12. Upper Limb I Flashcards
What are the main bony features of the Clavicle?
- Acromial End
- Sternal End
- Acromial Facet
- Conoid Tubercle
- Trapezoid Line
- Sternal Facet

What is the shape of the Clavicle Medially and Why?
Medially the Clavicle has a Convex Shape,
This allows the Brachial Plexus and Axillary Neurovascular Structures to run behind it.
Where do most Clavicle Fractures occur?
Between the Lateral 1/3 and Medial 2/3
What deformity results from a Fractured Clavicle?
Usually an obvious Bump at the site of Fracture.
What are the main bony features of the Scapula?
- Acromion/Acromial Angle
- Coracoid Process
- Glenoid Fossa
- Infraglenoid Tubercle
- Infraspinous Fossa
- Medial Border
- Lateral Border
- Inferior Angle
- Neck of Scapula
- Subscapular Fossa
- Superior Border
- Superior Angle
- Spine of Scapula
- Suprascapular Notch
- Supraspinous Fossa
How is the Scapula connected to the Skeleton?
The Scapula does not articulate directly with the Axial Skeleton.
It is connected by Muscles.
What does a Shallow Glenoid Fossa allow?
A wide range of movement of the Upper Limb.
What is the disadvantage of the
Shallow Glenoid Fossa?
It is prone to Dislocation.
It is the Most Commonly Dislocated Joint.
Where does the Tendinous Attachment
of the Short Head of Biceps arise from?
Coracoid Process of Scapula
What are the main bony features of the Humerus?
- Anatomical Neck
- Surgical Neck
- Greater Tubercle
- Lesser Tubercle
- Crest Of Greater Tubercle
- Crest Of Lesser Tubercle
- Intertubercular Sulcus
- Deltoid Tuberosity
- Radial Groove
- Radial Groove
- Medial Supracondylar Ridge
- Lateral Supracondylar Ridge
- Olecranon Fossa
- Lateral Epicondyle
- Trochlea
- Groove For Ulnar Nerve
- Medial Epicondyle
- Coronoid Fossa
- Radial Fossa
- Capitulum And Trochlea
Where is the Radial Groove found?
The Posterior Surface of the Humeral Shaft
What are the Epicondyles?
The two wing-like structures of the Distal Humerus
What is the difference between the two Epicondyles?
Why are they different?
The Medial Epicondyle is Larger,
And extends more Distally.
This is because:
The Ulnar Nerve passes through a Groove on the Posterior aspect of Medial Epicondyle.
Desribe the passage of the Ulnar Nerve down the Arm?
After arising from the Brachial Plexus,
The Ulnar Nerve descends down the Medial Aspect of the Upper Arm.
At the Elbow, it passes Posterior to the Medial Epicondyle of the Humerus,
And gives rise to an Articular Branch that supplies the Elbow Joint.
Where is the Ulnar Nerve vulnerable?
The Ulnar Nerve is palpable and vulnerable to injury at the Medial Epicondyle
What are the main bony features of the Radius?
- Head of Radius
- Neck of Radius
- Radial Tuberosity
- Shaft of Radius
- Oblique Line
What are the main bony features of the Ulna?
- Olecranon Process
- Coronoid Process
- Trochlear Notch
- Radial Notch
What is the Olecranon Process?
What Muscle attaches to it?
Projection of Bone extends Proximally forming part of Trochlear Notch.
Triceps Brachii attaches to its Superior Surface.
What is the Coronoid Process?
Ridge of Bone projects outwards Anteriorly forming part of Trochlear Notch.
Where is the Radial Notch located?
What does it Articulate with?
Located on Lateral Surface of Trochlear Notch
Articulates with the Head of the Radius.
What is the Trochlear Notch formed by?
Formed by Olecranon and Coronoid Process.
Which 3 Joints form the Shoulder Complex?
- Sternoclavicular Joint
- Acromioclavicular Joint
- Glenohumeral Joint
Which Ligaments form the Sternoclavicular Joint?
Interclavicular Ligament
Costoclavicular Ligament
Anterior Sternoclavicular Ligament
What does the Costoclavicular Ligament help attach?
Helps to attach the Clavicle securely to the First Costal Cartilage.
What movements normally occur at the
Sternoclavicular Joint?
