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Week 6 LOs
Terms in this set (73)
If someone can't do upward rotation of the glenoid fossa (bring arm 180 above head) what muscles can cause this?
Trapezius and serratus anterior
If the quadrangular space is damaged what muslce won't get innervation?
deltoid and teres major
What happens if there is an axillary artery blockage?
there are anastomoses connection in the via the scapular arteries
What are the arm muscles that move at the elbow joint?
During limb development how do you get joint development
first get single condensations and then will get the joint formations that result from cell death or apoptosis to form like the synovial joints (ex)
1)What type of primordia will form the limbs?
1)lateral plate mesoderm-->somatic
What is the purpose and function of the apical ectodermal ridge?
NOTE: additional AER= more limbs
What about diplopodia?
(AER)=important in development of limbs (sooner lose the less limb development will have)
-phocomelia: develop some lower limbs (legs) but no upper limbs (arms)
-amelia: no limb development at all
-meromelia: some limb development
Diplopodia= mirror images of foot (almost have 2 feet)
What are the primordial derivatives of the flexors and extensors of the upper limbs?
extensors= posterior (preaxial and postaxial divisions)
Flexors= anterior (preaxial and postaxial divisions)
Know which division during limb development (anterior vs. posterior) will become the flexors & extensors in the upper and lower limbs
posterior division= extensors
Anterior division= flexors
posterior division= flexors
Anterior division= extensors
Diagram the organization and structural relationships of the walls and contents of the axillary fossa.
Medial wall= ribs 2-6 and serratus anterior
Lateral wall=intertubercular groove of humerus
Posterior wall= scapula, subscapularis, teres major, latissimus dorsi
Anterior wall= pectoralis major & mino
Base= skin & axillary fascia
Apex= cervicoaxilary triangle
What fibers run in the brachial plexus?
All from ventral rami:
Preaxial correlates with what veins? Postaxial?
Preaxial= cephalic vein (more toward thumb)
Posaxial=basilic vein (more toward pinky)
What divisions make up the chords of the brachial plexus?
lateral cord= anterior division of upper trunk and middle trunk
posterior cord= all posterior divisions of upper, middle, and lower trunk
medial cord= anterior division of lower trunk
branch of lateral cord and medial cord will come together to form the cord going to the median nerve
If you damage the C5 nerve root what muscles would be affected (hint, think about what are the nerve branches)
-dorsal scapular nerve-->rhomboids & levator scapula
-suprascapular nerve-->supraspinatus, infraspinatus, shoulder joint
-Nerve to subclavius-->subclavius
ALSO: the long thoracic nerve (picks up branches from C6 & C7) that will supply the serratus anterior
-lateral pectoral nerve-->innervate pectoralis major (might be okay though becuase also get innervation from C7 anterior division)
NOTE: distal to the divisions chords will either have anterior or posterior divisions but NOT both
Which joints would be affected if had damage at the following roots:
C6=shoulder and bit of elbow
C7=bit of elbow and wrist
C8=wrist and part of digits
Know cutaneous innervation areas of the upper limbs
How to tell the difference if someone has dermatome vs. cutaneous damage and how does that correspond to where the damage could be in the brachial plexus?
If someone is having more stripy (more dermatome) like loss of sensation then more likely damage at the root
If having more patchy (more cutaneous nerve) loss of sensation more likely damage to be farther distal in the brachial plexus and affect more the branches or cords
How do tell the difference between the sternal vs. acromial end of the clavicle?
sternal end is more round
acromial end is more wide and flat
What is the only joint that connects the pectoral girdle to the and free upper limb to the axial skeleton?
Acromioclavicular joint function?
Coracoclavicular ligaments function?
Acromioclavicular joint= synovial joint, no muscles act directly on this joint-->it permits passive movements that transmit to SC joint
Coracoclavicular ligaments stabilize AC joint and permit should to move as a unit
Orientation with the humerus? proximal & distal
-greater tuberacle more lateral
-head faces medially
-lesser tuberacle face anteriorly
-medial epidondyle much more prominant
-trochlea more medial
-capitulum is more lateral
NOTE: corticobulbar tracts send fibers to both sides of the brain (bilateral) and ipsilateral: CN V, VII, IX, X, XI, XII
Eception: CN VII lower face only recieves contralateral input
What sort of presentation would you expect to see if there as a lacunar infart in the posterior limb of the internal capusle?
What about in the genu or bend?
Posterior limb of internal capsule= corticospinal fibers
Genu or bend= more corticobulbar fibers
What sort of deficts would you expect to see if there was damage to either the lateral white matter of the spinal cord vs. ventromedial?
Lateral= corticospinal & rubospinal tracts-->distal muscles and fine movements
Ventromedial= tectospinal, reticulospinal, vestibulospinal tracts-->distal/axial muscles and posture
If someones red nucleus is damaged from a small PCA perforator infarct, what tract will be affected and what will be the motor consequences?
and fine movements
If someone is having issues with posture which spinal tract pathway could be affected and where does this tract receive information from?
