Upper Limb

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cephallic v
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basillic v
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median cubital v
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the anterior muscles of the upper limb are (flexors/extensors)
flexors
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the posterior muscles of the upper lumb are (flexors/extensors)
extensors
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shoulder abduction innervator spine
C5-6
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shoulder adductor innervator spine
C5-T1
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elbow flexion innervators spine
C5-6
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elbow extension innervators spine
C6-8
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wrist extension
C6
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wrist flexion
C7
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finger extension
C7
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finger flexion
C8
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finger ab/adduction
T1
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where lymph drains from the upper limb
lateral nodes
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what type of joint is the sternoclavicular
synovial saddle
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what type of joint is the acromioclavicular
synovial plane
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what typre of joint is the glenohumeral
synovial ball and socket
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joints that reinforce acromioclavicular joint
acromioclavcular lig and coracoclavicular lig
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proximal attachement of deltoid
lateral third of the clavicle, the acromion process, and the spine of the scapula
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functions of the deltoid
anterior fib: flex and medially rotate
middle fib: abduct 90*
post fibers: extend and laterally rotate
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what innervates the deltoid
axillary n
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action of supraspinatois
15* of abduction
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prox attachment of supraspinatous
supraspinous fossa
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distal attachment supraspinatous
greater tubercle of humerous
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what is the supraspinatoud innervated by
suprascapular n
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infraspinatous action
lateral rotation
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infraspinatous prox attachement
infraspinous fossa
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distal attachement infraspinous
greater tubercle of humerous
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innervation infraspinatous
suprascapular n
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prox attachement teres minor
lateral border of scapula
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distal attachement teres minor
greater tubercle of humerus
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action teres minor
lateral rotation
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innervation teres minor
axillary n
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rotator cuff muscles (x4)
teres minor, subscapularis, supraspinatus, infraspinatus
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prox attachment subscapularis
subscapular fossa
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distal attachemnet subscapularis
lesser tubercle of humerus
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function of subscapularis
medial rotation
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innervation subscapularis m
upper and lower subscapular n
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prox attachment serratus anterior
lateral surface of the first 8-9 ribs and intercostal fascia
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distal attachment serratus anterior
medial border of scapula
superior angle of the scapula
inferior angle pf the scapula
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action of the serratus anterior
180* abduction
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innervation of the serratus anterior
long thoracic
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teres major distal attachment
intertubercular sulcys
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teres major function
medial rotator, extension
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teres major innervation
lower subscapukar n
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what lives in the triangular space
circumflex scapular a
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what lives in the quadrangular space
axillary n
posterior circumflex
humeral a
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what lives in the triangular interval
radial n
profunda brachii a
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what defines the first section of the ax artery
first rib to pec minor
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what defies the second section of the ax artery
post to pec minor
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what defines the third section of the ax artery
inf to pec minor b/4 teres major
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what branches of the first part of the ax artery
superior thoracic a
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what branches off the second part of the axilary artery
thoracoacromial trunk
lateral thoracic a
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what branches off the third part of the axillary a
posterior circuflex humeral a
anterior circumflex humeral a
subscapular a
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origin pec major
Clavicular head: Anterior surface of the medial half of the clavicle
Sternocostal head:
Anterior surface of the sternum
Costal cartilages of ribs 2-6
Aponeurosis of the external oblique muscle
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insertion [pec major
Lateral lip of the intertubercular sulcus of the humerus
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action of pec major
adduction and flex arm
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innervation pec major
lateral and medial pectoral n
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origin pec minor
anterior surface of ribs 3-5
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insertion pec minor
medial border and superior surface of coracoid process of scapula
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action pec minor
protraction of scapula
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innervation of pec minor
medial and lateral pec nerves
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what are the boundaries of the axilla
anterior: pec muscles
posterior: subscapularis, teres major, latissimus dorsi
medial: serratus anterior
lateral: humerus
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what lives in the axilla
axillary a and v
brachial plexus
lymphatics
coracobrachialis
biceps brachii
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what are the roots brachial plexus
C5-T1
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what are the trunks of the brachial plexus
upper, middle low
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what are the divisions of the brachial plexus
aterior and posterior
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what are the cords of the brachial plexus
lateral posterior medoal
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what branches off the C5
dorsal scapular n
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what branches of the upper trunk
subscapular n
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what branches off the lateral cord
lateral pec n, musculociutaneous n, median n
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what are the spinal roots of the long thoracic n
C5-C7
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whatbranches off the posterior cord?
