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Flashcards for Gross 1 exam 2, excluding the joints and arteries/ veins

Trapezius origins (4)

1. EOP
2. superior nuchal line
3. nuchal ligament
4. spines of thoracic vertebrae

trapezius insertion (2)

1. Clavicle
2. acrominon process + spine/ scapula

trapezius actions (3)

1. stabilize the scapula
2. upper portion elevates the scapula
3. middle + lower portions adduct scapula

Trapezius Nerve supply (2)

1. motor: spinal accessory nerve
2. sensory: C4 + C5

Weakness of trapezius (Trapezius Palsy)

-deepening of muscle on affected side
-shoulder drops on affected side
-superior portion is often involved in auto accidents (whiplash)

Clinical Exam for C.N. XI

ask patient to elevate shoulders (shrug) against resistance. Do both sides to evaluate weakness of one side relative to the other side

Rhomboid Major Origin

spines of the upper thoracic vertebrae

Rhomboid Major Insertion

vertebral border of the scapula

Rhomboid Minor Origin

spines of the lower cervicles + T1

Rhomboid Minor Insertion

vertebral border of the scapula

Levatator Scapula Origin

transverse processes of the upper cervicle vertebrae

Levatator Scapula Insertion

superior angle of the scapula

Rhomboid Major, Minor, and Levatator Scapula Actions (3)

1. elevate scapula
2. adduct scapula
3. stabilize the scapula

Rhomboid Major, Minor, and Levatator Scapula Nerve Supply

Dorsal Scapular Nerve (C5)

Damage to C5 (Dorsal Scapular Nerve)

-difficulty completely adducting scapula
-scapula on affected side is further from the midline

Latissimus Dorsi Origin (4)

1. spines of the lower thoracic and lumbar vertebrae
2. thoracodorsal fascia
3. crest of the ilium
4. lower ribs

Latissimus Dorsi Insertion

intertubecular groove / humerus

Latissimus Dorsi Actions (2)

1. extends, adducts, and medially rotates humerus
2. involved with forced expiration

Latissimus Dorsi Nerve Supply

Thoracodorsal Nerve (C6, C7, C8)

Weakness/Damage to Latissimus Dorsi

results in forward displacement of the shoulder

Lumbar Triangle

-Latissimus Dorsi
-crest of ilium
- external oblique muscle
--hernia of the posterior wall of the abdomen may develop here

Triangle of Auscultation

-latissimus dorsi
-vertebral border of the scapula
--enlarge by abducting scapula

Serratus Anterior Origin

upper ribs

Serratus Anterior Insertion

vertebral border of the scapula

Serratus Anterior Actions (3)

1. abducts the scapula (prime mover)
2. stabilize scapula
3. involved with forced inspiration (when humerus is abducted)

Serratus Anterior Nerve Supply

Long thoracic nerve (C5, C6, C7)

Long Thoracic Nerve Palsy
(Winged Scapula)

-Serratus Anterior weaked due to damage to long thoracic nerve or its segmental innervation
-patient will have difficulty abducting scapula and thus raising hand over head
-#1 clinical sign is difficulty keeping vertebral border and superior angle of the scapula against posterior thoracic wall when preforming abduction against resistance ("winging" of the scapula)
- +/- pain

Causes of Long Thoracic Nerve Palsy (3)

1. trauma/ subluxation
2. traction injury involving shoulder joint
3. recumbency for a long period of time

Rotator Cuff Muscles (4)

1. Supraspinatus
2. Infraspinatus
3. Subscapularis
4. Teres Major

Rotator Cuff Muscle Criteria (2)

1. tendon of insertion must contribute to forming a cuff around the proximal humerus
2. they participate in either lateral or medial rotation of the humerus

Deltoid Origins (3)

1. Anterior portion: clavicle
2. Middle Portion:acromion process
3. Posterior portion: spine of the scapula

Detoid Insertion

deltoid tuberosity of the humerus

Deltoid Actions (3)

1. Anterior portion:flexes and medially rotates the humerus
2. Middle Portion: abducts the humerus
3. Posterior portion:extends and laterally rotates the humerus

Deltoid Nerve Supply

Axillary Nerve (C5, C6)

Atrophy of Deltoid
"Crutch Paralysis"

-due to injury to Axillary nerve or its segmental innervations
-atrophy gives shoulder a flattened apperance
-loss of senation may occur over lateral aspect of arm (due to lateral brachial cutaneous branch of axillary nerve)
-abduction of arm is greatly impaired

