Anatomy I Midterm Questions
Coracobrachialis (proximal and distal attachments, innervation and action):
-proximal attachment: top of coracoid process of scapula -distal attachment: middle third of medial surface of humerus -innervation: musculocutaneous nerve -action: flexes and adducts arm
What is a bursae? What are the 2 types?
-"Purse" of closed synovial sacs Develop in response to friction between tendon and bone, ligament or other tendons, or between bone and skin -2 types: communicating and non-communicating
How many ribs are there? Which ribs are "true", "false" and "floating"?
-12 ribs total -1-7 are true (AKA vertebrocostal) -8-10 are false (AKA vertebrochondral) -11 and 12 are floating
Generalized patterns about the FOREARM's innervation:
-ANTERIOR COMPARTMENT: all innervated by the median nerve (except 1.5 muscles: FCU and 1/2 of FDP innervated by ulnar nerve) -POSTERIOR COMPARTMENT: all innervated by the radial nerve (even supinator and brachioradialis)
costochondritis: Multiple myeloma: Congenital malformations of pectus excavatum and pectus carinatum:
-inflammation of cartilage in rib cage, non cardiac chest pain -sternal pain: non cardiac chest pain -pectus excavatum: breast bone caves in towards chest and dec. lung and heart funxn etc. -pectus carinatum: breast bone caves out
What is the fascia called that lines body cavities? What are the subcategories?
-internal (subserous) fascia -Barely discernable linings of the thoracic and abdominal cavities (Endothoracic fascia Endoabdominal fascia and Endopelvic fascia) -function to affix parietal layers of serous sacs ("wall paper")
What veins can be found in the upper arm superficially? Deep?
-SUPERFICIAL: cephalic vein laterally and basilic vein medially -DEEP: venae comitantes of brachial artery join basilic vein to form axillary vein
topography of spinal cord inlcude
-cylindrical -cervical and lumbar enlargement -anterior median fissure and posterior median sulcus -dura matter, arachnoid, pia matter -denticulate ligaments; what anchor spinal cord to dura matter -vertebral and intervertebral foramina
What is the nickname for the radial nerve?
"the great extensor" [of the posterior compartment]
What are the suspensory ligaments of the breast called? Where are they?
(Cooper's ligaments) Lies in superficial fascia, separated from p. major by deep fascia
Palmaris longus (proximal and distal attachments, innervation and action):
***absent in ~10% of the population*** -proximal attachment: medial epicondyle of humerus -distal attachment: distal half of flexor retinaculum and palmar aponeurosis -innervation: median nerve -action: flexes wrist and tightens palmar aponeurosis
What clinical findings would lead to diagnosis of Klumpke's Palsy?
-"Claw hand" -loss of sensation to medial aspect of upper extremity -sometimes ptosis or full Horner's syndrome
What is the innervation of the rotator cuff?
-Branches of posterior cord of brachial plexus -Suprascapular n. -Axillary n.
What is fibrocystic breast disease? What populations does it typically affect?
-Common disorder in pre-menopausal females -Typically presents as firm, painful, lumpy breasts -Changes typically cyclic -Solid lumps (fibroadenomas) in teens and 20's, cysts in 40's and later
What is the definition, vasculature, innervation and lymphatics of the third part of the axilla?
-Definition: From inferior border of pec. minor to inferior border of teres major -Artery Subscapular artery (circumflex scapular, thoracodorsal, anterior circumflex humeral, posterior circumflex humeral) -Nerve Costobrachial nerve, axillary Musculocutaneous, Ulnar, median, radial -Lymphatics- Pectoral, lateral and subscapular groups Clinical Level I
What is a tendon?
-Dense fibrous connective tissue which connect muscle to bone -Fiber direction all in one direction
What is Starling's Law (AKA Frank-Starling Law)? What does this mean about rigidity/elasticity of the heart?
-The law represents the relationship between stroke volume and end diastolic volume *(stretch and contraction) -Diastolic dysfunction is associated with a reduced compliance, or increased stiffness, of the ventricle wall. This reduced compliance results in an inadequate filling of the ventricle and a decrease in the end-diastolic volume. The decreased end-diastolic volume then leads to a reduction in stroke volume because of the Frank-Starling mechanism
What does the supreme thoracic artery supply?
-The musculature of the 1st and 2nd intercostal spaces -Subclavius muscle
What is deep fascia?
-Thin grayish layer on the surface of the muscles -Continuous layer of dense connective tissue (and periosteum) that surrounds all body regions 2 specializations: inter-muscular septa and retinaculum
What is the function of portal circulation?
-Transport products of digestion to the liver (eg fatty acids and amino acids) -Oxygenation of liver (liver gets 2/3 of its oxygen from venous system, not arterial system)
How do you treat fibrocystic breast disease? What could it be mistaken for?
-Typically resolves with menopause, but will persist in the presence of hormone replacement therapy -Can be confused with breast cancer
blood supply of spinal cord
-anterior spinal artery and 2 posterior spinal arteries -circle of willis (vertebral arteries, ascending cervical arteries, posterior intercostal arteries, and lumbar arteries) -Great radicular artery: from lower posterior intercostal or upper lumbar artery, on left side, can be injured during aortic surgery
What is the function of the rotator cuff?
-hold humerus against glenoid fossa -rotation for proximal humerus
What is the function of a visceral ligament?
-holds two visceral organs close together, allows for transmission of neurovascular structures, may contain smooth muscle ex; falciform of liver holds right and left lobes together
What are the 4 types of skeletal muscle functions?
-prime mover -fixator -synergist -antagonist
Glenohumeral joint: What is it, where is it, and what does it articulate with? what type of capsule? it's movements:
-the shoulder joint -ball and socket type synovial joint -Humeral head articulates w glenoid and rotator cuff muscles holds the humeral head within the confines of the glenoid Capsule: thin and loose fibrous capsule. inferior part is the weakest area. allows great mobility -flexion, extension, abduction, adduction, external rotation, internal rotation, circumduction
List the different level of burns?
1st degree: erythema and pain 2nd degree= blistering, pain (superficial bw epidermis and dermis...and deep; into dermis but appendeges preserved) 3rd degree: full thickness skin and into deeper tissue (no pain receptor).
what structures pass through the carpal tunnel? which bones go through them? and where does it lie? what structures go around the carpal tunnel but not through it? Function of the carpal tunnel?
4 tendons of the Flexor digitorum superficialis , 4 flexor digitorum profundus tendons, flexor pollicis longus tendon, and the median nerve (which is the most superficial thing running through here). -bones: trapezium, trapezoid, capitate, hamate -Carpal arch -Ulnar artery, ulner nerve, PL tendon -funxn to hold tendons to the bony plane at the wrist and prevents bowstringing (so allowing flexion of wrist). and free movement of tendons in the carpal tunnel is facilitated by synovial sheaths that surround the tendons.
Break down the nomenclature of spinal nerves of the back. How many pairs are there?
8 cervical 12 thoracic 5 lumbar 5 sacral (fused) 1 coccyx 31 pairs of spinal nerves total
What is a myotome?
A myotome is that portion of a skeletal muscle innervated by a single spinal cord level or on one side of the body by a single spinal nerve
Where would you put a needle intercostally for a thoracentesis/chest tube? Why? for an intercostal nerve block?
