deep transverse metacarpal l.

mid-shaft of humerus fracture

-results from direct trauma to arm and damage to triceps hiatus structures.

Distribution of medial brachial cutaneous n. and spinal level contributions

-skin of medial brachium ( sensory) -can extend to medial epicondyle of humerus and olecranon process of ulna ( sensory) C8-T1

Function of ST joint

-stable base of support and surface area for muscle attachment GH joint - transfer forces along kinetic chain from proximal to distal -maintain glenoid contact with humeral head = mobility

List the three hypothenar muscles superior to deep

1. abductor digit mini m. 2. flexor digiti mini m. 3. opponens digiti minimi m.

List the three instrinic thenar muscles superior to deep

1. abductor pollicis brevis 2. flexor pollicis brevis 3. opponens pollicis m.

What is included in the apex of the axilla?

1. cervicoaxillary canal 2. 1st rib 3. clavicle 4. superior scapula

What other nerves branch off the root level of the bracia lplexus?

1. dorsal scapular n. (lateral) 2. long thoracic n. ( goes down to medial)

SC joint movements and how

1. extension= rotated clavicle/retracted shoulder complex 2. flexion of upper limb= rotated clavicle/protracted shoulder complex 3. elevation of upper limb and shoulder girdle= elevated clavicle/shoulder complex 4. abduction/adduction of upper limb= clavicle pivots anteriorly/posteriorly elevation/depression protraction/retraction axial rotation

what muscles make up the deep flexor group ?

1. flexor pollicis longus 2. flexor digitorum profundas m. 3. pronator quadratus m

What other nerves branch off the medial cord of the brachial plexus?

1. medial pectoral n. 2. medial cutaneous brachial n. 3. medial cutaneous ante-brachial n.

What is included in the base of the axilla?

1. skin 2. subcutaneous tissue 3. axillary fascia

From proximal to distal, generally list the bones of the hand

1. styloid process of radius and ulna 2. 8 carpals 3. 5 metacarpals 4. 14 phalanges

What two structures can be found on the superior and inferior aspects of the glenoid cavity/fossa?

1. supragleniod tubercle 2.infraglendoid tubercle

What other nerves branch off the superior trunk of the brachial plexus?

1. suprascapular n. 2.subclavian n.

What two trunks give off arteries for the anastomosis of the scapula?

1. thyrocervical trunk 2. subscapular trunk.

What other nerves branch off the posterior cord of the brachial plexus?

1. upper subscapular n. 2.thoracodorsal n. 3. lower subscapular n.

If the axillary a. is occluded, in his second part, how are we still getting blood to the brachial artery?

1. you could take the subclavian a. to dorsal scapular a. down and around inferior angle to meet up with thoracodorsal a. which wil take us back to subscapular trunk and resume blood flow to brachial a. 2. Suprascapular a. wind its way down supraspinous fossa and it meets up with circumflex artery.

how many muscles are in the posterior compartment of the arm, what kind of muscles are they? innervation?

12 muscles 3 radialis, 3 superficial and 5 deep *wrist extension/supinators of the forearm radial n.

Describe how PAC-D can be used?

4. branches of the thoracoacrominal a. P: pectoral A: acrominal C: Clavicular D: deltoid

describe the VIT C acronym and how its used

4 branches of subclavian a. V: vertebral a. I: inter-thoracic a. T: Thyrocervical a. C: costocervical trunk.

Dorsal interossei m.

4 muscles that work to abduct 2-5 digits.

what are the contents of the carpal tunnel?

4 tendons FDS 2-5 digits, 4 tendons of FDP and FPL to thumb. synovial sheath and median n.

Describe types 1 2 and 3 AC joint seperations

1; acromioclavicular l. superior or inferior are stretched. This can heal and not that severe 2: AC joint tears and separates. mobility issues and forces will go to the coraclavicular l. 3: all three are injured and most severe

At what point does the subclavian a. become the axillary a.?

1st rib

what percent of body fluids is in extracellular compartments?

20%

How can you organize the forearm extensor muscles?

3 carpi muscles act on carpi bones 3 pollicis that act on the thumb 3 digit act on the fingers 3 other

Palmar interossei m.

3 muscles that work to adduct digits 5, 4 and 2. Does not need to adduct middle finger because it is the midline and the thumb has its own adductors.

How many sections of the axillary have? and how many arteries are in each section?

