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When does the upper limb bud form? How do fingers form?
4th week; apoptosis
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Intramembranous v. endochondral ossifcation
bones of the face v. long bones
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How does muscle mesenchyme migrate into the upper limb?
- paraxial mesoderm -> somite -> hypomere organized into dorsal and ventral mass around developing bones
- innervated by ventral rami
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How does the orientation of the upper limb buds change during the 7th wk?
upper limb buds rotate laterally on longitudinal axis
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What are the joints of the shoulder?
- Acromioclavicular (AC)
- Sternoclavicular (SC)
- Glenohumeral joint (shoulder joint)
- scapulothoracic (not a true synovial joint)
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What are the joints of the hands, proximal to distal?
- wrist joint
- intercarpal joints
- carpalmetacarpal
- metacarpalphalangeal
- (proximal, distal) interphalangeal
- thumb doesn't have prox and distal
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Deep fascia of neck is continuous w/what 2 fascia of upper extremity?
- clavipectoral fascia (chest wall)
- axillary fascia (axilla)
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What are the compartments of the forearm?
- anterior compartment - superficial, intermediate, deep layers
- posterior compartment - superficial and deep layers
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Describe deep fascia of the wrist
thickens to form a flexor retinaculum & extensor retinaculum
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Describe deep fascia of the hand
- thenar compartment - thumb
- central compartment
- hypothenar compartment - pinky
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Branches of 1st part of subclavian artery
- Vertebral artery: thru C6 to basilar artery
- Thyrocervical trunk: inf. thyroid, transverse cervical, suprascapular, internal thoracic artery
- Costocervical trunk: small branches in deep neck
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Describe the course of the subclavian artery
- 3 parts: 1st medial to, 2nd beneath, and 3rd lateral to anterior scalene
- Becomes axillary artery deep to the clavicle at the 1st rib
- Becomes brachial artery at lower border of teres major muscle
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Branches of the axillary artery
- First part (medial to pectoralis minor): highest thoracic artery
- Second part: thoracoacromial, lateral thoracic
- Third part: subscapular artery (thoracodorsal and circumflex scapular branches), anterior humeral circumflex, posterior humeral circumflex
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Branches of brachial artery
- Profunda brachii (deep) artery
- Radial and ulnar arteries supply forearm and hand
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Ulnar artery branches
- Common interosseous artery -> anterior and posterior, supply deep muscles
- Superfcial palmar arch
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Superficial veins of dorsum of hand
- Cephalic vein on thumb side -> axillary vein
- Basilic vein on little finger side -> brachial vein -> axillary vein
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Name the cervical spinal nerves that innervate upper extremity muscles
- Dorsal scapular nerve (C5): rhomboids, levator scapulae
- Long thoracic nerve (C5-7): serratus anterior
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What is the brachial plexus/where is it?
- C5-T1 nerve roots
- between anterior scalene and middle scalene, enter the posterior triangle
- Somatic motor, somatic sensory, sympathetic postganglionic, visceral sensory
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brachial plexus roots
- Superior: C5 and C6, gives off terminal branches: nerve to subclavius and suprascapular nerve (supraspinatus, infraspinatus muscles)
- Middle: C7
- Inferior: C8-T1
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Brachial plexus cords
- named for relationship w/ axillary artery
- lateral cord (C5-C7): anterior divisions of upper and middle trunks
- medial cord (C8-T1): anterior division of inferior trunk
- posterior cord (C5-T1): posterior divisions of 3 trunks
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lateral cord termial branches
- lateral pectoral nerve
- musculocutaneus nerve
- lateral root of median nerve
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medial cord terminal branches
- medial pectoral nerve
- medial brachial cutaneous nerve
- medial antebrachial cutaneous nerve
- ulnar nerve
- medial root of the median nerve
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posterior cord terminal branches
- upper subscapular nerve
- lower subscapular nerve
- thoracodorsal nerve
- axillary nerve
- radial nerve
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Pain/sensation change for radiculopathy C5-T1
- C5 - point of shoulder
- C6 - thumb
- C7 - middle finger
- C8 - little finger
- T1 - medial forearm
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Movement deficity for radiculopathy C5-T1
- C5 - shoulder abduction
- C6 - elbow flexion, wrist extension
- C7- elbow extension
- C8/T1 - intrinsic hand muscles
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How is the spinal accessory nerve formed?
- C1-5 ventral rami form the spinal part, which goes thru jugular foramen
- Cranial fibers exit to the posterior triangle to innervate SCM and trapezius
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What are the boundaries of the posterior triangle?
- SCM, trapezius, middle third of clavicle
- the floor is formed by prevertebral fascia (deep to this are scalene muscles and the cervical sympathetic chain)
- the roof is formed by investing fascia that lines superficial fascia and skin
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Contents of the posterior triangle
- subclavian artery and vein
- transverse cervical artery
- suprascapular artery and vein
- spinal accessory nerve
- dorsal scapular nerve (C5)
- long thoracic nerve (C5-7)
- brachial plexus roots (C5-T1) and trunks
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what muscles does the median nerve innervate?
- pronator teres
- pronator quadratus
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what muscles does the musculocutaneous nerve innervate?
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what muscles does that radial nerve innervate?
- aconeus
- triceps brachii
- supinator muscle
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nerves that innervate muscles that move the elbow joint v. the radioulnar joint
C6-7, C6-8 nerve roots
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