Reticulospinal pathway-->acts mostly on axial/"trunk" muscles with posture
Reticular formations on the ipsilateral side receive info from either: pons or medulla
If someone is having trouble orientating the head to the location of a sensory stimulus which pathway would be damaged?
Tectospinal pathway-->originate in the superior colliculis and axons cross at level of the medulla
What are the components of the unconscious proprioreceptors?
golgi tendon organs (get activated when the muscle stretches that sends the information to the sensory 1b fiber that sends the fibers up to the cerebellum
What correlates (cerebellar homunculus) with the medial and lateral cerebellum?
medial= trunk muscles & vermis dysfunction (ataxia of gait and trunk muscles)
lateral= limb muscles & paravermis dysfunction (ataxia of ipislateral limb muscles)
If someone has a tremor that occurs when they try to move their arm (for example), what kind of tremor is this called and what could it indicate?
intention tremor and could indicate cerebellar damage
How does dopamine and ACH act on the pathways that are part of the basal ganglia system?
Dopamine-->excites direct pathway and inhibits indirect pathway
Ach-->inhibits direct pathway and excites indirect pathway
What are the actions of the humeroulnar joint?
it is a uniaxial hinge joint that ONLY does flexion and extension
NOTE: the humeroradial joint just tags along as a ride
Which ligaments of the elbow prevent abduction and adduction of the forearm and which ligament is stabilization of the proximal radioulnar joint?
ulnar collateral ligament= prevents abduction (most commonly torn in baseball) (
radial collateral ligament=prevents adduction (
anular ligament= stabilizes the proximal radioulnar joint (it is a ring around the head of the radius)
How do you perfrom and which ligaments does the varus and valgus test do?
Varus test= test the radial collateral ligament which prevents adduction so apply adduction pressure at distal forearm
Valgus test= test the ulnar collateral ligament which prevents abduction
If someone can't pronate or supinate which joints might be damaged?
What is a different between the proximal, middle, and distal radioulnar joints?
Proximal & distal are synovial joints
middle or interosseous membrane is a fibrous tissue and is highly movable
NOTE: the ulna does not articulate with the carpal bones
How to remember the carpal bones?
Proximal and by the thumb: So Long To Pinky, Here Comes The Thumb
What all is in the carpal tunnel and what nerve? Tendons from what muscles
What ligament is the anterior border of the canal?
What causes carpal tunnel syndrome?
8 tendons (4 each) from flexor digitorum superficialis & flexor digitorum profundus and 1 from flexor polliscus longus and then the medial nerve (located more anterior and closer to thumb)
Inflammation from use of the synovial sheaths
What components make up the radiocarpal joint? What type of and how many axes does it do?
scaphoid and lunate bones of the wrist articulate with the radius to form the radiocarpal joint (wrist)
It is a synovial, biaxial joint
What is the most common type of fracture to happen when we fall on our wrist?
Colles fracture-->fracture of the distal head of the radius
OR scaphoid fracture (MOST COMMON fracture of the carapals)
How many phalanges do the fingers have?
digits 2-5) each have 3 phalanges: proximal, middle, distal
digit 1 (thumb) has 2 phalanges (proximal and distal)
What type of joint and axes is the CMC joint of the thumb?
What about the MCP joints? What about MCP joint of the thumb?
What about IP joints?
multiaxial and a saddle joint
the trapeqium and the first metacarpal
MCP joints: are biaxial synovial joints
MCP joint of thumb= uniaxial and synovial (Only flexion and extension occur here)
IP: synovial, uniaxial and only do flexion and extension
If someone presents with normal strength but can't control their movements and don't have a babinski sign what part of the body do you think?
extrapyramidial (subcortical, basal ganglia, thalamus, brainstem)
If someone has damage to the direct pathway what type of abnormal movements would you expect?
What are the cardinal signs of parkinsons?
-resting tremor (decrease when move)-->
If you see lewy bodies that contain abnormally folded alpha-synuclein what should you think about?
parkinsons-->eosinophilic neuronal inclusions
What is the one best medication for parkinsons?
Carbidopa prevents the metabolism of levodopa?
Know how to identify:
-resting tremors= happens when just chilling (associated with parkinsons)
-acting/kinetic tremors= worse when doing an action (writing, eating)
-postural tremors = act up when have to hold a certain position (holding arms out)
What are the clinical features of huntingitons?
Treatment of huntingtons?
-changes in cognition
Pathophys= atrophy of basal ganglia (caudate putament, globus pallidus)
Treatment= dopamine blockers-->anti psychiotics
What is the innervation of flexor digitorum profundus?
digits 2-3 is the median nerve
digits 4-5 is ulnar nerve
What is in layer 3 of the flexor compartments of the forearm?
flexor digitorum profundus
flexor polliscus longus (goes to the distal phalanx of thumb)
What is the deepest layer of the flexor forearm?