3 sections 1 section: 1 a. 2 section: 2 aa. 3 section: 3 aa.

hypothenar muscles act on which digit?

5

how many muscles are in the anterior compartment of the arm, what kind of muscles are they? innervation?

8 total. 4 superficial, 1 intermediate and 3 deep. *flexors/pronators of the arm and median n. mostly for innervation ( little bit of ulnar n.)

where does fluid go after central nodes?

Apical nodes then out to supraclavicular nodes

what superficial vein runs along the entire medial aspect of the upper extremity?

Basilic v.

into which deep vein does the Basilic v. drain into directly?

Brachial v. then to axillary v.

What spinal cord levels supply the dorsal scapular n. ?

C5

What spinal cord levels supply the long thoracic n. ?

C5, C6, C7

Which nerve roots make up the lateral cord and what makes up the lateral cord?

C5, C6, C7 anterior divisions of both superior and middle trunk

Which spinal cord segments contribute to the brachial plexus?

C5, C6, C7, C8 & T1 (anterior rami connect to trunks)

Which nerve roots make up the superior trunk?

C5,C6

What spinal cord level is associated with elbow flexion, sensation of the thumb and the brachioradialis reflex?

C6

What spinal cord levels supply the thoracodorsal n. ?

C6,C7,C8

Which nerve roots make up the Middle trunk?

C7

Which nerve roots make up the inferior trunk?

C8, T1

Which nerve roots make up the medial cord and what parts makes up the medial cord?

C8,T1 extension of anterior division of inferior trunk

What spinal cord levels supply the medial brachial and antebrachial cutaneous n. ?

C8-T1

Why is the ulnocarpal joint not considered a true joint

Carpals are not in direct contact with ulna so there is a space between.

what superficial vein runs along the entire lateral aspect of the upper extremity?

Cephalic v.

How does a type 3 affect the structures around it?

Clavicle will elevate and acomion will drop due to the weight of the arm. This will create a bump called piano key signs. Sometimes you can immoblize it for healing, but other times you need surgery and they will put a pin in the joint and have scar tissue form

Radial n. injury

Commonly caused by fracture of humerus and often results in paralysis. Loss of sensation to areas of skin and wrist will drop.

Which digits both have proximal and distal interphalangeal joints (DIPS)

Digits 2-5

Course of the musculocutaneous nerve

Exits axilla by piercing coracobrachialis; descends between biceps brachii and brachialis, supplying both; continues as lateral cutaneous nerve of forearm

Which muscles of the posterior forearm compartment are superficial?

Extensor digitorum m., Extensor digiti minimi m., Extensor carpi ulnaris m

Clinical correlation of the nursemaids elbow

Extreme forces can tear anular l. and when this happens the radial head can slip out and can cause subluxation and dislocation. An example of an extreme force is when parents raise a childs arms above head and lift them up.

What does the musculocutaneous n. innervate?

Flexor of the arm

Swan Neck deformity

Hyperextension injury which ruptures the volar plate of PIP joint -Lateral bands loosen=flexion of DIP PIP id hyperextended and DIP is flexed

What is the correlation between all of these articulations?

If one moves, they all move. They move together

What structure runs directly between the length of the radius and the ulna? What is the purpose of this structure?

Interosseous Membrane -It increases surface area for muscle attachments -thick fibrous tissue -helps with movement -helps transmit forces from distal to proximal. -Strong

What is the function of the articular disc/triangular ligament

Keeps the ulna and radius together. -It assists with keeping joint together during motion. -It also separates cavity of the radio-ulnar joint from wrist joint

1. acromion process 2. coracoid process 3. scapular/ subscapular notch 4. superior angle 5. inferior angle 6. glenoid fossa 7. supraglenoid tubercle 8. infraglenoid tubercle 9. lateral/ axillary border 10. medial border 11. subscapular fossa

Label 1-11 structures 1. acromion process 2. coracoid process 3. scapular/ subscapular notch 4. superior angle 5. inferior angle 6. glenoid fossa 7. supraglenoid tubercle 8. infraglenoid tubercle 9. lateral/ axillary border 10. medial border 11. subscapular fossa

1. coracoacromial l. 2. coracohumeral l. 3. glenohumeral II. * axillary recess

Label GH joint ligaments 1. coracoacromial l. 2. coracohumeral l. 3. glenohumeral II. * axillary recess