thoracodorsal n, upper subscapular n, lower subscapular n, radial n, axillary n
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what branches off the medial cord
medial pec n, medial brachial cutaneous n, medial antebrachial cutaneous n, ulnar n, median n
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nerve that innervates flexors of the brachium
musciulocutaneous
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nerve that innervates extesors of the brachium
radial n
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nerve that innervaytes flexors of the antebrachium
median and ulnar n
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nerve that innervates the extensors of the antebrachium
radial n
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what type of joint is the humeroulnar and humeroradial?
synovial hinge
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what type of joint is the prox radioulnar
synovial pivot
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this joint holds the radial head to the capitulum
anular ligament
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this is when the radial head is pulled out of the anular ligament
nursemaid's elbow (subluxation of the radial head)
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origin biceps brachii lobg heaf
sup glenoid tubercle
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insertion biceps brachii (long and short)
biceps aponeurosis and radial tuberocity
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innervation biceps brachii (long and short)
musculocutaneous
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fx biceps brachii long and short
flex arm and forearm, suppination
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origin biceps brachii short head
coracoid process
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coracobrachiallis origin and insertion
origin: coracoud process
insertion: medial humerus
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function of coracobrachiallis
flex arm
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innervation coracobrachiallis
musculocutaneous n
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brachiallis origin and insertion
origin: midshaft humerus
insertion: ulna
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brachiallis fx
flex forearm
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brachiallis innervation
musculocutaneous n.
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innervation triceps brachii and anoconeus
radial n
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origin long head triceps brachii
infraglenoid tubercle
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origin medial head triceps brachii
shaft of humerus
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origin latreral head of triceps brachii
shaft of humerus
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insertion of triceps brachii
olecranon of ulna
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fx long head of triceps brachii
extend shoulder
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fx medial and lateral head of tricepos brachii
extend elbow
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origin and insertion anconeus
origin lateral epicondyle
insertion ulna
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fx anconeus
assist in elbow flexion
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what is damaged to a fracture to the surgical neck?
axillary n
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what is damaged in a fracture to the midshaft
radial n
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what is damaged to a fracture to the distal humerus
radial n and ulnar n
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what is damaged to a medial epicondyle injury
ulnar n
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what can be damaged wit a greater tubercle fracture
supraspinatous
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what can be damaged witj an injury to the lesser tubercle
subscapularis
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what lives in the cubital fossa (x3)
tendon of biceps brachii
brachial a.
median n.
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distal radioulnar joint type
synovial plane
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radiocarpal joint type
synovial condyloid
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distal interphalangeal and proximal interphalangeal joint type
hinge
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metacarpo-phalangeal type
condyloid
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carpometocarpal and intercapal joint type
plane synovial
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1st carpal metacarpal joint type
saddle joint
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insertion and origin pronator teres
origin: medial epicondyle
insertion: radius
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origin and insertion flexor carpi radialis
origin: common flexor tendon
insertion: base 2nd metacarpal
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origin and insertion flexor carpi ulnaris
or: common flexor tendon
in: 5th metacarpal and carpal bones
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origin and insertion palmaris longus
origin: common flexor tendon
insert: palmar aponeurosis
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fx pronator teres
pronation
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fx flexor carpi radialis
radial deviation
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fx: palmaris longus
flexes wrist joint
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fx flexor carpi ilnaris
ulnar devation
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innervation of pronator teres, flexor carpi radialis, palmaris longus
median n
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innervation flexor carpi ulnaris
ulnar n
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origin and insertion flexor digitorum superficialis
or: medial epicondyle, radial head
insert: middle phalanx of 2-5
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fx flexor digitorum superficialis
flexes middle phalanx at the interphalangeal joint
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innervation of flexor digitorum superficialis
median n.
