Anatomy Exam 1 Review 2024 PDF

Exam 1 Review Edgar R. Meyer, M.A.T., Ph.D. January 30, 2024 Exam 1 Breakdown 42 items from lecture content (6 lectures total) 7 items per lecture (about 8 second-order items per lecture) 12 items with images 4 illustrations/diagrams 4 photos 4 radiological images 8 items for radiology and surface a...

Exam 1 Review Edgar R. Meyer, M.A.T., Ph.D. January 30, 2024 Exam 1 Breakdown 42 items from lecture content (6 lectures total) 7 items per lecture (about 8 second-order items per lecture) 12 items with images 4 illustrations/diagrams 4 photos 4 radiological images 8 items for radiology and surface anatomy 4 items for radiology (all with radiological images) 1 second-order nerve injury w/ deficits 4 items for surface anatomy 2 with photos Muscles Matter, but They Ain’t Everything Muscle and muscle-related content = 34% of exam 5 items on muscles (as contents, borders, boundaries, etc.) 1 item from surface anatomy 5 items on actions (of muscles or nerves) 4 items on muscle innervation 2 items on muscle origins 1 item on muscle insertion Learning Objective Breakdown Example (Lecture 1) When studying, consider the breadth of your learning objectives. 1 1 1 1 1 1 1 For MOST learning objectives, there is Students will be able to… at least one exam item. 1) Define anatomy and the different branches of anatomy. 1 slide 2) Define the various anatomical planes AND apply them to the human body in the context of live persons, cadaveric donors and specimens, virtual and plastic models, and radiological images. 1 slide 3) Define the basic terms of anatomical position AND apply them to the human body in the context of live persons, cadaveric donors and specimens, virtual and plastic models, and radiological images. 4) Compare and contrast different modalities of radiological diagnostic imaging: plain radiography, ultrasound, CT, MRI (T1 & T2), NMI, and PET. 5) Discuss the roles of gastrulation, neurulation, neural crest, and body folding during the third week of embryonic development. 6) Describe AND demonstrate the basic terms of movement. 7) Describe the general composition and function of the body systems. 15 slides 1 slide 1 slide 6 slides 1 slide Lecture 1: 27 total slides of testable content (slides 24-51) (2) Lecture 1: Obj. 3 Anatomical Position (1) Erect Penis (Biological Man) (6) Dorsal (1) Face facing forward (2) Inferior margin of orbit level with top of external auditory meatus (3) Feet together with toes pointing forward (4) Thumbs pointing to the sides (4, 5) (5) Hands and arms by sides with palms facing forward (6) Penis in state of erection for biological men and trans men (3) Ventral Erect Penis, Phalloplasty (Trans Man) Dorsal Ventral (1) (7) Lecture 1: Objs. 2 & 3 (2) (1) (13) Anatomical planes? (5) (6) (2) Anatomical directional terms? (9) (3) (4) (11) (10) (9) (10) (12) (8) (4) Lecture 1: Obj. 4 - Intro to Radiology Plain radiography – X-rays (electromagnetic radiation) Attenuation of X-rays (least → greatest) Air → Fat → Water → Soft tissues → Bone → Metal/contrast agents Ultrasound – high frequency sound wave (NO radiation; cheap) Computed tomography (CT) – series of axial X-ray images Magnetic resonance imaging (MRI) – measures signals produced from hydrogen protons exposed to radio waves (NO radiation; expensive) T1-weighted images (A) → dark fluid; bright fat T2-weighted images (B) → bright fluid; less bright (intermediate) fat Nuclear medicine imaging – involves gamma rays (electromagnetic radiation) Positron emission tomography (PET) – detects positronemitting radionuclides (radioactive) Lecture 1: Obj. 5 - Intro to Embryology Overview of the first 3 weeks of development 1st week of development Fertilization – from fusion of gametes Mitotic cleavage (of blastomere) Formation (of morula, of blastocyst) Implantation (of blastocyst) Discuss the roles of gastrulation, neurulation, neural crest, and body folding during the third week of embryonic development. 