The scapular noth is bridged by the superior transverse scaplar ligmanet and is converted into a foramen which permits passage of what?

Suprascapular nerve

Supreglenoid and infraglenoid tuercles provide the origins for what?

The long heads of the biceps brachii and triceps brachii muscles respectively.

 What does the lesser tubercle provide an insertion for?

Subscapularis muscle

What does the intertubercular (bicipital) groove provide insertions for?

What is the surgical neck of the humerus in contact with?

Axillary nerve and posterior humeral circumflex artery

What runs through spiral groove?

Radial nerve, origin of lateral head of triceps above and medial head below

What artery and nerve may be damaged in the event that the shaft of the humerus is injured?

Radial nerve and deep brachial artery

Where do the extensor muscles of the forearm and the supinator muscle take origin?

Lateral epicondyle of the humerus

Where to the flexor muscles of the forearm and pronator teres originate?

Medial epicondyle of the humerus

What nerve might be damaged during fracture of the medial epicondyle?

Ulnar nerve

What nerve may be injured in supracondylar fractures?

Median nerve

What is Colle's fracture?

A fracture of the distal end of the radius characterized by displacement of the hand dorsally and radially.

What does the capitulum of the humerus articulate with?

The head of the radius

What is a clinical concern associated with a fracture of the scaphoid?

Fracture of the scapoid occurs often during  fall onto the outstretched hand and may lead to damage to the radial artery and avascular necrosis of the bone.

What is Boxer's fracture?

It is a fracture typicall seen in the necks of the second and third metacarpals in experienced boxers and in the 5th metacarpal in unskilled boxers.

What is the nerve and aterial supply of the elbow joint?

Receives innervation from the musculocutanious, median, radial and ulnar nerves. Receives its blood supply from the anastamosis between the brachial artery and recurrent branches of the radial and ulnar arteries.

Describe the lymphatic drainage of the upper limb.

There are dorsal and palmar plexuses

Medial group of lymphatic vessels accompany the basilic vein and drain into the lateral axillary lymph nodes which go into the central axillary and then the apical lymph nodes

Lateral group of lymphatic follow the cephalic vein and drain into the lateral axillary nodes into the dltopectoral node which then drains into the apical nodes.

What does the axillary sheath enclose?

The axillary vessels and the brachial plexus

What is the blood supploy of the mammaxry gland?

Medial mammary branches of the anterior perforating branches of the internal thoracic artery, the lateral mamary branches of the lateral thoracic artery, the pectoral branches of the thracoacromialtrunk, the lateral cutaneous branhces of the posterior intercostal arteries.

What is the nerve supply of the mamary gland?

Anterior and lateral cutaneous branches of the 2nd to 6th intercostal nerves

What is the lymphatic drainage of the mammary gland?

Drain primarily into the pectoral (anterior) nodes which then go into the parasternal (internal thoracic) nodes which lie along the internal thoracic artery.

Some also drains into the apical nodes and may connect to lymphatics draining thje oppoosite breast and to lymphatics draining the anterior abdominal wall.

What is the nerve supply and action of the pec major?

NS: Lateral and medial pectoral nerves

Action: Fexles, adducts and medially rotates arms

What is the nerve supply of the pec minor?

NS: Medial (and lateral) pectoral nerves

Action: Depresses scapula, elevates ribs

NS: Nerve to subclavius

Action: Depresses lateral part of the clavicle

NS: Long thoracic (nerve to serratus anterior)

Action: Rotates scapula upward, abudcuts scapula with arm and elvates it above the horizontal and also protracts scapula (paralysis leads to winging of the scapula).

Bounded superiorly by the teres minor and subscapularis muscles, inferiorly by the teres major, medially by the lon head of the triceps and laterally by the surgical neck of the humerus.

It transmits the axillary nerve the posterior circumflex humeral artery.

What are the boundaries and contents of the upper triangular space?

Superiorly: teres minor

Inferiorly: teres major

Laterally: long head of triceps

Contents: Circumflex scapular artery and vein

What are the boundaries and contents of the lower triangular space?

