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Upper Extremity #1

Terms in this set (140)

Name the 4 regions of the upper extremities
shoulder girdle
Arm
Forearm
Hand
What is the anatomy of the shoulder girdle
Bony ring- scapula and clavicle
posterior - attaches to axial skeleton via scapthoracic joint (not a true joint)
Anterior - attaches to axial skeleton via SC joint (true synovial jt)
What is the anatomy of the Arm region
region between shoulder and elbow
Humerus
What is the anatomy of the forearm region
region between elbow and wrist, radius and ulna bones
What does the hand region contain
carpals, metacarpals, and phalanges
Describe the anatomy of the clavicle
'S" shaped bone which allows for optimal elevation
only connection of axial skeleton to UE
2 articulations - Medial and Lateral
Describe the Medial and Lateral articulations of the clavicle
Medial- articulates with manubrium, for Sc joint
Lateral - articulates with the scapula forms the AC (acromicoclavicular) joint
Name 7 landmarks of the clavicle
sternal end (medial)
acromial end (lateral)
deltoid tubercle (attachment for deltoid)
impression for costoclavicular ligament
subclavion groove
trapezoid line
conoid tubercle
Name the clinical significance of clavicle problems
fractures usually occur at junction between middle and lateral third -
severe OA of SC or AC joints limit functional movement of shoulder
What is the scapular structure and function
triangular flat bone commonly referred to as "shoulder blade"
plays critical role in shoulder function
Name the 3 articulations of the scapula
scapulothoracic "articulation"
glenohumeral (GH) joint - glenoid fossa of scapula articulates with head of humerous
AC joint - acromian process of scapula articulates with lateral end of clavicle
Name 12 landmarks of scapula
acromian
coracoid process
spine of scapula
supraspinous fossa
infraspinous fossa
subscapula fossa
suprascapular notch
head
neck
glenoid cavity
supraglenoid tubercle
infraglenoid tubercle
Name the 3 borders of the scapula
medial
lateral
superior
Name the 3 angles of the scapula
superior - junction of medial and superior borders
inferior - junction of medial and lateral borders
lateral - junction of lateral and superior borders - not as distinct as the other two angles
What is the acromion
AC joint, deltoid and trapezius attachment
What attaches to coracoid process
short head biceps, coracobrachialis and pec minor attachments
What attached to the spine of scapula
deltoid and trapezius muscles
What surface of scapula is the supraspinous fossa on
posterior surface
What surface of scapula is infraspinous fossa on
posterior surface
What surface of scapular is subscapular fossa on
anterior surface
What attaches to the supraglenoid tubercle
long head of biceps
What attaches to the infraglenoid tubercle
long head of triceps
name the articulations of the humerus
GH -(glenohumeral joint) head of humerous articulates with glenoid fossa of scapula
Elbow (2) - humeroradial jt- articulation btwn capitulum of humerous and radial head
humeroulnar jt - articulation btwn trochlea of the humerus and trochlea notch of ulna
What is the anatomical neck of the humerus
medial to tubercles, indentation distal to head of humerus provides attachment for articular capsule
Where is the surgical neck of humerus
distal to tubercles, very common site for Fx
What attaches to the greater tubercle of humerus
external rotator cuff muscles (supraspinatus, infraspinatus, teres minor muscles
What attaches to the lesser tubercle of humerus
internal rotator of rotator cuff muscles (subscapularis)
Where is the bicipital groove and what attaches there
located btwn lesser and greater tubercles, groove for tendon of long head of biceps, also attachments for pec major, latissimus dorsi, and teres major
What is the deltoid tuberosity and what attaches
lateral aspect of humerus near midshaft, attachment for deltoid
What is the radial groove
groove for radial nerve as it travels posterior to humerus
name 3 fossa's of distal humerus
olecranon fossa - posterior surface
Coronoid fossa - anterior surface
Radial fossa - anterior surface
What attaches to the medial epicondyle
flexor muscles of forearm
What attaches to the lateral epicondyle
extensor muscles of the forearm
Name the 4 muscles of the anterior throacoappendicular region
Pectoral major
pectoral minor
sublavius
serratus anterior
Describe the structure and function of the pectoralis major
has 2 heads - clavicular head and sternocostal
