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Zumpano Gross II

NYCC midterm Zumpano Spring 2010

4 characteristics of first week of development Fertilization, Cleavage, Implantation, Blastocyst
1st FCIB first week: fertilization, cleavage, implantation, blastocyst
Second week of development- reorganization of the __________ into a ___________embryonic germ disk. blastocyst, bilaminar (2-layered)
2 layers of bilaminar embryonic germ disk of 2 week (2 week; 2 layer) HYPOblast, EPIblast
Third week first step primitive streak formation
In the third week, the primitive streak forms and the epiblast cells proliferate into the ___________ area (of the bilaminar disk). What is this migration of epiblast cells moving south? hypoblast (invaded) by epiblast - called DISPLACEMENT
The newly arrived epiblast cells which displaced the hypoblast form the ____________. endoderm
The epiblast cells move/displace down into the hypoblast cells, causing the formation of Endoderm. The third step is the proliferation of epiblast cells into the space between the epiblast and endoderm. These cells form the ____________- Mesoderm (middle)
The endoderm forms from epiblast cells descending into hypoblast and displacing them (inner). Mesoderm cells form from epiblast moving into space between epiblast and endoderm (Middle). Where does Ectoderm come from? Remaining epiblast!
4 stages of GASTRULATION: 1-primitive streak, 2-epiblast descends into hypoblast, displaces, forms ENdoderm, 3-epiblast cells move between endoderm and epiblast itself, form MEsoderm, 4-remaining epiblast cells form eCTOderm
primitive streak, epiblast forming endoderm, mesoderm, ectoderm are stages of Gastrulation (3rd week)
What are stages of gastrulation and what week? 3rd, primitive streak, epiblast forms endoderm, mesoderm, ectoderm
synonym for prechordal plate neural plate
How does the notochordal process and prechordal plate form? Newly formed MESOderm (middle) cells migrate through the primitive streak like a highway, knot up and condense along midline to form notochordal process and prechordal plate.
Where does the notochordal process and prechordal plate come from? mesodermal cells migrate along primitive streak, knot up/condense along midline to form the notochordal process and prechordal plate.
Is the notochordal process the same thing as the Notochord? No, the n. process forms the Notochord
Where is the Notochord? In the mesoderm - it is going to entrain the overlying ectoderm to develop into different things
What forms the Notochord? the notochordal process
What forms the Neural plate? the prechordal plate
When the mesoderm forms the notochordal process and prechordal plate, the two eventually approximate each other. What happens? inductive changes occur that trigger the formation of the neural plate in the ectoderm overlying the notochord
The notochordal process (mesoderm) becomes the notochord
The notochord stimulates the conversion of overlying __________ into neural tissue (going from prechordal plate to neural plate) ectoderm
The notochord entrains (influences the prechordal plate of ectoderm) to become Neural plate (neural tissue)
The notochord specifies the fate of certain cells within the nervous system (entrainment/induction) but very importantly instigates the development of ___________- SOMITES!
what instigates the development of somites? Notochord (old epiblast-mesoderm-nochordal process)
Induction of the ectoderm overlying the notochord produces the neural plate
what does the neural plate do? gives rise to most of the CNS
what gives rise to most of the CNS? Neural plate (old epiblast-prechordal plate)
The neural plate is made of ectoderm overlying the notochord and used to be called the prechordal plate. Now it needs to form into a tube. How does the neural plate form a neural tube? What is process called/ Neurulation: invagination of neural plate (still under influence of notochord)
why does it make sense that the neural plate of ectoderm would be the most sensible choice to form the CNS and not the notochord? notochord is busy forming middle structures (dermatomes, myotomes, scerotomes) while neural plate is most dorsal, like the coming spinal cord and brain - so it forms the CNS, not the container for it!
3 types of mesoderm paraxial, intermediate, lateral plate
paraxial mesoderm is where? either side of notochord (axis)
intermediate mesoderm is inbetween paraxial and lateral plate mesoderm
lateral plate mesoderm forms body wall, musculature
3 parts of the SOMITE dermatome, sclerotome, myotome
what initiates the formation of somites? notochord!
three parts of somites dermatome, sclerotome, myotome
3 types of mesoderm paraxial, intermediate, lateral
what does the lateral plate mesoderm form? body wall, musculature
the initiation of _________ development begins in the 34 day old embryo limb bud
Limb development begins on day 34 along the ___________ aspects of the body wall ventrolateral
Which develops first, the upper or lower limb? upper (think Hensen's node isn't down there yet)
******first type of mesoderm present in limb bud LATERAL PLATE MESODERM
similar to how the notochord is made from mesoderm and induces the overlying ectoderm to form the neural plate but does not, itself, become the spinal cord, the core plate of lateral mesoderm is surrounded by _____________ and will induce it to become? ectoderm, Apical Ectodermal Ridge
Once the Apical Ectodermal Ridge has been formed via induction of underlying lateral plate mesoderm, limb bud formation will henceforth be controlled by the Apical Ectodermal Ridge (AER)
Apical Ectodermal Ridge (AER) controls entire formation of limb bud
Once the AER is induced into being by the underlying lateral plate mesoderm, roles reverse and the AER begins to induce the underlying mesoderm to increase mitosis and grow the limb bud!
The _____________ forms a progressive zone that controls and organizes the proximodistal development of the limb bud. What are we talking about here and what does this mean? AER, determines ventral and dorsal sides (limb bud has axial line dividing front and back)
By day 40, there are defined somites, foot and hand _________, although the foot is still slightly behind in development. paddles
Differentiation of limb bud occurs during weeks 5 and 8
What day is the development of human hands and feet complete? 56! Day 56-ALL DONE!
Day 56 all done! complete development of upper and lower limbs in human
the process of cell death to form the digits is called ___________ and occurs as the ______ degenerates. apoptosis (programmed cell death), AER
Apical Ectodermal Ridge dysfunctions result in dysmorphologies (wrong growth)
failure of programmed cell death (apoptosis) causes syndactyly (webbing/together digits)
more than 4 AER zones causese the dysmorphological event of polydactyly (most common is bifid thumb - remember: 6 digits is the dominant gene!)
lack or incomplete formation of the AER by the ectoderm upon induction by lateral plate mesoderm Amelia (no limbs)
Amelia no limbs (failure of AER to fully develop and therefore fully function)
are combination AER dysmorphologies possible? yes
teratogens dangers to fetus
when are teratogens dangerous to the fetus and why? after first two weeks, blood of mother and fetus mixes and CNS develops (ectoderm) so anything she does, the baby does (alcohol, pills, etc.)
critical period the time during a structure's growth that is most susceptible to teratogens (dangers)
If mother exposes herself to teratogens in first two weeks (fertilization through blastulation, no gastrulation), what happens? spontaneous abortion if problem develops in first two weeks
what week is the embryo considered a "fetus" week 9
how does the limb bud grow? lateral plate mesoderm inducts AER, then AER inducts mesoderm, then AER directs overall shape and schedule of future limb
differential growth affects fetus how? dorsal half grows faster than ventral, thus the inward "fetus" rotation/curling of limbs causing them to occupy a position along the ventral body wall
What does not have to migrate into the limb bud because it is already there? Lateral plate mesoderm -gives rise to connective tissue, bones and some blood vessels
What cells DO migrate into the developing limb bud (except Lateral Plate Mesoderm, which is already present)? Myoblasts from somite to form limb muscles, Neural Crest cells migrate to form pigment cells, Lower Motor Neuron axonal sprouts from ventral horn cells migrate from neural tube
Name the 4 types of cells in the developing limb bud, and tell which of the 4 migrate: 1-lateral plate mesoderm (no migration), 2-myoblasts from somite to form limb muscles, 3-neural crest cells for pigment, 4-LMN's from ventral horn cells in neural tube
cells which give rise to muscles in the entire body myotome cells
cells which migrate from the somite and form limb muscles myoblasts
type of mesoderm which forms the body wall/musculature and is already present in the limb when it begins to develop/form the AER lateral plate mesoderm
cells which migrate into the limb bud and form melanocytes/pigment cells neural crest
sprouts from ventral horn cells that migrate from the neural tube, following the migrating mass of muscle tissue at each somite level Lower Motor Neuron Axonal Sprouts
general name for the cells which migrate into the limb bud from the myotome and form the limb musculature Myogenic cells (muscle growing cells)
The remains of the myogenic cells in the myotome form the ______________ and the ___________. hypomeres (hypaxial mm.) and epimeres (epaxial mm.)
