Written Examination Part IV. (36 pts) - Essay: Back and Upper Limb (October 6, 2006)

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Scapular Region

• General Comments
  • The scapula is a highly movable structure that makes up the bulk of the pectoral girdle.
  • Abduction from approximately 90 degrees to 180 degrees is largely accounted for by scapular movement (upward rotation).
  • A rich anastomotic network centered in the infraspinous fossa provides an arterial shunt across much of the axillary artery.
  • The scapula hosts the proximal component of the glenohumeral joint.
  • Positioning of the upper limb is largely dependent upon the anatomy of the scapular region
• Bones, Muscles and Movements
  • Medial border *Rhomboideus minor
    • Rhomboideus major
    • Serratus anterior
  • Superior Angle
    • levator scapulae
  • Inferior Angle
    • Serratus anterior
  • Lateral border
    • Teres major
  • Supraspinous fossa
    • Supraspinatous
  • Infraspinous fossa
    • Infraspinatous
    • Teres minor
  • Spine of the scapula
    • Upper fibers of trapezius
    • Lower fibers of trapezius
  • Acromion
    • Trapezius
    • Deltoid
    • Coracoacromial ligament and arch
  • Subscapular fossa
    • Subscapularis
  • Corocoid Process
    • Pectoralis minor
    • Coracobrachialis
    • Short head of biceps
  • Glenoid fossa
    • Proximal articulation for glenohumeral joint
  • Supraglenoid tubercle
    • Long head biceps
  • Infraglenoid tubercle
    • Long head triceps
• Vascularization and Scapular anastomosis
  • Transverse cervical artery
  • Suprascapular artery
  • Dorsal scapular artery
  • Posterior intercostal arteries
  • Circumflex scapular artery
• Innervation
  • Suprascapular nerve
  • Accessory nerve
  • Axillary nerve
  • Dorsal scapular nerve
  • Medial and Lateral pectoral nerves
  • Upper, middle, and lower subscapular nerves
  • Musculocutaneous nerve
  • Long thoracic nerve - winging
• Relationships
  • Superior transverse scapular ligament and scapular notch
    • Suprascapular nerve passes through osseofibrous foramen
    • Suprascapular artery passes superior to the superior transverse scapular ligament
    • Circumflex scapular artery in the triangular space
    • Posterior cord anterior to subscapularis
    • Subscapular fossa is part of posterior wall of axilla
    • Coracoacromial arch is superior support for glenohumeral joint
• Lymphatic drainage
  • • Posterior - intercostal nodes
    • Anterior - axillary nodes

Spinal Canal

• General Comment
  • Osseofibrous canal protecting the spinal cord
• Boundaries
  • Vertebral foramen
    • Anterior - posterior longitudinal ligament, vertebral body
    • Posterior - lamina
    • lateral right and left - pedicle
  • Intervertebral region
    • Anterior - intervertebral disk
    • Posterior - ligamentum flavum
    • Lateral right and left - intervertebral foramen, zygop
• Bones
  • Seven cervical, 12 thoracic, 5 lumbar, 5 sacral, 4 coccygeal = 33 (9 fused)
• Articulations
  • Intervertebral disk
  • Zygapophyseal joint
  • Costotransverse and costovertebral joints
• Ligaments and Limitation of Movements
  • Posterior longitudinal ligament - limit flexion
  • Ligamentum flavum - limit flexion
• Spaces and Contents
  • Epidural space
    • Internal anterior and posterior vertebral plexuses
    • Epidural fat
  • Subarachnoid space
    • Cerebral Spinal Fluid
  • Spinal cord - C1 to L2
  • Thecal sac (dural sac) - C1 to S3
  • Filum terminalis internal and external - coccyx
• Vascularization
  • Radicular arteries
    • Augment anterior and posterior spinal arteries
• Relationships
  • Wall of canal - epidural space - dura mater - arachnoidia - subarachnoid space - pia mater
• Lymphatic drainage
  • Paraaortic nodes

Extensor Region of Forearm and Dorsum of the Hand

• General Comment
  • The extensors of the wrist and digits arise from a common extensor tendon at the posterior aspect of the lateral epicondyle
  • Weak extension at the elbow
  • Included is an abductor of the thumb an two extensors that operate independently at their insertion
  • Anatomical "snuffbox"
• Bones
  • Humerus
  • Ulnar
  • Radius
  • Scaphoid
  • Lunate
• Articulations
  • Proximal radioulnar joint
  • Distal radioulanr joint
  • Radiocarpal joint
  • Articular disc (between ulna and triquetrum)
• Ligaments and Limitation of Movements
  • Radial collateral ligament of wrist
  • Ulnar collateral ligament of wrist
  • Annular ligament
  • Interosseous membrane
  • Extensor retinaculum
• Spaces and Contents
  • Gap between superior free edge of interosseous membrane and oblique cord
    • Interosseous recurrent artery
    • Posterior interosseous artery
  • Tendon sheaths
• Muscles, Movements, and Independence of Movement
  • Extensor carpi radialis longus
  • Extensor carpi radialis brevis
  • Extensor digitorum
    • Intertendenous slips
  • Extensor carpi ulnaris
  • Supinator
  • Extensor indicis
  • Adbuctor policis longus
  • Extensor policis brevis
  • Extensor policis longus
  • Extensor digiti minimi
• vascularization
  • Posterior and anterior interosseous arteries
  • Interosseous recurrent
  • Dorsal venous arch
  • Cephalic vein
  • Brachial vein
• Innervation
  • Radial nerve proper
  • Superficial radial nerve
  • Deep radial nerve
  • Dorsal branch of ulnar nerve
  • Palmar branches of the ulnar and median nerves
• Relationships
  • Especially the snuffbox
• Lymphatic drainage
  • Axillary
  • Brachial
  • Cephalic

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