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55 Cards in this Set

  • Front
  • Back
Upper Limb

Trapeziuz muscle
Attach:
proximal: occipital bone
Nuchal ligament
Spinous pricesses C7-T12

Distal: clavicle
Acromion
Spine of scapula

Innervation:

Spinal root of XI
Cervical plexus

Movements:

Superior part – elevation
Middle part – retraction
Inferior part – depression


Common action:

Rotation of scapula
Elevation of arm above the shoulder
Cooperates with Serratus anterior
Upper Limb

Latissimus dorsi
Attach:

Proximal:
Spinius prosses inferior – 6th vertebrae
Thoracolumbar fascia
Iliac crest
Inferior 3rd – 4th rib

Distal:
Floor of intertubercular groove ( of humerus)

Innervation:

Thoracodarsal nerve – branch of the branchial plexus
This nerve is sit. on posterior wall of axilla and may be injured during sugery


Action:

On the glenohumeral joint
Extention
Adduction
Medial rotation

Together with Pectoralis major:

Raises body toward arm during climbing
Depresses elevated upper limb during chopping wood
Upper Limb

Levator scapula
Attach;

Proximal:
Posterior tubercle of transverse processes C1-C4

Distal:
Median border of scapula superior to root of spine

Innervation:

Dorsal scapular (C5) and cervical (C3, C4) nerves
Upper Limb

Rhomboid minor
Attach:

Nuchal ligament
Spinous processes C7-T1

Innervation:

Dorsal scapular (C5) and cervical (C3, C4) nerves
Upper Limb

Rhomboid major
Rhomboid major

Attach:

Distal attach to borh Levator scapula & Rhomboid minor
Spinous pricesses T2-T5

Innervation:

Dorsal scapular (C5) and cervical (C3, C4) nerves




Testing the Rhomboids or dorsal scapula nerve or C4-C5 roots:
Patient has it hand on the hips & pushes elbows posterior against the resistance provided by examiner
Upper Limb

Function (Levatores & Rhomboids):
Movements of scapula
Elevation of scapula
Tilting the glenoid cavity inferiorly by rotating the scapula
Not elevation of upper limb!
Retraction of scapula (rhomboids)
Fixing scapula to thoracic wall
Upper Limb

A)Superficial Intrinsic Muscles of the Back?
B)Intermediate extrinsic muscles
A)
-Trapezius
-Latissimus
-Levator Scapula
-Rhomboid Minor & Major
B)
Serratus posterior superior
Serratus posterior inferior
Upper Limb

A)Serratus posterior superior
B)Serratus posterior inferior
Attach:
A)Superior – nuchal ligament
C7-T3
Inferior to 2nd-4th ribs
B)T11-T12 spinous pr.
Inferior 8-12th ribs


Innervation for both:
Intercostal nerve

Function for both:
Accessory muscle of inspiration
Upper Limb

A)Splenius muscle
-capitis
-cervicis

B)Erector spinae
-Illiocostalis
-Longissimus
-Spinalis
A)Location:
Lateral & posterior side of neck
Between midline & cervical vertebrae

B)Posterior part of iliac crest & sacrum

a) Iliocostalis – lateral column; Angles of ribs & transverse processes
b) Longissimus – intermediate column; Ribs between angles& tubercles& transverse pr.
c) Spinalis – medial column; Spinous processes, skull

Both:
Innervation:

Dorsal rami of the spinal nerve
Action:

Bilaterally (together) → external trunk & head
Unilaterraly (alone) → flex laterally & rotate trunk and head
Upper Limb

A)Transversospinal muscles
B)Minor deep layer
A)Attach:

Betw. Transverse processes & spinous pricesses

a)Semispinalis – 4-6 segments ( = ribs)
b)Multifidus – 2-4 segments
c)Rotators – 1-2 segment

B)a) Interspinalis – Cervical& lumbar processes; Inferior surface of spinous pr.
b) Intertransversii - Cervical & lumbar; Transverse processes
c) Levatores costarum – C7-T11; Tips of transverse processes
Upper Limb

Deep neck muscles
a)Rectus capitis posterior minor – post. tubercle C1, median part of infer. occipital b.
b)Rectus capitis posterior major – spinous processes C2, lateral part of inf. nuchal line
c)Superior oblique of the head – from transverse pr. C1
d)Inferior obliqueof the head – post. tubercle of post. arch of C1 transverse pr.