ABOVE the rib; located below the rib are nerve/artery/vein. 3rd -5th intercostal space in the midaxillary line and insertion above the rib EXCEPTION: when completing a nerve block that requires access to said nerve nerve block: at an angle of the rib, inject inferiorly w cephalad orientation, can "walk" from bone inferiorly, always aspirate first
AC ligament: Where is it? What does it do? what type of joint is it?,
AC ligament is superior to the joint itself -planar joint -acromial end of the clavicle articulates with the acromion
What type of shoulder dislocation is most common?
Anterior (95%) (posterior quite rare. Usually only assoc. with elect. or seizure) and inferior and superior
What is the strongest flexor of the forearm?
BRACHIALIS!
what happens in an injury to the central slip of the common extensor tendon?
Boutonniere injury. The proximal and interphalangeal joint near the middle phalanx flattens and gets swollen when you jam your finger. In the central slip, over time it ends up in a flexion deformity and won't extend again. So the lateral bands form into this boutonniere deformity and your distal phalangeal joints go into extension.
Injury to what area of the brachial plexus would lead to Erb-Duchenne palsy? What are possible causes of this injury?
C5 and C6; increasing the angle between the neck and shoulder causes this injury (fall landing on neck, birth)
Injury to what area would lead to Klumpke's palsy? What are possible causes of this injury?
C8 and T1; caused by excessive traction/excessive upward pull of limb; can be caused by separating shoulder (NURSEMAID'S ELBOW) or birth injury from being pulled out of birth canal by arm
List the functions of the following nerves CN3 CN7 CN9 CN 10 Sacral splanchnic nerves from S2-24
CN3 = oculomotor nerve: light reflex via constriction of pupillae and accommodation via ciliary muscle. CN7 = Facial Nerve: motor to salivary and lacrimal glands, special sensory (taste) to anterior tongue CN9= Glossopharyngeal nerve: motor to parotid glands (salivary glands), sensory to carotid body and sinus, special sensory (taste) to posterior tongue CN 10 = vagus nerve: sensory to carotid body, all parasympathetic to thorasic viscera & to abdominal viscera supplied by the celiac and superior mesenteric arteries
**extensor mechanism's we need to know are:
Common extensor tendon Sagittal Bands Central Slop of the common extensor tendon Terminal Tendon
Coracoclavicular ligament: Where it is? What does it support?
Coracoclavicular ligament is from the coracoid process to the inferior surface of the acromial end of the clavicle -helps strengthen AC ligament -strongest ligament that unites clavicle and scapula
what are the deep muscles of the hand?
Dorsal interossei and palmar interossei
When referring to nerve roots and spinal nerves, what is the acronym to remember in order to differentiate function of each section?
Dorsal root Afferent: transmit data from receptors in the PNS (touch, temp, vibration, proprioception) to CNS Ventral root Efferent: transmit both conscious and unconscious instructions from the CNS to motor cells (including vasomotor and secretomotor cells) in the periphery (DAVE)
TF: the bicipital aponeurosis ruptures if the biceps brachii ruptures
F. The bicipital aponeurosis stays intact even if the biceps brachii ruptures, and it can flex but cannot supinate.
what is the order of the metacarpals
First metacarpal is the thumb metacarpal, then second through fifth are index through small fingers
List the three thoracic splanchnic nerves
Greater splanchnic nerve (T5-T9): perforates crus of diaphragm and terminates at celiac ganglion (major part of endocrine system) Lesser splanchnic nerve (T10-T11): pierces crus either combined w greater splan. or individually terminates in the aorticorenal ganglion Least splanchnic nerve (T12): to the renal plexus
what are the intermediate muscles of the hand? *
Lumbricals....and these arise from tendons and the adductor pollicis
What muscles of the forearm are innervated by the musculocutaneous nerve?
NONE! musculocutaneous nerve innervates the upper arm
What is a good trend to remember about the extensors of the posterior compartment?
POSTERIOR EXTENSORS are supplied by the radial nerve in both arm and forearm
What is the strongest pronator of the forearm?
PRONATOR QUADRATUS
proximal radioulnar joint facts and effect of pulling on it's ligament:
PRUJ head of radius articulates with radial notch of ulna -articular surface is hyaline cartilage -synovial cavities of all 3 joints (humeroulnar/radial and PRUJ) are in free communication w each other motions: pronation and supination in conjunction w distal radioulnar joint -ligaments include the annular ligament which encircles and holds the head of the radius in the radial notch of the ulna.
What type of injury is associated with the flexor digitorum supeficialis and flexor digitorum profundus?
Pumpkin carving! lacerates digits and injres tendons and the fibrous digital sheath and develop pus in tendon, and since sheath doesn't expand it adds pressure around tendons = can lead to amputation
Describe the palsies of the hand
RUM = WCTU (women's Christian temperance union) R for radial nerve palsy: W for Wrist drop (can flex but not extend) U for ulnar nerve palsy: C for Claw hand (interosii atrophy, MP joints hyper extended and other fingers in flexed position) M for median nerve palsy: TU for thumb unopposable
What is the one branch of the radial artery?
Radial recurrent artery
What is the flow of pulmonary circulation?
Right ventricle Pulmonary arteries Pulmonary capillaries Alveoli Pulmonary veins Left atrium
What are the osteokinematic motions of the wrist in the sagittal plane and frontal plane
Sagittal plane: flexion and extention Frontal: Radial deviation (abduction) and ulnar deviation (adduction) We can't deviate the radial as much as we can the ulnar because radial styloid prevents it
What test would tell you if breast cancer had spread to lymph nodes and the extent of the spread?
Sentinel node biopsy
Where is the subclavius? What are its origin, insertion, innervation and action?
Subclavius is a small round muscle hidden by the clavicle. -Origin: 1st rib -Insertion: lower surface of clavicle -Actions: depress/protract clavicle and shunt clavicle toward manubrium in the violent movement of upper extremity (i.e.- throwing, punching) -
What are the 2 supinators of the forearm? Which is stronger?
Supinator and bicep brachii; biceps is MUCH stronger but supinator helps*
What does the axillary artery (broadly) supply?
Supplies the wall of the axilla and related regions and continues as the major blood supply of the upper limb
TF: the thumb lacks a middle phalanx
T
TF: there are cervical and thoracic splanchnic nerves
T
TF: the parasympathetic division is sometimes called the "Carniosacral Outflow" Where are cell bodies of parasympathetic located?
T in brainstem and spinal cord sacral splanchnic nerves from S2-S4 : abdominal viscera supplied by the inferior mesenteric artery and pelvic viscear
TF: the sympathetic division is sometimes referred to as the "thoracolumbar outflow"
T.
TF: for the spinal reflex, the receptor of the skin gets the signal which then travels to both the brain and the interneuron in the gray for a quick response
T. the interneuron is what allows the quick spinal reflex before the brain even processes the sensory info.
Which bones get injured in the puncher's injury?
The carpal metacarpal joint, happens when you angle you're punch wrong and impact goes on the ulnar side.
What happens in an injury to the sagittal bands?
These bands help keep the central tendon over metacarpal phalangeal joint, you can rupture one of these bands by boxing or flicking, and you wont be able to extend finger.
Dupuytren's contracture
Thickening and shrinking of the fascia of the palm &aponeurosis with fingers being drawn into a flexed position -produces longitudinal cords in palm which extend into the 4th and 5th fingers causing flexion at the MP and PIP joints -common in older males and can be hereditary -tx; excision of the involved fascia
Tapping the ulnar groove to elicit a tingling sensation in the hand is called:
Tinel's
What is the structure/function of muscle?