What joints do it move?
Does pronator of the radioulnar joints
What are some of the unique actions of the lateral compartment of the extensor forearm?
All 3 muscles pass
to the transverse axis so will flex the eblow BUT will extend the wrist and carpal muscles
-brachioradialis (pronates & supinates)
-extensor carpi radialis longus (abduct wrist)
-extensor carpi radialis brevis (abduct wrist)
If someone is going to give a handshake what muscle and innervation is mainly responsible?
if in supine position will pronate to get to shake hand position
if in pronation formation will do supination
If someone damages their lateral epicondlye at their elbow what muscles might be damaged?
-extensor carpi ulnaris (adduct wrist)
-extensor digitorum minimi
Extensor digitorum muscles will form the
of the dorsal hand
If someone punches a wall what type of injury could happen?
extensor hood rupture
of the tendons that come from extensor digitorum and extensor digitorum minini
What are the muscles and actions of the deep mulscles of the extensor forearm?
-extensor indicis (blends with extensor hood of digit 2)
-abductor pollicis longus
-extensor pollicis brevis
-extensor pollicis longus
What are the boundaries of the snuffbox
what artery runs between here?
If there is a transverse axis in middle of snuffbox which muscles will do what?
superior border= is extensor pollicis longus-->pass anterior to transverse axis so will
inferior border= extensor pollicis brevis-->pass inferior to transverse axis so will
inferior proximal= abductor pollicis longus-->pass inferior to transverse axis so will
Radial artery travel here
What are the muscles of the thenar eminence?
-flexor pollicis brevis
-abductor pollicis brevis
Innervated by median nerve
All cross CMC and MCPe
-abductor digiti minimi
-flexor digiti minimi
-oponens digiti minimi
What is the muscle just outside the thenar eminence?
Innervated by the ulnar nerve
What are the lumbricals extensions of and what are their innervation?
Lumbricals are originate and then also insert on the tendons:
-originate from flexor digitorum profundus
-insert on the extensor hoods
lumbricals 2-3= median nerve
lumbricals 4-5= ulnar nerve
What are the actions and innervation fo the dorsal and palmar interossei?
Both muscle types are innervated by the ulnar nerve
Dorsal interossei-->does abduction of the fingers
Palmar interossei-->does adduction of the fingers
Describe the action of the lumbricals and the interossei.
They both insert on the extensor hood and will flex the MCP joint so then the PIP and DIP joints can extend-->this is the only way to extend FULLY the PIP and DIPs
Describe which muscles are invovled to fully extend the MCP, PIP, and DIP joints.
extensor digitorum, extensor digitorum profundus
lumbricals and interiossei
Where does the ulnar nerve run and what happens if it is damaged?
Runs in the Guyon's canal-->superficial compared to the carpal tunnel
lose sensation to fingers 4 & 5 and also:
If ulnar nerve is damaged: will get
-loss of lumbricals and interossei
-digits hyperextension of MCP and flexion of PIP and DIP
What is the blood supply to the forearm?
Which artery is more supferifical?
Brachial artery in arm that splits into radial (more superficial) and ulnar artery
Common interosseous artery is more deep supply to forearm
What happens in the case of hypothenar hammer injury?
Occurs when there is repetitive imact to the hypothenar eminance (pinky side) and can get damage and occlusion of the ulnar artery BUT:
there is lots of collateral and anastamose connections with the radial artery that wraps around the thumb (snuffbox)
Which of the components of the brachial plexus has
anterior and posterior fibers and which have only 1 type?
Roots and trunks have
anterior and posterior fibers
Once get to divisions then the will only have anterior OR posterior fibers
Which nerves from the M in the brachial plexus?
musculocutaneous, median, ulnar
If you have a C8 injury what part of the body and muscles might be affected?
What about C5 & 6?
in terms of muscles
What is the sensory innervation of the roots C5-T1?
More in the wrist and hand muscles
C5 and 6 would be more shoulder and arm
-C6 is along the preaxial (lateral arm out to thumb)
-C7 is digit 2 &3
-C8 is digit 4 & 5 and along medial arm
-C5 is just medial stripe next to C6
-T1 is between C8 and C5
Headaches: most common symptom for brain tumors
1)What is the most common brain tumors for adults vs. children?
1)Astrocytoma (grade 4): tumor of neuroepithelial tissue, glioblastoma multiforme for
-->treat with fractioned radiation with temozolimide (alkalating agent) if the patient is MGMT methylated
Medulloblastoma: most common in
2)Surgery is usual treatment if benefits outweight the risks
-can also possibly do adjuvant corticosteroids or radiation
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