2nd week of development (week of 2’s) Two components of the trophoblast: Cytotrophoblast and Syncytiotrophoblast The embryoblast is converted to a bilaminar disc: Epiblast and Hypoblast Two new cavities: Amnionic and Chorionic Two extraembryonic mesoderm layers: Somatopleuric and Splanchnopleuric 3rd week of development Appearance of the primitive streak: Gastrulation – conversion of bilaminar disc to a trilaminar disc Appearance of the notochord: Neurulation – neural plate folds to form the neural tube Growth of the embryo: body folding – cephalocaudal and lateral folding Overview of Gastrulation The formation of three germ layers Form all structures Gastrulation turns the bilaminar embryonic disc to a trilaminar disc First, epiblasts invade the region of the hypoblasts to form the Then epiblasts migrate to form an intermediate layer, mesoderm Remaining epiblasts become ectoderm Overview of Neurulation and Neural Crest Neurulation – neural plate folds to form neural tube (seen in next slide) Neural crest – specific ectodermal cells that surround the neural plate They migrate and become essentially anything… Facial structures Heart structures Dorsal root ganglia Pre-aortic ganglia Enteric nervous system Etc….. Overview of Body Folding Body folding changes the trilaminar disc embryonic layout to a tube within a tube Establishes anterior/ventral and posterior/dorsal sides Distinguishes different mesoderm regions Somites Intermediate Lateral Plate Splanchnic Somatic Different regions contribute to different muscular structures Lecture 1: Obj. 6 - Movement Terms Movements occur in antagonist pairs: ✓Flexion vs. extension ✓Abduction vs. adduction ✓Pronation vs. supination ✓Inversion vs. eversion ✓Circumduction Lecture 1: Obj. 7 - the Rest of the Story: Body Systems 15 slides of content Body systems (1 slide) Skeletal system (4 slides) Muscular system (4 slides) 3 slides are on joints! 1 slide pertains to another learning objective (not included in above slide count) Skin and fascia (1 slide) Cardiovascular system (2 slides) Lymphatic system (2 slides) Nervous system (1 slide) You are not responsible for the content beyond slide 28. The Price Is Right: From which content area will this exam item be taken? Objectives Overview of Lecture 2 Skeletal Framework 2 1) Back 2 2) Spinal Cord 1 3) 1 4) 1 5) Bones (vertebrae) Joints Ligaments Musculature Innervation Associated Structures Composition Spinal Nerves Spinal Cord Neurons Sympathetic NS Within the back region, identify the different types of joints, ligaments, and vertebrae and their characteristic 8 slides features. 5 slides on vertebrae! Identify and describe the location, action, origin, insertion, innervation, and blood supply of the muscles of the back. 10 slides Identify and describe the spinal meninges as well as the components of the spinal cord and the spinal nerves 7 slides Discuss the general functional components of the nervous system: 8 slides GSA, GSE, GVA, GVE. Discuss the general organization of the sympathetic nervous system and its 7 slides connection to the spinal cord. Pay attention to organizational slides like this one, for example. Muscles of the Back 1. 2. 