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Flashcards

UL1

denise tan1844 Inglês 114 flashcards

UL1

Flashcards do conjunto (114)

  1. 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
  2. 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,
  3. 3Axillary veinmedial to axillary artery
    begins- lower margin of teres major
    ends at 1st rib (subclavian vein)
  4. 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]    Axillary lymph nodes
  5. 5brachial plexusorigin- from ventral primary rami of cervical spinal nerves C5 - T1
    roots C5-8,T1
    Draw
  6. 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
  7. 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
  8. 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.
  9. 9Draw NMJ of skeletal muscle:Draw NMJ of skeletal muscle:
  10. 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
  11. 11Dermatomes and myotomes:Dermatomes- test for sensation and spinal cord damage [central damage]
    Myotomes- test for motor and somatic functions, using tendon reflexes
  12. 12Draw the dermatomes of armDraw the dermatomes of arm
  13. 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)
  14. 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
  15. 15Damage of upper trunk of brachial plexus (C5-6)1) shoulder dystocia
    -traction damaged
    2) Erb- Duchenne Palsy
    -Erb's paralysis
  16. 16Damage of lower trunk (c8-T1)Klumpke's palsy
    -tree fall, obstetric injury
  17. 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
  18. 18posterior wall muscles of axillasubscapularis
    teres maj
    latissimus dorsi
  19. 19posterior axilla- UL to trunksubscapularis- subscapular fossa to lesser tubercle of humerus
    Lat dorsi- T7-L5 illiac fossa to floor of bicipital groove
  20. 20Posterior axilla- UL to scapulaTeres Maj- from lat margin of scapular to medial lip of bicipital groove
  21. 21clavipectoral triangleclavipectoral triangle
  22. 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
  23. 23Anterior axilla wallpec maj/ min and clavipectoral fascia
  24. 24Axilla medial wallserratus anterior
    ribs and intercostal spaces
  25. 25Axilla lateral wallbiceps and coracobrachialis
  26. 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]
  27. 27Deltoidflexion, extension, abduction and adduction
    axillary nerve
  28. 28Quadrangular triangleSuperior- teres min
    Inferior- teres maj
    lateral- surgical neck of humerus
    medial- long head triceps
  29. 29Upper triangularsuperior- teres minor
    inferior- teres maj
    lateral- triceps long head
  30. 30lower triangularsuperior- teres maj
    lateral- humerus
    medial- triceps long head
    [radial and profunda brachii nerves]
  31. 31function of rotator cuff muscles:stabalise and hold joint by pulling head of humerus to the gleanoid fossa
  32. 32Dislocation of GH effects:axillary and circumflex humeral artery affected.
    motor- loss of abduction
    sensory- desensitisation
  33. 33GH joint unstable?-glenoid fossa shallow
    -approx 1/3 humeral head pulled into glenoid fossa
    - surfaces covered by hyaline cartilage
  34. 34structures stabilises GHSITS- Supraspinatous, Infraspinatous,
    Teres min., Subscapular
  35. 35Sternoclavicular and acromioclavicular jointsSternoclavicular joint-
    extrinsic [costoclavicular ligaments]
    intrinsic [sternoclavicular ligaments]
    Acromioclavicular joint-
    extrinsic
    [coracoclavicular ligaments- strong]
    intrinsic
    [acromioclavicular ligaments- weak]
  36. 36GH VS scapulothoracic jointGH VS scapulothoracic joint
  37. 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
  38. 38cubital fossa boundries:lateral: brachioradialis
    medial: pronator teres
    superior: line of epicondyles
    roof: bicipital aponeurosis
    floor: brachialis, supinator    cubital fossa boundries:
  39. 39neurovascular branches in cubital fossa:neurovascular branches in cubital fossa:
  40. 40FA: superficial musclesPT, PL, FCR [median]
    FCU [ulnar nerve]
  41. 41FA intermediateFDS- median
    flexor retinaculum- 4 tendons insert to mid phalanges [median/ ulnar nerve]
  42. 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
  43. 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]
  44. 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]
  45. 453 nerves in contact with humerus:Axillary- surgical neck
    Radial- radial groove
    ulnar- medial epichondyle
  46. 46pressure point:point pressure is put on artery to prevent haemorrhage
    mid shaft of humerus
    cubital fossa
  47. 47elbow joints:humero- radial- capitulum
    humero- ulnar- trochlear
    superior radioulnar- head of radius
  48. 48elbow ligaments- stability: radial/ ulnar collateralflexion and extension
    (prevent lateral dislocation)
  49. 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
  50. 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
  51. 51TCATCA
  52. 52vit B2/ riboflavinderived FAD
    deficiency: lesions in mucous membrane (cracked sore lips and corners of mouth)
  53. 53mitochondria structurebilayer
    breakdown pyruvate
    CoA nucleotide- contains vit B5
    oxidative phosphrylation
    -inner mitochondrial membrane    mitochondria structure
  54. 54respiration chainNADH
    I
    NADH Q reductase
    I
    Q [FADH2 in flavoproteins]
    I
    cytochrome reductase
    I
    cyt c
    I
    cytochrome oxidase
    I
    o2
  55. 55Oxidation of each mol of NADH3 mols of ATP
    each mol of FADH2 -> 2 ATP mols
  56. 56respiratory chain and TCA and glycolysis30-32 ATP
  57. 57draw respiratory chaindraw respiratory chain
  58. 58bursitisdegenerative changes in supraspinatous tendon
    [inability to abduct- painful arc syndrome]
  59. 59duration glycogen stored in liver3-5 hours
  60. 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
  61. 61carpal bones:Tubercle of scaphoid, Scaphoid, Lunnate, Triquetrum, Pisiform