- Anterior, Posterior and Vertical Movement of Clavicle
- Limited Rotation.
Which Ligaments form the Acromioclavicular Joint?
Acromioclavicular Ligament
Coracoclavicular Ligaments:
- Trapezoid Ligament
- Conoid Ligament
Which are the two Strongest Ligaments
that provide support and attachment for Upper Limb?
Trapezoid Ligament
Conoid Ligament
What do the Coracoclavicular Ligaments help attach?
Help to attach the Clavicle securely to the Scapula.
What movements normally occur at the
Acromioclavicular Joint?
- Permits Anterior and Posterior Gliding of Acromion:
- This occurs during Pronation Retraction of Scapula - Permits Rotation of the Clavicle:
- Rotation occurs during Abduction and Adduction of the Shoulder.
Which Ligaments form the Glenohumeral Joint?
- Superior Glenohumeral Ligament
- Middle Glenohumeral Ligament
- Inferior Glenohumeral Ligament
- Transverse Humeral Ligament
What are 2 other components of the
Glenohumeral Joint?
Glenoid Labrum
Subacromial Bursa
What kind of Joint is the Glenohumeral Joint?
A Ball and Socket Joint
What is the Glenoid Labrum/Ligament?
A Fibrocartilaginous Rim attached around the Margin of the Glenoid Cavity.
What is the Function of the Glenoid Labrum?
Deepens the “Socket” of the Glenohumeral Ball and Socket Joint.
This helps hold the Humerus into the Socket.
What is the Subacromial Bursa?
What is its Main Function?
Fluid - Filled Sac between the Acromion and the Rotator Cuff.
Reduces Friction between the bones in the Glenohumeral Joint.
Which is the most common Bursa
to Inflame in the Shoulder?
Subacromial Bursa
Subacromial Bursitis: Inflammation of the Subacromial Bursa
What is Adhesive Capsulitis?
Frozen Shoulder:
- Painful and disabling disorder of Unclear Cause.
- The Shoulder Capsule becomes Inflamed and Stiff.
- Greatly Restricting Motion and causing Chronic Pain.
- Pain is usually worse at night.
How can the Glenohumeral Joint be described?
A Fibrous Capsule
Which part of the Fibrous Capsule is most loose?
How does this impact Joint Stability?
The Fibrous Capsule is most loose Inferiorly .
Increasing the risk of Inferior Dislocation.
How well does the Head of the Humerus fit
in the Glenoid Fossa?
Not, very well.
It is quite Loose within the Socket.
What is the impact of a Loose fitting Humerus?
This causes great Instability within the Glenohumeral Joint.
However, it also allows great Mobility within the Joint.
What prevents Upward Dislocation of the Humeral Head?
Upward Dislocation of the Humeral Head is prevented by:
- Presence of the Coracoacromial Arch
- The Support of the Rotator Cuff
How can Humeral Head dislocations be described
Clinically?
- Anterior Dislocation of the Glenohumeral Joint
- Posterior Dislocation of the Glenohumeral Joint: Much Rarer
Depending on whether the Humeral Head descends
Anterior or Posterior to the Infraglenoid Tubercle
What causes Anterior Dislocation of the
Glenohumeral Joint?
Excessive Extension of the Humerus
Excessive Lateral Rotation of the Humerus
What Structures are at risk of damage from
Anterior Dislocation of the Glenohumeral Joint?
- Tearing of Shoulder Capsule
- Detaching Labrum from Glenoid
- Axillary Artery Damage
- Brachial Plexus Injury
What kind of a Joint is the Elbow Joint?
Synovial Hinge Joint
Where is the Elbow Joint Loose
and where is it Strengthened?
Fibrous Capsule is Loose both Anteriorly and Posteriorly: To permit Movement.
Strengthened elsewhere by Ligaments: To provide Stability.
What are the Ligaments of the Elbow Joint?
- Annular Ligament
- Ulnar (Medial) Collateral Ligament
- Radial (Lateral) Collateral Ligament
- Fibrous Capsule
Where is the Annular Ligment found?
Wraps around head of Radius.
Radial Head can get caught.
Which 3 Joints comprise the Elbow Joint?
- Humeroradial Joint
- Humeroulnar Joint
- Proximal Radioulnar Joint
Where is the Humeroradial Joint found?
