Draw Brachial Plexus: begins in the lateral cervical region and extends into the axilla.
draw
Superficial Vessels of Upper LImb:
- Primary Superficial VEINS:
a) ____ vein ascends from LATERAL aspect of dorsal venous network, along lateral border of wrist and anterolateral surface of forearm and arm, passes between the ____ and _____ muscles and enter the clavipectoral triangle and joins the terminal part of the axillary vein.
b) _____ vein ascend from _____ end of dorsal venous network, along medial side of forearm and inferior part of arm, pierces _____ fascia and merges with accompanying veins to form the axillary vein.
C) ____ antebrachial vein (MAV) - communication between the _____vein and _____ vein on anterior portion of forearm.
- Cephalic Vein, deltoid and pectoralis major
- Basilic , medial end, brachial fascia
- Median antebrachial , cephalic and basilic vein
Anterior Axioappendicular Muscles:
- Move the pectoral girdle : Name 4 of them?
- Pectoralis major
- pectoralis minor
- subclavius
- serratus anterior
Posterior Axioappendicular Muscles:
- Attach the superior appendicular skeleton limb to the axial skeleton trunk
- Superficial posterior axioappendicular muscles are: 2
- Deep posterior axioappenicular muscles: 2
- Scapulohumeral muscles, pass from scapula to humerus and act of ______ joint . what are the 3 of them?
- trapezius and latissimus dorsi
- levator scapulae and rhomboids
- glenohumeral joint: deltoid, teres major, and rotator cuff
List 4 the rotator cuff muscles
supraspinatus,
infraspinatus
teres minor
subscapularis
Axilla
- Pyramidal space inferior to the __GH__ join and superior to the ____ and ____fascia. Provides a passageway for vessels and nerves going to and from upper limb.
Apex? base? anterior wall? posterior wall? medial wall? lateral wall?
- GH, superior to the skin and axillary fascia
- Apex- cervicoaxillary canal
- Base- skin, subcutaneous tissue and axillary fascia forming armpit
A- pectoralis major, minor, pectoral and clavipectoral fascia, and Anterior axillary fold.
P- scapula, and subscapularis anteriorly and teres major and latissimus dorsi inferiorly. And Posterior axillary fold
M- Thoracic wall and serratus anterior
L- Interrubercular groove of humerus
Axillary Artery:
- Continuation of what artery?
- Begins at later border of what rib?
- Ends at inferior border of what muscle and becomes what artery?
- divided into 3 parts:
a) between lateral border of __-rib and medial border of ______muscle. One branch ______ artery.
b) posterior to _____muscle. Two branches: ____ and ___ artery.
C) From lateral border of ___muscle to inferior border of ____ muscle. 3 branches: ___,____,___ artery.
- subclavian artery
- 1st rib
- infeior- teres major, brachial artery
- first rib, medial border of pectoralis minor , superior thoracic artery.
- posterior to pectoralis minor, thoracoacrominal artery and lateral thoracic artery
- pectoralis minor , teres major.
subscapular, anterior circumflex humeral and posterior circumflex humeral artery.
Axillary Vein :
Formed by the union of accompanying ____veins and ____ vein at inferior border of _____ muscle.
Ends at lateral border of ____rib and becomes ____vein
brachial veins, basilic vein. teres major
first rib, subclavian vein
Axillary Lymph Nodes-
Pectoral nodes subscapular nodes humeral nodes- \_\_\_\_axilla central nodes- near \_\_\_ of axilla apical nodes- at \_\_\_ of axilla Subclavian lymphatic trunk: a) right side of body to right \_\_\_\_\_ trunk or right \_\_\_\_\_ angle B) Left side of body to \_\_\_\_
- lateral
- near base
- at apex
- right lymphatic trunk or right venous angle
- thoracic duct
Arteries of the Arm:
Brachial artery- Main arterial supply to arm, continuation of axillary artery at inferior border of ____ muscle.
- Lies ____ to the humerus , palpable in bicipital groove
- lies anterior to _____ and ______muscles.
- Main branches : list 3
Ends in ____ fossa opposite the neck of the radius under cover of bicipital aponeurosis and divides into ___ and ___arteries
- teres major
- medial to the humerus
- triceps and brachialis
- deep artery of arm, superior ulnar collateral artery, and inferior ulnar collateral artery.
- cubital fossa, radial and ulnar arteries.
Superficial veins: cephalic and basilic vein .
Pair DEEP veins, collectively constituting the BRACHIAL veins, acomapny the brachial artery. The Brachial vein begins at the elbow by union of accompanying veins of the ___ and ___arteries. End by merging with basilic vein to form the ____ vein.
ulnar and radial arteries. axillary vein.
NERVES OF THE ARM:
Median Nerve: Formed in axilla by union of medial and lateral roots form the ___ and ____ cords of the brachial plexus.
- Initially on lateral side of ____artery until it reaches middle of arm and crosses to medial side.
- Descends in ___ fossa
Median Nerve Injury:
- most common site is ?
- Motor result: paralysis of ___muscles and first two ____ . Loss of ______ of thumb.
- Sensation Result: loss of sensation over_____and adjacent ____ fingers.
- injury in elbow region: Results in ____ hand, deformity in which thumb movements are limited to ____and ____ of thumb.
- medial and lateral cords
- brachial artery
- descends in cubital fossa
carpal tunnel
- thenar muscles and first two lumbricals,
- loss of opposition of thumb
- loss of sensation over thumb and 2.5 fingers
- result in Ape hand, limited to extension/flexion of thumb.
