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MSK week 2 SGU

Terms in this set (194)

Trapezius (superficial muscle)

elevate scapula
innervation= accessory nerve and cervical spinal nerves C3 and C4
Blood supply= ascending branch of transverse cervical artery

latissimus dorsi (superficial muscle)

Extends, adducts and medially rotates humerus
Innervation- Thoracodorsal nerve (C6-C8)
Blood supply- thoracodorsal artery

levator scapulae (superficial muscle)

elevates scapula
Innervation- dorsal scapular nerve and C3-C4
Blood supply- dorsal scapular artery

rhomboid major (superficial muscle)

Adducts and elevates scapula
Innervation- dorsal scapular nerve (C4-C5)
Blood supply- deep branch of transverse cervical artery and/or dorsal scapular artery

Rhomboid minot (superficial muscle)

Adducts and elevates scapula
Innervation= dorsal scapular nerve (C4-C5)
Blood supply- deep branch of transverse cervical artery and/or dorsal scapular artery

Serratus Posterior Superior (intermediate respiratory group)

elevates ribs II to V
innervation- anterior rami of upper thoracic nerves T2 to T5
Blood supply- segmental supply through intercostal arteries

Serratus Posterior Inferior (intermediate respiratory group)

depresses ribs IX to XII and may prevent lower ribs from elevated when diaphragm contracts
Innervation- anterior rami of lower thoracic nerves T9-12
Blood supply- segmental supply through intercostal arteries

erector spinae muscle group

Spinalis capitis, Spinalis cervicis, Spinal thoracis
illicostalis cervicis, illiocostalis thoracis, illiocostalis lumborum, longissimus cervicis, longissimus thoracis, longissimus capitis
Fxn-Extend vertebral column and head and laterally flexes vertebral column
Innervation- posterior rami of spinal nerves
Blood supply- vertebral, deep cervical, occipital, transverse cervical, posterior intercostal, subcostal, lumbar and lateral sacral arteries

splenius capitis

acting bilaterally, extend neck
Act unilaterally, laterally flexes and rotates to the same side
innervation- posterior rami of cervical spinal nerves
blood supply- deep cervical, occipital

splenius crevices

Act unilaterally, laterally flexes and rotates to the same side
acting bilaterally, extend neck
innervation- posterior rami of cervical spinal nerves
blood supply- deep cervical, occipital

extends head, cervical and thoracic regions of the vertebral column, rotates contra laterally
innervation- posterior rami of spinal nerves
Blood supply- deep cervical artery, posterior intercostal artery, subcostal arteries. lumbar arteries

stabilizes vertebrae
innervation- posterior rami of spinal nerves
Blood supply- deep cervical artery, posterior intercostal artery, subcostal arteries. lumbar arteries

Rotatores Cervicis, thoracis, lumborum

stabilizes vertebrae and assists with local extension and rotatory movements of vertebral column
innervation- posterior rami of spinal nerves
Blood supply- deep cervical artery, posterior intercostal artery, subcostal arteries. lumbar arteries

What determines bone mass?

genetics (gender and family hx), diet, body mass, hormones, illnesses, exercise, lifestyle choices

How much calcium is stored in bones?

osteoblasts, calcium

osteoblasts take free ionized Ca+ and puts it into the bone matrix

Osteoclasts, calcium

Takes Bone matrix Ca and turns it into free ionized Ca

Odontoid Fracture

Dens (C2) fracture
Type I and III are usually stable
Type II- Most common but unstable because the transverse ligament of that atlas becomes interposed between fragments. results in avascular necrosis

Hangman's fracture

Traumatic spondylolysis or spondylolisthesis of C2- occurs as result of hyperextension of the head and spinal cord

spondylolysis vs spondylolisthesis

Spondylolysis
- Stress fracture of the pars interarticularis - scotty dog
- Seen in dancers, gymnasts, lifters

Spondylolisthesis
- Vertebral sliding (step-off)
- Seen in dancers and gymnasts

Jefferson Burst Fracture

fracture of the anterior or posterior arches of atlas (C1)

Wedge/ Compression Fracture

vertebral compression fracture occurring anteriorly and/or laterally
Damage= at vertebral body, loss of height

margins of the vertebral body spread out in all directions
-may lead to spinal cord injury

