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12.2 Flashcards

1
Q

At the based of the neck, the roots of the brachial plexus converge forming 3 trunks. Name them.

A

Superior, middle, inferior trunks

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2
Q

Which trunk is made from the combination of C5 and C6 roots

A

Superior trunk

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3
Q

Which trunk is the continuation of C7?

A

Middle trunk

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4
Q

Which trunk is formed from the combination of C8 and T1 roots?

A

Inferior trunk

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5
Q

Anterior (ventral) nerve division supply which muscles?

A

Flexors and adductors

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6
Q

Posterior (dorsal) nerves supply which muscles?

A

Posterior (dorsal) nerves supply the extensors + abductors (muscles)

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7
Q

All 3 posterior division from the trunks combine to form which cord?

A

Posterior cord

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8
Q

The 2 of the anterior division nerves recombine to form which cord?

A

Lateral cord

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9
Q

Which cord does the anterior division of the inferior trunk form?

A

Median nerve

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10
Q

Which nerve innervates: Brachialis, biceps brachii, coracobrachialis muscles?

A

Musculocutaneous nerve

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11
Q

Which nerve innervates teres minor and the deltoid muscles?

A

Axillary nerve

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12
Q

Which nerve innervates triceps brachii + extensor muscles in posterior forearm?

A

Radial nerve

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13
Q

Problems with forearm pronation and supination is due to damage to which myotome?

A

C6

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14
Q

Problems with arm abduction and lateral rotation is due to damage to which myotome?

A

C5

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15
Q

Problems with arm adduction and medial rotation is due to damage to which myotomes?

A

C6,7,8

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16
Q

What are the myotomes associated with elbow flexion?

What are the myotomes associated with elbow extension?

A

o Flex – C5, C6

o Extend – C7, C8

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17
Q

All intrinsic muscles of the hand are innervated by which myotome (motor fibre of single spinal root)?

A

T1

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18
Q

Weakness of extensors (hand and forearm) and loss of sensation over dorsal web is indicative of injury to which nerve?

A

Radial nerve

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19
Q

Inability to extend 4th + 5th digits at interphalangeal joints leading to permanent flexion hence a claw, indicates damage to which nerve?

A

Ulnar nerve (distally).

The closer to the paw, the worse the claw

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20
Q

Explain ulnar paradox

A

The ulnar nerve also innervates the ulnar (medial) half of the flexor digitorum profundus muscle (FDP).

If the ulnar nerve lesion occurs more proximally (closer to the elbow), the flexor digitorum profundus muscle may also be denervated.

As a result, flexion of the IP joints is weakened, which reduces the claw-like appearance of the hand. (Instead, the fourth and fifth fingers are simply paralyzed in their fully extended position.)

This is called the “ulnar paradox” because one would normally expect a more proximal and thus debilitating injury to result in a more deformed appearance.

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21
Q

Consequences of a median nerve injury

A

‘Hand of benediction’ when patient attempts to make a fist.

Inability to oppose thumb.

Proximal median nerve injury –> can’t flex 2nd + 3rd fingers.

Distal median nerve injury –> can’t extend 2nd + 3rd fingers

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22
Q

What is Erb’s palsy?

A

Upper brachial plexus injury

Brachial plexus is stretched due to tractiontion and C5 tears

Affects:
 Ability to abduct the shoulder – arm hangs by side
 Arm remains pronated – hand tilted backwards

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23
Q

What is a Klumpke’s paresis?

A

Lower brachial plexus injury Tears

T1

Affects lower myotomes + dermatomes

Affects:
 Paralysis of intrinsic hand muscles – claw hand
 Numbness of C8-T1 dermatome

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24
Q

What is downward movement of the scapula called?

A

Depresion

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25
Q

What is forward movement of the scapula around the trunk called?

A

Protraction

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26
Q

What is backward movement of the scapula around the trunk called?

A

Retraction

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27
Q

The range of motion of the scapula provides what percentage of the total movement of the upper extremity relative to the body?

A

1/3rd sometimes more

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28
Q

What runs in the bicipital groove of the humerus?

A

Tendon of the long head of the biceps

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29
Q

What is the bicipital groove aka?