    Trapezium, Trapezoid, Capitate, Hook of Hammate, Hammate
  62. 62Attachment for flexor retinaculumTubercle of Scaphoid, Pisiform, Tubercle of trapezium, Hook of Hammate
  63. 63carpal tunnel symptoms nerve affectedparaesthesia lateral side of hand, weakness in abduction of thumb
    Hand out of bed improves!
    Median nerve
  64. 64median nerve- hand Motor supply- LOAFLateral 2 lumbricals, opponens pollicis, abductor pollicis, flexor pollicis
  65. 65carpal tunnel Sensory supplyloss of sensation over palmar surface of thumb and lateral fingers
  66. 66Avascular necrosis of the proximal fragment of scaphoiddisruption of blood supply due to scaphoid
    fracture
  67. 67ASBtenderness- due to scaphoid fracture
    radial artery affected- outstretched fall    ASB
  68. 68radial, median and ulnar in FAradial, median and ulnar in FA
  69. 692nd FA nerve pic:2nd FA nerve pic:
  70. 70Deep structures to flexor retinaculum: median nerve- between FDS and FCRDeep structures to flexor retinaculum: median nerve- between FDS and FCR
  71. 71Superficial structures of flexor retinaculum: thenar and hypothenar musclesSuperficial structures of flexor retinaculum: thenar and hypothenar muscles
  72. 72intrinsic muscles: hypothenar and thenarintrinsic muscles: hypothenar and thenar
  73. 73fibrous and synovial sheaths: tendon of FDS and FDPfibrous and synovial sheaths: tendon of FDS and FDP
  74. 74Superficial and deep palmar arch: superficial- distal phalanges of extended thumbSuperficial and deep palmar arch: superficial- distal phalanges of extended thumb
  75. 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]
  76. 76movements of thumb:movements of thumb:
  77. 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
  78. 78Intrinsic muscles: supplied by spinal segmental T1Intrinsic muscles: supplied by spinal segmental T1
  79. 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    function of the fibrous flexor sheaths(superficial) and synovial sheaths (deep)
  80. 80FA muscles:FA muscles:
  81. 81PAD and DABPalmar interossei- adduction
    Dorsal interossei- abduction
  82. 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
  83. 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
  84. 84Allen’s testperformed prior to radial arterial blood sampling- establish patency of radial and ulnar arteries
  85. 85motor and sensory branches of median and ulnar nerves:motor and sensory branches of median and ulnar nerves:
  86. 86Dupytren’s contracture- uneven thickening of palmar aponeurosis
  87. 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
  88. 88lumbricals:lumbricals:
  89. 89Adductor pollicis muscle testedForment's test
  90. 90cruciate fibres Flexion movement of fingerscruciate fibres Flexion movement of fingers
  91. 91function of synovial sheaths (deep)ensure friction free movement of tendonsfunction of synovial sheaths (deep)
  92. 92radial anatomyradial anatomy
  93. 93humerus anatomyhumerus anatomy
  94. 94nerve lesions and pathways: C5-T1nerve lesions and pathways: C5-T1
  95. 95tendon of extensor digitorum:tendon of extensor digitorum:
  96. 96C5-7 roots damaged long thoracicwinged scapula
    Serratus anterior from long scapular nerve damaged
    - Protraction of scapula, holds scapula on thorax wall
  97. 97rotator cuff muscles action and innervation:rotator cuff muscles action and innervation:
  98. 98posterior axilla muscle attachmentsposterior axilla muscle attachments
  99. 99position of brachial plexus (most posterior) subclavian vein (most anterior)position of brachial plexus (most posterior) subclavian vein (most anterior)
  100. 100cervical ribextra rib/ fibrous band
    articulate posteriorly to C7
    inferior trunk brachial plexus most affected
    nerve root T1
  101. 101symptoms of cervical rib:Weakness in intrinsic muscles of the the hand
    Paresthesia
  102. 102Tests of cervical rib:motor test: Abduction of fingers against resistance (myotome T1)
    DAB muscle tested
    sensory: Medial arm (dermatome T1)
  103. 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 minimiadductor pollicis [A OF A OF A] thenar: Abductor pollicis longus, opponens pollicis, flexor pollicis brevis, adductor pollicis hypothenar...
  104. 104scapula anatomyscapula anatomy
  105. 105clavicle anatomy:clavicle anatomy:
  106. 106humerus anatomy:humerus anatomy:
  107. 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 axillarybrachial plexus surrounding structures: anterior- [inf part] subclavian artery/ vein, clavicle, posterior- post/ mid scalene ant. to late...
  108. 108lateral and medial intermuscular septumlateral and medial intermuscular septum
  109. 109Rotator cuff muscles: Anterior- subscapularis superior- supraspinatus posterior- infraspinatus and teres minorRotator cuff muscles: Anterior- subscapularis superior- supraspinatus posterior- infraspinatus and teres minor
  110. 110coracoacromial ligament acramioclavicular ligamentcoracoacromial ligament acramioclavicular ligament
  111. 111FA muscles and tendons [note: deep radial nerve inserts into supinator median nerve posterior to FDS ulnar nerve- most medial border]FA muscles and tendons [note: deep radial nerve inserts into supinator median nerve posterior to FDS ulnar nerve- most medial border]
  112. 112'M' in brachial plexus musculocutaneous median ulnar'M' in brachial plexus musculocutaneous median ulnar
  113. 113Posterior cord not involved in the M medial to lateral cord- 2nd part of axillary artery profunda brachii with radial nerve at radial groovePosterior cord not involved in the M medial to lateral cord- 2nd part of axillary artery profunda brachii with radial nerve at radial groove
  114. 114superficial and deep structures overlying ASBsuperficial:
    branches of radial nerve
    cephalic vein
    deep:
    radial artery

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FlashCards sobre UL1, criado por denise tan1844 em 19-04-2015.
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