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