Anatomy Exam 4
Know the locations, functions, and innervation of the following: Thenar muscles opponens pollicis
innervation: median n Function: carpometacarpal joint of thumb; opposition
Know the locations, functions, and innervation of the following: Thenar muscles flexor pollicis brevis
innervation: median n and ulnar n function: Carpometacarpal joint of thumb flexion
What is the location, innervation, and the function of the triceps brachii?
innervation: radial n Function: these muscles act on two joints, which are the shoulder joint to help in extension and the elbow joint to help in extension as well. Also helps in the triceps brachii long head extension and adduction. Recall: that the muscles in the posterior part of the arm, help in extension.
Know the locations, innervations, and origins/insertions of the following muscles of the Forearm: Posterior Compartment- Deep Abductor pollicis longus
innervation: radial n Origin: Radius and ulna (dorsal surfaces, interosseous membrane) insertion: base of 1st metacarpal
Know the locations, innervations, and origins/insertions of the following muscles of the Forearm: Posterior compartment deep Extensor indicis
innervation: radial n Origin: Ulna and interosseous membrane Insertion: Posterior digital extension of 2nd digit
Know the locations, functions, and innervation of the following: Hypothenar muscles Palmaris brevis
innervation: ulnar n Function: Tightens the palmar aponeurosis (protective function)
name the carpal bones
scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate Scaphoid bone is the most frequent bone to fracture among the carpal bones Lunate is the most dislocated carpal bone
Know the Clinical significance of carpal tunnel, including the associated tendons.
-First know that the Two rows of the carpal bones produce the carpal groove which is concave anteriorly -There is something called the flexor retinaculum which is a Double layer of membrane covering the carpal groove anteriorly and produces the carpal tunnel for of flexor muscles and median nerve to pass through this tunnel -soooo Carpal Tunnel Syndrome: Compression to the median nerve in the tunnel due to hypothyroidism, rheumatoid arthritis, pregnancy, and amyloidosis The structures that pass through this tunnel are • Flexor digitorum superficialis and profundus • Flexor pollicis longus • Median nerve
What are the different fractures of the humerus?
-Fractures of the surgical neck can lead to injury to the Axillary nerve -Fractures of the middle of the shaft may cause injury to the radial nerve this will lead to wrist drop -Fractures of the distal end of humerus can lead to injury to the Median nerve -Fractures to the medial epicondyle can lead to injury to the ulnar nerve -Traumatic separation of the proximal epiphysis under 18-20 years can lead to humorous fractures -Dislocation of the shoulder joint can lead to humerus fractures.
biceps act on 2 joints which are...
-helps flex the shoulder joint -helps flex the elbow joint (recall that in anatomical correct position all those muscles that are anterior help with flexion)
What are the four joints of the shoulder?
1. glenohumeral 2. acromioclavicular 3. sternoclavicular 4. scapulothoracic
Know the Clinical significance of all brachial plexus injuries. Brachial Plexus Neuropraxia (Stretch)
Brachial Plexus Neuropraxia (Stretch) • Root compression usually by rotation of the head; commonly seen in older individuals • Nerve traction is a result of a downward pull; common among adolescents and young adults • Both characterized as "burners" or "stingers" depending on the sensation felt with each injury
Know the Clinical significance of a "winged scapula." How are two ways this could happen, i.e., what muscles and corresponding nerves would be damaged? How would you determine which muscles are compromised?
Damage to either the serratus anterior or Rhomboid muscle. -Damage to the long thoracic nerve in the serratus anterior causes a winged scapula, and the pt won't be able to life their arms above 90 degrees -Damage to the dorsal scapular nerve in the Rhomboid muscle causes a winged scapula h/w the pt has normal arm elevation so they would be able to lift their arm above 90 degrees.
Name the phalanges
Distal, middle, proximal
What is the location, function, and innervation of the latissimus dorsi?
Function: Adduction (bringing your arms down to the sides), medial rotation and extension of the arm. Innervation: Thoracodorsal nerve (C6, C8, and C8) Side-note: this muscle is known as the coughing muscle.
What is the location, innervation, and the function of the Serratus Anterior
Function: Elevation of the arm over 90 degrees; Protracts the scapula and holds it against the thoracic wall and rotates the scapula laterally to elevate the arm Innervation: Long thoracic nerve (C5- C6- C7)
The location, innervation and function of the trapezius?
Innervation: Accessory n (CN XI/11) and Cervical plexus (arises from C3-C4) Function of descending trapezius: Draws scapula obliquely upward, rotates the glenoid cavity of the scapula superiorly. Tilts head to same side and rotates it to opposite. Function of the transverse trapezius: Draws scapula medially Function of the ascending trapezius: Draws scapula medially downward. And steadies scapula on thorax.