Innervation:
Suboccipital nerve ( dorsal ramus)

Action:
Of atlanto-occipital joints
Atlanto-axial joints
Upper Limb

Pectoralis major
Attach:

Between clavicle, sternum & ribs lateral tip of intertubercular groove of humerus

Action:

Adduction
Medial rotation
Flexion of humerus

Innervation:

Medial and lateral pectoral nerves: clavicular head (C5, C6); sternocostal head (C7, C8, T1)
Upper Limb

Serratus anterior
Attach:
Between ribs and medial border of scapula

Innervation:
Long thoracic nerve

Action:
Elevation of shoulder
Upper Limb

Deltoid muscle
Attach:
Proximal:
Posterior part – spine of scapula
Middle part – acromion
Anterior part – clavicle

Innervation:
Axillary nerve ( branch of posterior cord of branchial plexus)

Action:
Posterior part – extension & lateral rotationof arm
Middle part – adduction of arm
Anterior part – flexion & lateral rotation
Upper Limb

Rotator Cuff Muscles
A)Supraspinatus
B)Infraspinatus
C)Teres minor
D)Subscapularis
Attachment:
A)Supraspinal fossa of scapula
Superior facet on the greater tubercle of humerus
B)Infraspinal fossa of scapula
Middle facet of greater tubercle of humerus
C)Lateral border of scapula
D)Anterior fossa of scapula
Lesser tubercle of humerus

Innervation:
A&B)Suprascapular nerve (b. plexus)
C)Axillary nerve (poster. cord of b.plexus)
D)Subscapular nerve

Action:
A)Abduction of arm
B&C)Lateral rotation of arm
D)Medial rotation of arm
Upper Limb

Teres major
Attach:
Inferior angle of scapula
Medial lip of intertubercilar groove of humerus

Innervation:
Subscapular nerve ( b. plexus)

Action:
Adduction
Medial rotation of arm
Upper Limb

Axilla (armpit)
Pyramidal space between thorax & upper limb

Axilla provides a passage from neck and nerves supplying upper limb

Boundaries:
Apex:
enterence from neck; betw. 1st rib,clavicle, subscapularies
Base:
skin, subcutaneous tissue, axillary fascia

Anterior wall Pectiralis major & minor misscles
Posterior wall:
-Scapula muscle
-Subscapular muscle
-Latissimus dorsi muscle
-Teres minor muscle
Medial wall:
-Thorax
-Serratus anterior muscle
Lateral wall:
-Humerus;intertubercular groove
Upper Limb

Brachial Plexus (axilla)
Contents:

Branchial plexus (cords & branches)
Axillary blood vessels
Axillary artery + vein
Axillary lymph nodes
Upper Limb

QUADRANGULAR SPACE
Boundaries:

Superior:
Teres minor
Inferior:
Teres major
Medial:
Long head of Triceps branchii muscle
Lateral:
Surgical neck of humerus

Contens:
Axillary nerve
Posterior circumflex humeral artery
Upper Limb

TRIANGULAR SPACE
Boundaries:

Superior:
Teres minor
Inferior:
Teres major
Lateral:
Long head of Triceps branchii muscle

Contens:
Circumflex scapular artery
Upper Limb

BRACHIAL PLEXUS (Suprascapular part)

Part 1
Roots:
Ventral rami of last 4 cervical spinal nerves
1st thoracic nerve ( C5-T1)

Trunks:
In the inferior part of neck ( posterior triangle), between anterior & middle scalene muscles, the roots of the branchial plexus unite ti form 3 trunks:

Superior trunk:
Union of C5-C6 roots
Middle trunk:
Continuation of the C7 root
Inferior trunk:
Union of the C8 and T1 roots
Upper Limb

BRACHIAL PLEXUS (Suprascapular part)

