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MRCS A > ANATOMY - Upper limb p1 > Flashcards

ANATOMY - Upper limb p1 Flashcards

1
Q

How many muscles attach to the scapula

A

17

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2
Q

what are the 3 surfaces of the scapula?

A

costal (anterior)
lateral
posterior

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3
Q

what does the acromion of the scapula articulate with?

A

clavicle

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4
Q

which muscle attaches to the supraglenoid tubercle of the scapula?

A

biceps brachii long head

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5
Q

which muscle attaches to the infraglenoid tubercle of the scapula?

A

triceps brachii long head

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6
Q

which muscles attach to the coracoid process of the scapula (3)

A

pec major
coracobrachialis
short head bicep

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7
Q

what muscle attaches to the subscapular fossa?

A

subscapularis

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8
Q

which muscles in general originate from the posterior surface of the scapula

A

rotator cuff muscles

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9
Q

supraspinatous fossa vs infraspinatous fossa - which is more convex

A

supraspinatous

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10
Q

what is the prominent feature of the posterior scapula

A

spine

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11
Q

what are the 2 articulations with the scapula

A

glenohumeral joint
acromioclavicular joint

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12
Q

are scapula fractures common

A

no (+ usually indicate severe trauma)

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13
Q

do scapula fractures tend to be displaced or undisplaced and why

A

undisplaced as mm hold in place
hence dont req fixation

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14
Q

what type of bone is the clavicle

A

long bone

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15
Q

functions clavicle (3)

A

attach upper limb to trunk
protect underlying NV structures
transmit forces from UL to axial skeleton

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16
Q

what does the large facet of the clavicle articulate with

A

sternum (–> sternoclavicular joint)

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17
Q

what attaches to the conoid tubercle of the clavicle

A

conoid ligament (medial part coracoclavicular ligament)

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18
Q

what attaches to the trapezoid line of the clavicle

A

trapezoid ligament (lateral part of coracoclavicular ligament)

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19
Q

which 1/3 of the clavicle has the majority of fractures

A

middle 1/3 (80%)

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20
Q

most common mechanism for clavicular fracture

A

FOOSH

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21
Q

mx clavicular fracture

A

conservative or orif

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22
Q

which nerve may have to be sacrified during ORIF of clavicle

A

supraclavicular nn

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23
Q

what does humerus articulate with proximally

A

glenoid fossa scapula (GH joint)

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24
Q

what does humerus articulate with distally

A

head of radius + trochlear notch ulna (elbow joint)

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25
Q

which 3 fossa on the humerus articulate with the radius and ulna during flexion and extension

A

olecranon fossa
coronoid fossa
radial fossa

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26
Q

what direction are supracondylar fractures of the humerus

A

transverse
oblique

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27
Q

which aa can be damaged by supracondylar fractures and what syndrome does it lead to

A

brachial aa
Volkmans ischaemic contracture

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28
Q

which 3 rotator cuff muscles attach to the greater tuberosity of the humerus?

A

supraspinatus
infraspinatus
teres minor

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29
Q

which nerve and vessel pass over the surgical neck of the humerus

A

axillary mm
posterior circumflex aa (and vv)

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30
Q

which 3 muscles attach to the intertubercular groove of humerus (and how to remember)

A

pec major
teres major
lat dorsi
a lady between 2 majors

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31
Q

what muscle runs through the intertubecular groove of humerus?

A

long head of biceps

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32
Q

what muscle attaches to the lesser tuberosity of the humerus

A

subscapularis

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33
Q

which muscles attach to the anterior shaft of the humerus (4)

A

coracobrachialis
deltoid
brachialis
brachioradialis

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34
Q

which muscle attach to the posterior shaft of the humerus?

