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

Note: This is an outline of topics to be covered. It is not the "answer key." It is an answer guide.

Scapular Region

Review the anatomy of the scapular region. Include bones, muscles, movements, vascularization, innervation, relationships, and lymphatic drainage. (12 pts).
  • 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

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Spinal Canal

Review the anatomy of the spinal canal. Include boundaries, bones, articulations, ligaments, spaces, contents, vascularization, relationships, and lymphatic drainage. (12 pts)
  • 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

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Extensor Region of Forearm and Dorsum of the Hand

Review the anatomy of the extensor region of the forearm and the dorsum of the hand. Include bones, articulations, ligaments, spaces, contents, muscles, movements, independence of movement, limitations of movement, vascularization, innervation, relationships, and lymphatic drainage. (12 pts)
  • 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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Topic revision: r1 - 29 Sep 2011, UnknownUser
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