Tissues which move body parts or temporarily alter the shape of internal organs. Muscle fibers are composed of long striated and specialized contractile cells.
TF: could someone accidentaly rupture the ulnar artery while inserting anesthesia in ulnar nerve?
True
What do gray matter nerve fibers in the CNS create collectively?
Within the grey matter of the CNS and contain discrete groups of cell bodies form nuclei -central part of the spinal cord, dorsal, lateral, and ventral horns
hypothenar muscles
abductor digiti minimi, flexor digiti minimi brevis, opponens digiti minimi
What are the thenar muscles?
abductor pollicis brevis, flexor pollicis brevis, opponens pollicis (OAF) -need to look for atrophy in this location
What are the AC joint ligaments?*
acromioclavicular ligament, coracoclavicular ligament* (coracoacromial ligaments)
how do you check for ulnar nerve funxn?
adduct and abduct fingers. ask to cross fingers or ask to spread fingers apart and try to close them
radial nerve innervates
all posterior arm compartments, and after giving off branches to long and medial heads of triceps it descends w profunda brachii artery in the radial groove of humerus. Gives off branch to lateral head of triceps then passes lateral to humerus through lateral intermuscular septum
Cutaneous innervation of pectoral region and motor innervation:
anteriorly: medial and lateral branches of anterior cutaneous branch of the intercostal n laterally: anterior branches of lateral cutaneous branch of intercostal nerves superiorly: supraclavicular nerves (c3,4) given off the cervical plexus Motor: by the branches of the brachial plexus (lat. pec nerve and medial pect nerve
How would you check to see if a patient's radial nerve is intact?
ask the patient to make the thumbs up sign
What would you be concerned with if there were to be a fracture of the proximal humerus?
axillary nerve damage and posterior humeral circumflex artery damage
what are three types of neurons? and where is the central body located? and list all the possible locations where nerve impulse goes:
bipolar, pseudo-unipolar, multipolar located in the dorsal root ganglion* dendrite to dendrite axon to dendrite axon to cell body axon to muscles
What makes up the bony pectoral girdle?
clavicle, sternum and scapula (links upper limb to axial skeleton)
What joins all 3 heads of the deltoid?
common tendon
musculocutaneous nerve innervates
coracobrachialis, biceps brachii, brachialis
what's happening in this image
deltoid muscle atrophy: cause by axillary nerve injury => surgical neck of humerus and dislocation of joint
Where does the spinal nerve for one particular section exit from the vertebra?
exits BELOW the vertebra
The POSTERIOR compartment contains muscles that predominantly ___________ the wrist and digits and _________ the forearm.
extend; supinate
The ANTERIOR compartment contains muscles that predominantly ___________ the wrist and digits that _________ the forearm.
flex; pronate
MCP flexion and extension movement:
flexion; moves distally extension; hood moves proximally
What is the one muscle in the intermediate layer of the forearm's anterior compartment?
flexor digitorum superficialis
The brachialis is the primary ........... of the elbow. The triceps is the primary........ of the elbow. Which portion provides the most power?
flexor, extensor. the lateral head
What are the groupings for flexion/extension and pronator/supinator muscles?
flexorpronator; extensorsupinator
Colles fracture
fracture of the distal radius at the wrist by falling on outstretched arm and extended hand
what does the anular ligament of the elbow joint do?
holds the radial head into the radial notch
the cell bodies of the sympathetic neurons lie in the ........ horn of spinal cord which only extend from ........ to ..........
latera, T1, L3
how do you check for axillary nerve sensation?
lightly touch pts lateral aspect of shoulder or over deltoid
What are the generalized components of the lymphatic system?
lymph nodes lymph vessels (Thymus and spleen are LYMPHATIC organs)
What is a major complication with radical mastectomy?
lymphedema d/t the removal of tertiary (on 1st level of axilla) lymph node removal;
What happens in an injury to the terminal tendon?
mallet finger can cause terminal tendon to rip, and could potentially rip off bone with it and the distal phalangeal joint ends up in flexion.
What nerve is responsible for CUTANEOUS innervation of the medial (ulnar side) of the forearm?
medial antebrachial cutaneous nerve (from medial cord of brachial plexus)
What nerves has NO branches in the axilla or upper arm? What DOES it innervate?
median and ulnar nerves- supply flexor muscles of anterior compartment of forearms.
What nerve supplies cutaneous innervation of thumb, index and middle fingers and half of ring finger?
median nerve
which joint below is most distal knee, ankle, hip, metatarsal phalangeal
metatarsal phalangeal (not metacarpals)
What is the classification of a spinal nerve?
mixed nerve because it carried both afferent (GVA/GSA) and efferent (GVE/GSE) fibers
Where does the radial artery begin? Which compartment does it primarily serve?
originates from the brachial artery in the cubital fossa; runs UNDER brachioradialis, along the radial aspect of the forearm serving primarily the posterior compartment
Where does the axillary artery turn into the brachial artery?
past teres major
What do dorsal rami branch off to form?
peripheral nerves associated with the back
On the posterior surface of the forearm/hand, what supplies cutaneous innervation of the medial strip of the forearm and runs down to the top of the hand?
posterior antebrachial cutaneous nerve (from the radial nerve)
What branches off the radial nerve?
posterior interosseous nerve
What follows the radial nerve through the 'V' of the long and medial heads of the triceps?
profunda brachii artery
What are the muscles of the superficial layer of the anterior compartment of the forearm?
pronator teres flexor carpi radialis palmaris longus flexor carpi ulnaris
when you fall on an outstretched hand with your weight landing on your palm what are you likely to fracture?
proximal radial head and neck
what are the contents of the anatomic snuff box?*
radial artery, superficial branch of the radial nerve, cephalic veins.
What would result from a radial nerve injury? How would this likely occur?
radial nerve palsy, likely d/t humeral fracture (axillary nerve at risk with surgical neck of humerus)
what muscles hold the head of the humerus in the glenoid cavity?
rotator cuff muscles: supraspinatus, infraspinatus, teres minor, subscapularis
Draw a typical rib and all it's parts. The superior margin of a rib tends to be ............. and smooth. The Inferior margin is ...........
rounded. sharp
Carpal bones
scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate
What are the intermediate muscles of the back?
serratus posterior inferior and serratus posterior superior
Pectoralis major specific actions of the sternal, clavicular, and costal
sternal portion: adduction and internal rotation (medial pectoral n) clavicular portion: flexion (lateral pectoral nerve innervation) costal portion: extension (medial pectoral n.)
What does the anterior circumflex humeral artery supply?
supplies the glenohumeral joint and the head of the humerus
What does the posterior circumflex humeral artery supply?
supplies the glenohumeral joint and the surrounding tissues
What type of fracture is this?
suprachondylar fracture
what's a common fracture point in kids?
supracondylar ridge fracture happens in a outstretched fall on elbow
What is the most common site of fracture on the humerus? What is your concern with vasculature?
surgical neck of the humerus; this can be dangerous because of the posterior circumfelx artery and axillary nerve
describe what happens in nursemaid's elbow?
the head of radius moves distally, and when traction is released, the annular ligament becomes trapped into the elbow joint.
What are the superficial group of back muscles?
trapezius, latissimus dorsi, rhomboid major/minor, and levator scapulae
Which artery is larger: radial or ulnar?
ulnar
What direction does the ulnar artery follow? What area does it supply?
