Describe the lymphatic circulation of the mammary glandDescribe the characteristic features of Erb-Duchenne palsy and Klumpke’s paralysisDescribe the arterial supply of the hand and layers of the palmar regionDescribe the cutaneous innervation of the upper limbDescribe the rotator cuff muscles and the avulsion fracture of the greater tubercleDescribe the scapular arterial anastomosis and its clinical importanceDescribe the pathogenesis of claw hand, ape hand, hand of benediction and wrist dropDescribe the borders and content of the cubital fossa, medial and lateral axillary spacesDescribe the carpal tunnel syndrome and the Dupuytren’ s contractureDescribe the anatomical snuff box – borders, contentDescribe the spinal chord levels associated with upper limb movements and reflexes

Describe the lymphatic circulation of the mammary gland

• Mammary gland, pectoreal (anterior lymph node), central, apical nodes

• To sublcavian trunk, to right subclavian trunk, jugular vein (on right; thoracic duct on left)

Describe the characteristic features of Erb-Duchenne palsy and Klumpke’s paralysis

• Clinical correlates; pages 38-42 in lab book• Erb is waiter’s tip

– No abduction, lateral rotation, arm flexors• Klumpke’s is claw HAND

Describe the arterial supply of the hand and layers of the palmar region

• Deep (radial a.) and superficial (ulnar a.) palmar arches– Branches of the radial/ulnar arteries

• Radial is more the deep side – supplies index, thumb as well

• SUper DR– Superficial ulnar– Deep Radial (interossei, lumbricals, deep muscles)

• Superficial branch splits into common digital arteries, which go up to become the proper digital arteries

Describe the cutaneous innervation of the upper limb

• Cutaneous innervation map

Describe the rotator cuff muscles and the avulsion fracture of the greater tubercle

• Subscapularis goes to the lesser tubercle– Other 3 go to the greater tubercle– Subscapularis would not be affected and would

medially rotate your arm; lateral rotators lost• Not attached to lesser tubercle

– Originates from the subscapular fossa

• Medial rotators of arm– 2 Majors and a Sexy Lady

• Pec/teres major, subscapularis, latissimus dorsi

Describe the scapular arterial anastomosis and its clinical importance

• Transverse cervical (dorsal scapular artery)– From subclavian

• Suprascapular artery– From subclavian

• Circumflex scapular artery– From the subscapular artery

• Importance= if one of the arteries is blocked, there will still be a blood supply to the muscles in the area

Describe the borders and content of the cubital fossa, medial and lateral axillary spaces

• Tendon of biceps, brachial artery, median nerve• Pronator teres on medial side, brachioradialis on

lateral side

• Triangular Space (t. minor over t. major)– Circumflex scapular artery

• Quadrangular Space (long head of biceps medially, humorous lat, t. minor superior, t. major inferior)– Axillary nerve, posterior circumflex artery

Describe the carpal tunnel syndrome and the Dupuytren’ s contracture

• 3 benediction– Dupuytren’s (palmar aponeurosis) Ulnar claw,

median (Ape hand)• median nerve; dig. Superficialis, dig.

Profundus, flexor pollicis longus– 10 things through the carpal tunnel

Describe the anatomical snuff box – borders, content

• Extensor pollicis longus (medial border), extensor pollicis brevis (lateral), abductor pollicis longus (lateral)

• Floor is scaphoid and trapezium• Radial artery, nerve and cephalic vein are in

there

Describe the spinal chord levels associated with upper limb movements and reflexes

• C5 (for biceps) tap the cubital fossa• C6 (for brachioradialis) tap radial nerve

– Right before the distal portion of the radius• C7 (for triceps) tap right above elbow joint • C5-C6 is shoulder• C5 is abduction (up), C6 is flexing, C7 is

extension of arm/forearm, C8 is wrist, T1 is ab/adduction of fingers