inferior border of deltopectorial triangle
lateral border forms anterior wall of axilla
Major function: adduction and medial rotation of the humerus, also assist in flex and extension of the humerus
What is the nerve for the pectoralis major
medial and lateral pectoral nerves
Where is the pectoralis minor, function and nerve
Deep to pec major, also part of anterior wall of axilla, functions to stabilize the scapula, protraction and depression of the scapula
N: medial pectoral nerve
Where is the subclavius muscle, function and nerve
located inferior to clavicle (attach subclavian groove of clavicle)
function to stabilize clavicle and SC joint - possible role in protecting subclavian artery
N: nerve to subclavius
Where is the serratus anterior, function and Nerve
forms medial wall of axilla
Major function: protraction and stabilization of the scapula and synergistically assists in external rotation of the scapula (elevate arm over your head)
Nerve: long thoracic nerve
Clinical outcome of damage to the long thoracic nerve
results in paralysis/weakness of the serratus anterior
"winging of the scapula"
dysfunction of shoulder abduction
What makes up the deltopectoral triangle and clinical significance
deltoid, pec major and clavicle form triangle
cephalic vein passes superficially to deep to join with axillary vein
Name the 2 superficial posterior thoracoappendicular muscles
Trapezius
Latissimus Dorsi
What does trapezius attach and what nerve
attaches shoulder girdle to axial skeleton
N: CN 11- accessory nerve and C2, C3, C4
name the 3 divisions of the trapezius and function
Synergistically will retract the scapula
Upper- elevate, upward rotation, retraction of scapula
middle - retraction of scapula
lower - depression, upward rotation, retraction of scapula
What are the 2 joints that Latissimus dorsi works on and major function and nerve and distal attachment
Acts directly on GH joint and indirectly on scapulothoracic joint
Function: extends, adducts and medially rotates humerus
Nerve: thoracodorsal nerve
Distal attachment: PLT of biciptal groove
What are the attachments included in the PLT of the biciptal groove
P=pec major lateral lip of biciptal groove
L= lats - floor of groove
T=teres major -medial lip of groove
Note: all three medially rotate humerus
Name the 2 Deep posterior throacoappendicular muscles
Levator scapulae
Rhomboid major/minor
What is the action and nervation of the levator scapula
elevates and downward rotation of scapula (prox attachment fixed)
lateral flexion and ipsilateral rotation of the neck (distal attachment fixed)
Nerve: C3, C4 and Dorsal scapular nerve
What is the action and location of Rhomboid and nerve
Deep to trapezius
retract and downward rotation of the scapula; stabilize scapula
N: dorsal scapular nerve
Damage to the dorsal scapular nerve will see what clinically?
scapula deviate laterally from midline
Name the 6 muscles of the scapulohumeral region
Deltoid
Teres major
4 Rotator cuff muscles -"SITS"
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
Name the 3 heads of the deltoid muscle and their individual functions
Anterior - flex and IR humerus
Middle - abduct humerus
Posterior - ext and ER humerus
What is the synergistic function of the 3 heads of Deltoid and nerve
contract to abduct the arm, posterior and anterior heads stabilize the humerus during abduction
when humerus is abducted deltoid assists in resisting distraction of GH joints
nerve: axillary nerve
What is the location, function and nerve for teres major
forms inferior portion of the posterior wall of the axilla
function -adduct and IR the humerus (similar to lats)
distal attachment part of PLT of biciptal groove
Nerve: lower subscapular nerve)
What is the general function of the rotator cuff muscles
provide dynamic stability of the GH joint
Name the P, D, N and A for Supraspinatus
P:supraspinous fossa
D: superior facet of greater tuberosity
N: suprascapular nerve
A:isolated action - abduct humerus
Name the P, D, N and A for Infraspinatus
P: infraspinous fossa
D: inferior to the supraspinatus attachment, middle facet of GT
N: suprascapular nerve
A:works synergistically with teres minor to ER humerus
What is the P, D, N and A for subscapularis
P: subscapular fossa
D: LESSER tuberosity of humerus
N: upper and lower subscapularis nerve
A: IR of humerus
What is the P, D, N, and A for Teres Minor
P: superior portion of lateral border of scapula
D: inferior to infraspinatus attachment, inferior facet of GT
