Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/550

Click to flip

550 Cards in this Set

  • Front
  • Back
Located on the posterior aspect of the occipital bone of the skull?
External Occipital Protuberance
Midline of Neck and Back?
Vertebral Furrow
First vertebral spine palpable?
C7: Vertebral Prominens
Vertebral Furrow is deepest where?
Thoracic and lumbar regions
Vertebral Furrow ends where?
Sacrum
Bi-lateral from the superior part of the sacrum is the _____________.
Iliac Crest
The highest point of the iliac crest is at what vertebral level?
L4 (Used as a surface reference for lumbar punctures)
The lateral most aspect of the shoulder?
Acromion of the Scapula
The acromion articulates with the ______.
Lateral end of the clavicle
The acromion continues postero-medially as the ____________.
Spine of the Scapula
The spine of the scapula is at what vertebral level?
T3
The inferior angle of the scapula is at what vertebral level?
T7
What makes up the posterior axillary fold?
Lower border of the Latissimus Dorsi and Teres Major
Cutaneous Nerves to the skin of the back are branches of the _____________.
Dorsal rami of the spinal nerves
# of pairs of spinal nerves?
31 pairs
The superficial group of muscles is composed of?
5 Muscles: Trapezius Latissimus Dorsi Levator Scapulae Rhomboid Minor and Rhomboid Major
The superficial group functionally contributes to the ___________.
Upper Limb
What muscles of the back cover most of the surface?
Trapezius and Latissimus Dorsi
Origin: Trapezius
External Occipital Protuberance ligamentum nuchae and C7-T12
Insertion: Trapezius
Lateral end of clavicle acromion and scapular spine
What artery and nerve lie deep to the lateral portion of the Trapezius?
Transverse Cervical Artery (& Vein) and Subtrapezial Nerve Plexus
Subtrapezial Nerve Plexus is formed by ___.
Accessory Nerve (CN XI) and the 3rd and 4th cervical spinal nerves
Latissimus Dorsi is (superficial/deep) to Trapezius?
Deep
What are the borders of the Triangle of Ascultation?
Superior: Rhomboid Major. Medially: Trapezius. Laterally: Medial border of Scapula. Inferiorly: Latissimus Dorsi
Where does Latissimus Dorsi cross the Scapula?
At the inferior angle of the scapula
The Latissimus Dorsi muscle fibers interdigitate with those of _________.
External Abdominal Oblique and Serratus Anterior Muscles
What muscle does the lateral and superior border of the Latissimus Dorsi wrap around?
Teres Major
What do the Latissimus Dorsi and Teres Major form together?
Posterior Axillary Fold
Latissimus Dorsi: origin blood supply and insertion
Thoracodorsal Nerve (Posterior Cord of Brachial Plexus) Thoracodorsal Artery (Branch of Subscapular Artery III) Intertubercular Groove of humerus
Insertion: Serratus Anterior
Ventral surface of the medial border of the Scapula
Action: Serratus Anterior
Holds scapula against posterior chest wall and rotates the scapula superiorly
Innervation: Serratus Anterior
Long Thoracic Nerve (C5 C6 C7)
Clinical: Paralysis of Long Thoracic Nerve
Winged Scapula
Consists of what muscles?
Posterior Superior Serratus. Posterior Inferior Serratus
Innervation?
Intercostal Nerves
Function of Middle Group of Back Muscles
Respiration
Function of the Deep Group of Muscles?
Direct movement of the vertebral column and skull
Innervation for Deep Group?
Dorsal rami of the spinal nerves
Innervation for the superficial and middle groups?
Ventral rami of the spinal nerves
Three parts of Erector Spinae Muscle (Medial to Lateral)
Spinalis Longissimus and Iliocostalis
Action: Erector Spinae Muscle
Extension and lateral flexion of vertebral column
What makes up the intervertebral disc?
Anulus Fibrosus and Nucleus Pulposus
# of Vertebrae: Cervical thoracic lumbar sacral coccyx
7 Cervical 12 thoracic 5 lumbar 5 sacral and 4 coccyx
Know body vertebral foramen vertebral canal pedicle laminae transverse process articular process and spinous process
What connects the inner surface of the laminae of adjacent vertebrae?
Ligamenta Flava
What is located in the epidural space?
Internal Vertebral Venous Plexus and Epidural fat
What is significant about the Internal Vertebral Venous Plexus concerning the spread of cancer?
Contains no valves. Pathway for the spread of cancer from abdomen to the brain
What are the 3 meningeal layers covering the spinal cord?
Dura Mater Arachnoid Membrane and Pia Mater
The Dura Mater extends from where to where?
The base of the skull to S2
What does the Dura Mater form at S2?
Filum Terminale Externum (Coccygeal Ligament)
What cannot be separated from the spinal cord?
Pia Mater
What joins to form a spinal nerve?
Dorsal and Ventral Roots of the Spinal Cord
What occurs on the dorsal root at approximately the vertebral foreman?
Dorsal Root Ganglion
What is a lateral extension of the Pia Mater?
Denticulate Ligaments
Denticulate ligaments extend between what?
Ventral and Dorsal Roots of the spinal cord
What is the function of the Denticulate Ligaments?
It anchors the Dura Mater between the exits of the ventral and dorsal roots from the dural sac to help stabilize the spinal cord
How far inferior does the spinal cord extend?
L2 (or L1)
Where does the spinal cord enlarge? Why?
Cervical and Lumbar Enlargements (many nerves that supply the upper and lower limbs)
What is the structure called where the spinal cord tapers off at L2?
Conus Medullaris
What extends from the inferior tip of the conus medullaris? What is it an extension of?
Filum Terminale Internum (Pia Mater)
What surrounds the filum terminale internum?
Cauda Equina
What is the cauda equina?
Massive collection of ventral and dorsal roots of the spinal nerves and filum terminale within the inferior part of the dural sac
What lines the posterior (anterior) surface of the vertebral bodies? Function?
Posterior (Anterior) Longitudinal Ligament (Prevents hyperflexion (hyperextension) of the vertebral column)
Muscles of the Scapular Region?
Deltoid Supraspinatus Infraspinatus Teres Minor Teres Major and Subscapularis
What nerves enter the skin at the posterior border of the Deltoid?
Branches of the superior lateral brachial Cutaneous nerve
What are the borders of the Quadrangular Space?
Superiorly: Teres Minor. Medially: Long Head of the Triceps. Laterally: Shaft of Humerus. Inferiorly: Teres Major
What is located in the Quadrangular Space?
Axillary Nerve and Posterior Circumflex Humeral Artery
What are the borders of the Triangular Space?
Superiorly: Teres Minor Laterally: Long Head of the Triceps Inferiorly: Teres Major
What is located in the Triangular Space?
Circumflex Scapular Artery
Insertion: Supraspinatus
Sup. Facet of Greater Tubercle of Humerus
What crosses the suprascapular notch?
Superior Transverse Scapular Ligament
What courses superiorly to the above-mentioned ligament?
Suprascapular Artery. (A-Army over the Bridge)
What courses inferiorly to the above-mentioned ligament?
Suprascapular Nerve (Superior Truck of Brachial Plexus) C5 and C6. N-Navy under the bridge
Suprascapular Nerve innervates?
Supraspinatus and Infraspinatus Muscles
What makes up the Rotator Cuff?
4 Muscles: Supraspinatus Infraspinatus Teres Minor Subscapularis
What is the lymphatic drainage of the mammary glands?
The entire mammary gland is superficial to what?