hypaxial muscles are formed from the remaining myogenic cells in the myotome
Hypaxial mm. are innervated by ventral primary rami
epaxial mm. are innervated by dorsal primary rami
somatopleuric lateral plate mesoderm is involved in the development of limb muscles
_____cells mature into myoblasts when they reach the limb bud and coalesce into two masses. myogenic
upper limb: ventral mass forms flexors and pronators (on the front of arm, anatomically)
upper limb: dorsal mass forms extensors and supinators (on the back of arm, anatomically)
lower limb: ventral mass forms flexors (ie, hamstrings, gastrocnemius) and adductors
lower limb: dorsal mass forms extensors (ie, quadriceps, tibialis anterior) and abductors
after myogenic cells mature into myoblasts when they reach the limb bud and coalesce into the ventral and dorsal muscles masses, ____________ from ventral horn cells grow to their respective masses axonal sprouts from ventral horn cells
upper limb segments C4-T2
lower limb segments L1-S2
somite levels associated with upper limb C4-T2
somite levels associated with lower limb L1-S2
trapezius innervation (Inv) Spinal Accessory IX, ventral rami C3,C4
trapezius spinal levels (splvs) 3, C4*, spinal portion IX
trapezius blood supply (bld) superficial branch of transverse cervical artery
latissimus dorsi inv. thoracodorsal n. (brachial plexus C6-C8)
latissimus dorsi splvs. C6*, C7*, 8
latissimus dorsi bld. thoracodorsal artery
levator scapulae inv. dorsal scapular nerve, ventral rami C3-C4
levator scapulae splvs. C3*,C4*,C5* (all equal)
levator scapulae bld. deep branch of transverse cervical artery
rhomboideus minor and major inv. dorsal scapular nerve
rhomboideus minor and major splvs. 4, C5*
rhomboideus minor and major bld. deep branch of transverse cervical artery
deltoideus inv. axillary n.
deltoideus splvs. C5*, 6
deltoideus bld. thoraco-acromial artery, deltoid branch of circumflex humeral a.
subscapularis inv. upper and lower subscapular nerves
subscapularis splvs. 5, C6*, 7
subscapularis bld. Suprascapular a., Subscapular a.
supraspinatus inv. suprascapular n.
supraspinatus splvs. 4, C5*, 6
supraspinatus bld. suprascapular a.
infraspinatus inv. suprascapular n.
infraspinatus splvs. C5*, 6
teres minor inv. axillary n.
teres minor splvs. C5*, 6
teres minor bld. suprascapular a.
infraspinatus bld. (3) suprascapular, circumflex scapular, posterior humeral circumflex a.
teres MAJOR inv. lower scapular n.
teres MAJOR splvs. 5, C6*
teres MAJOR bld. (2) posterior humeral circumflex a., thoracodorsal a.
pectoralis MAJOR inv. medial & lateral pectoral nerves (remember the branch between them?)
pectoralis MAJOR splvs. 5, C6*, C7*, C8*, T1 (all of them!)
pectoralis MAJOR bld. pectoral branch of thoraco-acromial trunk
pectoralis minor inv. medial & lateral pectoral nerves (remember the branch between them?)
pectoralis minor splvs. 6, C7*, 8
pectoralis minor bld. pectoral branch of thoraco-acromial trunk
subclavius inv. nerve to subclavius!
subclavius splvs. C5*, C6*
subclavius bld. (2) clavicular branch of thoraco-acromial trunk, subclavian a.
serratus anterior inv. long thoracic n.
serratus anterior splvs. 5, C6*, C7*
serratus anterior bld. lateral thoracic artery
what destroys linear somite levels and turns it into the dermatome organization we see in the adult? rotation of the upper and lower limbs inward
quadricep muscles are _______ (ventral or dorsal) muscle mass, due to 180 degree rotation to medial leg position for bipedalism. dorsal
what divisions of brachial plexus (anterior or posterior) supply all the dorsal muscle masses? posterior (due to medial rotation, it does not appear so)
Rotation and ___________ growth of the limbs results in a patterning of the dermatomes. differential
a _________ is skin innervated by a single spinal cord level dermatome
base of neck and laterally over shoulder (dermatome level) C3 and C4
lateral aspect of arm (dermatome level) C5
lateral aspect of forearm and thumb (dermatome level) C6
middle and ring fingers and middle of the posterior surface of the forearm (dermatome level) C7
little finger, medial aspect of hand and forearm (dermatome level) C8
medial aspect of middle of the forearm to axilla (dermatome level) T1
skin of the axilla, perhaps some bit of the arm (dermatome level) T2
what dermatome map do we use? Foerster (1933)
injuries to primary ventral rami where only a SINGLE spinal cord level is affected radiculopathy
how many levels of the spinal cord when an injury to the primary ventral rami results in radiculopathy? SINGLE
chemical radiculitis is a __________ @ a vertebral level stenosis
radiculopathy at C5 would include that dermatome and all the muscles innervated by C5 (lateral rotators of shoulder and supinators)
what is an entrapped nerve AWAY from the midline called? peripheral neuropathy
carpal tunnel syndrome is entrapment of the median nerve at the wrist - what kind of pathology is this? peripheral neuropathy
The _________ nerve supplies deltoid and teres minor muscles. Axillary
If the Axillary nerve supplies the deltoid and teres minor muscles, in what spinal levels does the Axillary nerve travel? C5*, 6
Since deltoideus and teres minor are supplied by C5*, 6 (axillary n.), we could conclude they come from C5*, 6 _________ levels. somite
Axillary n. entrapment is not so much of a skin problem and there is no problem with supination. C5* found in supination with skin involvement. Which of these is a radiculopathy and which is a peripheral neuropathy? Axillary n. is peripheral neuropathy (entrapment away from midline) and C5* is radiculopathy (includes skin dermatome and muscles innervated by that level - C5)
loss of innervation to the skin from damage to a single nerve may only involve a small part of a dermatome. Why? neighboring dermatomes overlap extensively
Are dermatomes static or variant from patient to patient? variant ('nothing is set in derma-stone')
Peripheral cutaneous nerves supply many dermatomes, thus they contain nerve fibers from multiple spinal levels
insertion of latissimus dorsi floor of intertubercular groove
Latissimus dorsi myotome muscle cells migrated out from the ____ ___________. C6 somite - an example of MRS (Muscle/Myotome Reflex Sensory)
why wouldn't injury to C8 produce marked weakness in the latissimus dorsi? It is innervated by C6*, C7*, and 8 ventral rami, but 8 is not a major contributor
weakest part of humerus surgical neck
how many facets does the greater tubercle of humerus have? for what? 3 - for Supraspinatus, Infraspinatus, Teres minor
is teres major an intrinsic or extrinsic shoulder muscle intrinsic, along with SITS muscles
when abducting the shoulder, which muscle lifts the first 15 degrees? supraspinatus (then deltoideus takes over to 90 degree level)
insertion of subscapularis muscle lesser tubercle of humerus
action of subscapularis MEdial rotation of humerus only
type of loading that puts a muscle at its weakest point eccentric
what muscle initiates abduction of the glenohumeral joint? supraspinatus
what are the two actions of supraspinatus? initiates abduction of glenhume, laterally rotates the humerus when DEcelerating the arm in a throwing motion
why is decelerating the arm in a throwing motion with lateral rotation and abduction dangerous to the supraspinatus? eccentric contraction stretched fully so weakest
what myotome controls lateral rotation and abduction of the shoulder (SITS, deltoids) C5*
what myotome controls medial rotation and ADDuction @ the shoulder (subscapularis, latissimus dorsi, teres major)? c6*
what does the subscapularis NOT do? (that you might think it would) adduct- the subscapularis is a MEDIAL ROTATOR only
upper lateral brachial nerve is a branch off? Axillary (swing the Axe Up) C5
lower lateral brachial nerve is a branch off? Radial nerve C6 (remember radial bone is under C6 dermatome)
triangular space of shoulder contents circumflex scapular a.
quadrangular space of shoulder contents axillary n., posterior humeral circumflex a.
triangular interval space of shoulder contents radial n. and profundus brachii a.
