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204: Theme 2 > Anatomy of the Upper Limbs > Flashcards

Anatomy of the Upper Limbs Flashcards

1
Q

How many bones and muscles are there in the Upper Limb?

  • main innervation structure
A
  • 32 bones
  • 57 muscles
  • the brachial plexus
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2
Q

What makes up the Pectoral girdle?

A
  • the scapula and the clavicle
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3
Q

Label this diagram - scapula humerus

A
  • the dotted lines indicate the anatomical (superior) and surgical (inferior) neck of the
    • the anatomical neck is at the glenoid fossa
    • the surgical neck is more prone to injury/breaks
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4
Q

Label this diagram - radius ulna

A
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5
Q

What is the difference between tubercles and tuberosities?

A
  • tuberosity are rough larger protrusions from the bone
  • tubercles are smaller rounder and often sit at the head of the bone
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6
Q

What are the joints of the upper limb and what movement can they do?

(7)

A
  • Glenohumeral
    • extension/ flexion
    • abduction/ adduction
    • circumduction
    • lateral and medial rotation
  • Elbow
    • flexion/ extension
    • pronation and supination
  • Radiocarpal joint
    • abduction/adduction (radial and ulnar deviation)
    • circumduction
  • Midcarpal (not much movement)
  • Carpometacarpal (saddle joint) - lots of movement
  • Metacarpophalangeal
    • abduction/ adduction (spreading your fingers)
    • flexion/extension
  • Interphalangeal
    • flexion extension
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7
Q

What are the functional compartments of the upper limb?

A
  • Flexor compartments - on the anterior
  • Extensor compartments - on the posterior
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8
Q

What are the attachment muscles of the upper limb to the trunk

A
  • Pectoralis major/ minor
  • Serratus anterior
  • Trapezius
  • Latissmus dorsi
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9
Q

OrIn of the Serratus anterior

  • movement
A
  • protractor, and stabilises the shoulder
  • ​Origin: the upper 8 ribs
  • Insertion: Medial edge of the scapula
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10
Q

OrIn of the Deltoid

  • movement
A
  • abduction, anterior part: flexion, medial rotation, posterior part: extension lateral rotation
  • ​Origin: Spine of the scapula, the Acromion, lateral part of the Clavicle
  • Insertion: Deltoid tuberosity (this sits on the lateral side halfway down the humerus)
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11
Q

OrIn of the Biceps Brachii

  • movement
A
  • flexor of humeral joint and flexor of the forearm at elbow joint
  • ​Origin: Coracoid process (short head)
  • Origin: above the Glenoid fossa (long head)
  • Insertion:Radial tubersoity
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12
Q

OrIn of the Brachialis

  • movement
A
  • flexor of the forearm at the elbow joint
  • ​Origin: Distal end of the humerus
  • Insertion: Ulna tuberosity
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13
Q

OrIn of the Triceps brachii

  • movement
A
  • extension
  • ​Origin: Glenoid fossa (long head)
  • Origin: Lateral side of the humerus (lateral)
  • Origin: Medial side of he humerus (medial)
  • Insertion: Olecranon (back of the elbow)
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14
Q

OrIn of the Brachioradialis

  • movement
A
  • flexion of the forearm at the elbow when you are half pronated (moves glass towards your mouth)
  • ​Origin: lateral side of the Humerus
  • Insertion: Radial Styloid process
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15
Q

OrIn of the Coracoidbrachialis

  • movement
A
  • flex arm at the glenohumeral joint
  • ​Origin: Corachoid proces
  • Insertion: Proximal part of the shaft of the humerus
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16
Q

What muscles in the forearm largely cause flexion and extension of the wrist and digits?

A
  • the Medial epicondyle is the origin of the muscles in the anterior part of the forearm that cause flexion
  • the Lateral epicondyle is the origin of the muscles in the posterior part of the forearm that cause extension
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17
Q

OrIn of the Pectoralis major & Minor

  • movement
A

Major- adductor, flexor, medial rotator of the glenohumeral joint

  • ​Origin: the sternum and the medial portion of the clavicle, and the costal cartilages,
  • Insertion: the lateral lip of the bicipital groove (intertubercular sulcus) sits between the greater and lesser tubercle of the humerus

Minor- protractor

  • Origin: Ribs 3,4,5
  • Insertion: Coracoid process of the scapula
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18
Q

What are the muscles of the thumb and the pinkie finger that cause?

A
  • Thenar muscles (thumb)
  • Hypothenar muscles (pinkie)
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19
Q

What are the curvatures of the vertebral column?

  • what are their significance?
A
  • Kyphoses - primary curvatures (fetal)
    • thoracic and sacral
  • Lordoses - secondary curvatures (childhood)
    • cervical
    • lumbar
  • they allow bipedalism, provide shock absorption and flexibility
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20
Q

What conditions are associated with the curvatures of the lumbar region?

A
  • Scoliosis - when the vertebral column is curved laterally
  • Hyperkyphoses - humpback
  • Hyper excessive lumbar lordoses - seen in osteoporosis
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21
Q

What are the ligaments of the vertebral column?