PTH (parathyroid hormone)- Calcium effect

increases blood calcium levels by stimulating osteoclasts to break down bone matrix (bone resorption) and by increasing reabsorption in the kidneys, GUT

PTH (parathyroid hormone)- phosphate effect

increase plasma level by bone resorption
decrease plasma levels by kidney excretion
Overall decreases

Vit D acts on calcium and phosphate

a vitamin D deficiency in children
Demineralisation of bone - soft pliable bones
Characteristic bow-leg deformity
Overgrowth at costochondral junction - rachitic rosary
Pigeon chest deformity
Frontal bossing
Labs- Increased ALP (alkaline phosphate), hypocalcemia, hypophosphatemia

Vitamin D resistant rickets

same symptoms as classic rickets but get alopecia
Plasma levels of 1,25(OH)2D are elevated.
caused by mutations in the gene encoding the vitamin D receptor in the intestine--- decrease Ca2+ absorption from diet.

disease marked by softening of the bone in adults caused by calcium and vitamin D deficiency

Hypervitaminosis D

hypercalcemia -> renal stones

lipid soluble vitamin

CATS- Convulsions, Arrythmias, Tetany, spasms and stridor
Lab values
-25 hydroxyvitamin D levels - low if nutritional deficiency of Vit D
-1,25 dihydroxyvitamin D levels - low if renal insufficiency
-Parathormone levels - low after parathyroidectomy

Excessive PTH production

increase PTH, increase Ca2+ and decrease PO42-

Hypervitaminosis D lab values

increase Ca2+, increase PO42- , and increase 1,25(OH)2D

Hypophosphatemia causes

(1) inadequate intestinal phosphate absorption -
vitamin D deficiency,
• (2) excessive renal phosphate excretion - PTH excess.

Anterior Nodes (pectoral)

Receive lymph from anterior and lateral thoracic wall and breast

Posterior Nodes (scapular)

Receive lymph from posterior thoracic wall, back and posterior shoulder

Lateral Nodes (humeral

Receive lymph from most
of the upper limb except lymphatics
travelling with the cephalic vein

Receive lymph from anterior, lateral and posterior groups
-collecting node (2nd)

•Most superior nodes •Receive lymph from all other axillary nodes and superficial lymphatics accompanying cephalic vein
-collecting node (2nd)

Ball and socket joint

shoulder joint (glenohumeral) can
flex, extend, circumduction, abduction, adduction, medially and laterally rotate
easily dislocate because of lots of mobility

parts of coracoclavicular ligament

trapezoid ligament and conoid ligament
if broken or damaged= shoulder displacement via clavicle

fluid-filled sac that allows for easy movement via friction free movement of one part of a joint over another (between tendon, bone, muscle)
-can get infection in=bursitis

Acromioclavicular joint ligaments

acromioclavicular ligament
coracoclavicular ligament

joint capsule and ligaments

Glenohumeral ligament (3 parts- superior, middle, inferior), transverse humeral ligament, coracohumeral ligament

Midshaft Fracture of Clavicle

• Lateral fragment downwards and inwards
• Medial fragment upward
-Sternocladomastoid pulls medial fragment of clavicle upwards
-Pectoralis major pulls lateral fragment medially
-Latissimus dorsi and gravity pulls lateral fragment downwards

shoulder separation

step deformity, Varying degrees of severity, Tearing of the acromioclavicular joint and/or the coracoclavicular ligament, 3 types (Grade 1 (minor tear of acromioclavicular ligament), Grade 2(full tear of acromioclavicular ligament and minor tear coracoclavicular ligament) and Grade 3(full tear of acromioclavicular ligament and full tear coracoclavicular ligament))

Pectoralis major

•Flexion, adduction and medial rotation of the arm
•medial and lateral pectoral nerves
-blood supply: Thoroacromial Trunk

▪ abducts arm from 15 ̊ to 90 ̊
▪ axillary nerve
-blood supply: Posterior Circumflex Humeral Artery

serratus anterior

•rotates scapula upward for abduction of arm above 90 degrees
•protracts the scapula
•long thoracic nerve (C5, 6, 7)
-Blood supply: Lateral Thoracic Artery

