Exam 2 : Anatomy NSU

What is hilton's law?

The nerves to the muscles acting on a joint give branches to that joint AS WELL as to the skin over the area of action of these muscles.

What are the axillary boundaries?

- INFERIOR to the glenohumeral joint and SUPERIOR to the skin of the axillary fold - three muscular walls 1. small lateral bony wall = intertubercular sulcus 2. posterior wall = scapular muscles (Humerus, Teres Major, Latissimus dorsi, subscapularis, and the scapula) 3. anterior wall = pectoral muscles (Pectoralis minor and major) 4. anterior axillary fold = inferior portion/border of the pectoralis major 5. posterior axillary fold = latissimus dorsi and teres major 6. medial wall = serratus anterior and 4th rib

What are some characteristics of the long head biceps brachii?

- content of the shoulder joint proper - visualize the tendon of origin of long head of biceps brachii (within a dissection) - have conjoined tendon that inserts into the radial tuberosity - ex. what you're working out at the gym (you're working out this muscle)

As the pitcher holds their arm superiorly, the pitcher will ___________

- extend, externally rotate, and ABduct the arm - sub scapularis will be firing a great deal!

What will side sleepers get at night?

- get ossifytes/spurs in the acromium - continual mictrotrauma to the supraspinatus (gets beat up between the bony acromion and bony humerus) - results in a degenerative tear of the supraspinatus

The winging scapula is _____________

- over retraction and no protraction

The radial nerve will provide ___________

- posterior cutaneous sensation of the limb - innervate all the posterior compartment (extensors of the forearm)

All the nerves of the brachial plexus will be posterior or anterior rami of spinal nerves?

- ventral rami! *fibers from efferent and afferent fibers come from anterior and posterior roots within the brachial plexus

All trapezius fibers contracting are going to have a ___________

-rotation of the axis on the scapula - glenoid is going to upwardly rotate to it

The vascularity pathway (ulnar and radial artery)

1. Aorta- coming out of the left ventricle 2. On the right side of the aortic arch we will have the brachiocephalic artery -> bifurcate into the common carotid and subclavian artery 3. subclavian artery = main artery in the upper EX 4. subclavian artery is going to have a branches in the upper neck, which will traverse beyond the lateral border of the 1st rib (change its name to the axillary artery) 5. axillary artery is going to run through the axilla and will run past teres major/ gets to the inferior border of the teres major -> will change its name to brachial artery 6. brachial artery will continue down the region of the arm and split in the region of the cuboidal fossa (split into ulnar and radial artery)

Continuation of Vascularity Pathway

1. Axillary artery coming down to the inferior border of teres major -> becomes the brachial artery 2. brachial artery gives off the profunda brachii artery will go to the radial groove (posterior mid humerus) which runs with the radial nerve 3. brachial artery will continue to the elbow pit (cubital fossa) which will give off the ulnar and radial branch 4. ulnar artery = is giving off the common interosseous arteries 5. common interosseous arteries will send off two branches (will bifurcate into anterior and posterior interosseous arteries) 6. anterior interosseous artery = pierces the interosseous membrane -> flexor compartment of the forearm 7. posterior interosseous arteries will remain on the posterior aspect of the limb -> pierce the interosseous membrane -> the extensor compartment

The area of axilla characteristics (Vulnerable region)

1. Prone to injury 2. lots of lymph nodes in this region (lymph node dissection) 3. tail of the mamillary gland (breast) is located here 4. Need to remove malignancy from this region 5. patients on crutches will irritate the nerve on this region 6. Masectomy 7. Masses and lymphadenopathy

In the medial arm centrally you can ___________

1. palpate the pulse 2. we can palpate the brachial artery pulse between the triceps and biceps

What occurs in the radial groove?

1. radial nerve and deep profundus brachial artery are running 2. region where the bone can break 3. these structures are at risk for mid-humeral fractures (stress risers)

The median nerve will _________

1. take a ride in the arm to the ante-brachium 2. head to the carpal tunnel 3. have difficulty/pain with carpal tunnel syndrome 4. do some hand muscles

What are the 3 parts of the axillary artery?

