Upper Limb Anatomy: Function and Brachial Plexus

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Questions and Answers

What primary function does the upper limb serve in daily activities?

  • Regulating body temperature.
  • Maintaining balance while standing.
  • Enabling precise movements for tasks like writing and eating. (correct)
  • Facilitating locomotion and weight-bearing.
  • Providing structural support for the body.

Which of the following is enabled by the shoulder joint and associated muscles?

  • Precise sensory perception.
  • A wide range of motion for reaching and lifting. (correct)
  • Stabilizing the body against external forces.
  • Maintaining balance during weight-bearing activities.
  • Fine motor movements of the hand.

What is the function of the elbow joint and its muscles?

  • To allow for shortening or elongation of the upper limb. (correct)
  • To provide sensory feedback from the hand.
  • To provide stability during weight-bearing activities.
  • To facilitate shoulder rotation.
  • To enable precise finger movements.

What type of movements are enabled by the hands and fingers?

<p>Precise movements. (A)</p> Signup and view all the answers

What type of perception is critical for safe interactions by the upper limb?

<p>Sensory perception. (D)</p> Signup and view all the answers

Where are the roots of the brachial plexus located?

<p>Between the anterior and middle scalene muscles. (B)</p> Signup and view all the answers

What structures form the trunks of the brachial plexus?

<p>Roots. (C)</p> Signup and view all the answers

Which nerve arises directly from the roots of the brachial plexus?

<p>Long thoracic nerve. (B)</p> Signup and view all the answers

A patient presents with an inability to abduct their arm. Which nerve is MOST likely affected?

<p>Axillary nerve. (B)</p> Signup and view all the answers

Which nerve is likely affected by a lesion proximal to the dorsal scapular nerve root level, impacting the rhomboids?

<p>Dorsal scapular nerve. (A)</p> Signup and view all the answers

What condition can occur due to compression by the scalene muscles, affecting the brachial plexus?

<p>Scalene muscle hypertrophy. (B)</p> Signup and view all the answers

What is the MOST likely consequence of compressed foraminal stenosis affecting the brachial plexus roots?

<p>Sensory and motor deficits in the upper limb. (B)</p> Signup and view all the answers

Which structure does the C8/T1 nerve root pass over, which may be affected by thoracic inlet pathologies?

<p>The first rib. (B)</p> Signup and view all the answers

How does a Pancoast tumor typically affect the brachial plexus?

<p>By infiltrating the lower trunk, especially the T1 root. (C)</p> Signup and view all the answers

What is the primary function of the trapezius muscle's superior fibers?

<p>Elevating the scapula. (E)</p> Signup and view all the answers

Which nerve innervates the trapezius muscle?

<p>Spinal accessory nerve. (B)</p> Signup and view all the answers

What action does the serratus anterior muscle perform to the scapula during shoulder movements?

<p>Protracts the shoulder girdle. (B)</p> Signup and view all the answers

What nerve innervates the serratus anterior muscle?

<p>Long thoracic nerve. (C)</p> Signup and view all the answers

What happens when the long thoracic nerve is damaged, leading to paralysis of the sarratus anterior?

<p>Scapular winging. (D)</p> Signup and view all the answers

What are the attachments of the latissimus dorsi muscle?

<p>Thoracolumbar fascia, iliac crest, and bicipital groove. (D)</p> Signup and view all the answers

Which nerve innervates the latissimus dorsi muscle?

<p>Thoracodorsal nerve. (D)</p> Signup and view all the answers

What is NOT a function of the latissimus dorsi muscle at the glenohumeral (GH) joint?

<p>Abduction. (D)</p> Signup and view all the answers

What is the location of the teres major muscle in relation to the latissimus dorsi?

<p>Deep. (E)</p> Signup and view all the answers

Which nerve innervates the teres major muscle?

<p>Lower subscapular nerve. (D)</p> Signup and view all the answers

What action does the teres major muscle perform at the GH joint?

<p>Internal rotation and adduction. (B)</p> Signup and view all the answers

What is the primary action of the clavicular fibers of the pectoralis major muscle?

<p>Shoulder flexion. (A)</p> Signup and view all the answers

Which nerves innervate the pectoralis major muscle?

<p>Medial and lateral pectoral nerves. (E)</p> Signup and view all the answers

What action do the sternocostal fibers of the pectoralis major muscle perform?

<p>Shoulder adduction. (A)</p> Signup and view all the answers

Which movement is primarily facilitated by the posterior fibers of the deltoid muscle?

<p>Extension. (C)</p> Signup and view all the answers

What nerve innervates the deltoid muscle?