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or and insert (FDP) flexor digirorum profundus
or: ulna
insert: distal phalanges digits 2-5
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flexor pollicis longus origin and insertion
or: radius
in: thumb
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pronator quadratus or and insert
or: radius
in: ulna
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flexor pollicis longus fx
flexes DIP joint
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flexor digitorum profundus fx
flexes DIP joints
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innervation flecor pollicis longus and flexor digitorum profundus
median n.
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innervation flexor digitorum profundus
medial half innervated by ulnar n
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what lives in the carpal tunnel
tendons of flexor digitorum superficialis, profundus, and tendon of flexor pollicis longus, median n
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or and insertion brachioradialis
or: above medial epicondyle
in: radius
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or and insert extensor carpi radialis longus
or: common extensor tendon
in: base of 2nd metacarpal
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or and insertion extensor carpi radialis brevis
or: common extensor tendon
insert: base third metacarpal
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innervation brachioradialis, extensor carpi radialis longus and brevis
radial n
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or and insert extensor digitorum
or: common ectensor tendon
in: digits 2-5 dorsum
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or and insertion extsnsor digiti minimi
or: extensor digitorum
insert: 5th digit
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or and insertion extebnsor carpi ulnaris
or: common extensor tendon
insert: base 5th metacarpal
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innervation extensor digitorum, extensor digiti minimi, extensor carpi ulnaris
radial n
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what arteries run the anterior forearm
radial to radial recurrent
ulnar to ulnar recurrent and common interossus to anterior and posterior interosseus
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or and in supinator
or: lateral epicondyle
in: radius and ulna
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action supinator
supinates forearm
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or and insertion abductor pollicis longus
or: interroseus membrane and radius
insert: thumb
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action abductor pollicis longus
abduct thumb
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or and insertion extensor pollicis brevis
or: interroseus membrane
insert: prox phalynx of thumb
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or and insert extensor pollicis longus
or: ulna
insert: distal phalynx of thumb
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action extensor pollicis longus and brevis
extend thumb
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or and insertion extensor indicis
or: ulna
insertion: distal phalynx 2nd digit
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action ectensor indicis
extend 2nd digit
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what innervates the muscles of the deep posterior forearm: supinator, abductor pollicis longus, extensor pollcis brevis, extensr pollucis longus, extensor indicis
radial n
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this is where muscles in the extensor compartment of the hand insert into and helps give find motor control to the digits
extensor hood
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what is the artery that supplies the posterior forearm; what does it branch from?
poisterior interosseus artery; common interosseus of ulnar a.
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this is the name for the deep fascia of the hand that covers the palmar brevis muscle
palmar aponeurosis
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name for the hand muscles that act on the thumb
thenar muscles: flexor pollicis brevis, abductor pollicis brevis, opponens pollicis
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or and insertion flexor pollicis brevis
or: flexor retinaculum
in: thumb
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or and insertion abductor policis brevis
or: flexor retinaculum
insert: thumb
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or and insertion opponens pollicis
or and insertion on the thumb
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hand muscles that act on the 5th digit
hypothenar muscles: flexor digiti minimi brevis, opponens digiti minimi, abductor digiti minimi
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or and insert flexor digiti minimi brevis and abductor digiti minimi
orL flexor retinaculum
insert: 5th digit
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opponens digiti minimi origin and insert
5th digit
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or and insert adducxtor pollicis
or: third betacarpal
insert: thumb
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actions adductor pollicis
adduct thumb
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origin and insertion lumbricals
or: tendons of FDP
insert: dorsal hood
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actions lumbricals
flex MP joint
extend IP and DIP joints
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innervation lumbricals
1 and 2nd median nerve
3rd and 4th ulnar n
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or and insert dorsal interossei (Dabs)
or: metacarpals
insert: dorsal hood
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action dorsal interossei (dabs)
abduct fingers at MP joints
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palmar interossei (pads) or and insert
or: metacarpals
insert: dosral hood
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palmar interossei (pads) action
adduct figers at MP joint
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what is the major contrbuter to the superficial palmar arch
ulnar artery
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what is the major contributer to the deep palmar arch
radial a.
