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UL1

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Fichas del conjunto (114)

1axillary arteryfrom subclavian artery
origin: outer border of 1st rib and posterior to scalene tubercle
passes through pec. minor
end: lower border of teres major
branch into brachial artery
23 parts of axillary arteryprox to pect minor- superior thoracic
behind pect minor- thoraco-acromial , lateral thoracic
distal to pect minor- ant/ post circumflex humeral,
subscapular branches- circumflex scapular, thoracodorsal,
3Axillary veinmedial to axillary artery
begins- lower margin of teres major
ends at 1st rib (subclavian vein)
4Axillary lymph nodes1) lateral- humeral
2) anterior- pectoral
3) posterior- subscapular
4) central
5) Apical
supraclavicular node
R/L venous angle
[internal jugular and subclavian vein]
5brachial plexusorigin- from ventral primary rami of cervical spinal nerves C5 - T1
roots C5-8,T1
Draw
6Histology features of cardiac, smooth and skeletal muscleCardiac- striation, mononucleate, via intercalating discs, branching chains
skeletal- striation, single long cylindrical, multinucleated cells
Smooth- no striation, single spindle shape, uninucleate
7Skeletal muscle NMJ activation1) AP arrive at axon terminal open gated ca2+ channels
2) inward diffusion of ca2+
3) fusion of Ach vesicles with presynaptic membrane
4) Ach diffusion across 20nm synaptic cleft
5) nicotine Ach receptors (chemically gated ion channel) allow monovalent cations to flow through
6) Net entry of Na+ into end plate causes depolarisation (EPP)
7) AP triggered in muscle fibre
8Innervation of skeletal muscles:voluntary, reflexes
[somatic system- nicotinic Ach]
Each skeletal muscle fiber is innervated by a single motor axon. The same axon may also innervate other muscle fibers. All the fibers innervated by the same axon are called a motor unit.
9Draw NMJ of skeletal muscle:
10Pathophysiology of Myasthenia gravisAutoimmune disease
autoantibodies- directed against Ach nicotinic receptor
-impair ability of Ach bind to receptor causes destruction of receptors
Symptoms:
-weakness increases during activity, rest improves
-eyelid movement and facial expression
11Dermatomes and myotomes:Dermatomes- test for sensation and spinal cord damage [central damage]
Myotomes- test for motor and somatic functions, using tendon reflexes
12Draw the dermatomes of arm
13DermatomesC5- upp lateral side of arm
C6- pad of thumb
C7- pad of index finger
C8- pad of little finger
T1- skin on medial side of elbow
shingles- T5 (below nipple)- T10 (umbilical)
14difference between dermatome and distribution of peripheral cutaneous nervedermatomes- axons of sensory neurones from a defined area of skin
peripheral cutaneous nerve- neurones delivered to skin through terminal branches of brachial plexus
ie. axillary nerve (c5-6)- supplies skin over deltoid muscle
ulnar nerve (c8-t1) - cutaneous branch to dorsal and palmar surfaces of hand
15Damage of upper trunk of brachial plexus (C5-6)1) shoulder dystocia
-traction damaged
2) Erb- Duchenne Palsy
-Erb's paralysis
16Damage of lower trunk (c8-T1)Klumpke's palsy
-tree fall, obstetric injury
173 main effects of nerve damage:1) Paraesthesia- loss of sensation
2) muscle atrophy- movement of muscle weakness (abduct/ adduct/ rotation)
3) paralysis- loss of muscles
18posterior wall muscles of axillasubscapularis
teres maj
latissimus dorsi
19posterior axilla- UL to trunksubscapularis- subscapular fossa to lesser tubercle of humerus
Lat dorsi- T7-L5 illiac fossa to floor of bicipital groove
20Posterior axilla- UL to scapulaTeres Maj- from lat margin of scapular to medial lip of bicipital groove
21clavipectoral triangle
22muscles of scapular region1) Superficial
–Latissimus dorsi
-Trapezius
[Upper- elevates scapula, middle- retracts scapula, lower- depresses and laterally rotates the scapula]
2) Deep (trunk to scapula)
-Rhomboids
-Levator Scapulae
3) Scapular (Scapula to humerus)
-Deltoid
-Teres Major
-Supraspinatus
-Infraspinatus
-Teres Minor
23Anterior axilla wallpec maj/ min and clavipectoral fascia
24Axilla medial wallserratus anterior
ribs and intercostal spaces
25Axilla lateral wallbiceps and coracobrachialis
26attachment of biceps brachii and triceps brachiibiceps long head- superglenoid tubercle
short head- coracoid process
[inserts to radial tuberosity]
triceps long head- infraglenoid tubercle of scapula
lateral head- shaft go humerus superior to groove
medial head- inferior to groove (deep)
[inserts to olecranon]
27Deltoidflexion, extension, abduction and adduction
axillary nerve
28Quadrangular triangleSuperior- teres min
Inferior- teres maj
lateral- surgical neck of humerus
medial- long head triceps
29Upper triangularsuperior- teres minor
inferior- teres maj
lateral- triceps long head
30lower triangularsuperior- teres maj
lateral- humerus
medial- triceps long head
[radial and profunda brachii nerves]
31function of rotator cuff muscles:stabalise and hold joint by pulling head of humerus to the gleanoid fossa
32Dislocation of GH effects:axillary and circumflex humeral artery affected.