Part 2
Cords:
Between clavicle and 1st rib
Each trunk divides into anterior & posterior
The division of the trunks form 3 cords:

Posterior cord:
Posterior division of all 3 trunks
Lateral cord:
Anterior div. of superior & middle trunks
Medial cord:
Anterior div. of inferior trunk

Supraclavicular nerves (branches) of branchial plexus


Dorsal scapular
Originates:
from C4-C5 roots
run along medial border of scapula
Innervates:
Levator scapular
Rhomboids major \ minor

Long thoracic nerve
Originates:
C5, C6-C7 rots
Runs to lateral wall of thorax of the surface of Serratus anterior muscle
Innervates:
Serratus anterior m.
Symptoms:
winglet scapula

Subclavian nerve
Originates:
Superior trunk
Posterior to clavicle
Innervates:
Subclavian muscle

Suprascapular nerve
Originates:
Superior trunk
Across the posterior triangle
Innervates:
Supraspinalis muscle
Infraspinalis muscle

Symptomes:
difficulties with abduction of arm
Upper Limb

BRACHIAL PLEXUS (Infraclavicular part)

Part 3
Lateral & medial pectoral nerves
Originates:
Lateral cord
Receiving fibers from C5, C6, C7
Innervates:
Primary pectoralis major
Pectiralis minor

Subscapular nerve
Originates:
Posterior cord of b.plexus
Innervates:
Subscapularis muscle

Thoracodorsal nerve
Originates:
Posterior cord of b.plexus
Runs inferolateral along the posterior axillary wall
Arises betw. upper &lower subscapular nerves
Innervates:
Latissimus dorsi

Axillary nerve
Originates:
Posterior cord
Leave axillary via posterior wall ( quadrangular space) around the surgical neck of humerus, deep to deltoid m. & teres minor
Give rise to superior lateral branchial cutaneous nerve
Innervates:
Deltoid m.
Teres minor
Glenohumeral joint
Skin of superolateral arm
Injury:
may be caused by fractures of the surgical neck of humerus or dislocation of the head of the humerus from the shoulder join
Symptoms:
Difficulties with abduction of shoulder joint
Area of anesthesia on the lateral surface of the shoulder
Upper Limb

BRACHIAL PLEXUS (Infraclavicular part)

Part 4
Long nerves of the infraclavicular branches of b. plexus

Posterior cord:
Radial nerve
Lateral cord:
Musculocutaneus nerve
Lateral rot of Median nerve
Median cord:
Ulnar nerve
Medial root of the median nerve
Medial brachial cutaneous nerve
Medial antebrachial cutaneous nerve
Upper Limb

Subclavian Artery

Part 1
Origin:
Right subclavian artery – brachiocephalic trunk
Left subclavian artery – arch of aorta

General course:
Passes over the apex of lungs (enclosed within the cupula of pleura)
Together with brachial plexus passes between clavicle and 1st rib (cervicoaxillary canal posteriorly to the anterior scalene muscle)
Enters the axilla and in the place of crossing with the lateral border of the 1st rib elongates in the axillary artery

Region of vasculature:
brain (mainly brainstems), spinal cord, neck, thorax and upper limb

Section of the subclavian artery:
-anterior scalene muscle divides the subclavian into three section:
1)medial to the anterior scalene muscle
2)posterior to the anterior scalene muscle
3)lateral to the anterior scalene muscle
Upper Limb

Subclavian Artery

Part 2
Branches of the first section

vertebral artery:
takes part in blood supply of spinal cord, brainstem, internal ear and occipital lobes of brain

internal thoracic artery:
takes part in blood supply of walls and organs of thorax
thyrocervical trunk
-inferior thyroid artery; takes part in blood supply of thyroid gland, trachea and esophagus
-suprascapular artery . supplies muscles on the posterior aspect of scapula
-transverse cervical artery; supplies posterior triangle of the neck



Branches of the 2nd section

Costocervical trunk:
-Superior (supreme) intercostals artery
-Deep cervical artery

Branches of the 3rd section

-Dorsal scapular artery: together with dorsal scapular nerve supplies the levator scapulae and rhomboids
Upper Limb

