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test 2 - Flashcards

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Class:ZOO 3733 - Human Anatomy
Subject:Zoology
University:University of Central Florida
Term:Spring 2010
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Fractures of clavicle Cleidocranial dysostosis
Fractures of the Humerus: Fractures of the surgical neck: injury to the Axillary nerve. *Fractures of the middle of the shaft: may cause injury to the radial nerve: Wrist drop Fractures of the distal end of humerus: injury to the Median nerve. (ape hand) Fractures to the medial epicondyle: injury to the ulnar nerve. (claw hand)
Colles’ Fracture: . fracture of the distal end of the radius, posterior displacement. Falling on hand with extended arm (eg.: falling on ice). May be accompanied by avulsion of ulnar styloid process.
carpal bones: proximal row 1- Scaphoid (largest in this row) 3- Lunate 4- Triquetrum 6- Pisiform *Scaphoid bone is the most frequent bone to fracture among the carpal bones. *Lunate is the most dislocated carpal bone.
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carpal bones: distal row Distal row: 7- Trapezium 11- Trapezoid 12- Capitate (bigest in 2nd row) 13- Hamate *Scaphoid bone is the most frequent bone to fracture among the carpal bones. *Lunate is the most dislocated carpal bone.
*Flexor Retinaculum: *Flexor Retinaculum: Is a double layer of membrane covering the carpal groove anteriorly and produces the carpal tunnel for transmission of flexor muscles and median nerve.
*Carpal Tunnel Syndrome: *Carpal Tunnel Syndrome: Compression to the median nerve in the tunnel due to hypothyroidism, rheumatoid arthritis, pregnancy, Amyloidosis etc. It is a very painful condition.
Supraspinatus: Supraspinatus: Abductor of the arm, belongs to the rotator cuff muscle group. NN: Suprascapular N. (C4-C6)
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Teres minor: Teres minor: Lateral rotator of the arm, Rotator cuff group, NN: Axillary (circumflex) N
Rotator cuff function: Rotator cuff function: help to maintain the stability of the shoulder joint.
Deltoid: NN: Axillary N. (C5- C6). Function: Most important abductor of the arm up to 90 degree.
Subscapularis M: Subscapularis M: Arm adduction and medial rotation, NN: Subscapular N.
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Teres major M: Teres major M: Arm adduction and medial rotation, NN: Lower subscapular N.
Latissimus dorsi M: . Latissimus dorsi M: (coughing M) Function: Adduction and medial rotation and extension of the arm, NN: Thoracodorsal N.
Coracobrachialis M: Coracobrachialis M: Flexion (anteversion) and adduction of arm, Musculocutaneous N.
Pectoralis Minor M: Pectoralis Minor M: It lowers and rotates the scapula, Medial pectoral N.
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Pectoralis major M: Pectoralis major M: F: Adduction and medial rotation of humerus NN: lateral and medial pectoral N
Serratus anterior M: Serratus anterior M: Function: **Elevation of the arm over 90o
Long thoracic N. (C5- C6- C7) Long thoracic N. (C5- C6- C7) **Paralysis: Winged scapula: lifting the arm beyond 90o is not possible
Differential diagnosis: Differential diagnosis: Rhomboid M injury, Here you have winged scapula as well, but arm elevation is normal.
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Subclavious M: Subclavious M: Number 1 (blue) F: it pulls the clavicle towards the sternum Nerve to the Subclavious
Biceps M (4): Acts on 2 joints: Long head (5): abductor and medial rotator of the arm Short head (7): adductor of the arm Both heads flex (anteroversion) shoulder joint On elbow joint: flexor and strong supinator of the forearm. NN: Musculocutaneous N. (C5- C6) **Biceps Jerk: C5- C6
Brachialis M (1): Powerful flexor of the elbow joint NN: Musculocutaneous N
Coracobrachialis M Flexor of the arm. Musculocutaneous N
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Triceps M: Chief extensor of elbow joint Long head acts on 2 joints: Retroversion and adduction of the arm Radial N. (C6- C7- C8) Triceps Jerk: C7- C8
Upper brachial plexus lesion: Erb-Duchenne paralysis Traction on the arm at birth or falling on the shoulder may damage the upper part of the plexus (roots may be pulled out of spinal cord) Signs: Deltoid and supraspinatus are paralyzed (no arm abduction) Infraspinatus paralysis leads to medial rotation of the arm. Biceps and Brachialis are also paralyzed (no elbow flexion)
Lower brachial plexus lesion: Lower brachial plexus lesion: Not as common as upper plexus injuries. Paralysis of the intrinsic muscle of hand (small muscles) with anesthesia. Results from sudden upward pull of the shoulder.
Pronator Teres Function: pronation of forearm and flexion at elbow NN: Median N
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Palmaris longus Palmaris longus Flexes the hand toward the palm, tenses the palmar aponeurosis, Median N.
Flexor carpi radialis Flexor carpi radialis F: Palmar flexion and Radial abduction of hand NN: Median N
Flexor digitorum superficialis Flexor digitorum superficialis Strong flexors of the finger (4 medial) joints; also flexes the wrist , Runs in the carpal tunnel NN: Median N