"Crutch Paralysis" Causes (3)

1. Fx of surgical neck of humerus (nerve injury immediate or during healing)
2. dislocation of shoulder joint
3. pressure of a crutch in axilla

Supraspinatus Origin

supraspinous fossa of the scapula

Supraspinatus Insertion

greater tuberosity of the humerus

Supraspinatus Actions (3)

1. initiates abduction of humerus (1st 30-45*)
2. laterally rotates the humerus
3. Stabilizes shoulder joint

Supraspinatus Nerve Supply

Suprascapular (C5 and C6)

Rotator Cuff Tendinitis

aka shoulder impingment syndrome
- pain can be sharp or aching, usually occurs in anterior +/- lateral aspects of the shoulder
-may feel like a "twinge" at first but progress to pain during and after activity
-usually result of overuse due to repetitive motion microtrauma to tendon's collagen fibers
-may be due to calcium deposits in elderly

Rotator Cuff Tears

-tearing usually a result of multifactoral conditions
--tendon usually ruptures near its insertion and can be partial or complete
- in young a complete tear is due to trauma or shoulder dislocation
- small tears can be from repetitive microtrauma or severe tendinitis
-large or complete tears from single trauma episode
-50+ years tears can occur with microtrauma
-symptoms similar to tendinitis, but with sig. tear patients will have difficulty abducting arm

Drop Test

-tests rotator cuff tears or degenerative athritis
-patient asked to lower fully abducted arm slowly
-limb will drop suddenly and uncontrolled if tendon is torn or diseased

Bursitis of Rotator Cuff

-affects deltoid or subacromial bursa
-may be more common than tendinitis, but difficult to distinguish

Subscapularis Origin

subscapular fossa/ scapula

Subscapularis Insertion

lesser tuberosity / humerus

Subscapularis Actions (2)

1. medially rotates humerus
2. stabilizes the shoulder

Subscapularis Nerve Supply

Upper and Lower Subscapular Nerve (C5, C6)

Infraspinatus Origin

infraspinous foss/ scapula

Infraspinatus Insertion

greater tuberosity / humerus

Infraspinatus Actions (2)

1. laterally rotates humerus
2. stabilizes shoulder joint

Infraspinatus Nerve Supply

Suprascapular (C5 and C6)

Teres Minor Origin

axillary border / scapula

Teres Minor Inserrtion

greater tuberosity / humerus

Teres Minor Actions (2)

1. laterally rotates humerus
2. stabilizes shoulder joint

Teres Minor Nerve Supply

Lower Subscapular Nerve (C6)

Teres Major Origin

inferior angle / scapula

Teres Major Insertion

intertubecular groove / humerus (medial lip)

Teres Major Actions (2)

1. adduct + medially rotates humerus
2. stabilizes shoulder joint

Teres Major Nerve Supply

Lower subscapular (C6)

Quadralateral Space

-space btwn teres major + minor
- more lateral
- contains axillary nerve and humeral circumflex

Triangular Space

-space btwn teres major + minor
- more medial
- contains circumflex scapular branch of the subscapular artery

Biceps Brachii Origin (2)

1. short head: coracoid process / scapula
2. Long head: supraglenoid tubercle / scapula

Biceps Brachii Insertion (2)

1. tuberosity / radius
2. shaft / ulna

Biceps Brachii Actions (4)

1. flexion of forearm at elbow joint
2. supination of forearm (prime mover)
3. short head: adducts humerus
4. long head: abducts humerus

Biceps Brachii Nerve Supply

musculocutanous nerve

Biceps Tendinitis

-long head is enclosed in snyovial sheath and moves within the intertuberclar groove
-wear and tear occurs on this tendon and cause inflammation and pain
-narrow or rough groove can cause crepitus
-occurs in sports with lots of throwing or raquet

Rupture of the Long Head of the Biceps Tendon

-tendon usually torn or ruptured near attachment on glenoid cavity
-rupture is dramatic and has pop or snap
-ruptured belly forms ball near center of the distal anterior aspect of arm (Popeye Deformity)

Causes for Rupture of the Long Head of the Biceps Tendon

-weaked by chronic tendinitis
-forceful flexion of arm against resistance (weightlifters)

Bicipital Reflex

-tests C5 and C6
-tap biceps tendon looking for reflex

Coraobracialis Origin

coracoid process / scapula

Coraobracialis Insertion

shaft / humerus

Coraobracialis Actions (2)

