A&P1 Upper Limb Flashcards
What are the components of the upper limb?
Shoulder
Arm
Forearm
Hand
What are the pectoral girdles?
Shoulder girdles
Attaches upper limbs to axial skeleton
Pectoral girdles are a part of which skeleton plane?
Appendicular
Humans have two pectoral girdles each composing what two structures?
Clavicle
Scapula
Where does the clavicle articulate?
What force does it transfer?
With sternum and scapula
Transmits mechanical force from upper limb to trunk
Define Conoid Tubercle
Site of attachment of conoid portion of coracoclavicular ligament
Where is the coracoclavicular ligament located?
Between clavicle and coracoid process of scapula
What does the scapula articulate with?
Clavicle and humerus
Scapula articulates with bones ______ but is held in place _______ by musculature
Anterior
Posterior
Define acromion
Lateral end of scapular spine and high point of the shoulder
What land mark on the scapula/upper limbs do tailors use for measurements?
Length of upper arm from acromium
Define glenoid cavity
Accepts humerus head to form glenohumeral joint
What is the thinner edge of the scapula?
What is the thicker edge of the scapula?
Medial border (vertebral border) Lateral border (axillary border)
Medial and lateral borders of the scapula form ____ _____
Inferior angle
Superior and medial border join at _____ ______
Superior angle
Define scapular notch
Suprascapular notch
Superior border indentation where suprascapular nerve passes
Define Coracoid process
Crow’s break
Lateral end of superior border
What muscle/ligaments attaches at the coracoid process?
Muscle: Pec minor
Coracobrachialis
Bicep
Ligament: Coracoacromial
Conoid
Trapezoid
Define supraspinous fossa
Define infraspinous fossa
Define subscapular foss
Supra: attachment of supraspinatus muscle
Infra: attachment for infraspinatus muscle
Sub: anterior surface attachment for subscapularis muscle
What does the superior transverse scapular ligament do?
Transverses scapular notch, converts to foramen
Where does the omohyoid muscle originate?
Scapular notch, extending to superior transverse scapular ligament
Where do the suprascapular nerve and artery travel?
On way to supraspinatus muscle, nerve travel under transverse scapular ligament; artery travels over ligament
What does the suprascapular nerve provide sensation for?
Sensory to shoulder joint
Motor to infra/supraspinatus muscles
Define suparascapular neuritis
Entrapment neuropathy caused by compression of suprascapular nerve
Pain radiates from C5/6 dermatomes, reproduced w/ pressure over nerve in notch
Prolonged entrapment leads to wasting of infra/supraspinatus muscles
Why is the suprascapular nerve liable to injury?
Travels through suprascapular notch, spanned by transverse ligament
Injury from overuse/excessive traction
Where does the clavicle and sternum articulate?
Sternoclavicular joint
What are the joints called where the scapula articulates with the clavicle and with the humerus?
Clavicle= acromioclavicular joint Humerus= glenohumeral joint
What type of joint is the sternoclavicular joint?
Why is this one important?
Synovial saddle joint
Only true synovial joint connecting pectoral girdle with ribcage
Define acromioclavicular joint?
What part of the body is it considered a joint of?
Lateral/acromial end of clavicle articulates w/ acromion process of scapula
Joint of the upper limb
What kind of joint is the acromioclavicular joint?
Synovial joint
Shoulder joints separate at which joint?
Acromioclavicular joint
What are the stabilizing ligaments of the acromioclavicular joint?
Acromioclavicular ligament
Coraclavicular ligament- trapezoid and conoid ligament
What are the functions of the trapezoid and conoid ligaments?
Comprose coracoclavicular ligament- attaches clavicle to coracoid process of scapular, stabilizes the acromioclavicular joint
Each upper limb has how many bones?
How many joints?
30 bones
5 joints
What does the humerus articulate with?
Proximally w/ glenoid cavity of scapula (glenohumeral joint)
Distally w/ both radius/ulna
Where do muscles that move the humerus insert?
Greater/lesser tubercles
What is the function of the humerus anatomical neck?
Between tubercles and head, site of attachment for articular capsule
What is the groove called that the long head of bicep brachii muscle lies in?
Intertubercular sulcus
Bicipital groove
Intertubercular groove
What site of the humerus is frequently broken?
Surgical neck, distal to tubercles
Where does the deltoid attach to the humerus?
Deltoid tuberosity
What are the ridges on the distal anterior end of the humerus?