motor- loss of abduction
sensory- desensitisation
33GH joint unstable?-glenoid fossa shallow
-approx 1/3 humeral head pulled into glenoid fossa
- surfaces covered by hyaline cartilage
34structures stabilises GHSITS- Supraspinatous, Infraspinatous,
Teres min., Subscapular
35Sternoclavicular and acromioclavicular jointsSternoclavicular joint-
extrinsic [costoclavicular ligaments]
intrinsic [sternoclavicular ligaments]
Acromioclavicular joint-
extrinsic
[coracoclavicular ligaments- strong]
intrinsic
[acromioclavicular ligaments- weak]
36GH VS scapulothoracic joint
37myotomes:C5- abduction of shoulder
C6- flexion at elbow, extension of wrist
C7- Extension at elbow, flexion of wrist
C8- flexion of fingers
T1- abduction and adduction of fingers
38cubital fossa boundries:lateral: brachioradialis
medial: pronator teres
superior: line of epicondyles
roof: bicipital aponeurosis
floor: brachialis, supinator
39neurovascular branches in cubital fossa:
40FA: superficial musclesPT, PL, FCR [median]
FCU [ulnar nerve]
41FA intermediateFDS- median
flexor retinaculum- 4 tendons insert to mid phalanges [median/ ulnar nerve]
42FA deep musclesFDP
[lateral 1/2- ant. interosseous nerve and ulnar- medial 1/2]
FPL, PQ
ant. interosseous nerve accompanied by median nerve
flexor retinaculum
43FA extensors:supply by posterior interosseous artery
[supinator and ASB]
innervated by posterior interosseous nerve [terminal branch of radial nerve]
1) Deep nerve branch- motor
[post. Interosseous nerve]
2) Superficial nerve branch- sensory
[supply skin on dorsum of hand]
44flexor, extensor compartment medial intermuscular septum lateral intermuscular septumflexor- BBC [Musculocutaneous]
biceps brachii- flex elbow and shoulder, suppinates FA
brachialis- flex elbow
coracobrachialis- flex shoulder
extensor- triceps [radial nerve]
453 nerves in contact with humerus:Axillary- surgical neck
Radial- radial groove
ulnar- medial epichondyle
46pressure point:point pressure is put on artery to prevent haemorrhage
mid shaft of humerus
cubital fossa
47elbow joints:humero- radial- capitulum
humero- ulnar- trochlear
superior radioulnar- head of radius
48elbow ligaments- stability: radial/ ulnar collateralflexion and extension
(prevent lateral dislocation)
49elbow ligaments- stability: annular ligament of radius- pulled (attached anteriorly and posterior to ulna)Supination and pronation- Stabilizes radial head
Supination- supinator and biceps brachii contract
Pronation- pronator teres and pronator quadratus contract
50distal radius fracture:colles fracture/ dinner fork
[median nerve affected]
disruption of the ulna styloid process very common
After a fall onto an outstretched hand.
A history of previous fractures may suggest underlying osteoporosis- post meno women
51TCA
52vit B2/ riboflavinderived FAD
deficiency: lesions in mucous membrane (cracked sore lips and corners of mouth)
53mitochondria structurebilayer
breakdown pyruvate
CoA nucleotide- contains vit B5
oxidative phosphrylation
-inner mitochondrial membrane
54respiration chainNADH
I
NADH Q reductase
I
Q [FADH2 in flavoproteins]
I
cytochrome reductase
I
cyt c
I
cytochrome oxidase
I
o2
55Oxidation of each mol of NADH3 mols of ATP
each mol of FADH2 -> 2 ATP mols
56respiratory chain and TCA and glycolysis30-32 ATP
57draw respiratory chain
58bursitisdegenerative changes in supraspinatous tendon
[inability to abduct- painful arc syndrome]
59duration glycogen stored in liver3-5 hours
60joints in hand:-Interphalengeal joints
Flexion and extension
-Metacarpophalengeal joints
Flexion, extension and circumduction, adduction and abduction
-Carpometacarpal joint
Gliding, flexion and extension
-Radiocarpal joint
Abduction, adduction, flexion, extension and circumduction
61carpal bones:Tubercle of scaphoid, Scaphoid, Lunnate, Triquetrum, Pisiform
Trapezium, Trapezoid, Capitate, Hook of Hammate, Hammate
62Attachment for flexor retinaculumTubercle of Scaphoid, Pisiform, Tubercle of trapezium, Hook of Hammate
63carpal tunnel symptoms nerve affectedparaesthesia lateral side of hand, weakness in abduction of thumb
Hand out of bed improves!
