Anatomy Unit 2

Cervical plexus nerves (C1-C4)

most cutaneous nerves of the neck are derived from here.

Abductor Pollicis Brevis

muscle responsible for abduction of thumb in sagittal plane

Trauma to median nerve (for forearm)

Lesions of the median nerve usually occur in two places: the forearm and wrist. Median nerve injury resulting from a perforating wound in the elbow region results in loss of flexion of the proximal and distal interphalangeal joints of the 2nd and 3rd digits.

Acromioclavicular Joint

Acromial end of clavicle and acromion of scapula - Synovial (plane) joint - Diarthorsis - Gliding of scapula on clavicle

Interphalangeal (IP joints)

Heads of proximal and middle phalanges with bases of middle and distal phalanges, respectively. - Synovial hinge joints - Diarthrosis - Extension and flexion of phalanges

Extensor Pollicis Longus and Brevis

These two muscles lead to extension of the thumb.

appendicular skeleton

composed of the pectoral girdle, upper limbs, pelvic girdle, and lower limbs.

flexor digitorum superficialis

flexes wrist and middle phalanges of fingers 2-5 - Action: anterior flexion of wrist; Flexion of metacarpophalangeal, and middle interphalangeal joints of digits 2-5

Brachioradialis

muscle that extends from the upper arm to the radial bone - Action: flexion of the elbow - Skeletal Attachments: Lateral supracondylar ridge of humerus; lateral surface of radius near styloid process.

Brachialis

responsible for flexion of the elbow. Lateral muscle of the arm.

Identify the one location where each upper limb attaches to the axial skeleton

The one place where the upper limbs attach to the axial skeleton is the sternal end of the clavicle, which attaches to the manubrium of the sternum.

Venous Blood from the Head

The right and left external jugular veins drain blood from the face and scalp, and descend to the sternocleidomastoid muscle before draining into the left or right subclavian veins. The right and left internal jugular veins drain blood form the brain, and descend deep to the sternocleidomastoid muscle. When they reach the level of the sternoclavicular joint, they empty inot the left or right subclavian veins, medial to the junction of the external jugular veins, forming the left and right brachiocephalic veins which drain into the superior vena cava.

Supinator muscle

muscle that supinates the arm

Skier's Thumb

Refers to the rupture or chronic laxity of the collateral ligaments of the first metacarpophalangeal joint. The injury results from hyperabduction of the metacarpopharyngeal joint of the thumb, which occurs when the thumb is held by a ski pole while the rest of the hand hits the ground or enters the snow. In severe injuries, the head of the metacarpal has an avulsion fracture.

Serratus Anterior

- the abs below your armpit basically - Action: lateral rotation, depression, and protraction of scapula

Is breast cancer common in men?

Approximately 4.5% of breast cancers occur in men. 1,000 men/yr

How does breast cancer normally spread?

Breast cancer typically spreads by means of lymphatic vessels (lymphogenic metastasis), which carry cancer cells from the breast to the lymph nodes, chiefly those in the axilla. The cells lodge in the nodes, producing nests of tumor cells (metastases). Because most of the lymphatic drainage of the breast is to the axillary lymph nodes, they are the most common site of metastasis from a breast cancer.

Bronchogenic carcinoma

Bronchogenic carcinoma is a common type of lung cancer that arises from the epithelium of the bronchial tree. Lung cancer is mainly caused by cigarette smoking. Bronchogenic carcinoma usually metastasizes widely because of the arrangement of the lymphatics.

Radiocarpal joint

Distal end of radius; lunate, scaphoid, and triquetrum - Synovial condylar joint - Diarthrosis - Abduction, adduction, circumduction, extension and flexion of the wrist

Inhalation of carbon particles

Lymph from the lungs carries phagocytes, cells possessing the property of ingesting carbon particles from inspired air. In many people, especially cigarette smokers, these particles color the surface of the lungs and associated lymph nodes a mottled gray to black. Smokers cough results from inhalation of irritants in tobacco.

Arterial anastomoses around the scapula

Many arterial anastomoses occur around the scapula. Several arteries join to form networks on the anterior and posterior surfaces of the of the scapula. The importance of the collateral circulation made possible by these anastomoses becomes apparent when ligation of a lacerated subclavian or axillary artery is necessary. Vascular stenosis may occur, but collaterals are there. Slow occlusion of an artery often enables sufficient collateral circulation to develop, preventing ischemia. Sudden occlusion does not allow sufficient time for adequate collateral circulation to develop; ischemia occurs. Abrupt surgical ligation of the axillary artery between the origins of the subscapular and the profunda brachii artery will cut off the blood supply to the arm because the collateral circulation is inadequate.

What is a mastectomy?

Mastectomy (breast excision) is not as common as it once was as a treatment for breast cancer.

adductor pollicis

Muscle which adducts the thumb. Draws thumb toward palm as in "gripping"

Heart Murmurs

Restriction of high-pressure blood flow (stenosis) and passage of blood through a narrow opening into a larger vessel or chamber (stenosis and regurgitation) produce turbulence. Turbulence sets up eddies (small whirlpools) that produce vibratory sensations - audible murmurs. Superficial auditory sensations - thrills - may be felt on the skin over an area of turbulence.

Pectoralis Minor

Smaller chest muscle - Action: protraction of scapula - Skeletal Attachments: Ribs 3-5; Coracoid process of scapula

What are the functions of the thoracic wall?

The functions of the thoracic wall include protecting the thoracic and abdominal organs; resisting the negative internal pressures generated by the elastic recoil of the lungs and inspiratory movement; providing attachment for and supporting the weight of the upper limbs; and providing attachment for many of the muscles of the upper limbs, neck, abdomen, and back and the muscles of respiration.

Cardiac-referred pain

The heart is insensitive to most things; however, ischemia and the accumulation of metabolic products stimulate pain endings in the myocardium. Cardiac referred pain is a phenomenon whereby noxious stimuli originating in the heart are perceived by the person as pain arising from superficial part of the body - the skin on the medial aspect of the upper left limb, for example.

Cardiac plexus

The heart is supplied by autonomic nerve fibers from superficial and deep cardiac plexuses. These nerve networks lie anterior to the bifurcation of the trachea and posterior to the ascending aorta.

Primary function of the heart

The heart, slightly larger than a clenched fist, is a double self-adjusting muscular pump, the parts of which work in unison to propel blood to the body.

Sternal biopsies - why are these done?

The sternal body is often used for bone marrow needle biopsy because of its breadth and subcutaneous position. This is commonly used to obtain specimens of bone marrow for transplantation and for detection of metastatic cancer.

Bursitis of elbow

The subcutaneous olecranon bursa is exposed to injury during falls on the elbow and to infection from abrasions of the skin covering the olecranon. Repeated excessive pressure and friction produces a friction subcutaneous olecranon bursitis. Subtendinous bursitis results from excessive friction between the triceps tendon and the olecranon. The pain is severe during flexion of the forearm because of pressure exerted on the inflamed subtendinous olecranon bursa by the triceps tendon.

Identify the thenar eminence and hypothenar eminence

The thenar muscles form the thenar eminence on the radial aspect of the palm.

Identify the trachea and esophagus and their major functions

The trachea is lined with C ring cartilage and brings air into the lungs. The esophagus brings food to the stomach

dermatome

The unilateral area of skin innervated by the general sensory fibers of a single spinal nerve is called a dermatome.

Identify the visceral and parietal pleurae

The visceral pleura (pulmonary pleura) covers the lung and is adherent to all its surfaces, including the surfaces within the horizontal and oblique fissures. The parietal pleura lines the pulmonary cavities, adhering to the thoracic wall, the mediastinum, and the diaphragm.

flexor pollicis longus

This muscle is responsible for flexion of interphalangeal joints of the thumb.

extensor carpi ulnaris

This muscle is responsible for the Extension and ulnar (medial) flexion of wrist

extensor digitorum

This muscle is responsible for the extension of metacarpophalangeal and interphalangeal joints of digits 2-5. Extension of the wrist

abductor pollicis longus

This muscles abducts the thumb in frontal and sagittal plane. It also leads to extension at carpometacarpal joint.

ulnar nerve

This nerve Innervates: flexor carpi ulnaris and ulnar half of flexor digitorum profundus (forearm); most intrinsic muscles of hand; skin of hand medial to axial line of digit 4

Costotransverse joint

Tubercle of rib with transverse process of corresponding vertebra - Synovial (plane) joint; diarthrosis

What are the three compartments of the thoracic cavity?

Two completely separated lateral compartments - the pulmonary cavities - that contain the lungs and pleurae (lining membranes). One central compartment - the mediastinum - that contains all other thoracic structures: heart, great vessels, trachea, esophagus, thymus, and lymph nodes.

axial skeleton

makes up the primary axis of the body and includes the skull, vertebrae, sternum, and ribs

Thoracic vertebrae

the second set of 12 vertebrae; form the outward curve of the spine and are known as T1 through T12 - seven processes for muscular and articular connections

flexor pollicis brevis

this muscle is responsible for flexion of metacarpophalangeal joint of thumb.