1. coracoacromial arch-prevents superior displacement of humerus 2. bursae- subacromial/subdeltoid and subscapular 3. transverse humeral l.- hold long head of bicep in groove

Label and determine function

1. head 2. anatomical neck 3. greater tubercle 4. surgical neck 5. radial/ spiral groove

Label posterior humerus

1. acromion process 2. coracoid process 3.scapular notch 4. superior angle 5. inferior angle 6. glenoid fossa 7. infraglenoid tubercle 8. spinoglenoid notch 9. lateral border 10. spine 11. supraspinatus fossa 12. infraspinatous fossa

Label posterior view of scapula 1. acromion process 2. coracoid process 3.scapular notch 4. superior angle 5. inferior angle 6. glenoid fossa 7. infraglenoid tubercle 8. spinoglenoid notch 9. lateral border 10. spine 11. supraspinatus fossa 12. infraspinatous fossa

label

Label the SC joint ligaments 1. costoclavicular l. 2. anterior sternoclavicular l. 3. interclavicular l.

1. head 2. anatomical neck 3. surgical 4. deltoid tuberosity 5. intertubercular sulcus/ bicipital groove 6. greater tubercle 7. lesser tubercle

Label the anterior side of the humerus

Label these structures

Label these structures 1. Acromioclavicular ligament 2. trapezoid l. 3. conoid l. * superior transverse l. of scapula 2+3= coracoclavicular l.

what happens when the SC capsule and ligaments are cut

Lateral end of clavicle will drop without any loading

Correlation between lateral and medial pectoral n.

Lateral pectoral n. sends fibers directly to pectoralis major m. and sends a communicating branch to medial pectoral n. which is why it also can supply pectoralis minor

What are the contents of the cubital fossa lateral to medial?

Lateral: radial n., biceps tendon, brachial a., median n.

What ligaments support the ulnocarpal joint?

Made up of the triangular fibrocartilage complex ( TFCC) -Triangular fibrocartilage -dorsal/palmar radio-ulnar l - ulnotriquetral & ulnounate l. -meniscus homologue

Describe the relationship between the pronator teres muscle and the median n.?

Median n. travels through pronator teres m. and repetitive pronation can compress n. which causes inflammation. Patients may complain about pain/tenderness and may have decreased sensation

What is the N. and A. supply for the AC joint

N. - lateral pectoral and axillary A. - suprascapular and thoracoacromial aa.

Nerve and artery supply to the SC joint

N. - supraclavicular n., subclavius n. A- internal thoracic, suprascapular aa.

N. and A. supply to GH joint

N.- suprascapular, axillary and lateral pectoral nn. A.- anterior and posterior circumflex humeral aa.

How would you test the function of palmar vs. dorsal interosseous mm.

PAD: piece of paper in between fingers and adduct them. Try to pull the piece of paper away DAB: abduct fingers and try to push them in

superficial flexor muscles medial to lateral

Pass Fail Pass Fail pronator teres- flexor carpi radialis- palmar longus-flexor carpi ulnaris

What carpal bone sits on the bottom of the triquetrum bone?

Pisiform

From which portion of the brachial plexus does axillary n. arise directly and what nerve fibers contribute to it?

Posterior cord. C5, C6

What is the anastomese pattern of the wrist?

Radial n. gives off superficial branch and deep arch. Ulnar n. also gives off superficial arch and deep branch. The radial and ulnar anastamose superficialto superficial and deep to deep

Tommy john surgery

Reconstruction to of the ulnar collateral ligament which is causes by repetitive trauma ( extreme valgus stress). It is commonly replaced with palmaris longus tendon

Describe the innervation of the lumbrical muscles

Recurrent median n. will innervate first two lumbricals (index and middle) and the ulnar n. goes through gyrons canal and innervates 3,4 lumbrical

where do the superior/ inferior collateral aa. branch from? verses the anterior and posterior ulnar recurrent aa.?

Superior/inferior branch directly off brachial artery and the ulnar recurrent aa. branch off the ulnar a.

Which muscles of the posterior forearm compartment are deep?

Supinator m., Abductor pollicis longus m., Extensor pollicis brevis m., Extensor pollicis longus m., Extensor indicis m.

On the lateral side of the brachium, what aa. anastomose

The radial collateral a. will anastomose with the radial recurrent a. The middle collateral a. will anastamose with the interosseous a.