A

Inter-tubercular groove - because it runs between the greater + lesser tubercle of the humerus

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30
Q

Which tendon arises from the infraglenoid tubercle?

A

long head of the triceps

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31
Q

Which tendon arises from the supraglenoid tubercle?

A

Long head of the biceps

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32
Q

To get to the supraglenoid tubercle, where does the tendon of the long head of the biceps travel along?

A

It passes inside the joint capsule + right over the top of the head of the humerus

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33
Q

Name the 3 short muscles on the back and 1 on the front that hold the humerus in place

A

front - subscaularis

back - supraspinatus

back - infraspinatus

back - teres minor

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34
Q

Movement of humerus subscaularis muscles allows?

A

Internal rotation

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35
Q

Where does the subscapularis arise from?

A

Almost all of the anterior (costal) aspect of the scapula

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36
Q

Where does subscapularis insert?

A

Lesser tubercle of the humerus

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37
Q

Where do the rotator cuff muscles insert?

A

Greater tubercle of humerus EXCEPT subscapularis which inserts into the lesser tubercle

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38
Q

Movement of supraspinatus muscle

A

Abduction of humerus

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39
Q

Where does the infraspinatus and teres minor muscles originate from?

A

Infraspinous fossa of scapula

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40
Q

Where does the supraspinatus muscles arise from?

A

Supraspinous fossa of scapula

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41
Q

Movement of the teres minor and infraspinatus muscles?

A

External rotation of the humerus

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42
Q

Name the muscle that run from the scapula to the humerus on the back which are not part of the rotator cuff

A

Teres major

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43
Q

Where does teres major originate and insert?

A

Origin - lower lateral border of scapulaInsertion - posterior lip of bicipital groove

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44
Q

Movement of teres major

A

Adductor of humerus

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45
Q

Where does coracobrachialis originate?

A

Coracoid process

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46
Q

Where does coracobrachialis insert?

A

On humerus

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47
Q

Movement of coracobrachialis

A

Helps to flex shoulder joint

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48
Q

How many muscles go from scapula to humerus?

A

7;

4 short rotator cuff muscles
Teres major
Coracobrachialis
Deltoid

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49
Q

How many muscles hold the scapula in place and move it in relation to the trunk?

A

6;

4 on back
1 in front
1 underneath

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50
Q

Name the large powerful muscle underneath the scapula that holds it in place

A

Serratus anterior

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51
Q

Where does the serratus anterior muscle arise from and inserts?

A

Origin - side + front of first 8 ribsInserts - medial border of scapula

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52
Q

Contraction of the serratus anterior muscle does what movement?

A

Protrusion of scapula when all of the muscle fibres contracts

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53
Q

Name the 3 smaller and deeper muscles on the back (relative to trapezius) that hold the scapula in place.

A

Rhomboid major

Rhomboid minor

Levator scapulae

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54
Q

How are joints classified?

A

Fibrous - limited movement

Cartilaginous - limited movement:

  • primary - e.g. 1st costosternal joint
  • secondary e.g. pubic symphysis

Synovial - contain synovial fluid

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55
Q

Give an example of a fibrous + synovial joint

A

Synovial - knee, shoulder

Fibrous - sutures of the skull

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56
Q

What type of joint is the distal tibiofibular joint?

A

Fibrous

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57
Q

What is articular cartilage?

A

The normal hyaline carilage covering bony articular surfaces.

It is avascular + derives its nourishment from synovial fluid

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58
Q

What are the surface-palpable surface features of the back?

A

C7 - vertebra prominens

T7 - inferior angle of scapula

L4 - crests of iliac bones - level of lumbar puncture

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59
Q

What are the parts of the thoracic vertebra?

A

Body

Pedicles

Superior + inferior articular process

Pars interarticularisSpinous + transverse processes

Lamina

Vertebral foramen for the passage of spinal cordIntervertebral foramen for passage of spinal nerves

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60
Q

What passes in the centre of the vertebral foramen?

A

Spinal cord

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61
Q

What passes in the centre of the intervertebral foramen?

A

Spinal nerves

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62
Q

Which vertebra supports the skull?

