Upper Limb Objectives

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

Proximal to distal the shoulder runs from the neck to the arm containing the clavicle and scapula. The brachium runs shoulder to forearm containing the humerus. The antibrachium runs arm to had containing the radius and ulna and the manis (wrist, hand proper, and digits) runs forearm distally containing the carpals, metacarpals, and phalanges.

List the bones involved in the pectoral/shoulder girdle and their general functions.

The clavicle projects the upper limb laterally and transmits all form from the upper limb to the sternum. The scapula is a site of extensive muscle attachment and is highly involved in shoulder movement. The humerus is the arm bone.

List the four articulations of the shoulder region, their classification and movements

The sternoclavicular joint joins the sternum and clavicle and is an incredibly strong multiaxial synovial joint. The acromioclavicular joint joins the scapula with the distal clavicle and is a synovial gliding joint that is stabilized by ligaments. The scapula can preform protraction/retraction, elevation/depression, and rotation. The glenohumeral joint connects the humerus with the scapula and is a ball and socket joint.

Describe the glenohumeral joint in terms of its structure and strength

1/3 of the humeral head sits in the glenoid fossa which allows for a huge rom but less stability. The glenoid labrum deepens the socket and the joint capsule allows for increased movement.

Describe the differences between the shoulder joint and hip joint.

Unlike the hip joint, the shoulder joint is non-propulsive and non-weight bearing.

Describe the boundaries and contents of the axilla.

The anterior border of the axilla includes pectoralis major and minor muscles. The medial border is the ribs and serratus anterior muscle. The posterior border includes subscapularis, teres major, and latissimus dorsi muscles. Contents include a neurovascular bundle (brachial plexus, axillary artery and vein), lymphatics and fat.

Define the breast. How is this different from the mammary glands?

The breast is a structure present in both males and females while mammary glands are milk producing accessory reproductive organs found only in females.

Describe the structure of the breast, include glands, ducts, ligaments and general characteristics

From posterior to anterior the breast contains ribs, pectoralis major and minor muscles, deep and superficial fascia, mammary glands that produce milk, lactiferous ducts with sinuses, the nipple, areola, fat, and suspensory ligaments

List 2-3 risk factors for breast cancer.

older age, late menopause, no pregnancies

List 2-3 types of breast cancer screening

mammography, ultrasound, and CT scans

Describe fibrocystic "changes"

noncancerous breast lumps that can be related to hormonal changes

Understand how breast cancer can spread to the axilla, opposite breast or lungs

breast cancer can metastasize to the rest of the body with axillary lymph nodes draining into systemic circulation via vasculature in the axilla. It can also spread between breasts via parasternal lymph nodes

Describe the components of the brachial plexus

The brachial plexus is composed of ventral rami and made up of sympathetic autonomics innervating the entire upper limb with roots, trunks, divisions, cords, branches, and terminal branches

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

The axillary nerve innervates the shoulder. The radial nerve innervates the posterior arm and forearm. The ulnar nerve innervates the hand intrinsics. The median nerve innervates the anterior compartment of the forearm and thumb. The musculocutaneous nerve innervates the anterior arm

Differentiate between paralysis, paresis, anesthesia and paresthesia.

Paralysis is the complete loss of motor function while anesthesia is the complete loss of sensory function. Paresis is weakness in motor function. Paresthesia is the pins and needles feeling.

Describe the effects of nerve damage to roots, trunks, cords and terminal nerves of the brachial plexus.

Root damage (like Long Thoracic) causes scapular winging; Trunk (Upper/Erb's Palsy) affects shoulder/elbow; Cord injury (Posterior/Radial) causes wrist drop; Terminal Nerves (Median, Ulnar, Radial) cause specific hand/finger deficits (claw hand, numbness)

Describe the elbow joint in terms of its sub-articulations

The subarticulations of the elbow include those between the ulna and trochlea, the radius and capitulum, and the radius with the ulna. They all share the same joint capsule

What is the "true" elbow joint?

The true elbow joint is the articulation between the ulna and trochlea which is responsible for all force transmission to the humerus. There is also the articulation between the radius and capitulum with no force.

Describe the collateral ligaments of the elbow

There are two very strong collateral ligaments that prevent abduction and adduction. The ulnar collateral ligament is vulnerable to injury in baseball players and the radial collateral ligament attaches to the annular ligament on the radius.

Describe the proximal and distal radioulnar joints.

The distal and proximal radioulnar joints are synovial rotational joints that allow pronation and supination.

What is the annular ligament?

A ligament between the radius and ulna that allows for pronation/supination

Describe supination and pronation in terms of the bones and joints involved

Pronation and supination are forearm movements where the radius rotates around the ulna

List the carpals proximal to distal and lateral to medial

Lunate, scaphoid, Triquetrum (pisiform on the palmar side), humate, capitate, trapezoid, and trapezium

How are the carpals and phalanges numbered in the hand?

Thumb to pinky/lateral to medial

Define collateral circulation and anastomoses.

Collateral circulation are alternate anastomoses between arteries and veins to bypass main circulation routes

List the origins of the arterial supply to the upper limb.

The arterial supply to the upper limb originates from the subclavian artery which branches directly from the aorta on the left side and from the brachiocephalic trunk on the right side

List the major arterial vessels of the upper limb.

the subclavian artery, axillary artery, brachial artery, radial and ulnar arteries

List the major branches of the vessels in the upper limb and their area of responsibilities

The axillary artery branches into the thoracoacromial trunk, lateral thoracic artery, and subscapular artery. The brachial artery gives rise to the profunda brachii. The ulnar artery forms the superficial palmar arch while the radial artery forms the deep palmar arch

Describe the differences between deep and superficial veins.

Deep veins accompany arteries in venae commentates whereas superficial veins have unique names and drain blood from superficial tissues.

List the major superficial veins of the upper limb and their destinations

The cephalic vein travels along the lateral arm and drains into the axillary vein. The basilic vein ascends the medial arm and drains into the brachial vein

What is the clinical significance of the median cubital vein?

the median cubital vein is the most commonly puncture spot in the arm for blood draws

Describe the distal radioulnar articulation

the distal radioulnar joint is responsible for anteroposterior transitional stability and is important in pronation and supination

Describe the wrist articulation and the bones involved.

The radiocarpal joint exists between the scaphoid and lunate bones and is a synovial biaxial joint that does flexion/extension and abduction/adduction

Describe the intercarpal joints

The intercarpal joints are synovial nonaxial joints meant to increase range of motion. They all share a common joint capsule.

Describe the carpometacarpal joints.

The carpometacarpal joints of digits 2-5 are synovial nonaxial and share a joint capsule with the intercarpals. The carpometacarpal joint of digit one is a synovial saddle joint between the trapezium and metacarpal one. It allows the thumb to rest 90 degrees from the palm, and can rotate along with its other actions of flexion/extension and abduction/adduction.

Describe the metacarpophalangeal joints.

metacarpophalangeal joints digits 2-5 are synovial biaxial. Digit one has a synovial uniaxial joint.

Describe the interphalangeal joints.

Digits 2-5 have a proximal and distal uniaxial interphalangeal joint while digit one has the proximal joint.