N: axillary nerve
A: Works synergistically with infraspinatus to ER humerous
Name the 4 landmarks of the posterior thoracoappendicular region
triangular spaces - upper and lower
Quadrangular space
triangle of auscultation
What are the borders and contents of the upper triangle
Superior - teres minor
Inferior - teres major
Lateral - long head of triceps
Contents: circumflex scapular artery
What are the borders and contents of the lower triangle
Superior - teres major
Medial - long head of triceps
Lateral - lateral head of triceps
Contents: radial nerve and deep artery of the arm
What are the borders and contents of the quadrangular space
Superior - teres minor and subscapularis
Inferior - teres major
Medial - long head of triceps
Lateral - surgical neck of humerus
Contents: axillary nerve and posterior humeral circumflex artery
What are the borders of the auscultation triangle and what function does it serve
trapezius, latissimus dorsi and medial border of scapula
Function: breath sounds heard more clearly hear
Where does the subclavion artery begin and end
Right: brachiocephalic trunk the start subclavion
Left: directly from aorta
Ends: outer border of first rib changes name to axillary
Where does the axillary artery begin and end
Begin: outer border of 1st rib
End:inferior border of teres major (name chgs to brachial)
has 3 portions
Where does the brachial artery begin and end
Begin - inferior border of teres major
End: divides into radial and ulnar arteries
What are the 2 loops formed by the radial and ulna arteries that supply the hand?
Superficial and deep palmer arches
Name the 3 major arteries that supply the scapula region
Suprascapular artery
Subscapular artery
Transverse cervical A (deep branch)
Name the major arteries supplying the shoulder
anterior and posterior circumflex humeral arteries (branch off the 3rd portion of the axillary artery)
Name the major arteries supplying the elbow and distal humerus
Deep artery of arm - branches off brachial and wraps posteriorly around humerus
Branches to radial collaterals that supply elbow
Brachial artery supplies ulnar collaterals that supply elbow
Recurrent arteries of radial and ulna arteries form anastomoses with collaterals
What is the axilla region and what is the clinical significance
a pyramidal shaped region at junction of arm and upper thorax
clinically site of palpation to identify enlarged lymph nodes (lymph drainage of breast drain here)
What are the boundaries of the axilla
Medial Wall- thoracic wall (1-4 ribs +intercostals) serratus anterior
Lateral Wall - narrow wall formed by humerus
Anterior Wall - pec major and minor
Posterior Wall - subscapularis, teres major, lats
Base: axillary fascia and concave skin
Apex - connection btwn neck and axilla (cervicoaxillary canal)
space btwn clavicle, 1st rib and scapula
What are the contents of the axilla
neurovascular bundle enclosed in axillary sheath, axillary artery and branches, axillary vein, brachial plexus
Axillary lymph nodes
The nerves that supply the thoracoappenicular region and UE originate primarily from where
C3-T1
The network of vental rami of spinal nerves that form the brachial plexus arise from where
C5-T1
What happens to the ventral rami to form peripheral nerves
they merge and divide
Name 5 major nerves of the upper limb
Axillary
musculocutaneous
radial
median
ulnar
What are the 5 regions for the brachial plexus
roots
trunks
divisions
cords
branches
How are the roots of the brachial plexus formed, where do they go and what happens to them
formed by ventral rami of spinal nerves C5-T1
pass through anterior and posterior scalene muscles
roots merge to form 3 trunks
Name the 2 peripheral nerves that emerge from roots
dorsal scapular nerve
long thoracic nerve
Name the 3 trunks of the brachial plexus and what roots they are formed by and what they divide into
Superior = C5-C6
Middle = C7
Inferior = C8-T1
each trunk divides into anterior and posterior to form divisions
Name one peripheral nerve that emerges from trunks
nerve to subclavius
What are the 2 divisions coming out of trunks of brachial plexus and what happens to them
Anterior and posterior divisions - they merge to form cords
Name one peripheral nerve that emerges from divisions
suprascapular nerve (some discrepancy on where)
Name the 3 cords and what they are formed from
Lateral cord - formed from anterior divisions of superior and middle trunk
Medial cord - formed from anterior division of inferior trunk
