Anatomy -Exam 2

Front 1

What are the surface landmarks in axilla region?

Back 1

Clavicle (clavicular head)
Pectoralis major (clavicular and sternocostal heads)
Sternocleidomastoid
Axillary folds (anterior, posterior)
Coracoid process
Deltopectoral triangle

Front 2

What is location of deltopectoral triangle and what are important clinical implications?

Back 2

The deltopectoral triangle (infraclavicular fossa) is a depressed area inferolateral to the lateral aspect of the clavicle. On deep palpation in the deltopectoral triangle, however, the tip of the process is palpable. In addition, the coracoid process is used as a bony landmark when performing a brachial plexus block, and the position of this process is important in diagnosing shoulder dislocations.

Front 3

What is a triangular-shaped area where arm and thorax unite?

Back 3

Axilla (Armpit)

Front 4

What are the bony borders of the axilla fossa?

Back 4

clavicle(anterior), first rib(medial), and scapula(posterior)

Front 5

What are the muscular walls of the axilla fossa?

Back 5

pectoralis major/minor and subclavius(anterior), serratus anterior,intercostals(medial), subscapularis, teres major, and lattissimus dorsi(posterior)

Front 6

The Axillary artery is divided into three major parts by what structure?

Back 6

by the tendon of the pectoralis minor
muscle.

Front 7

What is location of First Division of axillary artery?

Back 7

occurs between the lateral border of the first rib and the
medial border of the pectoralis minor muscle and has a single branch

Front 8

What is the single branch of the first division of the axillary artery?

Back 8

superior thoracic artery(highest thoracic)

Front 9

What is the course of Superior thoracic artery (highest thoracic)?

Back 9

highly variable, runs
inferomedially and posterior to the axillary vein to supply the serratus
anterior muscle, subclavius, pectoral muscles, and the muscles of
intercostal spaces 1-2

Front 10

What is Second Division of axillary artery?

Back 10

lies posterior to the pectoralis minor muscle and includes
two major branches

Front 11

What are branches of second division of axillary artery?

Back 11

thoracoacromial and lateral thoracic

Front 12

What is course of the Thoracoacromial artery?

Back 12

It is the proximal branch and occurs deep to the pectoralis minor and pierces the costocoracoid membrane (part of clavipectoral fascia). It lies deep to the clavicular head of the pectoralis major, where it divides into four primary branches (deltoid, pectoral,
clavicular, acromial).

Front 13

What is course of the Lateral thoracic artery?

Back 13

Though its origin is variable, it usually is the distal branch of this division. Other sites of origin include
thoracoacromial artery, suprascapular artery, or subscapular artery. It
descends at the lateral border of the pectoralis minor and supplies both pectoral muscles (major, minor) and serratus anterior, in women, it supplies the lateral part of each mammary gland.

Front 14

What is course of the Third Division of the axillary artery?

Back 14

courses from the lateral border of the pectoralis minor to the
inferior border of the teres major and has three branches

Front 15

What is course of Subscapular artery of the 3rd division of the axillary artery?

Back 15

It is the largest branch of the axilla area and descends along the lateral border of the subscapularis on the posterioraxillary wall.

Front 16

What are two branches of the subscapular artery?

Back 16

circumflex scapular and thoracodorsal artery

Front 17

What is course of the Circumflex scapular?

Back 17

the proximal branch of the subscapular which supplies
muscles to the dorsum of the scapula and participates in the
anastomoses of the scapula.

Front 18

What is the course of the Thoracodorsal artery?

Back 18

a continuum of the subscapularis distal to the branching of the circumflex scapular artery. It supplies
muscles on the dorsum of the scapula and participates in the
anastomoses of the scapula. It also supplies several muscles
(subscapularis, teres major, serratus anterior, and latissimus dorsi = mainly) of the back/shoulder.

Front 19

What about course of the Circumflex humeral arteries?

Back 19

These vessels arise opposite the subscapular artery and pass around the surgical neck of the humerus to anastomose with each other

Front 20

What are two vessels of the circumflex humeral arteries?

Back 20

anterior humeral circumflex and posterior humeral circumflex

Front 21

What is course of Anterior humeral circumflex artery?

Back 21

occurs deep to the
biceps brachii and coracobrachialis muscles

Front 22

What is course of posterior humeral circumflex artery?

Back 22

Passes through the
quadrangular space with the axillary nerve

Front 23

What about the Lymphoid tissues of the Axilla?

Back 23

lymph nodes of this area receive and filter lymph from
the upper limb,
anterior/posterior aspects of trunks, and areas from the iliac crest and umbilicus.Nodes are embedded in fatty connective tissue of this area and are related to the blood vessels.

Front 24

How many lymph nodes are usually in axilla area?

Back 24

Number of nodes range from 12-36, and form a straggling chain from the base of the axilla to its apex. Despite many interconnections, the nodes are usually subdivided into groups relative to drainage and location (aids in
identification).

Front 25

What is normal Afferent Lymphatic Drainage?

Back 25

from the periphery are received by three main
groups of nodes. Exceptions to this pattern of drainage involves the breast, which
drain into the pectoral nodes, but some may enter other groups.

Front 26

What are the three main groups of afferent lymphatic drainage?

Back 26

brachial(lateral), subscapular(posterior), pectoral(anterior)

Front 27

Brachial (lateral) afferent lymphatic drainage

Back 27

from scapular and back regions

Front 28

Subscapular (posterior) afferent lymphatic drainage

Back 28

from anterior walls of thorax and abdomen

Front 29

Pectoral (anterior) afferent lymphatic drainage

Back 29

from between the clavicle and umbilicus

Front 30

Clinical implication of a blocked primary nodes?

Back 30

When the primary nodes of drainage become blocked by cancer cells, alternative routes of flow open up and become routes to carry metastases to nodes outside the usual territory of drainage.

Front 31

What are clinical implications of the third division of the axillary artery?

Back 31

Compression of the third part of the axillary artery against the humerus may be necessary when profuse bleeding occurs (e.g., stab or bullet wound in axilla). The artery can also be
pressed against the first rib (origin of artery from subclavian) by exerting downward pressure
in the angle between the clavicle and the attachment of the sternocleidomastoid.

Front 32

What is clinically important about the anastomoses associated with the scapula?

Back 32

There are several arterial anastomoses associated with the scapula (e.g., dorsal scapula, suprascapular, and subscapular = by the circumflex scapular). The significance of the
collateral circulation created by these vessels becomes apparent when ligation of a lacerated subclavian or axillary artery is necessary or when vascular stenosis or an atherosclerotic lesion reduces blood flow and the direction of blood flow in the subscapular artery is reversed, which allows blood to reach the third part of the axillary artery. Note: This reversal allows structures supplied by the subscapular artery to receive blood by several other vessels including
suprascapular, transverse cervical, and intercostal arteries.

Front 33

Many times an aneurysm can involve which division of the axillary artery?

Back 33

The first divison

Front 34

What is clinically signifciant about aneurysm in first division of the axillary artery?

Back 34

An aneurysm of the axillary artery may involve the first part of this artery, which can
compress the trunks of the brachial plexus. This can cause pain and anesthesia in the areas of skin supplied by the affected nerves. It is a condition that may present in athletes (e.g.,baseball pitcher).

Front 35

What are borders of Quadrangular space?

Back 35

Surgical neck of humerus
Teres minor and major
Subscapularis (deeper)
Long head of triceps brachii

Front 36

What are contents of Quadrangular space?

Back 36

Axillary N
Post. circumflex humeral A

Front 37

What are borders of triangular space 1?

Back 37

Lateral border of scapula
Teres minor and major
Subscapularis
Long head of triceps brachii

Front 38

What are contents of triangular space 1?

Back 38

Circumflex scapular A

Front 39

What are borders of triangular space 2?

Back 39

medial shaft humerus
Long head of triceps brachii
Teres major

Front 40

What are contents of triangular space 2?

Back 40

Radial nerve
Profunda brachii A

Front 41

What is the Brachial plexus?

Back 41

Nerve supply to the upper limb (motor and sensory)
and has five basic components form that the brachial plexus includes roots, trunks, divisions,
cords, and branches (from medial to lateral).

Front 42

What are the roots of the brachial plexus?

Back 42

five roots (superior & inferior) form from the ventral rami of C5-T1.

Front 43

Where do the roots of the brachial plexus course?

Back 43

The roots pass between the anterior and middle scalene muscles with the
subclavian artery.

Front 44

Where do the sympathetic fibers of the brachial plexus course?

Back 44

The roots unite to form trunks. Sympathetic fibers are
carried by each root and are received from the gray rami of the middle and inferior cervical ganglia.

Front 45

What are the superior ganglion of the brachial plexus composed of ?

Back 45

Superior cervical ganglion: C1-C4

Front 46

What are the middle cervical ganglion of the brachial plexus composed of?

Back 46

Middle cervical ganglion: C5-C6

Front 47

What are the inferior cervical ganglion of the brachial plexus composed of?

Back 47

Inferior cervical ganglion: C7-T1

Front 48

What are the trunks of the brachial plexus?

Back 48

named based on a spatial-relationship to each other from superior to
inferior. Each trunk divides into anterior and posterior divisions as the plexus passes posterior to the clavicle (via the cervicoaxillary sheath)

Front 49

What does the superior trunk of the brachial plexus form?

Back 49

Superior (upper): Forms from the union of C5-C6

Front 50

What does the middle trunk of the brachial plexus form?

Back 50

Middle: Is a continuation of C7

Front 51

What does the inferior trunk of the brachial plexus form?

Back 51

Inferior (lower): Forms from the union of C8-T1

Front 52

What are the Divisions of the brachial plexus?

Back 52

six divisions (three anterior and three posterior) are present and pass through the cervicoaxillary canal (posterior to clavicle). Each trunk provides an anterior and a posterior division. The anterior divisions supply anterior
compartments (flexor), while the posterior divisions supply posterior compartments (extensor). The divisions form three cords.

Front 53

What do Cords of the brachial plexus do?:

Back 53

carry both motor and sensory N fibers and are named based on their relationship to the second portion of the axillary artery.

Front 54

What are three cords of the brachial plexus?

Back 54

lateral, medial, posterior

Front 55

What forms the Lateral cord?

Back 55

Forms by the union of the anterior divisions of the
upper and middle trunks

Front 56

What forms the Medial cord?

Back 56

Is a continuation of the anterior division of the
lower(inferior) trunk

Front 57

What forms the Posterior cord?

Back 57

Forms by the union of the posterior divisions of
all three trunks-superior, middle, inferior

Front 58

What do Branches of the brachial plexus do?

Back 58

supply nerve fibers that extend from the upper neck to the axilla and supply nerve fibers (motor/sensory) to the upper limbs

Front 59

What are the major branches of the brachial plexus?

Back 59

The numerous branches are divided into two major groups
(1. supraclavicular, above clavicle and 2. infraclavicular, below clavicle) based
on the relationship of the origin of the nerve branch to the position of the
clavicle.

Front 60

Where do branches of the Supraclavicular part of brachial plexus arise from?

Back 60

involves four major branches of the brachial plexus that
arise via the anterior rami or superior trunks of the brachial plexus. Thus, are
approachable through the neck.

Front 61

What are four major branches of the supraclavicular part?

Back 61

dorsal scapular, suprascaplar,nerve to subclavius and long thoracic

Front 62

What is origin of dorsal scapular?

Back 62

Ventral rami of C5 with frequent contribution of C4.

Front 63

What is course of dorsal scapular?

Back 63

pierces scalenus muscle, descends deep to levator scapulae,and enters deep surface of rhomboids

Front 64

What is innervated by dorsal scapular?

Back 64

innervates rhomboids and occasionally supplies levator scapulae

Front 65

What is origin of long thoracic?

Back 65

ventral rami of C5-C7

Front 66

What is course of long thoracic?

Back 66

descends posterior to C6 and T1 and passes distally on external surface of serratus anterior

Front 67

What is innervated by long thoracic?

Back 67

innervates serratus anterior

Front 68

What is origin of nerve to subclavius?

Back 68

superior trunk, recieving fibers form C5 and C6 and often C4

Front 69

What is course of nerve to subclavius?

Back 69

descends posterior to clavicle and anterior to brachial plexus and subclavian artery

Front 70

What is innervated by nerve to subclavius?

Back 70

innervates subclavius and sternoclavicular joint

Front 71

What is origin of suprascapular nerve?

Back 71

superior trunk receiving fibers from C5-C6 and sometimes C4

Front 72

What is course of suprascapular?

Back 72

passes laterally across posterior triangle of the neck through scapular notch under superior transverse scapular ligament

Front 73

What does suprascapular innervate?

Back 73

innervates supraspinatus, infrspinatus, and glenohumeral joint(shoulder)

Front 74

Lateral cord (LM) of the infraclavicular branch

Back 74

Arises from C5-C7 spinal nerves and has three branches

Front 75

What is the origin of lateral pectoral?

Back 75

lateral cord, receiving fibers form C5-C7

Front 76

What is the course of lateral pectoral?

Back 76

pierces clavipectoral fascia to reach deep surface of pectoral muscles

Front 77

What does it innervate--lateral pectoral?

Back 77

primarily supplies pectoralis major but sends a loop to medial pectoral nerve that innervates pectoralis minor

Front 78

What is the origin of Musculocutaneous

Back 78

lateral cord, receiving fibers form C5-C7

Front 79

What is the course of Musculocutaneous

Back 79

enters deep surface of choracobrachialis and descends between biceps brachi and brachiallis

Front 80

What does it innervate--Musculocutaneous

Back 80

innervates choracobrachialis, biceps brachii, and brachiallis. Continues as antebrachiallis cutaneous nerve

Front 81

What is the origin of median?

Back 81

lateral root is continuation of lateral cord receiving fibers form C6-C7; medial root is continuation of medial cord receivng fibers from C8-T1

Front 82

What is the course of median?

Back 82

lateral root joins medial root to form medial nerve lateral to axillary artery

Front 83

What does it innervate--median?

Back 83

innervates flexor muscles in forearm(except for flexor carpi ulnaris,ulnar half of flexor digitorum profundus) and five hand muscles

Front 84

What about the Medial cord (MU)?

Back 84

Arises from C8-T1 (C7, ulnar) spinal nerves and has five
branches

Front 85

What is origin of medial pectoral nerve?

Back 85

medial cord receiving fibers form C8 and T1

Front 86

What is course of medial pectoral nerve?

Back 86

passes between axillary artery and veins, pierces minor pectoral muscle and enters deep surface of pectoralis major

Front 87

What is innervated by medial pectoral nerve?

Back 87

innervates the pectoralis minor and part of pectoralis major

Front 88

What is origin of medial brachial cutaneous nerve?

Back 88

medial cord receiving fibers form C8 and T1

Front 89

What is course of medial brachial cutaneous nerve?

Back 89

runs along medial side of axillary vein and communicates with intercostobrachial nerve

Front 90

What is innervated by medial brachial cutaneous nerve?

Back 90

supplies skin on medial side of arm

Front 91

What is origin of medial antebrachial cutaneous?