Axillary Artery

Part 1
Origin:
Elongation of the subclavian artery, begins in the place of crossing with the lateral border of the first rib

General course:
-Passes posteriorly to the pectoralis minor in the direction of the axilla
-Within axilla is surrounded by the cords of the brachial plexus
-End in the place of crossing with the inferior border of the teres major and passes in the brachial artery

Section of the axillary artery

Pectoralis minor muscle divides the axillary artery into three sections:
1)first – superior to the pectoralis minor
2)posterior to the pectoralis minor
3)inferior to the pectoralis minor
Upper Limb

Axillary Artery

Part 2
Branches of the 1st section

superior thoracic artery:
takes part in blood supply of two upper intercostal spaces

Branches of the 2nd section

thoracoacromial artery:
divides into 4 branches: acromial, deltoid, pectoral, and clavicular which supply correspsonding muscles and areas

lateral thoracic artery takes part in blood supply of lateral wall of thorax (Serratus anterior and breast)

Branches of the 3rd part

subscapular artery divides into 2 branches:
circumflex scapular and Thoracodorsal which supply Subscapularis, Infraspinatus, teres major, and Latissimus dorsi muscle

Anterior circumflex humeral artery

Posterior circumflex humeral artery:
runs with axillary nerve and takes part in blood supply of muscles surrounding the quadrangular space and deltoid
Upper Limb

Coracobrachialis
• Attachments
o Proximal
• Coracoid process scapula
o Distal
• Medial third of medial surface of humerus
• Innervation
o Musculocutaneous nerve which pierces its belly
• Main Action
o Flexion and adduction in the glenohumeral joint
o Resists downward dislocation of the head of the humerus especially during carrying
Upper Limb

Biceps Brachii (know the attachments)
• Its proximal part is divided into two heads
o Short head
o Long head
• Proximal attachment of the short head
o Coracoid process of scapula
• Proximal attachment of the long head
o Supraglenoid tubercle of scapula
o Its tendon occupies intertubercular groove and is situated within the shoulder joint
• Distal attachment of the entire muscle
o Radial tuberosity (tendon situated within the cubital fossa)
o Bicipital aponeurosis (flat fibrous membrane blended with cubital fascia covering cubital fossa)
• Action
o In glenohumeral joint
• Flexion (both heads)
• Adduction (short head)
• Abduction (long head)
• Resisting downward dislocation of the head of humerus especially during carrying heavy objects (long head)
o In the elbow joint
• Flexion of the forearm (only in supine position)
o In the radioulnar joints
• Supination of the forearm
o Bicipital aponeurosis
• Protection of the contents of the cubital fossa
• Innervation
o Musculocutaneous nerve
Upper Limb

Brachialis
• Attachments
o Proximal
• Distal half of anterior surface of humerus joint
o Distal
• Coronoid process and tuberosity of ulna
• Innervation
o Musculocutaneous nerve
• Action
o In the elbow join
• Flexion of forearm in all positions (both supine and pronate forearm)
Upper Limb

Triceps brachii
• Its proximal part is divided into three heads
o Long head
o Lateral head
o Medial head
• Proximal attachments of the long head
o Infraglenoid tubercle of the scapula
• Proximal attachment of the lateral head
o Posterior surface of humerus (above the radial groove)
• Proximal attachment of the medial head
o Posterior surface of humerus (below the radial groove)
• Distal attachment of entire muscle
o Olecranon of the ulna
• Action
o In the glenohumeral joint (only long head)
• Extension
• Adduction
• Resisting downward dislocation of the head of the humerus
o In the elbow joint
• Extension of the forearm (main extensor)
• Innervation
o Radial nerve
Upper Limb

Canal of the radial nerve
Situated on the posterior surface of the arm
• Boundaries
o Superior
• Lateral head of triceps brachii
o Inferior: medial head of triceps brachii
o Posterior: long head of triceps brachii
o Anterior: radial groove of the body of humerus
• Contents (Crucial to know)
o Radial nerve
o Deep artery of arm (branch of the brachial artery)
o Deep veins of arm (tributaries of the brachial vein)