  • what is their significance?
A
  • Anterior longitudinal ligaments - prevent hyperextension
    • this can be torn if whiplash is experienced
  • Posterior longitudinal ligaments and ligamentum flava prevent hyperflexion
    • also have the supraspinous ligaments and interspinal ligaments that resist hyperflexion
  • they reinforce and stabilize joints
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22
Q

What are the intervertebral joints and discs

  • what is clinical relevant about the discs
A
  • Intervertebral joints are for weight-bearing and for strength
    • these are secondary cartilaginous joints - joint surfaces are separated by fibrocartilage –> the intervertebral discs
  • the discs are important for shock absorption
    • disc thickness increases as you move down the vertebral column
  • they have a semi-fluid core: nucleus pulposus this absorbs compression
  • the nucleus pulposus is surrounded by rings of fibre cartilage - annulus fibrosus
    • ​the annulus fibrosis binds each of the body’s vertebrae together
  • these discs can protrude or you can have nucleus pulposus herniation (from lifting heavy objects) –> impinge on nerves
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23
Q

Explain the various facet joints of the vertebral column and explain the movement they allow

  • clinical relevance
A

these are synovial joints

  • Cervical : flexion/ extension/ rotation
    • slight slope
  • Thoracic: rotation only
    • near-vertical
  • Lumbar: flexion-extension only
    • wrapped
  • back pain may be caused by degeneration of these joints
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24
Q

Explain the general division of the back muscles

A
  • Extrinsic muscles: they move the upper limbs/ribs
    • superficial and intermediate
  • Intrinsic muscles: postural/move the vertebral column
    • Deep
  • they are separated by the thoracolumbar fascia
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25
Q

What are the Superficial muscles of the back?

A
  • Trapezius: rotates the scapula
  • Latissmus dorsi: adducts/ extends/ medial rotation of the arm
  • Levator scapulae: elevates the scapula
  • Rhomboids (minor and major: retracts the scapula
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26
Q

OrIn of the Trapezius

  • movement
A
  • movement and rotation the scapula. can be separated into
    • Upper fibres: elevation of the scapula
    • Middle fibres: retraction (draws scapula backwards)
    • Lower fibres: depression of the scapula
  • ​Origin: the cervical and thoracic spinous processes
  • Insertion: spine of the scapular acromion and the lateral portion of the clavicle
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27
Q

OrIn of the Latissmus dorsi

  • movement
A
  • adducts/extends/ medial rotation of the arm
  • ​Origin: thoracolumbar fascia
  • Insertion: bicipital groove (the intertubercular sulcus that sits between the greater and lesser tubercles of your humerus)
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28
Q

OrIn of the Levator Scapulae

  • movement
A
  • elevates the scapula
  • ​Origin: upper cervical vertebrae
  • Insertion: superior angle of the scapula
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29
Q

OrIn of the Rhomboids

  • movement
A
  • retracts the scapula
  • ​Origin: lower cervical C7 - T5
  • Insertion: medial border of the scapula
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30
Q

What are the Deep muscles of the back?

A
  • they are involved with posture and movement of the vertebral column, they sit within a groove either side of the spinous processes
  • Splenius - most superficial mainly in the neck muscles​
  • Erector spinae - main group​
  • Multifidus - very deep
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31
Q

Explain the following about eh Erector spinae muscles

  • location
  • it’s 3 muscle blocks
  • OrIn
  • movements
A
  • sits within the grooves between the spinous processes and angles of the ribs
  • produces extension/ lateral flexion /rotation of the vert. column

Made up of the medial to lateral : Spinales, Longissmus, Iliocastalis

  • ​Origin: Erector spinae aponeurosis
  • Insertion: S - spinous processes, L- transverse process, I - the ribs
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32
Q

OrIn of the Multifidus

  • movement
A
  • extension/ rotation/ stabilizes the vertebral column
  • ​Origin: Sacrum, Erctor spinae aponeurosis
  • Insertion: Spinous process
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33
Q

What is the nerve supply of the Extrinsic muscles?

A

Anterior primary ramus

- mainly from the cervical rami apart from the trapezius which i ssupplied by the accessory nerve (CNXI)

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34
Q

What is the nerve supply of the Intrinsic muscles?

A

Posterior primary ramus

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35
Q

Which arteries supply the upper limbs?

  • where do they branch from?
A

the Subclavian arteries

  • Right subclavian artery form the brachiocephalic trunk
  • Left subclavian artery from the aorta
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36
Q

Describe the journey of the subclavian artery and describe its divisions

A
  • passes over the first rib through the scalene triangle formed by the rib and the scalene muscles
  • divided into three parts by the scalenus anterior
    • ​1st division medial to the muscle
      • ​Vertebral artery
      • Thyrocervical trunk (to thyroid cervical and scapular)
    • 2nd division is behind the muscle
      • ​Dorsal scapular artery
    • 3rd division is lateral to the muscle
      • ​Dorsal scapular artery
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37
Q

Label this diagram

A
  • the thyrocervical trunk also gives off a suprascapular artery which forms part of the anastomeses to the scapula
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38
Q

Describe the journey of the Axillary artery and its divisions

  • when does it become the axillary artery?
A
  • Axillary artery begins when the subclavian artery crosses the outer border of the first rib
  • It’s divided into three parts by pectoralis minor
    • 1st Medial to muscle
    • 2nd Behind muscle
      • ​the first and second parts are closely associated with the brachial plexus
    • 3rd Lateral to muscle
  • Ends at the lower border of the teres major, where it becomes the brachial artery
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39
Q

What are the branches of the third part of the Axillary artery? - label the diagram

  • what is the clinical relevance
A
  • the ant/post circumflex humeral arteries are at risk of rupture if the humerus is fractured
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40
Q

Describe the journey of the brachial artery and its divisions

A
  • remains superficial through the arm
  • supplies the flexor muscles
  • has a large branch - Profunda brachii artery
    • ​passes posterior to the humerus through the spiral/radial groove
    • this supplies the extensor muscles of the (triceps)
  • contributes to anastomosis around the elbow
  • Divides in the cubital fossa into the
    • Radial artery
    • Ulnar artery
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41
Q