3. Superficial mm. Movements of the upper limb Innervated by anterior (ventral) rami of spinal nn. Intermediate mm. Serve a respiratory function Innervated by anterior (ventral) rami of spinal nn. Deep mm. Movements of vertebral column & head Innervated by posterior (dorsal) rami of spinal nn. Subdivided into 3 other groups Lecture 2: Obj. 2 Mnemonics are your friends! Lecture 2: Obj. 2 Superficial Group Trapezius m. Accessory nerve Rotates scapula; elevates, adducts, & depresses scapula Latissimus dorsi m. Thoracodorsal nerve Extends, adducts, and medially rotates humerus Levator scapulae m. C3-C4 & dorsal scapular nerve Elevates scapula Rhomboid major & minor mm. Dorsal scapular nerve Retracts and elevates scapula Figure 2.22 Lecture 2: Obj. 2 Intermediate Group Serratus posterior superior m. Anterior (ventral) rami of spinal nn. Elevates ribs II to V Serratus posterior inferior m. Anterior (ventral) rami of spinal nn. Depresses ribs IX to XII Figure 2.25 Lecture 2: Obj. 2 Deep Group Erector spinae mm. Posterior (dorsal) rami of spinal nn. Function: Straighten the back Provide for side-to-side rotation Muscles: 1. Iliocostalis mm. 2. Longissimus mm. 3. Spinalis mm. spinalis longissimus iliocostalis Lecture 2: Objectives 3, 4, and 5 Identify the structures. Name the types of fibers or cells comprising these structures. Name the functional components comprising these structures. 2 1 11 5 3 6 4 8 9 7 12 10 Lecture 3 Objectives 1 1 1 1 1 1 1 1. Identify the bones of the upper limb. 2. Identify bony landmarks of the scapula, clavicle, and humerus. 3. Identify the joints and ligaments of the pectoral girdle. 4. Identity the joints and ligaments of the glenohumeral joint. 5. Describe the muscles of the shoulder including attachments, innervations, and actions. 6. Identify the major vasculature of the shoulder region. 7. Describe the boundaries and contents of the three spaces of the posterior shoulder region. 20 Lecture 3: Obj. 1 Bones of Upper Limb Shoulder Sternum Clavicle Scapula Arm Humerus Forearm Radius (lateral = thumb side) Ulna (medial = pinky side) Wrist and Hand Carpals (“wrist”) Metacarpals (“palm”) Phalanges (“fingers”) 21 Lecture 3: Obj. 2 Bones of the Shoulder 1 Sternum Manubrium Body Xiphoid process Clavicle Sternal end Acromial end 22 Bones of the Shoulder 2 Scapula 3 borders Medial Lateral Superior 3 angles Lateral (glenoid) Superior Inferior 3 projections Spine Acromion Coracoid process Lecture 3: Obj. 2 23 Bones of the Shoulder 2 Scapula Scapular notch Glenoid fossa Supraglenoid tubercle Infraglenoid tubercle Lecture 3: Obj. 2 24 Lecture 3: Obj. 2 Bone of the Arm – Proximal Landmarks Humerus - largest bone of upper limb Head Anatomical neck Surgical neck Greater tubercle (lateral) Lesser tubercle (anterior) Intertubercular groove Deltoid tuberosity 25 Lecture 3: Obj. 3 Joints of Upper Limb Named for which bones articulate Sternoclavicular (SC) Pectoral Girdle Acromioclavicular (AC) Glenohumeral Proximal and distal radioulnar Intercarpal (IC) Carpometacarpal (CMC) Metacarpophalangeal (MCP) Proximal and distal interphalangeal (IP) 26 Lecture 3: Obj. 3 Sternoclavicular Joint Only bony articulation of upper limb to axial skeleton Connects manubrium of sternum and sternal end of clavicle Saddle joint Ligaments: Anterior sternoclavicular Posterior sternoclavicular Costoclavicular Interclavicular 27 Lecture 3: Obj. 3 Acromioclavicular Joint Connects acromion of scapula to acromial end of clavicle Plane (sliding) joint Ligaments: Coracoclavicular – primary stabilizer of AC joint; 2 parts Conoid (medial and posterior) Trapezoid (lateral and anterior) Acromioclavicular – assists in stabilizing AC joint 28 Lecture 3: Obj. 4 Glenohumeral Joint Connects glenoid fossa of scapula to head of humerus Ball and socket joint Tons of freedom of movement Lots of instability Ligaments: 3 Glenohumeral (superior, middle, inferior) Coracohumeral 29 Lecture 3: Obj. 4 Glenoid Labrum Fibrocartilage support surrounding glenoid fossa Serves as site of attachment for many glenohumeral ligaments Can be torn, stretched, or damaged 30 Lecture 3: Obj. 5 Shoulder Muscles Overview Posterior Shoulder Supraspinatus Rotator Cuff Infraspinatus “S.I.T.S” on the Teres Minor Shoulder Teres Major Anterior Shoulder Subscapularis Pectoralis major and minor Lateral Shoulder Deltoid 31 Lecture 3: Obj. 5 Supraspinatus