Lateral supracondylar ridge ends in lateral epicondyle
Medial supracondyle ridge ends in larger medial epicondyle
Capitulum- near lateral epicondyle
Trochlea- medial indentation
What are the two anterior depressions of the humerus and what are their function?
Receive parts of radius/ulna when elbow is flexed
Radial fossa- lies above capitulum, contains radius during flexion
Coronoid fossa- above trochlea, receives ulnar coronoid process
What is the olecranon fossa?
Large depression of posterior humerus, receives ulna when forearm is extended
Most fractures of the proximal humerus are located where?
What kind of fractures are they?
Surgical neck
Impact
Transverse- due to direct to blow, pull of deltoid muscle carries proximal fragment of fractured humerus laterally
Avulsion- fall onto point of shoulder in middle age/elder
How are avulsion fractures typically repaired?
Open reduction and fixation w/ screws
Humerus fractures can be accompanies with nerve damage due to what nerve locations?
Surgical neck= axillary nerve
Shaft= radial nerve
Distal end= median nerve
Medial epicondyle= ulnar nerve
Ulna forms the ____ border of the forearm
Radius forms the ____ border
Medial
Lateral
The ulna is a _____ bone and the radius is a ____ bone
U= stabilizing R= moveable
Which bone contains the olecranon?
Ulna proximal end
What is the ulnar coronoid process?
Anterior projection at proximal end of bone
What forms the trochlear notch?
Olecranon and coronoid process receive trochlea of humerus
Trochlear notch= large curved area of elbow joint
Where is the radial notch of the ulna?
Lateral side of coronoid process, receives head of radius
Where is the ulnar tuberosity?
Inferior to coronoid process
Brachialis muscle attaches
Head of the ulna is at what end of the bone?
What separates the ulna from the wrist?
Distal
Fibrocartilage
Styloid process on distal end is point of attachment for collateral ligament
What is located at the proximal end of the radius?
What is the distal end called?
Head that articulates w/ capitulum of humerus and radial notch of ulna
Inferior head is neck
What is the function of the radial tuberosity?
Inferior neck that is attachment point for tendons of bicep brachii muscle
What is the function of the radial styloid process?
Lateral side, proximal to thumb
Attachment site of brachioradialis muscle and radial collateral ligament
What is the name of the membrane in between the radius and ulna?
Interosseous membrane
Site of attachment for tendons of deep muscles of forearm
What is the proximal radioulnar joint?
Articulation site of the ulna radial notch with the head of radius
What is the Dorsal Tubercle of the radius?
What is it AKA?
Prominence on dorsal aspect, lateral to groove for extensor pollicis longus tendon
Trochlea for tendon
Lister’s tubercle
How many carpal, metacarpal and phalanges are there in each arm?
8 carpal
5 metacarpal
14 phalanges- 3/finger, 2/thumb
Which arm bone does not participate in wrist joint?
Ulna
Distal radius and articular disc of distal radioulnar joint articulate with what bones?
All carpal
Except pisiform
What is the function of the pisiform?
What bone does it articulate with?
Increases leverage of flexor carpi ulnaris
Only w/ triquetrum
What are the mnemonic for carpal bones?
Lat-Medial/Lat-Medial
Stop Letting Those People Touch The Cadavers Hand
Metacarpals are numbered in which direction?
What are the 3 parts of the bones?
#1 proximal to thumb Base, shaft, head
Knuckles are called what kind of joints?
Metacarpophalangeal joint
What are the different parts of the phalanges?
Which digit is an exception?
Proximal Middle Distal on each finger Thumb is exception Base shaft head
Define Acromioclavicular Articulation
Articulation site of clavicle and acromion of the scapula
Define Jugular Notch
Depression between two sternal ends of clavicles
What is the most superficial muscle of the anterior thoracic wall?
Pectoralis
What is the insertion site for the 3 heads of the triceps?
Olecranon process
Which vein in the AC space is the normal site for venipunctures?
Median cubital vein
Which upper limb muscles attach to the thoracic cage?
Anterior:
Pec major/minor
Serratus Anterior
Subclavius
Posterior: Lats
What muscles is AKA Boxer’s Muscle?
Serratus anterior
What happens if the long thoracic nerve is injured?
What is the resulting condition called?
Paralysis of serratus anterior muscle
Arm can’t be abducted beyond horizontal position
Condition called winged scapula
What are the superficial layers of back muscles?