Posterior cord - formed from posterior division of all three trunks
How are the cords named and what emerges from them
named according to their relationship with the axillary artery
they divide and merge to form peripheral nerve branches
name the 3 peripheral nerve branches formed from the lateral cord
musculocutaneous nerve
lateral pectoral nerve
1/2 median nerve (other 1/2 from medial cord)
Name the 5 peripheral nerve branches formed from the medial cord
1/2 median nerve (other 1/2 from lateral cord)
medial pectoral nerve
medial brachial cutaneous nerve
medial antebrachial cutaneous nerve
ulnar nerve
Name the 5 peripheral nerve branches formed from the posterior cord
axillary nerve
radial nerve
thoracodorsal nerve
upper supscapular nerve
lower supscapular nerve
From the roots of the brachial plexus where does the dorsal scapular nerve go and what muscles does it innervate
pierces through medial scalene
supplies: rhomboids and occasionally levator scapula
From the roots of the brachial plexus what does the long thoracic nerve plug into
serratus anterior
From the trunk of the brachial plexus what does the nerve to subclavius plug into
subclavius
From the division of the brachial plexus where does the suprscapular nerve go and what does it innervate
passes through scapular notch
supplies: supraspinatus and infraspinatus
From the lateral cord of the brachial plexus where does the musculocutaneous nerve go and what does it innervate
pierces coracobrachialis
supplies coracobrachialis, brachialis, and biceps
continues on at lateral cutaneous nerve of forearm (aka lateral antebrachial cutaneous nerve)
From the lateral cord of the brachial plexus what does the lateral pectoral nerve plug into
pectoralis major
From the lateral and medial cord of the brachial plexus where does the median nerve plug into
supplies wrist/hand flexor muscles of forearm and muscles in thenar region of hand
From the medial cord of the brachial plexus what does the medial pectoral nerve supply
pec minor and major
From the medial cord of the brachial plexus what does the medial brachial cutaneous nerve supply
skin of medial arm
NO MUSCLES
From the medial cord of the brachial plexus what does the medial antebrachial cutaneous nerve supply
skin of medial forearm
NO MUSCLES
From the medial cord of the brachial plexus what does the ulnar nerve supply
muscles of hand and 1.5 flexor muscles of forearm
From the posterior cord of the brachial plexus where does the axillary nerve go and what does it innervate
exits through quadrangular space
Supplies: deltoid and teres minor
continues on as superior lateral brachial cutaneous nerve and supplies skin over deltoid region
From the posterior cord of the brachial plexus where does the radial nerve go and what does it innervate
travels posteriorly around humerus in radial groove
supplies: triceps, anconeus, brachioradialis and wrist/hand extensor muscles of forearm
From the posterior cord of the brachial plexus what does the thoracodorsal nerve plug into
lats
From the posterior cord of the brachial plexus what does the upper subscapular nerve plug into
superior portion of subscapularis
From the posterior cord of the brachial plexus what does the lower subscapular nerve plug into
superior portion of inferior portion of subscapularis and teres major
How are the muscles of the arm divided
anterior and posterior compartments
divided by medial and lateral intermuscular septum
Anterior muscles of arm are supplied by what nerve
musculocutaneous nerve
Posterio muscles of the arm are supplied by what nerve
radial nerve
name the 5 muscles of the arm
Coracobrachialis
Biceps
Triceps
Brachialis
Anconeus
Name the P,D and A for Coracobrachialis muscle
P: coracoid process of scapula
D: middle third of medial humerus
A: flex and adduct arm
Misc: musculocutaneous nerve pierces through this muscle
Name the P, D and A for Biceps
P: Long head - supraglenoid tubercle of scapula
Short head - coracoid process of scapula
D: radial tuberosity of radius and bicipital aponeurosis
A:flexes arm and forearm, supinates forearm
What is the bicipital aponeurosis and what function
fascia that extends from distal biceps tendon and blends with fascia of the flexor muscles of the forearm
Function: provide protection for structures in the cubital fossa
What are some clinical correlations of biceps
Transverse humeral ligament - contains tendon of the long head in bicipital groove - potential for dislocation