Profunda brachii artery

Label this diagram

A
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42
Q

Describe the journey of the Radial artery

A
  • comes from the brachial artery at the cubital fossa and travels on the lateral side of the forearm
    • it’s the smaller of the two terminal brachial branches
  • covered by the brachioradialis muscle
  • it travels to the hand where it forms a deep palmer arch deep relative to the long flexor tendons
  • at the wrist it winds around the dorsum of the hand
    • ​travels through anatomical snuff box
    • pierces through the 1st dorsal interosseous muscle (allows abduction - spread the index finger)
    • travels to the palmer aspect of the hand where it forms the deep arch and anastomoses with the ulnar artery on the medial side of the hand
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43
Q

Describe the journey of the Ulnar artery

A
  • comes from the brachial artery at the cubital fossa and travels on the medial side of the forearm
    • it’s the larger of the two terminal brachial branches
  • covered by the flexor carpi ulnaris muscle
  • It has a deep branch: common interosseous artery anterior and posterior branch which site either side of the interosseous membrane which hold the ulnar and radius together
  • it travels to the hand where it forms a superficial palmer arch relative to the long flexor tendons
  • eventually anastomoses with the radial artery​
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44
Q

Give an overview of venous return in upper limbs

A
  • it’s variable but all drain into the axillary vein into the subclavian vein
  • can be dived into the deep and superficial veins
    • Deep: paired veins- follows the arteries- venae comitantes
    • Superficial:
      • Cephalic vein which travels on the lateral aspect of the arm/ forearm
      • Basilic vein which travels on the medial aspect of the arm/ forearm
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45
Q

Label this diagram

A
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46
Q

Give an overview of the lymphatic drainage of the upper limb

A
  • relatively few lymph nodes in the upper limb
    • Cubital nodes (sits next to the basilic vein)
    • Deltopectoral node (sits next to the cephalic vein)
    • Axillary nodes (sits next to the axillary vein)
      • ​this is where they drain to
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47
Q

What is the nerve supply of the upper limb?

A

Brachial plexus

  • carriers motor, sensory and sympatheric axons
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48
Q

What are the overall divisions of the brachial plexus?

A
  • Roots –> Trunks –> Divsions –> Cords –> Terminal branches
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49
Q

What are the Roots of the brachial plexus?

A
  • they are ventral primary rami of C5- T1
  • they exit between the intervertebral discs
  • they supply motor innervation
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50
Q

What are the motor functions/innervations from the motor axons in the Brachial plexus Roots?

A
  • C5 - Arm abductor (Deltoid)
  • C6 - Forearm flexors (Biceps)
  • C7 - Forearm extensors (Triceps)/ Wrist flexors/extensors (curling fingers)
  • C8 - Digit flexors/extensors
  • T1 - Intrinsic hand muscles (spreading fingers)
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51
Q

What are the Trunks of the Brachial plexus

A
  • Roots form trunks
    • Superior: C5 + C6
    • Middle: C7
    • Inferior trunk: C8 + T1
  • Trunks pass through the scalene triangle
    • formed from the first rib and the anterior and middle scalene muscles
  • These trunks form divisions as they pass over they leave the scalene triangle
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52
Q

What are the Divisions of the Brachial plexus

  • which cords do they go on to form
A
  • Divsions are the trunks dividing into anterior and posterior divisions
  • Anterior: axons to flexor compartments
    • forms lateral and medial cords
  • Posterior: axons to extensor compartments
    • forms posterior cord
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53
Q

What are the Cords of the Brachial plexus?

  • location
  • terminations
A
  • Cords formed from Divisions of the brachial plexus
    • Lateral Cord - from the anterior division
      • terminates as the Musculocutaneous nerve which is the
    • Posterior Cord - from the posterior division
      • terminates as the Radial nerve and Axillary nerve
    • Medial Cord - from the anterior division
      • terminates as the Ulnar nerve
  • the medial cord and lateral cord form the Median nerve which has lateral and medial sides respectively
  • they lie beneath the pectoralis minor
  • cords named in relation to the axillary artery
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54
Q

What is the Musculocutenous nerve?

  • function
A
  • the lateral part of the Median nerve formed from the median cord
  • pierces through the Coracobrachialis muscle and sits between the brachialis and the biceps brachii muscle (supplies these muscles)
  • Motor supply: Anterior muscles of the arm
  • Sensory supply - Lateral skin of forearm
  • moves out from under the biceps to the lateral side of the elbow and changes to become the lateral cutaneous nerve to the forearm (hence the name first it innervates muscles then it becomes a cutaneous nerve)
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55
Q

What is the journey of the Median nerve?

  • innervation/action
A
  • formed from the medial and lateral cords
  • travels down the medial side of the arm along with the brachial arteries
    • passes into the forearm through the cubital fossa and goes into the anterior flexor compartment between the flexor muscles
    • innervates all the flexor muscles apart from flexor carpi ulnaris and the two medial bellies of flexor digitorum profundus
  • through the carpal tunnel to give motor and sensory innervation to the hand.
  • Motor – Anterior forearm and lateral hand (the intrinsic muscles mainly the thumb)
  • Sensory – Skin on the lateral palm hand, d1,2, 3 + half d4
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56
Q

What is the Ulnar nerve?

  • innervation/action
A
  • formed from the medial cord
  • travels behind the elbow through the cubital tunnel and travels along the medial side and sits flexor carpi ulnaris muscle and the ulnar artery
    • ​it innervates the flexor carpi ulnaris muscle and the medial two bellies of the flexor digitorum profundus
  • does not pass through the carpal tunnel
  • Motor – Medial side of the anterior forearm and hand
  • Sensory – Medial hand + half d4 + d5
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57
Q

What is the journey of the Radial nerve?