Ulnar Nerve:
- Arises from ____ cord of brachial plexus
- passes anterior to insertion of ____ muscle and pierces medial intermuscular septum in middles of arm.
- passes posterior to medial humeral epicondyle to enter forearm.
Injury: Occurs in 4 places
- Posterior to medial epicondyle of humerus (1 degree spot): Results in ______hand, atrophy of ____muscles of hand and unopposed action of _____and FDP. No opposition, MCP joints _____, No ____ of IP joints, no ____ of 4th and 5th fingers at DIP joints.
- In ____ fossa
- at the _____
- In the ____
- medial cord
- teres major
- epicondyle
- claw hand, atrophy of interosseous muscles, extensors. No opposition, MCP joints HYPEREXTENDS; No EXTENSION of IP joints, No FLEXION of 4th-5th fingers at DIP.
- cubital
- wrist
- hand
Musculocutaneous Nerve
- From ___ cord of brachial plexus
- Pierces ______ muscle and continues distally between ___ and ____ muscles.
- Supplies muscles and emerges lateral to the____ muscle as the _____ nerve of the forearm.
lateral
- coracobrachialis , brachialis and biceps
- biceps, lateral cutaneous nerve of the forearm.
Radial Nerve
- Enters arm posterior to ___l artery, medial to humerus, and anterior to ______muscle.
- Curves around humeral shaft in the radial groove
- Pierces lateral intermuscular septum and continues inferiorly in the anterior compartment between ____ and ____ muscles.
- Divides in ____ fossa into deep and superficial branches.
- supplies muscles in the ___ compartment of the arm and forearm and the overlying skin.
Injury:
- Fracture by ____
- Results in a condition: _____ ____ , loss of wrist and finger ____; hand is ____ at wrist and lies flaccid.
- posterior, brachial artery, medial to the humerus, anterior to long head of triceps
- Radial groove
- anterior compartment, brachialis and brachioradialis
- cubital fossa
- posterior compartment
- fracture by humeral shaft
- Results- wrist drop, loss of wrist/finger extension; hand is flexed
FRACTURES of Ulna and Radius: Associated with dislocation of the nearest joint.
____fracture is a fracture of distal 2 cm of radius.
The distal fragment of the radius is displaced ____and often comminuted. The fracture results from forced______of the hand, usually as the result of trying to ease a fall by outstretching the upper limb. Often, the ___ ____ is avulsed (broken off).
- This fracture is often referred to as a dinner fork (silver
fork) deformity because a _____ angulation occurs in the
forearm just proximal to the wrist 2 degree to posterior displacement and tilt of the _distal__ fragment of the radius - what degree angle between radius and ulna, decreased what degree to shortening of radius?.
Colles
- dorsally
- dorsiflexion
- ulnar styloid
- dinner fork deformity:
posterior angulation
15 degree angle between radius and ulna, decreased 2 degree to shortening of radius.
METACARPAL FX:
Ofte due to severe crushing injury of the hand. AKA ____ fractures.
PROXIMAL AND DISTAL PHALANX FX:
- Due to crushing or _____ injuries
Distal Phalanx Fracture
- Usually comminuted, paintul hematoma develops.
boxer’s fracture
- hyperextension
FX of CARPAL BONES:
Results from fall on the palm with the hand ____. Pain on lateral side of the wrist that increases with ____ and abduction of the hand. Takes several months to heal. Possible avascular necrosis, possible degenerative joint disease.
abducted.
dorsiflexion
Cubital Fossa, shallow triangular depression on the anterior surface of the elbow.
Boundaries: Superiorly medial lateral floor roof
Contents; terminal part of \_\_\_\_ accompanying veins of the arteries \_\_\_\_ tendon \_\_\_nerve and \_\_\_\_ nerve (dividing into superficial/deep branches
subcutaneous tissue over cubital fossa:
List 3 nerve.
S- imaginary line between medial and lateral epicondyles
m- pronator teres
l- brachioradialis
floor- brachialis and supinator muscles
roof- continuity of brachial and antebrachial fascia, reinforced by bicipital aponeurosis
Contents: terminal part of brachial artery accompanying veins of the arteries bicpes brachii tendon median nerve/ radial nerve
- median cubital nerve, medial /lateral cutaneous nerve of the forearm
Anatomical Snuff Box
bound by tendons of 2 muscles laterally? and 1 medially?
what artery lies on floor of snuff box
what can be palpated proximally?
what can be palpated distally?
two bones can be felt in the floor between the radial styloid and 1st metacarpal ?
- laterally: APL, EPB; medially: EPL
- radial artery , floor
- radial styloid, proximally
- base of 1st metacarpal, distally
- scaphoid and trapezium
Median nerve of the FOREARM:
principal nerve of _ant/post__ compartment of forearm. Enters forearm with ___ artery and lies medial to it. Leaves cubital fossa between heads of ____ muscles.
Two major branches:
1
2
Anterior compartment
brachial artery
Two major branches:
Anterior interosseous nerve
Palmar cutaneous branch of median nerve
Ulnar Nerve:
Passes posterior to ____ of humerus between heads of flexor carpi ulnaris.
Two major branches:
medial epicondyle of humerus
- palmar cutaneous branch of ulnar nerve
- Dorsal cutaneous branch of ulnar nerve
Radial Nerve:
In cubital fossa, divides into:
1. ___ branch of radial nerve (sensory)
2. ___ branch of radial /posterior interosseious nerve (motor)
superficial branch of radial nerve (sensory)
deep branch (motor)
Lateral Cutaneous Nerve of Foreaarm:
Continuation of ____ nerve distal to muscular branches
Musculoutaneous nerve