Back 91

medial cord receiving fibers from C8 and T1

Front 92

What is course of medial antebrachial cutaneous?

Back 92

runs between axillary artery and vein

Front 93

What is innervated by medial antebrachial cutaneous?

Back 93

supplies skin over medial side of forearm

Front 94

What is origin of ulnar?

Back 94

a terminal branch of medial cord, receiving fibers from C8 and T1 and often C7

Front 95

What is course of ulnar?

Back 95

passes down medial aspect of arm and runs posterior to medial epicondyle to enter forearm

Front 96

What is innervated by ulnar?

Back 96

innervates one and one half flexor muscles in forearm, most small muscles in hand, and skin medial to line bisectin 4th digit(ring finger)

Front 97

The Posterior cord (ULTRA)

Back 97

arises from C5-T1 spinal nerves and has five
branches-Upper subscapular, lower subscapular,thoracodorsal , radial, axillary

Front 98

ULTRA is a good mnemonic for 5 branches of posterior cord?

Back 98

The Upper subscapular, Lower subscapular, and Thoracodorsal (middle
subscapular) form three side branches
- The Radial and Axillary nerves form two terminal branches

Front 99

What is origin of upper subscapular nerve?

Back 99

Branch of posterior cord receiving fibers from C5 and C6

Front 100

What is course of upper subscapular?

Back 100

passes posteriorly and enters subscapularis

Front 101

What is innervated by upper subscapular?

Back 101

innervates superior portion of subscapularis

Front 102

What is origin of thoracodorsal?

Back 102

Branch of posterior cord receiving fibers from C6-C8

Front 103

What is course of thoracodorsal?

Back 103

arises between upper and lower subscapular nerves and runs inferolaterally along posterior axillary wall to latissimus dorsi

Front 104

What is innervated by thoracodorsal?

Back 104

latissimus dorsi

Front 105

What is origin of lower subscapular nerve?

Back 105

Branch of posterior cord receiving fibers from C5 and C6

Front 106

What is course of lower subscapular nerve?

Back 106

passes inferolaterally, deep to subscapular artery and vein, to subscapularis and teres major

Front 107

What is innervated by lower subscapular?

Back 107

inferior portion of subscapularis and teres major

Front 108

What is origin of Axillary nerve?

Back 108

terminal branch of posterior cord, receiving fibers from C5 and C6

Front 109

What is course of Axillary?

Back 109

passes to posterior aspect of arm through quadrangular space "in company with posterior circumflex humeral and then winds around surgical neck; gives rise to lateral brachial cutaneous nerve

Front 110

What is innervated by Axillary?

Back 110

teres minor and deltoid, shoulder joint and skin over inferior part of deltoid

Front 111

What is origin of Radial nerve?

Back 111

terminal branch of posterior cord, receiving fibers from C5 -C8 and T1

Front 112

What is course of Radial?

Back 112

descends posterior to axillary artery; enters radial groove with deep brachial artery to pass between long and medial heads of triceps

Front 113

What is innervated by Radial nerve?

Back 113

triceps brachii, anconeus, brachioradialis, and extensor muscles of forearm; supplies skin on posterior aspect of arm and forearm via cutaneous nerves of arm and forearm

Front 114

Motor innervation of the upper limb includes (general trends) --arm

Back 114

Anterior compartment: musculocutaneous
Posterior compartment: radial

Front 115

Motor innervation of the upper limb includes (general trends)--forearm

Back 115

Anterior compartment: median–ulnar
Posterior compartment: radial

Front 116

Motor innervation of the upper limb includes (general trends)--hand

Back 116

Anterior compartment: ulnar - median

Front 117

each movement of the upper limb at the major joints usually involves two spinal segments (sometimes a single spinal nerve for more precise movements) in a logical
sequence for each joint and are known as________.

Back 117

Myotomes

Front 118

Myotome Chart

Back 118

Shoulder Elbow Wrist Fingers
C6-8 C5-C6 C6-C7 C7-C8
(flexion)
C5 C7-C8 C6-C7 C7-C8
(Extension)
Pronation C7-C8 (Forearm)
Supination C6 (Forearm)
Adduction T1 (Intrinsic Hand)
Abduction

Front 119

What are surface landmarks of the scapula?

Back 119

Acromial angle, Acromion, Acromioclavicular joint, Scapular spine (crest,
root), Superior angle, Medial (vertebral) border, Lateral border, Inferior angle,
and Coracoid process

Front 120

What are surface landmarks of the humerus?

Back 120

Greater tubercle, Lesser tubercle, Intertubercular groove, Shaft (body)

Front 121

The Pectoral girdle is a Bony girdle formed by what 2 two bones

Back 121

clavicle and scapula

Front 122

Describe the Clavicle?

Back 122

articulates with the scapula and sternum, forms the acromioclavicular
joint (AC), receives muscles that depress the shoulder and the arm, transmits
shock (traumatic impacts) from the upper arm to the axial skeleton and acts like
a strut which extends the shoulder joint away from the body, is morphologically
(right is usually shorter than left) more variable than other long bones, and may
be pierced by a branch of the supraclavicular nerve

Front 123

Scapular

Back 123

is ?????

Front 124

What are two major groups of muscles move the pectoral girdle?

Back 124

anterior anterioappendicular
(anterior thoracoappendicular)
posterior anteroappendicular(posterior thoraoappendicular)

Front 125

What are muscles of the antero appendicular?

Back 125

pectoralis major and minor, subclavius, serratus anterior

Front 126

What muscles are the posterior axioappendicular?

Back 126

3 main groups including the superficial posterior axioappendicular, the intermediate posterior axioappendicular, scapulohumeral.

Front 127

What are muscles of the superficial posterior axioappendicular?

Back 127

trapezius and latissimus dorsi

Front 128

What are muscles of the intermediate posterior axioappendicular?

Back 128

levator scapulae and rhomboid major and minor

Front 129

What are muscles of the scapulohumeral?

Back 129

deltoid, teres major
rotator cuff:SITS

Front 130

What is innervation of trapezius?

Back 130

spinal root of assessory nerve(CNXI)-motor and cervical nerves(C3 and 4)(pain and propioception)

Front 131

What is main action of trapezius?

Back 131

elevates, retracts and rotates scapula;

Front 132

What is innervation of latissimus dorsi?

Back 132

thoracodorsal (C6, C7, C8)

Front 133

What is main action of latissimus dorsi?

Back 133

extends adducts and medially rotates humerus; raises body toward arms during climbing

Front 134

What is innervation of levator scapulae?

Back 134

dorsal scapular(C5) and cervical (C3 and C4)

Front 135

What is main action of levator scapulae?

Back 135

elevates scapula and tilts its glenoid cavity inferiorly by rotating scapula

Front 136

What is innervation of rhomboid major and minor?

Back 136

dorsal scapular C4 and C5 rotate

Front 137

What is main action of rhomboid major and minor?

Back 137

retract scapula and rotate it to depress glenoid cavity

Front 138

Clinical complication of injury to the thoracodorsal nerve?

Back 138

The thoracodorsal nerve
along the deep surface of the latissimus dorsi close to its tendonous part, thus this nerve maybe injured during surgical procedures of the inferior part of the axilla. With paralysis of the
the latissimus dorsi, an individual would not be able to raise their trunk.
ups). Note: when pressing inferiorly or resting on parallel bars, the latissimus dorsi holdsyou up (pectoralis major
C

Front 139

Clinical implication of injury to dorsal scapular nerve?

Back 139

Injury to dorsal scapular nerve scapulae), affects the actions of these
rhomboids on the ipsilateral side are paralyzed and
parasagittal to the midline
when compared to the contralateral scapula.

Front 140

What is innervation of deltoid?

Back 140

axillary nerve C5 and C6

Front 141

What is main action of deltoid?

Back 141

anterior part:flexes and medially rotates the arm; middle part abducts arm; posterior part extends and laterally rotates arm

Front 142

What is innervation of supraspinatus?

Back 142

suprascapular nerve C4, C5, C6

Front 143

What is main action of supraspinatus?

Back 143

initiates and assists deltoid in abduction of arm and acts with rotator cuff muscles

Front 144

What is innervation of infraspinatus?

Back 144

suprascapular nerve C5, C6

Front 145

What is main action of infraspinatus?

Back 145

laterally rotates arm;helps to hold humeral head in glenoid activity of scapula

Front 146

What is innervation of teres minor?

Back 146

axillary nerve C5 and C6

Front 147

What is main action of teres minor?

Back 147

laterally rotates arm;helps to hold humeral head in glenoid activity of scapula

Front 148

What is innervation of teres major

Back 148

lower subscapular nerve C5 and C6

Front 149

What is main action of teres major?

Back 149

abducts and medially rotates arm

Front 150

What is innervation of subscapularis?

Back 150

upper and lower subscapular nerves C5, C6, C7

Front 151

What is main action of subscapularis?

Back 151

medially rotates arm and adducts it; helps hold humeral head in glenoid cavity

Front 152

What is rotator cuff injury?

Back 152

complete or partial rupure ofone or more muscles/tendons of rotator cuff group and termed rotator cuff syndrome. Usually secondary to prolonged muscle wear and tear or to acute fall on outstretched arm. Limitaion of movement results especially abduction. Patient usually presents with frozen shoulder. Suprispinatus no longer functional---patient cannot initiate abduction of upper limb

Front 153

What is test for degenerative tendonitis of rotator cuff?

Back 153

patient is asked to lower the fully abducted limg slowly and smoothly. From 90 degree abduction limb will suddenly drop

Front 154

What is subacromial buristis?

Back 154

tendon of suprspinatus is separated from coracocromial ligament, acromion and deltoid by subacromial bursa. When bursa is inflamed, abduction of arm is painful during the arch from 50 to 130 degrees(painful arch syndrome)

Front 155

What abiut injury to axillary nerve?

Back 155

may cause deltoid atrophy. Nerve can be injured when surgical neck of humerus is fractured. This nerve an be injured during dislocation of shoulder joint(loss of sensation can occur) Awareness of axillary nerve when giving injections.

Front 156

What are three joints of pectoral girdle?

Back 156

Pectoral girdle has three joints that typically move concurrently
Sternoclavicular joint (SC) Acromioclavicular joint (AC)
Glenohumeral

Front 157

Describe the Sternoclavicular joint (SC):

Back 157

has a costoclavicular ligament and is a saddle-type
joint (functions as a ball and socket)

Front 158

What ar eclinical implications for dislocation of sternoclavicular joint?

Back 158

Clinical: Dislocation of the sternoclavicular joint (SC) is rare which attests to its strength. Lateral
blows to the acromion may fracture the clavicle near the junction of its middle and lateral third.
Most dislocations of the SC joint occur in persons younger than 25 and usually results from
fractures through the epiphyseal plate because the epiphysis at the sternal-end of the clavicle does not completely fuse until 23-25 years of age.

Front 159

Describe the Acromioclavicular joint (AC)

Back 159

has an acromioclavicular ligament and is a
plane–type joint

Front 160

Describe the Glenohumeral joint:

Back 160

has a glenohumeral ligament and is a ball and socket-type
joint

Front 161

What is innervation of subscapularis?

Back 161

upper and lower subscapular nerves C5, C6, C7

Front 162

What is main action of subscapularis?

Back 162

medially rotates arm and adducts it; helps hold humeral head in glenoid cavity

Front 163

What is rotator cuff injury?

Back 163

complete or partial rupure ofone or more muscles/tendons of rotator cuff group and termed rotator cuff syndrome. Usually secondary to prolonged muscle wear and tear or to acute fall on outstretched arm. Limitaion of movement results especially abduction. Patient usually presents with frozen shoulder. Suprispinatus no longer functional---patient cannot initiate abduction of upper limb

Front 164

What is test for degenerative tendonitis of rotator cuff?

Back 164

patient is asked to lower the fully abducted limg slowly and smoothly. From 90 degree abduction limb will suddenly drop

Front 165

What is subacromial buristis?

Back 165

tendon of suprspinatus is separarted form coracocromial ligamnet, acromion and deltoid by subacromial bursa. When bursa inflammed abduction of arm is painful during the arch from 50 to 130 degrees(painful arch syndrome)

Front 166

What abiut injury to axillary nerve?

Back 166

may cause deltoid atrophy. Nerve can be injured when surgical neck of humerus is fractured. This nerve an be injured during dislocation of shoulder joint(loss of sensation can occur) Awareness of axillary nerve when giving injections.

Front 167

What are three joints of pectoral girdle?

Back 167

Pectoral girdle has three joints that typically move concurrently
Sternoclavicular joint (SC) Acromioclavicular joint (AC)
Glenohumeral

Front 168

Describe the Sternoclavicular joint (SC):

Back 168

has a costoclavicular ligament and is a saddle-type
joint (functions as a ball and socket)

Front 169

What are clinical implications for dislocation of sternoclavicular joint?

Back 169

Clinical: Dislocation of the sternoclavicular joint (SC) is rare which attests to its strength. Lateral
blows to the acromion may fracture the clavicle near the junction of its middle and lateral third.
Most dislocations of the SC joint occur in persons younger than 25 and usually results from
fractures through the epiphyseal plate because the epiphysis at the sternal-end of the clavicle does not completely fuse until 23-25 years of age.

Front 170

Describe the Acromioclavicular joint (AC)

Back 170

has an acromioclavicular ligament and is a
plane–type joint

Front 171

Describe the Glenohumeral joint:

Back 171

has a glenohumeral ligament and is a ball and socket-type
joint

Front 172

What is rotator cuff injury?

Back 172

complete or partial rupture of one or more muscles/tendons of rotator cuff group and termed rotator cuff syndrome. Usually secondary to prolonged muscle wear and tear or to acute fall on outstretched arm. Limitaion of movement results especially abduction. Patient usually presents with frozen shoulder. Suprispinatus no longer functional---patient cannot initiate abduction of upper limb

Front 173

What is test for degenerative tendonitis of rotator cuff?

Back 173

patient is asked to lower the fully abducted limb slowly and smoothly. From 90 degree abduction limb will suddenly drop

Front 174

What is subacromial buristis?

Back 174

tendon of suprspinatus is separarted form coracocromial ligamnet, acromion and deltoid by subacromial bursa. When bursa inflammed abduction of arm is painful during the arch from 50 to 130 degrees(painful arch syndrome)

Front 175

What abiut injury to axillary nerve?

Back 175

may cause deltoid atrophy. Nerve can be injured when surgical neck of humerus is fractured. This nerve an be injured during dislocation of shoulder joint(loss of sensation can occur) Awareness of axillary nerve when giving injections.

Front 176

What are three joints of pectoral girdle?

Back 176

Pectoral girdle has three joints that typically move concurrently
Sternoclavicular joint (SC) Acromioclavicular joint (AC)
Glenohumeral

Front 177

Describe the Sternoclavicular joint (SC):

Back 177

has a costoclavicular ligament and is a saddle-type
joint (functions as a ball and socket)

Front 178

What are clinical implications for dislocation of sternoclavicular joint?