Pleuritis

During normal breathing, there is no sound detectable by auscultation (listening to breathing sounds); however, inflammation of the pleurae - pleuritis - makes the lung surfaces rough. The resulting friction may be heard with a stethoscope. Acute form may hurt from something such as climbing stairs.

Clavicle

connects the upper limb to the trunk. Its sternal end articulates with the manubrium of the sternum at the sternoclavicular joint (SC). Its acromial end articulates with the acromion of the scapula at the acromioclavicular joint (AC). Conoid tubercle near the inferior acromial end.

Anconeus

Muscle that connects from distal epicondyle of humerus to ulna posteriorly. - Actions: extension of the elbow

Palmaris Longus

- Action: anchors skin and fascia of the palm

Flexor Carpi Radialis

- Action: anterior flexion and radial (lateral) flexion of the wrist

Flexor Carpi Ulnaris

- Action: anterior flexion and ulnar (medial) flexion of the wrist

internal intercostals

- Action: depression of ribs for force expiration

External Intercostals

- Action: elevation of ribs for inspiration

Pectoralis Major

- big chest muscle - "say it with chest son!" - Action: flexion, adduction, and medial rotation of humerus at the shoulder. - Skeletal Attachments: Medial 1/2 of clavicle; lateral margin of the sternum; costal cartilages 1-5; aponeurosis of external oblique; intertubercular sulcus of humerus

Elbow Joints

Humeroulnar joints: trochlea of humerus and trochlear notch of ulna Humeroradial joint: Capitulum of humerus and head of radius - both synovial (hinge) joints - Diarthorsis - Extension and flexion of the elbow

Surgical significance of transverse pericardial sinus

After the pericardial sac has been opened anteriorly, a finger can be passed through the transverse pericardial sinus posterior to the aorta and pulmonary trunk. By passing a surgical clamp or placing a ligature around these vessels, inserting tubes of a bypass machine, and then tightening the ligature, surgeons can stop or divert the circulation of blood in these large arteries while performing cardiac surgery, such as coronary artery bypass grafting. Cardiac surgery is performed while the patient is on a cardiopulmonary bypass machine.

Synovial tendon sheaths at the wrist/hand

As tendons pass over the dorsum of the wrist, they are covered with synovial tendon sheaths, which reduce friction for the extensor tendons as they traverse the ossefibrous tunnels formed by the attachment of the extensor retinaculum to the distal radius and ulna.

1. Identify: areola, nipple, lactiferous ducts, lactiferous sinus (enlarged parts of the duct), pectoralis major muscle

At the greatest prominence of the breast is the nipple, surrounded by a circular pigmented area (the areola). The breast contains 15-20 lobules of glandular tissue, which constitute the parenchyma of the mammary gland. Each lobule is drained by a lactiferous duct, which opens independently on the nipple. Just deep to the areola, each duct has a dilated portion, the lactiferous sinus.

General location of the heart in the thorax

Be familiar with the location of the heart within the thorax. You don't need to know specifics, but know it sits posteriorly to the sternum, the apex tilts to the left

Dislocation of glenohumeral joint

Because of its freedom of movement and instability, the glenohumeral joint is commonly dislocated by direct or indirect injury. Anterior dislocation of the glenohumeral joint occurs most often in young adults, particularly athletes. The axillary nerve may be injured when the glenohumeral joint dislocates because of its close relation to the inferior part of the capsule of this joint.

Atrial and ventricular septal defects

Congenital abnormalities of the interatrial septum - usually related to incomplete closure of the oval foramen - are atrial septal defects or ASDs. Small ASDs are no problem; however, large ASDs allow oxygenated blood form the lungs to be shunted from the left atrium through the defect into the right atrium, causing enlargement of the right atrium and ventricles and dilation of the pulmonary trunk. The membranous part of the IV septum develops separately from the muscular part and has a complex embryological origin. Consequently, this part is the common site of ventricular septal defects of VSDs. These congenital anomalies rank first on all lists of cardiac defects. Accounts for approximately 25% of all heart disease. A large shunt increases pulmonary blood flow, which causes pulmonary disease (hypertension, or increased blood pressure) and may cause cardiac failure.

Role of costal cartilages

Costal cartilages prolong the ribs anteriorly and contribute to the elasticity of the thoracic wall, preventing many blows from fracturing the sternum and/or ribs. In elderly people, the costal cartilages undergo calcification, making them radiopaque and less resilient.

Injury to conducting system of the heart: Heart block

Damage to the AV node or bundle results in a heart block because the atrial excitation does not reach the ventricles. As a result, the ventricles contract on their own, much slower than the normal rate.

Rib identification and bone markings

Head of the rib: with superior and inferior articular facets for thoracic vertebral bodies. Neck: connects the head with the body (shaft) at the level of the tubercle Tubercle: (lump-like enlargement) at the junction of the neck and the body. Has articular facet for the transverse process of thoracic vertebrae Angle, Costal Groove, and Shaft

Elbow tendinitis or lateral epicondylitis

Elbow tendinitis is a painful musculoskeletal condition that may follow repetitive use of the superficial extensor muscles of the forearm. Pain is felt over the lateral epicondyle and radiates down the posterior surface of the forearm. Repeated forceful flexion and extension of the wrist strain the attachment of the common extensor tendon, producing inflammation of the periosteum of the lateral epicondyle (lateral epicondylitis). Associated tears of the common extensor tendon, which may be surgically repaired, are visible on MRI.

Supernumerary ribs - where are these most commonly found and what are the potential side effects?

Extra cervical ribs or failure of the 12th rib to develop can occur. Cervical ribs (1% of people) may compress spinal nerves and cause tingling and numbness along the forearm. They may also compress the subclavian artery, resulting in ischemic muscle pain (caused by poor blood supply). Resection may be required to relieve pressure on these structures, which can be performed through a trans axillary approach (incision in axillary fossa or armpit). Lumbar ribs are less common than cervical ribs but have clinical significance in that they may confuse the identification of vertebral levels in diagnostic images.

What is removed in a simple vs. radical mastectomy?

In simple mastectomy, the breast is removed down to the retromammary space. The nipple and areola may be spared, and immediate reconstruction performed in selected cases. Radical mastectomy, a more extensive surgical procedure, involves removal of the breast, pectoral muscles, fat, fascia, and as many lymph nodes as possible in the axilla and pectoral region.

What are the functions of mammary glands in women?

Mammary glands in women are accessory to reproduction; milk production and lactation occur here after birth.

Visualizing Breast Structure and pathology i. What is mammography?

Mammography is radiographic study of the breast, which is flattened to extend the area that can be examined and reduce thickness, making it more uniform for increased visualization. Carcinomas often appear as a large, jagged density in the mammogram.

Sternum

Manubrium: superior part of the sternum, a roughly trapezoidal bone that laies at the level of the bodies of the T3 and T4 vertebrae. Its thick superior border is indented centrally by the Suprasternal Notch (AKA jugular notch). Angle: the manubrium and body of the sternum lie in slightly different planes, forming a projecting sternal angle. Body (Gladiolus): (T5-T9 vertebral level) is longer, narrower, thinner, and inferior to the manubrium. Xiphoid Process - formed of hyaline cartilage in young children.

Coracobrachialis

Muscle on the medial inside of the superior arm that connects to the shoulder. - Actions: flexion adduction and medial rotation of the humerus at the shoulder.

Pronator Teres

Muscle which crosses over form the medial epicondyle of the humerus to the radius - Actions: pronation of the forearm

Coronary bypass graft

Patients with obstruction of their coronary circulation and severe angina (heart pain) may undergo a coronary bypass graft operation. A segment of an artery or vein is connected to the ascending aorta or to the proximal part of a coronary artery and then to the coronary artery distal to the stenosis. Great saphenous vein is commonly harvested for this procedure. A coronary bypass graft shunts blood from the aorta to a stenotic coronary artery to increase the flow distal to the obstruction.

Percussion of heart

Percussions defines the density and size of the heart. The classical percussion technique is to create vibration by tapping the chest with a finger while listening and feeling for differences in sound wave conduction. Normally, the percussion note changes from resonance to dullness (because of the presence of the heart). The character of the sound changes as different areas of the chest are tapped.

Radioulnar joint

Proximal joint: head of radius and radial notch of ulna Distal joint: distal end of ulna and ulnar notch of radius - both synovial pivot joints - both diarthrosis - rotation of radius with ulna Interosseus Membrane: Fibrous syndesmosis - amphiarthrosis

Coronary sinus

The coronary sinus, the main vein of the heart, is a wide and venous channel that runs from left to right in the posterior part of the coronary sulcus. The coronary sinus receives the great cardiac vein at its left end and the middle and small cardiac vein at its right end.