Course of medial brachial cutaneous n. from medial cord

branches from medial cord and travels along medial aspect of brachium, medial to axillary a./v.

Piano key sign

The step off between lateral clavicle and acromion process will create a bump

Which digit only has a proximal interphalangeal joint?

Thumb 1st

Where does the radial n. travel? what does it branch into?

Travels posterior arm, laterally to brachialis and as it passes the elbow joint it splits into superior and deep radial n.

posterior interosseous nerve.

Travels with posterior interosseous A. between the superficial and deep extensor of the posterior forearm.

Describe how the midshaft clavicular fracture can affect the SC joint and AC joints including the muscles

When there is a mid-shaft fracture, the medial half of the clavicle will be pulled up by the sternocleidmastoid which in turn makes the trapezius muscle elevate the scapula on the lateral side. Where the trap is pulling up, the deltoid and pectoralis major are pulling down. The trap and deltoid usually work together for the AC joint but in this case they act against eachother

Course of upper and lower subscapular nn. from posterior cord

branches from posterior cord and passes inferolateral to muscles

where is the cubital fossa located?

anterior side of junction between arm and forearm

What movements does the radio carpal joint provide

flexion/extension and radial/ulnar deviation

What is the anterior, middle and posterior origin of the deltoid muscle

anterior/clavicular part: clavicle middle: acromion process of scapula posterior: spine of scapula

actions of serratus anterior and what innervates it

abduction(protracts), upward rotation long thoracic n.

Which bone does the acromion process articulate?

acromion end of clavicle

the spine of the scapula is continuous laterally with the

acromion process

Between which two muscles can you find the subclavian a. running?

anterior and middle scalene muscles

what are the functions of rhomboid muscles

adduct and retract

What does the radial n. innervate?

all extensors of the upper extremities

What is the articular disc in the Sc joint?

all four ligaments and part of joint capsule attach here and it acts as shock absorber

what is common in overhead throwers?

aneurysm of axillary a. part 1 can compress brachial plexus trunks which causes pain and anesthesia to the areas of the affected nerves

Where does the ulnar nerve run?

behind the medial epicondyle

What bones articulate at the metacarpophalangeal joint

between metacarpals and phalangeals

What bones articulate at the interphalangeal joints?

between phalanges, distal and proximal (DIP, PIP) except thumb only has an IP not proximal and distal

what 3 structures run immediately superficial to the brachialis muscle?

biceps brachii, brachial a. and median n.

what are the muscles of the anterior arm (brachium)?

biceps brachii, coracobrachialis and brachialis

Best way to test biceps brachii, brachialis and brachioradialis

biceps: hands supinated brachialis: hands pronated brachioradialis: hands in nuetral ( drinking hand)

Which muscles of the posterior forearm compartment are part of the radialis m.?

brachioradialis, extensor carpi radialis longus and brevis

how many muscles are in the radialis muscle group of the arm? innervation?

brachioradialis, extensor carpi radialis longus and extensor carpi radialis brevis. radial n.

Glenohumeral joint structure and stabilizers

bony: poor congruencey, ball and socket joint static: glenoid labrum, GH capsule and lig dynamic: SITS

what is the sternoclavicular joint like?

bony: poor congruency, saddle joint

What is the structure like of the acromioclavicular joint?

bony: very poor congruency, plane/gliding joint, high variability in bones

Describe the location and function of the deep transverse metacarpal ligament

both sides of the digit and it attaches metacarpal to metacarpal to hold heads together.

Course of medial antebrachial cutaneous n. from medial cord

branches distally from medial brachial n. and runs with ulnar n. it enters subcutaneous tissue and divides into anterior and posterior branches

What type of joint is the moderately mobile/stable and united by cartilage?

cartilaginous joints

What do specific bones does the radial and collateral ligaments attach?

carpal to phalanges

What is the origin of most superficial extensor muscles?

lateralepicondyle.

