what are teh bones of the upper limb
pectoral girdle: clavicle and scapula
humerus
ulna
radius
what does the pectoral girdle do
attaches bones of upper limb to axial skeleton
what skeleton are the clavicle and scapula part of
appendicular
what is the only part of the upper limb that articulates with the axial skeleton
clavicle
what is the shoulder blade
scapula
what is the large long bone of the upper arm
humerus
what is the fixed bone of the forearm
ulna, always associated with pinky finger
what bone follows the thumb when pronating/supinating forearm
radius
a. brachial artery
b. axillary artery
c. subclavian artery
d. brachiocephalic trunk
what does the right side have in arterial supply that the left side does not
brachiocephalic trunk that splits into right common carotid and subclavian
what supplies blood to the upper extremity
subclavian artery
when does the subclavian artery become the axillary artery
first rib
a. axillary artery
b. first rib
a. teres major
b. brachial artery
when does the axillary artery become the brachial artery
teres MAJOR
what is the path of the brachial artery and what does it give off
down humerus and crosses elbow, gives off radial and ulnar arteries
a. deep palmar arch
b. radial artery
c. brachial artery
d. ulnar artery
e. superficial palmar arch
what is the medial branch of the brachial artery
ulnar artery
what is the lateral branch of the brachial artery
radial artery
where do the radial and ulnar arteries anastomose
palm of hand, forming superficial and deep palmar arch
what do the superficiel and deep palmar arches give off
digital arteries to supply fingers
what takes care of the deep venous drainage of the upper extremity
ulnar, radial, brachial, axillary veins
which veins in the hand are often paired
radial, ulnar, brachial
where are the superficial veins located
superficial fascia
what side of the arm is the cephalic vein
preaxial
where does the cephalic vein pass through in the axillary region
between deltoid and pec major (deltopectoral groove)
when does the basilic vein run into the axillary ven
when it joins with the brachial vein
what does the median cubital vein join
cephalic and basilic veins
what does the median cubital vein sit on top of
biceps brachii tendon
what does the brachial plexus provide in general
motor and sensory
where are the anterior rami of the brachial plexus from
C5-T1
what is interesting about the makeup of the brachial plexus
converge and diverge multiple times to form many segments
what is a prefixed brachial plexus
anterior ramus of C4 contributes to brachial plexus
what is a postfixed brachial plexus
anterior ramus of T2 contributes, may or may not have C5 involved
a. middle scalene
b. brachial plexus
c. anterior scalene
a. dorsal scapular nerve
b. long thoracic nerve
c. subclavian nerve
d. suprascapular nerve
e. medial pectoral nerve
f. upper subscapular nerve
g. lateral pectoral nerve
h. thoracodorsal nerve
i. lower subscapular nerve
j. medial cutaneous nerve of the arm
k. medial cutaneous nerve of the forearm
l. ulnar nerve
m. radial nerve (axillary comes off farther back)
n. median nerve
o. musculocutaneous nerve
where does the brachial plexus leave from? what does it go between
posterior triangel in neck between anterir and middle scalelen, follow near subclavian artery
what are teh divisions of motor neurons of the brachial plexus
anterior and posterir divisions
what does the anterior part of the brachial plexus supply
flexors
what does the posterior part of the brachial plexus supply
extensors
where are the sympathetics of the brachial plexus from
T2-T6
what are teh sympathetic brachial plexus functions
vasomotor
arrector pilli muscles
sweat gland fucntion in skin
what makes up the roots of the brachial plexus
anterior rami of C5-T1
what major nerves come off the roots of the brachial plexus
dorsal scapular nerve
long thoracic nerve
what does the dorsal scapular nerve supply
rhomboid major and minor and levator scapulae
what does the long thoracic nerve supply
serratus anterior
where are the trunks of the brachial plexus from
posterior triangle of neck
what levels is the superior trunk of the BP from
C5 and C6
what levels is the middle trunk of the brachial plexus from
C7
what levels is the inferior trunk of the brachial plexus from
C8 and T1
what are teh major nerves that come off of the superior trunk of BP
subclavian nerve
suprascapular nerve
what does the subclavian nerve supply
subclavius
what does the suprascapular nerve supply
supraspinatus and infraspinatus (rotator cuff muscles)
where are the divisions of the BP
behind the clavicle
what are teh divisions of the BP
anterior and posterior
what muscles do the atnerior divisions supply
flexors
what muscles do the posterior divisions supply
extensors
where are teh cords of the BP
around the axillary artery
what are the cords named for
in relation to the axillary artery
what BP parts form the lateral cord of the BP
anterior division of superior and middle trunks
what nerve comes off lateral cord of BP
lateral pectoral N.