Supraspinatus Attachments: supraspinous fossa of scapula to greater tubercle of humerus Innervation: suprascapular nerve Actions: initiate ABduction of glenohumeral joint (from 0 to 15 degrees) 32 Lecture 3: Obj. 5 Infraspinatus and Teres Minor Infraspinatus Attachments: infraspinous fossa of scapula to greater tubercle of humerus Innervation: suprascapular nerve Actions: laterally rotate arm at glenohumeral joint Teres Minor Attachments: lateral border of scapula to greater tubercle of humerus Innervation: axillary nerve Actions: laterally rotate arm at glenohumeral joint 33 Lecture 3: Obj. 5 Teres Major Attachments: inferior angle of scapula to intertubercular sulcus of humerus Innervation: lower subscapular nerve Actions: extend and medially rotate arm at glenohumeral joint 34 Lecture 3: Obj. 5 Subscapularis Subscapularis Attachments: subscapular fossa of scapula to lesser tubercle of humerus Innervation: upper and lower subscapular nerves Actions: medially rotate arm at glenohumeral joint 35 Lecture 3: Obj. 5 Pectoralis Major Attachments: clavicle, sternum, and upper ribs to intertubercular sulcus of humerus Innervation: medial and lateral pectoral nerves Actions: flex, ADduct, and medially rotate arm at glenohumeral joint 36 Lecture 3: Obj. 5 Pectoralis Minor Attachments: upper ribs to coracoid process of scapula Innervation: medial pectoral nerve Actions: depress and protract scapula 37 Lecture 3: Obj. 5 Deltoid Most superficial muscle along lateral shoulder Attachments: clavicle, acromion of scapula, and spine of scapula to deltoid tuberosity Innervation: axillary nerve Actions: ABduct arm at glenohumeral joint from 15 to 90 degrees Can also flex and extend arm at glenohumeral joint 38 Lecture 3: Obj. 6 Arteries of Shoulder Branches of subclavian artery: Dorsal scapular* Runs along medial border of scapula with dorsal scapular nerve Dorsal scapular artery Suprascapular* Runs through scapular notch with suprascapular nerve Circumflex scapular Runs through triangular space Posterior circumflex humeral Runs through quadrangular space with axillary nerve *actually from thyrocervical trunk, a branch of subclavian artery 39 Lecture 3: Obj. 7 Posterior Shoulder Spaces Act as “gateways” between posterior shoulder and axilla (i.e. armpit) 3 spaces of posterior shoulder Triangular space Quadrangular space Triangular interval 40 Lecture 3: Obj. 7 Triangular Space Borders: Teres minor Teres major Long head triceps brachii Contents: Circumflex scapular artery 41 Lecture 3: Obj. 7 Quadrangular Space Borders: Teres minor Teres major Long head triceps brachii Humerus Contents: Posterior circumflex humeral artery Axillary nerve 42 Lecture 3: Obj. 7 Triangular Interval Borders: Teres major Long head triceps brachii Lateral head triceps brachii Contents: Profunda brachii artery Radial nerve 43 Lecture 3: Obj. 7 Suprascapular foramen Route that connects base of neck to posterior scapula Formed by superior transverse scapular ligament and suprascapular notch Contains suprascapular artery and nerve Artery passes over ligament Nerve passes under ligament “Army Over, Navy Under” 44 Lecture 4 Contents Overview: Axilla and Arm Locations Contents Musculature Boundaries of the Axilla Muscles of the Arm Attachments Actions Innervations Vasculature Overview Axillary artery Brachial artery Brachial Plexus Overview Parts and Branches Draw it to know it Lecture 4 Objectives 1 1 1 1 1 1 1 Discuss the boundaries and contents of the arm and axilla Describe the organization of the structures of the arm into anterior and posterior compartments. List the actions, attachments, and innervations of each muscle of the arm. Describe the axillary artery in terms of its 3 parts and the branches that typically arise from each of them. Describe the blood supply of the arm. Describe the five main parts of the