Erb-Duchenne palsy: cause, mechanism and presentation

cause: rupture (torn nerve) or avulsion ( nerve detachment) at c5-c6 Mechanisms: -excessive increase in angle between neck and shoulder -landing on shoulder/neck after fall -improper childbirth techniques -carrying heavy loads with shoulder straps presentation: -waiters tip position (arm hangs in medial rotation -weakness or total paralysis of deltoid, biceps brachii, brachialis mm. -loss of sensation along lateral forearm * upper brachial plexus

where do these three nodes always drain into?

central nodes

what is inside the triangular space?

circumflex scapular artery

What bone provides the only connection between the thorax and upper limb?

clavicle

what is the most frequently fractured bone?

clavicle

Pectoralis major m. origin and insertion

clavicular head: anterior surface of medial 1/2 of clavicle sternal head: sternum, costal cartilages #'s 1-6 insertion: lateral lip of bicipital groove

How does the GH joint maintain the joints center of rotation for safe and optimal motion?

concavity and compression

SC joint ligaments

costoclavicular l.- prevent excessive elevation of shoulder complex anterior sternoclavicular l.- stablizes SC joint anteriorly Posterior sternoclavicular l.- stablizes SC joint posteriorly interclavicular l.-stabilzes SC jointsuperiorly/laterally

Location and functino of cruciform ligaments

criss cross l. help hold tendons in place for movement

describe the course of the central slip

crosses the pip and inserts base of middle phalanx Help PIP stay straight (extension)

Distributions of thoracodorsal n.

lattisimus dorsi and C6-C8

What is the lady between two majors?

lattisimus dorsi m. tendon between pectoralis major and teres major m. tendions

what muscle attaches to the superior angle of the scapula

lavetor scapula and it pulls muscles up

Course of ulnar nerve

descends medial arm passing posterior to medial epicondyle and continues down to ulnar aspect of forearm to hand

What are the central slip and lateral band of the extensor mechanism made of?

extensor digitorum

Where are veins in relation to their artery?

deep veins are parallel to the same names arteries

What are the scapulohumeral muscles?

deltoid, supraspinatus, infraspinatus, teres minor, teres major, subscapularis

Course of median n.

descends arm with brachial a. to mm. of anterior forearm

What is the radio ulnar articulation at the distal end?

distal end of radius and head of ulna.

over which bone does the extensor digitorum tendon divide into the central and lateral slips?

distal phalange

Where does the veins in the upper extremities start?

dorsal or palmar venous network of hand

what nerve innervates the levator scapulae and rhomboids

dorsal scapular n. (c5)

What bony landmark of the distal radius projects posteriorly?

dorsal tubercle of radius

what two structures does the extensor hood connect?

extensor tendon to the interosseous tendon

list the function at C7 myotome

elbow extension

list the function at C6 myotome

elbow flexion

what is the function of levator scapulae

elevate scapula

ST joint movements

elevation/depression protraction/retraction upward/downward rotation

Mechanisms of dislocation

excessive extension and lateral rotation of humerus. blow to humerus when GH joint is fully abducted

course of radial n.

exits axilla inferiorly passing posterior to humerus through radial groove. enters cubital fossa and divides into superficial radial n. (sutaneous) and deep radial. (motor)

course of Axillary n.

exits axilla through quadrangular space to muscles and gives off superior lateral cutaneous n.

What type of joint is the least mobile, most stable and united by dense connective tissue?

fibrous joints ( head sutures, between bones)

list the function at T1 myotome

finger abduction

list the function at C8 myotome

finger flexion

what position is the elbow joint most stable?

full extension Lateral epicondyle, olecranon and medial epicondyle are in line.

What does the lymphatic system do?

functions to collect fluids, clean fluids and return fluid to circulatory system

What type of joint are the interphalangeal joints? (IP)

hinge type synovial. flexion and extension only

What is the function of the anular ligaments?

hold tendons together

What are the three nodes on the bottom of the lymphatic drainage

humeral nodes, pectoral nodes and sub-scapular node

Label and what view

internal rotation 1. antomical neck 2. greater tubercle 3. lesser tubercle 4. surgical neck 5. humeral head 6.head of humerus 7. glenoid cavity 8. acromion 9. acromioclavicular joint AC 10. coracoid process 11. clavicle 12. superior angle of scapula 13. medial border of scap 14. inferior angle of scap 15. lateral border of scapula 16 scapula

Where does the articular disc get its blood supply from?

interosseous aa.