Connect upper limb->vertebral column, involved in respiration Traps Lats Levator scapulae Rhomboids maj/min
What are the functions of the deepest layers of the muscles in the back?
Extend the head and vertebral column
Rotate/lateral bending of head/neck/back
What nerves supply the superficial back muscles?
Ventral rami
Except Traps, innervated by CN11
What muscles stabilize the pectoral girdle?
Trapezius- skull and vertebrae->clavicle and scapula
Levator scapulae- cervical vertebrae->scapula
Rhomboideus- thoracic vertebrae->scapulas vertebral border
What forms the Triangle of Auscultation?
What movement makes it larger?
Superior horizontal border of lat dorsi
Medial border of scapula
Inferolateral border of traps
Folding arms on chest
Shoulder joint consists of what 4 smaller joints?
Glenohumeral
Acromioclavicular
Sternoclavicular
Scapulothoracic
Shoulder joint has what type of fossa when compared to the hip which has what type of fossa?
Shoulder= shallow glenoid Hip= deep acetabular
Shoulder circumduction is a combination of what movements?
Flexion
Extension
Abduction
Adduction
Define joint rotation
Circular movement around the long axis of the bond at the joint
What are the articulation points of the glenohumeral joint?
Humeral head articulates w/ glenoid cavity of scapula
Glenoid cavity holds how much of the humeral head?
What holds the head in the cavity?
1/3
Tonus of rotator cuff
What is the articular capsule of the glenohumeral joint?
What does the opening in the capsule allow?
Loose fibrous capsule surrounding joint
Attaches to margin of glenoid cavity and anatomical neck of humerus
Hole allows for passage of tendon of long head of bicep
What kind of muscles are the scapulohumeral muscles?
Intrinsic shoulder muscles
What muscles are the scapulohumeral muscles?
Deltoid Supraspinatus Infraspinatus Teres major/minor Subscapularis Pass from scapula to humerus and act on glenohumeral joint
What are the 4 muscles that make up the rotator cuff?
Supraspinatous Infraspinatous Subscapularis Teres minor Originate from scapula, cuff on head of humerus
Where does the rotator cuff insert?
Which muscle is an exception?
Greater tuberosity
Subscapularis inserts on lesser tuberosity, not a rotator of the humerus
What movement types does the rotator cuff help the arm perform?
Lift and rotate arm
Stabilize ball of shoulder w/in joint
What is the coracoacromial ligament?
Spans coracoacromial arch between acromion and coracoid process of scapul
Prevents superior displacement of humerus head
Define painful arc syndrome
Subacromial bursa is inflamed causing pain during arc of 50-130*
What connective structures does the subacromial bursa separate?
Separates tendon of supraspinatus from coracoacromial ligament, acromion and deltoid
Where does the axillary artery begin?
Where does it transition into the brachial artery?
Lateral border 1st rib
Becomes brachial at inferior border of teres major
Which muscle divides the axillary artery into three parts?
Pec minor
Where is the axillary vein in relation to the axillary artery?
Medial side of artery
What joins to form the axillary vein?
Union of brachial veins and basilic vein at inferior border of teres major
Define anterior scalene syndrome
Scalenus anterior syndrome or scalene entrapment syndrome; all a type of thoracic outlet syndrome
Compression of brachial plexus and brachial vessels in root of neck
Brachial plexus and vessels trapped between anterior and middle scalene muscles
What are the borders of the quadrangular space?
Superior: inferior border of teres minor
Inferior: superior border of teres major
Medial: head of tricep
Lateral: surgical neck of humerus
What structures are found/located in the quadrangular space?
Axillary nerve
Posterior circumflex humeral artery
Posterior circumflex humeral vein
Which nerve wraps around the surgical neck of the humerus?
Which nerve wraps around the shaft of the humerus?
Axillary
Radial
What muscles are in the Anterior Compartment of the arm?
Bicep
Brachialis
Corachobrachialis
What muscles are in the posterior compartment of the arm?
Triceps
Anconeus
Which artery is used for taking BPs and is also the supplying artery for the arm?
Brachial, continuation of the axillary
All muscles of the anterior compartment are innervated by what nerve?
Musculocutaneous nerve
What muscle is the flexor of the forearm with supination and pronation?
Supination- bicep
Pronation/supination- brachialis
All muscles of the posterior compartment are innervate by what nerve?