what does the lateral pectoral nerve supply
pectoralis major
what BP parts form the medial cord of the BP
anterior division of inferior trunk
what nerves come off the medial cord of the BP
medial pectorsal n
medial cutaneous nerve of the arm
medial cutaneous nerve of the forearm
what does the medial pectoral nerve innervate
pec minor and part of pec major
what does the medial cutaneous nerve of the arm innervate
cutaneous arm
what BP parts form the posterior cord of the BP
posterior division of ant, middle, and inferior trunks
what nerves come off the posterior cord of the BP
upper subscapular n
thoracodorsal n
lower subscapular n
what does the upper subscapular nerve innervate
superior subscapularis
what does the thoracodorsal nerve innervate
latissimus dorsi
what does the lower subscapular nerve innervate
teres major and lower subscapularis muscle
what are the terminal nerves of the BP called in general
branches
what part of the BP do the branches come from
cords
what are the anterior branches
musculocutaneous branch
medial branch
ulnar branch
what are teh posterior branches
axillary
radial
where does the musculocutaneous nerve come from
C5-C7
what cord does the musculoctaneous branch of BP come from
lateral cord
what does the musculocutaneous branch of BP innervate
arm flexors, skin on lateral forearm
what levesl does the median nerve come from
C5-T1
what cords does the median nerve come from
lateral and medial cord
what does the median nerve innervate
forearm flexors and skin on part of hand
what levels does the ulnar branch of BP come from
C8-T1
what cord does the ulnar branch of BP come from
medial cord
what does the ulnar branch of BP innervate
most of hand and skin on part of hand
what levels does the axillary barnch of BP come from
C5, C6
what cord does the axillary branch of BP come from
posterior cord
what does the axillary barnch of BP inervate
deltoid, teres minor, skin on proximal aprt of arm
what levels does the radial barnch of BP come from
C5-T1
what cord is the radial branch of BP come from
posterior cord
what does the radial branch of BP innervate
extensors of arm and forearm,parts of skin of arm, forearm, and hand
how would one get a stinger/burner
force head flexion away from shoulder depression
what happens in a stinger/burner
stretches brachial plexus, initiating repair response that can take function away temporarily
what are symptoms of stigner
tingling, numbness, weakenss to afected side
what can the inflammatory response of a stinger/burner lead to
narrowing of IV foramen
what will happen with an upper brachial plexus injury
Erb's palsy
what levels does Erb's palsy affect
C5-C6 superior trunk
what happens in Erb's palsy
severe stretching or rupture of roots
what is the characteristic limb position of Erb's palsy
waiter's tip palsy with an extended arm, hand turned backwards
what happens with an upper brachial plexus injury with anasthesia
anasthesia of lateral arm and forearm
what will happen in anasthesia with a lower brachial plexus injury
anasthesia of medial forearm and hand
what levels does Klumpke's palsy affect
C8-T1 inferior trunk
what happens with Klumpke's palsy to cause the injury
upper limb is pulled superiorly
what is a claw hand deformity
loss of fine motor movement of hand due to overriding flexor muscles
what type of injury may result in Horner's syndrome
lower brachial plexus injury
what happens in a lower BP injury that involves Horner's syndrome
cervical sympathetic chain may also be damaged
what is a winged scapula the result of
injury to long thoracic nerve; leads to serratus anterior paratlyssi
what is the role of serratus anterior usually
keeps scapula close to thoracic cage so when injured the scapula wings outward
what is another naem for crutch palsy
saturday night or drunkards paralysis
what is crutch palsy from
compression of BP in axillary region, particularly posterior cord radial nerve
what type of anasthesia results from crutch palsy
lateral and posterior part of arm and posterior forearm
what can crutch palsy lead to
hand drop
what can axillary nerve injury be from
damage or injury to proximal humerus
dislocation
where is anasthesia in an axillary nerve injury
inferior part of deltoid
if axillary nerve injury is too severe, what can it lead to
deltoid atrophy, thereofre loss of ability to abduct arm
what is thoracic outlet syndrome
compression of vessels/nerves, variable afffected
who are more prone to thoracic outlet syndrome
people with cervical ribs
what is the typical compressing bones of thoracic outlet syndrome
clavicle and ribs
what happens vascularly with thoracic outlet syndrome
subclavian artery is compressed and there is a reduction in distal pulses such as radial and brachial
what happens nuerologocally with thoracic outlet syndrome
tingling, numbness, weakness of upper extremity
what is adson's test
arm hyperextended/hyperadducted and head toward it; tries to minimize effects of BP injury
what is allen's test
arm hyperextended/hyperadducted and head away from it; tries to minimize effects of BP injury
do adsons or allens' test assess bilaterally
yes, if you have thoracic outlet syndrom it is on one side usually
what is the roos test
horizontal position, fully externally rotated upper extremity for 30 seconds to one minute, flex hands like pumping motion to see if symptoms come up
Adson's test
Roos Test
Allen's Test