<p>Axillary nerve. (D)</p> Signup and view all the answers

Through which anatomical space does the axillary nerve pass to innervate the deltoid and teres minor muscles?

<p>Quadrangular space. (B)</p> Signup and view all the answers

Which of the following muscles is NOT part of the SITS muscles?

<p>Teres major. (C)</p> Signup and view all the answers

Which nerve innervates both the supraspinatus and infraspinatus muscles?

<p>Suprascapular nerve. (B)</p> Signup and view all the answers

What is the primary action of the supraspinatus muscle?

<p>Initiation of shoulder abduction. (C)</p> Signup and view all the answers

What is the primary action of the infraspinatus and teres minor muscles?

<p>External rotation of the shoulder. (A)</p> Signup and view all the answers

A patient has difficulty with shoulder abduction and external rotation. Which two nerves are MOST likely affected?

<p>Suprascapular and axillary nerves. (D)</p> Signup and view all the answers

What best describes the innervation and primary action of the subscapularis muscle?

<p>Upper and lower subscapular nerves; shoulder internal rotation. (B)</p> Signup and view all the answers

Which of the following muscles is found in the posterior compartment of the arm?

<p>Triceps brachii. (A)</p> Signup and view all the answers

What nerve innervates all muscles in the posterior compartment of the arm?

<p>Radial nerve. (E)</p> Signup and view all the answers

Which muscle in the posterior compartment of the arm crosses both the shoulder and elbow joints?

<p>Triceps brachii - long head. (E)</p> Signup and view all the answers

What action does the biceps brachii NOT primarily perform?

<p>Elbow extension. (C)</p> Signup and view all the answers

What is the path of the musculocutaneous nerve in relation to the coracobrachialis muscle?

<p>It passes directly through the muscle. (D)</p> Signup and view all the answers

Following its motor function in the arm, what does the musculocutaneous nerve become distally?

<p>The lateral cutaneous nerve of the forearm. (B)</p> Signup and view all the answers

What part of the human would be affected by a lesion in the C5 dermatome?

<p>Lateral arm and upper forearm. (D)</p> Signup and view all the answers

What structures can potentially be affected by foraminal stenosis, leading to brachial plexus symptoms?

<p>The roots of the brachial plexus (A)</p> Signup and view all the answers

Which combination of actions does the latissimus dorsi primarily facilitate at the glenohumeral (GH) joint?

<p>Adduction, internal rotation, and extension (A)</p> Signup and view all the answers

A patient is diagnosed with damage to the musculocutaneous nerve. Which set of actions would be MOST difficult for them to perform?

<p>Elbow flexion and supination (A)</p> Signup and view all the answers

A surgeon dividing the axilla during of a tumor of the breast inadvertently severs the axillary nerve. The consequence of this injury will MOST likely be a severely limited ability to perform what arm action?

<p>Shoulder abduction (C)</p> Signup and view all the answers

What other pathology would MOST directly allow a skilled surgeon to have access to the location where the musculocutaneous nerve pierces coracobrachialis?

<p>A rotator cuff repair requiring acromioplasty of the shoulder (C)</p> Signup and view all the answers

Flashcards

Precise Movements

Movements essential for daily tasks like eating, writing, and using tools.

Mobility and Reach

Shoulder joint paired with muscles allows a wide range of motion for the upper limbs.

Upper Limb Organization

Skeletal, muscular, and neural elements work together in the skeletal muscles.

Brachial Plexus

Dorsal and ventral nerve roots from C5 to T1 that innervate the upper limb.

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Brachial Plexus Roots

Passes through the intervertebral foramina between anterior and middle scalene muscles.

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Foraminal Stenosis

Narrowing of the intervertebral foramina, often due to osteophytes or disc prolapse.

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C8/T1 Roots Location

Passage of the C8/T1 nerve roots over the first rib, vulnerable to compression.

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Cervical Rib

May compress the brachial plexus, especially the lower trunk.

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Trapezius Muscle

Superficial muscle with attachments at the nuchal line, and acromion, innervated by the spinal accessory nerve.

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Rhomboid Muscles

Located deep to the trapezius, retract the scapula, innervated by the dorsal scapular nerve (C5)

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Serratus Anterior

Holds the scapula against the rib cage, protracts the shoulder, and is innervated by the long thoracic nerve (C5-C7).

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Scapular Winging

Inability to hold the scapula against the thoracic wall due to serratus anterior paralysis.

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Latissimus Dorsi

Attaches from the thoracocolumbar fascia from the iliac crest running from the scapula to the bicipital groove and is innervated by the thoracodorsal nerve.