Ulnar artery leaves the cubital fossa by passing deep to pronator teres muscle and passes through the forearm in the fascial plane b/t FCU and FDP; supplies the medial (ulnar) forearm
which structures run adjacent to the hook of hammate? and what type of fx can happen here?
Ulnar nerve and artery run adjacent to the hook of hammate, and a fx can happen from a baseball injury and can affect the ulnar nerve.
What do ventral rami branch off to form?
Ventral rami branches can remain truly segmental (thoracic region) or they can intermingle with branches of other ventral rami in a nerve plexus (e.g. - cervical, brachial, lumbar, and sacral plexuses) to form large multilevel peripheral nerves
How do you check for radial nerve funxn and sensation?
check thumb resistance and dorsal first webspace
what muscle is responsible for wrinkles in the skin of hypothenar eminence and deepens hollow of palm?
palmaris brevis
Palmar aponeurosis is continuious with the
palmaris longus tendon/flexor retinaculum..and it radiates to extensions at the base of the digits that project into each of the digits. funx to protect vessels, nerves, and tendons of the palm
What are the intrinsic/ deep back muscles? What are they innervated by?
splenius muscles (splenius capitus and splenius cervicis) and erector spinae group ( iliocostalis, spinalis and longissimus) -innervated by dorsal rami of spinal nerves
What are the joints of the digits?
-MCP (metacarpophalangeal joint): @ base of finger -PIP (proximal interphalangeal joint): joint in middle of finger -DIP (distal phalangeal joint): joint closest to fingertip
What is breast carcinoma also called? Where does it typically present? What problems could this present?
-Malignant neoplasm of epithelial origin -Most common form originates in the ducts -Invasive ductal carcinoma -Spreads via the lymphatic system (Lymphogenous spread)
What would gnyecomastia be a possible comorbidity of?
-May be severe in the presence of chronic liver disease (bcuz steroid hormones are not metabolized which stimulates estrogens to inc. in breast.) -May be difficult to distinguish from male breast cancer (cancer is usually harder when palpated though)
What is the clinical extent of the breast?
-Medial - mid-sternum -Superiorly - Clavicle -Laterally - L. dorsi -Inferior - rectus abdominus
What is the arterial supply to the breast?
-Medial - perforating branches of the internal thoracic (a.k.a. internal mammary) through 2nd thru 4th anterior interspaces -Lateral - lateral thoracic artery, thoracoacromial branches, intercostal arteries (3rd through 5th
What is the anatomy of the breast?
-Modified sweat gland, therefore no capsule or sheath -Size of the breast is a function of the amount of fat, not of breast tissue -suspensory ligament and lies in superficail fascia, separated from. p. major by deep fascia mammary lymph nodes called rotter nodes
What do the divisions of the brachial plexus innervate?
-Nerve fibers from the anterior divisions innervate flexors and pronators of the anterior compartment on the arm. -Nerve fibers from the posterior divisions innervate extensors and supinators of the posterior compartment of the arm
What is an early sign of breast cancer?
-Nipple inversion alone -Remember, some women have this as a normal finding
Anatomy of male breast:
-Nipple-areolar complex similar but smaller -Rudimentary ductal tissue, no glandular elements (so can have ductal breast cancer but not lobular)
What is Horner's Syndrome? What are the 3 typical presentations? What could cause Horner's syndrome
-ptosis (drooping of eyelid) -anhydrosis (no sweating) -miosis (constricted pupil) -can be caused by trauma to the brachial plexus or nerves during CAD surgery, as well a Pancoast lung tumor.
What is the blood supply to the posterior chest wall?
-subclavian artery -axillary artery -aorta (posterior intercostals)
Extrinsic back muscles: what are the 2 layers, what are they based on?* and what distinguishes these from the other muscles of the back?
-superficial and intermediate layers -Embryologic origin and type (source) of innervation -these muscles are innervated by the anterior (ventral) rami of spinal nerves or for one muscle a cranial nerve
What are the muscles found within the deep layer of the forearm's posterior compartment?
-supinator -abductor pollicis longus -extensor pollicis longus -extensor pollicis brevis -extensor indicis
What are the muscles of the shoulder girdle, connecting the scapula and humerus?
-supraspinatus -infraspinatus -teres minor -subscapularis -teres major -deltoid
What is the most common site of a rotator cuff tear? What motion would this limit? How is it repaired?
-supraspinatus tendon; muscle is more important to abduction of humerus than deltoid (responsible for the first 15 degrees) -easiest approach is arthroscopic surgery
What happens if you cut the long thoracic nerve?
"The long thoracic nerve of Bell, he who cuts it goes to hell"; b/c the serratus anterior (which is innervated by the long thoracic nerve), is a strong protractor of the scapula and it fixes the scapula to the chest wall, the result is scapular winging *injury is checked by having pt perform a wall push up test (to check for serratus anterior muscle weakness) serratous is the boxers muscle
Mnemonic for the axillary artery? What are the branches of the axillary artery?
"Sixties teens love sex (STd) and pot"; which translates into: or Screw The Lawer, Save A patient Supreme thoracic artery, Thoracoacromial artery (ACDP; acromial, clavicular, deltoidal, pectoral), Lateral thoracic artery, Subscapular artery ([circumflex] Subscapular artery and Thoracodorsal artery), Anterior circumflex humeral artery and Posterior humeral circumflex artery
What is the difference between an intrinsic and extrinsic bony ligament?
-Intrinsic blend with the fibers of the joint capsule, specialized thickenings of the fibrous capsule -Extrinsic not associated with a joint capsule
What happens when there is trauma of the coracoclavicular joint? What is this called?
-"shoulder separation" = complete tear of coracoclavicular ligament...MOI for AC joint separation is most commonly a fall onto the point of the shoulder -dislocation of the AC joint -tip of shoulder (acromion) falls d/t weight of arm -clavicle is pulled upward by trapezius
The elbow joint: What articulates, type of cavity? and motions?
-2 articulations: humeroulnar and humeroradial (both synovial and hinge) -articular surface is hyaline cartilage -motions of elbow joint are flexion and extension
Describe the development process of the spinal cord?
-3 month embryo-cord occupies entire space -Cord terminates at L3 at birth -Cord terminates at L1-L2 disc in adults -Conus medullaris: terminus of cord -Cauda equina: spinal nerves distally from this location
What are the divisions of the vertebral column and how many vertebra are in each division? know what they look like
-7 cervical vertebra (Characterized by their small size and foramen in each of their transverse processes) -12 thoracic vertebra (Characterized by their rib articulations) -5 lumbar vertebra (Characterized by their large size) -5 sacral vertebra (Fuse into one bone called the sacrum) -USUALLY 4 coccygeal vertebrae (Fuse into a single triangular bone called the coccyx )
What is the deltopectoral triangle? What pierces through it?
-A triangle in the upper chest region that is bounded medially by the clavicle, superiorly by the deltoid m., and inferiorly by the pectoralis major muscle -It is pierced by the cephalic vein on its course from the upper limb to join the axillary vein in the axilla
What is the vascular supply of the rotator cuff?
-Anterior/Posterior circumflex humeral a -Suprascapular a. -Scapular circumflex a.
What can cause portal HTN?
-Ascites -Malnutrition -Bleeding (Coagulopathy, Esophagogastric varices, or Hemorrhoids)
Where does the axillary vein begin/end?