What is the location, innervation, and function of the Teres minor?
Innervation: Axillary (circumflex) nerve (C5-C6) Function: Lateral rotation of the arm
What is the location, innervation and the function of the levator scapulae:
Innervation: Dorsal Scapular nerve (C4-C5) Function: draws scapula medially upward, while moving inferior angle medially; inclines neck to same side.
What is the location, innervation, and function of the teres major?
Innervation: Lower subscapular nerve (C6-C7) Function: Arm adduction and medial rotation.
What is the location, innervation, and the function of the pectoralis minor?
Innervation: Medial and lateral pectoral nerves (C5-C7) function: Draws scapula downward, causing inferior angle to move posteromedially; rotates glenoid inferiorly; assists in respiration.
What is the location, innervation and function of the Pectoralis Major?
Innervation: Medial and lateral pectoral nerves. Function: adduction, internal rotation. The clavicular and sternocostal parts of the muscle (so the part of the muscle that attached to the sternum and clavicle) will assist in respiration when shoulder is fixed.
Know the locations, innervations, and origins/insertions of the following muscles of the Forearm: Anterior Compartment-Superficial Palmaris longus
Innervation: Median N Origin: Medical epicondyle of humerus Insertion: Palmer aponeurosis
Know the locations, innervations, and origins/insertions of the following muscles of the Forearm: Anterior Compartment- Deep Pronator quadratus
Innervation: Median n Origin: Distal quarter of ulna (anterior surface) Insertion: distal quarter of radius (anterior surface)
Know the locations, innervations, and origins/insertions of the following muscles of the Forearm: Anterior Compartment- Intermediate Flexor digitorum superficialis
Innervation: Median n Origin: Humeral head: Medial epicondyle Ulnar head: Coronoid process Insertion: Sides of the middle phalanges of the 2nd and 5th digits
Know the locations, innervations, and origins/insertions of the following muscles of the Forearm: Anterior Compartment-Superficial Pronator teres
Innervation: Median n Origin: Humeral head: medial epicondyle of humerus Ulnar head: coronoid process Insertion: Lateral radius (distal to the supination insertion)
Know the locations, innervations, and origins/insertions of the following muscles of the Forearm: Anterior Compartment-Superficial Flexor carpi radialis
Innervation: Median n Origin: Medial epicondyle of humerus Insertion: Base of the 2nd metacarpal
Know the locations, innervations, and origins/insertions of the following muscles of the Forearm: Anterior Compartment- Deep Flexor digitorum profundus
Innervation: Median n and the ulnar n Origin: Ulna and interosseous membrane Insertion: Distal Phalanges 2nd and 5th digits
What is the location, innervation, and the function of the corabrachialis
Innervation: Musculocutaneous n function: Flexion, adduction, and internal adduction.
What is the location, innervation, and the function of the Brachialis?
Innervation: Musculocutaneous n and radial n function: flexion of the elbow.
Know the locations, innervations, and origins/insertions of the following muscles of the Forearm: Posterior Compartment- Superficialis Extensor digitorum
Innervation: Radial n Origin: Common head (lateral epicondyle of humerus) Insertion: dorsal digit expansion of 2nd to 5th digits
Know the locations, innervations, and origins/insertions of the following muscles of the Forearm: Posterior Compartment- Deep Supinator
Innervation: Radial n Origin: Olecranon, lateral epicondyle of humerus, radial collateral ligament annular ligament of radius Insertion: Radius (b/w radial tuberosity and insertion of pronator teres)
What is the location, innervation, and function of the infraspinatus?
Innervation: Subscapular nerve (C4-C6) Function: :lateral rotator of the arm
What is the location, innervation, and function of the supraspinatus?
Innervation: Suprascapular nerve (C4-C6) Function: Abductor of the arm (bring the arms upward from the sides)
Know the locations, innervations, and origins/insertions of the following muscles of the Forearm: Anterior Compartment-Superficial Flexor carpi ulnaris
Innervation: Ulnar n Origin: Humeral head: medial epicondyle Ulnar hear: Olecranon Insertion: Pisiform; Hook of hamate; base of the 5th metacarpal.