Radial nerve
What artery supplies the arm and what are the subsequent branches?
Brachial artery
Teres major to cubital fossa w/ profunda brachii and ulnar collaterals branches
What are the superficial and deep veins of the arm?
Superficial: cephalic, basilic
Deep: brachial
Where does the brachial artery start and end?
Continuation of axiallary
Lower border of teres major to lower part of cubital fossa, terminates as radial/ulnar artery
What is the major branch of the brachial artery?
Deep brachial artery (profunda brachii) of proximal arm
What two veins are superficial to the brachial fascia?
Cephalic vein
Basilic vein
What arm vein diverts most/all blood to what vein?
Which vein may be absent/small in this case?
Basilic
Superior cephalic
What are the 4 main nerves that pass through the arm?
Which two don’t have branches in the arm?
Musculocutaneous
Radial
Median
Ulnar
Median and Ulnar
What is the path of the Musculocutaneous nerve through the arm?
Branches off brachial plexus and passes through coracobrachialis, continues distally between bicep and brachialis muscles
Musculocutaneous nerve supplies ___ above the elbow and supplies ___ below the elbow
Above- muscles
Below- cutaneous
Where/how does the musculocutaneous nerve terminate in the arm?
Lateral antebrachial cutaneous nerve, AKA lateral cutaneous nerve
What does the radial nerve supply?
Posterior compartment of the arm
What two structures form the trochlear notch?
Coronoid process
Olecranon
What kind of joint is the elbow joint?
Synovial hinge joint
What does the radial collateral ligament connect?
Lateral epicondyle of humerus to radial notch of ulna
What does the anular ligament cover?
Head of radius
What does the ulnar collateral ligament connect?
Medial epicondyle of humerus to coronoid process and olecranon of ulna
What is nursemaid’s elbow?
Subluxation of complete/partial dislocation of joint/organ
Radial head- common in girl peds, 2-3y/o on L side
Caused by sudden longitudinal traction on arm w/ elbow extended
How are golfer and tennis elbow similar and different?
Similar- epicondyle of elbow resulting from excessive/repetitive strenuous use
Different:
Golf- medial epidondyle
Tennis- lateral epicondyle
What are the extrinsic muscles of the hand?
Anterior: flexor/pronator
Posterior: extensor/supinator
Superficial anterior/flexor muscles of the forearm originate and insert where?
O- medial epicondyle
I- carpal/metacarpal/phalanges
What muscle bellies form the bulk of the forearm mass?
Superficial anterior flexors
What are the names of the superficial anterior compartment muscles?
Flexor carpi radialis Palmaris longus Flexor carpi ulnaris Flexor digitorum superficialis Pronator teres
Deep anterior flexor compartment muscles inster where?
Distal phalanges
What are the deep anterior flexor muscles?
Flexor pollicis longus
Flesor digitorum profundus
Pronator quadratus
Flexor digitorum superficialis inserts _____
Flexor digitorum profundus inserts _____
Middle phalange
Distal phalange
How is the function of the flexor digitorum profundus and median nerve tested?
Flexion of distal interphalangeal joint
What is stenosing tenosynovitis?
Trigger finger digit
Disproportional sizes of flexor and retinacular pulleys
What are the superficial posterior extensor compartments?
Brachioradialis Extensor carpi radialis longus Extensor carpi radialis brevis Extesnor digitorum Extensor digiti minimi Extensor carpi ulnaris
What is the brachioradialis reflex?
Supinator reflex
Striking brachioradialis tendon near insertion
SHOULD result in slight wrist extension/radial deviation/supination
What are the deep extensor compartment muscles?
Abductor pollicis longus Extensor pollicis brevis Extensor pollicis longus Extensor indicis Supinator
What is Lister’s Tubercle used for?
Extensor pollicis longus crosses wrist and turns toward thumb using dorsal tubercle on distal end of radius as pulley
Pronation is function of which nerve?
Supination uses what nerve?
Pro- Median
Sup- Musculocutaneous and radial
Where do the pronators insert and originate?
Insert on radius
Originate on ulna
What are the 3 pronators?
Pronator teres
Pronator quadratus
Brachioradialis
Where do the supinators originate and insert?
Origin- humerus
Insert- radius
What are the 3 supinator muscles?
Supinator muscle
Bicep brachii
Brachioradialis
What are the superficial veins of the forearm?