-Begins at the lower margin of the teres major muscle; is the continuation of the basilic vein -Passes medial to the axillary a. and become the subclavian vein at the lateral border of the 1st rib -Receives tributaries that generally correspond to branches of the axillary artery
What is gynecomastia? How does it present? How do you diagnose/cure it?
-Benign enlargement of male breast -Occurs in adolescence and in middle age -Presents as tender rubbery mass deep to nipple-areolar complex (may be unilateral or bilateral, but frequently resolves spontaneously) -Simple excision is diagnostic and curative; does not naturally go away,
What is the function of the lymphatic system in regards to circulation (not immune)?
-Blood vessels are not "waterproof", so there is leakage into interstitial fluid -Abnormal leakage = edema -fluid returns via veins/capillaries and lymphatic vessels (lymphatics)
What vertebrae are involved in the origin of the brachial plexus?
-C4 "pre-fixed" contribution -C5, C6, C7, C8 and T1 -T2 "post-fixed" contribution
What is a tendon sheath? What is its function?
-Closed synovial tubes which surround tendons -Function to provide nutrition and lubrication to minimize friction
What is the fat content of the nipple? What is special about the nipple?
-Contain no fat -Tip is fissured and contained 15 - 20 lactiferous ducts -Circularly arranged smooth muscles, causing erection and compression of the ducts
What is the definition, vasculature, innervation and lymphatics of the second part of the axilla?
-Definition - behind p. minor -Artery - Thoracoacromial artery Lateral thoracic artery -Nerve Three cords (posterior, lateral and medial) -Medial pectoral nerve -Lymphatics Central group (Level II)
What is the definition, vasculature, innervation and lymphatics of the first part of the axilla?
-Definition: Between lateral border of the 1st rib and the superior border of p. minor -Artery: Contained within the axillary sheath along with the vein and brachial plexus One branch - superior thoracic artery -Nerve Superior, medial and inferior trunks and the three posterior divisions of the plexus Lateral pectoral nerve (actually medial but originates from lateral cord) -Lymphatics Apical Group Clinically Level 3 nodes (in first part of axilla)
What is the function of fascia? What kind of tissue is fascia?
-Dense connective tissue -Separates the major muscle groups and neurovascular structures into compartments -Provides attachment sites for muscle -Maintains position of muscle groups during motion -Provides a mechanical advantage during muscle contraction
What is a ligament?
-Distinct bands of connective tissue that bind together two bones or bony segments -most fibers run in the same direction
What are the muscle types?
-Skeletal striated muscle: voluntary muscles which move or stabilize bones -Cardiac: non-voluntary striated muscle, branching fibers, -Smooth muscle: non-striated muscle in the walls of hollow organs and some blood vessels, involuntary, prolonged slow contraction and relaxation, regulates blood flow, peristalsis through muscle contractions.
What can cause edema (lymphatically, not cardiac)?
-Some cancers may invade lymphatics and spread (metastasize) -Removal of lymph nodes and/or disruption of lymphatic vessels can produce chronic edema (lymphedema)
What is the structure/function of bones?
-Structure: Hard, rigid form of connective tissue to provide: Support Leverage Protection Storage Blood formation
When would a skin laceration require stitches?
-control hemostasis -minimize scarring to speed healing -restore/maintain function
What are the 4 joints in the shoulder?
-acromioclavicular joint -sternoclavicular joint -glenohumeral joint -scapulothoracic joint
What are the muscles in the superficial layer of the posterior compartment of forearm?
-anconeus -brachioradialis -extensor carpi radialis longus -extensor carpi radialis brevis -extensor digitorum -extensor digiti minimi -extensor carpi ulnaris
What is an aerolae? What changes occur with puberty? What are the glands within the areola called?
-area around nipple -Usually at level of 4th interspace -Areolae enlarge with puberty and become heavily pigmented with pregnancy -Multiple sebaceous glands (Montgomery glands: present on aerola not the nipple, and they produce lubrication during lactation)
What is the triangle of auscultation?
-area of the back allowing for stethoscopic evaluation of breath sounds -Borders Inferior: latissimus dorsi Medial: lower trapezius Lateral: rhomboid major -Can be enlarged by drawing the scapula anteriorly- the lateral border is now the medial border of the scapulae
What is the axillary artery a continuation of? What are the parameters of the axillary artery?
-axillary artery is a distal continuation of the subclavian artery -begins at the lateral border of the 1st rib and ends at the inferior border of teres major to become the brachial artery
What are the ARM muscles of the shoulder girdle, which cross the shoulder?
-biceps brachii -coracobrachialis -triceps
Vasculature for the pectoral girdle:
-branches of the axillary artery (thoracoacromial trunk via its pectoral and clavicular branches; and the lateral thoracic artery) -branches of the subclavian artery (ant. perforating arteries from the internal thoracic artery)
What is the vasculature to the superficial back?
-branches off the axillary artery (subscapular and thoracodorsal arteries); there are 2 variations as well -branches off the post. of the thoracic aorta (9 pair intercostal arteries w/ dorsal branches) -branches off lumbar aorta (usually 4 pair of post. lumbar arteries w/ dorsal branches traveling posteriorly with dorsal rami) Difference!: on the 1/3 side: their dorsal scapular artery is not independent and is rising from the transverse cervical artery
Anatomical terms to describe motion/ show me what they are:
-flexion -extension -abduction -adduction -medial (internal) rotation -lateral (external) rotation -pronation -supination -circumduction -elevation/depression -upward rotation/downward rotation -protraction/retraction -plantar flexion/dorsiflexion -inversion/eversion
How are the somatic and visceral nervous system fibers organized?
-general somatic afferent (GSA) -general somatic efferent (GSE) -general visceral afferent (GVA) -general visceral efferent (GVE)
what are the functions of the intrinsic ligaments of the glenohumeral joint? The coracoacromial arch? What can happen at the glenoid labrum?
-glenohumeral ligaments: strengthen the anterior aspect of the capsule -coracohumeral ligament: strengthen capsule superiorly -transverse humeral ligament: strengthen capsule and bridges the gap bw greater and lesser tubercles of the humerus -coracoacromial arch is a protective strucre -glenoid labrum is attached to the margin of the glenoid cavity of scapula, and it's a fribrocartilage ligament tha deepens the glenoid cavity. A 360 degree labral tear = instability
In the PNS, how are neurons organized? What is the term for 1+ neuronal cell bodies in the PNS?
-in the PNS, neurons are organized by sensory and motor; nerve fibers for afferent and efferent neurons create the nerves of the PNS -collection of cell bodies = ganglion (plural form, ganglia)
What are good trends to remember in order to sort out innervation of the arm?
-in the anterior compartment, innervation is from the brachial plexus (musculocutaneous, median and ulnar nerves)- median and ulnar nerves supply ONLY the forearm, not upper arm
What else (apart from Erb-Duchenne and Klumpke's Palsy) could cause brachial plexus injury? What would this cause? Can it be repaired?
-invasion of brachial plexus by metastatic carcinoma -usually produces pain instead of paresis (muscular weakness) -not amendable to radiation therapy
Acromioclavicular joint: where is it? What type of joint is it? What motions are possible d/t this joint?