  • innervation/action
A
  • formed from the posterior cord
  • travels through the spiral groove of the humerus
    • It innervates the extensor compartment muscles in the arms - triceps
  • divides into a Deep branch (motor supply) and a Superficial branch (sensory supply)
    • deep branch goes into the posterior part of the forearm where it innervates the extensor muscles
    • superficial branch travels under the brachioradialis muscle to the hand
  • Motor – Posterior side of the forearm and arm
  • Sensory – Posterior arm and forearm + lateral dorsum of the hand
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58
Q

Label this Diagram

A
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59
Q

What is the Axiallry nerve?

  • journey
  • innervation/action
A
  • formed from the posterior cord
  • travels through the quadrangular space
  • Motor supply: deltoid and trees minor
  • Sensory: Lateral aspect of the arm (military badge area of the arm)
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60
Q

Label this diagram

  • what are they collectively know as?
A

Terminal branches of the Brachial plexus

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61
Q

What are the dermatome regions for the upper limb and the cutaneous innervation by terminal branches?

  • what is the clinical significance of these regions?
A
  • Altered sensation in the region of a dermatome indicates damage to specific spinal nerve of spinal cord segment (i.e. proximal nerve injury)
  • Altered sensation in one of the cutaneous areas indicates damage to a more distal nerve segment (i.e. distal nerve injury)
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62
Q

What are the branches of the Lateral cord?

  • terminates as?
A
  • has one branch the Lateral pectoral nerve
  • terminates as the Musculocutaneous nerve and the lateral part of the Median nerve
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63
Q

What are the branches of the Medial cord?

  • terminates as
A
  • medial pectoral nerve, cutanous nerves to the medial side of the arm and forearm
  • terminates as the medial part of the median nerve and the ulnar nerve
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64
Q

What are the branches of the Posterior Cord/ where do they innervate?

  • terminates as?
A
  • has three branches that innervate the posterior axillar
  • terminates as the Radial nerve and the Axillary nerve
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65
Q

What are the skeletal components of the clavicle?

  • what are the two joints? - clinical significance?
A
  • Clavicle
  • Scapula
  • Humerus
  • form the pectoral girdle
  • Glenohumeral joint
  • Acromioclavicular joint
    • synovial plain joint that can be easily dislocated
66
Q

Label this diagram

A
67
Q

Label this diagram

A
68
Q

Describe the location and function of the Coraclavicular and Coracoacromial ligaments

  • clinical significance?
A
  • Coracoclavicular
    • Two parts
    • Major stabilizing ligament
  • Coracoacromial
    • Forms arch - forms a space for the head of the humerus
      • the tendon of the supraspinatus muscle runs below this arch - this can become trapped
    • Provides support for head of humerus
      • Prevents superior dislocation
69
Q

Describe the location and function of the Glenohumeral joint

A
  • Highly mobile ball and socket joint
    • Abduction/Adduction
    • Flexion/Extension
    • Circumduction
    • Lateral/Medial rotation
70
Q

What muscle produces abduction of the arm?

  • nerve supply?
A
  • Performed by Deltoid
    • Origin: Spine of scapula + acromion + clavicle
    • Insert: Deltoid tuberosity
  • Supplied by Axillary nerve
  • Posterior fibres cause:
    • Extension + lateral rotation
  • Anterior fibres cause:
    • Flexion + medial rotation
  • when all the fibres contract they cause
    • Abduction
71
Q

What muscle(s) produce adduction of the arm?

A
  • Latissimus dorsi,
  • Pectoralis major
  • gravity as well
72
Q

What additional role does the scapula have in the abduction and adduction of the arm?

A
  • rotation of the scapula increases the range of movement past what the glenohumeral joint can facilitate
  • Abduction after 90 degrees: scapula is rotated by
    • Upper + lower fibres of the trapezius
    • Serratus anterior
  • Adduction: scapula is rotated by
    • Levator scapulae and Rhomboids
73
Q

Label this diagram

A
74
Q

What muscle(s) are involved in the flexion of the arm?

A
  • Biceps brachii
  • Coracobrachialis
  • the anterior fibres of the deltoid
75
Q

Label this diagram

A
76
Q

What muscle(s) produce extension in the arm?

A
  • Long head of the Triceps
  • Posterior fibres of the deltoid
  • Latissimus dorsi
77
Q

What factors increase stability in the Glenohumeral joint?

  • clinical significance?

(5)

A
  1. Coracoacromial arch: prevents superior dislocation
  2. Glenohumeral ligaments: support anterior of joint
  3. Deepening of glenoid fossa by the glenoid labrum
  4. Long heads of biceps (above) and triceps (below):
  5. Tendons of rotator cuff muscles
  • the glenohumeral joint is the most frequently dislocated joint
    • anterior dislocation is common- the humeral head descends inferiorly and ends up anterior
78
Q

Label this diagram

A
79
Q

How do the long head of the biceps and triceps stabilise the glenohumeral joint?

A
  • the origin of the long head of the biceps is the supraglenoid tubercle
    • ​held in place by the transeverse humeral ligament which goes across eh greater and lesser tubercles
  • the origin of the long head of the triceps is the infraglenoid tubercle

- this forms a Splint joint above and below the joint holding the head of the humerus against the glenoid fossa

80
Q

What are the muscles of the rotator cuff muscles and what is their action?

  • clinical significance?
A
  • Supraspinatus, Infraspinatus, Teres minor, Subscapularis
  • they insert on the humerus close to the glenohumeral joint
  • the tendons of the muscles fuse with the joint capsule and
  • forms a cuff which SITS around the joint on all sides except inferiorly
    • _​_hence why anterior dislocation is the most common - as the humerus is pulled in front of the joint
81
Q

Label this diagram

A
82
Q

What are the origins of the rotator cuff muscles?