1st part = 1 branch (supreme/superior thoracic artery) 2nd part = 2 branches ( 1st branch = thoracoacromial and 2nd branch = lateral thoracic) 3rd part = 3 branches (anterior and posterior circumflex humeral artery and subscapular artery)

The shoulder joint is innervated, in part by which of the following nerves? A.Lateral and medial pectoral nerves B.Nerve to subclavius C.Long thoracic nerve D.Spinal accessory nerve E.Thoracodorsal nerve F.Dorsal scapular nerve G.Axillary nerve H.Suprascapular nerve I.Lower subscapular nerve J.Upper subscapular nerve K.Musculocutaneous nerve L.Radial

A.Lateral and medial pectoral nerves yes*pectoralis major and minor B.Nerve to subclavius - no subclavius does not cross the glenohumeral joint (shoulder) C.Long thoracic nerve - no serratus anterior D.Spinal accessory nerve - no trapezius E.Thoracodorsal nerve yes*via latissimus dorsi F.Dorsal scapular nerve - no levator scapula + rhomboids G.Axillary nerve yes*via deltoid H.Suprascapular nerve yes*via supraspinatus and infraspinatus I.Lower subscapular nerve yes*via subscapularis and teres major J.Upper subscapular nerve yes*via subscapularis K.Musculocutaneous nerve yes*via long head of biceps and coracobrachialis L.Radial yes*via long head of triceps brachii

The middle trapezius fibers are going to do ___________

ADDuction

Triangular interval boundaries and contents

BOUNDARIES: - teres major muscle (above) - lateral border of the long head of triceps muscle (medial) - lateral head of triceps muscle (lateral) CONTENTS: - radial nerve - deep brachial artery and vein

Triangular space boundaries and contents

BOUNDARIES: - teres minor muscle (above) - teres major muscle (below) - long head of triceps muscle (lateral) CONTENTS: - circumflex scapular artery and vein

Quadrangular space boundaries and contents

BOUNDARIES: - teres minor muscle (above) - teres major muscle (below) - long head of triceps muscle (medial) - surgical neck of humerus (lateral) CONTENTS: - axillary nerve - posterior circumflex humeral artery and vein

Where did the suprascapular nerve come from?

From the superior trunk to go to the supraspinatus/infraspinatus on the posterior view

What muscle are you dealing with when you have a throwing injury?

You are dealing with the subscapularis - acute rupture of the rotator cuff

The subacromial bursa is DEEP to the ______________ but is SUPERFICIAL to the __________.

acromium AND deep to the deltoid; superficial to the supraspinatus

We don't see the posterior cord of the brachial plexus on a _______ view.

anterior

The brachial plexus emerges between the __________

anterior and middle scalene muscles

The muscular cutaneous nerve is going to pierce the ____________

anterior compartment of the corticobrachialis, which will then innervate the rest of the anterior aspect of the arm (humeral region) - biceps brachii/brachialis

The tendon of subscapularis is a _________

anterior muscle

The radial nerve is going to run _________

anterior to the lateral epicondyle of the humerus *DANGER

The brachial artery will go ______ while the deep profundus brachial artery will go ____________.

anterior; posterior

The coracobrachialis is deep to the ___________

biceps brachii - ex. really working out the brachialis rather than biceps brachii but what you see from surface anatomy is the biceps brachii

Brachialis is going to be deep to the __________ and inferior to the __________

biceps brachii; coricobrachialis

The anterior portion of the posterior wall of the axilla is going to contain the ___________

bicipital groove

The deep/profundus brachial artery will anastomose with the branches of the _____________

brachial artery

If you're triaging and have a distally really bad injury you can apply your thumb/ heel of your hand to the _________

brachial artery - push the artery against the humerus, and stop the hemorrhaging distally

Radial nerve runs with what artery?

brachial artery (deep/profunda brachial artery) - running posterior to the humerus

What intermingles of nerves wrap around the axillary artery?

brachial plexus

What ligament is going to help hold the femoral head in the glenoid?

coracoacromial ligament

The basilic vein is ________ to the deep fascia.

deep *basilic vein is going to pierce the deep fascia and run along the brachial artery (and becomes a brachial vein or dumps into the axillary vein)

One branch of the brachial artery that goes posterior to the humerus is the _____________

deep/profundus brachial artery (also known as deep artery of the arm)

The serratus anterior is inserting _________ and heading to the ____________.

deep; medial border of the scapula anteriorly

The long head of triceps is ________ to the teres minor but ________ to the teres major.