Between the Head of the Radius and Capitulum of the Humerus.
What Movement occurs at the Humeroradial Joint?
Flexion
Extension
Where is the Humeroulnar Joint found?
Between Trochlear Notch and Trochlea of the Humerus.
What Movement occurs at the Humeroulnar Joint?
Flexion
Extension
What Movement occurs at the Proximal Radioulnar Joint?
Supination
Pronation
Where is the Olecranon Process in relation to Epicondyles
In Elbow Extension and Elbow Flexion?
Extension: Olecranon lies Between the Epicondyles.
Flexion: Olecranon lies Inferior to Epicondyles.
What is Lateral Epicondylitis?
Tennis Elbow
- Due to repeated Forceful Flexion and Extension of the Wrist.
- Pain is felt over the Lateral Epicondyle and Radiates down the Posterior Surface of the Forearm.
- Strain of the attachment of the Common Extensor Tendon.
What can get Inflamed in Lateral Epicondylitis?
Periosteum of the Lateral Epicondyle
Common Extensor attachment of the Muscles.
Which Nerve is affected Lateral Epicondylitis?
Radial Nerve
What is Medial Epicondylitis?
Golfer’s Elbow
- Due to repetitive Flexing, Gripping, or Swinging.
- Pain radiates down the Anterior aspect from
- Can cause pulls or tiny Tears in the Tendons.
What can get Inflamed in Medial Epicondylitis?
Medial Flexor Tendons.
Which Structure is at risk of injury
with a Humeral Shaft Fracture?
Radial Nerve (Posterior) As this Nerve wraps around the Humerus.
What is the appearance of a Hand with Radial Nerve injury?
Wrist Drop
What is Transient Subluxation?
Pulled Elbow
- Incomplete Dislocation of the Head of the Radius.
- Due to Sudden Lifting (jerking) by the Upper Limb as the Forearm is Pronated.
- Preschool children are most vulnerable.
Which Ligment can Transient Subluxation damage?
Tears the Distal Attachment of the Annular Ligament,
Causing the Radial Head to move Distally, partially out of the Torn Annular Ligament.
Where can the Torn Annular Ligament get trapped?
The Proximal Part of the Torn Ligament may become trapped,
Between the Head of the Radius and the Capitulum of the Humerus.
How can Transient Subluxation be treated?
Treatment consists of Supination of the Forearm during Elbow Flexion.
What are the Main Components of the Brachial Plexus?
- Roots
- Trunks
- Divisions
- Cords
What are the Nerve Roots of the Brachial Plexus?
C5 - T1
What are the 3 Trunks of the Brachial Plexus?
Superior Trunk
Middle Trunk
Inferior Trunk
What are the 2 Divisions of the Brachial Plexus?
Anterior Division
Posterior Division
What are the 3 Cords of the Brachial Plexus?
Lateral Cord
Posterior Cord
Medial Cord
What are the 5 Terminal Nerves of the Brachial Plexus?
MARMU
- Musculocutaneous
- Axillary
- Radial
- Median
- Ulnar
What does the Musculocutaneous Nerve travel into?
Travels Into The Biceps Brachii Muscle.
What does the Axillary Nerve travel into?
Travels Into The Axilla.
Which Cord does the Axillary Nerve come from?
Posterior Cord
Which Muscle will atrophy if there is Axillary Nerve damage?
What movement does this limit?
Deltoid
Abduction of the Arm between 15 - 90 Degrees.
Where does the Radial Nerve lie?
Lies Deep to the Brachial Artery
Reflect Brachial Artery To Identify The Radial Nerve.
Where in the Cubital Fossa is the Radial Nerve?
Emerges into the Cubital Fossa between Brachialis and Brachioradialis
What branches does the Radial Nerve form?
- Superficial Radial: Cutaneous Sensation
- Deep Radial: Motor
How can Medial Nerve be located?
Find the Brachial Artery.
An “M” structure of Nerves lays on the Brachial Artery.
This “M” is formed by the Joining Of The Medial And Lateral Cords,
The Nerve extending from the middle of this “M” is the Median Nerve.
Where does the Ulnar Nerve lie?
The Ulnar Nerve lies Lateral to the Brachial Artery
It Is usually fairly Small.