Flexor carpi ulnaris Flexor carpi ulnaris F: Hand (palmar) flexion and adduction Runs outside of carpal tunnel. NN: Ulnar N
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Flexor digitorum Profundus Flexor digitorum Profundus Runs through the carpal tunnel Function: it is a flexor of the wrist, midcarpal, metacarpophalangeal and phalangeal joints NN: Median N. (ant. Interosseous branch)
Flexor pollicis longus ) Flexor pollicis longus Runs through the carpal tunnel Has it’s own tendon sheath Flexor of the terminal phalanx (thumb) NN: Median N. (ant. Interosseous branch)
Pronator quadratus Pronator quadratus Pronates the forearm (with Pronator Teres) Median N. (ant. Interosseous branch)
Brachioradialis (beer drinking M.) Brachioradialis (beer drinking M.) It brings the forearm into midposition between pronation and supination; NN: Radial N
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Extensor carpi radialis longus Extensor carpi radialis longus Extensor and abductor of hand at wrist joint NN: Radial N
Extensor carpi radialis brevis Extensor carpi radialis brevis Extensor and abductor of the hand at wrist joint NN: Radial N. (deep branch)
Extensor digitorum Extensor digitorum Function: Extends the 4 medial fingers (metacarpophalangeal J.), strong dorsiflexor of the hand at wrist joint NN: Post. Interosseous branch of deep radial nerve
Extensor digiti minimi Extensor digiti minimi Extension of the 5th digit and dorsiflexion of hand NN: Post. Interosseous branch of deep radial nerve
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Extensor carpi ulnaris Extensor carpi ulnaris Extends and adducts the hands NN: Post. Interosseous branch of deep radial nerve
Supinator Supinator Encircles the radius and supinates forearm NN: Deep branch of radial N
Abductor pollicis longus Abductor pollicis longus Runs through 1st tendon compartment Abduction of the first thumb+ it’s extension at carpometacarpal joint Post. Interosseous branch of deep radial nerve
Extensor pollicis brevis Extensor pollicis brevis Runs in the 1st tendon compartment Extension of the proximal phalanx at metacarpophalangeal joint. Post. Interosseous branch of deep radial nerve
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Extensor pollicis longus Extensor pollicis longus Runs through 3rd tendon compartment Extends the thumb using the crest on radius as a fulcrum (at metacarpophalangeal and Interphalangeal joints). Post. Interosseous branch of deep radial nerve
Extensor indicis Extensor indicis Runs through 4th compartment with Ext. digitorum Index extension and hand dorsiflexion Post. Interosseous branch of deep radial nerve
Extensor retinaculum Covers the carpal bones dorsally and has septae which produce 6 tendon compartments through which tendon of the extensor muscles and the abductor pollicis longus pass
Abductor pollicis brevis Abductor pollicis brevis: Abduction of thumb, Median N
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Flexor pollicis brevis Flexor pollicis brevis: Flexes the thumb Superficial innervation by median N. C8-T1 Deep head by ulnar N
Adductor Pollicis Adductor Pollicis: 2 heads Thumb Adduction. Deep branch of Ulnar nerve
Opponens pollicis Opponens pollicis (15) : Thumb opposition. Median N
Dupuytren’s contracture: progressive fibrosis, thickening and shortening of the aponeurosis leads to partial flexion of the ring and small finger Dupuytren’s contracture: progressive fibrosis, thickening and shortening of the aponeurosis leads to partial flexion of the ring and small finger
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Palmaris brevis in hypothenar eminence Palmaris brevis in hypothenar eminence connect the skin of ulnar border to palmar aponeurosis and flexor retinaculum. Innervation: superficial branch of ulnar N
Abductor digiti minimi Abductor digiti minimi (9) Abducts the 5th digit : deep branch of ulnar N
Flexor digiti minimi (10) Flexes the 5th digit Flexor digiti minimi (10) Flexes the 5th digit : deep branch of ulnar N
Opponens digiti minimi Opponens digiti minimi (11) Makes opposition of the 5th finger to thumb possible : deep branch of ulnar N
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Palmar interossei: 3 muscles Palmar interossei (1): 3 muscles Function: Adduction of digits, assist lumbricals Ulnar N. deep branch
Dorsal Interossei:4 muscles Dorsal Interossei: 4 muscles Function: Abduction of digits Ulnar N. (deep branch)
Lumbricals: 4 muscles Lumbricals: 4 muscles 2 lateral (radial) and 2 medial (ulnar) 2 lateral ones innervated by Median N. C8-T1 2 medial ones innervated by Ulnar N.
Breast cancer Breast Cancers may give metastasis to the axillary lymph node (75% of breast’s lymphatics drain here). Removal of the lymph nodes may be necessary. Mastectomy: removal of the breast.
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Lymph nodes of the Axillary region Arranged in 5 groups: Pectoral, medial, apical, central and subscapular
Medial bicipital groove: Between biceps and intermuscular septa
Anterior Brachial region Contents: Median N, Brachial artery and veins and basilic vein, medial cutaneous antebrachial nerve and ulnar N. medially