upper lateral brachial cutaneous is a skin nerve branch off axillary (C5)
when the scapula has a hollow, dished-out appearance, which nerve is entrapped? suprascapular n. (C5*, 6) because of spinoglenoid notch
at what levels may the suprascapular nerve become entrapped? C4,C5,C6
what structures may entrap the suprascapular n. (super 4.5.6)? suprascapular notch, spinoglenoid notch
C5 injury affects what major nerve? axillary
C5 injury affects what major muscles? deltoideus and teres minor
what two things might cause axillary n. entrapment? ventrolateral scapula (winging) & quadrangular space
C5 is axillary, ventrolateral scapula, quandrangular space, deltoids and teres minor
C6 muscles teres major, subscapularis, supinators
C6 is axillary (not as much as C5), ventrolateral scapula, quadrangular space, teres major, subscapularis, supinators (C6 is at the end of the throw, decelerating and medially rotating both the humerus and wrist)
which level is the end of the pitch/ C6
two main nerves supplying the skin of the arm axillary (C5) and radial (C6)
5 nerves supplying anterior cutanteous innervation of arm supraclavicular (C3,4 shoulder and prox hume), upper lateral brachial cutaneous (C5-swing the axe Up), intercostobrachial (T2-axe), medial brachial cutaneous (C8, T1 inside upper arm), lower lateral brachial cutaneous (C6-RADIAL over radius)
where is the intercostobrachial cutaneous nerve of the anterior arm? jutting out from T2 at serratus anterior on cadaver
what nerve is between the upper lateral brachial cutanteous n. and lower lateral brachial cutaneous n. on cadaver? intercostobrachial (T2)
identify the peripheral nerve that supplies the C5 dermatome upper lateral brachial cutaneous (C5 -swing the axe UP)
identify dermatomes supplied by lower lateral brachial cutaneous n. C5, C6*(radial), C7
what two nerves in addition to the 5 that supply the anterior cutaneous arm are added to the posterior arm? posterior brachial cutaneous n. (C8, T1 radial) & posterior antebrachial cutaneous n. (C6,C7 radial)
why would posterior brachial cutaneous n. (C8, T1) and posterior antebrachial cutaneous n. (C6,C7) be supplied by radial nerve? because the radial wraps around the humerus in the T1 dermatome (posterior brachial cutaneous), goes through T2 (lateral head of triceps) and innervates radial bone area for lower lateral brachial cutaneous (C6, C7) and lower lateral antebrachial (C6,C7)
MRS C5 nerve root reflex Biceps brachii
action of biceps brachii muscles weak flexor when supinated, supinaor and pronator of forearm when elbow approaches 90deg
L for Lateral is L for Long head of Biceps brachii inserting into supraglenoid tubercle
spinal level Biceps brachii C6
what is the 3 joint muscle of arm biceps brachii
Nerve of Biceps brachii Musculocutaneous (BBC)
artery of biceps brachii brachial artery
Nerve that pierces Coracobrachialis and divides for arm below spiral groove Musculocutaneous
Nerve of Coracobrachialis Musculocutaneous (BBC)
spinal level Coracobrachialis C6
insertion Coracobrachialis medial surface of middle humerus
primary impingement muscle for golf and tennis is ______________nerve musculocutaneous
smallest of anterior compartment muscles of arm Coracobrachialis
artery of Coracobrachialis Brachial artery
origin Brachialis distal half anterior humerus
insertion Brachialis ulnar tuberosity and ant. surface of coronoid process of ulna
spinal level brachialis C6
innervation brachialis Musculocutaneous (BBC)
action of brachialis flexes the forearm at the elbow in any position
controlled relaxation during extension of forearm to gently place a glass upon the table BRACHIALIS
most powerful forearm flexor brachialis
arterial supply to brachialis brachial artery
peripheral entrapment of what nerve is at coracobrachialis or space between biceps brachii and brachialis? Musculocutaneous (BBC)
symptoms of Musculocutaneous nerve entrapment, either at the coracobrachialis or between the biceps brachii and brachialis? forearm numbness, weak flexion/adduction
The Musculocutaneous n. becomes the Lateral antebrachial cutaneous nerve
The Lateral Antebrachial cutaneous nerve is derived from Musculocutaneous (C6)-BBC
peripheral entrapment of Lateral Antebrachial Cutaneous N. (formerly Musculocutaneous n.) is where and what are symptoms? Between biceps brachii and brachialis, weak forearm flexion, lateral forearm numbness
The arteries you don't know Anterior Ulnar Recurrent between pronator teres and brachialis, POsterior Ulnar Recurrent anastamoses with superior ulnar collateral
The Inferior Ulnar Recurrent anastamoses with what artery below it? Anterior Ulnar Recurrent
The Posterior Ulnar Recurrent anastamoses with what artery above it? The Superior Ulnar Recurrent
Which is deeper, the anterior interosseous artery of forearm or the posterior interosseous artery? posterior interosseous artery is deep
what does the suprascapular nerve innervate? supraspinatus and infraspinatus
In the deep dissection of the anterior arm, what nerve is lateral to median nerve? Musculocutaneous (BBC)-6
In the deep dissection of the anterior arm, what nerve is medial to Median nerve? Ulnar nerve
What nerve runs with Profunda Brachii artery? Radial nerve
What artery runs with Ulnar nerve? Superior Ulnar Collateral artery and Inferior Ulnar Collateral artery
What artery runs with the Median nerve? Brachial artery
what artery is on the lateral anterior arm? Radial collateral artery (above middle collateral that dives behind lateral epicondyle of humerus)
What nerve does Musculocutaneous become? Lateral Antebrachial Cutaneous n.
The BBC doesn't LAC anything! Musculocutaneous 6(BBC) becomes Lateral Antebrachial Cutaneous n.
origin of long head of triceps brachii infraglenoid tubercle of scapula
origin of medial head of triceps brachii posterior humerus UNDER radial groove (postero-medial surface) and medial intermuscular SEPTUM
origin of lateral head of triceps brachii posterio-lateral humerus and lateral intermuscular SEPTUM
innervation of Triceps Radial (C7/8)
spinal levels of triceps C7, C8 equally
long head of triceps both stabilizes the glenohumeral jt and extends the humerus at the glenohumeral jt.
arterial supply of triceps deep brachial artery
what is wrong with calling the medial head of triceps as such? It is not medial; it is deep.
which muscle helps stabilize the elbow and is a synergist for triceps extension? Anconeus!
Describe the cutaneous nerves of arm supraclavicular-superior lateral brachial cutaneous around deltoid-intercostobrachial @axilla-medial brachial cutaneous under ICB-inferior brachial cutaneous over spiral groove-medial antebrachial cutaneous over ulnar-lateral antebrachial cutaneous 2thumb
name of vein between inner Basilic and outer Cephalic at cubital fossa? Median cubital vein
what vein connects the Basilic to the Cephalic vein? Median cubital vein (MVC)
Does the cephalic vein continue along the lateral forearm or become something else? It continues as the Cephalic, alongside the lateral antebrachial cutaneous nerves
What becomes of the Basilic vein of the anteromedial forearm? Nothing - it stays the Basilic vein and runs alongside the medial antebrachial cutaneous nerves
At the Median Cubital Vein (MVC), what arises? the MEDIAN ANTEBRACHIAL VEIN (mav)
Describe the Veins from anterior and posterior hand to Basilic and Median Antebrachial Vein merger on medial forearm (Moore, pg. 417) Proper palmar digitals between fingers to Superficial venous palmar arch , perforating veins, and Dorsal venous network to Cephalic (lateral) & Basilic (Medial) at post wrist merge to anterior forearm. From SVPA the Median Antebrachial Vein to Basilic.
Describe Cephalic vein beginning at cubital fossa (Moore, pg. 417) Cephalic on lateral forearm splits with Median Cubital vein in cubital fossa. Cephalic continues lateral arm to dive into Clavipectoral triangle. Merges with Axillary vein to subclavian to brachiocephalic vein to superior vena cava.
Describe Basilic vein beginning just below medial epicondyle (Moore, pg. 417) Basilic most medial forearm merges with Median Antebrachial Vein then Median Cubital Vein @ cubital fossa. Basilic dives deep @ musculotendinous biceps short head level, and is joined by Brachial branches at axilla level. Merges with Cephalic.
Describe superficial cubital fossa Cephalic vein with Lateral Antebrachial Cutaneous Nerve. Median Cubital vein to Median Antebrachial vein. Basilic vein with Medial Antebrachial Cutaneous Nerve
Describe BOUNDARIES of superficial cubital fossa Brachialis-tendon forms the floor, Lateral epicondyle to Medial epicondyle line, Brachioradialis-lateral border, Bicipital aponeurosis-roof, Brachial Artery & Vein, Median Nerve, Pronator Teres-medial border
Medial (ulnar)border of superficial cubital fossa Pronator Teres muscle
Artery and Vein of superficial cubital fossa Brachial Artery and Vein
Nerves of superficial cubital fossa Median N., Lateral Antebrachial Cutaneous N., Medial Antebrachial Cutaneous N. (Wikipedia: Cubital fossa)
Tendon that forms the floor of superficial cubital fossa Brachialis muscle tendon
Roof of superficial cubital fossa Bicipital aponeurosis
Lateral (radial) border of superficial cubital fossa Brachioradialis muscle
superior (proximal) boundary of superficial cubital fossa an imaginary horizontal line connecting the medial epicondyle of the humerus to the lateral epicondyle of the humerus
Nerves of DEEP cubital fossa, starting from lateral Radial N. divides to Superficial branch and Deep branch. Musculocutaneous sneaks out between brachialis and long head of biceps. MeidaN N. runs with brachial a/v down middle. Ulnar N. descending most medial along "funny bone"
Arteries of DEEP cubital fossa, starting from Brachial artery Brachial artery has Inferior Collateral artery split off right below Superior Collateral artery. Brachial dives under biciptial aponeurosis and splits into Radial artery with Radial Recurrent artery to lateral, Ulnar artery to medial (Moore, pg 443)
are there any veins listed in Zumpano's deep cubital fossa? no
Muscles of DEEP cubital fossa Brachioradialis (looking under), Extensor carpi radialis longus and brevis, Pronator teres, Flexor carpi radialis, (biceps brachii visible but not listed)
spinal levels of RADIAL nerve C5-8, sometimes T1 from posterior cord (All!)
Where does the Radial nerve travel once it becomes a division of the brachial plexus? (Rob Thomas Drinks Cold Beer) behind the subclavian artery as the posterior cord, giving off Upper Subscapular nerve, Thoracodorsal nerve and Lower Subscapular nerve. After pectoralis minor, divides into Axillary n. and Radial n., with both going around behind the humerus.