1. flexion and weak adduction of the humerus
2. helps stabilize shoulder joint

Coraobracialis Nerve Supply

Musculocutaneous Nerve

Brachialis Origin

shaft of the humerus

Brachialis Insertion

coronoid process of the ulna

Brachialis Action

Flexion of forearm at elbow joint

Brachialis Nerve Supply

Musculocutaneous nerve

Triceps brachii Origin

Long head: infraglenoid tubercle / humerus
Lateral + Medial heads: shaft of the humerus

Triceps brachii Insertion

olecranon process / ulna

Triceps brachii Actions

extention of forearm at elbow
(medial head always works, gravity assists, lateral and long heads if extra force needed)

Triceps brachii Nerve Supply

Radial Nerve (C6, C7, C8)

Atrophy of Triceps brachii

passive extention by gravity, but lacks control and stability

Segmental Nerve test for Triceps brachii

C7 and C8 can be tested by tapping tendon of insertion and looking for simple extension reflex

Anconeus Origin

lateral epicondyle / humerus

Anconeus Insertion

olecranon process / ulna

Anconeus Action

assists in extension of forearm

Anconeus Nerve Supply

Radial Nerve (C6, C7, C8)

Blood Pressure

-Taken at brachial artery (because it's at the level of the heart and muscle mass can transmit cuff pressure to vessel)
-sphygmomanometer occludes vessel and then releases pressure slowly
-Systolic pressure is when blood flow 1st becomes audible
-Diastolic pressure is when blood flow can no longer be heard

Musculocutaneous Nerve Damage

-rarely injured because protected by biceps brachii
-injury due to direct wound in axilla, axillary artery aneurysm, or shoulder joint dislocation

Results of Musculocutaneous Nerve Damage

-flexion still possible because pronator teres can carry out weak flexion (not supplied my musculocutaneous)
-may lose sensation along lateral forearm (lateral antebrachial cutaneous nerve is a branch)

Cubital Fossa

-depression at anterior elbow
-many nerves and arteries enter here

Cubital Fossa Boundries

Lateral: brachioradialis muscle
Medial: pronator teres
Proximal: level of the epicondyles of the humerus

Cubital Fossa structures (4)

1. median nerve
2. brachial artery (branches into ulnar and radial art.)
3. tendon of biceps brachii
4. median cubital vein

Elbow Complex

-joints and muscles of the elbow serve the hand
-includes elbow and proximal radioulnar joint

Definition of Elbow "Complex"

1. radius and ulna are common articulation surfaces
2. synovial cavities are continuous
3. ligaments are continuous

Carrying Angle

greater in females than in males, angle disappears with pronation, allows elbow to closely into waist depression

Cubitus Valgus

an increase and latereal deviation of the carrying angle

Olecranon Bursa

Btwn olecranon and skin, dissipates pressure
- infectious bursitis- injury during falls and abrasions to skin
- friction bursitis- repeated excessive pressure

Articular disc of the wrist

excludes the ulna from taking part of the wrist joint, ulna is the stabilizing joint

Ossifiation in Radius and Ulna (sequence)

1) distal radius
2) proximal radius
3) distal ulna
4) proximal ulna

Fusion with shaft of Radius and Ulna (sequence)

1) proximal radius
2) proximal ulna
3) distal ulna
4) distal radius

Fracture of Radius or Ulna

- usually a result of severe direct injury
- usually transverse fx of both, but can be just 1 bone
- fragment displacement is usually considerable, depends on the pull of attached muscles
- pronation and supination will be impaired if normal anatomical relationship of radius, ulna, and interosseous membrane are not restored

Colles Fracture

- common in women 50 +
- occurs by fall on ourstreached, pronated hand
- force travels through carpal boned to fx distal radius

Features of Colles Fracture

- distal fragment displaced posteriorly, radius shortens
- fragments often comminuted
-"dinner fork deformity" posterior angulation occurs in forearm just proximal to wrist
- heal easily due to vascular supply
- flexion and extension of wrist impaired if normal articulations not restored

Smiths Fracture

- reverse of colles fx
- due to a fall on the back of hand
- distal fragment displaced anteriorly

Carpal Ossification Sequence

1. capitate and hamate
2. triquetral
3. lunate
4. trapezium/ trapezoid/ scaphoid
5. pisiform

Carpal Ossification

- completed by 14-16 years old
- xray tells skeletal age and any growth disorders
- carpals used to tell age of unknown child

Sesamiod Bones

-varying # embedded in flexor tendons
- most consistent over MP joints of 1, 2, 5 digits and IP joint of 1st digit