How is the Ulnar Nerve related to the Medial Epicondyle
Why is the Ulnar Nerve vulnerable here?
The Ulnar Nerve runs in a Groove on the Posterior aspect of the Medial Epicondyle.
At risk of injury in Fractures and Dislocation at the Elbow.
Which Nerve Roots supply the Long Thoracic Nerve?
C5, C6, C7
When is the Long Thoracic Nerve at risk of being injured?
What is the consequence of injury?
Surgical procedures to Axilla/Breast.
Winging of the Scapula.
What is the Nerve Root of the Musculocutaneous Nerve?
C5,C6,C7
What is the Motor Innervation of the Musculocutaneous Nerve?
Brachialis
Biceps Brachii
Coracobrachialis
What is the Sensory Innervation of the Musculocutaneous Nerve?
Gives off the Lateral Cutaneous Branch of the Forearm,
Which innervates the Lateral Half of the Anterior Forearm.
What is the Nerve Root of the Axillary Nerve?
C5 - C6
What is the Motor Innervation of the Axillary Nerve?
Teres Minor
Deltoid Muscles.
What is the Sensory Innervation of the Axillary Nerve?
Gives off the Superior Lateral Cutaneous Nerve of Arm,
Which innervates the Inferior Region of the Deltoid.
What is the Nerve Root of the Median Nerve?
C6-T1
What is the Motor Innervation of the Median Nerve?
Most of the Flexor Muscles in the Forearm
Thenar Muscles
Two Lateral Lumbricals: that move the Index and Middle Fingers.
What is the Sensory Innervation of the Median Nerve?
Gives off the Palmar Cutaneous Branch
Which innervates the Lateral Part of the Palm
Gives off the Digital Cutaneous Branch,
Which innervates the Lateral Three and a Half Fingers
On the Anterior (Palmar) Surface of the Hand.
What is the Nerve Root of the Radial Nerve?
C5-C8 and T1
What is the Motor Innervation of the Radial Nerve?
Triceps Brachii
Extensor Muscles in the Posterior Compartment of the Forearm
What is the Sensory Innervation of the Radial Nerve?
Posterior aspect of the Arm
Posterior aspect of the Forearm
Posterior aspect of the Hand
Lateral aspect of the Hand
What is the Nerve Root of the Ulnar Nerve?
C8 and T1
What is the Motor Innervation of the Ulnar Nerve?
Muscles of the Hand
Flexor Carpi Ulnaris
Medial Half of Flexor Digitorum Profundus.
What is the Sensory Innervation of the Ulnar Nerve?
Anterior Surfaces of the Medial one and Half Fingers,
And associated Palm Area.
Posterior Surfaces of the Medial one and Half Fingers,
And associated Palm Area.
Which Obstetric Complication can cause injury to the Brachial Plexus?
Shoulder Dystocia
What is Shoulder Dystocia?
Specific case of Obstructed Labour whereby after the delivery of the head
The Anterior Shoulder of the Infant cannot pass below the Pubic Symphysis.
List the main Muscles associated with the Upper Limb in the Shoulder:
Shoulder:
- Trapezius Muscle
- Deltoid Muscle
- Rotator Cuff:
- Supraspinatus
- Infraspinatus
- Teres Minor
- Subscapularis
List the main Muscles associated with the Upper Limb at the Back:
Back:
- Latissimus Dorsi Muscle
- Teres Major Muscle
- Rhomboid
List the main Muscles associated with the Upper Limb in the
Chest & Neck:
Chest & Neck:
- Pectoralis Major
- Sternocleidomastoid
Which Thoracic Muscles are associated with the Upper Limb?
Serratus Anterior
Lateral Oblique Muscles
What are the two heads of the Triceps Muscle?
Medial Head Of Triceps
Lateral Head Of Triceps
What are the 2 Rhomboid Muscles?
- Rhomboid Major
- Rhomboid Minor
Rhomboid Major is under Rhomboid Minor
What are the 3 Fibres that make up the Trapezius Muscle
- Descending Fibres
- Transverse Fibres
- Ascending Fibres
What are the 4 Muscles that make up the Rotator Cuff?
S I T S:
- Supraspinatus
- Infraspinatus
- Teres Minor
- Subscapularis
What is the Common Action of the Rotator Cuff Muscles?