What muscle divides the axillary nerve from the Radial nerve branches, as they both go around to the back of the humerus from their posterior cord origin? The insertion of Latissimus Dorsi in the Intertubercular groove of humerus
What pathway does the Radial nerve travel along the humerus? the spiral groove, baby
What muscles does the Radial nerve separate as it emerges in the deep cubital fossa? Brachioradialis from Brachialis <vs. musculocutaneous that sneaks out between brachialis and long head of biceps brachi, just above Radial nerve emergence>
What happens to the Radial nerve after it separates the Brachioradialis from Brachialis? Just below the lateral epicondyle, Radial splits into Superficial branch of radial n. and Deep branch of radial n.
Which branch of the radial nerve is cutaneous and which is motor, when the radial n. splits just distal to the lateral epicondyle? Superficial branch of radial nerve=cutaneous, Deep branch of radial nerve=MOTOR
Deep branch of radial n. is ________ to the forearm. MOTOR
Where can the Radial nerve become entrapped? (2) Spiral groove, Emergence between Brachialis and Brachioradialis
You are looking at a person's forearm to wrist. What do you see as landmarks? bulge from flexor mm. and pronator teres, Palmaris Longus tendon at wrist (medial), Flexor Carpi Radialis tendon at wrist (lateral), radial styloid process, ulnar styloid process
Describe the cutaneous (peripheral)innervation of the forearm C6 (posterior antebrachial cutaneous and superficial branch of radial nerve), T1 (lateral antebrachial cutaneous), C8 (medial antebrachial cutaneous and dorsal cutaneous branch of ulnar nerve)
Describe the dermatome innervation of the upper extremity C4 acromial, C5 deltoid to lateral epicondyle, C6 brachioradialis plus middle forearm to 1.5 digits (thumb to middle of index), C7 trident from cubital fossa to digits 2-4, C8 medial epicondyle to pinky, T1 inside elbow, T2 inside arm to axilla, T3 axilla
describe bony anatomy of ULNA ULNA: coronoid process, ulnar tuberosity, head, styloid process, radial notch, trochlear notch, olecranon process, SUPINATOR CREST, interosseous crest
describe bony anatomy of RADIUS RADIUS: head, neck, radial tuberosity, interosseous crest, Lister's (dorsal) tubercle, styloid process
Describe anterior compartment organization of forearm flexors/pronators, Median n., Anterior Interosseous n.
Describe posterior compartment organization of forearm extensors/supinators, Posterior Interosseous n., Deep Branch of Radial n., Radial n.
How many muscles does the Median n. innervate in the arm? none, it only innervates the antebrachium
Which nerve is exclusive to the arm? Musculocutaneous
Which nerve is exclusive to the forearm? Median
Median nerve is formed by what two cords? Lateral cord for lateral root, Medial cord for medial root
cervical levels that contribute to Median n. C5-T1 (All!)
Job of Median n. wrist flexors and thenar muscles
wrist flexors and thenar muscles are innervated by what nerve? Median (exclusive to forearm)
What muscle does the Median nerve pass through at the level of the cubital fossa? pronator teres
What vein is the Median n. running alongside when it passes through the pronator teres? Median antebrachial vein
Is there a reflex for Median n.? no
How do we test the Median n.? perform wrist flexion (Median is for flexors and thenars)
After passing through the cubital fossa and pronator teres, where does the MEdian n. travel? Gives off deep branch called Anterior Interosseous Nerve, then runs between FDS and FDP. Passes through carpal tunnel to enter hand, and gives off branches to supply to the hand called Recurrent Branches of Median N.
Pronation & Supination are perfomed by the _________, not the wrist/hand. forearm
3 nerves of anterior forearm Median, Anterior Interosseus n. (deep branch of median), Ulnar
Superficial muscles of anterior forearm (4) Pronator teres, Flexor carpi radialis, Palmaris longus, Flexor carpi ulnaris
Intermediate muscle of anterior forearm Flexor digitorum superficialis
Deep muscles of anterior forearm (3) Flexor digitorum profundus, Flexor pollicis longus, Pronator quadratus
Innervation of deep forearm flexor muscles: Flexor pollicis longus -anterior interosseous n., Flexor digitorum profundus (digits 2-3)-anterior interosseous n., Flexor digitorum profundus (digits 4-5)-Ulnar n., Pronator quadratus- anterior interosseous n.
origin Pronator teres (2) Humeral head: medial epicondyle, Ulnar head: coronoid process
insertion Pronator teres midway along lateral surface of radius
action Pronator teres pronation of forearm
innervation Pronator teres Median n.
spinal level Pronator teres C7
What happens to the Pronator teres when force or speed is needed? A secondary pronator is recruited
origin Flexor Carpi radialis medial epicondyle
insertion FCRadialis base of the 2nd and 3rd metacarpal
action FCRadialis (3) flexes 2nd carpo-metacarpal joint and the hand at the wrist, radial deviation (aBduction) with extensor carpi radialis, steadies the hand with Flexor carpi ulnaris.
innervation FCRadialis Median n.
spinal level FCRadialis C7
origin Palmaris longus medial epicondyle
insertion Palm long flexor retinaculum and the palmar aponeurosis
action Palm long tenses the palmar aponeurosis and weakly flexes the wrist
innervation Palm long Median n.
spinal level Palm long C8
origin Flexor Carpi Ulnaris (FCUlnaris) medial epicondyle, medial aspect of the olecranon process, posterior border of the ULNA
insertion FCUlnaris (3) pisiform, hamate, base of 5th metacarpal
action FCUlnaris flexes the 5th carpo-metacarpal joint, aDDuction of the hand (Ulnar deviation) with extensor carpi ulnaris, steadies the wrist with flexor carpi radialis
innervation FCUlnaris Ulnar n.
spinal levels FCUlnaris C7,C8 (FCU -class of '78)
At the intermediate level of the forearm, the only muscle? Flexor Digitorum Superficialis (FDSuper)
orgin of FDSuper (2) humero-ulnar head: medial epicondyle and coronoid process of ulna, radial head: anterior surface of radius below/distal to radial tuberosity
insertion of FDSuper 4 tendons which insert to 8 fingers (spinal innervation is C8, too!) at the base of each middle phalange on either side. Make the peace sign at your second knuckle - that's how FDSuper attaches
action of FDSuper! Powergrip flexor! Flexes the proximal interphalangeal joints and metacarpo-phalangeal joints (first and second knuckles)
FDsuper is the Powergrip flexor for 8 (digits and is spinal level C8) repeat... FDSuper is the Powergrip flexor for 8!
Name the deep flexors of anterior forearm Flexor Pollicis Longus, Flexor Digitorum Profundus (included in deep muscles is Pronator Quadratus)
origin Flexor Digitorum Profundus Upper 3/4 of the antero-medial aspect of the ulna and ulnar half of the INTEROSSEOUS membrane
insertion Flexor Digitorum Profundus after its 4 tendons pass through the split of FDSuper! 8 Powergripper, FDprofundus' tendons emerge at the middle phalanges and insert at the bases of the distal phalanges of all 8 proper "fingers", not thumbs.
Innervation of Flexor Digitorum Profundus (2) Lateral two digits (2-3) is Anterior Interosseous n. (deep branch of median). Medial digits (4-5) is Ulnar nerve
spinal level of Flexor Digitorum Profundus same as FDSuper - C8
action of Flexor Digitorum Profundus flexes the DIPs (distal interphalangeal joints) after the PIPs (that were flexed by FDSuper first). Gentle grip/fine flexor. Weak wrist flexor
Which muscle provides the finesse of a gentle grip, as in turning the page of an ancient and profound parchment of sacred writing? Flexor Digitorum Profundus - the gentle gripper
When all fingers are flexed into a grip, what relaxes (besides the other guy's bowels)? What if only one finger is flexed, as in making the OK sign? extensor tendons relax if all fingers flex but provide antagonistic extension if only one finger is flexed
If patient can make perfect OK sign, then what nerves are fine and dandy? anterior interosseous n. (deep branch of median) and the Ulnar n.
If patient makes a triangular shaped OK sign, what nerve and what muscle? Patient cannot fully flex Flexor Digitorum Profundus (ie, the tip of fingers 2-3 won't curl to meet thumb) and spinal level C8. This may or may not be right muscle, but it is the right nerve. Write your own cards!
If a patient can make a round OK sign but cannot hold fingers together when you pull them apart, which nerve is culprit? Ulnar
lumbricals "worm" - extension off FDSuper!
origin Flexor Pollicis Longus (FPlongus) has 2 origins radial head: anterior surface fo the radius and INTEROSSEOUS memebrane, humeral head: medial epicondyle and coronoid process of the ulna
insertion FPlongus base of distal phalanx of thumb (remember there are only 2 bones in thumb, not 3)
action of FPlongus flexes the IP joint and MCP joint of the thumb (ie, both joints of the thumb)
innervation of FPlongus anterior interosseous n. (deep branch of median n)
spinal level of FPlongus you got it - C8. Same as FDSuper! and FDProfundus.
4 muscles of anterior forearm with spinal level C8 FDSuper!, FDProfundus, FPlongus, ProQuad
Pronator quadratus origin (ProQuad) distal 1/4 of anterior ulnar surface
ProQuad distal 1/4 of anterior radial surface
Why would ProQuad insert on radius, not ulna? because pronation means pulling insertion towards origin/radius towards ulna
Innervation of ProQuad anterior interosseous n. (deep branch of median)
action of ProQuad MAIN PRONATOR OF FOREARM. ProTeres is recruited for forceful, rapid pronation.