posterior brachial region Radial nerve is found deep in the posterior brachial region in radial groove of humerus accompanied by deep brachial A and V.
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Arteries of the forearm and hand brachial artery 2- Radial artery 3- Ulnar artery
Palm of the hand 1- Superficial palmar arch 18- Deep palmar arch 11- median nerve 9- ulnar nerve
Dorsum of the Hand: Dorsum of the Hand: Radial artery (9) enters the Snuffbox and gives a dorsal branch which produces the dorsal arterial arch of the hand. Then it gives the principal artery of the thumb and then a main branch to join the deep palmar arch.
Snuffbox: borders: Snuffbox: borders: Tendon of extensor pollicis longus (superior) tendons of the ext. pollicis brevis and abductor pollicis longus (inferiorly).
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Contents of snuffbox: Contents of snuffbox: 9- Radial artery 8- Superficial radial N.
Skull: 2 parts: Neurocranium Facial skeleton Skull: 2 parts: Neurocranium Facial skeleton
Neurocranium: 8 bones Frontal X1 Parietal X2 Temporal X2 Occipital X1 Sphenoid X1 Ethmoid X1 Neurocranium: 8 bones Frontal X1 Parietal X2 Temporal X2 Occipital X1 Sphenoid X1 Ethmoid X1
Facial Skeleton: 14 bones Maxilla X2 Nasal X2 Zygomatic X2 Lacrimal X2 Palatine X2 Inferior Nasal Conchae X2 Mandible X1 Vomer X1 Facial Skeleton: 14 bones Maxilla X2 Nasal X2 Zygomatic X2 Lacrimal X2 Palatine X2 Inferior Nasal Conchae X2 Mandible X1 Vomer X1
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Fontanels in the skull are the unossified remnants of the membranes in newborns. Major fontanels are: anterior (ossified within 18-36 months), posterior, mastoid and sphenoid which are ossified within 6 month or more
mandible largest and strongest facial bone
mimetic muscle radiate into the skin of the face and the head, and their contraction causes displacement of the skin. 4 groups: A- Muscles of the Scalp B- Muscles in the region of eyelid C- Muscles in the Nasal region D- Muscle of the Mouth region
Muscles of the Scalp: Muscles of the Scalp: Epicranius Muscle: Has 2 bellies: Frontal (3), Occipital (2), and in between, the Galea Aponeurotica (1). Temporoparietalis M
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Epicranius Epicranius Function: produces wrinkles in forehead and gives facial expression of Astonishment. Innervation: All mimetic muscles by Facial nerve (cranial nerve CNVII)
Muscles in the region of eyelid Orbicularis Oculi muscle Corrugator supercilli
Orbicularis Oculi muscle: Orbicularis Oculi muscle: Has 3 parts: Orbital (1), Palpebral (2) and Lacrimal (3). Function: produces folds in lateral angle of the eye, expression of Worry and concern Facial (CNVII) N.
Corrugator supercilli Corrugator supercilli (7): Pulls the skin and eyebrow down and medially. Produces vertical folds. Protects against light. Thinker’s brow expression Facial (CNVII) N
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Orbicularis Oris M Orbicularis Oris M.: Function: its contraction closes the mouth. Strong contraction gives a sucking shape. Expression of reserve facial N. (CNVII)
Buccinator M Buccinator M.:Function: enables air to be blown out of the mouth. Pulls angle of the mouth laterally. Keeps the mucous membrane of the cheek free of folds. Contraction gives expression of satisfaction
Zygomaticus Major Zygomaticus Major: Function: lifts the corner of the mouth upward, giving expression of laughter or pleasure facial N. (CNVII)
Risorius Risorius: (laughing muscle) Function: together woth zygomatic major it produces the nasolabial folds. Its contraction gives expression of Action facial N. (CNVII)
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Lavator anguli oris Lavator anguli oris: It lifts the angle of the mouth, Giving expression of self confidence facial N. (CNVII)
Depressor anguli oris Depressor anguli oris: Function: pulls the angle of the mouth downwards and produces expression of sadness facial N. (CNVII)
Depressor labii inferioris Depressor labii inferioris: It pulls the lower lid down, giving expression of perseverance facial N. (CNVII)
Mentalis Mentalis: Produces: chin-lip furrow, giving expression of doubt and indecision facial N. (CNVII)
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CNV cranial nerve 5 (trigeminal nerve). It has 3 branches: ophthalmic, maxillary and mandibular
Masseter M: Masseter M: Has 2 parts: 7- Superficial part (oblique fibers) 8- Deep part (vertical fibers) Function: powerfully closes the jaw by elevating the mandible. NN: Masseteric N Mandibular nerve
Temporalis M: Temporalis M: Function: strongest elevator of lower jaw. NN: deep temporal N Mandibular nerve
Lateral pterygoid M Lateral pterygoid M (3): Has 2 parts (12 and 14) Function: mandibular movements (guiding muscle). NN: lateral pterygoid N Mandibular nerve
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Medial Pterygoid M Medial Pterygoid M (4): Function: elevates mandible and pushes it forward. Rotational movement. NN; Medial pterygoid N Mandibular nerve
Trigeminal (V) nerve Ophthalmic (V/1), Maxillary (V/2) and mandibular (V/3) nerves
