Anatomy of upper and lower limb
Terms
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- Shoulder Abduction
- Deltoid C5 Axillary
- Elbow Flexion
-
Biceps C5,6 Musculocutaneous
Brachioradialis C6 Radial
(+ reflex) - Elbow Extension
- Triceps C7 Radial (+ reflex)
- Radial wrist extension
- Extensor carpi radialis longus and profundus C6 Radial (+reflex)
- Finger extensors
- Extensor digitorum C7 Radial (post. interosseus)
- Finger flexors
-
Flexor digitorum longus and profundus C8 Median (ant. interossesus) (+reflex);
Flexor digitorum profundus C8 Ulnar - Finger abduction
- dorsal interossei T1 Ulnar; abductor pollicus brevis T1 Median
- Hip flexion
- Iliopsosas L1/L2, Femoral
- Hip adduction
- adductors, L2/3, Obturator
- Hip extension
- gluteus maximus, L5/S1, inferior gluteal
- Knee flexion
- Hamstrings, S1, sciatic
- Knee extension
- quads, L3/4, (++reflex), femoral
- Ankle dorsiflexion
- tibialis anterior, L4, deep peroneal
- Ankle eversion
- peronei, L5/S1, superficial peroneal
- Ankle inversion
- tibialis posterior, L4/5, tibial
- Ankle plantar flexion
- gastrocnemius, soleus, S1/2, tibial (++reflex)
- Big toe extension
- Extensor hallucis longus, L5, deep peroneal (babinski)
- Hip abduction
- gluteus medius, L4/5, superior gluteal
- Foregut
-
Abdominal esophagus, stomach, superior part of duodenum, liver, pancreas, spleen
Celiac, Greater Splanchnic T5-9 - Greater Splanchnic
- T5-9
- Midgut
-
descending duodenum-proximal 2/3 of transverse colon
Sup. Mesenteric, Lesser Splanchnic, T10-11 - Lesser Splanchnic
- T10-11
- Hindgut
-
distal 1/3 transverse colon-midway through anal canal
Inf. Mesenteric, Lumbar Splanchnic, L1-2 - Lumbar Splanchnic
- L1-L2
- Renal
- Renal Artery/Ganglion, Least Splanchnic, T11-T12
- Least Splanchnic
- T11-T12
- Referred pain of appendicitis
- via lesser splanchnic and sup. mesenteric ganglion to T10 (umbilicus)
- Referred pain of angina
- via sympathetics arising from T1-T5, and leaving symp chain from C1-T4. ischemia = pain at C1-T5 levels
-
Causalgia = pain from hyperstimulate nerves that travel w/blood vessels and follow sympathetics
Sympathetic Effects of anesthesia? - knock out sensory neurons in ganglion, but also knock out some of symp chain = 1)dilation (flushed skin), 2)sweat glands (dry skin), 3)erector pili muscles (no goosebumps); (sometimes constricted pupil and sunken eyeball = Horner's syndrome)
- Innerv and fn of Serratus Anterior?
- Long thoracic nerve (directly from C5,6,7 roots); scapular protraction, elevate glenoid; suscptible to injury--> winged scapula
- Suprascapular nerve, roots, fn, injury?
- C5,6 from upper trunk; infra- and supraspinatus (rotator cuff, abduction and lat rotation); compression = lat shoulder pain (C5,6 cutaneous territory), musc atrophy
- Thoracodorsal nerve, roots, fn?
- Lat. dorsi, from post cord C6,7,8 (susceptible in breast surgery), extension, medial rotation, adduction
- Axillary nerve, roots, fn?
- Deltoid, from post cord, C5,6, suscept to compression w/shoulder dislocation (abduction), sensory loss in patch of skin in upper lat arm
- Snuff box tendons?
- Abductor pollicus longus, extensor pollicus brevis, extensor pollicus longus; radial artery traverses it; point tenderness from scaphoid fracture or tenosynovitis of ext. poll. long. tend.
- Wrist abduction
- extensor (radial) and flexor (median) carpi radialis
- Wrist extension
- extensor carpi radialis and ulnaris, extensor digitorum
- Wrist adduction
- extensor (radial) and flexor (ulnar) qcarpi ulnaris
- Radial nerve injury
- suscept in radial groove and axilla (crutch paralysis); weak elbow extensors, paralysis of supinatory, wrist and thumb extensors = WRIST DROP; loss of triceps jerk, brachiorad tend reflex; sensory loss in post forearm and lat dorsum of hand
- Musculocutaneous nerve injury
- usu. in fractures of upper humerus; motor loss-elbow flexion weakness (esp when supinated), loss of biceps tend. reflex, sensory loss on anterolat. forearm
- Median nerve in forearm
-
C6,7,8;
-pronation (pronator teres and quadratus),
-wrist flexion (flexor carpi radialis, palmaris longus, digital flexors)
-wrist abduction (flexor carpi radialis)
-digit flexion (flexor digitorum superficialis and profundus) - Median nerve, intrinsic hand muscles
-
C8,T1
-Thumb flexion, medial rotation, opposition (flexor pollicus brevis, opponens pollicus
-Thumb abduction (abductor pollicus brevis---abd.poll.longus is radial n.)
-Abduction of index/midd fingers (lumbricals 1,2)
-Flexion MP + Extension PIP/DIP (lumbricals 1,2) - Median nerve paralysis-above elbow (forearm effects)
- motor paralysis of pronator teres = supinated forearm
- Median nerve paralysis-wrist effects
- weak flexion and abduction, causes hand extension and ulnar deviation (adduction)
- Median nerve paralysis-MP,PIP,DIP joints
- weak flexion, thus mid/index fingers extended
- Median nerve paralysis-hand
- thenar muscle paralysis (recurrent median nerve) = ape thumb (external rotation and adduction)
- Carpel Tunnel Syndrome
-
paralysis of thenar muscles-ape thumb
sensory loss on 3.5 fingers, palmar surface, and dorsal surface from tips of finger to PIP joing - Ulnar nerve at forearm
-
C8,T1
Wrist flexion and adduction, and some finger flexion (flexor carpi ulnaris, flexor digitorm profundus) - Ulnar nerve at hand
-
C8,T1
Thumb adduction (adductor pollicus,
finger adduction (palmar interossei and 3,4 lumbricals)
finger abduction (dorsal interossei and 3,4 lumbricals)
MP flexion and PIP/DIP extension (same) - Ulnar nerve injury
-
susceptible to injury in medial epicondyle groove (funny bone) and olecronon
partial claw hand--paralysis of intrinsic hand muscles (except thenar), abducted and externally rotated thumb
sensory loss of medial 1.5 fingers and ulnar border of hand - Upper trunk lesion
-
C5,6 (separation of shoulder and neck, seen in breech delivery)
axillary, suprascapular, musculocutaneous, radial nerve(to supinator and brachiorad.)
=Erb's paralysis --> waiter's tip position, sensory loss along lat arm and forearm (C5/6 dermatomes) - Lower trunk lesion
-
C8,T1
trauma due to tug by outstretched arm
paralysis of intrinsic hand muscles--> claw hand (b/c long digital flexors (med) and long wrist extensors (rad) unopposed)
sensory loss of medial forearm and hand - Costoclavicular syndrome or Thoracic Outlet Syndrome (TOS)
-
where subclav v./a. and lower trunk enter axilla, between scalene anterior and medius, and 1st rib and clavicle
-compression = lower trunk palsy and vascular insufficiency
also can be compressed by pancoast tumor