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what innervates the hypothenar muscles
ulnar n
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what innervates the adductor pollicis m
ulnar n
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what innervates the interossei (Dabs and Pads)
ulnar n
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what lives in the guyon's tunnel and can be impinged
ulnar n and artery: palmar arches branch before this so palmar n wont be fdamaged here but superficial and deep ulnar effected
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what innervates the opponens pollices?
median n
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what innervates the anductor pollicis brevis and flexor policis brevis
median n
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sensory btranch of median n that innervates skin of lateral palm
superficial palmar branch
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what two tendons line the snuff box
lateral: EPB
medial: EPL
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what lives in the snuff box
radial artery
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what does this show?
disloacation of the sternoclavicular joint
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what does this show?
collie's fracture: fracture of the dorsa;l radial head
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a condition where multiple peripheral nerves throughout the body are damaged, leading to a range of symptoms
polyneuropathy
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a physical exam test used to assess for nerve damage or compression. It involves tapping over a nerve, and a positive result is when the patient experiences tingling or "pins and needles" sensations in the area supplied by that nerve.
tinel's sign.
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a break in the neck of the fifth metacarpal bone, located in the hand near the pinky finger. It typically occurs when someone punches something with a closed fist, often a hard object or another person's face.
boxer's fracture
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what is damaged in klumpke's palsy?
lower trunk ofd brachial plexus
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what does pain in the shoulder indicate (reffered pain)
from peritonitis, gall bladder inflamations, hepatic abscess, pericarditis, pleurisy
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what does pain in the chest wall and medial left upper limb indocate
reffered pain from heart
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pathological thickening and shortening of the longitudinal bundles of the
palmar aponeurosis; draws fingers (usually digits 4 & 5) into palm to such a degree that they become
useless. Can mimic an ulnar claw since it commonly affects digits 4 & 5
dupuytren contracture
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hairlkine fracture to the hook of the hamayte, pain/tenderness in the palm or wrist
golfer's wrist
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reconstruction of a torn ulnar collateral ligament; carries serious risk of injury to
the ulnar nerve as it passes posterior to the medial epicondye
tommy john surgery
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tests the integrity of communication between the ulnar and radial arteries in the
hand; pt will make a tight fist and the radial and ulnar arteries are compressed at the wrist with
your fingers, the pt opens the hand (it should appear pale); the ulnar compression is removed →
if the circulation is intact, normal color will return in a few seconds, if the hand remains pale it
indicates that ulnar circulation to the hand is insufficient
Allen's test
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where is sympathetic innervatuon fro the upper lumb from
T2-7
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entrapment of the median nerve between heads of the pronator
teres (or fibrous bands of FDS); signs/symptoms are pain in proximal forearm
pronator syndrome
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Results in paresthesia of lateral 3 1/2 fingers and distal portion of palm (region
of palm innervated by the palmar cutaneous br. of median nerve is spared since
this nerve DOES NOT pass through the carpal tunnel) with paresis (weakness) in
flexion, abduction and opposition of the thumb, wasting of the thenar eminence,
and loss of the grasp reflex
carpal tunnel syndrome
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acute brachial plexus neuritis; bilateral in 20% of pts
b. most commonly affects long thoracic nerve, musculocutaneous n and axillary
c. etiologies: diabetes, lupus, viral infection, immunizatio
parsonage turner syndrome
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press thumb onto patient’s carpal tunnel for 30 seconds; pain or paresthesia in
median nerve territory is a positive test – this is the most sensitive test for carpal tunnel
syndrome!
durken's test
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chronic inflammation at the common origin of the forearm extensor
muscles, especially ECRB; pt presents with pain over lateral elbow; may lead to entrapment of the
posterior interosseus nerve (see radial tunnel syndrome, above)
lateral epicondylithis (tennis elbow)
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inflammation at the common origin of the forearm flexor muscles;
pt presents with pain over medial elbow, PE = pain with forearm flexion against resistance
medial epicondylithis (golfer's elbow)
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damage to extensor expansion; results in flexion of middle and
extension of distal phalange
boutonniere deformity
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partial avulsion of extensor tendon; flexion of distal phalanx
mallet finger
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stenosing tenosynovitis involving flexor tendon; results in “clicking” during
flexion/extension
trigger finger
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tearing of the flexor digitorum profundus tendon from the distal phalanx (from
getting your finger caught in the neck of someone’s jersey); affected finger is stuck in extension
Jersey finger
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