What is the location, innervation, and function of the Subscapularis? (this muscle is only seen anteriorly)
Innervation: Upper and lower Subscapular nerve (C6, C7, C8) Function: Arm adduction and medial rotation
Know the locations, innervations, and origins/insertions of the following muscles of the Forearm: Posterior Compartment- Superficialis Extensor carpi ulnaris
Innervation: radial n Origin: Common head (lateral epicondyle of humerus) and ulnar head (dorsal surface) Insertion: Base of the 5thb metacarpal
Know the locations, innervations, and origins/insertions of the following muscles of the Forearm: Posterior compartment deep Extensor pollicis brevis
Innervation: radial n Origin: radius and interosseous membrane insertion: Base of proximal phalanx of thumb
What is the location, innervation, and the function Aconeus?
Innervation: radial n function: Extends (extension) the elbow and tightens the joint.
What is the location, innervation, and function of the deltoid?
Innervation: the Axillary nerve (C5-C6) Function: most import abductor of the arm up to 90 degrees. Anterior Part: flexes (anteversion, moves arm forward) the arm+ medial rotation of the arm Middle part: abducts the arm Posterior Part: extends (retroversion, moves arm backwards) + lateral rotation
Know the locations, functions, and innervation of the following: Hypothenar muscles flexor digiti minimi
Innervation: ulnar n Function: Metacarpophalangeal joint little fingers; flexion
Know the locations, functions, and innervation of the following: Hypothenar muscles Abductor digiti minimi
Innervation: ulnar n Function: Metacarpophalangeal joint little fingers; flexion and abduction of little fingers and helps in extension of little fingers
Know the locations, functions, and innervation of the following: Hypothenar muscles Opponens digiti minimi
Innervation: ulnar n function: draws metacarpals in palmar direction (opposition)
Know the locations, functions, and innervation of the following: Thenar muscles Adductor pollicis
Innveration: Ulnar Function: Carpometacarpal joint of thumb; adduction and metacarpophalangeal joint of thumb: flexion
Name the metacarpal bones
Numbered I-V beginning with thumb
Know the locations, innervations, and origins/insertions of the following muscles of the Forearm: Radialis Group Brachioradialis
Origin: Distal humerus Insertion: Radial styloid process Innervation: Radial n.
Know the locations, innervations, and origins/insertions of the following muscles of the Forearm: Radialis Group Extensor carpi radialis brevis
Origin: Lateral epicondyle of humerus Insertion: 3rd metacarpal base Innervation: Radial n.
Know the locations, innervations, and origins/insertions of the following muscles of the Forearm: Radialis Group Extensor carpi radialis longus
Origin: Lateral supracondylar and ridge of distal humerus Insertion: 2nd metacarpal base Innervation: Radial n.
Know the Clinical significance of scaphoid and lunate fractures and/or dislocations
Scaphoid fractures are the most common carpal bone fractures, generally occurring at the narrowed waist between the proximal and distal poles (A, right scaphoid) Because blood supply to the scaphoid is transmitted via the distal segment, fractures at the waist can compromise the supply to the proximal segment, often resulting in nonunion and avascular necrosis (meaning the scaphoid bone can die)
Know the Clinical significance of the "anatomical snuffbox."
Snuffbox Borders: • Tendon of extensor pollicis longus (superior), tendons of the extensor pollicis brevis, and abductor pollicis longus (inferiorly) Contents of snuffbox: Radial artery and Superficial radial nerve -This is significant b/c if you have a fracture at your scaphoid bone or a dislocation here, the scaphoid can be pushed in to that anatomical snuffbox
What are the parts of the clavicle?
Sternal end (medial) Acromial end (lateral) Trapezoid line Conoid tubercle Impression for the costoclavicular ligament
Which veins are utilized during a venipuncture, and why?
The veins in the cubital fossa such as the median cubital vein. These veins are frequently used when drawing blood. In preparation, a tourniquet is applied. This allows arterial blood to flow but blocks the return of venous blood. The resulting swelling makes the veins more visible and palpable. So you can easily use it for a venipuncture.
What are the parts of the ulna
Trochlear notch, olecranon, coronoid process, radial notch, head (distal), styloid process
Ulnar Nerve Injury
claw hand
What are the parts of the radius
head, neck, radial tuberosity, styloid process, ulnar notch
What is the location, innervation and function of the Rhomboid major
innervation: Dorsal Scapular nerve (C4-C5) Function: Steadies scapula/holds the scapula in place; draws the scapula medially upward.
What is the location, innervation and function of the Rhomboid minor:
innervation: Dorsal Scapular nerve (C4-C5) Function: Steadies scapula/holds the scapula in place; draws the scapula medially upward.