Clinical significance of the radial nerve canal
• Symptoms of the palsy of the radial nerve is wrist-drop (because extensors of the wrist are paralyzed)
• Injury of the radial nerve in the canal of the radial nerve may be the result of:
o A fracture of the body of the humerus
o A compression of the nerve by heavy objects (IE, head laying on the arm during deep sleep – Saturday Night Palsy – too much alcohol and then sleeping on your arm)
Upper Limb

Anconeus
• Proximal attachment
o Lateral epicondyle of the humerus
• Distal attachment
o Olecranon of ulna
• Innervation
o Radial nerve
• Action
o Extension of elbow joint
o Stabilization of elbow joint
Upper Limb

Pronator teres
• Possesses two head in the proximal attachment (on the medial epicondyle of the humerus and Coronoid process of the ulna.)
• Distal attachment – middle part of radius
• In the elbow joint is a weak flexor
• In the radioulnar joint is a pronator
• Is supplied by median nerve which runs between its heads
Upper Limb

Flexor carpi radialis
• Proximal attachments
o Medial epicondyle of the humerus
• Distal attachment
o Base of 2nd metacarpal bone
• In the elbow joint is a weak flexor
• IN the radioulnar joint is a pronator
• In the wrist joint if a flexor and abductor of the hand.
• Supplied by the median nerve
Upper Limb

Palmaris Longus
• Proximal attachment
o Medial epicondyle of humerus
• Distal attachment
o Palmar aponeurosis
• IN the elbow join is a weak flexor
• IN the radioulnar joint is a weak pronator
• In the wrist joint is a flexor
• By tension of palmar aponeurosis may flex fingers in metacarpophalangeal joints
Upper Limb

Flexor carpi ulnaris
• Proximal attachment
o Medial epicondyle of the humerus
• Distal attachment
o Pisiform bone
• IN the eblow joint weak flexor
• IN the wrist joint is a flexor and adductor of the hand
• Supplied by the ulnar nerve
Upper Limb

Flexor Digitorum superficialis
• Possesses two head in the proximal attachment
o Humeroulnar: on the medial epicondyle of humerus and Coronoid process of ulna
o Radial: on the body of radius
• Distal attachment
o Middle phalanges of the 4 medial digits.
• Its tendons are pierced by the tendons of the flexor Digitorum profundus
• Action
o In the elbow joint is a weak flexor
o In the wrist joint is a strong flexor
o Flexes fingers in metacarpophalangeal and proximal interphalangeal joint
• Innervation
o Supplied by median nerve
Upper Limb

Flexor Digitorum profundus
• Proximal attachment
o Anterior surface of ulna and interosseous membrane
• Distal attachment
o Distal phalanges of medial 4 digits
• Its tendons pierce the tendons of the flexor Digitorum superficialis
• Action
o In the wrist joint is a flexor (only flexor of distal interphalangeal joints
o Flexes fingers in distal interphalangeal joints
• Innervation
o Lateral part (for 2nd and 3rd digits) is supplied by median nerve
o Medial part (for 4th and 5th digits) is supplied by ulnar nerve
Upper Limb

Flexor pollicis longus
• Proximal attachment
o Anterior surface of radius and interosseous membrane
• Distal attachment
o Distal phalanx of thumb
• Action
o In carpometacarpal joint of thumb – abduction
o In metacarpophalangeal and interphalangeal joint of thumb – flexion
• Innervation
o Median nerve
Upper Limb

Pronator quadratus
• Extended between the distal ends of the radius and ulna
• Action
o In the radioulnar joints is a pronator
• INnercation
o Branch of median nerve – anterior interosseous nerve
Upper Limb

Brachioradialis
• Attachments
o Proximal
• Lateral supracondylar ridge of humerus
o Distal
• Distal end of the radius
• Action
o In the elbow joint is a flexor
• Innervation
o Radial nerve
Upper Limb

Extensor carpi radialis longus
• Attachments
o Proximal
• Lateral supracondylar ridge of humerus
o Distal
• Base of 2nd metacarpal bone
• Action
o In the wrist joint is an extensor and abductor of the hand.
• Innervation
o Radial nerve
Upper Limb