• assists in rotating the scapula during abduction of arm above 90 degrees
• elevation of the scapula
• spinal accessory nerve

latissimus dorsi

• extends, adducts and medially rotates arm
• thoracodorsal nerve

•extension, adduction, media rotation of the arm
•lower sub scapular nerve
-blood supply: Posterior Circumflex Humeral A. and subscapular artery

▪ abduction of arm to 15 ̊
▪ suprascapular nerve
-rotator cuff muscle
-blood supply: Suprascapular Artery

▪ lateral rotation of arm
▪ suprascapular nerve
-rotator cuff muscle
-blood supply: Suprascapular A. & Circumflex Scapular A.

▪ lateral rotator of arm
▪ axillary nerve
-rotator cuff muscle
-blood supply: Posterior Circumflex Humeral A.

Shoulder Dislocation

prominence of the acromion with "squaring" of shoulder contour
Axillary nerve and posterior humeral circumflex artery can be damaged

1) An AP travels the length of the axon of a motor neuron to an axon terminal

2) voltage gated calcium channels open and calcium ions diffuse into the terminal

3) Ca entry causes synaptic vesicles to release acetylcholine via exocytosis

4) acetylcholinebinds to acetylcholine receptors (Nm) which have ligand-gated cation channels that open

5) sodium ions enter the muscle fiber and potassium ions exit the muscle fiber
--> Na has a greater driving force, Na entry leads to depolarization. This graded depolarization is called an End-Plate Potential(EPP)

6) The threshold EPP depolarizes the adjacent muscle membrane (Sarcolemma).

7) The resulting depolarization opens fast Voltage-gated Na+ channels on the muscles membrane propagating an Action potential

8) Action potentials are generated on either side of the endplate and are conducted away from the endplate in both directions along the muscle fiber.

9) ACh is then removed from the synaptic cleft by acetylcholinesterase.

- Black widows
- it opens presynaptic Ca2+ channels resulting in excess Ach release.
- Muscles NEVER relax

Lambert-Eaton myasthenic syndrome (LEMS)

-rare autoimmune attack against one of the voltage-gated Ca2+ channels in the nerve endings
-This decreases the normal Ca2+ influx that causes acetylcholine release.

Botulinum toxin

protease that interacts with Synaptobrevin and other proteins to prevent Ach release presynaptically

myasthenia gravis

caused by antibodies attack muscle type of nicotinic cholinergic receptors (Nm)
symptoms- muscle fatigue with sustained or repeated activity

Nm receptors antagonist (prevent Na entry)
used as a skeletal muscle relaxant

plant-derived alkaloid, used as arrows/blow dart poison. Competitive inhibitor of nicotinic receptors (Nm)

The association of a T tubule and the two terminal cisternae

excitation-contraction coupling steps

1) T-tubule action potential affects Dihydropyridine Receptors (DHPR) (voltage sensor)
2) Causes the RyR (Ryanodine receptor) to open and release calcium from the SR.
3)Create rapid release of calcium ions from terminal cisternae into intracellular space surrounding the myofilaments

junctional complex

DHPR (Dihydropyridine Receptors) and RyR (Ryanodine receptor)

- Blocks the myosin binding site on actin

Troponin subunits

-Troponin-T(binds to Tropomyosin)
-Troponin-I (Inhibits myosin binding to actin)
-Troponin-C (binds to calcium)

Has ATPase activity
S1 region= head, has ATP and actin binding sites
S2 region= tail

Calcium level in muscle when contracting and at rest

-intracellular low Calcium at rest (SERCA pumps calcium back into SR) and Calsequestrin binds to it
-contraction= calcium release from SR so increase in intracellular calcium

Increase in intracellular calcium (in muscle)

Ca2+ begin to bind to the Tn-C subunit associated with each tropomyosin molecule uncovering the myosin-binding sites on the actin filaments.

Malignant hyperthermia

trigger an abnormal release of Ca2+ from the sarcoplasmic reticulum in the muscle cell, resulting in sustained muscle contraction and heat production

Drug fix Malignant hyperthermia

Dantrolene directly interferes with muscle contraction by binding RyR receptors.

crossbridge cycle

1.Rest=Myosin and Actin interaction is blocked allosterically by tropomyosin.