Although you are not required to identify all of the lymphatic drainage of the breast, why is it of clinical significance?

The lymphatic drainage of the breast is important because of its role in the metastasis (spread) of cancer cells.

What structures can be found in the mediastinum?

The mediastinum is covered on each side by mediastinal pleura and contains all the thoracic viscera and structures, except the lungs. Contains the heart, thymus, esophagus, trachea, aorta, vena cave.

Pericardium (pg. 218) A. Identify the different parts of the pericardium and order them superficial-deep

The pericardium is a double-walled fibroserous membrane that encloses the heart and the roots of the great vessels, much like the pleura encloses the lungs. A conical pericardial sac lies posterior to the body of the sternum and the 2nd-6th costal cartilages at the level of the T5-T8 vertebrae. Its tough external fibrous layer is the fibrous pericardium which is continuous with the central tendon of the diaphragm. The internal surface of the fibrous pericardium is lined with glistening serous membrane, the parietal layer of serous pericardium. This layer is reflected onto the heart and great vessels as the visceral layer of serous pericardium.

Carpals

The wrist, or carpus, is composed of eight carpal bones (carpals) arranged in proximal and distal rows of four. From lateral to medial, the four bones in the proximal row of carpals are as follows - Scaphoid: a boat-shaped bone that has a prominent scaphoid tubercle - Lunate: a moon-shaped bone that is broader anteriorly than posteriorly - Triquetrum: a pyramidal bone on the medial aspect of the carpus - Pisiform: A small, pea shaped bone that lies on the palmar surface of the triquetrum The proximal surfaces of the distal row of carpals articulate with the proximal row of carpals, and their distal surfaces articulate with the metacarpals. From lateral to medial, the four bones in the distal row of carpals are as follows: - Trapezium: a four-sided bone on the lateral side of the carpus - Trapezoid: a wedge-shaped bone - Capitate: the head-shaped bones that is the largest bone in the carpus - Hamate: a wedge-shaped bone, that which has a hooked process, the hook of hamate, that extends anteriorly.

Biceps Brachii

These are the "gun show" muscles. - Actions: supination of forearm, flexion of elbow, flexion of the humerus at the shoulder (long head only). - skeletal attachments: glenoid cavity (long head); coracoid process of scapula (short head); Radial tuberosity; fascia of forearm.

musculocutaneous nerve:

This nerve Innervates: muscles of anterior compartment of arm (coracobrachialis, biceps brachii and brachialis); skin of lateral aspect of forearm.

median nerve

This nerve Innervates: muscles of anterior forearm compartment (except for flexor carpi ulnaris and ulnar half of flexor digitorum profundus); five intrinsic muscles in thenar half of palm and palmar skin.

radial nerve

This nerve innervates all muscles of posterior compartments of arm and forearm; skin of posterior and inferolateral arm, posterior forearm, and dorsum of hand lateral to axial line of digit 4

Thrombi

Thrombi (Clots) form on the walls of the left atrium in certain types of heart disease. If these thrombi detach or if pieces break off, they pass into the systemic circulation and occlude peripheral arteries. This may result in a stroke or cerebrovascular accident (CVA), which may affect, for example, vision, cognition, motor function, etc. controlled by the previously non-damaged part of the brain.

carpometacarpal joint

Thumb: trapezium and first metacarpal - synovial (saddle) joint - Diarthrosis - Abduction, adduction, circumduction, extension, flexion and opposition at thumb Other Digits: carpals and metacarpals II-V - synovial (plane) joints - diarthrosis - Gliding at digits II-V

Are mammary glands present in men?

Yes; however, in men, mammary glands are functionless, consisting of only a few small ducts or cords.

Diaphragm

a muscle that separates the chest from the abdominal cavity - Action: prime mover of inspiration; compresses abdomen

Englargement of axillary lymph nodes and lymphangitis

An infection in the upper limb can cause the axillary nodes to enlarge and become tender and inflamed, a condition called lymphangitis. The humeral group of nodes is usually the first ones to to be involved. Lymphangitis is characterized by warm, red, streaks in the skin of the limb. Infections in the pectoral region and breast, including the superior part of the abdomen, can also produce enlargement of the axillary nodes. These nodes are also the most common site of metastasis (spread) of cancer of the breast.

Motor innervation of the cervical plexus - upper limb spinal nerves and myotomes

C5 - shoulder abduction C5, C6 - elbow flexion C7 - elbow extension, wrist extension, finger extension C8 - wrist flexion, finger flexion T1 - intrinsic hand muscles

Rotator cuff injuries

Commonly injured during repetitive use of the upper limb above the horizontal. Recurrent inflammation of the rotator cuff, especially the relatively avascular area of the supraspinatus tendon, is a common cause of shoulder pain and results in tears of the rotator cuff. Baseball throws may lead to degenerative tendinitis of the rotator cuff. Because the supraspinatus is no longer functional with a complete tear of the rotator cuff, the person cannot initiate abduction of the upper limb. If the arm is passively abducted 15 degrees or more, the person can usually initiate abduction by leaning or using the hip, then maintain or continue the abduction using the deltoid.

What is the rotator cuff, and which muscles are part of the rotator cuff?

Four of the scapulohumeral muscles (intrinsic shoulder muscles) - Supraspinatus, Infraspinatus, Teres minor, and Subscapularis - are called rotator cuff muscles because they form a musculotendinous rotator cuff around the glenohumeral joint. All except the supraspinatus are rotators of the humerus. The supraspinatus, besides being part of the rotator cuff, initiates and assists the deltoid in the first 15 degrees of abduction of the arm. The tendons of the SITS or rotator cuff muscles blend with the joint capsule of the glenohumeral joint, reinforcing it as the musculotendinous rotator cuff, which protects the joint and gives it stability.

What type of gland is the mammary gland?

These glands are modified sweat glands and therefore have no special capsule or sheath.

Scapula

(shoulder blade) is a triangular flat bone that lies on the posterolateral aspect of the thorax, overlying the 2nd through 7th ribs. The convex posterior surface of the scapula is unevenly divided by the spine of the scapula into a small supraspinous fossa and a much larger infraspinous fossa. The concave costal surface of the scapula has a large subscapular fossa. The triangular body of the scapula is thin and translucent superior and inferior to the scapular spine. The scapula has medial (axillary), Lateral (vertebral), and superior borders and superior and inferior angles. The lateral border of the scapula is the thickest part of the bone, which, superiorly, includes the head of the scapula where the glenoid cavity is located. The neck of the scapula is just medial to the head. The superior border of the scapula is marked near the junction of its medial two thirds and lateral third by the suprascapular notch. The spine of the scapula continues laterally, expanding to form the acromion. The beak like coracoid process is superior to the glenoid cavity and projects anterolaterally.

Brachial Plexus

1. A network of nerves composed of anterior rami of C5-T1 nerves. 2. Most cutaneous nerves of the upper limb are derived from here 3. You are responsible for knowing/labeling the following: (please note you do not need to know/label the entire plexus, only the parts listed below.) a. Categories: roots, trunks, divisions, cords, branches (RTDCB) b. Spinal nerves C5, C6, C7, C8, T1

extensor carpi radialis longus and Brevis

These two muscles are responsible for extension and radial (lateral) flexion of wrist

Why are the consequences serious in males with breast cancer?

Although breast cancer is uncommon for men, the consequences are serious because they are frequently not detected until extensive metastases have occurred - for example, in bone.

Radial Nerve Injury

Although the radial nerve supplies no muscles in the hand, radial nerve injury in the arm by a fracture of the humeral shaft can produces serious disability of the hand. Wrist drop is the primary clinical manifestation.

Venipuncture

Because of the prominence and accessibility of the superficial veins, they are commonly used for venipuncture (to draw blood or inject a solution). By applying a tourniquet to the arm, the venous return is occluded, and the veins distend and usually are visible or palpable. Once a vein is punctured, remove the tourniquet so the puncture does not bleed extensively. Median cubital vein is commonly used for venipuncture. The veins forming the dorsal venous network and the cephalic and basilic veins are commonly used for long-term introduction of fluids (intravenous feeding). The cubital veins are also a site for the introduction of cardiac catheters.

What is a carcinoma?

Carcinomas of the breast are malignant tumors, usually adenocarcinomas arising from the epithelial cells of the lactiferous ducts in the mammary gland lobules. Metastatic cancer cells that enter a lymphatic vessel usually pass through two or three groups of lymph nodes before entering the venous system. Breast cancer can spread via lymphatics and veins as well as by direct invasion.

Coronary angioplasty

Cardiologists or interventional radiologists use percutaneous transluminal coronary angioplasty, in which they pass a catheter with a small inflatable balloon attached to its tip into the obstructed coronary artery. It is inflated to press atherosclerotic plaque down and expand lumen to increased blood flow. Thrombokinase enzyme may dissolve or reduce the blood clot. After dilation of the vessel, an intravascular stent may be introduced to maintain dilation. These are replacing bypass procedures requiring open surgery at markedly increasing rates.