Ophthalmic nerve Ophthalmic nerve: supplies the forehead Supratrochlear N (17) and supraorbital
Maxillary nerve Maxillary nerve: supplies lower eyelid, Cheek, lateral nasal, upper lip and anterior Temporal regions by Infraorbital N
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Mandibular N Mandibular N: lower lip over mandible (not angle) and chin by mental N (23). Auriculotemporal N (24) supplies skin on Mandible ramus
Trigeminal neuralgia A disorder of unknown etiology (cause) associated with intractable pain along the 3 branches of trigeminal nerve but especially along maxillary and mandibular nerves. A simple trigger such as touch, cold or hot can start the pain
Hyoid bone Is in the neck, but, may be included with the bony skeleton of the skull. PARTS: Body (anterior) Greater horns (laterally) Lesser horns (upwards)
Platysma Is the only cutaneous muscle in human body (under the skin) brings down corners of the mouth, expressing sadness. Facial N. (VII) Injury to this nerve leads to paralysis of platysma (skin falls away from the neck by folds)
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Trapezius M Function: elevation, retraction and rotation of scapula. Helps in adduction and slight elevation of arm *Innervation: spinal root of Accessory nerve
Sternocleidomastoid M Function: unilateral contraction turns the head to opposite side and bends it ipsilaterally. Bilateral contraction: lifts the head. Also functions in respiration. Innervation: Accessory nerve (CNXI)
Congenital Torticollis Head turns to the side and face away from the affected side. Leads to stifness of the neck due to fibrosis and shortening of the sternocleidomastoid.
SpasmodicTorticollis May involve bilateral neck muscles especially the Sternocleidomastoid M. Unilateral deviation of the head. (turning, tilting, flexion or extension of the neck) May involve other muscles in the body
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Omohyoid muscle Omohyoid muscle Has an Inferior and a superior belly Inf. Belly: Sup. Belly: Opens the mouth and helps in lateral flexion of the head. *Innervation: Most Infrahyoid muscles are innervated by cervical Ansa
infrahyoid muscles Sternohyoid M.: Omohyoid M. Sternothyroid: Thyrohyoid M.: Innervation: C1, before giving the branch to cervical ansa. *Action: All infrathyroid muscles work together to approximate thyroid cartilage to hyoid bone. When mouth is open, they stabilize laryngeal cartilages and the hyoid bone.
Digastric M Digastric M.: Function: Raising hyoid and stabilizing it in speaking and swallowing,depressing the mandible. **Innervation: Ant. Belly: V/3, trigeminal N. (from nerve to myelohyoid) and post. belly:
Stylohyoid M Stylohyoid M.: Function: elevates and retracts hyoid bone, elongates floor of the mouth. Innervation: VII, facial N. (cervical branch)
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Myelohyoid M Myelohyoid M.: Function: Elevates hyoid and floor of the mouth and tongue in swallowing and speaking. *Innervation: V/3 (myelohyoid N. from inf. Alveolar N.)
Geniohyoid M Geniohyoid M.: Function: pulls the hyoid anterosuperiorly, shortens floor of the mouth and widens pharynx. *Innervation: C1 via hypoglossal nerve
Paravertebrals Paravertebrals: Rectus Capitis Ant., Logus Capitis and Longus Colli.
Rectus capitis Rectus capitis: (1-3) Helps to flex the head. NN: Cervical Plex
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Longus Capitis Longus Capitis: (4-6) Bend the head forward and unilateral action turns the head sideways. NN: Cervical Plexus(C1-4
Longus Colli Longus Colli: (7, 8, 9) Action: unilateral contraction bends and turns cervical column to the side. Also bend the cervical spine forwards. NN: cervical and brachial Pl
Scalene muscles Scalene muscles Most important muscles for quiet inspiration They lift the first 2 pairs of ribs (sup part of thorax). Unilateral contraction tilts cervical column to one side. Scalene Anterior (17): Scalene Medius (20): Scalene Posterior (23): NN: Brachial plexus (C4-C8).
Scalene opening Scalene opening: brachial plexus and subclavian artery pass through.
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Occipital (Omotrapezoid) triangle: Floor: Splenius Capitis (17), Lavator Scapulae (16), Post. Scalene (15) and Middle Scalene (14). *Content: Cervical Plexus
carotid foramen transmits the internal carotid artery (brings blood to the brain)
jugular foramen transmits cranial nerves 9,10, 11 (bring blood back from the brain)
foramen lacerum internal carotid passes over
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foramen ovale transmits mandibular nerve
opthalmic artery bringing blood suppy to the eye
optic nerve brings sensory information to the brain
foramen rotundum transmits the maxillary nerve
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foramen spinosum transmits the middle meningeal artery and vein
foramen magnum transmits the medulla and meninges vertebral arteries and CN XI
hypoglossal canal transmits the hypoglossal nerver
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 Fractures of clavicle Cleidocranial dysostosis
 Fractures of the Humerus:Fractures of the surgical neck:
injury to the Axillary nerve.