Know the locations, functions, and innervation of the following: Thenar muscles abductor pollicis brevis
innervation: Median n Function: carpometacarpal joint of thumb; adbuction
Know the locations, innervations, and origins/insertions of the following muscles of the Forearm: Anterior Compartment- Deep Flexor pollicis longus
innervation: Median n Origin: Radius and adjacent interosseous membrane Insertion: Distal phalanx of thumb (palmar surface)
What is the location, innervation, and the function of the Biceps Brachii
innervation: Musculocutaneous n Function: Elbow joint flexion and supination (place your arm in anatomically correct position) -Help in should joint flexion, and stabilization of humeral head during deltoid contraction; abduction and internal rotation of the humerus.
Know the locations, innervations, and origins/insertions of the following muscles of the Forearm: Posterior Compartment- Superficialis Extensor digiti minimi
innervation: Radial n Origin: Common head (lateral epicondyle of humerus) Insertion: dorsal digit expansion of 5th digit.
Know the locations, innervations, and origins/insertions of the following muscles of the Forearm: Posterior compartment deep Extensor pollicis longus
innervation: Radial n Origin: Ulna and interosseous membrane Insertion: Base of the distal phalanx thumb
Median Nerve Injury
opponens splint, C-bar or thumb post splint Injury above the elbow: • Only muscles in the forearm and hand muscles are affected • All flexors of the wrist are paralyzed except flexor carpi ulnaris and the ulnar part of flexor digitorum profundus • Thumb flexors and abductor paralyzed but not the adductor (ulnar nerve) • Flexion at metacarpophalangeal joints possible (intact interossei muscles innervation by ulnar nerve) • 1st and 2nd Lumbricals lost function and are unable to fully flex index and middle finger -- Hand of Benediction • Pronation of forearm paralyzed and sensory loss over the median nerve area
what is the function of the rotator cuff muscles, and the 4 muscles?
supraspinatus, infraspinatus, teres minor, subscapularis Function: help to maintain the stability of the shoulder joint
Radial Nerve Injury
wrist drop
Know the Clinical significance of all brachial plexus injuries. Brachial Plexus Rupture
• A forceful stretch resulting in the partial or complete tear of a nerve • Associated with muscle weakness and pain, severity depends on location and extent of injury • Often require surgery to repair
What are the lymph node groups in the axillary region, and how are they involved in lymph drainage of the breast and upper limb?
• Arranged in 5 groups: Pectoral, lateral, apical, central and posterior • Drainage: subclavian lymphatic trunk to right lymphatic duct to right venous angle - if a pt has breast cancer metastasis meaning the tumor starts to break down so the metastatic cells/cancer cells will come off of the tumor and go elsewhere in the body. So it can get either into the vasculature or into the lymphatics/ axillary lymph nodes. (it is important to note that 75% of breast lymphatics drain here). To fix this you can conduct an mastectomy so you remove the breast. Or remove the lymph nodes. -It is also important to note that the lymphatics of the entire upper limb drain into the lymph nodes of the axillary region. So if you remove the lymph nodes in the axillary region the upper limb can not drain, and cause a person to have lymphangitis. So the upper limb will get engorged with extra lymph fluid.
Know the Clinical significance of all brachial plexus injuries. Brachial Plexus Neuroma
• Commonly occurs when a nerve is cut during surgery • Scar tissue forms a painful knot on the nerve, preventing it from healing itself • Surgery often required to remove scar tissue
What is the Clinical significance of Colle's fracture?
• Fracture of the radial styloid process; this will cause a posterior displacement that will force the process into the shaft • this fracture can occur if a person falls on their hand with an extended arm • What can also occur is an by avulsion( so this process will complete break and separate from the ulna) of ulnar styloid process
There are two types of brachial plexus avulsions which are... Upper Brachial Plexus (C5-C6)
• Most common type of avulsion -it is known as Erb-Duchenne paralysis Signs: • Numbness and loss of motion around the shoulder, inability to flex elbow • Deltoid and supraspinatus are paralyzed (no arm abduction) • Infraspinatus paralysis leads to medial rotation of the arm. • Biceps and Brachialis are also paralyzed, no elbow flexion • Loss of Biceps and supinator, weak supination)• Adductors of shoulder are mildly affected (pectoralis major and Latissimus dorsi)
Know the Clinical significance of all brachial plexus injuries. Brachial Plexus Avulsion
• Nerve root is completely separated from spinal cord • Common injury during childbirth (2/1000 births), among athletes, and blunt trauma • Two types depending on nerves involved • Treatment depends on severity
There are two types of brachial plexus avulsions which are... Lower Brachial Plexus (C8-T1)
• Not as common as upper plexus injuries • known as Klumpke's paralysis Signs: Signs: • Loss of movement and/or sensation of the wrist and hand • Paralysis of the intrinsic muscle of hand (small muscles) compromises finger movement • Atrophic paralysis of the forearm and small muscles of hand (Claw hand)