A
  • Supraspinatus:
    • supraspinous fossa of the scapula
  • Infraspinatus:
    • infraspinous fossa of the scapula
  • Teres minor:
    • lateral border of the scapula
  • Subscapularis
    • subscapular fossa of the scapula (the anterior aspect fo the scapula)
83
Q

Label this diagram

A
84
Q

What are the insertions of the rotator cuff muscles?

A
  • Supraspinatus, Infraspinatus,Teres minor:
    • greater tubercle
  • Subscapularis
    • lesser tubercle
85
Q

What is the function of the rotator cuff muscles?

A
  • together they stabilise the humeral head on to the glenoid fossa - concavity compression
  • Supraspinatus:
    • initiates abduction
  • Infraspinatus:
    • lateral rotation
  • Teres minor:
    • lateral rotation
  • Subscapularis
    • medial rotation
86
Q

What is the significance of Teres Major with the rotator cuff muscles?

  • OrIn?
A
  • Performs medial rotation
  • Stabilises the head of the humerus onto the glenoid fossa during abduction
    • called eccentric contraction
  • Origin: inferior angle of the scapula
  • Insertion: Medial lip of the bicipital groove of the intertubercular sulcus
87
Q

What injuries can happen to the rotator cuff?

A
  • Supraspinatus impingement- due to repetitive overhead activities
    • common in athletes - throwers
  • Supraspinatus most commonly injured
  • due to limited space for tendon under the coracoacromial arch
  • ultrasound is taken to identify the condition
88
Q

What is the blood supply of the shoulder region?

A
  • Supplied from the Scapula anastomosis
    • tributaries from the subclavian and axillary arteries
89
Q

Label this diagram

A
90
Q

What is the nerve supply of the shoulder?

A
  • from the brachial plexus
  • the Suprascapular nerve (from the superior trunk of the brachial plexus) innervates the
    • Supraspinatus and Infraspinatus ( rotator cuff muscles)
  • the Posterior cord
    • Upper/ lower subscapular nerves- Subscapularis, Teres major
    • Thoracodorsal nerve- Latissmus dorsi
    • Axillary nerve- Deltoid and teres minor
    • Radial nerve- Triceps brachii
91
Q

What muscles do the branches and terminals of the Posterior cord innervate in the shoulder?

A
  • Upper/ lower subscapular nerves- Subscapularis, Teres major
  • Thoracodorsal nerve (the middle branch) - Latissmus dorsi
  • Axillary nerve (travels through the quadrangular space)- Deltoid and teres minor
  • Radial nerve- Triceps brachii
92
Q

Label this diagram

  • what do these structures form?
A

Quadrangular space

93
Q

What is the Quadrangular space

  • what is the clinical significance?
A
  • formed by
    • long head of the triceps - medial border
    • teres minor - superiorly
    • teres major - inferiorly
    • humerus - lateral border
  • the axillary nerve and posterior circumflex humeral artery travel through there
    • axillary nerve innervates the deltoid, there minor and the badge area
  • if the surgical neck of the humerus is fractured it can damage these structures
    • they will struggle to abduct their arm as the axillary nerve is damaged and their deltoid won’t be innervated
    • sensation will also be lost in that badge area
94
Q

What are the branches and terminals of the Medial Cord?

  • innervations in the arm?
A
  • Median nerve
  • Ulnar nerve
  • Medial pectoral nerve - P_ectoralis major/ minor_
  • Medial cutaneous nerves to arm and forearm
95
Q

What are the branches and terminals of the Lateral Cord?

  • innervations in the arm?
A
  • Musculocutaneous nerve - Arm flexors
  • Median nerve -
  • Lateral pectoral nerve - P_ectoralis major_
96
Q

Label this diagram

A
97
Q

Label this diagram?

  • what does it show?
A

shows

  • the Synovial hinge joint (elbow joint)
  • Synovial pivot joint (proximal radioulnar joint)
98
Q

What range of motion does the Synovial Hinge Joint allow?

  • where is it
A
  • the elbow joint
  • flexion and extension of the forearm
99
Q

What range of motion does the Synovial Pivot Joint allow?

  • where is this joint?
A
  • it is the proximal radioulnar joint
  • it allows supination and pronation of the forearm
100
Q

Label this diagram

  • what do these structures do?
A
  • Ligaments stabilise and strengthen the joint
101
Q

What are the two compartments of the forearm?

A
  • Anterior/ flexor compartment
    • contains mainly flexor muscles
    • has superficial, intermediate and deep muscles
  • Posterior/ extensor compartment
    • contains mainly extensor muscles
    • has superficial and deep muscles
102
Q

What are the different layers of the anterior/flexor compartment of the forearm?

  • what actions do each layer create?
A
  • Superficial muscles:
    • 3 Flexors of wrist (carpi)
    • 1 Pronator
  • Intermediate muscles:
    • 1 Flexor of digits 2-5 (digitorum)
  • Deep muscles:
    • 1 Flexor of digits 2-5 (digitorum)
    • 1 Flexor of thumb (pollicis)
    • 1 Pronator
103
Q

What are the muscles of the Superficial layer of the Anterior compartment forearm?

