Upper Limb 2

Front 1

Transition areas between parts of upper limb

Back 1

1. Axilla- armpit
2. Cubital fossa- elbow
3. Carpal tunnel- wrist

Front 2

Axilla

Back 2

Pyramidal area for passage of major neurovascular structures from neck to arm

Front 3

Cubital fossa

Back 3

Triangular depression anterior to elbow for passage of:
1. Brachial artery
2. Median nerve

Front 4

Carpal tunnel

Back 4

Gateway to the palm for:
1. 9 long flexor tendons
2. Median nerve

Front 5

Cervicoaxillary canal

Back 5

Axillary inlet formed by:
1st rib
clavicle
superior border of scapula
coracoid process

axillary artery, vein, and brachial plexus pass through

Front 6

Clavicle

Back 6

Double S-shaped long bone connecting upper limb to trunk

Sternal end articulates at sternoclavicular joint

Acromial end articulates at acromioclavicular joint

Helps transmit shock from upper limb to axial skeleton; allows scapula to move along thoracic wall

Front 7

Clavicle break

Back 7

Fracture generally through middle third

Sternocleidomastoid elevates proximal fragment

Shoulder on affected side hangs lower; patients hold and support that arm

Front 8

Sternoclavicular joint

Back 8

Saddle-type synovial joint between clavicle and manubrium of sternum

Only true articulation between upper limb and axial skeleton; rarely dislocates

About 60 degrees of motion at joint

Front 9

Ligaments of SC joint

Back 9

1. Anterior SC ligament
2. Posterior SC ligament
3. Interclavicular ligament
4. Costoclavicular ligament

+ intra-articular cartilaginous disc between clavicle and manubrium (internal)

Front 10

Costoclavicular ligament

Back 10

Anchors sternal end of clavical to 1st rib

Front 11

Acromioclavicular joint

Back 11

Plane-type synovial joint between acromion and clavicle

Surrounded by loose fibrous capsule

LigamentsL
1. Acromioclavicular ligament- superior strength to joint capsule
2. Coracoacromial ligament- between coracoid and acromion processes
3. Coracoclavicular extrinsic ligaments: trapezoid and conoid ligaments

Front 12

Acromioclavicular ligament

Back 12

Superior strength to AC joint

Front 13

Coracoclavicular ligament

Back 13

"extrinsic" ligaments

pair of ligaments that unites coracoid process and clavicle

trapezoid and conoid ligaments

Front 14

Coracoacromial ligament

Back 14

Between coracoid and acromion processes

Front 15

1st degree AC injury

Back 15

stretch or minor tear of AC ligament (still intact)

AKA sprain

Front 16

2nd degree AC injury

Back 16

rupture of AC ligament with subluxation of the joint (separation but not dislocation)

AKA subluxation

Front 17

3rd degree AC injuries

Back 17

AKA shoulder separations

Severe AC and coracoclavicular ligament disruption

Shoulder separates or falls away from clavicle due to weight of arm

Front 18

Anterior thoracoappendicular muscles

Back 18

Pectoralis major
Pectoralis minor
Subclavius
Serratus anterior

Front 19

Pectoralis major

Back 19

Fan-shaped muscle in superior thorax

Origins: Clavicular and sternocostal
Insertion: lateral lip of intertubercular sulcus (groove)
Action: Adductor, medial rotator of arm; Flexes the arm at shoulder joint
Innervation: medial and lateral pectoral nerves

Front 20

Clavipectoral fascia

Back 20

Thick sheath of fascia connecting clavicle to floor of axilla

Surrounds pectoralis minor and subclavius

Front 21

Pectoralis minor

Back 21

Origin: anterior surface of 3rd-5th ribs
Insertion: coracoid process of scapula
Action: stabilizes scapula against thoraic wall
Innervation: medial pectoral nerve

Forms bridge over axillary artery, vein, and brachial plexus

Front 22

Axillary artery

Back 22

Continuation of subclavian artery as passes lateral margin of 1st rib

Provides vascular supply to pectoral girdle and shoulder

Divided into three parts by pectoralis minor (runs underneath); becomes brachial artery as passes lateral to teres major