Back 178

Dislocation of the sternoclavicular joint (SC) is rare which attests to its strength. Lateral blows to the acromion may fracture the clavicle near the junction of its middle and lateral third.
Most dislocations of the SC joint occur in persons younger than 25 and usually results from
fractures through the epiphyseal plate because the epiphysis at the sternal-end of the clavicle does not completely fuse until 23-25 years of age.

Front 179

Describe the Acromioclavicular joint (AC)

Back 179

has an acromioclavicular ligament and is a
plane–type joint

Front 180

Describe the Glenohumeral joint:

Back 180

has a glenohumeral ligament and is a ball and socket-type
joint

Front 181

What are Characteristics of glenohumeral joint?

Back 181

Head of humerus: large, rounded, less than 1/3 occurs within the glenoid cavity
Glenoid of scapula: very shallow cavity, labrum, articulates with head of
humerus
Synovial joint: ball and socket, provides great mobility but at a substantial price
Held in place by tendons of the rotator cuff muscles
A loose fibrous capsule attaches medially to the margin of the glenoid cavity and
laterally to the anatomical neck of the humerus

Front 182

The articular capsule of the glenohumeral joint has two apertures. what are they?

Back 182

1. Opening between the tubercles of the humerus for the tendon of the
long head of biceps brachii
2 . Opening inferior to the coracoid process where it forms the
subscapular bursa between the subscapularis tendon and the margin of
the glenoid cavity

Front 183

These ligaments include three fibrous bands obvious only on theinternal, anterior aspect of the capsule (superior, middle, and inferior
glenohumeral) which radiate laterally and inferiorly from the glenoid labrum at
the supraglenoid tubercle and bend distally with the fibrous capsule at the
anatomical neck of the humerus. These ligaments do not act like typical
ligaments (do not carry tensile force along their length).

Back 183

Glenohumeral ligaments

Front 184

Thsi ligament is an intrinsic ligament (part of fibrous capsule)
that strengthens the capsule superiorly. It is a strong, broad band that runs from
the base of the coracoid process to the anterior aspect of the greater tubercle of
the humerus.

Back 184

The coracohumeral ligament

Front 185

This ligament also strengthens the capsule and bridges the
gap between the tubercles of the humerus. It converts the intertubercular groove
into a canal that holds the synovial sheath and tendon of the long head of the
biceps brachii in place during movements of the shoulder joint.

Back 185

The transverse humeral ligament

Front 186

The___________ is an extrinsic, protective structure formed by three structures (a-c) which overlies the head of the humerus and prevents superior displacement of the humeral head from the glenoid cavity.

Back 186

Coracoarcromial arch

Front 187

What are three structures that make up the coracoarcromial arch?

Back 187

Acromion process
Coracoid process
Coracoacromial ligament (spanning process)

Front 188

Clinical pearl-- The coracoacromial arch

Back 188

Clinical: The coracoacromial arch is so strong that a forceful superior thrust of the humerus will not fracture it; instead, the humeral shaft or the clavicle will fracture first.

Front 189

Potential directions of dislocation and capsular support.

Back 189

Direction Support
Superior Coracoacromial arch, Supraspinatus
Inferior Tendon long head triceps brachii
Anterior Subscapularis
Posterior Infraspinatus, Teres minor

Front 190

Dislocation of the AC joint

Back 190

Coracoclavicular ligament is strong, but AC joint is
weak and easily injured by direct blows. Dislocations may result from hard fall on
shoulder with impact taken by acromion or from a fall on outstretched upper limb.
Dislocations can also occur when individual is driven into a wall or receives a severe blow to the superolateral part of the back.

Front 191

What about when AC and coracoclavicular ligaments are both torn?

Back 191

The AC injury (shoulder separation)
is grievous when both the AC and coracoclavicular ligaments are torn. When the
coracoclavicular ligament is torn, the shoulder falls away from the clavicle because of the weight
of the upper limb. Dislocation of the AC joint makes the acromion more prominent and the

Front 192

What are most common areas of dislocation?

Back 192

Dislocations are more common in the shoulder joint (glenohumaral joint) than in any other
major joint of the body. Most dislocations of the shoulder occur inferiorly but are referred to as anterior or posterior (in relation to the infraglenoid tubercle and the long head of the triceps).

Front 193

What is a glenoid labrum tear?

Back 193

Glenoid labrum tears commonly occur in althletes who throw an object with force, or those
who have shoulder instability and partial dislocation (subluxation) of the glenohumeral joint.
The tear often results from a sudden contraction of the biceps or forceful subluxation of the
humeral head over the glenoid labrum. Usually, a tear occurs in the anterosuperior part of the
glenoid labrum.

Front 194

What are symptoms of a glenoid labrum tear?

Back 194

Symptoms may include pain while throwing, especially during the acceleration
phase, but a sense of popping or snapping may be felt in the glenohumeral joint during abduction
and lateral rotation of the arm.

Front 195

Muscles involved with Elevation: reaching for objects overhead

Back 195

trapezius, descending part (spinal accessory); levator scapulae, rhomboids (dorsal
scapular)

Front 196

Muscles involved with Depression: chopping wood

Back 196

pectoralis major, inferior sternocostal head (pectoral); latissimus dorsi, (thoracodorsal)
trapezius, ascending part (spinal accessory); serratus anterior, inferior part (long
thoracic); pectoralis minor (medial pectoral)

Front 197

Muscles involved with Protraction

Back 197

lateral or forward movement of scapula (pushing)
serratus anterior (long thoracic); pectoralis major (pectoral)/minor (medial pectoral

Front 198

Muscles involved with Retraction: medial or backward movement of scapula (pulling)

Back 198

trapezius , middle part (spinal accessory); rhomboids (dorsal scapular); latissimus dorsi
(thoracodorsal)

Front 199

Muscles involved with Upward rotation:

Back 199

trapezius , ascending & descending parts (spinal accessory); serratus anterior , inferior
part (long thoracic)

Front 200

Muscles involved with Downward rotation

Back 200

levator scapular, rhomboids (dorsal scapular); latissimus dorsi (thoracodorsal); pectoralis
major, inferior sternocostal head (pectoral)/minor (medial pectoral)

Front 201

What are prime movers and synergists in flexion?

Back 201

pectoralis major(clavicular head) and deltoid(anterior part)-----choracobrachialis(assisted by biceps

Front 202

What are prime movers and synergists in extension?

Back 202

deltoid (posterior part)--------teres major

Front 203

What are prime movers and synergists in abduction?

Back 203

deltoid(as a whole but especially central part)-----------supraspinatus

Front 204

What are prime movers and synergists in adduction?

Back 204

pectoralis major and latissimus dorsi--------------subscapularis, infraspinatus, and teres minor

Front 205

What are prime movers and synergists in medial rotation?

Back 205

subscapularis-------------pectoralis major, deltoid(anterior fibers) latissimus dorsi

Front 206

What are prime movers and synergists in lateral rotation?

Back 206

infraspinatus-------teres minor, deltoid(posterior fibers)

Front 207

What are prime movers and synergists in flexion?

Back 207

pectoralis major(clavicular head) and deltoid(anterior part)-----choracobrachialis(assisted by biceps

Front 208

What are prime movers and synergists in extension?

Back 208

deltoid (posterior part)--------teres major

Front 209

What are prime movers and synergists in abduction?

Back 209

deltoid(as a whole but especially central part)-----------supraspinatus

Front 210

What are prime movers and synergists in adduction?

Back 210

pectoralis major and latissimus dorsi--------------subscapularis, infraspinatus, and teres minor

Front 211

What are prime movers and synergists in medial rotation?

Back 211

subscapularis-------------pectoralis major, deltoid(anterior fibers) latissimus dorsi

Front 212

What are prime movers and synergists in lateral rotation?

Back 212

infraspinatus-------teres minor, deltoid(posterior fibers)

Front 213

What are Surface landmarks of Arm-Posterior aspect:

Back 213

Deltoid, Triceps (long, lateral, and medial heads) and Olecranon

Front 214

What are Surface landmarks of Arm- Medial aspect

Back 214

Deltoid, Biceps brachii, Brachialis, Bicipital aponeurosis, Medial bicipital
groove, and Medial epicondyle
Posterior aspect: Deltoid, Triceps (long, lateral, and medial heads) and Olecranon

Front 215

What are boundaries of Pectoral fascia?

Back 215

it invests the pectoralis major muscle and continues inferiorly with the fascia of the anterior abdominal wall. It exits the lateral border of the pectoralis
major to become the axillary fascia, which forms the floor of the axilla.

Front 216

What is course of Clavipectoral fascia?

Back 216

it courses from the axillary fascia to enclose the pectoralis
minor and subclavius muscles. It attaches to the clavicle superior to the pectoralis
minor, where it forms the costocoracoid membrane. This membrane is pierced by the
lateral pectoral nerve, which innervates the pectoralis major. It also forms the
suspensory ligament of the axilla (pulls the fascia and skin upward during abduction of
the arm) and the axilla.

Front 217

What is course of Brachial fascia?

Back 217

it is the deep fascia of the arm which encloses the arm like a shirt sleeve.
Superiorly, it is continuous with the pectoral and axillary layers of fascia.
Inferiorly, it attaches to the epicondyles of the humerus (medial/lateral) and
olecranon of the ulna and is continuous with the antebrachial fascia (deep fascia of forearm). Two intermuscular septa (medial and lateral intermuscular septa) extend
from the deep surface of this fascia to the medial and lateral supracondylar ridges of
the humerus. The two septa separate the arm into flexor (anterior) and extensor
(posterior) fascial compartments.

Front 218

What about course of antebrachial fascia?

Back 218

the deep fascia of the forearm thickens posteriorly over the distal ends of the radius and ulna to form the extensor retinaculum. It also thickens anteriorly over the distal ends of the radius and ulna to form the flexor retinaculum.

Front 219

What about the Deep fascia boundaries?

Back 219

is continuous through the extensor and flexor retinacula of the palmar
fascia. The central part of the palmar fascia (aponeurosis) is thick, tendinous, and
triangular and overlies the central compartment of the palm. The aponeurosis forms
four distinct thickenings which radiate to the bases of each finger and becomes
continuous with the fibrous tendon sheaths of each digit.

Front 220

What is Humeral Head?

Back 220

two tubercles present (greater and lesser tubercles).
Radiographically, the greater tubercle is the most lateral structure of the shoulder.

Front 221

What is Anatomical neck?

Back 221

is formed by a groove circumscribing the head and separating it
from the greater and lesser tubercles.

Front 222

What is Surgical neck?

Back 222

is the narrow part of the humerus that is distal to the tubercles and the
crests descending from them, and flanks the intertubercular groove (common fracture
site of humerus).

Front 223

What is Shaft of humerus?

Back 223

has an anterior surface covered by three muscles (coracobrachialis, biceps
brachii, and brachialis) and a posterior surface that is somewhat twisted and covered
by two muscles (long, medial, and lateral heads of the triceps brachii and anconeus).

Front 224

What is Radial sulcus or spiral groove on humerus?

Back 224

occurs along the middle of the shaft on the posterior
surface of the humerus.

Front 225

What are the Condyles?

Back 225

are present on a wide articular surface that is divided by a central ridge
which separates lateral and medial segments.

Front 226

What has a groove which receives the ulnar nerve and also serves as an attachment for the ulnar collateral ligament, and is the site of attachment for the common flexor tendon (origin of several flexors and a pronator of the
forearm).

Back 226

Medial epicondyle

Front 227

What has a capitulum and a radial fossa as well as other structures?

Back 227

Lateral segment

Front 228

What has a trochlea, coronoid fossa, an olecranon fossa and other?

Back 228

Medial segment

Front 229

What fractures of humerus are most common?

Back 229

Surgical neck fractures are the most common fracture of the humerus.

Front 230

Is fracture of the humerus extracapsular or intracapsular?

Back 230

This type of fracture is considered extracapsular, and occurs most often in elderly people (especially with osteoporosis) but can occur in active young or middle aged adults.

Front 231

What types of fractures are greater tubercle and what age are they common in?

Back 231

Fractures of the greater tubercle are common in middle-aged and elderly people, and are considered avulsion fractures (pulls the greater tubercle away from the humeral head). This type of fracture can occur when a person falls on the point of the shoulder (acromion

Front 232

What about greater tubercle fractures in younger people?

Back 232

In younger individuals, fractures of the greater tubercle results from a fall on an outstretched hand
when the arm is abducted. In addition, fractures of the greater tubercle may result from a direct
blow or secondary to the combined muscular pull of the Supraspinatus, Infraspinatus, and
Teres minor muscles.

Front 233

Are lesser tubercle fractures common?

Back 233

fractures of the lesser tubercle are uncommon. Muscles
(especially the subscapularis) that remain attached to the humerus pull the limb into medial rotation.

Front 234

What can occur clinically when muscle attachments to greater tubercle are lost?

Back 234

when the muscle attachments to the greater tubercle are lost an inferior dislocation of the shoulder joint may occur

Front 235

How do transverse fractures of the arm occur?

Back 235

Transverse fractures of the humeral shaft usually occur as a direct blow to the arm.

Front 236

How does spiral fracture of the humeral shaft occur?

Back 236

A spiral fracture of the humeral shaft may result from a fall on the outstretched hand.

Front 237

When should you consider injury to radial nerve and profunda brachii?

Back 237

Injury to the radial nerve and profunda brachii artery should be considered, especially
when the fracture involves the area below the level of the insertion of the deltoid. Radial
nerve symptoms secondary to trauma in the mid-humeral area are most often purely motor in
function. Late radial nerve deficit may occur during the process of fracture healing.

Front 238

Describe intercondylar fractures?

Back 238

Intercondylar fractures of the humerus may result from a severe fall on the point of the
flexed elbow. The olecranon is usually driven like a wedge in to the condyle of the humerus,
which separates one or both parts from the humeral shaft

Front 239

What is another type of humerus fracture that results from an outstretched hand?

Back 239

Impact fractures of the humerus may result from a fall on an outstretched hand, which may transmit a strong force through the forearm to the distal end of the humerus. This type of
fracture site is usually stable, and the patient is able to move the arm passively with little pain. CT scans and radiographs will show such a fracture. The distal end of the humerus is weak because of the presence of the olecranon and radial and coronoid fossae.

Front 240

What is innervation of biceps brachii?

Back 240

musculocutaneous nerve C5 and C6

Front 241

What is main action of biceps brachii?

Back 241

supinates forearm and when it is supine flexes forearm

Front 242

What is innervation of brachialis?

Back 242

musculocutaneous nerve C5 and C6

Front 243

What is main action of brachialis?

Back 243

flexes forearm in all postions

Front 244

What is innervation of coracobrachialis?

Back 244

musculocutaneous nerve C5 and C6 and C7

Front 245

What is main action of mcoracobrachialis?

Back 245

helps to flex and adduct arm

Front 246

Biceps tendonitis (inflammation of tendon involves which muscle)?