To pull the head of the Humerus into the Glenoid Fossa.
What is the Innervation of the Supraspinatus Muscle?
C4 - C5
What is the Action of the Supraspinatus Muscle?
Abduction: Elevates the Shoulder Joint out to the Side.
What is the Origin of the Supraspinatus Muscle?
Medial 2/3 of Supraspinatus
Fossa above Scapular Spine
What is the Insertion of the Supraspinatus Muscle?
Greater Tuberosity of Humerus
Capsule of Shoulder Joint
How could you Test the Actions of the Supraspinatus?
Weakness and/or pain in resisting Abduction of 20°,
Indicates problem with Supraspinatus.
What is the Innervation of the Infraspinatus Muscle?
C5 - C6
What is the Action of the Infraspinatus Muscle?
Lateral Rotation: Externally Rotates the Shoulder Joint
What is the Origin of the Infraspinatus Muscle?
Infraspinous Fossa of Scapula
What is the Insertion of the Infraspinatus Muscle?
Greater Tuberosity of Humerus
Capsule of Shoulder Joint
How could you Test the Actions of the Infraspinatus?
Infraspinatus is the only efficient external rotator of the Shoulder.
Weakness and/or pain resisting External Rotation,
Indicates problem with Infraspinatus.
What is the Innervation of the Teres Minor Muscle?
C4 - C6
What is the Action of the Teres Minor Muscle?
Lateral Rotation: Externally Rotates the Shoulder Joint
What is the Origin of the Teres Minor Muscle?
Middle Half of Lateral Scapular Border
What is the Insertion of the Teres Minor Muscle?
Greater Tuberosity of Humerus
Capsule of Shoulder Joint
What is the Innervation of the Subscapularis Muscle?
C5 - C6
What is the Action of the Subscapularis Muscle?
Arm Internal Rotation
Stabilizes Humeral Head in Glenoid Cavity
Allows Humerus to move freely during Elevation of the Arm.
What is the Origin of the Subscapularis Muscle?
Subscapular Fossa
What is the Insertion of the Subscapularis Muscle?
Lesser Tuberosity of Humerus
Capsule of Shoulder Joint
Which Muscles attach the Scapula to the Vertebrae?
- Levator Scapulae
- Rhomboid Major
- Rhomboid Minor
What is the Origin of the Levator Scapulae?
1st - 4th Cervical Vertebrae
Transverse Processes C1 - C4
What is the Insertion of the Levator Scapulae?
Superior Angle of the Scapula
What is the Origin of the Rhomboid Minor?
Spinous Process: C7 and T1
What is the Insertion of the Rhomboid Minor?
Root of the Spine of the Scapula
What is the Origin of the Rhomboid Major?
Spinous Process: T2 - T5
What is the Insertion of the Rhomboid Major?
Vertebral Border of the Scapula
What are the 2 Axillary Folds?
- Anterior Axillary Fold
- Posterior Axillary Fold
Which Muscles form the Anterior and Posterior Axillary folds?
Anterior Axillary Fold:
- Pectoralis Major
Posterior Axillary Fold:
- Latissimus Dorsi
- Teres Major
Which Muscle lines the Medial Wall of the Axilla?
Medial Border: Serratus Anterior.
Which structures is responsible for the Gentle Roundness of Shoulder?
Deltoid
Which Muscles are responsible for Abduction to 90° and Beyond
at the Shoulder?
Deltoid
Trapezius
What are the Nerve Roots of the Shoulder Abduction Muscles?
Deltoid: C5 - C6
Trapezius: C3 - C4
Which Muscles are responsible for Adduction at the Shoulder?
- Pectoralis Minor
- Pectoralis Major
- Latissimus Dorsi
- Teres Major
What are the Nerve Roots of the Shoulder Adduction Muscles?
Pectoralis Minor: C8 - T1
Pectoralis Major: C7 - T1
Latissimus Dorsi: C6 - C8
Teres Major: C5 - C7
Which Muscles are responsible for Flexion at the Shoulder?
- Pectoralis Major
- Coracobrachialis
- Biceps Brachii
- Deltoid (Anterior Fibres)
What are the Nerve Roots of the Shoulder Flexion Muscles?