Biceps tendonitis - irritation of long head tendon as it passes through bicipital groove
Rupture of long head tendon
Rehab strengthening - optimal in supinated position
Name the P, D and A for brachialis
P: distal half of anterior surface of humerus
D: coronoid tuberosity of ulna
A: flexor of forearm (in all positions supinated, neutral or pronated)
Rehab strengthening of brachialis is best in what position
active in all positions
What is the P, D and A for triceps
P: Long head: infraglenoid tubercle
Lateral Head - posterior humerus superior to radial groove
Medial head - posterior humerus inferior to radial groove
D: olecranon process of ulna
A: primary extensor of forearm
What is the P, D and A for Anconeus
P: Lateral epicondyle of humerus
D: olecranon process of ulna
A: assists in forearm extension, stabilizes elbow joint
Pathway of the axillary nerve through shoulder/arm
branches off posterior cord travels posteriorly, exits through quadrangular space and supplies the teres minor and deltoid
Pathway of the musculocutaneous nerve
begins inf border of pec minor, pierces coracobrachialis, travels btwn biceps and brachialis after innervating biceps and brachialis nerve becomes lateral cutaneous nerve of forearm
Pathway of radial nerve
travels posterior to brachial artery and medial to humerus, descends with deep artery of arm, travels posterior to humerus in radial groove, wraps anterior and pierces lateral intermuscular septum, travels btwen brachialis and brachioradialis to elbow
Pathway of median nerve
in arm follows brachial artery, runs lateral to brachial artery and then crosses to run medial to brachial artery
does not have any branches in the axillary or arm
pathway of ulnar nerve
travels medial to brachial artery and anterior to triceps, mid point of humerus it pierces medial intermuscular septum and descends posteriorly, passes posterior to medial epicondyle and enters the forearm
DO NOT have any branches in axilla or arm
Explain the blood supply to the arm
axillary artery becomes brachial artery at inf border of teres major
brachial gives off branch -deep artery of arm which travels posterior to humerus in radial groove then branches into radial collateral arteries the supply lateral elbow.
Brachial artery gives off ulnar collateral branches that supply medial elbow.
Brachial ends in cubital fossa where it divides into radial and ulnar arteries
Name the 2 main ligaments of the AC joint
AC ligament - superior and inferior portion
Coracoclavicular Ligament - 2 ligaments that connect coracoid process of scapula and inferior surface of clavicle
Name the 2 ligaments that make up the coracoclavicular ligament
trapezoid ligament - coracoid process to trapezoid line of clavicle
conoid ligament - coracoid process to conoid tubercle of clavicle
How many types of AC joint sprains are there
6
What is type 1 AC joint separation
partial injury to AC ligament, coracoclavicular is intact
What is type 2 AC joint separation
disruption of AC ligament CoraEcoclavicular still intact
What is type 3 AC joint separation
disruption of AC and coracoclavicular ligaments - clavicle displaced superiorly
Explain the articulation of the GH joint
humeral head articulates with glenoid cavity of scapula and glenoid labrum increases congruency of the joint
Name the 4 ligaments of the GH joint
glenohumeral ligament (strengthen anterior aspect of joint)
coracohumeral ligament
coracoacromial ligament
transverse humeral ligament
Name the 3 parts of the glenohumeral ligament
superior
middle
inferior
Where does the coracohumeral ligament connect
coracoid process to greater tuberosity of humerus
What does the coracoacromial ligament form
part of the coracoacromial arch
What does the coracoacromial arch consist of
coracoacromial ligament and acromion process
Subacromial space - supraspinatus tendon passes through here and is protected by the subacromial bursa (lies between arch and bursa)
What is the transverse humeral ligament and what does it contain
acts as a bridge over the bicipital groove and contains long head of biceps tendon
Name the 2 bursas of the GH joint
subacromial bursa
subscapularis bursa
Where is the subscapularis bursa
between subscapularis tendon and the neck of the scapula -
communicates with GH joint capsule (ext of Gh joint capsule)
Name 4 clinical correlations of GH joint
Supraspinatus tendonitis
impingement syndrome
rotator cuff tears
dislocation of GH joint
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