2.Ca2+ binds to troponin-C allowing the myosin head binds to actin

3.Release of ADP and P changes the conformation of the myosin head from 90° to 45°, stretching the myosin head

4.power stroke (rigor crossbridge)

5. ATP molecule binds to the myosin head and is subsequently hydrolyzed

6. Back to rest= myosin head from 45° conformation back to original 90° conformation

stiff body due to- detachment can't occur because of the lack of ATP

Sliding Filament

-A band remains constant
-H and I band both decreases in size
-Z Lines are drawn closer to the ends of the A bands

-Titan
-Collagen fibers in the connective tissue (endomysium, perimysium, and epimysium)
-Incompressibility of the muscle cell itself due to the high fluid content

isometric contraction

muscle will not shorten.
Force= active tension
Peak total force dependent on starting length of muscle (proportional to preload)

Isotonic contraction and phases

muscle shortens
Isometric phase: myosin/actin crossbridges generate tension/force just enough to move the object
• Isotonic phase: once muscle force = weight, then any further crossbridges are used in muscle shortening and movement of load (plateau portion or flattened top).

total force - passive force

Vmax in cross bridge cycling

Determined by myosin ATPase activity→how fast crossbridge cycle spins

Type I (slow oxidative) fibers

• Lower Myosin ATPase activity (slower muscle)
• Contains a large amount of myoglobin pigment (imparts red color)
• High capacity for aerobic metabolism
• Slow twitch, fatigue resistant motor units
smal, red

type II (fast-glycolytic) fibers

large, white
High Myosin ATPase activity (fast muscle)
• Low myoglobin
• High capacity for anaerobic glycolysis
• Fast twitch fibers, which have rapid conduction rates and which are adapted to fast, short lived forces

-a sustained muscular contraction resulting from a rapid series of nerve impulses
-is a neurologic disorder caused by the toxin produced in the bacterium Clostridium tetani which blocks GABA leads to increase in the resting firing rate of motor neurons. muscles don't relax

symptoms of tetanus

"lockjaw" and the neck, shoulder, back, upper and lower extremities spasms Generalized spasms may jeopardize breathing.

Tetanus treatment

Antitoxin -neutralize circulating and unbound toxin.
Diazepam (GABA agonist)- to control spasm.

axillary sheath

Deep fascia that encloses the brachial plexus and blood vessels

Used as an entrance to the subclavian vein for the insertion of subclavian venous catheter.

Triangular space

-circumflex scapular artery
-teres minor, teres major, long head of triceps

quadrangular space

-axillary nerve and posterior circumflex humeral artery
-teres minor, teres major, long head of triceps, humerus

triangular interval

-radial nerve and deep brachia artery
-teres minor, long head of triceps, humerus

Clavipectoral fascia

•Connects clavicle to floor of axilla
•Encloses the pectoralis minor and subclavius muscle
•Gap allows for cephalic vein, thoracoacromial artery and lateral pectoral nerve

Axilla boundaries

-Anterior wall: Pectoralis major and minor
-Lateral wall: intertubercular sulcus
-Posterior wall: Subscapularis, teres major, latissimus dorsi
-Medial wall: serratus anterior, upper ribs, intercostal muscles

▪ Flexion of the forearm, supination of forearm, accessory flexor at the arm
▪ Musculocutaneous nerve
-blood supply: Brachial Artery

Coracobrachialis

▪ Flexion of arm
▪ Musculocutaneous nerve
-blood supply: Brachial Artery

▪ Flexion of forearm flexor
▪ Musculocutaneous nerve
-blood supply: Brachial Artery

Triceps brachii

▪ Extension of the forearm.
▪ Long head: assist in extension and adduction the arm at the shoulder joint
▪ Radial nerve
-blood supply: Profunda brachii

• Borders: Pronatorteres (medially) and Brachioradialis (laterally)
•Contents: Median nerve, Brachial artery and Biceps tendon

Elbow joint- three articulations

• Humero-radial joint: flexion & extension
• Humero-ulnar joint: flexion & extension
• Radio-ulnar joint: pronation and supination

median cubital vein

interconnects basilic and cephalic veins
blood draw vein

Nursemaid's elbow

-subluxation of the radial head
-Radial head slips out of the annular ligament
-Radiocapitellar line does not intersect the capitulum

neurovascular structures are at most risk in displaced
supracondylar fractures?