Cephalic
Basilic
Median antebrachial
When taking a PTs radial pulse, you’re pressing in between what tendons?
Flexor carpi radialis
Abductor pollicis longus
Which forearm muscles are innervated by the ulnar nerve?
Flexor carpi ulnaris
Flexor digitorum profundus- also supplied by median nerve
Interossei
Half Lumbricals
Which forearm muscles are innervated by the median nerve?
Flexor carpi radialis Palmaris longus Flexor digitorum superficialis Flexor pollicis longus Flexor digitorum profundus- also innervated by ulnar nerve
What is Radial Nerve Dysfunction?
Peripheral neuropathy effecting arm, forearm or hand
Caused by prolonged pressure, swelling or injury
Crutch palsy
Wrist and hand have _ bones, _ intrinsic and _ extrinsic muscles
28
19
20
What is the retinacula?
Antebrachial fascia w/ thick posterior portion on distal radius/ulna
Forms transverse band- extensor retinaculum, retains extensor position and prevents bowstringing
What happens when the retinacula thickens on the anterior side?
Palmar carpal ligament
Flexor retinaculum- aka transverse carpal ligament
What bones does the flexor retinaculum stretch across?
From scaphoid and trapezium bone to hamate and pisiform
What 3 structures lie in between palmar carpal ligament and flexor retinaculum?
Palmaris longus muscle
Ulnar nerve
Ulnar artery
The canal formed by the flexor retinaculum and carpal bones hold what structures?
Flexor pollicis longus
Flexor digitorum superficialis
Flexor digitorum profundus
Median nerve passes through the wrist via what tunnel?
Carpal tunnel
What are the two terminal sensory branches of the median nerve?
Skin of hand
Lateral 3 and 1/2 digits
Carpal tunnel sydrome can lead to hypoestheia or anesthesia of the hand. What does that mean?
Hypo- diminished sensation
Anesth- loss of sensation
What parts of the hand will remain unaffected by carpal tunnel syndrome?
Central palm
Medial one and one/half of digits (ulnar nerve supply)
What is the terminal motor branch of the median nerve serving the 3 thenar musles?
Thenar branch
Unable to oppose thumb
Define Tinel Sign
Detection method for irritated nerves
Tap/percuss over nerve to cause pins/needles sensation
How is Tinel Sign positive for carpel tunnel syndrome?
Tingling in thumb, index and middle finger
Tinel’s sign is aka?
Distal Tingling on Percussion, DTP
Palmar aponeurosis is an extension of what tendon?
Palmaris longus muscle
What is the most superficial structure in the hand?
Palmar aponeurosis
What are the intrinsic muscles of the hand?
Hypo/thenar
Adductor
Lumbrical
Interosseus
What are the muscles of the thenar compartment?
As a unit, what movement do they provide by what nerve?
Abductor pollicis brevis
Flexor pollicis brevis
Opponens pollicis
Move the thumb via median nerve
What is the adductor of the thumb?
What function does this muscle provide?
Fan-shaped adductor pollicis in the ADDuctor compartment
Strength of grip
What type of movement causes Skier’s/Gamekeeper’s thumb?
Hyperabduction of MP joint causing rupture/chronic laxity of UCL
Skier- acute
Game- chronic
What are the muscles of the hypothenar compartment?
What movement do they provide?
Abductor digiti minimi
Flexor digiti minimi brevis
Oppenens digiti minimi
Move little finger via ulnar nerve
What are the Lumbrical muscles?
What movement do the provide and by what nerve?
Proximal attachment to tendons of flexor digitorum profundus and distally to extensor digitorum
Flex digits at MC joint and extend interphalangeal joints
Lateral- median
Medial- ulnar
How many interossei muscles are there?
What movement do they provide and by what nerve?
Four dorsal- abduction
Three palmar- adduct
Ulnar
What tendons form the anatomical snuff box?
Abductor pollicis longus
Extensor pollicis brevis
Extensor pollicis longus
What is important about the anatomical snuff box?
Radial artery in floor
Superficial branch of radial nerve provides cutaneous sensation
Sequence of blood flow to hand?
Ulnar/radial artery
Ulnar->superficial and deep
Superficial-> superficial palmar arch meeting with superficial branch of radial artery
What is Allen’s Test?
Blood supply from ulnar/radial artery to anastomose.
Blood squeezed/removed from fist, ulnar pressure is released, color returns w/in 7sec means radial artery is safe for use for ABG/cannulation