Superiorly: tres major

Medially: long head of triceps

Laterally: medial head of triceps

Contains: radial nerve and deep brachial artery

What is the nerve supply of the and action of the deltoid muscle?

NS: axillary

Action: Adducts, abucts arm, flexes, extends and rotates arm medially laterally

What is the nerve supply and action of the supraspinatus?

NS: suprascapular N

Action: Abducts arm

What is the nerve supply and action of the infraspinatus?

NS: Suprascapular N

Action: Rotates arm laterally

What is the nerve supply and action of the subscapularis?

Upper and lower subscapular N

Adducts and rotates arm medially

What is the nerve supply and action of the teres major?

Lower subscapular nerve

Adducts and rotates arm medially

What is the action and nerve of the supply of the teres minor?

Axillary nerve

Rotates arm laterally

What is the nerve supply and action of the latissimus dorsi?

Thracodorsal N

Adducts, extends and rotates arm medially

What is the nerve supply and action of triceps?

Radial N

Extends forearm

What is Dupuyutren's Contracture?

Thickening, shortening and fibrosis of the palmar fascia especially the palmar aponeurosis. Leads to inability to fully extend fingers.

What is Volkmann's contracture?

An ischemic muscular contracture (flexion deformity) of fingers and sometimes the wrist resulting from ischemic necrosis of the forearm flexor muscles resulting form pressure injury or a tight cast. The muscles are replaced by fibrous tissue.

What is the Carpal tunnel?

It is formed anteriorly by the flexor retinaculum and posteriorly by the carpal bones. It transmits the median nerve and the tenons of the flexor pollicis longus, flexor digitorum profundus and flexor digitorum superficialis muscles.  

What is Carpal tunnel syndrome?

It is caused by compression of the median nerve due to the reduced size of the osseofibrous carpal tunnel, resulting from inflammation of the flexor retinaculum, arthritic changes in the carpal bones, or inflammation or thickening of the synovial sheaths of the flexor tendons.

What are the upper roots of the Brachial plexus?

C5 and C6

What are the middle roots of the Brachial plexus?

C7

What are the lower roots of the Brachial plexus?

C8 and T1

Where do the trunks of Brachial plexus lie?

Posterior triangle of neck

What forms the lateral cord of the Brachial plexus?

The anterior divisions of the upper and middle trunks (C5-C7) join to form the lateral cord

What forms the medial cord of the Brachial plexus?

It is a continuation of the lower trunk (C8-T1)

What forms the posterior cord of the Brachial plexus?

It is formed by the merger of the posterior divisions of all the trunks of the Brachial plexus (C5-T1)

What branches does the upper trunk of the Brachial plexus give?

Suprascapular N (C5, C6)

Nerve to subclavius (C5)

What are the branches from the lateral chord of the Brachial plexus?

Lateral pectoral nerve (C5-C7)

Lateral root of median nerve (C5-T1)

Musculocutaneous nerve (C5-C7)

(Lady Loves Me)

What are the branches from the middle chord of the Brachial plexus?

Medial pectoral nerve (C8-T1)

Medial root of the median nerve (C5-T1)

Medial cutaneous nerve of forearm (C8-T1)

Ulnar nerve (C7-T1)

Medial cutaneous nerve of forearm (C8-T1)

(Most Medical Men Use Marijuana)

What are the branches of the posterior cord of the Brachial plexus?

Upper subscapular (C5-C6)

Lower subscapular (C5-C6)

Nerve to latissimus dorsi (thoracodorsal N) (C7-C8)

Axillary (C5-C6)

Radial nerve (C5-T1)

Which nerve is responsible for wrist drop?

Radial nerve

Dr. Cuma = Drop wrist - radial, Claw hand- ulnar, median nerve – ape hand

Fracture of the surgical neck of the humerus or inferior dislocation of humerus can result in what?

It can result in damage to the axillary nerve. It results in weakness of lateral rotation and abudcution of the arm (the supraspinatus can abduct the arm but not to a horizontal level)

What does the musculocutaneous nerve supply?