What other muscles attach onto the extensor hood? and what does it do?

interosseous and lumbricals and help to extend

what does the unlar n. innervate?

intrinsic muscles of the hand

What is the difference between intrinsic and extrinsic muscles?

intrinsic: originate and insert in the hand. Less power more dexterity Ex: originate in the forearm. more power less dexterity

The greater tubercle is found _________ to the lesser tubercle of the humerus

lateral

the styloid process of the radius is ______ to the styloid process of the ulna

lateral

From which portion of the brachial plexus does musculocutaneous n. arise directly and what nerve fibers contribute to it?

lateral cord. C5, C6, C7,

what happens when the coracoclavicular lig and disc is cut?

lateral end of clavicle elevates and and cannot depress

how does the lateral clavicle sit when everything is normal?

lateral end of clavicle is in elevated position even is load is applied due to the static stabilizers

Origin and insertion of extensor carpi ulnaris m.

lateral epicondyle base of 5th metacarpal wrist extension

Origin and insertion of extensor digitorum m.

lateral epicondyle digits 2-5 extend wrist, extend metacarpal phalangeal

Explain the radial collateral ligament (RCL)

lateral epicondyle and blends with anular l. It is a weak joint that resists varus force

What other nerves branch off the lateral cord of the brachial plexus?

lateral pectoral n.

What does long thoracic n. travel with and what do they both supply?

lateral thoracic a. -serratus anterior,

describe the typical causes of carpal tunnel syndrome

lesions that decrease size of tunnel or increase tendons. Decreasing the space in the tunnel. Can be causes by excessive exercise, moving, infection. progressive loss of coordination and strength of thumb sensory changes can radiate into forearm. Palmar branch is unaffected. May feel tinglingly feeling in median n. half of hand but sensation in palm of hand wont be affected while the fingers might be

what muscles are found immediately deep to trap muscles

levator scapulae m. and rhomboids

lymphedema

localized swelling due to inadequate drainage of lymph

if the neurons within the ulnar nerve were injured, what would most likely happen?

lose sensory feelings in hand and some wrist flexion would be affected. Median n. also helps with flexion

What structure leads into the median cubital v.?

media ante-brachial v.

From which portion of the brachial plexus does Median n. arise directly and what nerve fibers contribute to it?

medial and lateral cord. C6, C7, C8 and T1

Describe the borders of the cubital fossa

medial border: pronator teres lateral border: brachioradialis inferior border: junction of pronator teres and brachioradialis superior border: space between epicondyles of humerus floor: brachialis/ supinator roof: skin, fascia and aponeurosis

From which portion of the brachial plexus does ulnar n. arise directly and what nerve fibers contribute to it?

medial cord. C8, T1, C7

what specific perhipheral nerve is involved with sensation of the thumb?

median

Which superficial vein provides a connection between cephalic and basilic v.?

median cubital v.

innervation and action of pronator teres m.

median n. and pronates forarm

origin and insertion of the coracobrachialis?

origin: coracoid process insertion: mid shaft of humerus (pierced by musculocutaneous n.)

origin and insertion of the coracobrachialis m.

origin: coracoid process of scapula insertion: mid-shaft of humerus

the trochlear notch is between which two bony landmarks?

olecranon process ( funny bone ) and coronoid process

Origin and insertion lumbricals

origin: 1 & 2: lateral 2 tendons of FDP 3 & 4: medial 3 tendons of FDP insertion: lateral side of extensor action: flexion of MCP and extension of PIP/DIP innervation: 1/2- median n. 3/4- ulnar n.

Origin and insertion of the adductor pollicis m.

origin: oblique head: base of 2/3rd metacarpal, capitate tansverse head: anterior shaft of 3rd metacarpal insertion: base of proximal thumb action: adduction of CMC joint and flexion of MCP joint ulnar n.

Origin and insertion of the dorsal interossei mm.

origin: adjacent side of 2 metacarpals insertion: base of proximal phalange; extensor expansions 2-4 ulnar n.

Origin and insertion of the palmar interossei mm.

origin: anterior surface of 2nd 4th and 5th metacarpal insertion: base of phalange; extensor expansions of 2, 4 and 5th digit. MCP adduction ulnar n.

origin and insertion of serratus anterior

origin: anterior surface of ribs 1-8 insertion: medial border of scapula, anterior surface

What type of joint are the intercarpal joints? (IC)

plane synovial joints

What type of joint are the Carpometacarpal joints? (CMC)

plane synovial joints except the CMC joint of the thumb is a saddle joint

Synovial cysts of the wrist

pockets of swelling which occur most often on dorsal wrist. they do not know the specific cause but it is associated with the tendon sheath. Can become larger as you flex the wrist and can be painful

Structure of the scapulothoracic "joint"

poor congruencey not a true joint

What does the axillary n. travel with and what do they supply?

post. humeral circumflex a. supply deltoid and teres minor

what is the common location of the forearm extensor muscles?

posterior arm

From which portion of the brachial plexus does radial n. arise directly and what nerve fibers contribute to it?

posterior cord. All nerve segments

what muscles are anterior on the scapula vs. posterior side?

posterior: supraspinatous, infraspinatous, teres minor anterior: subscapularis

What are the stabilizers of the elbow complex?

primary: humeroulnar joint secondary: ligamentous support tertiary: muscualr

What is the most proximal branch of the brachial artery?

profunda brachii a.