  • what is there action
  • what is the clinical relevance of the origin of these muscles?
A
  • Pronator teres
  • Flexor carpi radialis - inserts on the 2 and 3rd metacarpal
  • Palmaris longus
  • Flexor carpi ulnaris- inserts on the 5th metacarpal
  • theses muscles flex our wrist
  • Golfers elbows/ Medial Epicondylitis is caused by inflammation at common flexor origin due to overuse/ excessive gripping
104
Q

Label this diagram

  • where are these muscles found?
A
  • the superficial layer of the anterior compartment of the forearm
105
Q

What are the muscles of the Intermediate layer of the anterior compartment of the forearm

  • which structures does its action impact?
A
  • Flexor digitorum superficialis acts on digits 2-5
  • causes flexion
    • in digits the carpus
    • the middle metacarpal phalangeal joints (nuckles)
    • the proximal interphalangeal joints
106
Q

What are the muscles of the Deep layer of the anterior compartment of the forearm

  • which structures does its action impact?
A
  • Flexor pollicis longus - digits 1
  • inserts on the distal phalanx of the thumb
  • pronator quadratus
  • Flexor digitorum profundus
  • cause flexion
    • the distal phalanx
    • flex our wrist
    • the metacarpal joints of 2-5
    • flex the proximal and distal interphalangeal joints
107
Q

Label this diagram?

  • where are these muscles, what are their action?
A
  • muscles of the deep layer of the anterior compartment of the forearm
    • flexion in the distal phalanges digits 1-5
108
Q

What are the different layers of the posterior/extensor compartment of the forearm?

  • what actions do each layer create?
A
  • mainly extonsor muscles
  • Superficial muscles:
    • 3 Extensors of wrist (carpi)
    • 1 Extensor of digits 2-5 (digitorum)
    • 1 Accessory extensor to digit 5 (digiti minimi)
    • Brachioradialis and anconeus
  • Deep muscles:
    • 2 Extensors of thumb (pollicis)
    • 1 Abductor of thumb (pollicis)
    • 1 Accessory extensor to digit 2 (indicis)
    • 1 Supinator
109
Q

What are the muscles of the superficial layer of the posterior compartment of the forearm?

  • which structures does its action impact?
  • what is the clinical significance of the muscle origin
A
  • Extensor Carpi radialis longus/ brevis
  • origin of the supracondylar ridge
    • brevis from the CEO
  • inserts on the 2nd metacarpal
    • brevis on the 3rd metacarpal
  • Extensor digitorum
  • inserts on the wrist causing extension
  • inserts on digits 2-5 on the middle and distal phalanx
  • Extensor digiti minimi (accesory to extensor digitorum) - digit 5
  • Extensor carpi ulnaris - extends our wrist
  • Brachioradialis - flexor when half pronated
  • Anconeus- stabilises the elbow
  • causes extension of the metacarpals, middle phalanges and distal phalanges
  • Tennis elbow/ lateral epicondylitis - inflammation of the tendons at the Common Extensor Origin due to overuse/ forceful extension
110
Q

Label this diagram

  • where are these muscles found, what do they do?
A
  • found in the superficial layer of the posterior compartment of the forearm
  • they cause flexion at the metacarpals, middle and distal phalanges
111
Q

Label this diagram

  • what is the action of the muscles?
A
  • Brachioradialis acts as a flexor when half pronated
  • Anconeus stabilises the elbow
112
Q

What are the muscles of the Deep layer of the Posterior compartment of the forearm?

  • which structures does its action impact?
A
  • Supinator
  • Abductor pollicis longus *
  • inserts on digit 1 metacarpal
  • Extensor pollicic brevis and longus *
  • brevis on proximal phalanx
  • longus on distal phalanx

* part of the anatomical snuff box

  • Extensor indicis (accessory to extensor digitorum)
  • cause extension in distal phalanx digits 2
113
Q

Label this diagram

  • where are these muscles found, what is their action?
A
  • found in the deep layer of the posterior compartment of the forearm
  • causes extension in the first metacarpal the proximal and distal phalanx of digits 1-2
114
Q

Which muscles perform wrist abduction and adduction?

A

Performed by the carpi muscles

  • Abduction (radial deviation):
    • Flexor carpi radialis
    • Extensor carpi radialis (longus + brevis)
  • Adduction (ulnar deviation):
    • Flexor carpi ulnaris
    • Extensor carpi ulnaris

Together muscles splint the wrist to allow fine movements of the hand

115
Q

What muscles are involved in pronation and supination of the forearm?

A

Supination

  • Biceps brachii
  • Supinator teres - superficial/ deep

the radius and ulnar are parallel

Pronation

  • pronator teres
  • pronator quadratus
  • the radius rotates over the ulnar
116
Q

Review the structures within the carpal tunnel and the flexor retinaculum

  • what is the purpose of the flexor retinaculum?
A
  • prevents bowing of tendons
  • * the median nerve is the only nerve that passes through the carpal tunnel
117
Q

Review the Extensor retinaculum

  • what is its purpose?
A
  • prevents bowing of tendons
  • separates tendons into compartments
  • which are covered by a synovial sheath keeping the tendons lubricated
118
Q

Where do the long tendons insert in the hand?

A
  • they are tendons for digits 2-5
  • Flexor digitorum profundus into the distal phalanx
  • Flexor digitorum superficialis into the middle phalanx
  • Extensor profundus into the middle + distal phalanx

the superficial splits allowing the profundus tendon to pass through to the distal phalanx

119
Q

Label this diagram

  • what is the name of the area?
A
  • the cubital fossa
120
Q

Label this image and give the clinical significance of these structures.

A
  • clinically significant in venepuncture
121
Q

How does the brachial artery divide at the cubital fossa?

  • where do the divisions travel?
A

divides into the

  • Radial artery
    • Under brachioradialis
  • Ulnar artery
    • Under flexor carpi ulnaris
    • Gives off common interosseous

these anastomoses around the elbow joint

122
Q

Label this diagram

A
123
Q

Label this diagram, what does it show?

