Anatomy - Upper Limb Flashcards
Describe the arrangement of tendons palpable medial to the radial pulse
FCR, palmaris longus, FDS, FCU (inserting into pisiform), ulnar pulse
Describe the surface anatomy of the cephalic vein
- Origin = within the superficial fascia just posterior to the radial styloid
- Elbow = lies in the groove along the lateral border of biceps before piercing deep fascia
- Shoulder = lies in the deltopectoral groove
List the 4 unique features of the clavicle
- No medullary cavity
- First to ossify in the foetus at week 5/6
- Develops in a membrane and not cartilage despite being a long bone
- Most commonly fracture long bone in the body
Describe the ligament structure connecting the clavicle to the coracoid process
- Conoid ligament = connects conoid tubercle of clavicle to coracoid process
- Trapezoid ligament = connects trapezoid line of clavicle to coracoid process (lateral to conoid ligament)
List the 3 prominent scapular landmarks
- Spine
- Acromion
- Coracoid process
What separates the greater and lesser tubercles of the humerus?
Bicipital groove (contains long head of biceps)
What structures lie within the spiral groove of the humerus?
- Radial nerve
- Profunda vessels
Describe the structure of the distal humerus
- Rounded capitulum laterally for articulation with the radial head
- Spoon-shaped trochlea medially for articulation with the trochlea notch
- Medial and lateral epicondyles are extracapsular
- Anterior conoid fossa accepts coronoid process of ulna
Explain the deforming forces in PROXIMAL radius fractures
(If proximal to insertion of pronator teres)
- Proximal fragment = supinated by biceps
- Distal fragment = pronated by pronator teres
(Means the fracture must be splinted in supination so the distal fragment aligns with the proximal fragment)
Describe the arrangement of the carpus
- Proximal row = scaphoid, lunate, triquetral, pisiform
- Distal row = trapezium, trapezoid, capitate, hamate
What maintains the arch of the carpus?
- Shape of the bones
- Flexor retinaculum
Describe the articular surfaces of the glenohumeral joint
- Head of humerus
- Shallow glenoid fossa (deepened by glenoid labrum)
Describe the attachments of the GH joint capsule
Around the epiphyseal lines of the glenoid and humeral head. Extends down the diaphysis on the medial aspect of the neck of the humerus.
List the openings in the GH joint capsule
- Between greater and lesser tubercles for passage of the long head of biceps
- Between superior and middle glenohumeral ligament , via which the subscapular bursa communicates with the GH joint cavity
What dictates the stability of the shoulder joint?
- Dynamic stabilisers = rotator cuff, long head of biceps, deltoid, long head of triceps, pec major, lat dorsi, teres major
- Static stabilisers = GH ligaments, labrum, negative intra-articular pressure
List the ligaments of the glenohumeral joint
- Superior, middle, and inferior GH ligaments
- Coracohumeral ligament
- Transverse humeral ligament
- Coraco-acromial ligament
Describe the process of shoulder ABduction
- Initiated by supraspinatus followed by deltoid to 90 degrees
- 180 degrees is achieved through rotation of the scapula upwards by trapezius and serratus anterior
List the principle abductors of the shoulder
- Supraspinatus
- Deltoid
List the principle adductors of the shoulder
- Pec major
- Lat dorsi
- Subscapularis
List the principle flexors of the shoulder
- Biceps brachii
- Pec major
- Coracobrachialis
- Deltoid (anterior fibres)
List the principle extensors of the shoulder
- Triceps
- Teres major
- Lat dorsi
- Deltoid (posterior fibres)
List the principle ERs of the shoulder
- Infraspinatus
- Teres minor
- Deltoid (posterior fibres)
List the principle IRs of the shoulder
- Pec major
- Lat dorsi
- Teres major
- Deltoid (anterior fibres)
- Subscapularis
What ligaments are involved in the sternoclavicular joints
- Costoclavicular
- Anterior and posterior sternoclavicular
- Interclavicular
What ligament supports the superior radio-ulnar joint?
Annular ligament
What structures form the articular surfaces of the wrist?
- Proximal = distal radius, articular disc of distal radio-ulnar joint
- Distal = scaphoid, lunate, triquetral
What type of joint is the wrist joint?
Condyloid synovial joint
What is the surface marker of the wrist joint?
Proximal wrist crease
What prevents the MCP joints spreading?
Deep transverse ligaments
Describe the ligamentous arrangement about the MCP and IP joints
- Posterior = joint capsule is replaced by the expansion of the extensor tendon for that digit
- Anterior = capsule is formed by dense plate of fibrocartilage
- Lateral = collateral ligaments that are lax in extension and taught in flexion
Describe how the long flexors of the digits insert
- FDP inserts into the bases of the four distal phalanges (pierces the FDS tendon)
- FDS inserts into the sides of the bases of the four middle phalanges
Describe the digits extensor insertion arrangement
Aponeurotic expansion covers the dorsum of the proximal phalanx. This then attaches to the middle phalanx via a central slip and the distal phalanx by two lateral slips. The margins are reinforced by the tendons of the intrinsic muscles of the fingers.
What is the axilla?
Zone of transition between the neck and the upper limb. Shaped like an irregular pyramid.
Outline the boundaries of the axilla
- Base = skin and fascia
- Medial wall = rib cage covered by serratus anterior
- Lateral wall = bicipital groove of humerus
- Anterior wall = pec major, pec minor, subclavius, clavipectoral fascia
- Posterior wall = subscapularis, teres major, latissimus dorsi
List the structures that pass through the cervico-axillary opening
- Axillary artery and its branches
- Axillary vein
- Cords of the brachial plexus
- Axillary lymph nodes
- Intercostobrachial nerve
- Axillary fat