Extensor carpi radialis brevis
• Attachments
o Proximal
• Lateral supracondylar ridge of the humerus
o Distal
• Base of 3rd metacarpal bone
• Action
o In the wrist joint is an extensor and abductor of the hand
• Innervation
o Radial nerve
Upper Limb

Extensor Digitorum
• Attachments
o Proximal
• Lateral epicondyle of the humerus
o Distal – tendons are linked by intertendinous connections
• Extensor expansion of medial 4 digits.
• Action
o In the wrist join is an extensor of the hand
o In the metacarpophalangeal joint is an extensor of 4 medial fingers
• Innervation
o Radial nerve – deep branch
Upper Limb

Extensor digiti minimi
• Attachments
o Proximal
• Lateral epicondyle of the humerus
o Distal
• Extensor expansion of 5 digit
• Actions
o In the wrist joint is an extensor of the hand
o In the metacarpophalangeal is an extensor
• Innervation
o Radial nerve – deep branch
Upper Limb

Extensor carpi ulnaris
• Attachment
o Proximal
• Lateral epicondyle of the humerus
o Distal
• Base of 5th metacarpal bone
• Action
o In the wrist joint is an extensor and adductor of the hand
• Innervation
o RADIAL NERVE – deep branch
Upper Limb

Abductor pollicis longus
• Attachment
o Proximal
• Posterior surfaces of the forearm bones and interossues membrane
o Distal
• Base of the 1st metacarpal bone
• Action
o IN the wrist joint – abduction
Upper Limb

Extensor pollicis brevis
• Attachments
o Posterior surfaces of the radius and interossues membrane
o Distal
• Base of the proximal phalanx of the thumb
• Action
o In the wrist joint . extension and abduction of the hand
o In the carpometacarpal joint of the thumb is an extensor
• Innervation
o Radial nerve
Upper Limb

Extensor pollicis longus
• Attachmetn
o Proximal
• Posterior surfaces of the ulna and interossues membrane
o Distal
• Base of the distal phalanx of the thumb
• Action
o In the wrist joint – extension and abduction
o In the carpometacarpal and interphalangeal joints
• Innervation
o Radial nerve
Upper Limb

Extensor indicis
• Attachment
o Posterior surfaces of the ulna and interossues membrane
o Distal
• Extensor of the 2nd digit
• Action
o In the wrist joint – enxtension of the hand
o In the metacarpophalangeal joint 2nd digit
• Innervaiton
o Radial nerve
Upper Limb

Supinator Muscle
• Situated in the floor of the cubital fossa
• Attachemtn
o Promxal
• Lateral epicondyle of the humerus, anular ligament and crest of ulna
o Distal
• Surrounds promxal end of radius
• Action
o IN radioulnar joints ia supinator (lateral rotation of the arm)
• Innervation
o Radial nerve – deep branch wchich pierces the supinator
Upper Limb

Cubital Fossa
• Boundaries
o Lateral
• Brachioradialis
o Medail
• Pronator ters
o Floor
• Brachilalis and supinator
o Roof
• Cubital fascia and bicipital aponeurosis
• Contents (important)
o Median nerve (in the central part of the cubital fossa)
o Radial nerve divided into superficial and deep branches (in the lateral part of the cubital fossa)
o Vessels
• Brachial artery and its division into readial and ulnar artery
• Brachial veins
o Cubital lymph nodes
o Superifically
• Superifical veins
• Cutaneous nerves
Upper Limb

Anatomical Snuff Box
• Situated in on the lateral side of the wrist, in the position of abduced thumb
• Boundaries
o Anterior
• Tendons of abductor pollicis longus and extensor pollicis brevis
o Posterior
• Tendon of extensor pollicis longus
o Floor
• Scaphoid and trapeziu bones
• Contents
o Radial artery and vein
o Superifical branch of the radial nerve
o Cephalic vein
• Clinical significance
o Fracture of the scaphoid bone results in pain in the region of anatomical snuff box