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Teres Major

Attaches scapula to the proximal humeral shaft, and innervated by thoracodorsal nerve.

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Pectoralis Major

Attaches from the sternum and manubrium to the lateral lip of the bicipital groove and is innervated by pectoral nerves.

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Deltoid Muscle

Attaches from the clavicle to the deltoid tuberosity on humerus an innervated by the axillary nerve.

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Axillary Nerve Motor Supply

Deltoid, teres minor.

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Rotator Cuff Muscles

Supraspinatus, Infraspinatus, Teres Minor, Subscapularis

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Suprascapular Nerve

Provides motor innervation to supraspinatus and infraspinatus muscles, crucial for shoulder abduction and rotation.

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Triceps brachii Heads

Long, Lateral, Medial

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Radial nerve

Originate from posterior cord. Provides motor innervation to posterior arm and extensors in forearm.

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Biceps Brachii

Anterior side, has a short and long head that connect to radial tuberosity; also flexion at GH joint.

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Coraco-brachialis

Deep to the Biceps, from the the coracoid process to the humeral shaft in the middle, innervated by the musculocutaneous nerve which causes flexion of the GH joint.

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Brachialis Muscle

Goes from the distal humerus to ulna, in the anterior compartment of the arm but does not cross the GH joint.

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Study Notes

Overall Function of Upper Limb Notes

  • The upper limb facilitates precise movements for daily tasks like eating and writing.
  • It provides sensory perception through tactile and stereognosis for safe interactions.
  • Mobility and reach are enabled by the shoulder joint and associated muscles for activities like reaching.
  • The elbow joint and its muscles position the hand through flexion/extension and orientation.
  • Hands and fingers enable precise movements.
  • The upper limbs contribute to stability and balance, especially during weight-bearing.
  • Focus is on understanding skeletal, muscular, and neural organization and clinical conditions of the UL.

Brachial Plexus Overview

  • The brachial plexus is responsible for the nerve supply to the upper limb.
  • The dorsal root is sensory, while the ventral root is motor.
  • Roots, trunks, divisions, cords, and branches form the structure of the brachial plexus.
  • Long thoracic nerve (C5-C7) and dorsal scapular nerve (C5) are important nerves originating from it.
  • The suprascapular nerve originates from the superior trunk (C5, C6), and the lateral pectoral nerve originates from the lateral cord.
  • The musculocutaneous nerve supplies the brachialis and the median and ulnar nerves supply the forearm.

Brachial Plexus Relations and Injuries

  • The brachial plexus passes through the intervertebral foramina and is located between the anterior and middle scalene muscles.
  • It is located in the posterior triangle of the neck and below the clavicle.
  • Proximally travels roots that travel through intervertebral foramina.
  • Osteophytes in Cx spondylosis or IV disc prolapse can cause compressed foraminal stenosis.
  • Scalene muscle hypertrophy can compress the brachial plexus.
  • Thoracic outlet pathologies like cervical ribs or apical lung tumors can affect it.
  • clavicle fractures may affect the divisions.
  • Pass through intervertebral foramina located between anterior & middle scalene muscles from spinal cord - via intervertebral foramina
  • the axillary artery is named in relationship to the artery - cross lateral, medial, posterior

Motor and Sensory Innervation

  • The anterior compartment primarily involves flexors of the elbow (musculocutaneous nerve) and wrist (median nerve).
  • Key muscles are the supraspinatus, infraspinatus, and teres minor and subscapularis.
  • The posterior compartment includes extensors of the elbow and wrist (radial nerve).
  • C5 is associated with shoulder abduction, C5/6 with elbow flexion, C7/8 with elbow extension, and T1 with finger adduction/abduction.
  • C5 dermatome covers the Lateral arm and upper forearm.
  • Motor innervation of supraspinatus/infraspinatus allows shoulder abduction.
  • Radial nerve innervates the upper arm while the Axillary artery is located at the back.
  • The cervical rib runs at C7, with the pancoast tumour at T1

Shoulder Associated Muscles

  • Scapulo-thoracic muscles attach the scapula to the axial skeleton like the trapezius, rhomboids and serratus anterior.
  • Scapulo-humeral muscles attach the upper limb to the shoulder girdle. - Supraspinatus, Infraspinatus, teres minor, and subscapularis are the key muscles - Thoracodorsal innervates latissimus dorsi.
  • Scapulo-humeral muscles involve movement muscles and stabilisers.
  • Important muscles for humerus are the infraspinatus , teres major and latissimus dorsi

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