Back 246

involves the long head of the biceps, which is enclosed by a synovial sheath and moves superiorly/inferiorly in the intertubercular groove of the humerus.

Front 247

How is shoulder pain related to biceps tendonitis?

Back 247

Shoulder pain is common because of the wear and tear on the tendon of this
muscle. This condition usually results from microtrauma caused by the overuse in several
sporting events (e.g., baseball, football, tennis, and golf). The intertubercular groove is a very
tight, narrow, and rough surface which is prone to causing inflammation, irritation, tenderness,
and crepitus (crackling noise).

Front 248

Dislocation of the long head of the biceps

Back 248

Dislocation (partial or complete) and rupture of the tendon of the long head of the biceps are painful conditions. Dislocations of this tendon may occur in young individuals during traumatic separation of the proximal epiphysis of the humerus. The dislocation also occurs in older athletes with a history of biceps tendonitis. It usually produces a sensation of catching or popping when the arm is rotated.

Front 249

How does rupture of the long head in biceps occur?

Back 249

Ruptures commonly occur in older (33 years +) athletes
(especially pitchers). The tendon is torn from its insertion point (supraglenoid tubercle of scapula) and may be associated with a snap or pop. Also, the muscle belly may form a ball near the center of the distal part of the anterior aspect of the arm (popeye deformity). This tendon may also rupture in weight lifters who provide forceful flexion of the arm against excessive resistance. However, it usually ruptures from the result of prolonged tendinitis which weakens
the tendon.

Front 250

In what percentage are ther variations in brachial artery?

Back 250

Variations of the brachial artery: In nearly 30% of the population, two arteries proceed
down the arm.

Front 251

What is the most common variation in the brachial artery?

Back 251

The most common involves the brachial artery which gives off the radial or ulnar branch at a level that is higher than usual (well above the cubital fossa). In this case,
only one of the two arteries in the arm is truely the brachial artery.

Front 252

What is a less common variation in the brachial artery?

Back 252

A second variation occurs when a true doubling of the brachial artery (axillary artery
gives rise to two vessels) occurs, which is less common. In this example, two brachial
arteries unite in the cubital fossa before dividing into radial and ulnar arteris. However, on occassion, the two brachial arteries form one branch that divides in the usual way and the other continues into the forearm without division, as the common interosseous artery of the forearm.

Front 253

What are factors used in identifying the brachial artery?

Back 253

The proper identification of the vessel is determined by it’s relation to the median
nerve and its fate in the forearm.

Front 254

What is the normal arterial scheme?

Back 254

the axially artery takes the usual course and gives rise to
a single brachial artery which is crossed superficially by the median nerve. If a
second branch arises via the axillary artery, a variable arterial route may be observed.
This route shows a more superficial position and is named either a superficial
brachial artery, or superficial radial, or superficial ulnar artery depending on the
branching pattern and course it pursues in to the forearm.

Front 255

What are the brachial vessels located in this area of the arm?

Back 255

Brachial vessels: runs from the inferior border of teres major (recall end of
axillary artery) to the cubital fossa opposite the neck of the radius

Front 256

What are arteries located in this area of the arm?

Back 256

- Arteries: Profunda brachii, superior ulnar collateral, and Inferior ulnar collateral

Front 257

What are the veins located in this area of arm?

Back 257

Basilic and vena comites

Front 258

What is innervation of triceps brachii?

Back 258

radial nerve C5, C7, C8

Front 259

What is main action of triceps brachii?

Back 259

extends the forearm; it is chief extensor of the forearm; long head steadies head of abducted humerus

Front 260

What is innervation of Anconeus?

Back 260

radial nerve C7, C8 and T1

Front 261

What is main action of Anconeus?

Back 261

assists triceps in extending forearm; stabilizes elbow joint;abducts ulna during pronation

Front 262

Where is best location to compress arm to control hemmorage?

Back 262

Compression of this vessel (to control hemorrhage) occurs best at the middle of the arm.

Front 263

Where is best place to clamp brachial artery if needed during surgery?

Back 263

Because anatomoses about the elbow provide a functionally and surgically important collateral circulation, the brachial artery may be clamped distal to the profunda brachii artery without producing tissue damage

Front 264

What is clinical danger of clamping brachial artery proximally to the profundi brachii?

Back 264

ischemia of the elbow and forearm results from clamping of the brachial artery proximal to the profunda brachii for an extended period.

Front 265

What is problem if the brachial artery is suddenly occluded or lacerated?

Back 265

Occlusion or laceration of the brachial artery that is sudden and complete creates a surgical emergency because paralysis of muscles results
from ischemia within a few hours (6 hours for muscles and nerves, after which fibrous scar tissue replaces necrotic tissue and causes involved muscles to shorten permanently = produces a flexion
deformity or an ischemic compartment syndrome like Volkmanns’ contracture).

Front 266

Clinical importance of the quadrangular space?

Back 266

Through the quadrangular space pass the axillary nerve and the posterior humeral
circumflex vessels, both of which leave the axilla and pass posteriorly below the inferior
attachment of the capsule of the shoulder joint (at the level of the surgical neck of the humerus).

Front 267

What are the surface landmarks of the forearm?

Back 267

Proximal ulna & radius: olecranon and radial head Distal humerus: epicondyles (lateral, medial) and supracondylar ridges (lateral, medial)

Front 268

What is normal about elbow joint and how is it important for elbow injuries?

Back 268

When extended, the tip of the olecranon and humeral epicondyles lie in a straight line, but when flexed the olecranon descends until its tip forms the apex of an
equilateral triangle (epicondyles form the angles at the base of the equilateral
triangle). The normal relationships of this triangle are important in the diagnosis of some elbow injuries (e.g., dislocation of elbow joint

Front 269

What is the stabilizing bone of the forearm?

Back 269

Ulna is the stabilizing bone of the forearm, occurs medially, and is longer than the radius.

Front 270

What are the proximal and lateral
landmarks of the ulna?

Back 270

Proximally, it has two major projections (olecranon, coronoid process). The
anterior surface of the olecranon forms the posterior wall of the trochlear notch
(articulates with the trochlea of the humerus). Laterally, the coronoid process is a
smooth, rounded concavity (= radial notch), which articulates with the head of the
radius.

Front 271

What does articulation of the ulna and humerus allow for?

Back 271

The articulation of the ulna and humerus allows flexion/extension (mostly) of the elbow joint. During pronation and supination of the forearm, however, little wobble
(= abduction/adduction) occurs.

Front 272

What is the mobile, lateral, and shorter bone of the forearm?

Back 272

Radius

Front 273

What are the proximal and distal relationships with the ulna?

Back 273

Proximally, it has a short
cylindrical head which has several characteristics including a smooth, superior aspect
that is concave and articulates with the capitulum of the humerus (during
flexion/extension of the elbow) and distally with the radial notch of the ulna (covered
with articular cartilage). It also has a neck and medially directed tuberosity

Front 274

What forms the ulnar notch?

Back 274

The medial aspect of the distal part of the radius forms a concavity (ulnar notch),
which accommodates the head of the ulna.

Front 275

Is the radial styloid process larger that the ulnar styloid process?

Back 275

The radial styloid process is much larger than the ulnar styloid process and extends about a finger’s breadth further distally. The
later relationship is of clinical importance when the ulna and/or the radius are
fractured.

Front 276

Is the ulna considered an upward or downward extension of the arm?

Back 276

the ulna is considered a downward extension of the arm because it is associated with the motion and strength of the elbow.

Front 277

Is the radius considered an upward extension for the arm and if so why?

Back 277

In contrast, the radius is an upward extension of the hand and is concerned with motions of the wrist and hand.

Front 278

What kind of fracture is usually associated with the ulna and radius?

Back 278

Fractures of the radius and ulna are usually the result of a severe injury. A direct injury
usually produces transverse fractures at the same level (usually the middle 1/3 of the bone).Isolated fractures of the radius or ulna may also occur.

Front 279

What membrane connects both bones?

Back 279

Both bones are connected by an interosseous membrane; thus, a fracture of one bone is likely to be associated with
dislocations of the nearest joint. For example, a fracture of the distal 1/3 of the radius may be associated with the distal radioulnar joint.

Front 280

Is the distal or proximal end most commonly fractured in adults over 50?

Back 280

A fracture of the distal end of the radius is most common in adults over 50 years old (especially women)

Front 281

What generally occurs when both the radius and the ulna are fractured?

Back 281

If both the ulna and radius are fractured, the interosseous membrane has a tendency to pull the ulna toward the radius.

Front 282

Fractures above the important muscular landmark known as the pronator teres will present with what?

Back 282

Fractures above this muscular landmark will present with the upper fragment pulled into supination, while the lower fragment is pronated.

Front 283

Fractures below the important muscular landmark known as the pronator teres will present with what?

Back 283

Fractures below this landmark will present with the upper fragment equalized between pronation and supination, while the lower fragment is in full pronation.

Front 284

What type of fracture involves the distal end of radius?

Back 284

Colles’ fracture involves the distal end of the radius and usually results from a fall on an
extended hand.

Front 285

What is a typical sign of Colles fracture?

Back 285

A typical sign for this type of fracture is the “Silver Fork” deformity, which
presents as a prominence on the back of the wrist and lateral displacement of the hand
toward the radial side. If the fracture is impacted or incomplete, the deformity may not be observed.

Front 286

What is name for a reverse Colles fracture?

Back 286

A reverse Colles’ fracture is called Smith’s fracture and is usually produced by a fall on the back of the hand with the wrist flexed.

Front 287

What condition could be confused with a Colles fracture?

Back 287

An epiphyseal separation may be confused with a Colles’ fracture and is common in children or teenagers (may occur up to the 20th year).

Front 288

Does the radius or the ulna generally receive most of the injury in a fall on the hand?

Back 288

The radius receives most of the
injury in falls on the outstretched hand, thus separation of the distal ulnar epiphysis is rare.

Front 289

What nerve should be checked in Colles and Smith fractures?

Back 289

It is important to check for median nerve deficit in all such fractures.

Front 290

What is the IMPORTANT RULE in fractures above the position of a Colles fracture?

Back 290

- The IMPORTANT RULE in all fractures of the radius above the position of a Colles’ fracture is to
keep the elbow flexed. Otherwise, it is impossible to maintain the forearm in any given position of
rotation.

Front 291

What comprises the Elbow Joint?

Back 291

Possesses a single synovial cavity that provides for three separate articulations
between the arm and forearm

Front 292

What are three separate articulations of elbow joint in arm and forearm?

Back 292

Humeroulnar joint: hinge joint
2. Humeroradial joint: ball and socket joint
3. Proximal radioulnar joint: Pivot

Front 293

Where does the Ulnar collateral ligament course?

Back 293

occurs between the medial epicondyle and ulna, while the
anterior band extends to the olecranon and coronoid process.

Front 294

Where does the Radial collateral ligament arise from and attach?

Back 294

Arises at the lateral epicondyle and attaches to the
stationary annular ligament (not radius), while it functions as an independent rotator
of the radius.

Front 295

What are the Two Radioulnar Joints are present

Back 295

the proximal and distal radioulnar joints

Front 296

What movement do proximal and distal radioulnar joints allow?

Back 296

The proximal and distal radioulnar joints allow pronation and supination
where the radius turns around the stationary ulna at the proximal radioulnar joint.

Front 297

Describe the distal radioulnar joint?

Back 297

The distal radioulnar joint has a convex lower end of the ulna and articulates with the ulnar notch of the radius (Pivot-type Joint).

Front 298

What are primary actions of the elbow joint?

Back 298

Actions of the elbow joint include flexion/extension but limited abduction/adduction.

Front 299

What is a transient sublaxation?

Back 299

Transient subluxation (incomplete dislocation) of the head of the radius (pulled elbow) is common in preschool children (especially girls). This injury can occur when the child is suddenly lifted (jerked) by the upper limb while the forearm is in pronated. The sudden pulling
of the upper limb tears the distal attachment (to neck of radius) of the anular ligament. The radial head then moves distally, partially out of the torn anular ligament. The proximal
part of the torn ligament may become trapped between the head of the radius and the capitulum of the humerus.

Front 300

What is source of pain in transient sublaxation?

Back 300

The source of pain is the pinched anular ligament.

Front 301

What is tx for transient sublaxation?

Back 301

Treatment includes
supination of the patient’s forearm while the elbow is flexed

Front 302

What is escape of fluid into tissue or space known as and how is it treated?

Back 302

Elbow joint effusions (escape of fluid into a tissue or space) usually present posteriorly,
because the joint capsule is weakest in this area and is not supported, as it is anteriorly. The
elbow joint is easily aspirated posteriorly with a needle placed in the joint space from either side of the olecranon.

Front 303

What is elbow tendinitis or lateral epicondylitis?

Back 303

Elbow tendinitis or lateral epicondylitis (Tennis Elbow) is a painful musculoskeletal
condition that may follow repetitive use of the superficial extensor muscles of the forearm.
Pain is experienced over the lateral epicondyle and radiates down the posterior surface of
the forearm. Individuals with elbow tendinitis often feel pain when they open a door or lift a
drinking glass.

Front 304

What can occur with repeated forceful flexion/extension of wrist?

Back 304

Repeated forceful flexion and extension of the wrist will strain the attachment of the common tendon (produces inflammation of the periosteum of the lateral
epicondyle = lateral epicondylitis and the common extensor attachment of the muscles).

Front 305

What is golfers elbow?

Back 305

Epicondylitis may refer to pain over the lateral epicondyle and at the elbow secondary to chronic or repeated flexion and extension at the wrist. It usually, follows prolonged rotary motion of the forearm. The lateral epicondyle is more commonly involved compared to the medial epicondyle
(Golfers Elbow).

Front 306

What are the most common dislocations involving the elbow joint?

Back 306

Posterior dislocations are most common and usually follow a fall onto the outstretched hand.

Front 307

Is dislocation of anterior, lateral, and medial bones fairly common?

Back 307

Anterior, lateral, and medial dislocation of both bones is rare. The distal end of the humerus is driven through the weak anterior part of
the fibrous capsule as the radius and ulna dislocate posteriorly. The ulnar collateral ligament is
often torn, and an associated fracture of the head of the radius, coronoid process, or olecranon
process of the ulna may occur.

Front 308

What occurs when the ulna nerve is damaged in elbow injuries?

Back 308

If the ulnar nerve is
injured (impinged), the result may be numbness of the little finger and weakness of flexion and adduction of the wrist.

Front 309

Can fracture/dislocation of the elbow include the olecranon?

Back 309

Of course! Fracture and/or dislocation of elbow joint may include the olecranon process. The fracture of the olecranon process (fractured elbow) is common because this process is subcutaneous.

Front 310

What is a common mechanism for the fracture of the olecranon process?

Back 310

A common mechanism for this injury is a fall on the elbow combined with a sudden powerful
contraction of the triceps. The fractured olecranon is pulled apart and the injury is often
considered to be an avulsion fracture. This is a serious fracture requiring the services on an
orthopedic surgeon. Because of the traction produced by the tonus of the triceps on the
olecranon fragment, pinning is usually required. Healing may take up to a year

Front 311

How does avulsion of the medial epicondyle in children occur?