A

Atlas

Which articulares inferiorly with the axis

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63
Q

What do the atlas + axis articular?

A

The axis projects the dens upwards behind the anterior arch of the atlasIt is held in place by the transverse ligament of the atlas

This is the point of rotation for the skull

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64
Q

What type of joints are the elbow and knee joints?

A

Synovial - hinge

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65
Q

What type of joints are the wrist/ankle joints

A

Plane

66
Q

What are the differences between the upper and lower limbs?

A

Rotation during development:

  • upper: external 45 degrees
  • lower: internal 90 degrees

Elbow + knee flex in opposite directions

Palm = anterior

Sole = posterior

67
Q

What does the pectoral gridle consists of?

A

Clavicle

Scapula

Proximal humerus + their respective joints: sternoclavicular, acromioclavicular, glenohumerus

68
Q

Name the ligaments of the acromioclavicular joint

A

Coracoclavicular

Acromioclavicular

Coracoacromial

69
Q

Function of the corcacoacromial joint

A

Provides roof for the joint

70
Q

What are the parts of the humerus?

A

Upper end:

  • head articulates with glenoid cavity
  • greater + lesser tubercles

Shaft:
- sprial groove posteiorly

Lower end:

  • capitellum (lateral) articulates with radius
  • trochlea (medial) articulates with ulna
  • medial + lateral epicondyles
71
Q

What 2 main movemens are possible at the elbow joint?

A

Flexion/extension

Pronation/supination

72
Q

What are the boundaries of the cubital fossa?

A

Medially: pronator teres

Laterally: brachioradialis

Base: imaginary line between the humerual epicondyles

Floor: supinator muscle + brachialis

Roof: skin, fascia + bicipital aponeurosis

73
Q

From lateral to medial what are the contents of the cubital fossa?

Really Need
Beer To
Be At
My Nicest

A

Radial nerve

Biceps tendon

Brachial artery

Median nerve

74
Q

What are the structures felt anteriorly at the wrist?

A

Medial to lateral:

  • Flexor carpi ulnaris tendon
  • Ulnar artery
  • Flexor digitorum superficialis
  • Tendons
  • Palmaris longus (can be absent)
  • Flexor carpi radialis tendon- radial artery
  • Brachialis tendon
75
Q

What lies in the anatomical snuff box?

A

Radial artery

Superficial branch of radial nerve

Scaphoid bone

76
Q

What is fascia?

A

A sheet or band of fibrous tissue lying deep to the skin that lines, invests + separated structures within the body.

It covers the muscles + helps divide the muscular sections into compartment

77
Q

Name the 5 muscle groups that produce movement of the hip joint.

A

Short rotaters

Flexors

Abductors

Adductors

Extensors

78
Q

Name the short hip rotator muscle

A

Piriformis

Obturator externus

Obturator internus

Gemellus muscles, superior + inferior

Quadratus femoris muscle

79
Q

Which short hip rotator muscle arises from the scarum?

A

Piriformis

80
Q

What does the piriformis muscle pass through as it leaves the pelvis

A

Passes through the greater sciatic foramen along w/ the sciatic nerve

81
Q

All short rotator muscles pull the back of the femur medially producing which movement?

A

Lateral rotation of hip joint

82
Q

Name the 3 extracapsular ligaments of the hip joint

A

Iliofemoral

Pubofemoral

Ischiofemoral

83
Q

Describe the shapes of the 3 extracapsular ligaments of the hip joint

A

Iliofemoral - Y shaped.

Pubofemoral - triangular.

Ischiofemoral - spiral orientation.

84
Q

Which movements does the extracapsular ligaments of the hip joint prevent?

A

Iliofemoral + ischiofemoral - excessive extension.

Pubofemoral - excessive abduction + extension

85
Q

Name the intracapsular ligament of the hip joint

A

Ligament of the head of femur aka ligamentum teres femoris

86
Q

Which ligament of the hip joint encloses a branch of the obturator artery?

A

Ligament of the head of femur aka ligamentum teres femoris

87
Q

Arterial supply of hip joint is largely via which arteries?

A

Medial + lateral circumflex femoral arteries - which are branches of the profunda femoris artery (deep femoral artery)

88
Q

Which of the circumflex femoral arteries is responsible for the majority of the arterial suply?