Why does it makes sense for ProQuad, not ProTeres, to be the main pronator of the forearm? ProQuad is a right angle (hence "quad"), vs. ProTeres long oblique axis
spinal level ProQuad C8
Describe the course of the Median nerve Runs alongside brachial artery. Divides biceps brachii from brachialis, gives articular branch, then pops thru heads of ProTeres. Ant.Interosseous n. & Palmar Cutaneous branches. carpal tunnel. Hand: recurrent, common palmar digital, proper palmar digital
List Median nerve branches Median: Articular branch, Anterior interosseous n., Palmar Cutaneous branch, (carpal tunnel), Recurrent branch, Common palmar digital branch, Proper palmar digital branch
Describe the muscles innervated by the Median nerve itself superficial and intermediate forearm flexors: pronator teres, flexor carpi radialis, palmaris longus, FDSuper!
Which superficial forearm flexor is NOT innervated by median n.? What is its innervation? Flexor Carpi Ulnaris, Ulnar n.
which septa can entrap the Median n? Medial intermuscular septa (arm)
Describe forearm sites of entrapment for Median n. (5) Pronator teres, FDSuper!/FDProfundus tunnel, ProQuad and the Anterior interosseous n., CARPAL TUNNEL (it's the only nerve in it), FPbrevis/AbdPbrevis due to recurrrent median nerve
Which nerve branch of Median n. helps you rule in or out more distal entrapment sites of the Median n.? Palmar Cutaneous n. (branch of median)
Is Palmar Cutaneous branch of median nerve affected by entrapment? no
Describe the interosseous membrane and related structures between radius and ulna along crests. Posterior, Common, & Anterior interosseous membranes studded with nutrient arteries
describe the surface anatomy of the palm Hypothenar eminence (2 muscles), Thenar eminence (2 muscles), interdigital folds between fingers
name carpal bones scaphoid, lunate, triquetral with pisiform, hamate with hamulus, capitate, trapezoid, trapezium
1.5 muscles of anterior forearm supplied by Ulnar n. 1/2 FDProfundus (medial) and whole FCUlnaris (FCU class of '78)
Everything in anterior forearm is supplied by ______________ or the _____________nerves, execept for FDProfundus medial half and FCU entirely by the Ulnar n. Median nerve or Anterior Interosseous n. (deep branch of median n.)
what is the only muscle of anterior forearm that does not go under the flexor retinaculum? PL-pollicis longus
9 tendons, 1 nerve carpal tunnel
the carpal tunnel has ___tendons and ___nerve 9:1
9 tendons and 1 nerve of carpal tunnel 4 FDS, 4FDP, 1FDL and Median n.
syngergistic wrist flexors/deviators working with their extensor relatives, neither of which flexors run through the carpal tunnel FCRadialis & FCUlnaris, synergists that don't run through the carpal tunnel
medial 1.5 digits are supplied by Ulnar n.
Lateral 3.5 digits are supplied by Median n.
what spinal level supplies middle (3rd) digit? C7
name of canal for Ulnar nerve, similar to carpal tunnel for median n.? Canal of Guyon
Base of thumb is supplied by Superficial branch of Radial n.
what nerve of the forearm finally ends at the wrist? Lateral Antebrachial Cutaneous n.
what protects the thenar and hypothenar branches of Median and Ulnar nerves? nothing
Does the palmar aponeurosis protect the Ulnar and Median Palmar branches over the thenar and hypothenar areas? no, it does NOT -that's why chiros can get injured as well as carpenters, etc.
function of palmar aponeurosis, if not to protect nerves? protects against frictional torsion and protects the guts of the hand
From where are the Proper palmar digital nerves derived? Superficial branches of Median and Ulnar nerves
Nerves between branches of flexor retinaculum are nerves that supply a SINGLE side of a digit Proper Palmar Digital Nerves from superficial branches of ulnar and median nn.
origin of the palm palmar aponeurosis and flexor retinaculum
innervation of superficial palm superficial branch of Ulnar n.
where does the palm insert? skin on the ulnar side of palm
spinal levels of palm C8,T1 (I see you will live to be 81 from your palm lines)
action of palm wrinkles and tenses skin over the hypothenar eminence
muscle of superficial hypothenar Palmaris brevis
muscle of superficial middle of palm Palmaris longus
prevents "bowstringing" of flexor tendons in wrist flexor retinaculum
shifts moment-arm of extensors and flexors origin to the wrist so actually increases the strength of flexion flexor retinaculum
Flexor Retinaculum attaches medially to ____ and laterally to ____? medially: hamulus of hamate and pisiform, laterally: scaphoid and trapezium
the ONLY muscle supplied by superficial branch of Ulnar n. via the Canal of Guyon Palmaris Brevis
supplies palm superficial branch of Ulnar n.
supplies intrinsic hand muscles DEEP branch of Ulnar n.
name the external carpals pisiform, hamate, scaphoid, triquetral, trapezium
name the internal carpals capitate, lunate, trapezoid
nerve supplying intrinsic hand muscles DEEP branch of Ulnar n.
weakness in intrinsic hand muscles signal DEEP branch of Ulnar n. entrapment
roof of carpal tunnel flexor retinaculum
lateral boundary of carp tunnel tubercles of scaphoid and trapezium
medial boundaries of the carp tunnel (what can you feel) hook of hamate and pisiform
floor of carp tunnel palmar Ulnocarpal and palmar Radiocarpal ligaments
9 tendons, 1 nerve carp tunnel: 4FDS, 4FDP, 1FPlongus, Median n.
do either flexor carpi ulnaris or radialis sit in carpal tunnel? no
which flexor prone to tenosynovitis FCRadialis, which can displace carp tunnel and Median n.
what are between the carpal bones, connecting them to one another? interosseous ligaments, i.e., capitate-hamate
Describe the Canal of Guyon Flexor Carpi Ulnaris, Ulnar n. and Ulnar artery
what carpal bone is just outside/lateral to the Canal of Guyon for the Ulnar n, Ulnar artery, and Flexor Carpi Ulnaris? pisiform
where does blunt trauma neuropathy occur at the pisiform? Canal of Guyon with Ulnar n. contusions
Using the heel of the hand to bang things into place or using a mouse and leaning on the pisiform bone will cause trauma to the canal of Guyon (Flexor Carpi Ulnaris, Ulnar n., Ulnar a.)
Describing the arteries of palm deep to the palmar aponeurosis but at the superficial level @ wrist, Ulnar artery and Radial artery both split into SUPERFICIAL & DEEP branches, with the superficial Ulnar supplying 80% of blood to hand. The Superficial Palmar Arch of Ulnar Artery supplies digits 1-4, anastamosing with the SBofRA at index.
The ____________palmar branch of the __________artery supplies common palmar digital arteries, which then turn into Proper palmar digital arteries Superficial, Ulnar (80%)
What supplies the other 20% of blood supply to palm? Superficial Palmar branch of Radial Artery
What supplies the thumb and lateral index finger with blood? The DEEP palmar arch supplies the Princeps pollicis artery to thumb.
What is the radial contribution to the superficial palmar branch called? Superficial Palmar branch of Radial artery
what makes up the entire superficial palmar arch? Superficial palmar branches of Radial (20%) and Ulnar (80%) arteries.
What nerves join in the palm? Median and Ulnar via Recurrent Branches of Median n.
How do the Median and Ulnar nerves meet in the palm? via the RECURRENT branches of the Median n.
all the muscles of the palm have spinal levels ____ and ___ C8 & T1
3 thenar muscles of Palm Abductor Pollicis Brevis (APB), Flexor Pollicis Brevis, Opponens Pollicis
3 Hypothenar muscles of the Palm (the 3 mini me's) Abductor Digiti Minimi, Flexor Digiti Minimi, Opponens Digiti Minimi
Central (deep) group of Palmar muscles (The Isle of Palms was discovered in 1443) Adductor pollicis, 4 Lumbricals, 4 Dorsal Interossei, 3 Palmar Interossei
All the muscles except 4 of the palm are innervated by the Deep branch of the Ulnar n.
What 4 palmar exceptions are NOT innervated by the deep branch of the ulnar nerve? What nerve does innervated these 4 exceptions? Abductor Pollicis Brevis (AbPB), Flexor Pollicis Brevis, Opponens Pollicis, 1st and 2nd Lumbricals:MEDIAN NERVE
Why would the 4 palmar exceptions to Ulnar n. innervation be likely innervated by the Median nerve instead? Because they are all on lateral hand, which is MEDIAN nerve territory!
Name the 4 palmar exceptions to the Ulnar n. rule: Abductor Pollicis Brevis, Flexor Pollicis Brevis, Opponens Pollicis, 1st and 2nd Lumbricals
Name the superficial thenars from widest to smallest Abductor Pollicis Brevis is the big honker in the meat of the thumb, Opponens Pollicis peeks out from the most radial/lateral edge but underneath AbPB, it is large and flat, Flexor Pollicis Brevis sits right on top of AbPB and is long and thin.