Median nerve and brachial artery

Volkmann's Ischemic Contracture

• Consequence of supracondylar fracture if not recognized and quickly repaired
• Injury to brachial artery lead to ischemic flexor contracture of the muscles of the anterior compartment

neurovascular structures can be damaged from Posterior dislocation of the elbow joint

Ulnar and median nerves, brachial artery

• Pronation
• Median nerve
-blood supply: ulnar artery

Flexor carpi Radialis

• Flexes and aBduct the wrist
• Median nerve
-blood supply: ulnar artery

Palmaris longus

• Flexes the wrist
• Resist shearing forces when gripping
• Median nerve
-blood supply: ulnar artery

interosseous membrane

-flexible membrane connecting radius and ulna & tibia and fibula
-separates into posterior and anterior compartments

Flexor carpi ulnaris

• Flexes and Adduct the wrist
• Ulnar nerve
-blood supply: ulnar artery

Flexor digitorum superficialis

• Flexes the wrist, MCPJs, proximal IPJ of index,
middle, long, and little finger
• Median nerve
attaches to the middle phalanx
-blood supply: ulnar artery

flexor pollicis longus

• Flexes CMC, MCPJ and IPJ of the thumb
• Anterior interosseous nerve
-blood supply: ulnar artery

Anterior interosseous nerve is a branch of

Flexor digitorum profundus

• Flexes the wrist, MCPJs, proximal and distal IPJ of index, middle, long, and little finger
• Anterior interosseous nerve (lateral half), ulnar nerve (medial half)
attaches to the distal phalanx
-blood supply: ulnar artery and Anterior Interossus artery

Pronator quadratus

• Pronation
• Anterior interosseous nerve
-blood supply: Anterior Interossus A

Extensor carpi ulnaris

Common extensor tendon
• Extends and aDducts the wrist
• Posterior interosseous nerve
-blood supply: Posterior Interossus A.

Extensor digiti minimi

• Common extensor tendon
• Extends the little finger
• Posterior interosseous nerve
-blood supply: Posterior Interossus A.

Extensor carpi radalis longus

• Extends and aBducts the wrist
• Radial nerve
-blood supply: radial artery

Extensor carpi radalis brevis

• Common extensor tendon
• Extends and aBducts the wrist
• Deep branch of the radial nerve
-blood supply: radial artery

Extensor digitorum

• Common extensor tendon
• Extends digits & wrist
• Posterior interosseous nerve
-blood supply: Posterior Interossus A.

Extensor policis longus

• Extends CMC, MCPJ and IPJ of thumb
• Posterior interosseous
-blood supply: Posterior Interossus A.

extensor indicis

• Extends the index finger
• Posterior interosseous
-blood supply: Posterior Interossus A.

• supination
• Posterior interosseous
-blood supply: Posterior Interossus A.

Abductor policis longus

-Abducts CMC of the thumb
-Posterior interosseous
-blood supply: Posterior Interossus A.

Extensor policis brevis

• Extends CMC and MCPJ
• Posterior interosseous
-blood supply: Posterior Interossus A.

Cardiac tissue does not have

• tetanic contractions (ratio of action potential duration to twitch duration is much less in skeletal muscle)
•temporal summation (due to long absolute refractory period)
-spatial summation (due to all cells connected by gap junction)

excitation-contraction coupling cardiac muscle steps

1- action potential
2-voltage gates calcium channels open and calcium enters cell
3- calcium induces calcium release through RYR
4- Local release causes calcium spark
5- Summed calcium sparks crease a calcium signal
6- calcium binds to troponin to imitate contraction
7-relaxation= calcium unbinds from troponin
8-calcium is pumped back into SR for storage
9-calcium is exchanged with sodium in extra cellular matrix
10- sodium maintained by Na/K ATPase