A

Medial circumflex femoral artery

89
Q

What can damage to the medial circumflex femoral artery lead to?

A

Avascular necrosis of the femoral head

90
Q

Name the 4 nerves which innervate the hip joint

A

Femoral nerve.

Obturator nerve.

Superior gluteal nerve

Nerve to quadratus femoris

91
Q

Which ligament is most anterior out of the iliofemoral, pubofemoral and ischiofemoral ligaments?

A

Iliofemoral ligament

92
Q

Which ligament is most posterior out of the iliofemoral, pubofemoral and ischiofemoral ligaments?

A

Ischiofemoral ligament

93
Q

What is DDH?

A

Developmental dysplasia of the hipIt occurs when hip joint does not develop properly in utero

94
Q

Name the common clinical features of DDH

A

Limited abduction at the hip joint.

Limb length discrepancy – the affected limb is shorter.

Asymmetrical gluteal or thigh skin folds

95
Q

Treatment of DDH

A

Pavlik harness.

This holds the femoral head in the acetabular fossa + promotes noramal development of the hip joint

96
Q

Alternative treatment option for DDH if Pavlik harness ineffective

A

Surgery

97
Q

Hip dislocation is rare but name the 2 main types of acquired hip dislocation

A

Posterior dislocation.

Anterior dislocation (more rare)

98
Q

Describe posterior hip dislocation

A

Femoral head is forced posteriorly + tears through the inferior + posterior part of the joint capsule, where it is at its weakest.

Affected limb becomes shortened + medially rotated

99
Q

Describe the clinical presentation of a hip fracture vs a hip posterior dislocation

A

Fracture - The affected leg is externally rotated and may be shortened

Dislocation - The affected limb becomes shortened and medially (internally) rotated.

100
Q

What is an anterior dislocation of the hip joint often associated with?

A

Fractures of the femoral head

101
Q

Which type of fascia does this describe: bends with the reticular layer beneath the dermis

A

Superficial fascia

102
Q

Which type of fascia provides membranous investments that suspend organs within their cavities

A

Visceral fascia

103
Q

Which type of fascia envelopes muscles, bones and neurovascular structures

A

Deep fascia

104
Q

What is fascia lata?

A

A deep fascial investment of the whole thigh musculaature + is analogous to a strong, extensible, elasticated stocking

105
Q

Where is the coracoid process found?

A

Scapula

106
Q

What fracture of the humerus can lead to Volkmanns contracture?

A

Supra-condylar fracture.

Interferes with the supply of the brachial artery

107
Q

The tendon of which muscle runs in the intertubercular groove?

A

Long head of biceps brachii

108
Q

Where does pectoralis major attach to?

A

Intertubercular sulcus (not groove)

109
Q

Name the 3 thenar muscles

A

Opponens pollicis

Abductor pollicis brevis

Flexor pollicis brevis

110
Q

Action of opponens pollicis muscle

A

Opposes thumb by medially rotating + flexing the metacarpal on the trapezium

111
Q

Which thenar muscle is the largest?

A

Oppenens pollicis

112
Q

Which muscle is found anteriorly to the opponens pollicis + proximally to the flexor pollicis brevis?

A

Abductor pollicis brevis

113
Q

What is the action of flexor pollicis brevis?

A

Flexes the metacarphophalangeal joint of the thumb

114
Q

Which thenar muscle is the most distal?

A

Flexor pollicis brevis

115
Q

What produces the hypothenar eminence?

A

Hypothenar muscles:

  • Opponens digiti minimi
  • Abductor digiti minimi
  • Flexor digiti minimi brevis
116
Q

Which hypothenar muscle lies deep to the others?

A

Opponens digit minimi

117
Q

Which hypothenar muscle is most superficial?

A

Abductor digiti minimi

118
Q

Which hypothenar muscle lies laterally to the abductor digiti minimi?

A

Flexor digiti mini brevis

119
Q

Which nerve innervates all hypothenar muscles?

A

Ulnar nerve

120
Q

Which muscle rotates the metacarpal of. the little finger towards the palm, producing opposition?