Carpal tunnel syndrome

Carpal tunnel syndrome results from any lesion that significantly reduces the size of the carpal tunnel or, more commonly, increases the size of some of the structures that pass through it (e.g. - inflammation of synovial sheaths). Medial nerve is most sensitive; thus, paresthesia (tingling), hypesthesia (diminished sensation), or anesthesia (absence of tactile sensation) may occur in the lateral three and a half digits. Palm is unaffected. Wasting of the thenar eminence and progressive loss of coordination and strength in the thumb may occur if the cause of the compression is not alleviated. To relieve the compression and resulting symptoms, partial or complete surgical division of the flexor retinaculum, a procedure called carpal tunnel release, may be necessary.

Changes in breasts during menstrual cycle, pregnancy, breastfeeding, and age

Changes, such as branching of the lactiferous ducts, occur in the breast tissues throughout the menstrual cycles and during pregnancy. Mammary glands do not produce milk until shortly after the baby is born. Colostrum, a creamy white to yellowish pre-milk fluid, may be secreted from the nipples during the last trimester of pregnancy and during initial episodes of nursing. In multiparous women (those who have given birth two or more times), the breasts often increase in size and pendulous. The breasts in elderly women are usually small because of the decrease in fat and atrophy of glandular tissue.

Fracture of clavicle

Commonly fractured during a fall. The weakest part of the clavicle is at the junction of its middle and lateral thirds. After fracture of the clavicle, the sternocleidomastoid (SCM) muscle elevates the medial fragment of bone. The trapezius muscle is unable to hold up the lateral fragment owing to the weight of the upper limb, and thus the shoulder drops. In addition to being depressed, the lateral fragment of the clavicle may be pulled medially by muscles that normally adduct the arm at the should joint, such as the pectoralis major. Overriding the bone fragments shortens the clavicle.

What bones do the costal cartilages connect?

Costal cartilages form the anterior continuation of the ribs, providing a flexible attachment at their articulation with the sternum. The ribs and their cartilages are separated by intercostal spaces, which are occupied by intercostal muscles, vessels, and nerves.

phalanges

Each digit has thee phalanges (proximal, middle, and distal) except for the first (thumb), which has only two (proximal and distal). Each phalanx has a base proximally, a shaft (body), and a head distally. The distal phalanges are flattened and expanded at their distal ends, which underlie the nail beds.

Pneumothorax, hydrothorax, hemothorax, chylothorax

Entry of air into the pleural cavity - pneumothorax - resulting from a penetrating wound of the parietal pleura, tearing of the parietal pleura from a fractured rib, or rupture of a lung from a bullet, for example, results in partial collapse of the lung. The accumulation of a significant amount of fluid in the pleural cavity - hydrothorax - may result from pleural effusion (escape of fluid into the pleural cavity. With a chest wound, blood may enter the pleural cavity (hemothorax). Lymph from a torn thoracic duct may also enter the pleural cavity (chylothorax).

Costovertebral Joint

Facets of heads of ribs and bodies of adjacent thoracic vertebrae and intervertebral discs between adjacent vertebrae; articular part of tubercles of ribs and facets of transverse processes of thoracic vertebra - Stuctural Classification: synovial (plane joint) - Functional classification: diarthrosis - Movement: some slight gliding

Flail chest

Flail chest occurs when a sizeable segment of the anterior and/or lateral thoracic wall moves freely because of multiple rib fractures. This allows the loose segment of the wall to move paradoxically (inward on inspiration and outward on exhalation). Extremely painful and impairs oxygen movement. During treatment, the loose segment may be internally fixed with plates or wires to prevent movement.

glenohumeral joint

Glenoid cavity of scapula and head of humerus - Synovial (ball and socket) joint - Diarthrosis - Abduction, adduction, circumduction, extension, flexion, lateral rotation and medial rotation of arm

Metacarpophalangeal joints

Heads of metacarpals and bases of proximal phalanges - Synovial condylar joints - diarthrosis - Abduction, adduction, circumduction, extension, flexion of phalanges

Herpes Zoster infection (shingles)

Herpes Zoster (shingles) - a viral disease of spinal ganglia - is a skin lesion with a dermatomal distribution. The herpes virus invades a spinal ganglion and is transported along the axon to the skin, where it produces an infection that causes a sharp burning pain in the dermatome supplied by the involved nerve. A few days later, the skin of the dermatome becomes red and vesicular eruptions appear. Vaccination is available for people 50+.

Pulmonary collapse

If a sufficient amount of air enters the pleural cavity, the surface tension adhering visceral to parietal pleura (lung thoracic wall) is broken, and the lung collapses because of its inherent elasticity (elastic recoil). When a lung collapses (atelectasis), the pleural cavity - normally a potential space - becomes a real space. Mediastinal shift, diaphragm upshift, and the appearance of a white lung (denser) on radiography will occur. One lung may be collapsed after surgery, for example, without collapsing the other because the pleural sacs are separate.

Pericarditis and pericardial effusion

Inflammation of the pericardium (pericarditis) usually causes chest pain. Pericarditis makes the serous pericardium rough and the resulting friction, pericardial friction rub, sounds like the rustle of silk when listening with a stethoscope. Certain inflammatory diseases may also produce pericardial effusion (passage of fluid from the pericardial capillaries into the pericardial cavity). As a result, the heart becomes compressed (unable to expand and fill, cardiac tamponade) and is ineffectual.

Injury to radial nerve, including wrist-drop

Injury to the radial nerve superior to the origin of its branches to the triceps brachii results in paralysis of the triceps, brachioradialis, supinator, and extensor muscles of the wrist and fingers. Loss of sensation occurs in areas of skin supplied by this nerve. The characteristic clinical sign of radial nerve injury is wrist-drop (inability to extend the wrist and fingers at the metacarpophalangeal joints). Instead, the wrist remains in the flexed position because of unopposed tonus of the flexor muscles and gravity.

What primary, overall function does joint movement in the thoracic wall serve?

Joint movement in the thoracic wall and diaphragm leads to inspiration and exhalation during respiratory movement.

Fun fact for pain of the shoulder

Know that the phrenic nerves (C3-C5) are responsible for sensory information (including pain), which is commonly transferred to the ipsilateral (same side) shoulder region via dermatomes. (pg. 220, under "nerve supply of the pericardium").

What are some warning signs on the breast a person should look for?

Lymphedema (edema, excess fluid in subcutaneous tissue) in the skin, Prominent "puffy" skin between dimpled pores gives it an orange appearance (peau d'orange). Larger dimples result from cancerous invasion of the glandular tissue and fibrosis (fibrous degeneration), which causes shortening or places traction on the supersensory ligaments. Subareolar breast cancer may cause inversion of the nipple by a similar mechanism involving the lactiferous ductus. Enlargement of nodes suggests the possibility of breast cancer early on.

Does breast cancer in men have the same effects as in women?

More or less the same. A visible and/or palpable subareolar mass or secretion from a nipple may indicate a malignant tumor. Breast cancer in males tends to infiltrate the pectoral fascia, pectoralis major, and apical lymph nodes in the axilla.

Pulmonary embolism

Obstruction of a pulmonary artery by a blood clot (embolus) is a common cause of morbidity and mortality. An embolus in a pulmonary artery forms when a blood clot, fat globule, or air bubble travels in the blood to the lungs from a leg vein. The embolus passes through the right side of the heart to a lung through a pulmonary artery. The embolus may block a pulmonary artery - pulmonary embolus - or one of its branches. The obstruction results in a sector of the lung that is ventilated but not perfused with blood. Large embolism may lead to acute respiratory distress. Medium sized embolus may block an artery supplying a bronchopulmonary segment, producing a pulmonary infarct, an area of necrotic (dead) lung tissue.

Anterior compartment of the arm will flex the elbow

Of the four arm muscles, three flexors (biceps brachii, brachialis, and coracobrachialis) are in the anterior (flexor) compartment and are supplied by the musculocutaneous nerve.

Posterior compartment of arm will extend the elbow

One three headed extensor muscle (triceps brachii) is in the posterior compartment, supplied by the radial nerve.

Dislocation of elbow joint

Posterior dislocation of the elbow joint may occur when children fall on their hands with their elbows flexed. Dislocations of the elbow may result from hyperextension or a blow that drives the ulna posteriorly or posterolaterally. The distal end of the humerus is driven through the weak anterior part of the fibrous layer of the joint capsule as the radius and ulna dislocate posteriorly. Injury to the ulnar nerve may also occur.

Rupture of tendon of long head of biceps

Rupture of the tendon of the long head of the biceps usually results from wear and tear of an inflamed tendon (biceps tendinitis). Normally, the tendon is torn from its attachment to the supraglenoid tubercle of the scapula. Commonly dramatic and is associated with a snap or pop. The detached muscle belly forms a ball near the center of the distal part of the anterior aspect of the arm (Popeye deformity).

