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innervations of anterior/posterior arm, anterior/posterior forearm, intrinsic hand muscles
- anterior arm: musculocutaneous
- posterior arm: radial nerve
- anterior forearm: medial nerve except flexor carpi ulnaris and medial 2 branches of flexor digitorum profundus
- posterior forearm: radial nerve
- intrinsic hand muscles: ulnar nerve except thenar muscles and lateral 2 lumbricals (median nerve)
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cutaneous innervation of arm
- posterior cutaneous nerve of arm (radial nerve): lateral arm and posterior arm/forearm
- lateral antebrachia cutaneous (continuation of musculocutaneous): lateral forearm
- median nerve: lateral palmar surface & lateral fingertips
- superficial branch of radial nerve: lateral dorsum
- ulnar nerve: medial hand
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carpal tunnel
- flexor carpi radialis travels thru tunnel w/its own synovial sheath
- ulnar nerve goes thru Guyon/ulnar tunnel, not carpal!
- palmaris longus tendon blends w/flexor retinaculum
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tendons v. ligaments
- tendons: uniformly stiff
- ligaments: little resistance to compression so that it deforms w/o damage, but strong w/tension. Mechanoreceptors in ligament needed for proprioception.
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ligament attachments to bone
- fibrous attachment: to periosteum or into bone
- enthesis: matrix of fibrous tissue gradually replaced w/ fibrocartilage
- In both types, Sharpey fibers extend into bone
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sprain
- acute/traumatic injury to a ligament
- Grade 1 (strain): pain, no joint instability
- Grade 2: partial tear of ligament
- Grade 3: complete tear of ligament
- ligament healing: inflammation, granulation tissue (hyaluronan), remodeling & scar
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Marfan's syndrome
- mutation in code for fibrillin
- an elastic fiber = elastin core covered by fibrillin microfibrils
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4 main types of collagen
- type I: skin, bone, tendon, ligament, joint capsule
- type II: cartilage
- type III: lymphoid
- type IV: basement membranes
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production and destruction of ECM
- fibronectin-collagen-integrins in PM-actin-nucleus
- degradation: matrix metalloproteases (MMPs) and serine proteases
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endotenon
- packages collagen fibers into fascicles
- contains blood vessels
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myotendinous junction
- where tendon receives most blood supply
- connection w/muscle
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tendinopathy
tendonitis or tendonosis
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bursa
fibrous sac lined w/ synovium
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cartilage ECM
- fibers: type I and II collagen, elastic
- ground substance: GAG (hyaluronan), proteoglycan (chondroitin sulfate, keratin sulfate = aggrecans), adhesion glycoprotein molecules
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elastic cartilage
- type II collagen, elastic fibers
- locations: auricle, epiglottis
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hyaline cartilage
- type II collagen
- articular cartilage
-
fibrocartilage
- type I collagen
- no perichondrium
- intervertebral disk, symphysis pubis
- chondrocytes line up in direction of force
-
perichondrium
- lines cartilage except fibrocartilage
- outer fibrous layer
- inner cellular layer w/ chondroprogenitor cells
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deep fascia of the neck is continuous w/what fascia of upper extremity?
- axillary fascia
- clavipectoral fascia of chest wall
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what are the branches of each part of the axillary artery?
- 1st: highest thoracic
- 2nd: lateral thoracic, thoracoacromial
- 3rd: suprascapular (thoracodorsal + circumflex scapular), anterior humeral circumflex, posterior humeral circumflex
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slipped capital femoral epiphysis
- obligatory external rotation when hip is flexed
- usually a gradual slip
- presentation w/knee pain
- possible endocrine factors and radiation
- surgery, complications of avascular necrosis and achondrolysis
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supracondylar fracture
- proximity to brachial artery
- volkman ischemic contracture
- cubital varus (decreased carrying angle)
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