A
  • shows divisions of the ulnar artery
124
Q

Label this diagram- what is the journey of this structure?

A
  • the radial artery winds to the dorsum of the hand
125
Q

What is the clinical significance of the Median nerve?

  • supply?
A
  • it causes carpal tunnel syndrome when the nerve is compressed
    • due to increased pressure in the carpal tunnel usually associated with trauma, obesity and pregnancy

Motor: Anterior compartment muscles, except FCU/medial part of FDP, and the medial two bellies of flexor digitorum profundus

Sensory: Lateral palm, including d1, d2, d3, ½ d4

126
Q

What is the clinical significance of the Ulnar nerve?

  • supply?
A
  • when compressed causes Cubital tunnel syndrome. causes pain in the sensory areas

Motor: FCU and medial part FDP, and intrinsic muscles of hand

Sensory: Medial side of hand, including ½ d4 + d5

127
Q

Give an overview of the Radial nerves journey

  • branches and their journey
A

Enters forearm on lateral side under brachioradialis and divides into two branches:

  • Superficial branch (sensory)
    • Under brachioradialis
    • Winds round to dorsum of hand
  • Deep branch - posterior interosseous nerve (motor)
    • Passes through supinator muscle
    • Enters extensor compartment
128
Q

Label this diagram, what is the clinical significance of the main structure?

  • supply?
A
  • the damage to the radial nerve can cause wrist drop, can’t extend wrists

Motor: Deep branch supplies posterior extensor compartment muscles

Sensory: Superficial branch supplies dorsolateral aspect of the hand

129
Q

Label this diagram and what is the clinical significance?

A

Altered sensation in one of the above areas indicates damage to a more distal nerve segment

130
Q

Label this diagram - what is it showing?

  • clinical significance?
A
  • the carpal bones
  • The scaphoid bone is most commonly fractured carpal bone - takes a long time for the bone to heal as there is poor blood supply to the proximal ends of the bone
131
Q

What are the joints in the hand?

(6)

A
132
Q

Give an overview of the Radiocarpal (wrist) joint

  • structure
  • action
A
  • it’s between the radius, disc and the first carpal row
  • it’s a synovial joint
  • it’s reinforced by ligaments
    • Ulnar and radial collateral ligaments (limits abduction/adduction)
    • Ligaments on the palmar/dorsal surfaces (limits extension/flexion
  • allows, flexion/extension, abduction/ adduction, circumduction
133
Q

Label this diagram

A
134
Q

Give an overview of the Carpometacarpal joint

  • structure
  • action
A
  • they are plane joints with limited movement except for the saddle joint
    • saddle joint is between the trapezium and metacarpal of d1
  • it enables opposition of the thumb
135
Q

Give an overview of the Metacarpophalangeal joints

  • structure/ type of joint
  • action
A
  • It is a condylar joints
  • formed by deep transverse metacarpal ligaments
    • holds metacarpals together
    • apart from between digit 1 and 2
  • allows flexion/ extension, abduction/ adduction
136
Q

Give an overview of the Interphalangeal joints

  • structure
  • actions
A
  • it is a hinge joint
  • there are proximal and distal and interphalangeal joints
    • there are also between the proximal and middle phalangeal joints (dips and pips)
  • allows flexion and extension
137
Q

What is the Palmar aponeurosis

  • structure
  • clinical significance
A
  • thickened deep fascia continuous with palmaris longus
  • triangular: formed of longitudinal fibres and transverse fibres
  • Dupuytren’s contracture: caused by shortening or fibrosis of the longitudinal fibres
    • you can’t straighten D4, D5
    • heredetary, seen in older males
138
Q

Which digits do the long flexor tendons correspond to?

(3)

  • what other structures are important as they go into the hand

(3)

A
139
Q

Label this diagram

  • what is it showing?
A
  • the long flexor tendons
140
Q

Review how the flexor tendons insert onto the digits

  • the fibrous digital sheath
  • clinical relevance
A
  • the tendons enter the fibrous digital sheath as they move into the palm of the hand (still held within a synovial sheath)
    • formed of alternating annular and cruciate ligaments all the way to the distal phalanx
  • the annular ligaments are referred to as the pullies
    • tendons can become stuck/ trapped underneath these pullies
  • the vinculae hold the main tendons up against the phalanges
141
Q

Match the extensor muscles of the posterior compartment to their attaching digits

(6)

A

Digits 2-5

  • Extensor digitorum
  • Extensor indicis
  • Extensor digit minimi

Digit 1

  • Extensor pollicis longus
  • Extensor pollicis brevis
  • Abductor pollicis longus
142
Q

Which structures form the Anatomical snuff box?

(5)

A
  • Abductor pollicis longus - inserts to the base of the first metacarpal
  • Extensor pollicis brevis - inserts to the base of the proximal phalanx
  • Extensor pollicis longus - inserts to the base of the distal phalanx
  • Scaphoid bone + Trapezium makeup the floor of the snuff box
143
Q

What structures are found in the Anatomical snuff box?

  • what is the clinical significance of the snuff box?
A

found on the floor

  • scaphoid: can be palpated if they have a scaphoid fracture - would experience tenderness
  • radial artery- can be used to feel the radial pulse
144
Q

What muscles insert on the extensor hoods?

