Upper Limb BMS301

• List the bones, anatomical names and common names for the different parts of the upper limb.

  Shoulder Region

  Area: neck->arm

  Name: shoulder

  Bones: clavicle/scapula (*Pectoral Girdle)

  
  

  Arm Region

  Area: shoulder-> forearm

  Name: brachium

  Bones: humerus

  
  

  forearm Region

  Area:arm-> hand

  Name:antibrachium

  Bones:radius/ulna

  
  

  hand Region

  Area:forearm->distal

  Name: manus(wrist, hand proper(palm), digits)

  Bones:carpals, metacarpals, phalanges

  
• List the bones involved in the shoulder girdle.


  Sternum, clavicle, scapula
• List a general function of each of the bones involved in the shoulder girdle

  Sternum

  -

  
  

  Clavicle

  -Strut(pushses upper limb out laterally)

  -transmits all energy from upper limb to axial skeleton

  
  

  Scapula

  -Articulates with humerus
• List the four articulations of the shoulder region, their classification and movements.

  sternoclavicular joint

  acromioclavicular joint

  scapulothoracic joint

  glenohumeral joint
• sternoclavicular joint


  -Articulation between the clavicle and the sternum

  -synovial joint

  -saddle joint

  -strong(rarely dislocates)

  
• acromioclavicular joint


  the joint where the acromion and the clavicle meet

  -synovial

  -plane/gliding

  -ligaments

  -shoulder separation

  -Coracoclavicular ligament(stabilizing)

  
• scapulothoracic joint


  *not really an articulation

  -scapula/ribs

  -elevate/depress scapula

  -ab/adduct scapula

  -rotate scapula(glenoid fossa up/down)

  
• Describe the glenohumeral joint in terms of its structure and strength


  "true shoulder joint"

  -scapula/humerus

  -synovial

  -ball and socket

  -increased range of motion(sacrifices stability)

  -less than 1/3 head of humerus in glenoid fossa on scapula

  -joint capsule DOES NOT contribute to strength

  -muscles are the strength of the joint

  -rotator cuff muscles (keep head of humerus in glenoid fossa)

  -rotator cuff muscles are stong posterior/superior (almost all dislocations occur anterior and inferior )

  -rim of cartilage-glenoid labrum

  
• Describe the differences between the shoulder joint and hip joint.


  Shoulder joint

  -increased range of motion(sacrifices stability)

  -less than 1/3 head of humerus in glenoid fossa on scapula

  
  

  Hip joint

  -stable, over 1/2 head of femur in acetabulum
• Describe the differences between axiohumeral, axioscapular, and scapulohumeral muscles.


  Axiohumeral(skeleton-humerus)

  -pectoralis major

  -latissimus dorsi

  
  

  Axioscapular(skeleton-scapula)

  -trapezius

  -rhomboids

  -levator scapula

  -serratus anterior

  -Pectoralis minor

  
  

  Scapulohumeral(scapula-humerus)

  -Deltoid

  -teres major

  Rotator Cuff muscles

  -supraspinatus

  -infraspinatus

  -teres minor

  -subscapularis
• List the attachments, actions and nerve supply of the muscles in axiohumeral, axioscapular, and scapulohumeral
• Pectoralis major


  A:

  -sternal:sternum

  -clavicular:clavicle

  B: intertubercular groove, humerus

  action: adduction(humerus), medial rotation(humerus)

  inn: medial & lateral pectoral nerve

  
  

  clavicular head can flex the shoulder

  sternal head can extend & flex shoulder

  
• latissimus dorsi


  *not a true back muscle

  A:spinous process L5-T7

  B: intertubercular groove, humerus

  Action: medial rotation, adduction, powerful extension

  inn: thoracodorsal nerve

  
• Trapezius


  *not a true back muscle

  A:

  external occipital protuberance

  nuchal ligament

  spinous process cervical-T12

  B:

  upper: clavicle, acromion of scapula

  middle: spine of scapula

  lower: spine of scapula

  
  

  Actions:

  Upper- elevation scapula, upward rotation

  middle- retraction(adduction)

  lower- depression, upward rotation

  
  

  inn:accessory nerve CNXI

  
• Rhomboids


  A: spinous process C7-T5

  B: medial border, scapula

  Action:retraction of scapula(adduction)

  inn: dorsal scapular nerve

  
• Levator scapula


  A:transverse processes of C1-C4

  B: superior angle, scapula

  Action: elevation of scapula, downward rotation

  inn: dorsal scapular nerve

  
• serratus anterior


  A: first 8-9 ribs

  B: medial border, scapula

  action:protraction(abduction)

  inn: long thoracic nerve

  
• Pectoralis minor


  A: ribs 3-5

  B: coracoid process

  action: depress scapula

  *stabilizer muscle, forced respiration

  inn: medial + lateral pectoral nerve

  
• deltoid


  3 heads

  A:

  -spinal: spine of scapula

  -acromoion: acromion process scapula

  -clavicular: lateral 1/3 clavicle

  B: deltoid tuberosity, humerus

  
  

  Action:

  S-extend shoulder, lateral rotation, abduction

  A-abduction

  C-flex shoulder, medial rotation, abduction

  inn:axillary nerve

  
• Teres major


  A: inferior angle of scapula

  B: intertubercular groove, humerus

  action: medial rotation shoulder, adduction shoulder, extension shoulder

  inn: lower subscapular nerve

  
• Supraspinatus


  *most commonly injured of rotator cuff muscles, small

  A:supraspinous fossa, scapula

  B:greater tubercle, humerus

  action: abduction (10-15 degrees)

  inn: suprasscapular nerve

  
• infraspinatus


  A: infraspinous fossa, scapula

  B:greater tubercle of humerus

  action: lateral rotation shoulder, adduction arm

  inn:suprascapular nerve

  
• teres minor


  A:lateral border of scapula

  B: greater tubercle of humerus

  action: lateral rotation shoulder, adduction arm

  inn: axillary nerve

  
• Subscapularis


  A: scapularis fossa

  B:lesser tubercle, humerus

  action: medial rotation, adduction

  inn: upper & lower subscapular nerve

  
• List the muscles of the rotator cuff and their effect on the glenohumeral joint.