Sesamoid Bone Functions

1. protect and stabilized tendons
2. change angle of tendons as they pass to insertion (increase angle)

Scaphoid Fracture

- most commonly fx carpal
- due to fall on palm- hand hyperextended
- takes twice as much force to fx scaphoid as to fx radius

Scaphoid Fracture Symptoms

- sweeling and pain in wrist, many patients think they sprained wrist
- tenderness and swelling in anatomical snuffbox
- initial rads may not reveal fx
- prolonged healing due to poor vascular supply, can result in degenerative arthritis in 1st CM joint

Fracture of Hamate

- may not fuse again due to traction of attached muscles
- ulnar nerve is close to hook of hamate and can be injured

Metacarpal Fractures

- metacarpals held by ligaments and have little displacement
- good blood supply and heal quickly
- can fx multiple metacarpals at once

Boxer's Fracture

- fx of 5th metacarpal
- occurs when you punch with closed fist
- fx to base of 1st metacarpal will cause instability to 1st CM joint

Movements of Hand at Wrist Joints (4)

1. Flexion
2. Extension
3. Abduction (radial deviation)
4. Adduction (ulnar deviation)

Movements of Digits

- occur at MP, MC, PIP, DIP, IP joints
1. Flexion
2. Extension
3. Abduction (digits 1, 2, 4, 5)
4. Adduction (digits 1, 2, 4, 5)
- 3rd digit does lateral or medial abduction

Pronator Teres Origins (2)

1. medial epicondyle / humerus
2. coronoid process / ulna

Pronator Teres Insertion

pronator ridge / ulna

Pronator Teres Actions (2)

1. pronation of forearm at superior radioulnar joint
2. assists in flexion of arm

Pronator Teres Nerve Supply

median nerve (C8, T1)

Pronator Teres Syndrome

compression of the median nerve in the proximal forearm btwn the heads of the pronator teres

Pronator Teres Syndrome Causes

1. direct trauma
2. excessive pronation/ supination

Flexor Carpi Radialis Origin

medial epicondyle / humerus

Flexor Carpi Radialis Insertion

2nd metacarpal (with slip to 3rd metacarpal)

Flexor Carpi Radialis Actions (2)

1. equal prime mover for flexion at wrist joint
2. abduct hand

Flexor Carpi Radialis Nerve Supply

Median Nerve (C8, T1)

Ulnar Deviation

abnormal flexion of Flexor Carpi Radialis due to weakness of the muscle, pulls medially

Palmaris Longus

vestigial in humans, in many species it operates the claw, missing in about 15% of humans

Palmaris Longus Origin

medial epicondyle / humerus

Palmaris Longus Insertion

palmer aponeurosis (facia, attaches to bone)

Palmaris Longus Actions (2)

1. weak flexion at wrist
2. tightens facia of palm (allows palm to "cup")

Palmaris Longus Nerve Supply

Median nerve (C8, T1)

Flexor Carpi Ulnaris Origins (2)

1. medial epicondyle / humerus
2. olecranon

Flexor Carpi Ulnaris Insertion (3)

1. pisiform
2. hamate
3. 5th metacarpal

Flexor Carpi Ulnaris Actions (2)

1. equal prime mover for flexion at wrist joint
2. adduction of hand

Flexor Carpi Ulnaris Nerve Supply

Ulnar Nerve (C7, C8)

Radial Deviation

-abnormal flexion at hand due to weakness of Flexor Carpi Ulnaris
- more lateral

Flexor Digitorum Superficialis Origin

medial epicondyle / humerus

Flexor Digitorum Superficialis Insertion

middle phalanges of digits 2-5

Flexor Digitorum Superficialis Actions (2)

1. flexes PIP joints of digits 2-5
2. assists in flexion at the wrist joint

Flexor Digitorum Superficialis Nerve Supply

Median nerve (C8, T1)

Flexor Digitorum Profundus Origin

shaft / ulna

Flexor Digitorum Profundus Insertion

distal phalanges of digits 2-5

Flexor Digitorum Profundus Actions (2)

1. flex DIP joints 2-5
2. flexion of wrist joint

Flexor Digitorum Profundus Nerve Supply

Median (C8, T1) (lateral half)
Ulnar (C7, C8) (medial half)

Flexor Pollicis Longus Origin

shaft / radius

Flexor Pollicis Longus Insertion

distal phalanx of 1st digit

Flexor Pollicis Longus Actions (2)

1. pronates forearm at distal radioulnar joint
2. helps stabilize distal radioulnar joint

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