Modulation of the influx of
calcium in cardiac tissue through

- DHP channels
- G protein-linked receptor
- non-receptor-mediated events

The ability of myocardial cells to change the strength of contraction at the level of the cell.

increased isotropism

-greater degree of Force of Contraction for a given preload
-Inotropy and preload can act together
-B1 receptor to cAMP to calcium influx
-Sympathetic increases SERCA activity which results in faster pumping of Ca2+ into SR stores→ faster relaxation, shorter interval between contraction/heart rate (Lusitropy).

decreased inotropy

-Beta blocker=no cAMP= no enhanced beta agonist calcium entry

increased isotropy
1. Direct effect inhibits Na/K pump
2. Increase intracellular Na+.
3. Decrease gradient for Na+
and Decrease Ca2+ efflux
4. Increase intracellular Ca2+
5. More Ca2+ pumped into SR. Greater SR Ca2+ stores
6. Subsequent contraction
7. Increase Ca2+ released SR Increase force of contraction

Smooth muscle key ideas regarding contraction

• Side polar cross bridges- actin/myosin provide tension over long muscle lengths
• Much passive tension at optimal force/length- reduce overextension e.g. gut
• Tension generated is greater than skeletal muscle (due to myosin structure)

smooth muscle contraction

1) Intracellular calcium contractions increase when calcium enters cell and is released from SR
2) calcium binds to calmodulin
3) Calcium/Calmodulin activates myosin light chain kinase (MLCK)
4) Active myosin cross bridges slide along active and creates muscle tension

Vmax in smooth muscle

• Much slower Vmax due to myosin ATPase activity- in smooth vs skeletal muscle.
• Slower crossbridge cycling rate

Single Unit Smooth muscle (majority)

Made up of groups of cells joined together by gap junctions FUNCTIONAL SYNCYTIUM
• Allows for coordinated contractions
(Uterus, GIT)

Multi-unit Smooth Muscle

Large blood vessels, large airways, ciliary muscle
• Discrete units, separately stimulated by nerves
• Each fiber contract independently
• Fine control/gradual responses (vessels, lungs)
• Autonomic stimulation

require Ca2+-induced Ca2+ release in order to initiate contraction

cardiac and smooth muscle

Snuff box contents

lateral epicondylitis, inflammation of the attachment site for the extensors of the wrist

medial epicondylitis; inflammation of common flexor tendon

Radius articulate with what carpal bones

scaphoid and lunate

Radioulnar disc articulate with what carpal bones

lunate and Triquetrum

carpal tunnel contents

Flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus, median nerve

• Roof: palmar carpal ligament
• Floor:flexorretinaculumandhypothenarmuscles
• Medial boundary: pisiform
• Lateral boundary: hook of hamate
• Contents: Ulnar artery and nerve

Colles' Fracture

-distal radius fracture
-distal fracture fragment of fracture is displaced posteriorly

Smith's fracture

-reverse Colles, distal radius fracture
-anterior displacement of the distal fragment

Midpalmar (central) contents

long flexor tendons, lumbricals, palmar arches

thenar eminence contents

-FPL tendon and Flexor policies brevis, Abductor pollicis brevis, Opponens pollicis
-Recurrent branch of the median nerve

Hypothenar eminence contents

-Flexor digiti minimi, Abductor digiti minimi and Opponens digits minimi
-Deep motor branch of the ulnar nerve

Dupuytren's Contracture

-Thickening and contraction of the palmar aponeurosis (would need to cut this to fix)
-Unable to extend fingers

Fibrous digital tendon
sheaths

FDP, FDS & FPL
Hold tendons to the phalanges and prevent bowing

Synovial sheaths in digits

FDP, FDS & FPL tendons
Midpalmar space and wrist continuous with 5th
ulnar bursa

Synovial sheath in wrist

- FPL tendon
radial bursa

-A condition whereby the finger flexors contract but are unable to reextend because of a nodule within the tendon sheath or due to the sheath being too constricted to allow for free motion.
-At MCP joint
-FIBROSIS OF SHEATH AT MCP