*Fractures of the middle of the shaft: may
cause injury to the radial nerve: Wrist drop

Fractures of the distal end of humerus: injury
to the Median nerve. (ape hand)

Fractures to the medial epicondyle: injury to
the ulnar nerve. (claw hand)
 Colles’ Fracture: . fracture of the distal end of the radius, posterior displacement. Falling on hand with extended arm (eg.: falling on ice).
May be accompanied by avulsion of ulnar styloid process.
 carpal bones: proximal row1- Scaphoid (largest in this row)

3- Lunate
4- Triquetrum

6- Pisiform


*Scaphoid bone is the most frequent
bone to fracture among the carpal bones.
*Lunate is the most dislocated carpal bone.
 carpal bones: distal row
Distal row:
7- Trapezium

11- Trapezoid
12- Capitate (bigest in 2nd row)
13- Hamate


*Scaphoid bone is the most frequent
bone to fracture among the carpal bones.
*Lunate is the most dislocated carpal bone.
 *Flexor Retinaculum: *Flexor Retinaculum:
Is a double layer of membrane covering the
carpal groove anteriorly and produces the
carpal tunnel for transmission of flexor
muscles and median nerve.
 *Carpal Tunnel Syndrome: *Carpal Tunnel Syndrome:
Compression to the median nerve in the
tunnel due to hypothyroidism, rheumatoid
arthritis, pregnancy, Amyloidosis etc.
It is a very painful condition.
 Supraspinatus: Supraspinatus: Abductor of the arm,
belongs to the rotator cuff muscle group.
NN: Suprascapular N. (C4-C6)
 Teres minor: Teres minor: Lateral rotator of the arm,
Rotator cuff group, NN: Axillary (circumflex) N
 Rotator cuff function: Rotator cuff function: help to maintain the stability of the shoulder joint.
 Deltoid:
NN: Axillary N. (C5- C6).
Function: Most important abductor of the arm
up to 90 degree.
 Subscapularis M: Subscapularis M:
Arm adduction and medial rotation,
NN: Subscapular N.
 Teres major M: Teres major M:
Arm adduction and medial rotation,
NN: Lower subscapular N.
 Latissimus dorsi M: . Latissimus dorsi M: (coughing M)

Function: Adduction and medial rotation and
extension of the arm,
NN: Thoracodorsal N.
 Coracobrachialis M: Coracobrachialis M:

Flexion (anteversion) and adduction of arm,
Musculocutaneous N.
 Pectoralis Minor M: Pectoralis Minor M:

It lowers and rotates the scapula,
Medial pectoral N.
 Pectoralis major M: Pectoralis major M:

F: Adduction and medial rotation of humerus
NN: lateral and medial pectoral N
 Serratus anterior M: Serratus anterior M:

Function:
**Elevation of the arm over 90o
 Long thoracic N. (C5- C6- C7) Long thoracic N. (C5- C6- C7)
**Paralysis: Winged scapula: lifting the
arm beyond 90o is not possible
  Differential diagnosis: Differential diagnosis: Rhomboid M injury,
Here you have winged scapula as well,
but arm elevation is normal.
 Subclavious M: Subclavious M: Number 1 (blue)

F: it pulls the clavicle towards the sternum
Nerve to the Subclavious
 Biceps M (4):