Back 311

Avulsion of the medial epicondyle in children can result from a fall that causes severe abduction of the extended elbow which is an abnormal movement of this joint. The resulting traction on the ulnar collateral ligament pulls the medial epicondyle distally.

Front 312

What is the anatomical basis of avulsion of the medial epicondyle?

Back 312

The anatomical basis of avulsion of the medial epicondyle is that the epiphysis for this epicondyle
may not fuse with the distal end of the humerus until an individual is 20 years of age
(radiographically at age 14 in females and 16 in males).

Front 313

What complications frequently occur with abduction type of avulsion injuries of this epicondyle?

Back 313

A traction injury of the ulnar nerve is a frequent complication of the abduction-type of avulsion of this epicondyle (= the ulnar
nerve passes posterior to the medial epicondyle prior to entering the forearm).

Front 314

What are the borders and contents of theCubital fossa?

Back 314

Borders: Brachioradialis & Pronator teres
Contents: Median nerve, Radial artery, Radial nerve, Ulnar artery

Front 315

Where is majority of "muscle mass" located in the forearm?

Back 315

Posterior and anterior aspects of the forearm contain most of the muscle mass at or
near the elbow, while their tendons go to the wrist and digits.

Front 316

Describe how the "muscle mass" in the forerm works?

Back 316

The mass includes the
extrinsic muscles that serve as extensors/flexors of the thumb or digits, and so the
distal forearm, wrist, and hand have minimal bulk to maximize their function. This
“remote control” is by extrinsic muscles attaching to medial and lateral extensions of
the distal humerus.

Front 317

Describe the posterior and anterior compartments of forearm

Back 317

The proximal parts of the anterior compartment (flexor/pronator) occur
anteromedial, and the muscles of the posterior (extensor/supinator) are located posterolateral. Spiraling gradually over the length of the forearm, the compartments become truly anterior and posterior in the distal forearm and wrist.

Front 318

Remember that names of muscles in this area correspond in part to the element they serve

Back 318

Names of the muscles, in part, correspond to the element (e.g., muscles that serve digits are termed digitorium; muscles that go to the thumb are called extensor pollicis longus/brevis;) they serve.

Front 319

What are the muscles that go to the index finger called?

Back 319

indicis

Front 320

What are the muscles
that go to the ring finger are called?

Back 320

annulus

Front 321

What about the muscles that go to the little finger?

Back 321

minimi

Front 322

What plane of movement does the thumb move when the thumb is abducted?

Back 322

hitch a ride!

Front 323

What are the two abductor muscles of the thumb?

Back 323

the abductor pollicis longus and the abductor pollicis brevis

Front 324

What muscles occupy the Anterior Compartment (Flexors/Pronators)?

Back 324

The muscles of this group occupy four layers and most muscles arise at the medial epicondyle and insert on the metacarpals or phalanges. Most muscles of this group are innervated by the median (mostly) and ulnar nerves.

Front 325

What are the four muscles that originate on the medial epicondyle of
the humerus?

Back 325

Pronator teres: Occurs laterally (does not cross wrist)
Flexor carpi radialis: Most lateral (crosses wrist)
Palmaris longus: Medialmost of this group, vestigal (absent in 10-12% of
the population); if present, it has a small belly and a long thin tendon that inserts on the palmar fascia (source for tendon grafting).
Flexor carpi ulnaris: most medial of 1st layer

Front 326

What is innervation of pronators teres?

Back 326

medial nerve C6 and C7

Front 327

What is main action of pronators teres?

Back 327

pronates and flexes forearm( at elbow)

Front 328

What is innervation of flexor carpi radialis?

Back 328

medial nerve C6 and C7

Front 329

What is main action of flexor carpi radialis?

Back 329

flexes and abducts hand(at wrist)

Front 330

What is innervation of palmaris longus?

Back 330

medial nerve C7 and C8

Front 331

What is main action of palmaris longus?

Back 331

flexes hand (at wrist) and tightens palmar aponeurosis

Front 332

What is innervation of flexor carpi ulnaris?

Back 332

ulnar nerve C7 and C8

Front 333

What is main action of flexor carpi ulnaris?

Back 333

flexes and adducts hand(at wrist)

Front 334

What does the middle layer of forearm consist of?

Back 334

Middle Layer consists of superficial flexors that become tendinous in the lower one-third of the forearm.

Front 335

What is innervtion of Flexor digitorum superficialis?

Back 335

median nerve C7, C8 and T1

Front 336

What is main action Flexor digitorum superficialis?

Back 336

flexes middle phalanges at proximal interphalangeal joints of medial four joints; it also flexes proximal phalanges at metacarpophalangeal joints and hand

Front 337

What is location of the Flexor digitorum profundus?

Back 337

Third layer with about 4 tendons each of which can be traced to a distal phalanx; allows flexion of the distal
phalanx (the claw, lesion of ulnar nerve)

Front 338

Where does the pronator quadratus arise from and where does it insert?

Back 338

Pronator quadratus arises from the ulna and inserts on the
distal part of the radius (4th layer).

Front 339

What is innervation of Flexor digitorum profundus?

Back 339

medial part: ulnar nerve C8 and T1
lateral part:median nerve C8 and T1

Front 340

What is main action of Flexor digitorum profundus?

Back 340

flexes distal phalanges at distal interphalangeal joints of medial first four digits; assists with flexion of the hand

Front 341

What is innervation of flexor pollicus longus?

Back 341

anterior interosseuous nerve C8 and T1

Front 342

What is main action of flexor pollicus longus?

Back 342

flexes phalanges of first digit(thumb)

Front 343

What is innervation of Pronator quadratus?

Back 343

anterior interosseuous nerve C8 and T1

Front 344

What is main action of Pronator quadratus?

Back 344

pronates forearm. Its deep fibers bind radius and ulna together

Front 345

Is brachioradialis a flexor or extensor? Careful now!

Back 345

Brachioradialis: Likely a flexor but is supplied by the nerve to the extensors, it occurs on the flexor side, and does not cross the wrist

Front 346

What is innervation of brachioradialis?

Back 346

radial nerve C5, C6, and C7

Front 347

What is main action of brachioradialis?

Back 347

extend and abduct hand at wrist joint

Front 348

What is innervation of Extensor carpi radialis longus

Back 348

radial nerve C6 and C7

Front 349

What is main action of Extensor carpi radialis longus

Back 349

extend and abduct hand at wrist
joint

Front 350

What is innervation of Extensor carpi radialis brevis?

Back 350

deep branch of radial nerve C7 and C8

Front 351

What is main action of Extensor carpi radialis brevis?

Back 351

extend and abduct hand at wrist
joint

Front 352

What is innervation of Extensor digitorum?

Back 352

posterior interosseuous nerve C7 and C8-the continuation of the deep branch of the radial nerve

Front 353

What is main action of Extensor digitorum?

Back 353

extends medial 4 digits at metacarpopharangeal joints; extends hand at wrist joint

Front 354

What is innervation of Extensor digiti minimi?

Back 354

posterior interosseuous nerve C7 and C8;the continuation of the deep branch of the radial nerve

Front 355

What is main action of Extensor digiti minimi?

Back 355

extends 5th digit at metacarpophalangeal and interphalangeal joints

Front 356

What is innervation of Extensor carpi ulnaris?

Back 356

posterior interosseuous nerve C7 and C8;the continuation of the deep branch of the radial nerve

Front 357

What is main action of Extensor carpi ulnaris?

Back 357

extend and adducts hand at wrist
joint

Front 358

What is innervation of Extensor pollicis longus?

Back 358

posterior interosseous nerve C7 and C8, the continuation of deep branch of radial nerve

Front 359

What is main action of Extensor pollicis longus?

Back 359

extends proximal phalanx of thumb carpometacarpal joint

Front 360

What is innervation of Extensor pollicis brevis?

Back 360

posterior interosseous nerve C7 and C8, the continuation of deep branch of radial nerve

Front 361

What is main action of Extensor pollicis brevis?

Back 361

extends distal phalanx of thumb at metacarpophalangeal and interphalangeal joints

Front 362

What is innervation Extensor indicis?

Back 362

posterior interosseous nerve C7 and C8, the continuation of deep branch of radial nerve

Front 363

What is main action Extensor indicis

Back 363

extends 2nd digit and helps to extend hand

Front 364

What does the Musculocutaneous innervate?

Back 364

Small in size, innervates muscles of the anterior arm, and continues into the forearm as the lateral antebrachial cutaneous nerve.

Front 365

What is the largest nerve of the upper limb?

Back 365

Median: Largest and does not branch in the arm; supplies forearm and hand, enters
forearm with the brachial artery, occurs between the two heads of the pronator teres,
continues between FDS and FDP, at the wrist it becomes superficial (between
FDS/flexor carpi radialis). A branch of the median nerve, anterior interosseous nerve,
follows an artery by the same name.

Front 366

What is the course of the ulnar nerve?

Back 366

Ulnar: passes behind medial epicondyle, enters forearm between the two heads of flexor carpi ulnaris( brevis and longus), prominent and supplies muscles in the forearm and fingers.

Front 367

What is course of the radial nerve?

Back 367

Radial: Crosses the anterior aspect of the lateral epicondyle and enters the cubital fossa between the brachialis/brachioradialis. It then divides into deep and
superficial branches. It supplies posterior arm and forearm. The deep branch runs
through the supinator muscle and emerges with the posterior interosseous artery.
Soon after its emergence from the supinator muscle, it is termed the posterior
interosseous nerve.

Front 368

Is the radial nerve or musculocutaneous nerve more prone to injury?

Back 368

The radial nerve is much closer to the bone than the
musculocutaneous, and so more prone to injury in humeral fractures

Front 369

What does the axillary nerve supply and what does it become?

Back 369

Terminal branch of posterior cord and supplies deltoid, teres minor, and muscles of the posterior arm, and forearm. It continues superiorly as the lateral
cutaneous branch supplying skin over inferior half of the deltoid.

Front 370

Where does the axillary artery get termed the brachial artery?

Back 370

At the level of the inferior margin of teres major, the axillary artery is termed the brachial artery.

Front 371

Where does profundi brachii arise from?

Back 371

Profunda brachii: Arises via the brachial, axilla, or posterior humeral circumflex, and has two terminal branches (text terms ascending and descending):Middle collateral Radial collateral

Front 372

What are two of the collateral branches of the brachial artery?

Back 372

Superior ulnar collateral and Inferior ulnar collateral:

Front 373

What are three branches of the terminal radial branch of the brachial artery?

Back 373

Radial recurrent at the elbow (ascends between the brachialis and brachioradialis and joins the radial collateral artery)
2. Dorsal carpal branch at the wrist
3. Deep palmar arch (main contribution

Front 374

The ulnar has five main branches form proximal to distal?

Back 374

Ulnar has five main vessels (from proximal to distal)
1. Anterior ulnar recurrent
2. Posterior ulnar recurrent
3. Common interosseous
4. Dorsal carpal branch
5. Superficial palmar arch (main contribution):

Front 375

What are two main branches of the common interosseous branch of the ulnar branch of the brachial artery?

Back 375

Anterior branch: Passes distally on the anterior aspect of the interosseous membrane. At the proximal border of
the pronator quadratus it pierces the interosseous
membrane to continue distally into the wrist on the
posterior aspect of the interosseous membrane.
- Posterior interosseous: Passes posteriorly between the
radius and ulna, proximal to the interousseous membrane.
It supplies adjacent muscles and then gives off the
interosseous recurrent artery, which passes superiorly,
posterior to the lateral epicondyle and participates in the arterial anastomoses about the elbow (does not course
along the membrane, instead it occurs between the superficial and deep layers of the extensor muscles with
the posterior interosseous nerve). It is mostly absent in
the distal forearm and is replaced by the anterior
interosseous artery.

Front 376

What is Volkmann’s ischemic contracture?

Back 376

In the event of an extensive post-traumatic hemorrhage into either compartment or an improper use of a tourniquet, the fascia is limiting and permits no blood to escape. The resulting muscular fibrosis, secondary to the pressure of the enclosed hematoma, is called Volkmann’s ischemic contracture (condition of the fingers and sometimes of the wrist, with loss of power). This condition is characterized by fixed high resistance to passive stretch of a muscle.

Front 377

What are the Superficial Veins of the upper limb?

Back 377

Cephalic, Basilic, Median cubital, Median antebrachial, Dorsal venous
network, Palmar venous network

Front 378

What are the Deep Veins of the upper limb?

Back 378

Deep venous arcade, Radial, Ulnar, Perforating (communicating)

Front 379

What is the venipuncture?

Back 379

Venipuncture of the upper limb is common because of the prominence and accessibility of the superficial veins of the upper limb. The veins are embedded with the subcutaneous tissue, which may make them difficult to observe. Note that considerable variation occurs in the
connection of the basilic and cephalic veins in the cubital fossa area

Front 380

What are some notable variations of veins of the cubital fossa?

Back 380

About 20% of the population has a median antebrachial vein (median vein of forearm) which divides into a median basilic vein that joins the basilic vein and a median cephalic vein that joins the cephalic vein. In these cases, a clear M-formation is produced by the cubital veins. It is important to observe and recall that
either the median cubital or median basilic veins (whichever pattern is present) will cross superficial to the brachial artery.

Front 381

Two important distinctions regarding the median antebrachial veins

Back 381

If the median antebrachial vein enters both the cephalic and basilic via median branches, there is no median cubital V; however, if the median antebrachial enters the basilic, the median cubital joins
the cephalic and basilic

Front 382

What bones in the hand are considered in the proximal row?

Back 382

The scaphoid, lunate, triquetrum, and pisiform bones are the proximal row.

Front 383

What bones in the hand are considered in the distal row?

Back 383

The hamate, capitate, trapezoid, and trapezium are the distal row.

Front 384

How are metacarpals indicated?

Back 384

There are 5 metacarpals, referred to by Roman numerals I-V from the pollex (thumb, or digit 1) to digiti minimi (little finger, or digit 5).

Front 385

Describe each metacarpal

Back 385

Each metacarpal has a head at the distal end, a shaft in the middle, and a base at the proximal end. There is also a tubercle on the flexor (palmar) side.

Front 386

Does development of metacarpals progress as they are numbered?

Back 386

No, development of phalanges progresses from digiti minimi(digit 5) to pollex(thumb, digit 1)

Front 387

How many phalanges does the thumb have?

Back 387

The pollex (thumb) has two phalanges (singular: phalanx

Front 388

What type of bones develop in the tendon?

Back 388

Sesamoids: Sesamoids are bones which develop within tendons

Front 389

Which bone develops in the tendon of flexor carpi ulnaris?

Back 389

The pisiform bone is a sesamoid bone that develops in the tendon of m. flexor carpi ulnaris

Front 390

Do sesamoid bones develop at the first metacarpal?

Back 390

Sesamoid bones also develop at the head of the first metacarpal. These are in the tendons of m. flexor pollicis brevis (on the radial side) and adductor pollicis (on the ulnar side).