brachial plexus including the roots (technically, rami), trunks, divisions, cords, and terminal branches. List the terminal nerves and the nerve branches associated with each part of the brachial plexus. Draw and label the brachial plexus, including the five main parts and nerve branches coming from each part. Lecture 4: Obj. 1 - Boundaries of the Axilla * * Floor Skin Anterior wall * 3 muscles Posterior wall 4 muscles Lateral wall Insertion of 3 muscles Medial wall 1 muscle * * * Lecture 4: Obj. 2 Overview: Arm Located between shoulder and elbow Contents: Humerus 4 muscles of the arm Brachial artery Brachial vein(s) Brachial plexus branches Divided into anterior and posterior compartments Lecture 4 Contents Overview: Axilla and Arm 1 1 1 Locations Contents Musculature Boundaries of the Axilla Muscles of the Arm Attachments Actions Innervations Vasculature Overview Axillary artery Brachial artery Brachial Plexus Overview Parts and Branches Draw it to know it Lecture 4 Objectives Let’s review without looking at slides! 1 1 1 1 Discuss the boundaries and contents of the arm and axilla Describe the organization of the structures of the arm into anterior and posterior compartments. List the actions, attachments, and innervations of each muscle of the arm. Describe the axillary artery in terms of its 3 parts and the branches that typically arise from each of them. Describe the blood supply of the arm. Describe the five main parts of the brachial plexus including the roots (technically, rami), trunks, divisions, cords, and terminal branches. List the terminal nerves and the nerve branches associated with each part of the brachial plexus. Draw and label the brachial plexus, including the five main parts and nerve branches coming from each part. Arm: Anterior Compartment Biceps Brachii Muscle Are there any secondary actions? Primary action: flex forearm at elbow Innervation: musculocutaneous nerve Long Head Origin (proximal attachment): supraglenoid tubercle of scapular Insertion (distal attachment): radial tuberosity Short Head Origin (proximal attachment): coracoid process of scapula Insertion (distal attachment): radial tuberosity Lecture 4: Obj. 3 Lecture 4: Obj. 3 Arm: Anterior Compartment Coracobrachialis Muscle Primary action: flex arm at shoulder Innervation: musculocutaneous nerve Origin (proximal attachment): coracoid process of scapula Insertion (distal attachment): midshaft of humerus Brachialis Muscle Primary action: flex forearm at elbow Innervation: musculocutaneous nerve Origin (proximal attachment): anterior aspect of humerus Insertion (distal attachment): How do I not mix these tuberosities up? tuberosity of ulna M Arm: Posterior Compartment Triceps Brachii Muscle Primary action: extend forearm at elbow; long head also extends and adducts arm at How? shoulder Innervation: radial nerve Long Head Origin (proximal attachment): infraglenoid tubercle of scapula Insertion (distal attachment): olecranon process of ulna Lateral Head Origin (proximal attachment): posterior surface of humerus Insertion (distal attachment): olecranon process of ulna Lecture 4: Obj. 3 Arm: Posterior Compartment Triceps Brachii Muscle Primary action: extend forearm at elbow; long head also extends and adducts arm at shoulder Innervation: radial nerve Medial Head Origin (proximal attachment): posterior surface of humerus Insertion (distal attachment): olecranon process of ulna Lecture 4: Obj. 3 Lecture 4: Obj. 4 Vasculature: st 1 Part Axillary Artery Superior thoracic artery Proximal to pectoralis minor muscle 1 branch Superior thoracic artery Supplies superior thorax Lecture 4: Obj. 4 Vasculature: nd 2 Part Axillary Artery Thoracoacromial trunk Deep to pectoralis minor muscle Lateral thoracic artery 2 branches Thoracoacromial trunk Branches supply clavicle, acromion, pectoralis muscles, and