The deep fascia of the Pectoralis Major Muscle
What veins are located at the lateral and medial aspects of the arm respectively?
Cephalic and Basilic Veins
Where do the Cephalic and Basilic Veins originate?
Lateral and medial sides of the dorsal venous arch respectively on the posterior of the hand
Describe the path and termination of the Cephalic Vein.
Anterior surface of the forearm and arm Ascends between the Deltoid and Pec. Major In the Deltopectoral Triangle. Inferior to clavicle the Cephalic vein penetrates the costocoracoid membrane. Terminates in the Axillary Vein in the axilla
What forms the axillary vein?
2 brachial veins and the Basilic Vein
What connects the Basilic and Cephalic Veins? Significance?
Median Cubittal Vein (Phlebotomy)
What forms the anterior axillary fold?
Pectoralis Major
Where does Pec. Major insert?
Crest of Greater Tubercle
What passes through the costocoracoid membrane of the clavipectoral fascia?
Cephalic Vein Lateral Pectoral Nerve and Thoracoacromial Artery Trunk
These 3 structures pass through the costocoracoid membrane in what relation to Pec. Minor?
Medial to Pectoralis Minor
What is the origin of the Thoracoacromial Artery Trunk?
A branch of the 2nd part of the Axillary Artery
What does the clavicular branch supply?
Subclavius M. and the sternoclavicular Joint
What encloses pectoralis minor?
Clavipectoral fascia
Where is the clavipectoral fascia located?
Between the clavicle to the axillary fascia
What is the costocoracoid membrane?
The clavipectoral fascia between the clavicle and pectoralis minor
What is the Suspensory Ligament of the Axilla?
The clavipectoral fascia located inferior to Pec. Minor and extending to the axillary fascia
Where does Pectoralis Minor insert?
Coracoid Process of the Scapula
What pierces Pectoralis Minor?
Medial Pectoral Nerve
Why is Pectoralis Minor an important landmark?
Its position divides the Axillary Artery into 3 parts
Boundaries of the Axilla
Triangle Shape
Anterior
Pectoralis Major Pectoralis Minor Clavipectoral Fascia
Medial
Serratus Anterior Upper Ribs
Posterior
Subscapularis Latissimus Dorsi Teres Major
Lateral
Intertubercular Groove
Base
Axillary Fascia
Apex
Clavicle Scapula First Rib
Axillary Vein Borders (Becomes)
Lateral border of Teres Major Lateral border of first rib (Subclavian Vein)
What is the main source of blood to the shoulder and upper limb?
Axillary Artery
Borders?
Lateral border of first rib Inferior border of Teres Major
What divides the Axillary Artery into 3 parts?
Pectoralis Minor
Name the location of the divisions?
1st Part: Medial to Pectoralis Minor 2nd Part: Deep to Pectoralis Minor and 3rd Part: Lateral to Pectoralis Minor
What branches from the 1st part of the Axillary Artery? Supplies?
Superior Thoracic Artery 1st and 2nd Intercostal Space
What branches from the 2nd part of the Axillary Artery?
Thoracoacromial Artery Trunk Lateral Thoracic Artery
What is the path of the Lateral Thoracic Artery?
Courses on the surface of Serratus Anterior to supply structures of the chest wall
What courses with the Lateral Thoracic Artery?
Long Thoracic Nerve (Serratus Anterior: Winged Scapula)
What branches from the 3rd part of the Axillary Artery?
Subscapular Artery Posterior Circumflex Humeral Artery and Anterior Circumflex Humeral Artery
What branches from the Subscapular Artery?
Circumflex Scapular Artery and Thoracodorsal Artery
What provides collateral circulation with the Circumflex Scapular Artery?
Suprascapular Artery (Subclavian Artery) and Dorsal Scapular Artery (Subclavian Artery)
What does the Circumflex Scapular Artery pass through? Does it course with any other structure?
Triangular Space. No
What is the main blood supply to Latissimus Dorsi?
Thoracodorsal Artery
What courses with the Thoracodorsal Artery?
Thoracodorsal Nerve (Posterior Cord on BP)
What does the Posterior Circumflex Humeral Artery pass through? Does it course with any other structure?
Quadrangular Space Axillary Nerve (C5 and C6)
What part of the Humerus does the Anterior and Posterior Circumflex Humeral Arteries surround?
Surgical Neck of the Humerus
Which Humeral Circumflex Artery is larger?
Posterior Humeral Circumflex
What does the Axillary artery become at the lateral border of Teres Major?
Brachial Artery
The 5 parts of the Brachial Plexus?
Roots Trunks Divisions Cords Branches
The roots of the Brachial Plexus are made up of ____________.
Ventral Rami of C5 – T1
What part of the Brachial Plexus is superior to the clavicle?
Ventral Rami Roots and the 3 Trunks
What part of the Brachial Plexus is deep to the clavicle?
The 3 anterior and 3 posterior Divisions
What parts of the Brachial Plexus is inferior to the clavicle?
3 Cords and the Terminal Branches
What is the significance of anterior and posterior Divisions of the Brachial Plexus?
They represent the separation of nerve fibers that innervate the ventral and dorsal muscle masses of the limb
What are the Cords of the Brachial Plexus?
Lateral Posterior Anterior
What are the Cord names in reference to?
Their relationship to the 2nd part of the Axillary Artery (Deep to Pec. Minor)
What forms the posterior cord?
The junction of 3 posterior Divisions. Derived from each of the 3 Trunks
The posterior cord contributes to the innervation of what?
The dorsal (extensor) surface of the limb and shoulder
What forms the lateral cord?
Anterior Divisions of the Superior and Middle Trunks
What forms the medial cord?
The anterior Division of the inferior trunk
What do the lateral and medial cords innervate?
Muscles on the ventral (flexor) surface of the limb and anterior chest wall
The cords of the Brachial Plexus should be found deep to what muscle?
Pectoralis Minor (2nd part of the Axillary Artery)
What nerve branches off the lateral cord?
Lateral Pectoral Nerve
What is the path of the Lateral Pectoral Nerve?
Passes Medial to Pectoralis Minor Through Costocoracoid Membrane and Innervates Pectoralis Major
What nerves branch off the medial cord?
Medial Pectoral Nerve Medial Antebrachial Cutaneous Nerve and Medial Brachial Cutaneous Nerve
What is the path of the medial pectoral nerve?
Passes between the Axillary Artery and Axillary Vein Penetrates (Innervates) Pectoralis Minor and Innervates Pectoralis Major
What courses with the Basilic Vein?
Medial Antebrachial Cutaneous Nerve
To what nerves does the medial cord contribute?
Median and Ulnar Nerve
What contributes to the formation of the Median Nerve?
Lateral Cord and Medial Cord (C5 C6 C7 C8 T1)
Initially where is the Median Nerve located?
On the anterolateral side of the Axillary Artery
What contributes to the formation of the Musculocutaneous Nerve?
Lateral Cord
What does the Musculocutaneous Nerve innervate?
Ventral side of the arm and lateral skin of the forearm?
What is the path of the Musculocutaneous Nerve as it enters the arm?
It penetrates the Coracobrachialis Muscle
What is the path of the Musculocutaneous Nerve as it enters the arm?
It penetrates the Coracobrachialis Muscle
What nerves branch off from the posterior cord?
Upper Subscapular Nerve Thoracodorsal Nerve and Lower Subscapular Nerve
What innervates Subscapularis Muscle?
Upper and Lower Subcapular Nerves
What innervates Teres Major?