Acts on 2 joints:
Long head (5): abductor and medial rotator
of the arm
Short head (7): adductor of the arm
Both heads flex (anteroversion) shoulder joint
On elbow joint: flexor and strong supinator of
the forearm. NN: Musculocutaneous N. (C5- C6)
**Biceps Jerk: C5- C6
 Brachialis M (1): Powerful flexor of the elbow joint
NN: Musculocutaneous N
 Coracobrachialis M Flexor of the arm. Musculocutaneous N
 Triceps M: Chief extensor of elbow joint
Long head acts on 2 joints:
Retroversion and adduction of the arm
Radial N. (C6- C7- C8)
Triceps Jerk: C7- C8
 Upper brachial plexus lesion: Erb-Duchenne paralysis
Traction on the arm at birth or falling on the shoulder may damage the upper part of the plexus (roots may be pulled out of spinal cord)
Signs: Deltoid and supraspinatus are paralyzed (no arm abduction)
Infraspinatus paralysis leads to medial rotation of the arm.
Biceps and Brachialis are also paralyzed (no elbow flexion)
 Lower brachial plexus lesion: Lower brachial plexus lesion:
Not as common as upper plexus injuries. Paralysis of the intrinsic muscle of hand (small muscles) with
anesthesia. Results from sudden upward pull of the shoulder.
 Pronator Teres Function: pronation of forearm and flexion
at elbow
NN: Median N
 Palmaris longus Palmaris longus
Flexes the hand toward the palm,
tenses the palmar aponeurosis, Median N.
 Flexor carpi radialis Flexor carpi radialis
F: Palmar flexion and Radial abduction of hand
NN: Median N
 Flexor digitorum superficialis Flexor digitorum superficialis
Strong flexors of the finger (4 medial) joints;
also flexes the wrist , Runs in the carpal tunnel
NN: Median N
 Flexor carpi ulnaris Flexor carpi ulnaris
F: Hand (palmar) flexion and adduction
Runs outside of carpal tunnel.
NN: Ulnar N
 Flexor digitorum Profundus Flexor digitorum Profundus
Runs through the carpal tunnel
Function: it is a flexor of the wrist, midcarpal,
metacarpophalangeal and phalangeal joints
NN: Median N. (ant. Interosseous branch)
  Flexor pollicis longus ) Flexor pollicis longus
Runs through the carpal tunnel
Has it’s own tendon sheath
Flexor of the terminal phalanx (thumb)
NN: Median N. (ant. Interosseous branch)
 Pronator quadratus Pronator quadratus
Pronates the forearm (with Pronator Teres)
Median N. (ant. Interosseous branch)
 Brachioradialis (beer drinking M.) Brachioradialis (beer drinking M.)
It brings the forearm into midposition between
pronation and supination;
NN: Radial N
 Extensor carpi radialis longus Extensor carpi radialis longus
Extensor and abductor of hand at wrist joint
NN: Radial N
 Extensor carpi radialis brevis Extensor carpi radialis brevis
Extensor and abductor of the hand at wrist joint
NN: Radial N. (deep branch)
 Extensor digitorum Extensor digitorum
Function: Extends the 4 medial fingers
(metacarpophalangeal J.), strong dorsiflexor
of the hand at wrist joint
NN: Post. Interosseous branch of deep
radial nerve
 Extensor digiti minimi Extensor digiti minimi
Extension of the 5th digit and dorsiflexion of hand
NN: Post. Interosseous branch of deep
radial nerve
 Extensor carpi ulnaris Extensor carpi ulnaris
Extends and adducts the hands
NN: Post. Interosseous branch of deep
radial nerve
 Supinator Supinator
Encircles the radius and supinates forearm
NN: Deep branch of radial N
 Abductor pollicis longus Abductor pollicis longus
Runs through 1st tendon compartment
Abduction of the first thumb+ it’s extension
at carpometacarpal joint
Post. Interosseous branch of deep
radial nerve
 Extensor pollicis brevis Extensor pollicis brevis
Runs in the 1st tendon compartment
Extension of the proximal phalanx at
metacarpophalangeal joint.
Post. Interosseous branch of deep
radial nerve
 Extensor pollicis longus Extensor pollicis longus
Runs through 3rd tendon compartment
Extends the thumb using the crest on radius
as a fulcrum (at metacarpophalangeal and
Interphalangeal joints).
Post. Interosseous branch of deep
radial nerve
 Extensor indicis Extensor indicis
Runs through 4th compartment with Ext. digitorum
Index extension and hand dorsiflexion
Post. Interosseous branch of deep
radial nerve
 Extensor retinaculumCovers the carpal bones dorsally and has
septae which produce 6 tendon
compartments through which tendon of
the extensor muscles and the abductor
pollicis longus pass
 Abductor pollicis brevisAbductor pollicis brevis:
Abduction of thumb, Median N
 Flexor pollicis brevisFlexor pollicis brevis:
Flexes the thumb
Superficial innervation by median N. C8-T1
Deep head by ulnar N
 Adductor PollicisAdductor Pollicis: 2 heads
Thumb Adduction. Deep branch of Ulnar nerve
 Opponens pollicis Opponens pollicis (15) :
Thumb opposition. Median N
 Dupuytren’s contracture: progressive fibrosis, thickening and shortening of the aponeurosis leads to partial flexion of the ring and small fingerDupuytren’s contracture: progressive fibrosis,
thickening and shortening of the aponeurosis leads
to partial flexion of the ring and small finger
 Palmaris brevis in hypothenar eminence Palmaris brevis in hypothenar eminence
connect the skin of ulnar border to palmar aponeurosis
and flexor retinaculum.
Innervation: superficial branch of ulnar N
 Abductor digiti minimi Abductor digiti minimi (9)
Abducts the 5th digit
: deep branch of ulnar N
 Flexor digiti minimi (10) Flexes the 5th digit Flexor digiti minimi (10)
Flexes the 5th digit
: deep branch of ulnar N
 Opponens digiti minimi Opponens digiti minimi (11)
Makes opposition of the 5th finger to thumb possible
: deep branch of ulnar N
 Palmar interossei: 3 muscles Palmar interossei (1): 3 muscles
Function: Adduction of digits, assist lumbricals
Ulnar N. deep branch
 Dorsal Interossei:4 muscles Dorsal Interossei: 4 muscles
Function: Abduction of digits
Ulnar N. (deep branch)
 Lumbricals: 4 muscles Lumbricals: 4 muscles
2 lateral (radial) and 2 medial (ulnar)
2 lateral ones innervated by Median N. C8-T1
2 medial ones innervated by Ulnar N.
 Breast cancerBreast Cancers may
give metastasis to the axillary
lymph node (75% of breast’s
lymphatics drain here).
Removal of the lymph nodes
may be necessary.
Mastectomy: removal of the
breast.
 Lymph nodes of the Axillary regionArranged in 5 groups:
Pectoral, medial, apical,
central and subscapular
 Medial bicipital groove: Between biceps and intermuscular septa
 Anterior Brachial region Contents:
Median N, Brachial artery and veins and
basilic vein, medial cutaneous antebrachial
nerve and ulnar N. medially
 posterior brachial regionRadial nerve is found deep in the
posterior brachial region in radial
groove of humerus accompanied
by deep brachial A and V.
 Arteries of the forearm and handbrachial artery
2- Radial artery
3- Ulnar artery
 Palm of the hand1- Superficial palmar arch
18- Deep palmar arch
11- median nerve
9- ulnar nerve
 Dorsum of the Hand: Dorsum of the Hand:
Radial artery (9) enters the Snuffbox and
gives a dorsal branch which produces the
dorsal arterial arch of the hand.
Then it gives the principal artery of the thumb
and then a main branch to join the deep
palmar arch.
 Snuffbox: borders: Snuffbox: borders:
Tendon of extensor pollicis longus (superior)
tendons of the ext. pollicis brevis and
abductor pollicis longus (inferiorly).
 Contents of snuffbox: Contents of snuffbox:
9- Radial artery
8- Superficial radial N.
 Skull: 2 parts: Neurocranium Facial skeleton Skull:
2 parts:
Neurocranium
Facial skeleton
 Neurocranium: 8 bones Frontal X1 Parietal X2 Temporal X2 Occipital X1 Sphenoid X1 Ethmoid X1 Neurocranium:
8 bones
Frontal X1
Parietal X2
Temporal X2
Occipital X1
Sphenoid X1
Ethmoid X1
 Facial Skeleton: 14 bones Maxilla X2 Nasal X2 Zygomatic X2 Lacrimal X2 Palatine X2 Inferior Nasal Conchae X2 Mandible X1 Vomer X1 Facial Skeleton:
14 bones
Maxilla X2
Nasal X2
Zygomatic X2
Lacrimal X2
Palatine X2
Inferior Nasal Conchae X2
Mandible X1
Vomer X1
 Fontanelsin the skull are the unossified remnants of the membranes in newborns.
Major fontanels are: anterior (ossified within 18-36 months), posterior,
mastoid and sphenoid which are ossified within 6 month or more
 mandiblelargest and strongest facial bone
 mimetic muscleradiate into the skin
of the face and the head, and their contraction
causes displacement of the skin.
4 groups:
A- Muscles of the Scalp
B- Muscles in the region of eyelid
C- Muscles in the Nasal region
D- Muscle of the Mouth region
 Muscles of the Scalp: Muscles of the Scalp:

Epicranius Muscle:
Has 2 bellies: Frontal (3), Occipital (2), and in
between, the Galea Aponeurotica (1).

Temporoparietalis M
 Epicranius Epicranius Function:
produces wrinkles in forehead and gives facial
expression of Astonishment.
Innervation: All mimetic muscles by Facial
nerve (cranial nerve CNVII)
 Muscles in the region of eyelid Orbicularis Oculi muscle
Corrugator supercilli
 Orbicularis Oculi muscle: Orbicularis Oculi muscle:
Has 3 parts: Orbital (1), Palpebral (2) and
Lacrimal (3).
Function: produces folds in lateral angle of the
eye, expression of Worry and concern
Facial (CNVII) N.
  Corrugator supercilli
Corrugator supercilli (7):
Pulls the skin and eyebrow down and medially.
Produces vertical folds. Protects against light.
Thinker’s brow expression
Facial (CNVII) N
 Orbicularis Oris M Orbicularis Oris M.:
Function: its contraction closes the mouth.
Strong contraction gives a sucking shape.
Expression of reserve
facial N. (CNVII)
 Buccinator MBuccinator M.:Function: enables air to be blown out of the
mouth. Pulls angle of the mouth laterally.
Keeps the mucous membrane of the cheek
free of folds.
Contraction gives expression of satisfaction
 Zygomaticus MajorZygomaticus Major:
Function: lifts the corner of the mouth upward,
giving expression of laughter or pleasure
facial N. (CNVII)
 RisoriusRisorius: (laughing muscle)
Function: together woth zygomatic major it
produces the nasolabial folds.
Its contraction gives expression of Action
facial N. (CNVII)
 Lavator anguli orisLavator anguli oris:
It lifts the angle of the mouth,
Giving expression of self confidence
facial N. (CNVII)
 Depressor anguli orisDepressor anguli oris:
Function: pulls the angle of the mouth
downwards and produces expression of
sadness
facial N. (CNVII)
 Depressor labii inferiorisDepressor labii inferioris:
It pulls the lower lid down, giving expression
of perseverance
facial N. (CNVII)
 MentalisMentalis:
Produces: chin-lip furrow, giving expression of
doubt and indecision
facial N. (CNVII)
 CNVcranial nerve 5 (trigeminal nerve).
It has 3 branches: ophthalmic, maxillary
and mandibular
 Masseter M: Masseter M:
Has 2 parts:
7- Superficial part (oblique fibers)
8- Deep part (vertical fibers)
Function: powerfully closes the jaw by elevating
the mandible. NN: Masseteric N Mandibular nerve
 Temporalis M: Temporalis M:
Function: strongest elevator of lower jaw.
NN: deep temporal N Mandibular nerve
 Lateral pterygoid M Lateral pterygoid M (3):
Has 2 parts (12 and 14)
Function: mandibular movements (guiding muscle).
NN: lateral pterygoid N Mandibular nerve
  Medial Pterygoid M
Medial Pterygoid M (4):
Function: elevates mandible and
pushes it forward. Rotational movement.
NN; Medial pterygoid N Mandibular nerve
 Trigeminal (V) nerveOphthalmic (V/1),
Maxillary (V/2) and mandibular (V/3) nerves
 Ophthalmic nerveOphthalmic nerve: supplies the forehead Supratrochlear N (17) and supraorbital
 Maxillary nerveMaxillary nerve: supplies lower eyelid,
Cheek, lateral nasal, upper lip and anterior
Temporal regions by Infraorbital N
 Mandibular NMandibular N: lower lip over mandible
(not angle) and chin by mental N (23).
Auriculotemporal N (24) supplies skin on
Mandible ramus
 Trigeminal neuralgia A disorder of unknown etiology (cause) associated with intractable pain along the 3
branches of trigeminal nerve but especially along maxillary and mandibular
nerves. A simple trigger such as touch, cold or hot can start the pain
 Hyoid boneIs in the neck, but, may be
included with the bony
skeleton of the skull.