Rotator cuff injuries (which is the muscle most commonly injured?)

Rupture or tear of the supraspinatus tendon is the most common injury of the rotator cuff. Degenerative tendinitis of the rotator cuff is common, especially in older people.

Conducting system of the heart i. Identify: 1. SA (sinu-atrial) node 2. AV (atrioventricular) node 3. AV bundle 4. Right and left bundle branches 5. Subendocardial branches (aka Purkinje fibers)

SUMMARY: The SA node initiates and regulates the impulses for contraction. The signal generated by the SA node passes through the walls of the right atrium propagated by the cardiac muscle (myogenic conduction), which transmits the signal rapidly from the SA node to the AV node. This then distributes the signal to the ventricles through the AV bundle (bundle of His). Bundle of his passes signal down the IV separation to the left and right and left bundle branches. The bundles proceed to the rest of the heart via subendocardial branches (Purkinje fibers).

Dislocation of Ribs

Slipping rib syndrome (dislocation of the ribs) or dislocation of the sternocostal joint is the displacement of a costal cartilage from the sternum. A rib separation refers to dislocation of a costochondral junction between the rib and its costal cartilage.

Subluxation and dislocation of radial head

Small girls are particularly vulnerable to transient subluxation (incomplete temporary dislocation) of the head of the radius (pulled elbow). Sudden lifting usually causes this. It tears the distal attachment of the anular ligament, where it is loosely attached to the neck of the radius. The radial head then moves distally, partially out of the anular ligament. The proximal part of the torn ligament may become trapped between the head of the radius and the capitulum of the humerus. The source of pain is the pinched anular ligament. The treatment of subluxation consists of supination of the child's forearm while the elbow is flexed. The tear in the anular ligament soon heals when the limb is placed in a sling for about 2 weeks.

Ulna

Stabilizing bone of the forearm, medial and longer of the two forearm bones. Its proximal end has two projections - the olecranon posteriorly and the coronoid process anteriorly; they form the walls of the trochlear notch. The trochlear notch of the ulna articulates with the trochlea of the humerus. On the lateral side of the coronoid process is a smooth, rounded concavity, the radial notch, which articulates with the head of the radius. At its narrow distal end is the rounded head of ulna with the small, conical ulnar styloid process. The ulna does not articulate with the carpal bones. It is separated from the carpals by a fibrocartilaginous articular disc.

Stenosis - Valvular heart disease

Stenosis (narrowing) is the failure of a valve to open fully, slowing blood flow from a chamber.

Sternocalvicular Joints

Sternal end of clavicle manubrium of sternum and first costal cartilage - Synovial (saddle) joint - Diarthrosis - Elevation, depression, circumduction

Location of the transverse pericardial sinus

The aorta and pulmonary trunk leave the heart; a finger can be inserted through the transverse pericardial sinus located posterior to these large vessels and anterior to the SVC

Carpal tunnel

The carpel tunnel is the passageway deep to the flexor retinaculum between the tubercles of the scaphoid and the trapezium bones on the lateral side and the pisiform and the hook of hamate on the medial side.

In addition to the mammary glands, what else contributes to the size and shape of the breast?

The contour and volume of the breasts are produced by subcutaneous fat except during pregnancy, when the mammary glands enlarge and new glandular tissue forms. During puberty, the female breasts normally grow because of glandular development and increased fat deposition. Breast size and shape result from genetic and nutritional factors.

Identify pulmonary arteries, pulmonary veins, pulmonary trunk i. What is different about pulmonary arterires and veins compared to other arteries and veins in the body (where is oxygenated/deoxygenated blood found?)

The large left and right pulmonary arteries arise from the pulmonary trunk at the level of the sternal angle. The pulmonary arteries carry poorly oxygenated (venous) blood to the lungs for oxygenation. The pulmonary arteries pass to the corresponding lung as part of its root. The pulmonary veins carry well-oxygenated (arterial) blood from the lungs to the left atrium of the heart.

Left Atrium

The left atrium receives blood from the pulmonary circuit. This is oxygen-rich blood. The pairs of valve-less right and left pulmonary veins enter the left atrium. Four pulmonary veins (usually right and left superior and inferior) enter its posterior wall.

Left Ventricle 1. Identify: a. Mitral valve (aka bicuspid valve or left atrioventricular (AV) valve) Aortic valve

The left ventricle receives blood from the left atrium via the bicuspid valve. This is oxygen rich blood. Because arterial pressure is much higher in the systemic than in the pulmonary circulation, the left ventricles preforms more work than the right ventricle, and thus has more muscle.

What is the primary function of the lungs?

The lungs are the vital organs of respiration. Their main function is to oxygenate the blood by bringing inspired air into close relation with the venous blood in the pulmonary capillaries.

Triceps Brachii

The muscle that extends the elbow, three heads. - Action: extension and adduction of the humerus at the shoulder (long head only); Extension of the elbow (whole group) - Skeletal Attachments: Glenoid Cavity and Joint Capsule (long head); Posterior surface of head of humerus (lateral head); posterior surface of humeral shaft (medial head); Olecranon process of ulna; Fascia of forearm

Parasympathetic supply - which nerve carries the parasympathetic supply to the heart and what is the effect on the heart when activated

The parasympathetic supply of the heart is from presynaptic fibers of the vagus nerve (CN X). Postsynaptic parasympathetic cell bodies are located near the SA and AV nodes and along the coronary arteries. Parasympathetic stimulation slows the heart rate, reduces the force of the contraction, and constricts the coronary arteries, saving energy between periods of increased demand.

Right ventricle a. Identify: i. Trabeculae carneae - irregular muscular elevations ii. Tricuspid valve (aka right atrioventricular (AV) valve) iii. Tendinous cords (chordae tendineae) - know its function: functions to hold AV valve closed during contraction to prevent backflow iv. Papillary muscles v. Interventricular septum vi. Septomarginal trabecular (moderator band) - functions as a "shortcut" in the cardiac conduction system for papillary muscles. Closes AV valve. vii. Pulmonary valve

The right ventricle forms the largest part of the anterior surface of the heart, a small part of the diaphragmatic surface, and almost the entire inferior border of the heart. This receives oxygen-poor blood from the right ventricle. Blood leaves the right ventricle via the pulmonary valve to go into the pulmonary circuit.

What structures pass through the inferior thoracic aperture?

The thoracic cavity communicates with the abdomen through the inferior thoracic aperture, the anatomical thoracic outlet. The diaphragm closes the inferior thoracic aperture, separating the thoracic and abdominal cavities almost completely. Structures passing to or from the thorax and abdomen pass through openings in the diaphragm (ex - the inferior vena cava (IVC) and esophagus) or posterior to it (ex - aorta).

What structures pass through the superior thoracic aperture?

The thoracic cavity communicates with the neck and upper limb through the superior thoracic aperture, the anatomical thoracic inlet. Structures entering and leaving the thoracic cavity through this aperture include the trachea, esophagus, vessels, and nerves. Look at pic above

What bones are included in the thoracic cage?

The thoracic skeleton forms the osteocartilaginous thoracic cage. This skeleton includes 12 pairs of ribs and costal cartilages, 12 thoracic vertebrae and intervertebral discs (IV), and the sternum.

How many pairs of ribs are normally present?

There are normally 12 pairs of ribs.

Surgical entry into the thorax - Where do surgeons cut to gain entry to the mediastinum? What about for minimally invasive procedures?

To gain wide access to the thoracic cavity for surgical procedures in the mediastinum, the sternum is divided (split) in the median plane (median sternotomy) and retracted (ex - for coronary artery bypass grafting). Lateral thoracotomy through intercostal spaces provides wide access to the pulmonary cavities. However, minimally invasive thoracic surgery (thorascopy) allows access to the thorax through small intercostal incisions for many intrathoracic procedures.

Ulnar nerve injury

Ulnar nerve injury usually occurs in one of four places: (1) posterior to the medial epicondyle of the humerus (most common), (2) in the cubital tunnel formed by the tendinous arch connecting the humeral and ulnar heads of the FCU, (3) at the wrist, and (4) in the hand. Ulnar canal syndrome is manifest by hypoesthesia in the medial one- and one-half fingers and weakness of the intrinsic hand muscles, but in contrast to proximal ulnar nerve injury, their ability to flex is unaffected, and there is no radial deviation of the hand.

What other methods are used to visualize the breast?

Ultrasonography (US) is useful for looking at formations palpated but not clearly observed on a mammogram, especially in women with dense breast tissue, and to gain more info. US is a noninvasive means of distinguishing fluid-filled cysts or abscesses from solid masses; can also be used to guide a biopsy needle. MRI is used to further examine problems detected by mammography or US, to rule out false positive findings, and to plan retirement.