deltoid muscle (CAPD) Lateral thoracic artery Supplies lateral thorax (serratus anterior muscle) Lecture 4: Obj. 4 Vasculature: rd 3 Part Axillary Artery Subscapular artery Distal to pectoralis minor muscle Anterior & Posterior 3 branches circumflex humeral arteries Subscapular artery Circumflex scapular artery Supplies scapula Thoracodorsal artery Supplies latissimus dorsi muscle Anterior circumflex humeral artery Supplies head of humerus Posterior circumflex humeral artery Supplies head of humerus Some Times Life Seems A Pain. M Lecture 4: Obj. 5 Vasculature: Brachial Artery Continuation of axillary artery Profunda brachii artery Begins at inferior border of teres major muscle, roughly where profunda brachii artery originates Ends at bifurcation into radial and ulnar arteries Brachial artery Supplies anterior compartment of arm Profunda brachii artery branches from it Supplies posterior compartment of arm Brachial Plexus: Step-by-Step Roots o C5-T1 ventral rami Trunks o Superior o Middle o Inferior Divisions o 3 anterior o 3 posterior Cords o Lateral o Posterior o Medial Terminal Branches o Musculocutaneous (C5-C7) o Axillary (C5, C6) C6 C7 C8 T1 o Median (C5-T1) C5 o Radial (C5-T1) o Ulnar (C7, C8, T1) M Lecture 4: Objs. 6 & 7 Brachial Plexus: Step-by-Step Additional branches o C5 ▪ Dorsal scapular nerve o C5, C6, C7 ▪ Long thoracic nerve o Superior trunk ▪ Nerve to subclavius m. (C5, C6) ▪ Suprascapular nerve (C5, C6) o Lateral cord ▪ Lateral pectoral nerve (C5-C7) o Posterior cord ▪ Upper (superior) subscapular nerve (C5, C6) ▪ Middle subscapular nerve (thoracodorsal nerve) (C6-C8) ▪ Lower (inferior) subscapular nerve (C5, C6) o Medial cord ▪ Medial pectoral nerve (C8, T1) ▪ Medial brachial cutaneous nerve (C8, T1) ▪ Medial antebrachial cutaneous nerve (C8, T1) Lecture 4: Objs. 6 & 7 Overview of Lecture 5 Skeletal Framework Bones Elbow Joints and ligaments Origins and insertions Review of the Muscles of the Arm Cubital fossa Boundaries Contents Forearm Overview Anterior (flexor) compartment Muscles Neurovasculature Posterior (extensor) compartment Muscles Neurovasculature Objectives 1) 2 2) 1 3) 1.5 4) 2.5 5) * 6) Review muscles of the arm with attachments in and actions on the forearm. Describe the bones and ligaments that 4 slides comprise the elbow joint. Describe the boundaries and the contents of the cubital fossa. 2 slides Describe the organization of the anterior and posterior compartments of the forearm. 8 slides Identify the muscles of the forearm and their blood supply, attachments, major action(s), and innervation. Discuss clinical correlations relevant to the elbow and the forearm. Lecture 5: Obj. 2 Forearm Bones Trochlear notch Head Neck Olecranon Radial tuberosity Radial notch Coronoid process Supinator crest Oblique line Radius (Proximal) Ulna (Proximal) Tuberosity of the ulna Lecture 5: Obj. 2 Elbow: Joints & Ligaments Elbow formed by distal end of humerus, head of radius, and proximal end of ulna - Head of radius forms joint with capitulum of humerus - Trochlear notch of ulna forms joint with trochlea of humerus Joint capsule surrounds all joints in a common structure. The capsule is thickened in three areas to produce ligaments that aid in strengthening the joint. - Radial collateral ligament - Ulnar collateral ligament - Annular ligament Radial collateral ligament Annular ligament Ulnar collateral ligament Elbow: Insertions and Origins Lecture 5: Obj. 2 Origins: Medial epicondyle - 1 Pronator teres muscle (1) common flexor tendon (2) 2 Lateral epicondyle - common extensor tendon (3) Insertions: Radial tuberosity - Biceps brachii muscle (4) Tuberosity of the ulna - Brachialis muscle (5) 3 4 5 Lecture 5: Objective 3 Identify the boundaries. Identify the contents. Apply anatomical directions. Lecture 5: Objs. 4 & 5 Anterior (flexor) compartment