-lateral end of clavicle/acromion of scapula -synovial/planar joint -motions: ant/post glide, sup/inf glide and rotation of shoulder
define Myelin sheath and nodes of ranvier, endoneurium, epineurium
-myelin: covers axon, made by glial cells called shwann, insulate and structural support of axon -nodes of ranvier: gaps in myelin containing ion channells, allowing for ion influx at intervals along axon to regenerate/replenish AP endoneurium: layer of connective tissue enclosing myelin sheath of individual nerve fibers w/in nerve epineurium: helps from nerve
What are the muscles of the pectoral girdle?
-pectoralis major -pectoralis minor -subclavius -all originate from the anterior thoracic wall and insert on the bones of the upper extremity -all innervated by ventral rami
What are the muscles of the shoulder girdle, connecting the shoulder girdle to the thorax?
-pectoralis major -pectoralis minor -subclavius -serratus anterior
What are the functions of the coracoclavicular ligament?
-provide weight-bearing support for the upper limb on the clavicle -maintain position of the clavicle on the acromion
Extensor carpi radialis brevis (proximal and distal attachments, innervation and action):
-proximal attachment: lateral epicondyle of humerus -distal attachment: base of 3rd (middle finger) metacarpal bone -innervation: radial nerve -action: extend/abduct hand at wrist joint (radially deviates wrist) ***culprit of tennis elbow AKA lateral epicondylitis*** ecrb
Where does the radial nerve run down the arm? What area does it supply?
-runs through the radial spiral groove of the humerus and b/t the medial and lateral heads of triceps brachii (innervates all 3 heads); wraps around humerus and descends through posterior arm -DOES NOT PASS THROUGH ANTECUBITAL FOSSA -supplies into posterior forearm and supplies all muscles of extensor forearm; does not supply and intrinsic hand muscles
what type of joint is a sternoclavicular joint? what does it articulate with? what are it's ligaments? what movement does it allow us to do? What's special about the SC joint?
-saddle type Synovial joint w an articular disc -Articulation between the clavicle and the sternum and the 1st costal cartilage -Anterior and posterior SC ligament, interclavicular ligament -allows movement of pectoral girdle and upper limb anteriorly, posteriorly, inferiorly -it is interclaviculuar (bw both clavicles and connects two sternoclavicular joints)
What clinical findings would lead to diagnosis of Erb-Duchenne Palsy?
-shoulder rotated forward -affected arm diminished in length and girth -muscle atrophy of affected arm -"waiter-tip" deformity of affected wrist -cervical and lumbar scoliosis -"bird-winging" of affected scapula -Horner Syndrome
What is retinacululm?
-specialization of deep fascia -Localized thickening over tendons Prevents "bowstringing"
What is intermuscular septa?
-specialization of deep fascia -separate muscles into compartments, provide for muscle attachments, and aids in venous return
spinal vs. epidural anesthesia
-spinal more useful for lower abdomen, pelvis, or lower extremity. Single-dose, limited duration, AE: spinal HA -Epidural: multiple dosage, or continuous infusion, can be used for thoracic procedures as well, useful for post-op analgesia (pain relief w out losing consciousness), NO spinal HA...can be placed w a catheter
What are the 3 big landmarks of the pectoral region?
-sternal angle -deltopectoral triangle (cephalic vein runs thru here; borders are clavicle, pec major, deltoid) -jugular notch
Where does the ulnar nerve run down the arm? What muscles does the ulnar nerve supply?
-ulnar nerve runs down medial then posterior side of arm, crosses the elbow by passing posterior to the medial epicondyle of the humerus (FUNNY BONE) -does NOT supply any muscles in the upper arm -supplies: flexor carpi ulnaris and the medial (ulnar) 1/2 of flexor digitorum profundus
Define joints the 3 different types
-unions or junxns bw two or more bones -fibrous (no movement ie. sutures of cranium), synovial (lots of movement; 6 types), cartilaginous (limited movement ie. epiphysis-growth plate, symphysis-intervertebral disc)
What is an aponeurosis?
-very broad, flat tendons resembling deep fascia but fibers are predominantly parallel vs. interwoven
What is a dermatome?
A dermatome is an area of skin that is mainly supplied by a single spinal nerve. There are 8 cervical nerves (note C1 has with no dermatome), 12 thoracic nerves, 5 lumbar nerves and 5 sacral nerves. Each of these spinal nerves relay sensation from a particular region of the skin to the brain. (including fat and connective tissue) of the neck, back and the ventral and lateral trunk
TF: the coracobrachials flexes and adducts the elbow
FALSE: it does not pass elbow so therefore does not act on it.
The ulnar nerve enters the hand lateral to the pisiform with the ulnar artery in .............. ............. The ulnar nerve gives rise to which two branches:
Guyon's canal. Superficial branch, deep branch
What are the generalized components of the cardiovascular system?
Heart Pulmonary Circulation Systemic Circulation Portal Circulation
Which form of brachial plexus injury is more common?
Klumpke's palsy (lower brachial plexus injury) is much more rare than Erb-Duchenne Palsy (upper brachial plexus injury)
endoneurium, perineurium, epineurium
Layers of connective tissue of a nerve from interior to exterior
What is the flow of systemic circulation?
Left ventricle Aorta (elastic arteries) Muscular arteries Arterioles Capillaries Venules Veins Venae cavae Right atrium
What happens in an injury to the common extensor tendon?
MALLET FINGER caused when the tendon that straightens the finger (extensor tendon) is damaged. when a ball or other object strikes the tip of the finger or thumb and forcibly bends it the force tears the tendon
What is polythelia? What about polymastia?
Polythelia= supernumary nipples Polymastia= accessory breasts or mammary glands (more rare) (breast ectopia, especially axillary)
TF: there are two parts to a tubercle on a typical rib
T. The articular part articulates w the corresponding facet on the transverse process of the associated vertebrae, and the non articular part is lateral and is roughened by the attachment of ligaments
Radius articulates with what area of the humerus? what about ulnar?
capitulum trocheal Come Run Until Tomorrow
chain of events of the sensory receptor of the skin stimulating the dendrites of a sensory neuron: Cell body the primary (first order) neuron is located in the ............, the central axon of first order neuron continues along this path to the ................ dorsal horn where it synapses with a second order neuron in the appropriate nucleus. The axon of the second order neuron then .................. to the .................. ..white matter where it ascends to the spinothalamic tract to the ..............., where another synapse occurs with a third order neuron who's axons transmit info to the appropriate area of the cerebral cortex
dorsal root ganglion, ipsilateral, decussates, contralateral, thalamus.
after reaching the sympathetic ganglion, the presynaptic axon may either synapse and exit via the ............ ramus and travel with the same spinal nerve. It can travel via the sympathetic chain to a higher or lower spinal nerve, synapse and exit via the ........ ramus and travel with the spinal nerve at that level. Or it can exit the sympathetic chain w out synapse as a ............. ...........
gray, gray, splanchnic nerve
What do white matter nerve fibers in the CNS create collectively?
grow up (ascending), or down (descending), or across to form discrete groupings called tracts (of axons) -peripheral part of cord -dorsal, lateral and ventral columns
What nerve is responsible for CUTANEOUS innervation of the lateral (radial side) of the forearm?
musculocutaneous nerve
You use this test to check for carpal tunnel? -What are symptoms of carpal tunnel?
tinel's sign -be careful not to tap ulnar nerve Symptoms: -edema of tissue in the carpal tunnel due to inflammation, trauma, fluid retention -causes compression of median nerve -manifest as sensory changes over median n. distribution in hand, atrophy of thenar eminence, and inability to oppose thumb. -treated by surgery division of flexor retinaculum
what's happening in this image?
scapular winging. concern for long thoracic nerve=> damage to serratus anterior
Which portion of the axillary artery is enclosed in a sheath? What else can be found in this sheath?