Lower Subscapular Nerve
What courses with the Thoracodorsal Nerve?
Thoracodorsal Artery (3rd part of the Axillary Artery)
What forms the Axillary Nerve?
Posterior cord splits to form the Axillary Nerve(C5 C6) and the Radial Nerve(C5 C6 C7 C8 T1)
What is the path of the Axillary Nerve? (Relate to Subscapularis)
Passes inferior to Subscapularis Through Quadrangular Space
What does the Axillary Nerve innervate?
Teres Minor and Deltoid
What passes through the Quadrangular Space?
Axillary Nerve Posterior Circumflex Humeral Artery
What cutaneous nerves does the Axillary Nerve provide?
Posterior Shoulder
What form the Radial Nerve?
The split of the posterior cord into Radial Nerve and Axillary Nerve
What in general does the Radial Nerve innervate?
The dorsal muscle mass and skin of the arm and forearm
Note the characteristic M configuration on the ventral surface of the Axillary Artery
Where is the Musculocutaneous nerve in relation to the Axillary Artery?
Lateral
What nerves are medial to the Axillary Artery?
Ulnar Nerve Medial Brachial Cutaneous Nerve and Medial Antebrachial Cutaneous Nerve
What is the initial path of the Radial Nerve?
Posterior to the Axillary Artery and Enters the Radial Groove of the Humerus
What does these 5 groups receive?
Afferent lymphatic vessels from the upper limb shoulder and mammary gland
What group is mainly responsible for draining lymph from the mammary gland?
Pectoral Group
Collectively these 5 groups form what?
Subclavian Lymphatic Trunk
Where does the Subclavian Lymphatic Trunk drain?
Right: Junction of the Right Subclavian and Internal Jugular veins. Left: Left Brachiocephalic vein
What boundary is the Serratus Anterior in the axilla?
Medial Wall of the Axilla
What is the origin of the Serratus Anterior Muscle?
Upper eight or nine ribs
Where does the Serratus Anterior insert?
The costal surface of the entire medial border of the Scapula
What innervates Serratus Anterior?
Long Thoracic Nerve and (Long –N- Nerve)
Function of Serratus Anterior?
Holds scapula against thoracic wall Protracts the scapula and Rotates glenoid cavity of scapula superiorly
What occurs if the Serratus Anterior or Long Thoracic Nerve is damaged?
Winged Scapula (Scapula projects dorsally away for chest wall)
What forms the posterior wall of the axilla?
Subscapularis (Largest) Latissimus Dorsi and Teres Major
What innervates Subscapularis?
Upper Subscapular Nerve and Lower Subscapular Nerve
What stabilizes the Humerus in the glenoid cavity?
Rotator Cuff and Tendon of Long Head of Triceps
What makes up the Rotator Cuff?
Supraspinatus SitS: Infraspinatus Teres Minor Teres Minor and Subscapularis
What compartments of the arm exist?
Anterior Flexor Compartment and Posterior Extensor Compartment
What separates these compartments?
Intermuscular Septa
What supports and maintains the structure of the arm?
Brachial Fascia
What does the Brachial Fascia form on the lateral and medial aspects of the arm?
Lateral and Medial Intermuscular Septa
What muscles are located in the Anterior Flexor Compartment of the arm?
Biceps Brachii Coracobrachialis and Brachialis
Where does the Biceps Brachii originate?
Short Head: Coracoid Process Long Head: Supraglenoid Tubercle
Where does the Biceps Brachii insert?
Tuberosity of the Radius
What is the Bicipital Aponeurosis?
Superficial medially directed aponeurotic extension from the medial side of the Biceps Brachii Tendon
What is the function of the Bicipital Aponeurosis?
Protective covering for the Median Nerve and Brachial Artery in the Cubital Fossa
Where is the Brachialis Muscle located?
Deep to the inferior half of the Biceps Brachii
Where does the Brachialis Muscle originate?
Ventral surface of the inferior Humerus
Where does the Brachialis Muscle insert?
Tuberosity of the Ulna
What is the location of the Coracobrachialis? (In Relation to the Biceps Brachii)
Medial and parallel to the short head of the Biceps Brachii
What is the origin and insertion of the Coracobrachialis?
Origin: Coracoid Process Insertion: Medial aspect of the middle of the Humerus
What innervates the muscles of the anterior compartment?
Musculocutaneous Nerve
What is the course of the Musculocutaneous Nerve through the arm?
Pierces the Coracobrachialis Muscle Into the muscular plane between the Brachialis Muscle and the Biceps Brachii
Where does the Musculocutaneous nerve emerge from the arm?
Laterally from between the Brachialis Muscle and the Biceps Brachii
After emerging in the inferior part of the arm what does the Musculocutaneous Nerve become?
Lateral Antebrachial Cutaneous Nerve
What does the previous nerve supply?
Cutaneous innervation to the skin of the lateral forearm (GSE GVE GVA)
What supplies cutaneous innervation to the medial aspect of the forearm?
Medial Antebrachial Cutaneous Nerve (Medial Cord of Brachial Plexus)
Where is the origin of the Brachial Artery?
Originates from the inferior border of Teres Major as a continuation of the Axillary Artery
Where does the Brachial Artery course?
Anterior Compartment of the arm Within the Neurovascular compartment
What forms the Neurovascular compartment of the arm?
Splitting of the medial intermuscular septum
Initially what is the position of the Median Nerve and Ulnar Nerve in relation to the Brachial Artery?
Median Nerve: Lateral to Brachial Artery Ulnar Nerve: Medial to Brachial Artery
During their course through the arm what is the relationship between the Median Nerve and Brachial Artery?
The Median Nerve passes from the lateral side of the Brachial Artery ventrally across to the medial side of the Brachial Artery
What accompanies the Brachial Artery?
2 Brachial Veins (Not nerves) (Venae Comitantes)
Where do these veins terminate?
Basilic Vein
What are the main branches of the Brachial Artery (superior to inferior)?
Deep Brachial Artery Superior Ulnar Collateral Artery and Inferior Ulnar Collateral Artery
The Deep Brachial Artery arises just inferior to what muscle?
Teres Major Muscle
What is the course of the Deep Brachial Artery?
Medial to the Humerus it enters the posterior compartment of the arm in the Radial Groove of the Humerus
What enters the Radial Groove with the Deep Brachial Artery?
Radial Nerve
What arises from the Brachial Artery just inferior to the Deep Brachial Artery?
Superior Ulnar Collateral Artery
What courses with the Superior Ulnar Collateral Artery?
Ulnar Nerve
What is the path of the Superior Ulnar Collateral Artery and Ulnar Nerve?
Penetrates the intermuscular septum to enter the posterior compartment of the arm. Descending the arm both pass posterior to the medial epicondyle of the Humerus
Where does the Inferior Ulnar Collateral Artery originate?
From the Brachial Artery just superior to the medial epicondyle
What is the path of the Inferior Ulnar Collateral Artery?
It passes anterior to the medial epicondyle of the Humerus
What is significant about the Deep Brachial Artery Superior Ulnar Collateral Artery and the Inferior Ulnar Collateral Artery?
Collateral Circulation for the Brachial Artery around the elbow
Intersecting artery in collateral circulation?
Radial Recurrent Artery Recurrent Interosseous Artery and Posterior Ulnar Recurrent Artery
Do the Median Nerve and Ulnar Nerve provide innervation within the arm?
No
What is the origin of the Triceps Brachii?