Front 391

Are babies born with carpal bones?

Back 391

Babies are born with the carpal bones formed in cartilage but not ossified

Front 392

Is ossification of carpal bones quicker in males?

Back 392

Ossification progresses more quickly in females than in males, but in a typical order, such that a “skeletal age” can be assigned.

Front 393

When do the capitate and the hamate appear in males and females?

Back 393

Male 12 mo, Female 10 mo: capitate and hamate appear

Front 394

When does the triquetal appear in males and females?

Back 394

Male 36 mo., Female 27 mo.: triquetral appears, lunate may appear, epiphyses on fingers.

Front 395

What is order of ossification in carpal bones?

Back 395

Trapezium, scaphoid, trapezoid, ossify in that order. The pisiform is the last to ossify, between the ages of 8 and 12 years.

Front 396

When do the epipyses usually fuse in males and females?

Back 396

Epiphyses in the hand usually fuse by 16 years in females, 19 years in males.

Front 397

Describe the radiocarpal joint?

Back 397

The radiocarpal joint is formed of the distal end of the radius, and an articular disc (or fibrocartilage) at the distal end of the radius articulating with the scaphoid and lunate. When the hand is adducted the triquetrum also articulates. The articular disc degenerates with age, sometimes wearing almost completely away. The synovium of the joint capsule is usually separate from that of the distal radio-ulnar joint, where pronation and supination occur.

Front 398

Is there much movement in the synovial joints of the hand?

Back 398

There are synovial joints between the carpals, although they are for the most part tightly attached to each other by dorsal, palmar, and interosseus ligaments.

Front 399

In which joints of the hand does motion occur?

Back 399

Motion does occur, however, at the midcarpal joint. Most extension occurs at the midcarpal joint, and part of the adduction and abduction also occurs there. Abduction from the neutral position occurs solely on the midcarpal joint.

Front 400

Do the carpometacarpal joints allow for movement?

Back 400

These are simple hinges, except for the one at the base of the thumb, which is saddle-shaped and allows movement in any plane. The CMCs of digits 2 and 3 (index and middle fingers) don’t move appreciably.

Front 401

Do the intermetacarpal joints allow for any movement?

Back 401

Joints occur between metacarpals of digits 2-5; these don’t move appreciably, except for that between metacarpals IV and V, which moves in cupping the hand, gripping a door handle, and opposing digiti minimi.

Front 402

Describe the radiocarpal joint?

Back 402

The radiocarpal joint is formed of the distal end of the radius, and an articular disc (or fibrocartilage) at the distal end of the radius articulating with the scaphoid and lunate. When the hand is adducted the triquetrum also articulates. The articular disc degenerates with age, sometimes wearing almost completely away. The synovium of the joint capsule is usually separate from that of the distal radio-ulnar joint, where pronation and supination occur.

Front 403

Is there much movement in the synovial joints of the hand?

Back 403

There are synovial joints between the carpals, although they are for the most part tightly attached to each other by dorsal, palmar, and interosseus ligaments.

Front 404

In which joints of the hand does motion occur?

Back 404

Motion does occur, however, at the midcarpal joint. Most extension occurs at the midcarpal joint, and part of the adduction and abduction also occurs there. Abduction from the neutral position occurs solely on the midcarpal joint.

Front 405

Do the carpometacarpal joints allow for movement?

Back 405

carpometacarpal joints
These are simple hinges, except for the one at the base of the thumb, which is saddle-shaped and allows movement in any plane. The CMCs of digits 2 and 3 (index and middle fingers) don’t move appreciably.

Front 406

Do the intermetacarpal joints allow for any movement?

Back 406

Joints occur between metacarpals of digits 2-5; these don’t move appreciably, except for that between metacarpals IV and V, which moves in cupping the hand, gripping a door handle, and opposing digiti minimi.

Front 407

What motions do the metacarpophalangeal joints allow for?

Back 407

Motions at the MP joints include flexion, extension, abduction, adduction, and circumduction

Front 408

Which ligament courses from the styloid process of the ulna to the triquetrum and pisiform?

Back 408

ulnar collateral ligament

Front 409

Where is the radial collateral ligament attached?

Back 409

from the styloid process of the radius to the scaphoid and trapezium

Front 410

Which ligament is found between the anterior distal radius and the scaphoid, lunate, triquetrum, and capitate?

Back 410

palmar radiocarpal ligament –

Front 411

Where does the dorsal radiocarpal ligament attach?

Back 411

from posterior distal radius and the scaphoid, lunate, and triquetrum

Front 412

Where is the extensor retinaculum locted?

Back 412

The extensor retinaculum crosses the back of the wrist and holds the extensor tendons in place.

Front 413

What are attachments of the extensor retinaculum?

Back 413

Its attachments are the anterior border of the radius, multiple points on the ridged posterior of the radius, and to the triquetrum and pisiform bones.

Front 414

What is relationship between dorsal branches of radial and ulnar nerves to extensor retinaculum?

Back 414

It creates six tunnels, through which the extensor tendons pass within synovial sheaths. Dorsal branches of the radial and ulnar nerves are superficial and dorsal to the extensor retinaculum.

Front 415

Can the extensor tendons be at risk if the radius is broken?

Back 415

Note that the position of the extensor tendons may put them at risk if the radius is broken. One possible complication of Colles’ fracture (discussed in the last lecture) is malunion of the radius creating a rough edge, which can cut through the tendon of extensor pollicis longus.

Front 416

Where can ganglion cysts form?

Back 416

Distal to the extensor retinaculum, synovial or “ganglion cysts” may form in the sheaths of the extensor tendons.

Front 417

What are some of the clinical implications of the ganglion cysts?

Back 417

“Ganglion cysts” – which have nothing to do with nerve ganglia – occur in the synovia of extensor or flexor tendons. A synovial cyst in the synovial sheath of extensor carpi radialis brevis is common but they occur in any of the sheaths. They may or may not be painful, and they may or may not be caused by overuse. A synovial cyst in the flexor sheath can compress the median nerve, resulting in symptoms of carpal tunnel syndrome.

Front 418

Where is the flexor retinaculum located?

Back 418

The flexor retinaculum is a heavy, thick band attached on the radial side to the tubercles of the scaphoid and the trapezium, and on the ulnar side to the pisiform and hook of the hamate.

Front 419

What makes up the area known as the "carpal tunnel"

Back 419

It converts the carpal sulcus to the carpal tunnel, which occurs between the tubercles of the scaphoid and trapezoid laterally and the hook of the hamate and the pisiform medially. The proximal border of the retinaculum is at about the distal skin crease of the wrist, and the distal border is at the distal margin of the base of the abducted thumb. Structures deep to the retinaculum include the median nerve, the tendon of flexor pollicis longus, and the tendons of flexors digitorum superficialis and profundus. Note that the ulnar artery and nerve are superficial to the retinaculum.

Front 420

What is median neve entrapment known as and what are it's symptoms?

Back 420

Median nerve entrapment or “carpal tunnel syndrome” results from any lesion reducing the space in the tunnel. Symptoms include pain, paraesthesias or loss of sensation in the thumb, index finger, middle finger, and lateral side of the ring finger.Symptoms may also include weakness and clumsiness of the thenar muscles, pain with use of the thenar muscles, and may progress to pain up the limb to the axilla.

Front 421

Is slitting the wrist a good way to commit suicide?

Back 421

In cross-section it is possible to see why laceration of the flexor surface of the wrist is not a particularly efficient way to commit suicide, but often causes median nerve injury. The median nerve is commonly injured proximal to the flexor retinaculum, resulting in paralysis of the muscles it supplies.

Front 422

movements of the wrist

FLEXION

Back 422

is primarily produced by the flexor carpi radialis and flexor carpi ulnaris mm. These muscles are assisted by the digital flexors and m. palmaris longus.

Front 423

movements of the wrist

EXTENSION

Back 423

is primarily effected by extensor carpi radialis longus and brevis and by extensor carpi ulnaris, assisted by digital extensors.

Front 424

movements of the wrist

ABDUCTION

Back 424

is primarily produced by the simultaneous contraction of flexor carpi radialis, and extensor carpi radialis longus and brevis. It is limited to about 15 degrees because of the styloid process of the radius.

Front 425

movements of the wrist

ADDUCTION

Back 425

is effected by simultaneous contraction of extensor carpi ulnaris and flexor carpi ulnaris.

Front 426

movements of the wrist CIRCUMDUCTION involves all the muscles above.

Back 426

all the muscles above

Front 427

Most muscles of the anterior compartment are innervated by one of two nerves?

Back 427

median-mostly
ulnar-flexor carpi ulnaris
flexor digitorum profundus(but only the lateral half)

Front 428

The superficial layers of the muscles of the forearm originate where?

Back 428

medial epicondyle

Front 429

Are complete lesions of the brachial plexus common?

Back 429

Complete lesions involving all roots are rare. Incomplete nerve injuries, however,
are common and are usually caused by traction or pressure on nerves or nerve roots.

Front 430

What causes Upper Brachial Plexus Segment (upper trunk injury) Syndrome (C5-C6) Erb-Duchenne Palsy?

Back 430

Injuries to the superior part of the brachial
plexus result from an excessive increase in the angle between the neck and shoulder.
Such as landing on the shoulder in a manner that widely separates the shoulder from the neck.

Front 431

Displacement of the head to the contralateral side and depression of the shoulder to the ipsilateral side can be caused by what?

Back 431

May occur in a newborn when excessive stretching of the neck occurs during delivery
Fall from a horse or from a motorcycle
The roots of the cervical nerves may be injured by a prolapse of an
intervertebral disc (upper radicular syndrome)

Front 432

How is arthritis related to upper brachial plexus syndrome?

Back 432

The roots may be irritated by arthritic changes in either the synovial joints between the vertebrae or in the uncovertebral joints (between the uncinate processes of C3-C6 and the beveled surface of the respective centra). These are frequent sites for bone spurs.

Front 433

How are myotmes at C5 affected in upper brachial plexus injury?

Back 433

Abduction and lateral
rotation of the shoulder
flexion at the elbow

Front 434

How are myotmes at C6 affected in upper brachial plexus injury?

Back 434

Adduction and medial
rotation at the shoulder
flexion at the elbow

Front 435

What is result of nerve damage in upper brachial plexus injuries?

Back 435

Nerve damage (in all cases) will cause paralysis of the muscles of the
shoulder, arm, and forearm supplied by C5-C6 (e.g., deltoid, biceps, brachialis,
and brachioradialis).

Front 436

What is location of many lesions related to upper brachial plexus injuries?

Back 436

The lesion often occurs at Erb’s point (junction of C5 and C6).

Front 437

What are some of the clincial presentations of an upper brachial plexus injury?

Back 437

Arm is adducted and medially rotated at the shoulder
- Arm hangs at the side in a medial position and is extended at the elbow
- Forearm is rotated medially and the palm of the hand faces superiorly
- These are abnormal attitudes and are referred to as the “waiters tip” a discrete
position as the server walks away

Front 438

Are Injuries to the Lower Brachial Plexus Segment (lower trunk injury) as common as upper trunk injuries?

Back 438

Injuries to the inferior part of the
brachial plexus are less common.

Front 439

What are some causes of lower trunk brachial plexus injuries?

Back 439

may occur when the upper limb is suddenly pulled superiorly such as when grasping a limb during a fall toward the ground. This type of
injury may occur when the upper limb of an infant is excessively pulled during delivery (e.g., limbs pulled over the head during a breech birth).

Front 440

What portion of lower trunk is usually injured and what is result?

Back 440

injure the inferior trunk of the plexus (C8-T1) and may pull the dorsal and ventral roots of the spinal nerves from the spinal cord.The short muscles of the hand are affected which results in a claw-hand deformity.

Front 441

When can Palsy of Klumpke occur?

Back 441

Palsy of Klumpke may occur after a difficult breech delivery. It may occur as the result of an individual grasping something to break a fall, which causes the arm to abduct excessively.

Front 442

What is thoracic outlet syndrome?

Back 442

Thoracic outlet syndrome: is a general term for several conditions attributed to the compromise of blood vessels or nerve fibers (brachial
plexus) at any location between the base of the neck and the axilla. The
classification is based on the structure known or presumed to be compromised (e.g., vessels or nerves), and so are divided into two main
groups (vascular and neurologic). Usually an obstruction that occurs in
the root of the neck with the manifestations of the syndrome involves the
upper limb.

Front 443

What are the myotomes affected in lower brachial injury?

Back 443

C8 Flexion of wrist and fingers
T1 Intrinsic muscle function of the hand

Front 444

What occurs with a proximal injury in the lower brachial plexus?

Back 444

A proximal injury may cause serious damage to the cervicothoracic ganglion (stellate) producing sympathetic denervation to the head (Horner’s syndrome).

Front 445

What does thoracic coutlet syndrome involve?

Back 445

Thoracic outlet syndrome involves the superior thoracic aperture.

Front 446

What is costoclavicular syndrome?

Back 446

Costoclavicular syndrome (coldness of skin of upper limb and diminished radial pulse) results from the compression of the subclavian artery between the clavicle and first rib.

Front 447

What results when C8 and T1 are involve in lower brachial plexus injury?

Back 447

Involvement of C8 and T1 produces an attitude of combined “Clawhand”
(Ulnar nerve) and “Simian-hand” (median nerve, cannot appose thumb). The thumb is held in the same plane as the palm similar to that of median nerve palsy (Simian hand), but the thumb cannot be adducted because of the nerve loss to the adductor pollicis (Ulnar nerve).Intrinsic muscle wasting occurs and includes the thenar and hypothenar
muscles
- There is hyperextension at the MCP joints, but little clawing of the IP joints because of the weak flexor muscles of the forearm
-There is a loss of opposition for the thumb.

Front 448

What nerve comprises Middle Brachial Plexus Segment Syndrome?

Back 448

C7 may be involved in both upper and lower segment injuries (uncommon).

Front 449

What actions are affected when myotome C7 is injured?

Back 449

Extension of the elbow
Extension of the wrist and digits

Front 450

What are some of the clinical presentations of injury to C7?

Back 450

C7 gives a similar scenario to radial nerve palsy.
- The brachioradialis, and its reflex, escapes but there is a loss of the triceps reflex
- There is loss of extension of the elbow and wrist drop occurs.

Front 451

What are some specific clinical presentations of injury to musculocutaneous nerve?:

Back 451

Flexion of the elbow joint and supination of the forearm are greatly weakened.

Front 452

The musculocutaneous nerve supplies and courses through?

Back 452

supplies all of the muscles of the anterior compartment of the arm. These muscles cause flexion of the elbow joint and
supination of the forearm.
Pathway:
- It passes through the coracobrachialis muscle
- It occurs between the biceps brachii and brachialis muscles

Front 453

The median nerve supplies what areas?

Back 453

The median nerve supplies most of the muscles of the anterior compartment of
the forearm, muscles of the thenar eminence, and radial-most two lumbricals (2,
3).

Front 454

The median nerve can be injured in several locations?