What is the first branch off of brachial a.?

profunda brachii a. -travels to posterior humerus and descends in radial spiral groove with radial n.

what is inside the triceps hiatus

profunda brachii a. and radial n.

when are the radius and ulna crossed?

pronation

what structure lies directly between the bicipital aponeurosis and the skin overlying the cubital fossa?

pronator teres

function of palmar aponeurosis

protects underlying n. t. and vessels

What is found deep to the joint capsule of the elbow?

radial and lateral collateral ligaments (prevent excessive movement) and annular l.

What does the brachial a. branch into?

radial and ulnar a.

Where does the radial nerve run?

radial groove on posterior humerus

What two structures run through the radial/spiral groove?

radial n and profundi brachii

what specific peripheral nerve is involved with brachioradialis reflex?

radial n.

what structure does profunda brachii run with?

radial n.

what is the origin of most deep extensor muscles?

raidus/ulna

What nerve innervates the thenar muscles?

recurrent branch of median nerve Medial n. travels through carpal tunnel and after it ascends a branch backwards called the recurent branch.

from deep to superficial, what makes up the snuff box?

scaphoid bone, radial a., superficial radial n.

Which carpal bone is most commonly fractured?

scaphoid bone. When you fall this bone hits the ground first and takes the most force.

What is the first row of carpal bones?

scaphoid, lunate, triquetrum and pisiform

List the muscles that provide support to the scapulothoracic joint

scapular sling muscles: trapezius m., levator scapulae m., rhomboid minor/major, serratus anterior, pectoralis minor and subclavius

Scapulohumeral vs. axioappendicular

scapulohumeral: 6 muscles axioappendicular: anterior 4 muscles and posterior 5 muscles

movements of the AC joint

secondary movement to ST movement and acromion of scapula rotates on acromial end of clavicle

Superficial branch of the radial n.

sensory cutaneous n.

Differences between sensory and motor ulnar n.

sensory: superficial branch becomes the common palmar digital n. and then also spit into the proper palmar digital. Supplies sensory to 4 and 5 digits motor: deep branch that innervates muscles as it goes Split into these two after passing tunnel of guyon

list the function at C5 myotome

shoulder abduction

static and dynamic stabilizers for the ST joint

static: indirectly from other joints dynamic: Traps m., rhomboid mm., levator scap, serratus anterior, latissimus dorsi m., pect minor

static and dynamic stabilizers in the AC joint

static: intra-articular disc, AC joint capsule and ligaments, coracoclavicular ligaments ( conoid and trapezois) and costoclavicular ligaments dynamic: deltoid and traps

what are the static stabilizers and dynamic stabilizers of the SC joint?

static: intra-articular disc, SJ joint capsule and ligaments, interclavicular ligaments and costoclavicular ligaments dynamic: subclavius m.

Course of lateral pectoral n. once it leaves the lateral cord?

stays on level as cord and it sends communicating branch to medial pectoral branch n. and courses through pectoral fascia to deep.

What structure fills the space of the subscapular fossa?

subscapular m.

What muscles resist anterior and posterior movements in the transverse plane

subscapularis and infraspinatus

What two muscles lie between the rib cage and scapula?

subscapularis and serratus anterior

What muscles resist superior and inferior movements in the frontal plane

subscapularis and supraspinatous m.