Long Head: Infraglenoid Tubercle and Lateral Head: Humerus superior and lateral to Radial Groove and Medial Head: Humerus inferior and medial to Radial Groove
What is located deep to the Lateral Head of the Triceps Brachii?
Radial Groove Radial Nerve and Deep Brachial Artery
What nerve innervates Triceps Brachii?
Radial Nerve
What regions does the Radial nerve provide cutaneous innervation to the skin?
Posterior Brachial Cutaneous Branches and Posterior Antebrachial Cutaneous Branches
In the lower 3rd of the arm what is the path of the Radial Nerve?
Pierces lateral intermuscular septum just superior to lateral epicondyle Passes anterior to lateral epicondyle
When the Radial Nerve moves across the lateral epicondyle what is its relationship to neighboring muscles?
As it passes anterior to the lateral epicondyle the Radial Nerve is between the Brachialis Muscle and the Brachioradialis Muscle
What muscles do the Radial Nerve innervate at the lateral epicondyle?
Brachioradialis Muscle and Extensor Carpi Radialis Longus Muscle
What forms an arterial branch that contributes to collateral circulation between the axillary and brachial arteries?
Deep Brachial Artery and Has ascending branch that anastomoses with the Anterior and Posterior Circumflex Humeral vessels
What courses with the Radial Nerve anterior to the lateral epicondyle?
Radial Recurrent Artery
What is the Cubital Fossa?
The triangular region on the ventral side of the elbow that contains most of the vessels and nerves that pass between the arm and the forearm
Is the Ulnar Nerve in the Cubital Fossa?
No
What significant vein is superficial to the Cubital Fossa?
Median Cubital Vein (Phlebotomy)
Boundaries of the Cubital Fossa
Roof (Anterior): Bicipital Aponeurosis. Floor (Posterior): Brachialis Muscle and Supinator Muscle. Lateral: Brachioradialis Muscle. Medial: Pronator Teres
What nerve is deep to the lateral boundary of the Cubital Fossa?
Radial Nerve
What does the Radial Nerve divide into?
Superficial Radial Nerve and Deep Radial Nerve
What is the path of the Superficial Radial Nerve?
Passes superficial to the Supinator Muscle Deep to the Brachioradialis Muscle
What is the initial path of the Deep Radial Nerve?
Penetrates the Supinator Muscle
Lateral to Medial what structures are found in the Cubital Fossa?
TAN
At the apex of the Cubital Fossa what does the Brachial Artery divide into?
Radial Artery Ulnar Artery
Where does the Biceps Brachii insert?
Tuberosity of the Radius
Where does the Brachialis Muscle insert?
Tuberosity of the Ulna
What connects the Ulna and Radius of the forearm?
Interosseous Membrane
What is the Extensor Retinaculum?
A transverse thickening of the deep (Antebrachial) fascia on the dorsum of the wrist
What is found on the dorsum of the hand that forms the Cephalic and Basilic Veins?
Dorsal Venous Plexus. Medial side: Basilic Vein. Lateral side: Cephalic Vein
What supplies cutaneous nerves to the dorsum of the hand?
Medial: Ulnar Nerve. Lateral: Superficial Radial Nerve
What are the superficial muscles of the extensor compartment of the forearm?
Brachioradialis Muscle Extensor Carpi Radialis Longus Muscle Extensor Radialis Brevis Muscle Extensor Digitorum Muscle Extensor Digiti Minimi Muscle and Extensor Carpi Ulnaris Muscle
What muscles are innervated by the Radial Nerve before its division?
Brachioradialis Muscle and Extensor Carpi Radialis Longus Muscle
What innervates the Extensor Carpi Radialis Brevis Muscle? When?
Deep Radial Nerve Proximal to the Supinator Muscle
What muscles are innervated by the Deep Radial Nerve distal to it penetration of the Supinator Muscle?
Extensor Digitorum Muscle Extensor Digiti Minimi Muscle Extensor Carpi Ulnaris Muscle
Which muscle’s tendon does not cross the carpal bones to the dorsum of the hand in the superficial extensor group?
Brachioradialis Muscle
Where does the Brachioradialis Muscle insert?
Styloid Process of the Radius
What muscles make up the deep extensor muscle compartment of the forearm?
Supinator Muscle Abductor Pollicis Longus Muscle Extensor Pollicis Brevis Muscle Extensor Pollicis Longus Muscle Extensor Indicis Muscle
Where does the Supinator Muscle insert in relation to the Pronator Teres Muscle?
Anterior surface of the radius proximal to the insertion of Pronator Teres
What nerve innervates the Supinator Muscle?
Deep Radial Nerve
What nerve innervates the remaining four muscles?
Deep Radial Nerve
The 3 pollicis muscles cross what tendons to get to the thumb?
Brachioradialis Muscle Extensor Carpi Radialis Longus Muscle and Extensor Carpi Radialis Brevis Muscle
Do the pollicis muscles cross deep or superficial to the tendons mentioned above?
Superficial
The tendon of Extensor Indicis effects what digit?
2nd Digit (Index Finger)
What binds the tendons of the superficial and deep muscles to the carpal bones?
Extensor Retinaculum
What covers the tendons as they pass deep to the extensor retinaculum?
Synovial Sheaths
What nerves and vessels course together as they descend the forearm?
(Distal to the Supinator) Deep Radial Nerve Posterior Interosseous Artery
What is the origin of the Posterior Interosseous Artery?
Common Interosseous Artery
What is the origin of the Common Interosseous Artery?
Ulnar Artery
What are the boundaries of the Anatomical Snuff Box?
Lateral Abductor Pollicis Longus Extensor Pollicis Brevis Medial Extensor Pollicis Longus
What passes through the floor of the snuff box?
Radial Artery
Where does the Radial Artery go from the after it passes through the anatomical snuff box?
To the 1st Interosseous space on the dorsum of the hand where it pierces the first dorsal Interosseous muscle and enters the deep palm
What does the Radial Artery contribute to after it pierces the 1st dorsal Interosseous muscle and enters the deep palm?
Deep Palmar Arterial Arch
What contributes to the Dorsal Carpal Arterial Arch?
Dorsal Carpal Branch of the Radial Artery Dorsal Carpal Branch of the Ulnar Artery
Is the Dorsal Carpal Arch superficial or deep to extensor tendons?
Deep
Name from lateral to medial the superficial Muscles of the Flexor Compartment?
Pronator Teres Muscle Flexor Carpi Radialis Muscle Palmaris Longus Muscle Flexor Digitorum Superficialis Muscle and Flexor Carpi Ulnaris Muscle
Of these muscles which do not have tendons that cross the wrist into the hand?
Pronator Teres
What nerve innervates all these muscles with one exception? Exception?
Median Nerve. Exception: Flexor Carpi Ulnaris Muscle and Ulnar Nerve
Name the deep muscles in the flexor compartment of the forearm?
Flexor Digitorum Profundus Muscle Flexor Pollicis Longus Muscle and Pronator Quadratus Muscle
What innervates Flexor Pollicis Longus Muscle and Pronator Quadratus Muscle?
Anterior Interosseous Nerve
What innervates Flexor Digitorum Profundus Muscle?
Lateral _: Anterior Interosseous Nerve and Medial _: Ulnar Nerve
What accompanies the Superficial Radial Nerve?
Radial Artery
What is the path of the Superficial Radial Nerve?
Courses between the Brachioradialis and the Supinator Continues between the Brachioradialis and the Flexor Pollicis Longus Muscle Passes dorsally across the anatomical snuff box onto the dorsum of the wrist and hand for cutaneous innervation from the lateral 2 or 3 and _ digits
What is the origin of the Radial Artery?