A

medial and lateral head of triceps

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35
Q

which nerve and vessel are at risk with a mid shaft fracture of the humerus

A

radial nn —> wrist drop
profunda brachii aa

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36
Q

which is larger - medial or lateral epicondyle humerus

A

medial

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37
Q

which nerve passes through groove on medial epicondyle humerus

A

ulnar nn

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38
Q

which part of humerus articulates with radius

A

capitulum

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39
Q

what is Volkmann’s ischaemic contracture

A

uncontrolled flexion hand due to flexor mm becoming fibrotic and short

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40
Q

which nerves can be damaged in supracondylar humeral fracture (3)

A

anterior interossous, ulnar and radial nn

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41
Q

which classification is used for supracondylar fracture

A

Gartland

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42
Q

Gartland criteria 1

A

minimally displaced

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43
Q

Gartland type 2

A

displaced by intact posterior cortex

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44
Q

Gartland type 3

A

completely off ended

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45
Q

Mx Gartland criteria type 1

A

conservative mx

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46
Q

Mx Gartland criteria type 2 + 3

A

surgery - bionical fused K wired

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47
Q

2 articulations of the ulna

A

proximally - humerus at elbow joint + radius at prox RU Joint
distally - distal RU joint

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48
Q

which muscle attaches to the olecranon

A

triceps brachii

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49
Q

which muscle articulates with the coranoid processes ulnar tuberosity

A

brachialis

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50
Q

which part of the ulna is most likely to fracture

A

shaft

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51
Q

3 surfaces and 3 borders of the ulna

A

surfaces - ant, post, med
borders - post, interosseous, ant

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52
Q

what are the 4 articulations of the radius

A

elbow joint - head radius + capitulum humerus
prox RU Joint - radial head + radial notch ulna
wrist joint - end radius + carpal bones
distal RU joint - ulnar notch radius with ulna head

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53
Q

which side of radial head is thicker - medial or lateral

A

medial

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54
Q

which muscle attaches to radial tuberosity

A

biceps brachii

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55
Q

what muscle attaches to lateral shaft of radius

A

pronator teres

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56
Q

name of 8 carpal bones

A

scaphoid
lunate
triquentrum
pisiform
hamate
capitate
trapezoid
trapezium

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57
Q

2 aa supplying scaphoid bone

A

dorsal carpal brachial aa
superficial palmar arch

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58
Q

boxers fracture

A

5th metacarapl neck fracture

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59
Q

bennetts fracture

A

fracture 1st MC base by forced hyperabduction thumb

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60
Q

how many metacarpals per hand

A

5

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61
Q

how many phalanges per hand

A

14

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62
Q

anterior border axilla

A

pec major + minor

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63
Q

lateral border axilla

A

intertubecular sulcus humerus

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64
Q

posterior border axilla

A

scapularis
teres major
latissimus dorsi

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65
Q

medial border axilla

A

serratus anterior
thoracic wall

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66
Q

contents axilla (lateral to medial)

A

short head biceps
coracobrachialis
brachial plexus
axillary aa
axillary vv
axillary LN

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67
Q

which space is in the posterior wall of the axilla

A

quadrangular space

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68
Q

what bounds the quadrangular space?

A

teres minor
teres major
triceps
surgical neck of humerus

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69
Q

contents quadrangular space?

A

axillary nn
posterior circumflex humeral aa (branch of axillary aa)

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70
Q

what bounds the clavipectoral triangle?

A

pec major
deltoid
clavicle

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71
Q

contents clavipectoral triangle?

A

cephalic vv
medial + lateral pectoral nn

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72
Q

what 4 muscles constitute the pectoral region?