of the forearm Consists of three layers of muscle: superficial, intermediate, and deep Superficial layer Consists of 4 muscles that take origin from the medial epicondyle and/or ulna (from lateral to medial)* Pronator teres m. (1) Flexor carpi radialis m. (2) Palmaris longus m. (3) Flexor carpi ulnaris m. (4) 1 2 3 4 * For details of origin, insertion, innervation and function see table 7.10 in text Mnemonics are your friends! Mnemonics are your friends! Intermediate layer One muscle that takes origin from the medial epicondyle, coronoid process, and radius Flexor digitorum superficialis* * For details of origin, insertion, innervation and function see table 7.11 in text Lecture 5: Objs. 4 & 5 Lecture 5: Objs. 5 & 6 Arteries and Nerves of Anterior Compartment of the Forearm Arteries Clinical significance? Radial artery (1) Ulnar artery (2) Common interosseous artery (3) Posterior interosseous artery (4) Anterior interosseous artery (5) Nerves Median nerve (6) Ulnar nerve (7) Superficial branch of the radial nerve (8) Which anterior compartment muscles are NOT supplied by the median nerve? 2 3 5 4 1 2 6 8 7 Lecture 5: Objs. 4 & 5 Mnemonics are your friends! Posterior (extensor) compartment of the forearm Consists of 2 layers: a superficial and a deep layer Superficial layer* Consists of 7 muscles that originate above (lateral supracondylar ridge) or on the lateral epicondyle Brachioradialis m. (1) Extensor carpi radialis longus m. (2) Extensor carpi radialis brevis m. (3) Extensor digitorum m. (4) Extensor digiti mini m. (5) Extensor carpi ulnaris m. (6) Anconeus m. (7) *For details of origin, insertion, innervation and function see table 7.13 in text 7 1 4 6 5 2 3 Lecture 5: Objs. 5 & 6 Mnemonics are your friends! Deep layer Consists of 5 muscles that that take origin from the lateral epicondyle and/or the posterior surface of the radius and/or ulna* Supinator (1) Abductor pollicis longus (2) Extensor pollicis brevis (3) Extensor pollicis longus (4) Extensor indicis (5) Remember oral cues in lecture! *For details of origin, insertion, innervation and function see table 7.14 in text 1 Anatomical snuffbox is a brevis sandwich 2 5 4 3 Lecture 5: Obj. 5 Nerves and Arteries of the Posterior Compartment of the Forearm Nerve supply to the extensor region is by the radial nerve and the posterior interosseous (1) branch of the radial nerve 1 2 Blood supply is via the posterior interosseous artery (2) What about the deep and superficial branches of the radial nerve? What about the anterior interosseous nerve? Learning Objectives: Lecture 6 * 1 1 1 1 1 1 1 Recall anatomical position as it relates to the hand. Identify the bones of the wrist and hand. Identify the muscles of the hand. Identify the actions and attachments of the muscles of the hand. Describe the structure of the carpal tunnel. Identify the contents of the carpal tunnel. Describe the arterial supply and venous drainage of the hand. Describe the motor and sensory innervation of the hand. Identify the spinal levels that supply the myotomes of the upper limb. Identify the spinal levels that supply the dermatomes of the upper limb. Identify the peripheral nerves that receive sensory information from the skin and the associated patches of skin. Lecture 6: Obj. 2 distal Bones middle 8 carpal bones Bones of the wrist 5 metacarpals proximal PHALANGES Bones of the metacarpus 14 phalanges METACARPALS Bones of the digits CARPAL BONES distal V IV III proximal II I Lecture 6: Obj. 4 - Interossei muscles Lecture 6: Objs. 3 & 4 abduction adduction Action: PAD → Palmar ADduct DAB → Dorsal ABduct Innervation: Ulnar nerve 1st palmar (pollical palmar) interosseous muscle often rudimentary Why is there no palmar interosseous muscle associated with the middle digit? Lecture 6: Objective 6 Identify the contents. Thenar Muscles Lecture 