Back 454

The nerve may be injured at the elbow or wrist, and may suffer entrapment as it
passes through the carpal tunnel of the wrist

Front 455

What is the pathway of the median nerve?

Back 455

It passes between the two heads of pronator teres
- Its deep branch (anterior interosseous nerve) arises in the cubital fossa
- It occurs between the superficial and the deep flexors of the forearm
5
- It occurs superficial to the flexor tendons at the level of the wrist
- It passes through the carpal tunnel to enter the palm
- A short, stubby muscular branch is given off from the radial side (motor
recurrent branch).

Front 456

What is typical presentation when median nerve is injured at or above the elbow?

Back 456

The position of supination with an extended index is termed the “Benediction Attitude”. It is typical attitude for lesions of the median
nerve at or above the elbow.

Front 457

What is result of loss of thenar musculature?

Back 457

Loss of the thenar musculature results in the palmar surface of the
thumb being placed in the same plane as that of the palm. This is the socalled
“Simian hand” (Ape-hand). This is a deformity of the hand which
is marked by thumb movements being limited to flexion and extension of
the thumb in the plane of the palm because of the inability to oppose the
thumb. Note that adduction of digit I is possible

Front 458

What are 4 sites where ulnar lesions can occur?

Back 458

Lesions or compressions can occur at 4 sites (posterior to the medial epicondyle,
cubital tunnel, wrist, or hand)

Front 459

What is the cubital tunnel formed by?

Back 459

The cubital tunnel is formed by a tendinous arch connecting the humeral
and ulnar heads of the flexor carpi ulnaris

Front 460

What occurs in ulnar canal syndrome?

Back 460

In Ulnar canal Syndrome
(Guyon’s Canal Syndrome), compression of the ulnar nerve occurs at the
wrist where it passes between the pisiform and hook of the hamate. The depression between these bones is converted by the pisohamate ligament
into an osseofribrous tunnel (Ulnar tunnel). This condition may result in hypoesthesia in the medial one and one-half digits and weakness of the
intrinsic muscles of the hand.

Front 461

What does the ulnar nerve supply?

Back 461

Some musculature on the ulnar side of the forearm
- Most of the intrinsic muscles of the hand
- Its sensory supply is to the ulnar side of the hand
- The nerve is vulnerable at the elbow and to a lesser extent at the wrist.

Front 462

When the ulnar nerve is involved at or above the elbow region what are clinical implications?

Back 462

Flattening of ulnar forearm musculature.
Hyperextension of the MCP joints of digits IV-V.
Wasting of the hypothenar muscles and of the interosseoi
between the metacarpals.
Inability to hold piece of paper between the pulp of a straight thumb and curled index finger (form of key grip)
Key grip is weak because of loss of first dorsal interosseous and the adductor pollicis muscles.
Inability to flex distal joints of the ring and little fingers.
Flexion of the wrist produces radial deviation. When flexing the wrist joint, the hand is drawn to the lateral (radial) side by the flexor carpi radialis in the absence of the “balance” provided by the flexor carpi ulnaris.

Front 463

What is the ulnar nerve paradox?

Back 463

Clawing deformity of ring and little fingers. The higher the ulnar nerve lesion, the less obvious is the “clawing.” This has been called the ulnar nerve paradox.

Front 464

Can injury to the Radial Nerve affect the hand?

Back 464

It does not directly supply muscles of the hand but an injury to this nerve can affect the hand

Front 465

What does the radial nerve supply?

Back 465

The radial nerve supplies the muscles of the posterior compartments of the arm
and forearm. The only exception is brachioradialis which occurs in the anterior
compartment and is a flexor of the forearm.

Front 466

Where is radial nerve subject to injury?

Back 466

This nerve is subject to injury in the arm by compression or fractures of the humerus

Front 467

What can compression of radial nerve result in?

Back 467

Compression results in transient paralysis, which may occur as a result of
poor-fitting crutches creating pressure on the nerve in the axilla area or in the radial groove by the arm of a chair while the subject is asleep

Front 468

Can fractures of humerus damage the radial nerve?

Back 468

Fractures of the surgical neck or shaft of the humerus can damage this
nerve. There is considerable overlap of cutaneous nerves, and so testing may give equivocal results.

Front 469

What is one way to determine radial nerve damage related to humeral fracture?

Back 469

If the radial nerve is
injured, wrist extensors will be paralyzed, resulting in the characteristic
posture of wrist-drop.

Front 470

What is "wrist drop"?

Back 470

Loss of extension of the wrist, and the wrist is flexed and the fingers straight, the typical attitude of “wrist drop.” Wrist drop may be caused by
damage to the radial nerve along the shaft of the humerus. It may cause
the inability to extend the wrist resulting from paralysis of extensor
muscles of the forearm. The radial nerve has only a small area of
cutaneous supply on the hand, and so the extent of anesthesia is minimal,
even in serious radial nerve injuries.

Front 471

What occurs with injury to the deep branch of the radial nerve?

Back 471

Injury to the deep branch of the radial nerve results in inability to extend
the thumb and MP joints of other digits. The digits also remain flexed at the MCP joints. However, the IP joints (DIP/PIP) can be slightly extended
because of the action of the intact lumbricals and interosseoi (supplied by
the ulnar and median nerves).

Front 472

What causes "Saturday night Palsy" or radial neuropathy?

Back 472

Injury to the deep branch of the radial nerve results in inability to extend
the thumb and MP joints of other digits. The digits also remain flexed at
the MCP joints. However, the IP joints (DIP/PIP) can be slightly extended
because of the action of the intact lumbricals and interosseoi (supplied by
the ulnar and median nerves).

Front 473

Damage to the ulnar nerve prevents the thumb _______________________.

Back 473

from being abducted because of the nerve loss to the adductor pollicis muscle.

Front 474

Damage to the median nerve holds the thumb ______________

Back 474

in the same plane as the palm because the motor loss to the thenar muscles.

Front 475

What is area in the digital fibrous sheaths is sometimes known as?

Back 475

The area within the digital fibrous tendinous sheaths, particularly that in which the deep flexor tendon slides through the superficial flexor tendon, is sometimes referred to as the “surgical no-man’s land.” This is because scarring within the sheath can result in a loss of function, especially ability to flex and extend at the distal joint.

Front 476

What are the 6 ½ exceptions to what you might expect

Back 476

Flexor carpi ulnaris – ulnar nerve (not median)
Ulnar half of flexor digitorum profundus – ulnar nerve (not median)
3 Muscles of the thenar compartment( abductor pollicis brevis, flexor pollicis brevis, opponens pollicis) – median nerve (not ulnar)
Lumbricals 2 and 3 – median nerve (most of the time) (not ulnar)

Front 477

The anterior wrist and palm are a functional extension of what compartment?

Back 477

antebrachial flexor compartment.

Front 478

The posterior wrist and dorsum of the hand are a functional extension of what compartment?

Back 478

antebrachial extensor compartment

Front 479

Which tendons create the anatomical snuffbox?

Back 479

The tendons of mm. extensor pollicis longus and abductor pollicis longus create the “anatomical snuffbox” on the dorso-radial side of the wrist.

Front 480

What are the contents of the snuffbox?

Back 480

Contents of the snuffbox include the radial artery (sometimes a radial pulse can be taken here) and superficial branches of the radial nerve. The floor of the snuffbox is the scaphoid bone.

Front 481

Does extension of the fingers occur by the same mechanism as the flexors?

Back 481

NO

Front 482

What is the dorsal digital expansion or "extensor hood"

Back 482

Rather than having a split tendon, a single tendon of extensor digitorum, which may be joined by extensor digiti minimi or extensor indicis, spreads into an aponeurosis called the dorsal digital expansion or “extensor hood.”

Front 483

What other tendons contribute the the "extensor hood"?

Back 483

Tendons of the lumbrical and dorsal and palmar interosseous muscles also contribute to the aponeuroses, as does abductor digiti minimi on the little finger. The hood then has separate insertions in the middle and distal phalanges.

Front 484

Where does most FLEXION and EXTENSION occur in the hand?

Back 484

occur mostly at the metacarpal phalangeal joints and at the interphalangeal joints.

Front 485

Which muscles produce flexion in hand?

Back 485

Flexion is produced by the mm. flexor digitorum profundus and flexor digitorum superficialis

Front 486

Which muscles produce extension in the hand?

Back 486

Extension is produced by m. extensor digitorum, extensor indicis, extensor digiti minimi, the interosseus muscles, and the lumbrical muscles.

Front 487

Adduction is relative to axis drawn through middle of middle finger and is performed by

Back 487

adduction is produced by the palmar interossei

Front 488

Abduction is relative to axis drawn through middle of middle finger and is performed by

Back 488

Abduction is done by the dorsal interossei

Front 489

What is thumb relationship to hand and adduction/abduction?

Back 489

The thumb is oriented at almost 90 degrees from the plane of orientation of digits 2-5. Therefore, flexion/extension and abduction/adduction of the joints occur in a different direction. This means that when you spread your hand out, you are abducting your fingers but extending your thumb.

Front 490

What is DAB?

Back 490

Dorsal interossei abduct (DAB)

Front 491

What is PAD?

Back 491

Palmar interossei adduct (PAD)

Front 492

What are the interossei innervated by?

Back 492

The interossei are all innervated by the deep branch of the ulnar nerve

Front 493

How many dorsal interossei muscles are there and what do they do?

Back 493

The dorsal interosseous muscles abduct the fingers away from the center axis of the hand. They are bipinnate, and there are four of them: none on the thumb or little finger (which are moved instead by the thenar or hypothenar muscles); one on the radial side of the index finger, one on the ulnar side of digit 4, and one on each side of digit 3. They are numbered 1-4 in radial-to-ulnar order.

Front 494

How many Palmar interossei are there?

Back 494

Palmar interossei adduct the fingers toward the median axis of the hand. Thus, none are attached to the middle finger. There are three palmar interossei, numbered 1-3 in radial to medial order, attaching to digits 2, 4, and 5.

Front 495

Where do lumbrical muscles originate?

Back 495

The four lumbrical muscles originate on the tendon of flexor digitorum profundus that goes to each finger, and they insert on and contribute to the extensor hood distal to the MP joint.

Front 496

What is action of the lumbricals?

Back 496

As a result, they flex the MP and simultaneously extend the proximal and distal interphalangeal joints (PIP and DIP). This movement is key to pinching with or appressing the pads of the fingers with the pad of the thumb, as in writing or in picking a playing card up from the surface of a table.

Front 497

What is innervation of the lumbricals?

Back 497

The lumbricals are innervated primarily through the ventral ramus of spinal nerve T1, with some contribution from C8. Generally the lateral (radial) two (1 and 2) are innervated by the median nerve and the median (ulnar) two (3 and 4) are innervated by the ulnar nerve. However, it is common for the 2nd lumbrical to be innervated by branches from both the median and ulnar nerves, and in some people all four are innervated by the ulnar nerve.

Front 498

What muscles make up the thenar muscle compartment?

Back 498

The thenar muscles are opponens pollicis, flexor pollicis brevis, abductor pollicis brevis, and adductor pollicis(not directly in thenar compartment).

Front 499

What are muscles in thenar compartment innervated by?

Back 499

Muscles of the thenar compartment are all innervated by the recurrent branch of the median nerve.

Front 500

What are the hypothenar muscles?

Back 500

Hypothenar muscles are m. abductor digiti minimi, m. flexor digiti minimi brevis, and m. opponens digiti minimi.

Front 501

Branches of the ulnar nerve include--Palmar cutaneous –innervates what

Back 501

to skin on the medial palm

Front 502

Branches of the ulnar nerve include--Superficial branch ---innervates what?

Back 502

– m. Palmaris brevis

Front 503

Branches of the ulnar nerve include--Deep branch –innervates what?

Back 503

hypothenar mm, lumbricals 4 & 5, all interossei, and deep head of flexor pollicis brevis

Front 504

Branches of the ulnar nerve include--Common palmar digital nerve –innervates what?

Back 504

to proper palmar digital nerves
Proper palmar digital nerves – palmar surface of digit 5 and half of digit 4; dorsal surface of distal segments of digits 4 and 5.

Front 505

What is the course of the dorsal branch of the ulnar nerve?

Back 505

The ulnar nerve also has a dorsal branch which branches in the forearm and passes deep to flexor carpi ulnaris, then divides into 2 or 3 dorsal digital nerves on the dorsum of the hand. These nerves supply only the proximal parts of the backs of digits 4 and 5; the distal parts are supplied by proper palmar digital branches of the ulnar nerve.

Front 506

Surface landmarks in thoracic:Anterior median (midsternal) line

Back 506

indicates the intersection of the median plane with
the anterior chest wall

Front 507

Surface landmarks in thoracic:Midclavicular line

Back 507

passes through the midpoints of each clavicle and mid-inguinal

Front 508

Surface landmarks in thoracic: Anterior axillary line:

Back 508

formed by the border of the pectoralis major spanning from the thorax to the humerus

Front 509

Surface landmarks in thoracic:Midaxillary line:

Back 509

parallels the anterior axilla line

Front 510

Surface landmarks in thoracic:Posterior axilla line

Back 510

formed by the latissimus dorsi and teres major spanning from the
back to the humerus

Front 511

Surface landmarks in thoracic:Sternal angle

Back 511

indicates the level of the second pair of costal cartilages

Front 512

The sternal angle has important clinical implications because of ________ and __________.

Back 512

the ascending part of the aorta of right and the descending part of aorta on the left

Front 513

What fascia contains fat, blood and lymphatic vessels,cutaneous nerves, sweat glands, and mammary glands.

Back 513

Superficial fascia

Front 514

What is an investing fascia that forms a thin fibrous membrane and a dense, loose attachment with the superficial layer; forms an epimysium (a CT envelope of deep fascia that invests with underlying muscles); attaches to the periosteum; invests with muscles and tendons to bone junction; and is named for the muscle that it invests

Back 514

Deep fascia

Front 515

What is investing fascia that forms a thin fibrous membrane and a dense, loose attachment with the superficial layer; forms an epimysium (a CT envelope of deep fascia
that invests with underlying muscles); attaches to the periosteum; invests with muscles and tendons to bone junction; and is named for the muscle that it invests (e.g., pectoralis fascia = see notes on shoulder).

Back 515

deep fascia

Front 516

What is location of mammary glands?

Back 516

The glands extend from the 2nd to 6th rib and possesses several key structures.

Front 517

What does nonlactating breast consist of?

Back 517

Note a nonlactating breast consists of fat compartmentalized in connective and
glandular tissue septa.

Front 518

What kind of glands are mammary glands?

Back 518

modified sweat glands

Front 519

Key structures of the mammary gland:Lactiferous ducts

Back 519

15-20 run dorsally in the long axis of the nipple spread radially and drain the glandular tissue

Front 520

Key structures of the mammary gland: Suspensory ligaments:

Back 520

extend from the pectoral fascia to skin

Front 521

Key structures of the mammary gland: Glandular tissue:

Back 521

lies within a dense areolar stroma from which supsensory
ligaments extend to the deeper layers of skin

Front 522

Key structures of the mammary gland:
Retromammary bursa

Back 522

potential space, area between pectoral fascia and deep
surface of the gland, which permits it to move on the deep
fascia

Front 523

Key structures of the mammary gland: Axillary tail

Back 523

projects to the axilla

Front 524

What is the Thoracic Cage formed by?