Dorsal Interossei

• Abduction
• Deep branch of the ulnar nerve

Palmar interossei

• Adduction
• Deep branch of the ulnar nerve

Adductor policis

• Adducts the thumb
• Deep motor branch of the ulnar nerve
-blood supply: Deep Palmar Arterial Arch

determining the patency of the radial and ulnar arteries by compressing one artery site and observing return of skin color as evidence of patency of the other artery

tip of xiphoid process

inguinal region

pectoralis minor

Draws the scapula downward
Medial Pectoral Nerve (C8-T1)
blood supply: Thoroacromial Trunk

Brachioradialis

-blood supply: radial artery
radial nerve
elbow weak flexor

abductor pollicis brevis

-Thumb: Abduction at the CMC
-blood supply- radial artery
-Recurrent Median N. (C8-T1)

flexor policies brevis

-Thumb: Flexion at the CMC Joint
-blood supply- radial artery
-Recurrent Median N. (C8-T1)

abductor digiti minimi

-Pinky: Abduction at the MCP and Extion at the PIP and DIP Joints
-blood supply: ulnar artery
-nerve: deep Ulnar (C8-T1)

Flexor Digiti Minimi

-Pinky: Flexion at the MCP Joint
-blood supply: ulnar artery
-nerve: deep Ulnar (C8-T1)

Opponens digits minimi

-Pinky: Draws the 5th metacarpal in the opposite direction
-blood supply: ulnar artery
-nerve: deep Ulnar (C8-T1)

Opponens Pollicis

-Thumb: Opposition at the CMC Joint
-radial artery
-Recurrent Median N. (C8-T1) -Test by making the OK sign

Spiral midshaft fracture of the humerus (damages)

radial nerve and deep brachial artery

shoulder separation

acromioclavicular separation and coracoclavicular ligament tear

fracture of hook of hamate damages

ulnar nerve and ulnar artery

posterior dislocation of elbow (damages)

-ulnar and median nerve
-brachial artery

shoulder droop, nerve injured

-spinal accessory nerve (trapezius)

Erb palsy ("waiter's tip")

Nerves- axially, suprascapular, and musculocutaneous

SUPERFICIAL ARM DRAINAGE

BASILIC (Median)=AXILLARY VEIN
CEPHALIC (Lateral)=AXILLARY VEIN

DEEP ARM DRAINAGE

Basilic= Axillary @ Lower Teres Major

Flexor Pollicius Longus

Flexor Digitorum Superficialis + Flexor Digitorum Profundus

Lateral to flexor carpi ulnaris (Pressed against Distal Radius) or between Extensor Pollicus Brevis and Extensor Pollicus Longus (Pressed against Scaphoid)

Radial Nerve Palsy

No Extension of MCP Joint (Extensor Digitorum/Extensor Digiti
Minimi)

Radial N. AXILLA DAMAGE

Subclavian Artery

1. Vertebral Artery
2. Internal Thoracic (3 branches) Mnemonic: "AIMS"
A. Anterior Intercostals B. Musculophrenic
C. Superior Epigastric
3. Thyrocervical Trunk (2 Branches) A. Transverse Cervical
- Descending Branch of Transverse Cervical (Supplies Rhomboids + Lev. Scapula)
- Ascending Branch of Transverse Cervical (Supplies Trapezius) B. Suprascapular Artery (Supplies Infraspinatus + Supraspinatus)
C. Thyrocervical Artery
4. Costocervical Trunk 5. Dorsal Scapular

Axillary Artery

1. Superior Thoracic (Sixties)
2. Thoracoacromial Trunk (Teens)
Mneumonic: "Cadavers Are Dead People" - Clavicular branch (Cadavers)
- Acromial branch (Are)
- Deltoid branch (Dead)
- Pectoral branch (People) 3. Lateral Thoracic Artery (Love)
4. Subscapular Artery (Sex)
Mneumonic: "after sex you always get "STds"
- Scapular circumflex (S) (in ∆ space)
- ThoracoDorsal (TD) (supplies latissimus dorsi)
5. Anterior humeral circumflex (And)
6. Posterior humeral circumflex (Pot) (In Quad. Ang. Space w/ Ax. Nerve)

Ach causes conductance of...

sodium and potassium

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