PARTS:
Body (anterior)
Greater horns (laterally)
Lesser horns (upwards)
 PlatysmaIs the only cutaneous
muscle in human body
(under the skin)
brings down corners of the
mouth, expressing sadness.
Facial N. (VII)
Injury to this nerve leads to
paralysis of platysma (skin falls
away from the neck by folds)
 Trapezius MFunction: elevation, retraction and
rotation of scapula.
Helps in adduction and slight elevation of arm
*Innervation: spinal root of Accessory nerve
 Sternocleidomastoid MFunction: unilateral contraction turns the head
to opposite side and bends it ipsilaterally.
Bilateral contraction: lifts the head.
Also functions in respiration.
Innervation: Accessory nerve (CNXI)
 Congenital TorticollisHead turns to the side and face away
from the affected side.
Leads to stifness of the neck due to fibrosis
and shortening of the sternocleidomastoid.
 SpasmodicTorticollisMay involve bilateral neck muscles especially
the Sternocleidomastoid M.
Unilateral deviation of the head.
(turning, tilting, flexion or extension of the neck)
May involve other muscles in the body
 Omohyoid muscle Omohyoid muscle
Has an Inferior and a superior belly
Inf. Belly:
Sup. Belly:
Opens the mouth and helps in lateral
flexion of the head.

*Innervation: Most Infrahyoid muscles are
innervated by cervical Ansa
 infrahyoid musclesSternohyoid M.:
Omohyoid M.
Sternothyroid:
Thyrohyoid M.:
Innervation: C1, before giving the branch to
cervical ansa.
*Action: All infrathyroid muscles work together
to approximate thyroid cartilage to hyoid bone.
When mouth is open, they stabilize
laryngeal cartilages and the hyoid bone.
 Digastric MDigastric M.:
Function: Raising hyoid and
stabilizing it in speaking and
swallowing,depressing the mandible.
**Innervation:
Ant. Belly: V/3, trigeminal N. (from nerve to
myelohyoid) and post. belly:
 Stylohyoid MStylohyoid M.:
Function: elevates and retracts hyoid bone,
elongates floor of the mouth.
Innervation: VII, facial N. (cervical branch)
 Myelohyoid M Myelohyoid M.:
Function:
Elevates hyoid and floor of the
mouth and tongue in swallowing
and speaking.
*Innervation:
V/3 (myelohyoid N. from
inf. Alveolar N.)
 Geniohyoid M Geniohyoid M.:
Function: pulls the hyoid anterosuperiorly,
shortens floor of the mouth and widens pharynx.
*Innervation: C1 via hypoglossal nerve
 ParavertebralsParavertebrals:
Rectus Capitis Ant., Logus Capitis and
Longus Colli.
 Rectus capitisRectus capitis: (1-3)
Helps to flex the head. NN: Cervical Plex
  Longus Capitis
Longus Capitis: (4-6)
Bend the head forward and unilateral action
turns the head sideways.
NN: Cervical Plexus(C1-4
 Longus ColliLongus Colli: (7, 8, 9)
Action: unilateral contraction bends and turns
cervical column to the side.
Also bend the cervical spine forwards.
NN: cervical and brachial Pl
 Scalene musclesScalene muscles
Most important muscles for quiet inspiration
They lift the first 2 pairs of ribs (sup part of thorax).
Unilateral contraction tilts cervical column to one
side.
Scalene Anterior (17):
Scalene Medius (20):
Scalene Posterior (23):
NN: Brachial plexus (C4-C8).
 Scalene opening Scalene opening:
brachial plexus and subclavian artery pass through.
 Occipital (Omotrapezoid) triangle: Floor: Splenius Capitis (17),
Lavator Scapulae (16), Post. Scalene (15)
and Middle Scalene (14).
*Content: Cervical Plexus
 carotid foramentransmits the internal carotid artery (brings blood to the brain)
 jugular foramentransmits cranial nerves 9,10, 11 (bring blood back from the brain)
 foramen laceruminternal carotid passes over
 foramen ovaletransmits mandibular nerve
 opthalmic arterybringing blood suppy to the eye
 optic nervebrings sensory information to the brain
 foramen rotundumtransmits the maxillary nerve
 foramen spinosumtransmits the middle meningeal artery and vein
 foramen magnumtransmits the medulla and meninges vertebral arteries and CN XI
 hypoglossal canaltransmits the hypoglossal nerver
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