Back 524

formed by bones and cartilage, protects viscera of the thorax and limited
abdominal organs, and is composed of ribs (separated by spaces), sternal bones, costal cartilages,
and vertebrae

Front 525

What are the three classifications of ribs?

Back 525

vertbrocostal ribs(true ribs), vertebrochondral ribs(flse ribs), and vertebral free(floating ribs)

Front 526

Ribs 1-7 attach directly to the sternum by costal cartilages, and thus considered _____________.

Back 526

Vertebrocostal ribs or true ribs

Front 527

Ribs 8-10 have indirect
attachments to the sternum, and so are considered FALSE ribs

Back 527

Vertebrochondral ribs or false ribs

Front 528

Ribs 11-12 do not attach to the sternum directly or indirectly. These ribs end in the posterior abdominal musculature, and therefore are referred to as floating.

Back 528

Vertebral free or floating ribs

Front 529

What are some of the typical ribs (ribs 3-9) characteristics?

Back 529

a single head with two facets: one facet articulates with the same thoracic vertebra, while the other facet articulates with the vertebra superior to it
- a single neck occurs at the level of the tubercle and attaches the head of
the rib with the body of the vertebra
- tubercles occur at the junction of the neck and the body
- smooth parts articulate with corresponding transverse processes
- rough parts attach to the costotransverse ligament
- a shaft (body) is thin, flat, and curved
- a costal angle is where the rib turns anterolaterally
- a concave surface occurs on the internal side with a costal groove which protects costal nerves and vessels

Front 530

What are the Atypical ribs?

Back 530

ribs 1-2, 10-12

Front 531

What is unique about ribs one and two?

Back 531

tubercles occur on ribs 1-2 and are attachment sites for the scalene muscles (other ribs do not possess such bumps)

Front 532

Which rib is the broadest, shortest, and has a single facet?

Back 532

the first rib

Front 533

Which rib has two facets and a single tubercle for muscle
attachments?

Back 533

the second rib

Front 534

Which ribs each have a single facet on each rib head?

Back 534

the tenth and twelfth ribs

Front 535

What is unique about the eleventh and twelfth ribs?

Back 535

are short, lack necks or tubercles, and costal
cartilages prolong these ribs anteriorly which contributes to the elasticity of the thoracic wall

Front 536

Which rib has a scalene tubercle that separates the subclavian vein and artery and is also a
place to compress either vessel)

Back 536

first rib

Front 537

What are the three major elements that compose the flat sternum?

Back 537

manubrium, body, and xiphoid process

Front 538

At what level does the manubrium occur?

Back 538

A manubrium occurs at the level of the vertebral bodies of T3-T4. It is the widest and thickest unit of the sternum with a concave superior border
that is easily palpated (jugular notch).

Front 539

The manubrium and body of
the sternum lie in different planes. What does their junction form?

Back 539

Sternal angle (of Louis). This is a palpable clinical landmark, and is located opposite the 2nd pair of costal cartilages and the level of the IV disc between T4-T5.

Front 540

At what level does rib counting usually begin in a physical examination?

Back 540

The first rib is not easily palpated, so rib counting in
a physical examination usually begins with the 2nd rib (adjacent the sternal
angle).

Front 541

What level is the body of sternum located at?

Back 541

It is located at the level of T5-T9.

Front 542

The xiphoid process is the smallest element of the sternum
and is located at level______.

Back 542

T10

Front 543

Which process is an important process clinically?

Back 543

The xiphoid process is an
important landmark in the median plane because of its junction with the body of the sternum at the xiphisternal joint, which indicates the inferior
limit of the central portion of the thoracic cavity projected onto the
anterior body wall. The xiphisternal joint is the site of the infrasternal
angle (subcostal) of the inferior thoracic aperture. It is a midline marker
for the upper limit of the liver, the central tendon of the diaphragm, and
the inferior border of the heart.
- The distal part of a transverse process of both cervical and lumbar

Front 544

What occurs during inspiration in the thoracic wall?

Back 544

movements of the thoracic wall and
diaphragm increase the intrathoracic volume and diameters of the thorax. Thus, pressure changes result in air being drawn into the lungs (inspiration) via the nose, mouth, larynx, and
trachea

Front 545

What occurs during expiration in the thoracic wall?

Back 545

-intrathoracic volume decreases
-diameter of thorax decreases
-pressure changes and air is expelled
-intercostal muscles relax
-elastic tissue of lungs recoils
-intraabdominal pressure decreases

Front 546

Chest pain can result form number of different sources?

Back 546

Chest pain (thoracic) varies from very serious to negligible and can result from pulmonary
disease (most important symptom of cardiac disease for men). It can result from intestinal, gall
bladder, or musculoskeletal disorders. Patients who experience a heart attack usually describe a crushing substernal pain that does not go away with rest.

Front 547

What thoracic branches are generally correlated with cardiac referred pain?

Back 547

T1-T5, especially on the left side

Front 548

Is the first rib normally involved in fractures?

Back 548

No, rib fractures rarely involve the first rib because it is protected. When it is broken however injuries to
the brachial plexus and subclavian vessels may result. The first rib is clinically important because of the numerous structures which have a relationship to it (e.g., cross or attach).

Front 549

Which ribs are most commonly fractured?

Back 549

The middle ribs usually by crushing blows or injuries

Front 550

Where is the weakest point of the rib?

Back 550

anterior to the angle

Front 551

What is a major concern of a fractured rib?

Back 551

is that it may pierce an internal organ or burst a vessel.

Front 552

Broken ribs are painful for several reasons?

Back 552

They
are painful because of the broken parts that move during breathing, laughing, coughing, or sneezing. Pain can also result form metastisis of cancer

Front 553

What is an anterior thoracotomy?

Back 553

The surgical creation of an anterior opening into the thoracic wall is termed an anterior thoracotomy. The procedure utilizes H-shaped cuts through the perichondrium of the cartilages which remove segments of costal cartilage to gain entrance to the
thoracic cavity

Front 554

What are Supernumerary Ribs?

Back 554

Extra ribs may result from the retention and development of costal processes of cervical and lumbar vertebrae (cervical: 0.05-1.0%, articulate with C7, not attach to
sternum; lumbar is less common than cervical

Front 555

Are Bony xiphoid processes ever confused for anything else?

Back 555

Bony xiphoid processes are often confused for a tumor or stomach cancer in people over 40 years of age because this process hardens and becomes more prominent on palpation for this age group.

Front 556

Are sternal fractures common?

Back 556

No, a fracture of the body of the sternum is usually a
comminuted fracture (sternum is broken into pieces). The most common site for a sternal fracture is the sternal angle.

Front 557

What is a Median Sternotomy?

Back 557

Allows access to the thoracic cavity for surgeons operating on the mediastinum (e.g., coronary artery bypass grafting). The sternum is divided in the median plane
and retracted. It is the flexibility of the ribs and costal cartilages that enables spreading of the
sternal halves.

Front 558

What are some of the clinical uses of the sternal body?

Back 558

Often used for bone marrow needle biopsies (Sternal biopsies) because of its breadth and subcutaneous position. The needle pierces the thin cortical bone and enters the vascular spongy bone (used for bone marrow transplantations and detection of metastatic cancer and blood dyscrasias = morbid condition or abnormalities; any abnormal material in blood or pathological condition of the blood).

Front 559

Where is a good place to introduce cardiac drugs?

Back 559

the sternal body

Front 560

What kind of sternal anomaly can arise form failure of bones to ossify?

Back 560

Sternal anomalies can occur because of an incomplete ossification such as when the sternal cleft remains unfused and the sternal halves (sternal bars) from each side fail to fuse forming a sternal foramen. This foramen is usually associated with the sternal body.

Front 561

Are there gender differences between male and female sternal bodies?

Back 561

There are also gender differences in the sternum that may include the body of the sternum being shorter and thinner in females

Front 562

What is included in the radial trio?

Back 562

radial artery,flexor carpi radialis,flexor pollicus longus

Front 563

What is included in the ulnar trio?

Back 563

flexor carpi ulnaris, ulnar artery and nerve

Front 564

What is included in the tendon quartet?

Back 564

flexor digitorum profundus, flexor digitorum superfiliacis

Front 565

What is included in the median duo?

Back 565

median nerve, palmaris longus

Front 566

Does the ulnar nerve pass under the flexor retinaculum in the wrist?

Back 566

NO

Front 567

The ulnar nerve does pass, with the ulnar artery, under the pisohamate ligament connecting the pisiform bone and the hook of the hamate bone. This is sometimes referred to as the ulnar canal. If it is compressed in this canal the most common symptom is weakness of the hand, particularly the first dorsal interosseus muscle, and numbness in the little finger. Dorsal ulnar cutaneous sensation will not be affected, as the dorsal ulnar cutaneous nerve branches proximal to the wrist. Causes of compression may be a cyst, a tumor, an abberant ulnar artery, fracture of the hamate, or occupational factors such as using a jackhammer.

Back 567

Ulnar Canal Syndrome

Front 568

What causes condtion that is commonly called “cyclist’s palsy” or “handlebar palsy.”

Back 568

Cyclists who rest most of their body weight on the handlebars with the wrist extended often compress the ulnar nerve as well, causing Cyclist’s palsy.It is not strictly the same thing as ulnar canal syndrome, as the ulnar nerve is not trapped in the canal between the pisiform and the hamate. It occurs because the cyclist leans her weight hard on the nerve when riding. Cyclist’s palsy was shown in one study to be more common in mountain bikers than in road bikers.

Front 569

Median nerve
Branches of the median nerve include-Palmar cutaneous

Back 569

to skin of central palm

Front 570

Median nerve
Branches of the median nerve include-Medial branch –

Back 570

2nd lumbrical, palmar and distal dorsal digits 2-4

Front 571

Median nerve
Branches of the median nerve include-Recurrent branch –

Back 571

abductor pollicis brevis, opponens pollicis, superficial head of flexor pollicis brevis

Front 572

Median nerve
Branches of the median nerve include-Lateral branch –

Back 572

1st lumbrical, palmar and distal dorsal skin of thumb, radial side index finger

Front 573

Does the median nerve have branches to lumbricals

Back 573

Yes

Front 574

Median nerve
Branches of the median nerve include-Common palmar digital nerves –

Back 574

to proper palmar digital nerves

Front 575

Median nerve
Branches of the median nerve include- palmar digital nerves –

Back 575

to digits, from medial and lateral branches via the common palmar digital nerves.

Front 576

What does the superficial branch of the radial nerve innervate in the hand?

Back 576

innervates the skin of the dorsum of the hand.

Front 577

Are dermatomes of the hand supplied by the same areas as the cutaneous branches?

Back 577

No, the dermatomes of the hand are not the same as the areas supplied by the cutaneous branches of named nerves. This is, of course, because named nerves are composed of parts of more than one ventral ramus.

Front 578

The radial and ulnar arteries form two anastomoses in the wrist. What are they?

Back 578

the palmar and dorsal carpal arteries

Front 579

The radial and ulnar arteries form two anastomoses in the hand. What are they?

Back 579

the superficial and deep palmar arches

Front 580

What is vascular supply of the superficial palmar arch?

Back 580

The superficial palmar arch is principally supplied by the ulnar artery, but also supplied by one of the branches of the radial artery (superficial palmar, princeps pollicis, or radialis indicis).

Front 581

What is vascular supply of the deep palmar arch?

Back 581

The deep palmar arch, separated from the superficial by the flexor tendons and running with the deep branch of the ulnar nerve, is often principally supplied by the radial artery, although the ulnar also contributes.

Front 582

What forms the dorsal carpal arch?

Back 582

The dorsum of the hand is supplied by branches of the dorsal carpal radial and ulnar arteries, which form the dorsal carpal arch.

Front 583

Where isa good place to check the radial pulse?

Back 583

The radial artery usually lies very superficially on the flexor surface of the wrist, just above the thenar eminence, and can be pressed against the distal radius there. This is often a good place to take a radial pulse. Sometimes a radial pulse can also be found in the anatomical snuffbox.

Front 584

The CENTRAL COMPARTMENT of the hand contains what?

Back 584

contains the palmar aponeurosis, the superficial palmar arch, palmar branch of the median nerve, the flexor tendons and their sheaths, the lumbrical muscles, and the superficial branch of the ulnar nerve. The deepest part of this compartment is a potential space called the MIDPALMAR SPACE, which runs proximally into the wrist.

Front 585

What does the THENAR COMPARTMENT contains what?

Back 585

the muscles abductor pollicis brevis, flexor pollicis brevis, and opponens pollicis, and the nerves and arteries supplying them. The THENAR SPACE is a potential space in the same plane as the midpalmar space.

Front 586

What does the The HYPOTHENAR COMPARTMENT contain?

Back 586

contains the muscles abductor digiti minimi, flexor digiti minimi, and opponens digiti minimi, and the nerves and arteries supplying them.

Front 587

Injuries resulting from a fall on the extended hand --fracture of scaphoid:

Back 587

most commonly fractured carpal. It may be tender in the anatomical snuffbox. The risk with this break is avascular necrosis of the proximal part, since blood supply is to the distal portion.

Front 588

Injuries resulting from a fall on the extended hand--dislocation of lunate:

Back 588

most commonly dislocated carpal, it is displaced in the palmar direction. This sometimes produces carpal tunnel syndrome symptoms.

Front 589

Injuries resulting from a fall on the extended hand--perilunate dislocation:

Back 589

in this case, the lunate stays in articulation with the forearm, but the distal carpals are dislocated posteriorly relative to it.

Front 590

Injuries resulting from punching immovable objects:
Boxer’s fracture

Back 590

head of the 5th metacarpal) – the most common injury from this activity

Front 591

Injuries resulting from punching immovable objects:
dorsal dislocation of 4th and 5th metacarpals w/ hamate fracture :

Back 591

less common, often (possibly even usually) missed on first presentation, but much easier to repair before the bone heals by itself.

Front 592

Puncture wounds in the palm can present with what symptoms?

Back 592

Puncture wounds in the palm can cause infection of the synovial sheaths. When inflammation of the tendon and synovial sheath occurs (tenosynovitis) the digit swells and movement becomes painful. Since the tendons of digits II-IV usually have separate synovial sheaths, the infection is usually confined to the infected digit. If, however, the infection is neglected, the proximal ends of these sheaths may rupture, allowing the spread of infection to the midpalmar space. From there infection may spread to the wrist and forearm.

Front 593

What is effect of puncture wound in the palmar arch?

Back 593

A puncture wound may also lacerate one of the palmar arches and cause bleeding. Because of the considerable anastomoses, compression of the brachial artery, before its split into ulnar and radial arteries, may be necessary.