Pectoralis Major: C7 - T1
Coracobrachialis: C6 - C7
Biceps Brachii: C5 - C6
Deltoid (Anterior Fibres): C5 - C6
Which Muscles are responsible for Extension at the Shoulder?
- Latissimus Dorsi
- Teres Major
- Long Head of Triceps
- Posterior Fibres of Deltoid
What are the Nerve Roots of the Shoulder Extension Muscles?
Latissimus Dorsi: C6 - C8
Teres Major: C5 - C7
Long Head of Triceps: C5 - C6
Posterior Fibres of Deltoid: C5 - C6
Which Muscles are responsible for Internal Rotation at the Shoulder?
- Subscapularis
- Latissimus Dorsi
- Teres Major
- Pectoralis Major
- Deltoid (Anterior Fibres)
What are the Nerve Roots of the Shoulder Internal Rotation Muscles?
Subscapularis: C5 - C6
Latissimus Dorsi: C6 - C8
Teres Major: C5 - C7
Pectoralis Major: C7 - T1
Deltoid (Anterior Fibres): C5 - C6
Which Muscles are responsible for External/Lateral Rotation at the Shoulder?
- Infraspinatus
- Teres Minor
- Deltoid
What are the Nerve Roots of the Shoulder Lateral Rotation Muscles?
Infraspinatus: C5 - C6
Teres Minor: C4 - C6
Deltoid: C5 - C6
What are the 2 Muscular Compartments of the Arm?
Anterior Flexor Compartment
Posterior Extensor Compartment
What is the Innervation of the Flexor Compartment of the Arm?
Musculocutaneous Nerve
C5 - C7
Which Muscles make up the Anterior Flexor Portion of the Arm?
- Brachialis Muscle
- Biceps Brachii Muscle
Which Vessels are found in the Anterior Portion of the Arm?
Brachial Artery
Basilic Vein
Cephalic Vein
Which Muscles make up the Posterior Extensor Portion of the Arm?
Lateral Head of Triceps Brachii
Medial Head of Triceps Brachii
Long Head of Triceps Brachii
What is the Innervation of the Extensor Compartment of the Arm?
Radial Nerve
C5 - T1
Axillary Nerve
C5 - C6
List the Main Muscles of the Arm:
- Biceps Brachii
- Brachialis (Smooth one underneath)
- Coracobrachialis
- Triceps Brachii
What is the Origin of the Coracobrachialis Muscle?
The Coracoid Process
List the Main Arteries of the Arm:
- Axillary Artery
- Circumflex Humeral Artery
- Brachial Artery
- Radial Artery
- Ulnar Artery
- Anterior Interosseous Artery
- Posterior Interosseous Artery
List the Main Veins of the Arm:
- Cephalic Vein
- Basilic Vein
- Median Cubital Vein
Which Artery is the Axillary Artery a continuation of?
Subclavian
At which point does the Axillary become the Brachial Artery?
Lower Margin of Teres Major Muscle.
What is the relationship between the Brachial Artery
and the Tendon of Biceps?
Brachial Artery is Medial to the Tendon of Biceps Brachii.
The Aponeurosis protects the Cubital Fossa.
What structure divides the Axillary Artery into 3 Portions?
Pectoralis Minor Muscle
What are the 3 parts of the Axillary Artery?
- First Part: The Part of the Artery above the Pectoralis Minor.
- Second Part: The Part of the Artery that lies behind the Pectoralis Minor.
- Third Part: The Part of the Artery below the Pectoralis Minor.
What are the Branches of the Axillary Artery?
Screw The Lawyers, Save A Patient
- Superior Thoracic Artery
- Thoracoacromial Artery
- Lateral Thoracic Artery
- Subscapular Artery
- Anterior Humeral Circumflex Artery
- Posterior Humeral Circumflex Artery
Where can the Brachial pulse be palpated?
Just above the Cubital Fossa, next to the Biceps Brachii Tendon.
Also, can be palpated inferomedially to heads of Biceps Brachii.
How is the Brachial Artery useful Clinically?
Blood Pressure Measurement
How is the Cubital Fossa useful Clinically?
Cubital Fossa is normally a good location for Venous access.
Blood Taking and Cannulations.
What are the characteristic features of Veins?
Veins are Bouncy and Non - Pulsatile.