  Muscles

  -supraspinatus

  -infraspinatus

  -teres minor

  -subscapularis

  
  

  Effect on glenohumeral joint

  -rotator cuff muscles (keep head of the humerus in glenoid fossa)

  -rotator cuff muscles are stong posterior/superior
• Axilla and Breast
• Describe the boundaries and contents of the axilla.

  Boundaries

  -anterior: pectoralis major &minor

  -medial: ribs, serratus anterior

  -posterior: subscapularis, teres major->latissimus dorsi

  
  

  Contents

  -brachial plexus nerve

  -axillary artery & vein

  -lymphatics

  -axillary lymph nodes
• Describe the breast


  -all of the structures are present in both male and female

  -susceptible to changes

  ex: menstrual cycle, hormonal influences pregnancy, cancer &cycts
• Describe the differences between the breast and mammary gland


  mammary glands(glandular lobules)

  =modified sebaceous (sweat) glands

  exocrine, produce milk(accessory organ of female reproductive system

  
  

  Breast

  = group of modified sweat glands, including mammary glands

  -Packed in fat

  -supported by suspensory ligaments( borrowed from superficial fascia

  -covered by delicate skin
• Describe the structure of the breast, include glands, ducts, ligaments and general characteristics

  Structure from posterior to anterior

  -ribs

  -pectoralis minor muscle

  -pectoralis major muscle

  -deep fascia

  -superficial fascia

  -mammary glands

  (exocrine organ (milk produced))

  -lactiferous ducts

  -lactiferous sinuses

  (act as milk reserve (little milk stored for immediate milk for baby))

  -nipple

  (where milk exits)

  *reflex involved with the nipple, baby sucks signal to the hypothalamus, back from the hypothalamus to the mammary gland to release milk

  -areola

  (lateral to nipple, sweat and oil glands)

  -fat(increased estrogen increased fat=varying breast sizes)

  -suspensory ligaments

  (from superfical fascia to skin anteriorly

  cancers can develop in these ligaments)
• List 2-3 risk factors for breast cancer


  older age(50+)

  early puberty/late menopause

  No pregnancies
• List 2-3 types of breast cancer screening.


  Mammography (low dosage Xray), CT scan, ultrasound, self exam
• Describe fibrocystic changes


  noncancerous breast lumps in the breast which can sometimes cause discomfort, often periodically related to hormonal influences from the menstrual cycle & stress.

  *Cysts move more freely than Cancerous tumors
• Understand how breast cancer can spread to axilla, opposite breast or lungs


  Breast cancer can spread through 2 different kinds of lymph nodes

  
  

  Axillary lymph nodes

  -drains from lateral/superior breast

  -drains lateral --> medial(bring lymph back to systemic circulation

  
  

  Parasternal lymph nodes

  -drains from both breasts

  - cancer in the more medial breast can spread from one breast to another, or to lungs through parasternal lymph
• Brachial Plexus
• Describe the components of the brachial plexus

  -Nerve supply to upper limb

  -motor:lower motor neuron to skeletal muscles

  -sensory: general sensation(pain, vibration, touch, proprioception from skin)

  -autonomic: sympathetic only

  (Sweat glands, smooth muscle in vessels, arrector pili muscles(goosebumps))

  -ventral(anterior) rami of spinal nerves

  (C5,C6,C7,C8,T1)

  -motor cell bodies= ventral horn

  -sensory cell bodies= dorsal root ganglia
• Be able to differentiate between trunks, divisions, cords and terminal branches of the brachial plexus.

  
• Describe the nerve branches of the roots, trunks and cords of the brachial plexus


  Roots

  -C5, C6, C7, C8, T1

  (C5 branch of dorsal scapular nerve)

  (C5, C6, C7 branch of long thoracic nerve)

  
  

  Trunks

  -superior

  (branch of suprascapular nerve)

  -middle

  -inferior

  
  

  Divisions

  -anterior

  -posterior

  
  

  cords

  -lateral

  (Branch of lateral pectoral nerve)

  -posterior

  (Branches of upper scapular nerve, Thoracodorsal nerve, and lower Subscapular nerve)

  -medial

  (branch of medial pectoral nerve)

  
  

  branches

  
  

  From lateral/medial cords

  -musculocutaneous nerve

  -lateral root of median nerve

  -median nerve

  -medial root of median nerve

  -ulnar nerve

  
  

  From posterior cord

  -radial nerve

  -Axillary nerve

  
• Describe the terminal nerves of the plexus and their areas of responsibilities.

  Musculocutaneous Nerve

  -innervates anterior arm muscles(elbow flexors)

  
  

  Median Nerve

  -innervates anterior forearm muscle, thumb muscles

  
  

  Ulnar nerve

  -innervates small hand muscles

  
  

  
  

  Radial Nerve

  -innervated posterior arm muscles and posterior forearm muscle

  
  

  Axillary nerve

  -innervates posterior shoulder

  
• Differentiate between paralysis, paresis, anesthesia and parathesia.


  Paralysis-complete loss of voluntary movement

  
  

  Paresis- weakness in voluntary movement

  
  

  Anesthesia- complete loss of sensation

  
  

  Parathesia- numbness and tingling sensation