The Brachial Artery bifurcates at the apex of the Cubital Fossa into the Radial and Ulnar Nerves
What is the 1st branch of the Radial Artery?
Radial Recurrent Artery (Anastamoses with Radial Collateral Artery)
What is the path of the Radial Recurrent Artery?
Ascends ventral to the lateral epicondyle deep to the Brachioradialis (with Radial Nerve)
What is the Radial Artery’s position to the Superficial Radial Nerve?
Radial Artery is Medial to Nerve
What is the course of the Radial Artery in the lower 1/3 of the forearm and hand?
Passes laterally through the snuff box onto the dorsal surface of the hand To the 1st Interosseous space on the dorsum of the hand where it pierces the first dorsal Interosseous muscle and enters the deep palm Deep Palmar Arterial Arch
What is the path of the Ulnar Nerve?
After passing posterior to the medial epicondyle the Ulnar nerve courses between the Flexor Carpi Ulnaris Muscle superficially and the Flexor Digitorum Profundus Deeply
What accompanies the Ulnar Nerve and when?
Ulnar Artery in the distal 2/3 of the forearm
What is the relationship of the Ulnar Artery to the Ulnar Nerve?
Ulnar artery is lateral to the Ulnar Nerve
Ulnar Nerve provides cutaneous innervation where?
Medial 1 and _ Digits
Name the heads of the Pronator Teres Muscle?
Superficial (Humeral) Head Deep (Ulnar) Head
What is the course of the Median Nerve in relation to the Pronator Teres Muscle?
It leaves the Cubital Fossa by passing between the 2 heads of the Pronator Teres Muscle
What occurs as the Median Nerve passes through Pronator Teres?
Branches to create Anterior Interosseous Nerve
What is the course of the Ulnar Nerve in relation to the Pronator Teres Muscle?
Ulnar Nerve passes deep to both heads of Pronator Teres Enters between Flexor Carpi Ulnaris and Flexor Digitorum Profundus
Name the origins of the Flexor Digitorum Superficialis Muscle?
Ventral Surface of Radius Ventral Surface of Ulna
What is the course of the Median Nerve Ulnar Artery and Radial Artery in relation to the Flexor Digitorum Superficialis Muscle?
Median Nerve and Ulnar Artery pass deep to the upper free arch of the Flexor Digitorum Superficialis Radial Artery courses superificial to the muscle along its lateral border between Brachioradialis and Supinator
Continue the course of the Median Nerve?
Courses between the Flexor Digitorum Superficialis and Profundus
What is the course of the Anterior Interosseous Nerve?
Joins Anterior Interosseous Vessels of ventral side of Interosseous Membrane
What does the Anterior Interosseous Nerve innervate?
Flexor Pollicis Longus Pronator Quadratus
Where does the Anterior Interosseous Nerve terminate?
Sensory branches from the wrist and radioulnar joints
Path of the Ulnar Artery?
Leaves Cubital Fossa deep to both heads of Pronator Teres Flexor Digitorum Superficialis and Flexor Carpi Ulnaris
What contribution to collateral circulation does the Ulnar Artery provide?
Anterior and Posterior Recurrent Arteries
When does the Median Nerve cross the Ulnar Artery? How?
Just inferior to Pronator Teres Median Nerve crosses (medial to lateral) ventral to the Ulnar Artery
What occurs to the Ulnar Artery at the time it is crossed by the Median Nerve?
Branches to form Common Interosseous Artery
What branches from the Common Interosseous Artery? Where?
Anterior Interosseous Artery Posterior Interosseous Artery Superior margin of the Interosseous Membrane
Path and Branches of Posterior Interosseous Artery?
Path: Enters posterior compartment of forearm to course shortly with Deep Radial Nerve. Branches: Recurrent Interosseous Artery (connect with Middle collateral Artery branch of Deep Brachial Artery)
Path of Anterior Interosseous Artery?
Courses with Anterior Interosseous Nerve on ventral surface of Interosseous Membrane
At the wrist what superficial structures are easily damaged?
Radial Artery Median Nerve Ulnar Nerve Ulnar Artery
What branches from the Radial Artery before entering the floor of the snuff box?
Palmar and Dorsal Carpal Branches
What does the Superficial Palmar Branch contribute to?
Superficial Palmar Arterial Arch
What passes deep to the Flexor Retinaculum?
Flexor Digitorum Superficialis Median Nerve Flexor Digitorum Profundus Flexor Pollicis Longus
Where is the Flexor Retinaculum attached?
Medial Hamate and Pisiform Lateral Scaphoid and Trapezium
What is covered by the Radial Bursa?
Flexor Pollicis Longus
What is covered by the Ulnar Bursa?
Flexor Digitorum Superficialis Flexor Digitorum Profundus
What is the most superficial structure passing through the carpal tunnel?
Median Nerve
Path of Radial Artery related to Flexor Retinaculum?
Lateral to flexor retinaculum Not is carpal tunnel
Insertion of Flexor Carpi Ulnaris?
Base of 5th metacarpal
Insertion of Flexor Carpi Radialis?
Base of 2nd and 3rd metacarpal
What is deep to the palmar skin?
Palmar Aponeurosis (Tight)
Function of the Palmar Aponeurosis?
Covers the central compartments of the palm Protects vessels and nerves immediately deep
What are the muscle compartments of the hand?
Thenar Hypothenar Central Adductor-Interosseous
Where is the Thenar Compartment located?
Lateral side of the palm (thumb region)
What muscles are located in the Thenar Compartment?
Abductor Pollicis Brevis Flexor Pollicis Brevis Opponens Pollicis Tendon of Flexor Pollicis Longus
What covers the Flexor Pollicis Longus tendon?
Radial Bursa
Length of Radial Bursa?
Flexor Retinaculum to Distal Phalanx of thumb
What innervates the Thenar Muscles?
The Recurrent Motor Branch of the Median Nerve
What passes through the thenar muscles to contribute to the superficial arterial palmar arch?
Superficial Palmar Branch of Radial Artery
What muscles are found in the Hypothenar Compartment?
Abductor Digiti Minimi Flexor Digiti Minimi Opponens Digiti Minimi
What occurs to the Ulnar Nerve and vessels at the midpoint of the Flexor Retinaculum?
They divide into the Superficial and Deep Ulnar Nerve and Vessels
What does the superficial Ulnar Nerve innervate? (Muscular and Cutaneous)
Palmaris Brevis Muscle Cutaneous innervation to 1 and _ Digits (Common Palmar Digital Nerves)
What is the main contributor to the Superficial Palmar Arterial Arch?
Superficial Branch of Ulnar Artery
What is the path of the Deep Ulnar Nerve and Vessels?
Penetrate between the Abductor Digiti Minimi and the Flexor Digiti Minimi to reach the deeper Abductor-Interosseous Compartment
What does the Recurrent Branch of the Median Nerve innervate?
Muscles of the Thenar Compartment
What does the Common Palmar Digital Nerves branching from the Median Nerve innervate?
Cutaneous innervation to the lateral 3 and _ Digits
What muscles in the Central Compartment does the Median Nerve innervate?
2 Lumbrical Muscle on the lateral side
Describe the tendons of the Flexor Digitorum Profundus in the carpal tunnel?
The 4 tendons lie deeply in a single row
Describe the 4 tendons of the Flexor Digitorum Superficialis in the carpal tunnel?