(2)

A
  • lumbrical muscle
  • interosseous muscle
145
Q

What is the role of the Lumbricals muscle

  • what is its structure
A
  • originate from tendons and insert on tendons
  • links the flexor to the extensor tendons
    • flexor digitoriu profundus tendons to the extensor hood
  • Extends the interphalangeal joints and
  • Flexes MCP joints
    • digits 2-5 - it’s on the radial side of their respective digits
  • aids in precision grip (hold pen/pinch)
146
Q

Which nerves innervate the Lumbricals muscles

A
  • Median nerve innervates muscles on d2+ medial side of d3
  • Ulnar nerve innervates muscles between d3-d4 and d4-5
147
Q

What is the role of Palmar Interossei muscles?

  • describe location/structure
A
  • they sit between the metacarpals - unipennate muscles
  • attaches the metacarpals to the extensor hoods on d2,d4,d5
  • facilitates palmar adduction at the MCP joint
    • this is relative to d3 (they adduct towards the middle finger)
  • There is no palmar interossei for D1 or D3
    • ​adduction in D1 is performed by the adductor pollicis muscle
  • PAD- palmer adduction
148
Q

What is the role of Dorsal Interossei muscles

  • their location/ structure
A
  • they sit between the metacarpals - bipennate muscles
  • attaches the metacarpals to the extensor hoods on d2,d3 (on either side),d4
  • facilitates dorsal abduction at the MCP joint
    • this is relative to d3 (they adduct towards the middle finger)
  • There is no dorsal interossei for D1 or D5
    • ​abduction in D1 + D5 is performed by the thenar and hypothenar muscles
  • DAB- dorsal abduction
149
Q

Label this diagram

  • what is the relevance of these structures?
A
  • Flexor retinaculum is the origin of the thenar and hypothenar muscles
  • Thenar muscles - fine movement of the thumb
  • Hypothenar muscle - fine movement of the little finger
150
Q

Describe the structure of the Thenar muscles

(3)

  • what are their actions?
A

all originate from the flexor retinaculum

  • Opponens pollicis (deepest)
    • ​inserts into the first metacarpal
  • Abductor pollicis brevis*
  • Flexor pollicis brevis*
    • * both insert into the proximal phalanx
  • allow opposition, abduction and flexion of the thumb respectively
151
Q

Describe the structure of the Hypothenar muscles

  • what is their action?
A

all originate from the flexor retinaculum

  • Opponens digiti minimi (deepest)
    • ​inserts into the 5th metacarpal
  • Abductor digiti minimi*
  • Flexor digiti minimi*
    • * both insert into the proximal phalanx of the 5th digit
  • allow opposition, abduction and flexion of the pinkie respectively
152
Q

What structure facilitates the adduction of the thumb?

  • describe its structure/ location
A
  • Adductor pollicis
    • it is deep to the thenar muscles
  • it has an oblique head
    • originates from the base of the 2nd and 3rd metacarpal + carpal bone
  • and a transverse head
    • originates from the 3rd metacarpal
  • both heads insert onto the proximal phalanx of digit 5
153
Q

Which arteries supply the hand?

A
  • Radial and Ulnar artery
  • form a complex anastomosis around the hand
154
Q

What are 3 key blood structures in the hand?

A
  • the radial artery found in the anatomical snuffbox this forms the deep palmar arch
    • mainly supplies D1 and 1/2D2
  • the deep palmar arch which is below the long flexor tendons
  • the superficial palmar arch which is above the long flexor tendons
    • ulnar artery mainly supplies 1/2D2 to D5
155
Q

Label this diagram

  • where do these structures supply?
A
  • 1/2 of D2 to D5
156
Q

Label this diagram

  • where do these structures supply?
A
  • D1 and 1/2 of D2
157
Q

Label this diagram

  • what structure is this and what is the clinical significance?
  • where do these structures supply?
A
  • Median nerve
    • Recurrent branch - thenar muscles
    • Digital nerves -
      • lateral 2 lumbricals (d2 + d3)
      • and sensory of D1 - 1/2 D4
  • passes through the carpal tunnel. if it is compressed can cause pain, pins and needles, numbness and tingling in the hand
    • carpal tunnel syndrome
    • the palmar branch is spared in carpal tunnel syndrome
      • so symptoms aren’t felt on the palm
158
Q

Label this diagram

  • what structure is this and what is the clinical significance?
  • where do these structures supply?
A
  • Ulnar nerve: passes through the pisiform born and the hook of the hamate instead of the carpal tunnel
  • Deep branch
    • hypothenar muscles
    • interossei
    • medial 2 lumbricals
    • adductor pollicis
  • Superficial branch-
    • sensory 1/2 of D4 and D5
  • Clawed hand due to ulnar damage at the wrist
    • D4 +D5 MCP joint extension, interphalangeal joint flexion is seen
      • this isn’t seen if the ulnar nerve is injured at the cubbital tunnel as the medial two bellies of flexion digitorum profundus is not innervated so you don’t see flexion of the digits
159
Q

What are structures in the hand are innervated by the Deep branch of the Ulnar nerve?

A
  • hypothenar muscles
  • interossei muscles
  • medial 2 lumbricals (d3/d4 + d4/d5)
  • adductor pollicis
160
Q

Explain what causes a clawed hand and any variations you would see

A
  • Clawed hand is due to ulnar damage at the wrist
    • it effects D4 and D5
    • the medial two lumbricals are no loner innervated
      • so usually perform flexion of the MCP joints and extension of the interphalangeal joints the
    • instead, we see MCP joint extension, interphalangeal joint flexion is seen
      • due to the action of flexor digitourm profundus - flexion into our palm giving the clawed appearance
  • this isn’t seen if the ulnar nerve is injured at the cubital tunnel as the medial two bellies of flexion digitorum profundus are also not innervated as well as the intrinsic hand muscles
    • so you don’t see flexion of the digits

204: Theme 2 (7 decks)

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