-First part of the axillary artery -This portion of the axillary artery is enclosed within the axillary sheath with the trunks and cords of the brachial plexus
What is the embryology of breast development directionally? What can occur along this ridge?
-Embryonic mammary ridge from axilla to groin -along this ridge, accessory nipple(s) can form
What are 2 brachial plexus injury results?
-Erb-Duchenne Palsy -Klumpke's Palsy
What does the lateral thoracic artery supply?
-Pectoral muscles -Serratus anterior -Branches of this artery also participate in the vasculature of the breast
What is the definition/anatomic outline of the axillary space?
-Posterior wall - Scapula, subscapularis, teres major, latissimus dorsi -Medial wall - Serratus anterior, chest wall (ribs and intercostal muscles) -Anterior wall - P. major and minor, clavicle -Lateral wall - intertubercular groove of humerus (containing tendon of the long head of b. brachii)
What are the wrist joints?
-Proximal (radioulnar) wrist joint -Distal Wrist joint (distal row of carpals w/ 5 metacarpal bones)
What IS the rotator cuff?
-Rotator cuff is a common name for the group of 4 distinct muscles (supraspinatus, infraspinatus, teres minor and subscapularis) and their tendons that provide strength and stability during motion of the shoulder. The muscles arise from the scapula and connect to the head of the humerus, forming a cuff at the glenohumeral joint.
aortic plexus contains
-celiac, superior mesenteric, renal and inferior mesenteric plexuses -sympathetic input from thoracic and lumbar splanchnic nerves -parasympathetic input from vagus nerve and from sacral splanchnic nerves
What is superficial fascia? What is it also called?
-loose, fatty subcutaneous connective tissue that provides padding just below the skin -contains the retinacula cutis (skin ligaments: fascial bands that connect the dermis of the skin to the underlying deep fascia) -AKA hypodermis, subcutaneous fascia
What are the branches of the brachial artery?
-profunda brachii -humeral nutrient artery -superior ulnar collateral artery -inferior ulnar collateral artery -multiple anastamoses at elbow- both medially and laterally (rich circulation around elbow)
what are the three bursa's of the shoulder and what can happen here?
subacromial, subdeltoid, subscapular. Bursa can become inflamed (bursitis)
What is the flow of blood through the arm, beginning with the subclavian artery?
subclavian artery -> axillary artery -> brachial artery (branches into profunda brachii, nutrient artery, superior/inferior ulnar collateral arteries and anticubital area where it bifurcates)
What ankle joint is responsible for inversion/eversion
subtalar joint (b/t calcaneus and talus)
What ankle joint is responsible for dorsi/plantar flexion?
tibiotalar joint (b/t tibia and talus)
What nerve supplies cutaneous innervation of the OTHER half of the ring finger and the pinky?
ulnar nerve
how do you check for median motor funxn?
check ok signs (flex distal phalangeal joint on index and interphalangeal joint of thumb)
radial and ulnar .............. ligaments of the elbow joint helps prevent ...........&............ elbow stress which is common in ...........
collateral, valgus, varus, pitchers
following transection or other serious injuries, that portion of the axon distal to the injury will undergo ............, known as ........ or .......... THe axon stump proximal to the injury will sprout and regrow at the rate of ....... mm/day. If the regenerating nerve fibers re-enter the .............tube, function may be [regained/not-regained]
degeneration, anterograde, or wallerian degeneration 1-2, endoneural, regained
(t/f) everyone has a median cubital vein
false! some people do not have the median cubital vein (found in the anterior curve of the forearm)
What muscle does a pumpkin carving injury injure?*
flexor digitorum superficialis and flexor digitorum profundus
The median nerve enters the hand deep to the ....... .................. through the ................. ..............
flexor retinaculum, carpal tunnel
what tendon do surgeons use to replace other tendons with?
palmaris longus because of it stretching out into the palmar aponeurosis
what are the 6 types of synovial joints
plane/gliding, hinge, pivot, condyloid/ellipsoid, saddle, ball and socket
describe locations of the radial and ulnar collateral ligaments of the elbow joint?
radial: extends from the lateral epicondyle of humerus and blends distally w the annular ligament of the radius ulnar: extends from the medial epicondyle of the humerus to the coronoid process and olecranon of the ulna and has 3 bands: anterior (strongest), posterior (weakest), oblique (deepns socket for the trochlea of the humerus)
brachioRADIALIS (proximal and distal attachments, innervation and action):
-proximal attachment: proximal 2/3rds of lateral supracondylar ridge of humerus -distal attachment: lateral surface of distal end of radius (styloid) -innervation: radial nerve -action: flexes forearm
What is the function and innervation of the deep back (AKA intrinsic) muscles of the back?
-Function - Support and move the vertebral column and participate in moving the head -Are innervated by the dorsal (posterior) rami of spinal nerves
What is the anatomical extent of the breast?
-Medial: Mid sternum -Lateral: Posterior axillary fold (axillary tail, Tail of Spence) -Superiorly: Clavicle and deltopectoral groove -Inferiorly: Insertion of external oblique
What are the 6.5 muscles in the anterior forearm supplied by the median nerve?
-pronator teres -flexor carpi radialis -palmaris longus -flexor digitorum superficialis -flexor pollicis longus -pronator quadratus -LATERAL (radial) 1/2 of flexor digitorum profundus
Flexor carpi ulnaris (proximal and distal attachments, innervation and action):
-proximal attachment: HUMERAL HEAD: medial epicondyle of humerus ULNAR HEAD: olecranon process and posterior border of ulna -distal attachment: pisiform bone, hook of hamate bone and 5th metacarpal bone -innervation: ulnar nerve -action: flexes wrist and adducts it (b/c it is on the pinky side!)