Valvular insufficiency of the heart

Valvular insufficiency, or regurgitation, is failure of the valve to close completely, usually owing to nodule formation on (or scarring and contraction of) the cusps so that the edges do not meet or align.

Variations of the brachial plexus: (prefixed or postfixed)

Variations in the brachial plexus formation are common. In addition to the five anterior rami (C5-T1) that form the roots of the plexus, small contributions may be made by the anterior rami of C4 or T2. When the superiormost root of the plexus is C4 and the inferiormost root is C8, it is called a prefixed brachial plexus. Alternatively, when the superior root is C6 and the inferior root is T2, it is a postfixed brachial plexus. In the latter type, the inferior trunk of the plexus may be compressed by the 1st rib, producing neurovascular symptoms in the upper limb.

Cardiac cycle

We will not go into this process during this class, but you should know definitions of these terms: 1. Cardiac cycle: describes the complete movement of the heart or heartbeat and includes the period from the beginning of one heartbeat to the beginning of the next one. 2. Diastole: a period of ventricular elongation and filling 3. Systole: ventricular shortening and emptying

Metacarpals

forms the skeleton of the palm of the hand between the carpus and the phalanges. It is composed of five metacarpal bones. Each of these bones consists of a base, a shaft, and head. The proximal bases of the metacarpals articulate with the carpal bones, and the distal heads of the metacarpals articulate with the proximal phalanges and form the knuckles.

Manubriosternal Joint

joint between manubrium and body of the sternum - Cartilaginous symphysis (often fuses into synostosis); amphiarthrosis

Xiphisternal joint

joint between the Xiphoid process and body of the sternum - Cartilaginous symphysis (often fuses into synostosis); amphiarthrosis

Ligamentum arteriosum

this is a remnant similar to the fossa ovalis. During the fetal period, blood bypasses the lungs through a vessel called the ductus arteriosus. The ductus arteriosus takes blood directly from the left pulmonary artery directly to the aorta (instead of going toward the lungs). From the aorta, blood will travel throughout the body before returning to the heart. After birth, when the placenta is no longer supplying oxygen, blood from the pulmonary trunk must go to the lungs to receive oxygen. The ductus arteriosus closes at birth to allow this. After a few months, this vessel fully closes, but you can still see a remnant: the ligamentum arteriosum. Look for this between the left pulmoary artery and the aorta.

axillary nerve

this nerve Innervates: glenohumeral joint; teres minor and deltoid muscles, skin of superolateral arm (over inferior part of deltoid)

the flexor retinaculum

transverse carpal ligament

Deltoid

your shoulder muscle; has multiple heads - Action: abduction, flexion, extension, Median rotation and lateral rotation of the humerus at the shoulder - Skeletal Attachments: Acromion and spine of scapula; clavicle; Deltoid tuberosity of the humerus

Intercarpal joints

Adjacent bones in proximal row of carpal bones. Adjacent bones in distal row of carpal bones. Adjacent bones between proximal and distal rows (midcarpal joints) - Synovial plane joints - Diarthrosis - Gliding

Wrist Fractures and dislocations

Anterior dislocation of the lunate is an uncommon but serious injury that usually results from a fall on the dorsiflexed wrist. The displaced lunate may compress the median nerve and lead to carpal tunnel syndrome. Because of its poor blood supply, avascular necrosis of the lunate may occur. In some cases, excision of the lanate may be required. In degenerative joint disease of the wrist, surgical fusion of carpals (arthrodesis) may be necessary to relieve the severe pain. Fracture-Separation of the distal radial epiphysis is common in children because of frequent falls in which forces are transmitted form the hand to the radius.

What parts of thoracic vertebrae are adapted for rib attachment? Where, specifically, do ribs attach to thoracic vertebrae?

Characteristic features of thoracic vertebrae include: - Bilateral superior and inferior costal facets (demifacets) on their bodies for articulation with the heads of ribs; atypical thoracic vertebrae have a single whole costal facet in place of the demifacets - Costal facets on their transverse processes for articulation with the tubercles of ribs, except for the inferior two or three thoracic vertebrae. - Long inferiorly slanting spinous processes that overlap the IV disc and vertebra below.

Arteries of the Upper Limbs

Following the branching of the vertebral artery, the subclavian artery will rise above the clavicle then will being to descend towards the axillary space. As it passes the first rib, the subclavian artery will be renamed the axillary artery, then will be renamed the brachial artery as it passes the "loop" of the circumflex humeral artery. The brachial artery gives off the superior ulnar collateral artery, which unites with the ulnar artery distal to the elbow. As the brachial artery passes the elbow, it bifurcates into the radial and ulnar arteries. The radial artery supplies the lateral and posterior forearm muscles while the ulnar artery nourishes the medial and anterior forearm muscles. The two vessels join to form the deep palmar arch and the superficial palmar arch which supply the palmar region of the hands and the digits

Fractures of hand - specifically of the scaphoid

Fracture of the scaphoid often results form a fall on the palm with the hand abducted. The fracture occurs across the narrow part of the scaphoid. Pain occurs primarily on the lateral side of the wrist, especially during dorsiflexion and abduction of the hand. Initial radiographs of the wrist may not reveal a fracture, but radiographs taken 10-14 days later may reveal a fracture because bone resorption has occurred. Owing to the poor blood supply to the proximal part of the scaphoid, union of the fractured parts may take several months. Avascular necrosis of the proximal fragment of the scaphoid (pathological death of bone resulting from poor blood supply) may occur and produce degenerative joint disease of the wrist.

Aneurysm of ascending aorta

The distal part of the ascending aorta receives a strong thrust of blood when the left ventricle contracts. Because its wall is not yet reinforced by fibrous pericardium, an aneurysm (localized dilation) may develop. An aortic aneurysm is evident on a chest film or an MRI angiogram as an enlarged area of the ascending aorta silhouette. Chest pain that radiates in the back may occur; difficulty breathing and swallowing.

Posterior compartment of forearm will extend the wrist

The extensors and supinators of the forearm are in the posterior compartment and are all innervated by the radial nerve. Muscles may be organized into three functional groups: 1) Muscles that extend and abduct or adduct the hand at the wrist joint: extensor carpi radialis longus (ECRL), extensors carpi radialis brevis (ECRB), and extensor carpi ulnaris (ECU). 2) Muscles that extend the medial four digits: extensor digitorum, extensor indicis, and extensor digiti minimi (EDM). 3) Muscles that extend or abduct the thumb: abductor pollicis longus (APL), extensor pollicis brevis (EPB), and extensor pollicis longus (EPL).

What are the main functions of the fibrous pericardium?

The fibrous pericardium protects the heart against sudden overfilling because it is unyielding and closely related to the great vessels that pierce it superiorly and posteriorly.

Anterior compartment of the forearm will flex the wrist

The flexor-pronators of the forearm are in the anterior compartment and are served mainly by the median nerve; the one and a half exceptions are innervated by the ulnar nerve. Superficial layer or group: pronator teres, flexor carpi radialis (FCR), palmaris longus, and flexor carpi ulnaris (FCU). Intermediate layer or group: flexor digitorum superficialis (FDS). Deep layer or group: flexor pollicis longus (FPL)

Variations of great arteries

The most superior part of the arch of the aorta is usually approximately 2.5 cm inferior to the superior border of the manubrium, but it may be more superior or inferior. Sometimes, the arch curves over the root of the right lung and passes inferiorly on the right side, forming a right arch of the aorta. Less frequently, a double arch of the aorta or retro-esophageal right subclavian artery forms a vascular ring around the esophagus and trachea. If the trachea is compressed enough to affect breathing, surgical division of the vascular ring may be needed.

What is found between the two layers of the serous pericardium? What is the purpose of this fluid?

The pericardial cavity is the potential space between the opposing layers of the parietal and visceral layers of serous pericardium. It normally contains a thin film serous fluid that enables the heart to move and beat in a frictionless environment.

What is between the visceral and parietal pleurae? What is its function?

The pleural cavity - the potential space between the visceral and the parietal layers of pleura - contains a capillary layer of serous pleural fluid, which lubricates the pleural surfaces and allows the layers of pleura to slide smoothly over each other during respiration. Its surface tension also provides the cohesion that keeps the lung surface in contact with the thoracic wall.

Right Atrium 1. Identify: a. right auricle b. pectinate muscles c. opening of superior and inferior vena cava (SVC and IVC) d. opening of the coronary sinus e. Oval fossa (aka fossa ovalis): remnant of the oval foramen (aka foramen ovale). During the fetal period (before birth), the right and left atria are connected by an opening, the foramen ovale. During the fetal period, blood between the right and left atria is allowed to mix via this opening. After birth, this opening closes but you can see the remnant, which is the fossa ovalis/oval fossa. f. Interatrial septum - muscle that separates the left and right atrial chambers

The right atrium forms the right border of the heart and receives venous blood from the SVC, IVC, and coronary sinus. This blood is oxygen-poor, as it is returning from the body circuit and heart circuit.