What else does the ulnar a. give off?

superficial palmar arch gives off common palmar aa. as the common palmar aa. branch into the fingers they are going to split off into proper palmar digital aa. these aa. supply remainder of the digits.

what are the superficial flexor mm. vs. deep flexor mm.

superficial: pronator teres m., flexor carpi radialis m., palmaris longus m. and flexor carpi ulnaris m. deep: flexor pollicis longus m., flexor digitorum profundus m., pronator quadratus m,

The head of the radius is __________ of the head of the ulna

superior ( more proximal to elbow joint)

describe the borders of the triangular space?

superior angle: teres minor inferior angle: teres major lateral angle: triceps brachii m. long head

describe the borders for the quadrangular space in the shoulder area

superior border: teres minor inferior border: teres major medial border: triceps long head lateral: shaft of humerus

describe the borders of the triecps hiatus space

superior border:: teres major medial border:: triceps brachii long head lateral border: triceps brachii lateral head

Where does the suprascapular n. pass under?

superior transverse l. of scapula which make it have an increased risk of entrapment

On the medial side of the brachium, what aa. anastomoses

superior ulnar collateral a. goes to posterior ulnar recurrent a. Inferior ulnar collateral a. goes with anterior ulna recurrent a.

When are the radius and ulna parallel?

supination

At what point does the Axillary A. turn into the brachial a.?

teres major m. (inferior border)

What does the axillary n. innervate?

teres minor, deltoid

Distribution & spinal level contribution of long thoracic n.

terminates on external surface of serratus anterior m., C5-C7

Why is the DIP forced into hyperflexion after mallet finger?

the central slip comes off and the central slips help to straighten finger

What is the function of synovial membrane vs. synovial fluid

the membrane secretes synovial fluid which lubricates, nourishes and maintains health

What is scapulohumeral rhythm?

the movement relationship between the shoulder girdle and the shoulder joint. 2:1 ratio . 60 degrees ST and 120 degrees GH

Now describe how these arteries work to form the anastomosis of the scapula

the thyrocervical trunk gives off suprascapular a. where it anastomosis with circumflex scapular a. on the lateral side. the thyrocervical trunk also gives off the dorsal scapular a. where it meets at the inferior angle and anastomosis with the thoracodorsal a. all four arteries meet in the middle to communicate as well

what do all the anterior brachial joints have in common? what is its function and what is it innervated by

they all flex the elbow and are innervated by the musculocutaneous n.

What is the actions of the lumbricals?

they cross the distal interphalangeal (DIP), metacarophalangeal (MCP) and proximal interphalangeal (PIP) joints. Ext expansion hood crosses infront of MCP joint so the pull of the lumbrical causes flexion. but the expansion hood is in the BACK of the DIP and PIP therefore is extends.

Why do we have compartments?

they prevent the spread of fluids and infection. They typically end at joints

What branches off the subscapular trunk?

thoracodorsal is the extension while circumflex scapular a. branches off

What does thorocodorsal a. travel with and what do they both supply?

thoracodorsal n. both supply the lats

Describe the territory of median n. for cutaneous sensation

thumb to half of palm

What ligaments support the radiocarpal joint?

ulnar and radial collateral ligaments.

What are the ligaments of the elbow complex?

ulnar collateral l., radial collateral l. lateral ulnar collateral l. and anular l.

innervation of hypothenar muscles

ulnar n. travels through gyrons canal ( CT between pisiform) and enters hand to give innervation to muscles

What are the contents of tunnel of guyon?

ulnar n./a., Ulnar n. comes in as a mixed n. and then divides into superficial ( sensory) or deep ( motor) the a gives blood to digits 2-5

Distal humerus fracture

uncommon, causes by falling on elbow, direct truama or fall on outstretched arm. damage to cubital fossa structures median n.

The suprascapular n. passes ___________ the superior transverse L. whiole the suprascapular A. passes __________

under and over

force coupling for upward rotation

upper and lower traps and serratus anterior

What spinal cord levels supply the lower and upper subscapular n. ?

upper: C5,C6 lower: C5,C6

describe the actions of the portions of trapezius muscle

upper: elevate middle: adduct ( retraction) down: depress

When all portions of the trapezius contract together, what is the resulting motion?

upward rotation

Medial epicondyle fracture

usually fall on flexed elbow and damage to ulnar n.

what forces are applied to the lateral epicondyle aspect of the elbow resulting in tension of what ligament

valgus forces and ulnar collateral l.

what forces are applied to the medial epicondyle aspect of the elbow resulting in tension of what ligament

varus forces and the radial collateral l.

if the neurons within the ventral ramus of C8 were injured, what would most likely happen?

wrist flexors, median and ulnar n. would be affected

if the median n. was injured what would likely happen?

you would lose sensory only in median nerve sensory field