Biceps brachii, brahcialis, coracobrachialis. It continues as the lateral cutaneous nerve of the forearm

What does the median nerve supply?

Pronator teres, flexor digitorum superficialis, palmaris longus, flexor carpi radialis, abductor pollicis brevis, opponens pollicis, flexor pollicis, 1^st and 2^nd lumbricals

It also does the lateral 3 and a half digits on the palmar surface of the hand in addition to the tips of those fingers on the dorsum of the hand

What is anterior interosseous nerve a branch of and what does it supply?

It is a branch of the median nerve and it supplies the flexor digitorum profundus, flexor pollicis longus muscle and the pronator quadratus

What does the ulnar nerve supply?

It supplies the flexor carpi ulnaris muscle, flexor digitorum profundus and the palmaris brevis muscle. It gives a deep branch that supplies the hypothenar muscles (abdudctor short flexor and opponens) as well as the adductor pollicis muscle and the deep head of the flexor pollicis brevis muscle.

It provides cutaneous sensation for the medial 1 and a half fingers as well as most of the palm and the dorsum on the corresponding side of the hand.

What does the axillary nerve supply?

Teres minor and deltoid

What does the radial nerve supply?

All 3 heads of triceps

Brachialis (proprioceptive fibers)

Aconues

Brachioradialis

Extensor carpi radialis longus

Extensor carpi radialis brevis

Supinator

Posterior interosseous branch innervates:

Extensor digitorum muscle

Extensor digiti mimimi

Extensor carpi ulnaris

What is Erb-Duchenne palsy?

An injury to the upper trunk of the brachial plexus. It is caused by a birth injury during a breech delivery or a violent displacement of the head from the shoulder such as might result from a fall from a motorcycle or horse. It results in a loss of abduction, flexion and lateral rotation of the arm, producing a waiter’s tip hand, in which the arm tends to lie in medial rotation resulting from paralysis of lateral rotator muscles.

What is Klumpke’s Palsy?

It is a lower trunk injury. It may be caused during a difficult breech delivery, by a cervical rib or by a abnormal insertion or spasm of the anterior and middle scalene muscles. The injury causes claw hand.

What passes over the superior transverse scapular ligament?

The suprascapular artery. The nerve passes below (remember: the Army goes over the bridge and the Navy goes under)

What are the parts of the axillary artery and what branches do they give?

1^st part – Superior and medial to pec minor, gives the superior thoracic artery

2^nd part – Behind the pec minor, gives the thoracoacromial and lateral thoracic arteries

3^rd part – Lateral to and behind the pec minor, gives the subscapular, anterior and posterior circumflex humeral arteries

Remember: SALSAP

What are the branches of the subclavian artery?

Vertebral artery

Internal thoracic artery

Thyrocervical trunk

Costocervical trunk

Dorsal scapular artery (occasionally)

Rembember: VIT C & D

What are the branches of the thyrocervical trunk?

Suprascapular artery

Inferior thyroid artery

Transverse cervical artery

(Remember: SIT)

What is the radial collateral artery a branch of and what does it anastamose with?

What are the branches of the common interosseous artery and what is it a branch of?

It is a branch of the ulnar artery and it gives the recurrent interosseous artery as well as the anterior and posterior interosseous arteries.

How do the limbs begin to develop?

Limb development begins with the activation of mesenchymal cells in the lateral plate somatic mesoderm

What does the appendicular skeleton develop from?

Develops from mesenchyme derived from the somatic mesoderm in the limb buds.

What are limb buds?

They consist of a mesenchymal core covered with ectoderm and capped by an apical ectodermal ridge that induces limb growth and development. They arise in the somatic mesoderm at week 4. The upper limb buds arise first and then the lower limb buds soon follow.

Describe the rotation of the upper and lower limb buds.

Upper limb buds rotate laterally through 90 degrees, whereas the lower limb buds rotate medially through almost 90 degrees.

What are the bones of the limbs derived from?

Lateral plate somatic mesoderm.