Median nerve
64median nerve- hand Motor supply- LOAFLateral 2 lumbricals, opponens pollicis, abductor pollicis, flexor pollicis
65carpal tunnel Sensory supplyloss of sensation over palmar surface of thumb and lateral fingers
66Avascular necrosis of the proximal fragment of scaphoiddisruption of blood supply due to scaphoid
fracture
67ASBtenderness- due to scaphoid fracture
radial artery affected- outstretched fall
68radial, median and ulnar in FA
692nd FA nerve pic:
70Deep structures to flexor retinaculum: median nerve- between FDS and FCR
71Superficial structures of flexor retinaculum: thenar and hypothenar muscles
72intrinsic muscles: hypothenar and thenar
73fibrous and synovial sheaths: tendon of FDS and FDP
74Superficial and deep palmar arch: superficial- distal phalanges of extended thumb
75layers of the hand:Skin, superficial fascia,
palmar aponeurosis,
superficial arch,
median and ulnar nerve,
tendons of FDS and FDP with lumbricals, Deep palmar arch,
palmar interossei and [adductor pollicis, carpal tunnel, flexor and opponens pollicis],
dorsal interossei [1st, 2nd, ASB, extensor retinaculum, dorsal digital expansion]
76movements of thumb:
77Extrinsic- power grip Intrinsic- pinch grip=power grip- long flexor/ long extensor
long flexor- median 3.5 and ulnar nerve 1.5 fingers
ie. 4 tendons of FDS insert on to middle phalanges,
4 tendons of FDP insert on to distal phalanges (Deep),
lumbricals from FDP
long extensor- radial nerve (post interosseous branch)
=pinch grip- short muscles
ulnar and median nerves
(median supplies thenar muscles and lateral 2 lumbricals)
extension of IP and flexion of MTCP
78Intrinsic muscles: supplied by spinal segmental T1
79function of the fibrous flexor sheaths(superficial) and synovial sheaths (deep)flexor sheaths- attached to margins of phalanges, and bind down tendons on phalanges
synovial sheath- ensure friction free movement of tendons
80FA muscles:
81PAD and DABPalmar interossei- adduction
Dorsal interossei- abduction
82Superficial arch radial and ulnar arteryRadial artery
4 branches- supply medial 3 ½ fingers
digital arteries and nerves lie along borders of digits
vessels deep to palmar aponeurosis at level of distal border of extended thumb
83Deep arch radial and ulnar arteryAnastomosing with deep branch ulnar and continuation of radial artery from superficial arch
-Proximal border of extended thumb
-metacarpal branches connect 2 arches together
84Allen’s testperformed prior to radial arterial blood sampling- establish patency of radial and ulnar arteries
85motor and sensory branches of median and ulnar nerves:
86Dupytren’s contracture- uneven thickening of palmar aponeurosis
87Radial artery (posterior to hand)Passes between head of 1st dorsal interosseous muscle, adductor pollicis
Anastomosing with deep branch ulnar artery
superficial branch of the radial nerve supplies skin on the dorsum of the hand and the lateral 3½ digits
88lumbricals:
89Adductor pollicis muscle testedForment's test
90cruciate fibres Flexion movement of fingers
91function of synovial sheaths (deep)ensure friction free movement of tendons
92radial anatomy
93humerus anatomy
94nerve lesions and pathways: C5-T1
95tendon of extensor digitorum:
96C5-7 roots damaged long thoracicwinged scapula
Serratus anterior from long scapular nerve damaged
- Protraction of scapula, holds scapula on thorax wall
97rotator cuff muscles action and innervation:
98posterior axilla muscle attachments
99position of brachial plexus (most posterior) subclavian vein (most anterior)
100cervical ribextra rib/ fibrous band
articulate posteriorly to C7
inferior trunk brachial plexus most affected
nerve root T1
101symptoms of cervical rib:Weakness in intrinsic muscles of the the hand
Paresthesia
102Tests of cervical rib:motor test: Abduction of fingers against resistance (myotome T1)
DAB muscle tested
sensory: Medial arm (dermatome T1)
103adductor pollicis [A OF A OF A] thenar: Abductor pollicis longus, opponens pollicis, flexor pollicis brevis, adductor pollicis hypothenar: opponens digiti minimi flexor digiti minimi abductor digiti minimi
104scapula anatomy
105clavicle anatomy:
106humerus anatomy:
107brachial plexus surrounding structures: anterior- [inf part] subclavian artery/ vein, clavicle, posterior- post/ mid scalene ant. to lateral chord- pect minor medial to lateral chord- 2nd part of axillary
108lateral and medial intermuscular septum
109Rotator cuff muscles: Anterior- subscapularis superior- supraspinatus posterior- infraspinatus and teres minor
110coracoacromial ligament acramioclavicular ligament
111FA muscles and tendons [note: deep radial nerve inserts into supinator median nerve posterior to FDS ulnar nerve- most medial border]
112'M' in brachial plexus musculocutaneous median ulnar
113Posterior cord not involved in the M medial to lateral cord- 2nd part of axillary artery profunda brachii with radial nerve at radial groove
114superficial and deep structures overlying ASBsuperficial:
branches of radial nerve
cephalic vein
deep:
radial artery