3rd and 4th digit tendons superficial to 2nd and 5th digit tendons
What covers these 8 tendons?
Ulnar Bursa
How many lumbrical muscles are there?
4 (2nd to 5th digits)
What is significant about there point of origin?
The have a moving point of origin from the 4 tendons of the Flexor Digitorum Profundus
Where do the lumbricals insert?
The lateral (radial) side of the extensor expansion on the dorsum of digits 2 – 5
What innervates the lumbrical muscles?
Lateral 2: Median Nerve. Medial 2: Deep Ulnar Nerve
What is superficial to the central compartment at the horizontal plane of the extended thumb?
Superficial Palmar Arterial Arch
What is the main contributory of the above arch?
Superficial Branch of the Ulnar Artery
What is the purpose of the Superficial Palmar Arterial Arch?
Provides common palmar digital arteries
What is a lesser contributor to the arch?
Laterally Superficial Palmar Branch of the Radial Artery
What do the eight tendons enter on the ventral surface of the 2-5 digits?
Digital (Fibrous) Sheath
Purpose?
Prevent bowstringing
In relationship to Profundus tendons what is unique about Superficialis tendons near the point of insertion?
The tendons of the Flexor Digitorum Superficialis split to allow passage of the tendons of the Flexor Digitorum Profundus
What is the deepest compartment in the palm?
Interosseous-Adductor Compartment
What is contained in this compartment?
Palmar Interosseous Muscles Dorsal Interosseous Muscles Adductor Pollicis Muscle Deep Palmar Arterial Arch and Deep Branch of the Ulnar Artery
Name the heads and origins of the Adductor Pollicis Muscle?
Oblique Head: Capitate Bone. Transverse Head: Shaft of 3rd Metacarpal Bone. Transverse Head: Shaft of 3rd Metacarpal Bone
Insertion of Adductor Pollicis Muscle?
Proximal Phalanx of the thumb
Where do the Interosseous Muscles (and Lumbricals) insert?
Extensor Expansion
What ligaments separate the Lumbrical Muscles and the Interosseous Muscles?
Deep Transverse Metacarpal Ligaments
Which muscles are deep to the above ligaments?
Interosseous Muscle (Deep compartment)
The extensor expansion is made of what 2 types of bands? Insertion?
Central Bands: Middle Phalanx Lateral Bands: Distal Phalanx
What is one function common to both the Lumbricals and the Interosseous Muscles?
Flex the Metacarpophalangeal joints but extend the Interphanlangeal joints of digits 2-5
Path of Deep Ulnar Nerve and Artery?
Penetrate deep to Hypothenar Compartment and course across the ventral surface of the Interosseous Muscles
What does the Deep Ulnar Nerve innervate?
3 Hypothenar Muscles Interosseous Muscles Adductor Pollicis 3rd and 4th Lumbircals
Contributors to Deep Palmar Arterial Arch?
Deep Ulnar Artery (medially) Radial Artery (Laterally after passing through 1st Dorsal Interosseous Muscle)
Position of Deep Palmar Arterial Arch?
Deep & Proximal to Superficial Palmar Arterial Arch
Where is the Suprasternal Notch?
Superior surface of the Manubrium
What is the most superior bone articulation with the Sternum? Joint name?
Clavicle Sternoclavicular Joint
What muscles attach on the superior part of the clavicle and sternum at the Sternoclavicular Joint? Function?
Sternocleidomastoid Muscles (Elevates sternum in respiration)
What is the ridge called where the Manubrium and Body of Sternum articulate?
Sternal Angle (of Louis)
What articulates with the sternum at the Sternal Angle?
2nd Costal Cartilage
Why can the 1st rib not be palpated?
Deep to clavicle
What is at the inferior end of the sternum?
Xyphoid Process
What is significant about the xyphosternal junction?
It is an anterior surface projection of the inferior border of the heart
The nipples are located approximately where?
4th Intercostal Space
What is the most superficial muscle in the intercostal space?
External Intercostal Muscle
How many pairs of these muscles are there?
11
Extend from where to where?
Tubercles of ribs (posteriorly) To Costochondral Articulations (anteriorly)
What is muscle fiber direction analogy?
Hands in Pockets
Function of External Intercostals?
Elevate ribs Increase width of thoracic cavity
What muscle group is deep to External Intercostals?
Internal Intercostals
# of pairs?
11
Extend from where to where?
Lateral margin of sternum To Angle of the Ribs
Muscle fiber direction?
90 Degrees to External Intercostals
What courses on the deep aspect of the chest wall at the lateral margins of the sternum?
Internal Thoracic Artery and Vein
What muscle is found on the inner surface of the chest wall and binds the Internal Thoracic vessels against the inner surfaces of the costal cartilage?
Transversus Thoracis Muscle
Of the Internal Thoracic Vessels which is most lateral?
Internal Thoracic Artery (AVVA)
What is the origin of the Internal Thoracic Arteries?
Right and Left Subclavian Arteries
What does the Internal Thoracic Artery divide into? Where?
R and L Superior Epigastric Artery R and L Musculophrenic Artery Deep to 6th Costal Cartilage
Path of Superior Epigastric Arteries?
Continues vertical course and enters rectus sheath of the abdominal wall
Path of Musculophrenic Arteries?
Contour of the rib cage giving rise to lower Anterior Intercostal Arteries and branches to the diaphragm
Where do the Internal Thoracic Veins drain?
Brachiocephalic Veins
Transversus Thoracis Muscle origin? Insertion?
Inner surface of sternum Inner surfaces of 2nd – 6th costal cartilages
What vessels (how many) are found in the innercostal spaces?
Anterior Intercostal Vein(2) Anterior Intercostal Artery(2) Anterior Intercostal Nerve(1)
What is the origin of the Anterior Intercostal Arteries?
Upper 5 Spaces: Internal Thoracic Artery Lower 5 or 6 Spaces: Musculophrenic Artery
What do these arteries anastamose with?
Posterior Intercostal Arteries
This forms collateral circulation between?
Internal Thoracic Artery And Descending Aorta
What collateral circulation is formed in the venous system?
Connect Internal Thoracic and Musculophrenic Veins anteriorly to Azygos system of veins posteriorly
Superior to inferior what vessels are found in the intercostal space?
VAN: Vein Artery Nerve
Intercostal nerves provide what innervation?
Somatic and motor innervation for the muscles and skin of the chest wall (and abdominal wall for intercostal nerves 7 – 11)
What are the boundaries of the mediastinum?
Anteriorly: Sternum Posteriorly: 12 Thoracic Vertebra Laterally: Parietal (mediastinal) Pleura
Are the lungs in the mediastinum?
No
The thoracic cavity communicates to the neck through the ____________?
Superior Thoracic Aperture
What separates the thoracic cavity from the abdomen?
Diaphragm
What does the diaphragm close in the thorax?
Inferior Thoracic Aperture
What surrounds each lung?
Pleura
What are the layers of pleura?
Inner layer: Visceral Pleura. Outer layer: Parietal Pleura
Are these 2 layers separate?
No they are continuous at the hilum (root) of the lung
Where is the visceral pleura?
Directly adherent to the surfaces of the lung
Where is the parietal pleura?
Follows the contours of the thoracic wall and lateral boundary of mediastinum
What is contained in the potential space between the two?
Serous Fluid Facilitates movement of the pleural layers
What are the regions of the Parietal Pleura?
4  Cervical Costal Diaphragmatic Mediastinal
What is the superior (apex) of the pleura called?