deep; superficial

Coracobrachialis does NOT act upon the ________

elbow or forearm

When you bring the arm to reach the cabinet, the axilla will ________

flatten out quite a bit

Bicipetal Aponeurosis curves around the ______

flexors of the forearm and inserts into the deep fascia of the forearm

Deltoid is only going to get the humerus _____________

halfway to a neutral position

An example of the axillary fold is ______________

hanging from a chin up bar, and you can see your axilla (axillary fold is associated with this)

The suprascapular nerve can become ____________

impinged and cause weakness in the posterior aspects of the rotator cuff

The glenoid fossa is also called the _________

labrum - help hold the femoral head

The brachial artery will give off the radial branch which will go _______ and the ulnar branch which will go ___________.

lateral;medial

Where the arm is ABducted and the scapula is upwardly rotated we see a very prominent tissue of ___________

lymph nodes

The ulnar nerve is the direct continuation of the (choose one from below) : lateral cord posterior cord middle trunk medial trunk of the median nerve medial cord

medial cord!

The ulnar nerve is going to head down and be posterior/associated with the ____________

medial epicondyle of the humerus

The triceps brachii is going to be the most _________

medial triceps (long head of triceps brachii)

Supraspinatus will initiate ABduction and get the deltoid to _______

neutral

The long head of the triceps brachii muscle (choose one from below): passes between the humerus and the medial head of the triceps. passes between the teres major and teres minor muscles. flexes the arm. flexes the forearm. supinates the forearm.

passes between the teres major and teres minor muscles

The axillary artery will split into three parts defined by the ___________

pectoralis minor

The axillary nerve is going to innervate the deltoid and then its going to ____________

pierce the deep fascia and come out towards the skin and innervate the lateral portion of the shoulder

The axillary nerve is a branch of the ___________ cord.

posterior

The ulnar artery branch is going to end up supplying muscles of the __________

radial nerve

The larger branch of the posterior cord is the ___________

radial nerve (extensor nerve, which innervate the extensors)

The capsule of synoviam is going to hang down and have ___________

redudancy with the shoulder/glenohumeral joint

The circumflex humeral arteries will anastomose around the ____________

scapula and anastomose with the branches of the dorsal thoracic artery and suprascapular artery

The retraction of the scapula shows the weakness of the __________

serrates anterior (which will give protraction of the scapula)

The brachialis does NOT act on the ________

shoulder joint

The rotator cuff is trying to ___________

stabilize the humerus in the glenoid (relatively shallow glenoid) - NOT getting the power of the wind up from the infraspinatus and supraspinatus (small intrinsic muscles of the shoulder)

When you throw a ball, which muscle is most active on the wind up?

sub scapularis

At the lateral border of the 1st rib the ____________ will become the ____________

subclavian artery becomes the axillary artery

The long thoracic nerve of the serratus anterior is coming down to enter the muscle from the ___________

superficial side

The suprascapular artery is ________ to the transverse scapular ligament while the suprascapular nerve is _______ to the ligament.

superficial; deep

biceps brachii is a very strong ___________

supinator of the forearm!

Median nerve goes to the forearm and __________

supply some flexor muscles of the forearm

Which tendon is pinched between two bony structures?

supra spinatus

What is the innervation of infraspinatus?

suprascapular nerve ***DANGER - does NOT run with the suprascapular artery

What two nerves come off the superior trunk of the brachial plexus?

suprascapular nerve and nerve to subclavius

Suprascapular notch syndrome is expected to cause neurological pain from the _______________ and disability of the ____________________ muscle. dorsal scapular nerve/supraspinatus subscapular nerve/infraspinatus suprascapular nerve/supraspinatus subscapular nerve/subscapularis suprascapular nerve/subscapularis

suprascapular nerve/supraspinatus

Lower fibers of the subscapularis are also innervated by the same nerves as the _____________

teres major (lower subscapular nerve)

Posterior cord of the brachial plexus is made up of ____________

the posterior divisions of the superior, middle, and inferior trunks **DANGER

The ligament going over the superior notch of the scapula is the ____________

transverse scapular ligament

There's no nerve in the ______ space.

triangular space

The upper fibers and lower fibers of the trapezius are also know as ___________

upper fibers = descending fibers lower fibers = ascending fibers