Thoracotomy - after rib removal, regeneration of ribs occurs from the intact periosteum (don't worry about knowing how to do the specific surgical procedures)

The surgical creation of an opening through the thoracic wall to enter a pleural cavity is called a thoracotomy. Following surgery, the missing pieces of ribs regenerate from the intact periosteum, although imperfectly. In many cases, intrathoracic surgery can be performed using a minimally invasive endoscopic approach.

Does the cartilage of the trachea continue all the way around?

The walls of the trachea and bronchi are supported by C-shaped rings of hyaline cartilage. They do NOT continue all the way around the trachea.

Sympathetic supply -results on the heart when activated

The sympathetic supply of the heart is from presynaptic fibers with cell bodies in the intermediolateral cell columns (lateral horns) of the superior five or six thoracic segments of the spinal cord and form postsynaptic sympathetic fibers with cell bodies in the cervical and superior thoracic paravertebral ganglia of the sympathetic trunks. Sympathetic stimulation of the nodal tissue increases the rate and force of the heart's contractions. It indirectly produces dilation of the coronary arteries by inhibiting their constriction. This supplies more oxygen and nutrients to the myocardium during periods of increased activity.

Biceps tendinitis

The tendon of the long head of the biceps, enclosed by a synovial sheath, moves back and forth in the intertubercular sulcus (groove) of the humerus. Wear and tear of this mechanism can cause shoulder pain. Inflammation of the tendon (biceps tendinitis) usually is the result of repetitive microtrauma in sports involving throwing.

What structures are included in the thoracic wall?

The thoracic wall consists of skin, fascia, nerves, vessels, muscles, cartilages, and bones. The mammary glands of the breasts are located in the subcutaneous tissue overlying the pectoral muscles covering the anterolateral thoracic wall.

Age changes in thymus

The thymus is a prominent feature of the superior mediastinum during infancy and childhood. In some infants, the thymus may compress the trachea. The thymus plays a role in development and maintenance of the immune system. As puberty is reached, the thymus begins to diminish in relative size. By adulthood, it is usually replaced by adipose tissue and is often scarcely recognizable; however, it continues to produce T cells.

1Rib fractures - Where is the weakest part of a rib? What is the danger of a broken rib?

The weakest part of a rib is just anterior to its angle. Rib fractures commonly result from direct blows or indirectly from crushing injuries. The middle ribs are most commonly fractured. Direct violence may fracture a rib anywhere, and its broken ends may injure internal organs such as a lung or the spleen

Bronchoscopy

When examining the bronchi with a bronchoscope - an endoscope for inspecting the interior of the tracheobronchial tree for diagnostic purposes - one can observe a ridge, the carina, between the orifices of the main bronchi. The carina is a cartilaginous projection of the last tracheal ring. If the tracheobronchial lymph nodes in the angle between the main bronchi are enlarged because cancer cell shave metastasized from a bronchogenic carcinoma, the carina can be distorted, widened posteriorly, and immobile.

Dyspnea - Difficult Breathing

When people with respiratory problems such as asthma or emphysema or with heart failure struggle to breathe, they use their accessory respiratory muscles to assist the expansion of their thoracic cavities. Recruitment of neck muscles occurs.

Fun fact about elevation of the arm

1. For every 3 degrees of elevation of the arm, approximately 2 degrees occur at the glenohumeral joint and 1 degree at the scapulothoracic joint. (The movement of the scapula plays an important role in arm movement.)

Veins of the upper limbs

1. Superficial veins of the upper limbs: a) The cephalic vein begins in the radial part of the dorsal aspect of the hand, ascends along the radial side of the forearm, passes between the pectoralis major and deltoid muscles and ends in the subclavian vein. b) The basilic vein begins in the ulnar part of the dorsal aspect of the hand, ascends along the ulnar side of the forearm, and then joins the brachial vein to form the axillary vein of that side. It drains blood from the hand, forearm, and arm. It is the largest of superficial veins. C) the median cubital (basilic) vein connects the cephalic and bacilic veins ventral to the elbow. It is the vein of choice for transfusions and venipuncture 2. Deep veins of the upper limbs: A) two radial veins drain blood from the palm and lateral muscles and skin of the forearm, and travel proximally along the radius B) Two ulnar veins drain blood from the medial side of the arm and the palm, and travel proximally along the ulna. C) Two Brachial Veins are formed at the elbow by the union of the radial and ulnar veins. They ascend ventral to the elbow joint before uniting in the brachial region of the arm. D) The axillary vein is formed by the union of the basilic and brachial veins. It travels through the axillary region before uniting with the cephalic vein. It is renamed as the subclavian vein at the lateral region of the first rib. E) the subclavian vein is the end of the venous system of the upper extremity. At the sternal end of the clavicle, it unites with the internal jugular vein to form the brachiocephalic vein of that side.

The 3 classes of ribs.

1. True (vertebrosternal) ribs: (1st to 7th ribs) attach directly to the sternum anteriorly through their own costal cartilages. 2. False (vertebrochondral) ribs: (8th to 10th ribs) have cartilages on their anterior ends that are joined to the cartilage of the rib just superior to them; thus, their connection with the sternum is indirect. 3. Floating (Free) ribs: (11th and 12th ribs; sometimes the tenth rib) have rudimentary cartilages on their anterior end that do not connect even indirectly with the sternum; instead, they end in the posterior abdominal musculature.

Colles fracture

A complete fracture of the distal 2 cm of the radius, called a colles fracture, is the most common fracture of the forearm. The distal fragment of the radius is displaced dorsally and often comminuted (broken into pieces). Usually results from dorsiflexion when breaking a fall. Often, the ulnar styloid process is avulsed (broken off). Normally, the radial styloid process projects farther distally than the ulnar styloid process; consequently, when a colles fracture occurs, this relationship is reversed because of shortening of the radius. This fracture is often referred to as a dinner fork deformity.

Branching of the bronchial tree:

The right main bronchus is wider and shorter and runs more vertically than the left main bronchus as it passes directly to the hilum of the right lung. The left main bronchus passes inferolaterally, inferior to the arch of the aorta and anterior to the esophagus and thoracic aorta, to reach the hilum of the left lung. Each main bronchus divides into lobar bronchi (secondary bronchi), two on the left and three on the right, each of which supplies a lobe of the lung. Each lobar bronchus divides into segmental bronchi (tertiary bronchi) that supply the bronchopulmonary segments. Beyond the segmental bronchi, there are 20-25 generations of branches that end in terminal bronchioles. Each bronchopulmonary segment is pyramidal, with its apex directed toward the root of the lung and its base at the pleural surface and is named according to the segmental bronchus that supplies it. Each bronchopulmonary segment is supplied independently by a segmental bronchus and a tertiary branch of the pulmonary artery and is drained by intersegmental parts of the pulmonary veins. Each terminal bronchiole gives rise to several generations of respiratory bronchioles and each respiratory bronchiole provides 2-11 alveolar ducts, each of which gives rise to 5 or 6 alveolar sacs. The pulmonary alveolus is the basic structural unit of gas exchange in the lung

Identify the vagus nerves and phrenic nerves and their major functions in the thoracic cavity

The vagus nerves (CN X) arise bilaterally from the medulla of the brain, exit the cranium, and descend through the neck posterolateral to the common carotid arteries. Each nerve enters the superior mediastinum posterior to the respective sternoclavicular joint and brachiocephalic joint. It acts in the parasympathetic stimulation of the heart. The phrenic nerves are the sole motor supply to the diaphragm.

Injury to pleurae

The visceral pleura is insensitive to pain because its innervation is autonomic. The parietal pleura is sensitive to pain because it is richly supplied by branches of the somatic intercostal and phrenic nerves.

Layers of the heart wall and what tissue they are composed of

The wall of the heart consists of three layers as described as follows form superficial to deep: Epicardium: a thin external layer (mesothelium) formed by the visceral layer of serous pericardium Myocardium: thick middle layer composed of cardiac muscle Endocardium: a thin internal layer (endothelium and subendothelial connective tissue) or lining membrane of the heart that also covers its valves.

Radius

lateral and shorter of the two forearm bones. Its proximal end consists of a cylindrical head, a short neck, and a projection from the medial surface, the radial tuberosity. Proximally, the smooth superior aspect of the head of the radius is concave for articulation with the capitulum of the humerus. The head also articulates with the radial notch of ulna. The neck of the radius is the narrow part between the head and the radial tuberosity. The medial aspect of the distal end of the radius forms a concavity, the ulnar notch, which accommodates the head of the ulna. Its lateral aspect terminates distally as the radial styloid process.