Cupula of the Parietal Pleura
What vessels are found between the pericardium and the mediastinal Parietal Pleura?
Phrenic Nerve Pericardiacophrenic Artery Pericardiacophrenic Vein
What are the major recesses of the parietal pleura?
Costomediastinal Recess Costodiaphragmatic Recess
What is clinically significant about these recesses?
Provide areas where excess pleural fluid can be withdrawn without damaging the lungs
What are the borders of the Superior Mediastinum?
Superiorly: Superior Thoracic Aperture Inferiorly: Level of Sternal Angle (T4 vert.) Lateral: Mediastinal Parietal Pleura
What is the most anterior structure in the SM?
Thymus Gland (Two lobes)
Position of the Thymus?
Directly posterior to Manubrium Anterior to Brachiocephalic Veins and Superior Vena Cava
What level does the pericardium of the heart terminate?
Level of Sternal Angle becomes continuous with adventitial layer of the great vessels
What makes up the great vessels?
SVC Pulmonary Trunk Pulmonary Trunk Pulmonary Veins Ascending Aorta
What is immediately deep to the Thymus gland?
Brachiocephalic Veins SVC
What is the origin of the Brachiocephalic Veins?
Junction of the:Internal Jugular Vein and Subclavian Vein
What is the superior continuation of the Accessory Hemiazygos Vein?
Left Superior Intercostal Vein
What two structures does the above vein separate?
Left Vagus and Left Phrenic Nerves at the left lateral surface of the Aortic Arch
What does the junction of the Left and Right Brachiocephalic Veins form?
Superior Vena Cava
Location of SVC origin?
Deep to right 1st Costal Cartilage
What vein terminates on the posterior side of the SVC?
Arch of the Azygos Vein
What structure is immediately deep and inferior to the Left Brachiocephalic Vein?
Aortic Arch and its branches
Where does the Aortic arch begin?
As a continuation of the Ascending Aorta the Aortic Arch begins at the Sternal Angle
Describe the Aortic Arch?
Aorta arches superiorly posteriorly and to the left
What does the Aorta come in contact with as it arches posteriorly?
Trachea
Where does the Aortic Arch end? Level?
Left side of the body at the disc of the 4th Thoracic Vertebra
What is the first and largest branch of the Aortic Arch?
Brachiocephalic Trunk
Where does the Brachiocephalic Trunk arise?
Posterior to the middle of the Manubrium
What does the Brachiocephalic Trunk give rise to?
Right Common Carotid Artery Right Subclavian Artery
What is the 2nd branch of the Aortic Arch?
Left Common Carotid Artery (Arises from highest aspect of the arch)
What is the 3rd branch of the Aortic Arch?
Left Subclavian Artery
What is the band of connective tissue between the Aortic Arch and the Left Pulmonary Artery? Reminence?
Ligamentum Arteriosum (Reminisce of Fetal Ductus Arteriosus)
Path of Right Vagus Nerve?
Descends between R Brachiocephalic Vein and Brachiocephalic Arterial Trunk Lateral Surface of Trachea deep to the root of the lung
Path of Left Vagus Nerve?
Descends between “L Common Carotid and L Subclavian Arteries” and the L Brachiocephalic Vein It then crosses the lateral surface of the Aortic Arch
What binds the Left Vagus Nerve to the surface of the Aortic Arch?
Left Superior Intercostal Vein
What nerve is lateral to this vein?
Left Phrenic Vein
What side does the Left Vagus Nerve pass the Ligamentum Arteriosum on? What occurs here?
Left Left Vagus Nerve branches to form Left Recurrent Laryngeal Nerve
Path of Left Recurrent Laryngeal Nerve?
Courses deep and posterior to ligamentum arteriosum then it ascends posterior to the Aortic Arch
How do the Phrenic Nerves enter the mediastinum?
Between the Subclavian Arteries and Veins
What is the position of the Phrenic Nerves to the Vagus Nerves?
Phrenic is lateral to Vagus on both sides
Path of Right Phrenic Nerve?
Courses lateral to the R Brachiocephalic Vein and SVC
Relationship of Phrenic Nerves to the root of the lungs?
R and L Phrenic Nerves course with the Pericardiacophrenic Vessels lateral to the pericardium of the heart ventral to the roots of the lungs
What is deep to the 1st part of the Aortic Arch?
Trachea Esophagus
What is the pericardium?
Serous sac that surrounds the heart
Pericardium attachments?
Anteriorly: Sup. And Inf. Sternopericardial Attachments. Inferiorly: Fused to the central tendon of the diaphragm
What are the 2 components of the pericardium?
Fibrous Serous
What is the fibrous layer?
External layer of pericardium In contact with pleura and sternum Continuous with adventitia of great vessels
What are the 2 components of the serous pericardium?
Parietal layer of serous pericardium (fused to inner aspect of Fibrous Pericardium) Visceral layer of serous pericardium (Fused to epicardial surface of Heart)
What sinuses are found within the pericardial cavity?
Transverse Sinus Oblique Sinus
Transverse Sinus Describe?
Transverse Sinus Horizontal at base of heart between the (Ascending Aorta and Pulmonary Trunk) and the (Pulmonary Veins and SVC)
Oblique Sinus Describe?
Oblique Sinus Posterior to the heart between the right and left pulmonary veins
What separates the 2 sinuses?
2 folds of pericardium
What occurs to the pericardium at the great vessels?
At sternal angle reflection from visceral to parietal pericardium occurs
Define descriptive terms of the heart
Base
Superiorly at level of 3rd rib formed by great vessels
Apex
Inferior and to the left 5th intercostal space Formed by left ventricle
Anterior (Sternocostal) Surface
Ventral surface of heart composed of all 4 chambers
Diaphragmatic Surface
Right and left ventricle resting on the Diaphragm
Right Border
Right Atrium
Left Border
Left Ventricle
Inferior Margin
Separates the Sternocostal Surface from the Diaphragmatic Surface
Posterior Surface
Left and Right Atria
What are the major sulci on the surface of the heart?
Coronary Sulcus Anterior interventricular Sulcus Posterior Interventricular Sulcus
Right Coronary Artery
Origin
Right (Coronary) Cusp of Aortic Valve
Path
Arises from right aortic sinus Courses into coronary sulcus between Pulmonary Trunk and Right Auricle Continues toward inferior margin of heart Leaves sternocostal surface posteriorly continuing between the right atrium and right ventrcle in coronary sulcus
1st Branch Location Purpose
Sinoatrial Nodal Artery (Near Origin) Encircle SVC to supply sinoatrial node
2nd Branch Location Vein Purpose
Right Marginal Branch of Right Coronary A. (Near inferior margin) Small Cardiac Vein Supply Right Ventricle
Termination Location Vein Purpose
Posterior Interventricular Artery (Posterior Interventricular Sulcus) Middle Cardiac Vein Supply both ventricles
What does the Posterior Interventricular Artery anastamose with at the apex of the heart?
Anterior Interventricular Branch of Left Coronary Artery
What also anastomoses with the Right Coronary artery before descending the posterior interventricular sulcus?
Circumflex Artery (Branch of Left Coronary Artery)
What branch of Right Coronary Artery penetrates into the interatrial septum at the upper end of the post. Interventricular sulcus?
Atrioventricular Nodal Artery
Left Coronary Artery
Origin
Left (Coronary) cusp of Aortic Valve
Path
Courses in coronary sulcus left of the Pulmonary Trunk and deep to left auricle
Terminates into . . . . .