If pollicis is in the name, it is probably ___ C8
If pollicis is in the name, it is probably ___ C8
*spinal levels of thenar and hypothenar muscles T1
*spinal levels of thenar and hypothenar muscles T1
spinal level of Lumbricals T1 (Median nerve for 2-3, Deep branch of Ulnar for 4-5)
C8 dermatome covers the little finger; what is the myotome T1
name the two opponens muscles Opponens pollicis (C8) and Opponens digiti minimi (T1)
What nerve separates the Abductor pollicis brevis from Flexor pollicis brevis Recurrent branch of Median n.
origin AbPB flexor retinaculum and tubercle of trapezium (same as FBP)
insertion AbPB base of proximal phalanx of thumb
Innervation of AbPB Recurrent branch of Median n. (separates AbPB from FPB)
spinal level/myotome of AbPB C8 (If it's pollicis, it's probably C8)
action AbPb abducts the thumb
Flexor Pollicis Brevis has pollicis in the name so it's probably C8
Origin FPB (2, where one is stressed in the notes) deep head: trapezoid and capitate, superficial head: flexor retinaculum and tubercle of trapezium (stressed)
what two pollicis muscles orginate on the flexor retinaculum and tubercle of trapezium AbPB and FPB
insertion of FPB base of proximal phalanx of thumb
innervation of FPB Recurrent branch of Median N. (separates AbPb from FPB)
spinal levels of FPollicisB C8 (If it has pollicis in the name, it's probably C8)
action of FPB flexes both joints of thumb
flexion of thumb is different from abduction how? flexion pulls thumb across palm while abduction pulls away from median plane (gripping a jar)
origin of Opponens POllicis flexor retinaculum, scaphoid and trapezium
insertion Opponens Pollicis OP entire length of lateral border of metacarpal bone (opponens is on the bonens)
innervation! of OP! (how does this affect weakness/carpal tunnel) Recurrent branches of Median n. (sometimes deep branch of Ulnar n.) so there is no overt weakness for carpal tunnel syndrome due to compensation from deep branch of Ulnar nerve
spinal level of OP C8 (if it has pollicis in the name, it's probably C8)
action OP opposes the thumb to other fingers (picture it rolling the thumb internally and medially vs. the actions of FPB and AbPB)
What nerve can compensate for overt weakness due to carpal tunnel syndrome and the irritation of the Recurrent branches of the Median nerves? Deep branch of Ulnar n.
origin AbDMini pisiform and tendon of FCUlnaris
insertion AbDMini base of proximal phalanx of 5th digit
innervation of AbDMini deep branch of Ulnar n.
spinal level of Abductor Digiti Minimi T1
action of AbDMini abducts the little finger
where do the lumbricals attach? dorsal digital expansion/EXTENSOR HOOD
they may flex the MCP's (knuckles) & extend the IP joints by helping to bring the hand OUT of a fist (karate chop!) lumbricals
origin lumbricals four tendons of FDProfundus
insertion lumbricals radial side of dorsal digital expansion/extensor hood of 2-5
innervation lumbricals 2-3 Median, 4-5 Deep branch of Ulnar
spinal levels lumbricals T1 (all 4 are T1)
action lumbricals flex MCP (knuckles) and extend IP's (fingers)
origin of Adductor Pollicis (AdP) oblique head: capitate and bases of 2nd and 3rd metacarpals, transverse head: palmar surface of 3rd metacarpal
insertion of AdP common insertion on ulnar side of base of the proximal phalanx of the thumb
innervation AdP Deep branch of Ulnar n.
spinal level AdP T1 (exception to the rule on the thumb side!)
action AdP adducts the thumb
is AdP a thenar muscle? no
what is AdP's classification: thenar or intrinsic hand? What is the difference in spinal level and innervation between intrinsic hand and thenar? AdP is an intrinsic hand muscle, therefore spinal level is T1 (not C8 like pollicis muscles) and is innervated by Deep branch of Ulnar n. (not like pollicis is recurrent branch of median nerve)
what spinal level supplies all intrinsic hand muscles? T1
what spinal level supplies all pollicis muscles C8
what spinal level supplies AdP? What kind of muscle is it? T1, intrinsic hand
when does the Radial artery become the Deep Palmar Arch after it crosses pronator quadratus and curves around the thumb metacarpal
Deep palmar arch of Radial carries ____% of blood, while Deep palmar arch of Ulnar carries ___% of blood in hand Deep palmar radial=20%, Deep palmar ulnar=80%
princeps pollicis splits into a proper palmar to ________, and a proper palmer to the medial side of __________ thumb, index finger
What do proper palmar digital arteries anastamose with? PALMAR METACARPAL ARTERIES (heading down and back into hand at knuckle level on palm side)
action of palmar interossei muscles? 3 Palmar interossei ADduct (3PAD) towards the middle finger. Adduct 5,4 and 2 towards middle finger
Palmar interossei adduct the digits and assist the lumbricals. Which digit is still standing when 3PAD works? Middle finger! Palmar interossei adduct 5,4 and 2 towards middle finger
The palmar interossei _______ the palm of the hand, while the dorsal interossei _________ the dorsum of the hand. 3PAD adduct palm while dorsal aBduct (4DAB)
3PAD vs. 4DAB? 3PAD= 3 palmar interossei adduct palm via 5,4 & 2, 4DAB=4 dorsal interossei abduct dorsum of hand
sign of ulnar entrapment involving palm hollowing out of palmar interossei (3PAD) because innervated by deep branch of Ulnar n.
innervation of 3PAD deep branch of Ulnar n.
spinal level of 3PAD T1 (because they are 1ntrinsic hand muscles)
all 1ntrinsic hand muscles are spinal level T1 1ntrinsic
which finger doesn't have 3PAD? middle (3rd digit)
4DAB? 4 Dorsal interossei aBducting 1ntrinsic hand muscles
what muscles would you use to make the Star Trek Vulcan sign? 4DAB because the aBduct the 4 digits away from center, then use the 3PAD to bring index to middle and pinky to ring fingers.
4DAB are intrinsic hand muscles so spinal level? T1 1ntrinsic
4DAB innervation Deep branch of Ulnar n.
spinal levels of Musculocutaneous n. C567 Musculo
spinal levels of Radial n. all (C5678,t1)
name the 3 nerves of roots C5,6,7 in order from origin outward long thoracic n., lateral pectoral n., musculocutaneous n.
what dermatomes for posterior forearm and back of hand? C6 (radial side includes thumb and index from elbow), C7 (middle finger), C8 (ring and pinky), T1 (ulnar side from elbow to styloid process of ulna)
The entire posterior forearm and dorsum of hand are innervated by Radial n., Ulnar n., and a little Musculocutaneous n. Where on the hand does the rogue Median nerve jump in? 2nd knuckles to tips of thumb, index, middle and half of ring
a lesion on the lateral antebrachial cutaneous skin dermatome can be traced back to what trunk? upper for Musculocutaneous
you must know the spinal levels in each of the main nerves of the brachial plexus and the dermatomes vs. the myotomes
what does the superficial portion of the Radial n. innervate? cutaneous palm over thumb and index (remember it curls around to the back of the thumb so goes dorsal)
cutaneous fingertips 1-3 are supplied by what nerve Median n.
cutaneous fingertips 4-5 are supplied by what nerve Dorsal Cutaneous br. of Ulnar n.
what nerve supplies superfical fingertips 4-5 dorsal cutaneous br. of Ulnar n.
dcbun45 dorsal cutaneous branch of ulnar nerve (supplies superficial fingertips 4-5)
primary myotome of thumb (primary spinal cord innervation) C8
describe the grooves on the dorsum of the distal end of radius B/w styloid process and Lister's tubercle: groove for ECRL & ECRB and EPL next to Lister's tubercle. B/w Lister's tubercle and medial edge that meets ulna: grooves for ED & Extensor Indicis (accessory extensor of index finger)
Muscle that sits in space where radius and ulna articulate at the wrist, but that does not sit in a groove, per se, on a bone? Extensor Digiti Minimi
Describe grooves on ulnar head at wrist There is only one groove between the styloid process of ulna and it's articular head: the groove for Extensor Carpi Ulnaris
what happens to the Radial nerve as it enters the posterior arm? It winds around radial groove, becomes lateral, then splits into posterior interosseous n. and deep branch of Radial n.