Arteries of the Chest

Arterial blood from the Aortic Arch: as the heart pumps blood, it enters the ascending aorta which curves to form the aortic arch, and then turns inferiorly as the descending aorta. The siginifcance of the aortic arch is that it gives off three arterial bracnhes in this order: the 1. Brachiocephalic trunk, the 2. left common carotid artery and the 3. left subclavian artery. 1. The brachiocephalic trunk ascends a short distance before bifurcating into the right subclavian artery and the right common carotid artery. A) on both the right and left sides of the body, the subclavian artery will branch laterally, giving off the vertebral artery, which ascends through the transverse foramina of the cervical vertebrae and enters the foramen magnum at the base of the skull. The right and left vertebral arteries join the single basilar artery at the base fo the brain, which contributes to the formation of the Circle of Willis. B) Following the branching of the vertebral artery, the subclavian artery will rise above the clavicle then will begin to descend towards the axillary space. As it passes the first rib, the subclavian artery will be renamed the axillary artery. C) The right common carotid artery rises cranially parallel to the trachea. It bifurcates into the internal carotid artery and the external carotid artery. 2. The Left common carotid artery branches off of the aorta and continues to bifurcate in the same fashion as the right common carotid artery. 3. The left Subclavian artery will branch off of the aorta, giving off arterial branches similar to the right subclavian artery.

Aspiration of foreign bodies

Because the right bronchus is wider and shorter and runs more vertically than the left bronchus, aspirated foreign bodies are more likely to enter and lodge in it or one of its branches. A potential hazard encountered by dentists is an aspirated foreign body, such as a piece of tooth or filling material.

Fractures of ulna and radius (we will discuss these in class) i. Why is fracture of one bone likely to be associated with dislocation of the nearest joint?

Because the shafts of these bones are firmly bound together by the interosseous membrane, a fracture of one bone is likely to be associated with dislocation of the nearest joint.

Coronary atherosclerosis

Buildup of plaques in the coronary arteries leads to stenosis of arteries. Insufficiency of blood supply to the heart (myocardial ischemia) may result in MI.

Cardiac tamponade

Cardiac Tamponade (heart compression) is a potentially lethal condition because the fibrous pericardium is tough and inelastic. Consequently, heart volume is increasingly compromised by the fluid outside the heart but inside the pericardial cavity. When there is a slow increase in the size of the heart, cardiomegaly, the pericardium gradually enlarges, allowing the enlargement of the heart to occur without compression. Gunshot wounds or stabs may lead to cardiac tamponade (hemopericardium). Circulation fails due to heart compression. Pericardiocentesis (drainage of serous fluid from the pericardial cavity) is usually necessary to relieve the cardiac tamponade.

Fractures of the humerus

Fractures of the surgical neck of the humerus are especially common in elderly people with osteoporosis. Even a low energy fall on the hand, with the force being transmitted up the forearm bones of the extended limb, may result in a fracture. Transverse fractures of the shaft of the humerus frequently result from a direct blow to the arm. Supra-epicondylar fractures may also occur. Since nerves are in contact with the humerus, they may be injured when the associated part of the humerus is fractured. i. Comminuted ii. Spiral iii. Transverse iv. Greenstick v. Compound vi. Oblique

Is a mastectomy as common as it used to be? What is the surgical norm now for breast cancer if cancerous tissue needs to be surgically removed?

In current practice, often only the tumor and surrounding tissues are removed - a lumpectomy or quadrantectomy (known as breast-conserving surgery, a wide local excision) - followed by radiation therapy.

Brachial plexus injuries

Injuries it the brachial plexus result in loss of muscular movement (paralysis) and loss of cutaneous sensation (anesthesia). In complete paralysis, no movement is detectable. In incomplete paralysis, not all muscles are paralyzed; therefore, the person can move, but those movements are hindered. Injuries to the superior parts of the brachial plexus (C5 and C6; Klumpke paralysis) usually result from an excessive increase in the angle between the neck and the shoulder. Being thrown from a vehicle or horse usually stretches or ruptures superior parts of the brachial plexus or avulses (tears) the roots of the plexus from the spinal cord. Upper brachial plexus injuries can also occur in a newborn when excessive stretching of the neck occurs during delivery - leads to Erb-Duchenne palsy. Chronic microtrauma to the superior trunk of the brachial plexus from carrying a heavy backpack can produce motor and sensory deficits in the distribution of the musculocutaneous and radial nerves. Injuries to inferior parts of the brachial plexus (klumpke paralysis) are much less common. These injuries may occur when the upper limb is suddenly pulled superirorly. These events injure the inferior trunk of the plexus (C8 and T1) and may avuls the roots of the spinal nerves from the spinal cord. The short muscles of the hand are affected and a claw hand results.

Myocardial infarction

With sudden occlusion of a major artery by an embolus (plug), the region of myocardium supplied by the occluded vessel becomes infarcted (rendered virtually bloodless) and undergoes necrosis. Three most common sites: the anterior IV (LAD) branch of the LCA (40-50%); the RCA (30-40%); and the circumflex branch of the LCA (15-20%).

Humerus

largest bone in the upper limb; articulates with the scapula at the glenohumeral joint and the radius and ulna at the elbow joint. The head of the humerus articulates with the glenoid cavity of the scapula. The intertubercular sulcus (bicipital groove) of the proximal end of the humerus separates the lesser tubercle from the greater tubercle. Just distal to the humeral head, the anatomical neck of the humerus separates the head from the tubercles. Distal to the tubercles is the narrow surgical neck of the humerus. The shaft of the humerus has two prominent features: the deltoid tuberosity laterally and the radial groove (groove for spinal nerve, spiral groove) posteriorly for the radial nerve and profunda brachii artery. The inferior end of the humeral shaft widens as the sharp medial and lateral supra-epicondylar ridges form then end distally in the prominent medial epicondyle and lateral epicondyle. The distal end of the humerus makes up the condyle of the humerus. It has two articular surfaces: a lateral capitulum for articulation with the head of the radius and a medial trochlea for articulation with the trochlear notch of the ulna. Superior to the trochlea anteriorly is the coronoid fossa, which receives the coronoid process of the ulna during full flexion of the elbow. Posteriorly, the olecranon fossa accommodates the olecranon of the ulna during extension of the elbow. Superior to the capitulum anteriorly, the shallow radial fossa accommodates the edge of the head of the radius when the elbow is fully flexed.

Polapsed Mitral Valve

A prolapsed mitral valve is an insufficient or incompetent valve which one or both leaflets are enlarged, redundant, or floppy, and extending back into the left atrium during systole. As a result, blood regurgitates into the left atrium when the left ventricle contracts, producing a characteristic murmur.

Sternocostal joint

A) Sternum and first pair of ribs - forms cartilaginous (synchrondosis) joint; synarthrosis; No movement between sternum and first ribs B) Sternum and pairs of ribs 2-7 - forms Synovial (plane) joints; diarthrosis; some gliding movement permitted between sternum and ribs 2-7

Ossification of the clavicle - which ossification process is used inititally?

The clavicle is the first long bone to ossify (via intramembranous ossification). The ends of the clavicle later pass through a cartilaginous phase (endochondral ossification); the cartilages form growth zones similar to those of other long bones. A secondary ossification center appears at the sternal end and forms a scale-like epiphysis that begins to fuse with the shaft (diaphysis) between 18 and 25 years of age; completely fused by 25-31 years. An even smaller scale-like epiphysis may be present at the acromial end of the clavicle; it must not be mistaken for a fracture. Sometimes, fusion of the two ossification centers of the clavicle fails to occur; as a result, a bony defect forms between the lateral and the medial thirds of the clavicle. Awareness of this possible birth defect should prevent diagnosis of a fracture in an otherwise normal clavicle. When doubt exists, both clavicles are radiographed because this defect is usually bilateral.

Identify: i. all lobes and fissures of each lung ii. cardiac notch iii. Hilum and root iv. Costal surface, medastinal surface, diaphragmatic surface v. Anterior border, inferior border, posterior border

i. The horizontal and oblique fissures divide the lungs into lobes. The right lung has three lobes; the left lung has two. ii. The anterior margin of the right lung is relatively straight, whereas this margin of the left lung has a cardiac notch. The notch primarily indents the antero-inferior aspect of the superior lobe of the left lung. iii. The hilum of the lung is the area on the medial surface of each lung at which the structures forming the root - the main bronchus, pulmonary vessels, bronchial vessels, lymphatic vessels, and nerves - enter and leave the lung iv. Three surfaces: costal surface, adjacent to the sternum, costal cartilages, and ribs; mediastinal surface, including the hilum of the lung and related medially to the mediastinum and posteriorly to the sides of the vertebrae; and diaphragmatic surface, resting on the convex dome of the diaphragm. v. Three borders: anterior border, where the costal and mediastinal surfaces meet anteriorly and overlap the heart (the cardiac notch indents this border of the left lung); inferior border, which circumscribes the diaphragmatic surface of the lung and separates the diaphragmatic surface from the costal and mediastinal surfaces; and posterior border, where the costal and mediastinal surfaces meet posteriorly (it is broad and rounded and lies adjacent to the thoracic region of the vertebral column)