Anterior Interventricular Artery Circumflex Artery
Where does this division occur?
Junction of the coronary and anterior interventricular sulcus
Anterior Interventricular Artery
Sternocostal surfaces of both ventricles
Supplies?
(Great Cardiac Vein)
Vein?
Apex with anastomoses with Post. Interv. Artery
Circumflex Artery
Continues in coronary sulcus
Path?
Supplies Left Atrium and Left Ventricle
Supplies?
Collateral anastomoses with Right Coronary Artery
Smooth portion on posterior wall?
Sinus Venarum
Muscular portion of anterior wall?
Pectinate Muscles
What separates the 2 areas listed above?
Terminal Crest
What is the depressed area on the interatrial wall?
Fossa Ovalis
What is the elevated superior margin of the fossa ovalis?
Limbus Fossa Ovalis
Where is the atrioventricular node located?
Between the valve of the Coronary Sinus and the Atrioventricular aperture
What is the valve between the right atrium and right ventricle?
Tricuspid Valve
Name the cusps of the tricuspid valve?
Anterior Cusp Posterior Cusp Septal Cusp
What papillary Muscles are found in the RV?
Anterior Papillary Muscle Posterior Papillary Muscle Septal Papillary Muscle
What connects the papillary muscles to the valve cusps?
Chordae Tendineae
What is the smooth-walled portion of the ventricle?
Conus Arteriosum
What makes a majority of the ventricular wall?
Trabeculae Carnae
What is just inferior to Conus Arteriosus and connects to the Anterior Papillary Muscle?
Moderator Band
The moderator Band is apart of what?
Septomarginal Trabeculae
Name the cusps of the pulmonary semilunar valve?
Anterior Cusp Left Cusp Right Cusp
The Anterior Papillary Muscle is attached to what surface of the heart?
Sternocostal Surface
The Posterior Papillary Muscle is attached to what surface of the heart?
Diaphragmatic Surface
What enters the left atrium?
Left and Right Pulmonary Veins
What papillary muscles are found in the left ventricle?
Anterior Papillary Muscle Posterior Papillary Muscle
What is the atrioventricular valve found on the left side of the heart?
Mitral Valve
Name the cusps.
Anterior Cusp Posterior Cusp Of Left atrioventricular valve
Name the cusps of the Aortic Semilunar Valve.
Right (Coronary) Cusp Left (Coronary) Cusp Posterior (Noncoronary) Cusp
What initiates contraction?
Sinoatrial Node
Where is the SA node located?
At the base of the SVC
What sends out the second signal?
Atrioventricular Node
Where is the AV Node located?
In the interatrial wall between the coronary sinus and the right atrioventricular opening
What is the path of the AV Node?
Leads to the atrioventricular bundle which divides into left and right cura (bundle branches) Each crus descends beneath the endocardium on each side of the interventricular septum to reach the inferior end of the septum where each crus runs into the ventricles to provide Purkinje fibers to remainder of heart
When the pulmonary trunk divides what is its relationship to the aorta?
Divides inferior to aortic arch at the plane of the sternal angle into right and left pulmonary arteries
Left Pulmonary Artery Path?
Course ventral to the thoracic aorta and arches over the left main bronchus to enter the left lung
Right Pulmonary Artery Path?
Crosses posterior to ascending aorta and SVC to enter right lung ventral to main bronchus
In root of lung what is the relationship of Pulmonary Arteries to Pulmonary Veins?
Pulmonary Veins are ventral and inferior to the Pulmonary Arteries
Path of Left Pulmonary Vein?
Crosses ventral to thoracic aorta
Path of Right Pulmonary Vein?
Posterior to SVC and right atrium
Where does the trachea bifurcate?
At the level of the sternal angle
Describe Right Main Bronchus.
Larger Shorter Enters lung posterior to R Pulmonary Artery
Describe Left Main Bronchus.
Deep to aortic arch Anterior to esophagus and thoracic aorta Enters lung inferior to the left Pulmonary Artery
What part of the pleura is inferior to the root of the lung?
Pulmonary Ligament
Name the lobes of the Right Lung.
Superior Lobe Middle Lobe Inferior Lobe
Name the fissures of the Right Lung.
Horizontal Fissure Oblique Fissure
Right Lung: Artery v. Bronchus
Pul. Artery is ventral to bronchus
Name the divisions of the right main bronchus.
Superior Lobar Bronchus Intermediate Bronchus Middle Lobar Bronchus Inferior Lobar Bronchus
Name the lobes of the Left Lung.
Superior Lobe Inferior Lobe
Name the fissures of the Left Lung.
Oblique Fissure
Left Lung: Artery v. Bronchus
Artery is superior to bronchus
Name the divisions of the Left Main Bronchus.
Superior Lobar Bronchus Inferior Lobar Bronchus
The esophagus enters the posterior mediastinum just posterior to what structure at the level of the sternal angle?
Trachea Bifurcation
What is the relationship of the esophagus and the thoracic aorta?
The thoracic aorta is posterior and to the left of the esophagus
Where does the esophagus exit the Posterior Mediastinum?
Esophageal Hiatus Vertebral Level T10
Entrance of Vagus Nerves.
Enter posterior to root of lung
Left Vagus Nerve on esophagus.
Passes to the anterior surface of the esophagus (Clockwise)
Right Vagus Nerve on esophagus.
Passes mostly posterior to esophagus
The esophageal plexus forms what on the surface of the esophagus as it passes into the abdomen?
Anterior Vagal Trunk Posterior Vagal Trunk
What do the Ant. and Post. Vagal Trunks do?
Distribute Parasympathetic to the viscera of abdomen
How does the esophagus pass through the diaphragm?
Through the esophageal hiatus
Where does the descending thoracic aorta begin?
T4 or T5
What branches from the descending aorta?
Bronchial Esophageal Posterior Intercostal Subcostal and Superior Phrenic Arteries
# of pairs of Posterior Intercostal Arteries?
9
How does the aorta pass through the diaphragm? Level? What passes with it?
Aortic Hiatus T12 Thoracic Duct
What is the primary venous drainage of the Thorax?
Axygos System of Veins
Where is the azygos vein located?
Right posterior thoracic wall
What forms the Azygos Vein?
Junction of the ascending Lumbar and Right Subcostal Veins
Where does the azygos vein terminate?
The Azygos Arch terminates in the SVC posteriorly
Path of the Azygos Arch?
Curves over the root of the right lung
What does the Accessory Hemiazygos Vein form? Terminates where?
Forms the Left Superior Intercostal Vein Terminates into the Left Brachiocephalic Vein
What role does the Azygos system play in collateral circulation?
Collateral flow between the superior and inferior vena cava
What is the Thoracic Duct?
Large terminal Lyphatic vessel
What does the Thoracic Duct drain?
All lymph from body inferior to diaphragm and left side of body superior to the diaphragm
How does the Thoracic Duct pass through the diaphragm?
Aortic Hiatus
Where does the Thoracic Duct terminate?
At the junction of the Left Subclavian Vein and the Internal Jugular Vein
What provides collateral circulation between the Aorta and Subclavian Arteries?
Anterior and Posterior Intercostal Arteries
How can you tell the difference between gray and white rami communcantes?
White rami is more lateral
What Splanchnic Nerves arise from the Thoracic Chain Ganglia? What Ganglia?
Greater Splanchnic Nerve: T5-T9 Lesser Splanchnic Nerve: T10 11 Least Splanchnic Nerve: T12
White Rami is pre or post ganglionic?
Preganglionic