describe organization of anterior forearm flexors/pronators, Median n., Anterior Interosseous n., Interosseous membrane
describe organization of posterior forearm extensors/supinators, Radial n., Posterior Interosseous n., Deep Branch of Radial n., Interosseous memebrane
what is the muscle test for P.I.N. entrapment (Posterior Interosseous Nerve)? extend each digit
superfical layer muscles of post forearm (3 groups with 3 nerves): Radial: Anconeous,Brachioradialis,ECRLongus (to index)...Deep Branch of Radial: ECRBrevis (to middle finger)...Posterior Interosseous Nerve (PIN): ExD, ExDMini, ExCU
how are the 3 groups of superficial muscles grouped in relationship to the lateral epicondyle? 3 muscles above ExRB are all innervated by Radial n. (Anc, Brachioradialis, ECRLongus). ECRBrevis is the divider and is the only superficial innervated by Deep Branch of Radial n. Most distal 3 are innervated by PIN: ExD, ExDMini, ExCU
Radial (most medial) to Deep Branch of Radial to PIN (most lateral) - name the 7 muscles in this order: R: anconeous, brachioradialis, ExCRLongusDBRn.: ExCRBrevis (divider)PIN: ED, ExDMini, ExCU
what superficial post forearm muscles are innervated by PIN Extensor Digitorum, Extensor Digiti Minimi, Extensor Carpi Ulnaris - the three furthest away from common extensor origin
name the middle divider superficial post forearm muscle and its innervation Extensor Carpi Radialis Brevis divides the upper 3 (Radial) and lower 3 (PIN). ECRBrevis is innervated by the Deep Branch of Radial n.
superficial PIN muscles of posterior forearm Extensor Digitorum, Extensor Digiti Minimi, Extensor Carpi Ulnaris
3 nerves of post forearm radial, deep branch of radial, PIN
deep muscles of post forearm innervated by deep branch of radial n. supinator
deep muscles of post forearm innervated by PIN Abductor pollicis brevis, Extensor pollicis brevis, Extensor pollicis longus, Extensor Indicis
through what muscle does the PIN exit on it's way through the posterior antebrachium? supinator, which is innervated by the deep branch of the radial nerve!
anconeus origin lateral epicondyle of humerus
anconeus insertion lateral side of olecranon + shaft of ulna. Joint capsule of elbow
anconeous action assists triceps brachii and extends elbow joint capsule during extension
anconeus spinal level 7-8-1
anconeus innervation radial nerve
what forms the lateral border of the cubital fossa? Brachioradialis
origin brachioradialis upper 2/3 lateral SUPRACONDYLAR ridge of humerus
uppper 2/3 lateral supracondylar ridge of humerus gives origin to what muscle? Brachioradialis!
insertion brachioradialis lateral aspect STYLOID process of ulna
origin and insertion of brachioradialis (short form) SUPRACONDYLAR : STYLOID (brachioradialis)
action brachioradialis SUPERCONDYLAR:STYLOID muscle? flexes semiprone forearm
innervation brachioradialis Radial nerve
what muscles does the Radial nerve separate? Brachialis and brachioradialis
why would it make sense for brachioradialis to have spinal level C6? because it is a forearm FLEXOR (flexors are 6)
where does extensor carpi radialis longus attach? base of 2nd metacarpal
origin ECRlongus lower 1/3 of lateral supracondylar ridge (with brachioradialis;-)
why are ECRlongus and ECRbrevis thusly named? ECRLongus starts from up higher, on the lower 1/3 of the supracondylar ridge of humerus, wherears ECRbrevis begins on the lateral epicondyle of humerus (lower than s.c. ridge)
insertion of ECRLongus base of 2nd metacarpal (index)
insertion of ECRbrevis base of 3rd metacarpal (middle)
innervation of ECRLongus Radial n., same as brachioradialis and same general origins
ECRLongus spinal level 6,7
why does it make sense for ECRLongus to be spinal levels 6 and 7 6 is flexion: ECRL abducts/radially deviates the wrist which is like lateral flexion! 7 is extension and ECRL fixes the wrist with Extensor Carpi Ulnaris in extension.
which muscle is responsible for a lot of hand movements when people are dancing the Charleston? ECRLongus (abduction of wrist radially then fixed extension) 6,7
Which muscle would extend the index finger if it could, but doesn't go far enough, stopping short at base of 2nd metacarpal? Extensor Carpi Radialis Longus
name all the muscles of the posterior cord: Axillary: teres minor and deltoid - Radial: lateral, medial, long heads of triceps/anconeus/brachioradialis/ECRLongus/ECRbrevis/supinator/Extensor Digitorum/EDMini/ECUlnaris/AbPlongus/EPbrevis/EPLongus/Extensor Indicis
why is ECRbrevis only spinal level 7 and not 6/7 like ECRLongus? 7 is extension and ECRbrevis stops on the base of 3rd metacarpal, way to far towards the middle of wrist to be involved in radial deviation (lateral flexion) of wrist like ECRLongus which has levels 6/7 for abduction and fixing wrist in extension
ECRLongus spinal levels _______ ECRbrevis spinal levels ______ ECRLongus 6/7, ECRbrevis 7
action of ECRbrevis assist ECRLongus
who has short man syndrome on the dorsum of hand? ECRbrevis7, he's the assist to ECRLongus6/7
innervation of ECRbrevis deep branch of Radial n.
which is only superficial post forearm muscle innervated by deep branch of radial n.? (all others by either Radial or PIN) ECRbrevis (short man syndrome) 7
origin Extensor Digitorum ED? lateral epicondyle of the humerus via common extensor tendon
insertion ED dorsal digital expansions of 2-5 digits
does ED have anything to do with the thumb? no
innervation ED PIN
is ED deep or superficial PIN superficial, with ExIndicis and ECU
spinal level ED 7! like all good pure extensors
what does ED do for a living? extends digits 2-5; extends the metacarpophalangeal and interphalangeal joints (knuckles and fingers)
Extensor Digiti Minimi origin EDMini comes from the medial belly of ED! hahahahaha that's pretty good.
From the belly of ED, comes... EDMini
insertion of EDMini dorsal expansion of 5th digit via one or two tendons
spinal level of EDMini 7, just like ED senior
action of little EDMini assist ED, of course, in extending little finger
origin ECU lateral epicondyle humerus
insertion ECU base of 5th metacarpal (pinky)
action ECU adduct or ulnar deviation with FCU, fixes wrist, extends wrist
innervation ECU PIN from the radial
what is the nerve of Extensor Carpi Ulnaris? posterior interosseous n. PIN from the Radial
spinal level ECU 8
origin supinator lateral epicondyle humerus, RADIAL COLLATERAL LIGAMENT, supinator crest of ulna
insertion supinator lateral 1/3 upper radius
supinator stretches from (bones?) ulna to radius
action supinator supinates forearm
innervation supinator (one of two have this innervation) deep branch Radial n. (other is ECRbrevis to middle finger metacarpal)
spinal level supinator 6
name the 6's of spinal levels brachioradialis6, supinator6, extensor carpi radialis longus67
what kind of muscles are usually 6's? flexors, except supinator and ECRlongus but brachioradialis is a weak flexor when forearm prone
origin AbPLongus post surface of radius ulna and interosseous membrane
insertion of AbPLongus base of 1st metacarpal and trapezium
AbPL was the one you drew on your forearm that was closest to you when your forearm was __________ pronated
AbPL stops at the first metacarpal and trapezium
what's fishy in the notes about Abductor Pollicis Longus? it doesn't go to the trapezium in the drawing in Functional Anatomy of the Limbs and Back - it only goes to the first metacarpal of thumb. It says "base of first metacarpal" in the text.
innervation of AbPLongus? PIN from the Radial
why does it make sense for AbPLongus to be innervated by the PIN of radial n? because most of the posterior forearm is!
PIN is a good guess for the innervation of posterior forearm because 7 of 12 muscles are innervated by PIN (excepting ECRL67 & ECRbrevis7, everything named Extensor and the one Abductor pollicis longus is a PIN)
3 nerves of post forearm Radial, Deep branch of radial, PIN
How many muscles of post forearm does Radial innervate and what are they? 3: Anconeus, Brachioradialis, ECRLongus
How many muscles of post forearm does Deep branch of radial nerve innervate and what are they? 2: supinator and ECRbrevis
How many muscles does PIN innervate in post forearm and what are they? 7: Extensor Digitorum, Extensor Digiti Minimi, Extensor Carpi Ulnaris, Abductor Pollicis Longus, Extensor Pollicis Brevis (in the crevice), Extensor Pollicis Longus, Extensor Indicis
AbPLongus wraps around the ________ in order to insert there. 1st metacarpal (of thumb)
What are the 3 muscles called together that come out of the posterior compartment and run to the thumb? Thenar Outcropping
What muscles do the thenar outcroppings wrap around in order to reach the thumb? ECRLongus and ECRbrevis
What can happen to the thenar outcropping (AbPL, EPB, EPL) because they wrap around Extensor Carpi Radialis Longus and Brevis? Compartmental syndromes due to friction bw the ECRLandB's up against the muscle bellies of the thenar outcropping.
AbPLongus origin and insertion post surface of radius/ulna/interosseous mem., base of 1st metacarpal and supposedly trapezium
AbPLongus action opens the thumb as if reaching for a jar so...Abduct and extend thumb
AbPLongus innervation PIN of the radius
AbPLongus spinal level 8 (if it has pollicis in it, it's probably 8)
spinous level of AbPLongus and innervation 8, PIN
Where is Extensor Pollicis BREVIS in the crevice
EPbrevis in the crevice origin posterior surface of radius and interosseous memebrane
EPbrevis in the crevice insertion base of PROXIMAL phalanx of thumb (that's why it's called brevis)
innervation of EPbrevis in the crevice PIN
EPbrevis in the crevice innervation PIN
EPbrevis in the crevice spinal level 8 (if it has pollicis in the name, it's probably 8)
action EPbrevis in the crevice extend the metacarpophalangeal joint (base of thumb)
Origin of EPLongus posterior surface of ulna and interosseous membrane
how is the origin of EPbrevis in the crevice different from the origin of EPLongus, he who has gone on us EPbrevis in the crevice originates on post RADIUS (and interosseous mem) while EPLongus orginates on ulna and i.mem.