Abductor pollicis longus (proximal and distal attachments, innervation and action):
-proximal attachment: posterior surfaces of ulna and radius and interosseous membrane -distal attachment: base of 1st (thumb) metacarpal bone -innervation: radial nerve (posterior interosseous branch) -action: abducts thumb and extends it at carpometacarpal joint (hitchhiker muscle!*)
Flexor digitorum superficialis (proximal and distal attachments, innervation and action):
-proximal attachment: HUMEROULNAR HEAD: medial epicondyle of humerus, ulnar collateral ligament and coronoid process of ulna RADIAL HEAD: superior 1/2 of anterior border of radius -distal attachment: bodies of middle phalanges of medial 4 digits -innervation: median nerve -action: flexes middle phalanges of all digits except thumb (acting more strongly, it flexes proximal phalanges and hand by acting on the middle phalynx
Triceps brachii (proximal and distal attachments, innervation and action):
-proximal attachment: LONG HEAD: infraglenoid tubercle of scapula LATERAL HEAD: posterior surface of humerus, superior to radial groove MEDIAL HEAD: posterior surface of humerus, inferior to radial groove -distal attachment: proximal end of olecranon ulna and fascia of forearm -innervation: radial nerve -action: extends forearm (chief extensor); long head steadies hand of the abducted humerus
Biceps brachii (proximal and distal attachments, innervation and action):
-proximal attachment: SHORT HEAD: tip of coracoid process of scapula LONG HEAD: supraglenoid tubercle of scapula -distal attachment: tuberosity of radius and fascia of forearm via bicipital aponeurosis -innervation: musculocutaneous nerve -action: supinates forearm and WHEN SUPINE, flexes arm
Flexor pollicis longus (proximal and distal attachments, innervation and action):
-proximal attachment: anterior surface of radius adjacent interosseous membrane -distal attachment: base of distal phalanx of thumb -innervation: median nerve (anterior interosseous nerve) -action: flexes phalanges of thumb
Brachialis (proximal and distal attachments, innervation and action):
-proximal attachment: distal 1/2 of anterior surface of humerus -distal attachment: coronoid process and tuberosity of ulna -innervation: musculocutaneous nerve -action: flexes forearm in all positions
Pronator quadratus (proximal and distal attachments, innervation and action):
-proximal attachment: distal 4th of anterior surface of ulna -distal attachment: distal 4th of anterior surface of radius -innervation: median nerve -action: pronates forearm; deep fibers bind radius and ulna together
Teres major (proximal and distal attachments, innervation and action):
-proximal attachment: inferior angle of scapula -distal attachment: medial lip intertubercular sulcus of humerus -innervation: lower subscapular nerve -action: adducts and medially rotates arm
Infraspinatus (proximal and distal attachments, innervation and action):
-proximal attachment: infraspinous fossa -distal attachment: greater tubercle of humerus -innervation: suprascapular nerve -action: laterally rotates arm and helps to hold humeral head in glenoid cavity of scapula
Deltoid (proximal and distal attachments, innervation and action):
-proximal attachment: lateral 1/3 of clavicle, acromion and spine of scapula -distal attachment: deltoid tuberosity of humerus -innervation: axillary nerve -action: flexes and medially rotates, acromial part abducts and posterior part extends and laterally rotates
Teres minor (proximal and distal attachments, innervation and action):
-proximal attachment: lateral border of scapula -distal attachment: greater tubercle of humerus -innervation: axillary nerve -action: laterally rotate arm and helps to hold humeral head in glenoid cavity of scapula
Extensor digiti minimi (proximal and distal attachments, innervation and action):
-proximal attachment: lateral epicondyle of humerus -distal attachment: extensor expansion of pinky (5th digit) -innervation: radial nerve -action: extends 5th finger @ MP and IP joints
Extensor digitorum (proximal and distal attachments, innervation and action):
-proximal attachment: lateral epicondyle of humerus -distal attachment: extensors expansions of all digits except thumb -innervation: radial nerve -action: extends all digits except thumb @ metacarpophalangeal joints; extends hands @ wrist joints
Extensor carpi ulnaris (proximal and distal attachments, innervation and action):
-proximal attachment: lateral epicondyle of humerus, posterior border of ulna -distal attachment: dorsal base of 5th finger metacarpal bone -innervation: radial nerve -action: extends and adducts hand @ wrist joint
Supinator (proximal and distal attachments, innervation and action):
-proximal attachment: lateral epicondyle of humerus, radial collateral and annular ligaments, supinator fossa and crest of ulna -distal attachment: lateral, posterior and anterior surfaces of proximal 3rd of radius -innervation: radial nerve -action: supinates forearm
Extensor carpi radialis longus (proximal and distal attachments, innervation and action):
-proximal attachment: lateral supracondylar ridge of humerus -distal attachment: base of 2nd (index finger) metacarpal bone -innervation: radial nerve -action: extend and abduct hand at wrist joint
Flexor carpi radialis (proximal and distal attachments, innervation and action):
-proximal attachment: medial epicondyle of humerus -distal attachment: base of 2nd (index finger) metacarpal bone -innervation: median nerve -action: flexes wrist and abducts is
Pronator teres (proximal and distal attachments, innervation and action):
-proximal attachment: medial epicondyle of humerus and coronoid process of ulna -distal attachment: middle of lateral surface of radius -innervation: median nerve (C6 and C7) -action: pronates/flexes arm
Extensor pollicis longus (proximal and distal attachments, innervation and action):
-proximal attachment: posterior surface of middle 3rd of ulna and interosseous membrane -distal attachment: base of distal phalanx and thumb -innervation: radial nerve (posterior interosseous branch) -action: extends distal phalanx of thumb @ MP and IP joints
Extensor pollicis brevis (proximal and distal attachments, innervation and action):
-proximal attachment: posterior surface of radius and interosseous membrane -distal attachment: base of proximal phalanx of thumb -innervation: radial nerve -action: extends proximal phalanx of thumb @ MP joint
Extensor indicis (proximal and distal attachments, innervation and action):
-proximal attachment: posterior surface of ulna and interosseous membrane -distal attachment: extensor expansion of 2nd digit -innervation: radial nerve -action: extends index finger and helps extend hand
Flexor digitorum profunda (proximal and distal attachments, innervation and action):
-proximal attachment: proximal 3/4 of medial and anterior surfaces of ulna and interosseous membrane -distal attachment: bases of distal phalanges of medial 4 digits -innervation: MEDIAL: (ulnar 2 digits) ulnar nerve LATERAL: (radial 2 digits) median nerve -action: flexes distal phalanges of all digits except thumb by acting on the distal phalynx
Subscapularis (proximal and distal attachments, innervation and action):
-proximal attachment: subscapular fossa -distal attachment: lesser tubercle of humerus -innervation: upper and lower subscapular nerve action: medially rotates arm and adduction; helps to hold humeral head in glenoid cavity
Supraspinatus (proximal and distal attachments, innervation, and action):
-proximal attachment: supraspinous fossa -distal attachment: greater tubercle of humerus -innervation: suprascapular nerve -action: aids deltoid in arm abduction (first 15 degrees) and acts with rotator cuff muscles to stabilize shoulder
What is the fibrous digital sheaths function?
-surround tendons, and hold the tendons to the bone preventing the tendons from bowing when the digits are flexed. Infection can spread to whole hand if one of the bursa's is infected
The cubital fossa is a triangular hollow area on the [anterior/posterior] aspect of the arm. What are its contents
-terminal part of brachial artery and beginning of the radial and ulnar arteries -biceps brachii tendon -bicipital aponeurosis -brachial artery -radial and unlar artery -median nerve -median cubital vein -medial and lateral antebrachial cutaneous nerves related to basilic and cephalic veins
What area does the median nerve innervate? What does it pass thorough to get to the hand muscles?
-the median nerve does NOT give off any branches in the UPPER arm; supplies all of the muscles in the anterior compartment [6.5 muscles] of the forearm (except FCU and the ulnar 1/2 of FDP) -leaves the forearm and enters the palm by passing through the carpal tunnel deep to the flexor retinaculum
What does the subscapular trunk supply?
-thoracodorsal artery supplies latissimus dorsi -circumflex scapular artery passes through the triangular space and anastamoses with the dorsal scapular artery
What are the muscles of the shoulder girdle, connecting the shoulder girdle to the spinal column?
-trapezius -latissimus dorsi -rhomboid major and minor -levator scapula
What is fascia?
-visible connective tissue mb w thin layer of dense connective tissue without obvious organization of its fibers -Organized into sheets or tubes forming a layer of connective tissue between and/or around structures -Continuous - has no beginning and no end
What nerve would you agitate if you hit your funny bone? and what does it innervate?
ulnar nerve; passes posterior to medial epicondyle into forearm -no innervation or motor function in upper extremity, just forearm and hand.