Front 23

Branches of axillary artery

Back 23

1st part: one branch- superior thoracic artery
2nd part: thoracoacromial trunk, lateral thoracic artery
3rd part: subscapular, anterior humeral circumflex, posterior humeral circumflex

Front 24

Subscapular artery

Back 24

Largest branch

Supplies muscles and anastomoses around scapula

Gives rise to thoracodorsal artery and scapular circumflex (triangular space)

Front 25

Anterior and posterior humeral circumflex

Back 25

Help vascularize the humerus and surrounding muscles

Posterior passes through quadrangular space

Front 26

Brachial plexus: definition and segments

Back 26

Large nerve network (ventral rami) that innervates the upper extremity and its musculature

Extends from cervical region to axilla

5 segments:
Roots
Trunks
Divisions
Cords
Branches

Front 27

Brachial plexus roots

Back 27

Formed by ventral rami of C5 through T1

AKA "origins" of brachial plexus (roots is a misnomer)

Front 28

Brachial plexus: trunks

Back 28

Superior- C5 & C6
Middle- C7
Inferior- C8 & T1

Front 29

Brachial plexus: divisions

Back 29

Each trunk divides into anterior and posterior ____

Anterior divisions: form nerves that innervate flexor compartments of arm

Posterior divisions: form nerves that innervate extensor compartments of arm

Front 30

Brachial plexus: cords

Back 30

Divisions combine to form 3 main ____

Anterior divisions of superior and middle trunk unite to form lateral cord

Anterior divisions of inferior trunk continues as medial cord

Posterior divisions of all three trunks unite to form posterior cord

Front 31

Brachial plexus: branches

Back 31

Cords gives rise to major terminal ____

Lateral cord --> musculocutaneous branch and lateral root of median nerve

Medial cord --> ulnar nerve and medial root of median nerve

Posterior cord --> radial and axillary nerves

Front 32

5 major terminal nerve branches of brachial plexus

Back 32

1. Axillary nerve (posterior cord)
2. Radial nerve (posterior cord)
3. Median nerve (lateral and medial cords)
4. Ulnar nerve (medial cord)
5. Musculocutaneous (lateral cord)

Front 33

Musculocutaneous

Back 33

Innervates flexors of arm

Front 34

Ulnar nerve

Back 34

Innervates intrinsic muscles of the hand and some forearm flexors

Front 35

Axillary nerve

Back 35

Innervates deltoid and teres minor

Front 36

Radial nerve

Back 36

Innervates extensors of arm and forearm

Front 37

Median nerve

Back 37

Innervates most forearm flexors and thenar (thumb muscles)

Front 38

Subscapular nerves all innervate

Back 38

muscles that adduct and medially rotate the arm (like the subscapularis, lat, pectoralis major, teres major)

Front 39

Upper subscapular nerve innervates

Back 39

Subscapularis

C5/C6

Front 40

Middle subscapular nerve innervates

Back 40

Latissimus dorsi

(C6/7/8)

Front 41

Lower subscapular nerve innervates

Back 41

Subscapularis
Teres major

C5/C6

Front 42

Medial cutaneous nerves of the arm and forearm

Back 42

Supply sensation to medial arm and forearm

C8/T1

Front 43

Medial and lateral pectoral nerves innervate

Back 43

Pectoral muscles

C5-C7

Front 44

Roots of the brachial plexus and subclavian artery pass between...

Back 44

Anterior and middle scalene muscles that arise from cervical vertebrae and insert onto 1st rib

Front 45

Anterior and middle scalene muscles

Back 45

Arise from cervical vertebrae

Insert onto 1st rib

Brachial plexus and subclavian artery pass through

Deep fascia around scalene muscles = pre-vertebral fascia

Front 46

Pre-vertebral fascia

Back 46

Surrounds scalene muscles in neck

Extends laterally as axillary sheath, surrounding plexus and axillary vessles

Front 47

Intercostobrachial nerve

Back 47

Only nerve in upper extremity that doesn't come from brachial plexus