EPLongus insertion base of distal phalanx of thumb
EPLongus action extends thumb at both joints (interphalangeal and metacarpophalangeal)
spinous level of EPLongus 8 (if it has pollicis in the name, it's probably 8)
innervation of EPLongus PIN of radius
origin EIndicis post surface of interosseous mem, post surface of ulna (just like EPLongus)
is EIn closer to middle finger or thumb? middle finger, so it is inside the extensor digitorum whereas extensor digiti minimi is outside the ED
EIn is closer In. EIn origIn: posterior interosseous and ulna
EIn Insertion dorsal digital expansion of index finger
EIn action extends index assisting ED
EIn Innervation PIn
EIn spInal level 8
floor of cubital fossa brachialis
name change of musculocutaneous n. lateral antebrachial cutaneous
what runs with the deep branch of the ulnar nerve in the palme the deep palmar arch
what muscle is missing a groove on the ends of the radius and ulna (where Lister's tubercle is) Extensor Digiti Minimi
describe the anatomical snuff box medial boundary: EPLongus, lateral boundary: EPbrevis in the crevice & AbPLongus. Radial artery running in crevice.
what artery runs through the anatomical snuff box Radial artery in the crevice (with EPbrevis)
describe the dorsum of the hand extensor retinaculum, extensor tendons, dorsal interossei muscles, dorsal digital expansion, dorsal venous network/arch
Dorsal Venous Arch returning to what veins on the thumb and pinky sides? to cephalic on thumb and basilic on pinky
what's the divider for the veins as you go down the arm? clavicle between subclavian and axillary, teres major between axillary and basilic (medial) and cephalic (lateral), Median cubital vein between B & C at elbow
what space does the Radial nerve pop out of on the post arm? Triangular interval with Profunda brachii artery
while the radial nerve is running along back of arm, what's it called? before supinator? after supinator? Radial nerve - Deep branch of Radial nerve (Supinator and ECRbrevis) - PIN
If a patient has numbness etc. on post forearm below supinator, what nerve is entrapped? PIN
If a patient has numbness etc. at supinator, what nerve is entrapped? Deep branch of Radial
If a patient has numbness on back of arm around triceps, what nerve is entrapped? Radial (exiting out triangular interval)
If a patient has numbness on the back of the hand from thumb to ring finger, what nerve is entrapped or lesioned? Superficial branch of Radial n.
what does the superficial branch of the Radial n. do? innervates the back of the hand from thumb to ring finger
Lateral epicondylitis is due to irritation of bursa by ECRbrevis in the crevis or Deep branch of radial n. entrapment (ECRbrevis and supinator)
will lateral epicondylitis cause pain upon extension? no
study of joints arthrology
any joint between two bones (or occasionally cartilages) is termed an __________ (or joint or arthrosis). articulation
An articulation can either confer ________ to a structure, or allow _________between the involved bones. stability, motion
immoveable joints synarthroses -sutures
slightly moveable joints amphiarthroses -IVD
highly moveable joints diarthroses -synovials
two types of synarthroses (immoveable) joints fibrous and cartilaginous
the only type of diarthrosis joint (highly moveable) synovial
a synarthrosis has _______________ between a sandwich of bone on either side solid CT
a diarthrosis has what between bones? hyaline articular cartilage, then cavitated CT, then hyaline articular cartilage again
a majority of joints in the extremities are __________ joints diarthrotic
example of ellipsoid (biaxial) joint radiocarpal
radiocarpal joint is a convex surface to a concave surface - what type of joint? ellipsoid
example of trochoid (pivot) joint proximal radioulnar joint (and distal radioulnar)
an osseous pivot or rotation of a bone about a single axis trochoid
saddle joint example thumb to scaphoid
saddle-shaped surfaces articulating also called? sellar (like sella turcica)
what kind of joints are NOT in the upper extremity bicondylar (condyloid) joints (book says metacarpophalangeal joints are condylar-type joints)
ginglymus joint hinge joint -humeroulnar -one degree freedom of motion
plane synovial joints have purely _________ motion translational
sternoclavicular, acromioclavicular, glenohumeral, cubital, middle radioulnar (proximal), distal radioulnar, Radiocarpal, Intercarpal, carpometacarpal, metacarpophalangeal, interphalangeal joints of upper extremity
ligaments of sternoclavicular joints anterior sternoclavicular, costoclavicular, interclavicular, and articular disk
interclavicular ligament of sternoclavicular joint resists depression and lateral displacement
costoclavicular ligaments of sternoclavicular joint limits elevation and lateral displacement of clavicle
what kind of joint is the sternoclavicular joint saddle (sellar) sterno
sterno sellar saddle is sternoclavicular joint
Acromioclavicular joint is a (type) ? plane synovial (two flat surfaces translating across one another)
acromion is flat, distal clav is flat. So what kind of joint do two flat surfaces make? plane synovial
acromioclavicular ligament supports the capsule
name the two parts of the coracoclavicular ligament conoid and trapezoid
conoid and trapezoid ligaments CORACOclavicular ligament parts
strongest band of stabilizers for AC joint CORACOclavicular ligament made of conoid and trapezoid parts
AC Strongest band CORACOclavicular ligament
coracoacromial ligament assists costoclavicular ligament of sternoclav joint, which limits elevation and lateral displacement of the clavicle
Glen-o-humeral is a _____________joint spheroidal synovial! He's Glen with a jolly good sense of humeral and round like a sphere!
what does the head of the humerus sit on in the glenohumeral joint? glenoid labrum (surface area and cushion)
what muscle runs through the capsule of the glenohumeral joint? long head of biceps brachii
what do the rotator cuff muscles do for the glenohumeral joint? stabilize the head of the humerus
what is between the coracoid and acromion in the glenohumeral joint? the coracoacromial Arch
what makes up the coracoacromial arch over the glenohumeral joint? coracoid, coracoacromial ligament, acromion
the glenohumeral joint has two bursae: subacromial/deltoid to move supraspinatus tendon and subscapular for subscapularis tendon
what contains the long head of biceps in the intertubercular sulcus? synovial sheath and transverse humeral ligament
what do the numerous ligaments of the glenohumeral joint do? prevent inferior displacement during ABDUCTION or superior displacement during ADDUCTION
there are superior, middle, inferior and coracohumeral ligaments of the glenohumeral capsular ligament
what muscle initiates abduction of the glenohumeral joint? Who takes over? supraspinatus then middle deltoid
chief medial rotator of glenohumeral jt? subscapularis (assist PLT and anterior delt)
chief adductor of glenohumeral jt? pectoralis MAJOR, latissimus dorsi (Mjr. Pectoral likes cream ADDed to his latte)
chief lateral rotators of glenohumeral jt? infraspinatus
describe humeroradial joint elbow: pivot/gliding head of radius to capitulum innervated MUSCULOCUTANEOUS and RADIAL nn.
describe humeroulnar joint elbow: hinge joint, trochlea of humerus to trochlear notch of ulna, MUSCULOCUTANEOUS, ULNAR and RADIAL nn.
describe proximal radioulnar joint elbow: pivot, head of radius in ulnar notch just like distal radioulnar joint, ANTERIOR and POSTERIOR INTEROSSEOUS N. ( AIN & PIN)
what lashes head of radius to ulna annular ligament
what prevents adduction of the olecranon radial collateral ligament
what prevents aBduction of the olecranon ulnar collateral ligament
what is inside the elbow to prevent friction? olecranon bursae
chief flexors elbow biceps and brachialis
chief supinators elbow supinator when weak, biceps when needed to be strong
chief extensors of elbow triceps
chief pronators of elbow pronator quadratus and teres
what holds together the radioulnar syndesmosis? interosseous membrane
what is the quality of the interosseous membrane during supination? taut
the distal radioulnar joint type pivot
distal radioulnar pivot joint is held together by the articular disk!
condyloid joint of wrist Radiocarpal
describe the radiocarpal joint condyloid, scaphoid and lunate articulating with distal end of radius (primarily)
the articular disc with the __________ in the radiocarpal joint is on top of the ulna triquetral bone
ligament that resists radial deviation in wrist ulnar collateral ligament
ligament that resists ulnar deviation in wrist radial collateral ligament
ligament that strengthens a supinated palm palmar radiocarpal ligament
ligament that reinforces the ulnar side of the radiocarpal joint palmar ulnocarpal ligament
equivalent of palmar radiocarpal ligament on back of hand dorsal radiocarpal ligament, strengthens pronated palm
equivalent of palmar ulnocarpal ligament on back of hand dorsal ulnocarpal ligament, also strengthens ulnar side of joint
what type of movement at metacarpophalangeal joint (knuckle) circumduction
type of movement at finger/hinge/interphalangeal joints flex-extend
which metacarpals move the most 4,esp 5
Created by: hecutler