6: Objs. 3 & 4 thenar eminence Opponens pollicis muscle Action: medially rotates thumb Innervation: median nerve Flexor pollicis brevis muscle No one likes A FOe. Action: flexes thumb Innervation: median nerve Abductor pollicis brevis muscle Action: abducts thumb Innervation: median nerve flexor pollicis brevis muscle opponens pollicis muscle abductor pollicis brevis muscle Lecture 6: Objs. 3 & 4 Hypothenar Muscles Opponens digiti minimi muscle Action: laterally rotates metacarpal V Innervation: ulnar nerve hypothenar eminence Abductor digiti minimi muscle Action: abducts little finger Innervation: ulnar nerve Flexor digiti minimi brevis muscle Action: flexes little finger Innervation: ulnar nerve opponens digiti minimi muscle flexor digiti minimi brevis muscle abductor digiti minimi muscle Does the flexor digiti minimi brevis muscle have a longus muscle agonist? Lecture 6: Obj. 7 Arterial supply Anastomoses between the radial and ulnar arteries through the superficial and deep palmar arches What is the benefit of this anastomotic connection between the radial and ulnar arteries? Where else in the body have you already read about similar vascular connections? Pulse Points Lecture 6: Objs. 3 & 4 Anatomical snuffbox Borders: Extensor pollicis longus muscle tendon Extensor pollicis brevis muscle tendon Abductor pollicis longus muscle tendon Contents: Radial artery radial artery extensor pollicis brevis tendon extensor pollicis longus tendon abductor pollicis longus tendon Lecture 6: Obj. 8 Median nerve Recurrent branch Motor Supplies the thenar muscles Palmar digital branches ½ LOAF Mixed: Mainly sensory Supply skin on the palmar surface of the lateral three and one-half digits and the nail beds of those digits Supply the lateral two lumbrical muscles Palmar branch Sensory Supplies skin on the middle palmar surfaces of hand, wrist, and distal forearm What forearm muscles are innervated by the median nerve? Ulnar nerve Lecture 6: Obj. 8 Deep branch Motor Supplies: Hypothenar muscles Interossei muscles Adductor pollicis muscle Two medial lumbrical muscles Superficial branch Mixed: Mainly sensory Supplies the palmaris brevis muscle Supplies skin on the palmar surface of the little finger and medial half of the ring finger Palmar branch Sensory Supplies skin on medial aspects of superior palm, wrist, and distal forearm Dorsal branch Sensory Supplies skin on the dorsal surface of the medial aspect of the hand, including the dorsal surfaces of the little finger and the medial half of the ring finger What forearm muscles are innervated by the ulnar nerve? Lecture 6: Obj. 9 Myotomes The portion of skeletal muscle supplied by a single spinal cord level Some movements are caused by motor fibers from a single spinal cord level so that they can be performed to test those individual spinal cord levels. Lecture 6: Obj. 10 Dermatomes The area of skin supplied by a single spinal cord level Black and white concentric circles denote areas where overlap of dermatomes is minimal so that individual spinal cord levels can be tested. Anterior (Ventral) View Posterior (Dorsal) View Lecture 6: Obj. 11 Peripheral nerve sensory innervation Anterior (Ventral) View Posterior (Dorsal) View axillary nerve The major peripheral nerves of radial nerve the brachial plexus receive sensory information from these patches of skin. musculocutaneous nerve These areas of skin are supplied [a.k.a., lateral antebrachial cutaneous nerve (lateral cutaneous nerve of forearm)] by multiple spinal cord levels, even though the fibers carrying radial nerve the sensory information comprise (superficial branch) specific peripheral nerves. (See next slide.) median nerve radial nerve (superficial branch) ulnar nerve median nerve ulnar nerve Lecture 6: Obj. 11 Dermatome & Peripheral Nerve Sensory Innervation Comparison Questions