A

Opponens digiti minimi

121
Q

How many lumbricals are there in the hand?

A

4, each associated with a finger

122
Q

Where do lumbricals originate from?

A

A tendon of the flexor digitorum profundus

123
Q

Where does lumbricals insert?

A

Into the extensor hood (once the’ve passed dorsally + laterally around each finger from origin)

124
Q

What are the actions of the 4 lumbricals found in the hand?

A

All flex at the MCP joint + extend at the interphalangeal joints of each finger

125
Q

What is the innervation of the lumbricals?

A

The lateral 2 (of the index + middle fingers) = median nerve.

Medial 2 lumbricals (of little + ring fingers = ulnar nerve

126
Q

Which lumbricals are unipennate + which are bipennate?

A

I + II are unipennate.

III + IV are bipennate.

127
Q

Define unipennate

A

Fascicles insert into only 1 side of the tendon

128
Q

Define bipennate

A

Fascicles insert into the tendon from opposite sides

129
Q

Define multipennate

A

Fascicles attach obliquely from many directions to several tendons

130
Q

Where are interossei muscles located?

A

Between the metacarpals

131
Q

Into which 2 groups can the interossei muscles be divided?

A

Dorsal + palmar interossei

132
Q

What action does dorsal interossei do?

A

Abduction of the fingers at the MCP joint

133
Q

What action does palmar interossei do?

A

Adduction of the. fingers at the MCP joint

134
Q

Which nerve innervate the interossei muscles?

A

Ulnar nerve

135
Q

What is the action of the adductor pollicis muscle?

A

Adductor of thumb

136
Q

What is the deep palmar arch formed by?

A

Radial artery passes anteriorly through the space between the 2 heads of adductor pollicis

137
Q

What is the action of palmaris brevis?

A

Wrinkles skin of hypothenar eminence + deepens the curvature of the hand Improving grip

138
Q

Describe the shape of the palmaris brevis muscle

A

Small thin, found very superficially in the subcutaneous tissue of hypothenar eminence

139
Q

Describe the shape of the adductor pollicis muscle

A

Large triangular with 2 heads

140
Q

Which nerve innervates the medial 2 lumbricals?

A

Ulnar nerve

141
Q

What action does the lumbricals have on the MCP joints?

A

Flexion

142
Q

What is the action of the dorsal interoseei?

A

Abduction of the fingers

143
Q

What is. the action of palmaris brevis?

A

Deepen the curvature of the hand

144
Q

What is the action of the dorsal interoseei?

A

Abduction of the fingers

145
Q

What action does the lumbricals have on the MCP joints?

A

Flexion

146
Q

Name 2 muscles in the palm that are not lumbricals or interossei + do not fit in the hypothenar + thenar compartments

A

Palmaris brevis

Adductor pollicis

Both innervated by ulnar nerve

147
Q

How many palmar interossei muscles are there?

A

3

148
Q

How many dorsal interossei muscles are there?

A

4

149
Q

Which nerve innervate the interossei muscles?

A

Ulnar nerve

150
Q

What action does palmar interossei do?

A

Adduction of the. fingers at the MCP joint

151
Q

What action does dorsal interossei do?

A

Abduction of the fingers at the MCP joint

152
Q

In addition to their actions of abduction (dorsal interossei) + adduction (palmar interossei), what do the interossei muscles also assist in

A

Flexion of lumbricals MCP joints.

Extension at IP joints.

153
Q

List 7 types of fascicles in muscles.

A

Circular

Convergent

Parallel

Unipennate

Multipennate

Fusiform

Bipennate

154
Q

Define multipennate

A

Fascicles attach obliquely from many directions to several tendons

155
Q

Define bipennate

A

Fascicles insert into the tendon from opposite sides

156
Q

Define unipennate

A

Fascicles insert into only 1 side of the tendon

157
Q

Which muscle flexes the MCP joint of the little finger?

A

Flexor digiti minimi brevis

158
Q

Which muscle abductors the little digit?

A

Abductor digiti minimi

159
Q

Which nerve innervates all hypothenar muscles?

A

Ulnar nerve

160
Q

Which thenar muscle is the largest?

A

Oppenens pollicis

A** (19 decks)

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