A

pec major
pec minor
serratus anterior
subclavius

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73
Q

pectoralis major origin/insertion

A

anterior medial clavicle + anterior sternum, superior 6 CC + aponeurosis EO muscle (2 heads) –> intertubercular sulcus humerus

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74
Q

actions pectoralis major

A

adduct + medial rotate UL
draws scapular anteriorinferiorly
clavicular head flexes shoulder

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75
Q

innervation pectoralis major

A

lateral and medial pectoral nerves

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76
Q

origin/insertion pectoralis minor

A

3-5th ribs –> corocoid process

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77
Q

action pectoralis minor

A

stabilises scapula by drawing anteroinferiorly

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78
Q

innervation pectoralis minor

A

medial pectoral nerve

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79
Q

origin/insertion serratus anterior

A

lateral aspect ribs 1-8 –> costal surface medial border scapula

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80
Q

action serratus anterior

A

rotates scapula + holds scapula against ribcage

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81
Q

innervation serratus anterior

A

lateral thoracic nerve

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82
Q

damage to lateral thoracic nn leads to…

A

winging scapula

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83
Q

origin/insertion subclavius

A

junction of 1st rib + CC –> inferior middle 1/3 clavicle

84
Q

action subclavius

A

anchors + depresses clavicle

85
Q

innervation subclavius

A

nerve to subclavius

86
Q

what are the 2 extrinsic muscles of the shoulder?

A

trapezius
latissimus dorsi

87
Q

origin/insertion trapezius

A

skull, nuchal ligament + SP C7-T12 –> clavicle, acromion, spine of scapula

88
Q

action trapezius - upper fibres

A

elevate scapula + rotate during abduction of arm

89
Q

action trapezius - middle fibres

A

retract scapula

90
Q

action scapula - lower fibres

A

pull scapula inferiorly

91
Q

innervation trapezius

A

CN XI
(also proprioceptor fibres C3/4)

92
Q

latissimus dorsi origin/insertion

A

SP T7-11, iliac crest, thoracocolumbar fascia + inferior 3 ribs
–> tendon that inserts onto intertubercular sulcus humerus

93
Q

action latissimus dorsi

A

extend, adduct + medial rotate UL

94
Q

innervation latissimus dorsi

A

thoracodorsal nn

95
Q

what are the 3 deep extrinsic muscles of the back

A

levator scapulae
rhomboid minor
rhomboid major

96
Q

origin/insertion levator scapulae

A

TP C1-4 –> medial border of scapula

97
Q

action levator scapula

A

elevates scapula

98
Q

innervation levator scapula

A

dorsal scapular nerve

99
Q

origin/insertion rhomboid minor

A

SP C7-T1 –> medial border scapula at level of spine

100
Q

action rhomboid minor

A

retracts and rotates scapula

101
Q

innervation rhomboid minor

A

dorsal scapular nerve

102
Q

origin/insertion rhomboid major

A

SP T2-5 –> medial scapula

103
Q

action rhomboid major

A

retracts + rotates scapula

104
Q

innervation rhomboid major

A

dorsal scapular nerve

105
Q

origin/insertion deltoid

A

lateral 1/3 clavicle, acromion, spine scapula –> deltoid tuberosity humerus

106
Q

action anterior fibres deltoid

A

flex + med rotate shoulder

107
Q

action posterior fibres deltoid

A

extend + lat rotate shoulder

108
Q

action middle fibres deltoid

A

major arm abductor after 15’

109
Q

innervation deltoid mm

A

axillary nn

110
Q

origin/insertion teres major

A

post surface of inferior angle scapula –> medial lip intertubercular groove humerus

111
Q

action teres major

A

adduct, extend shoulder + medially rotate arm

112
Q

innervation teres major

A

lower subscapular nerve

113
Q

what are the 4 rotator cuff muscles

A

subscapularis
supraspinatus
infraspinatus
teres minor

114
Q

supraspinatus orign/insertion

A

supraspinatous fossa scapula –> GT humerus

115
Q

action supraspinatus

A

abducts arm 0-15’
assists abduction up to 90’

116
Q

innervation supraspinatus

A

suprascapular nerve

117
Q

origin/insertion infraspinatous

A

infraspinatus fossa scapula –> GT humerus

118
Q

action infraspinatus

A

laterally rotates arm

119
Q

innervation infraspinatus

A

suprascapular nn

120
Q

origin/insertion teres minor

A

posterior surface scapula –> GT humerus

121
Q

action teres minor

A

laterally rotates arm

122
Q

innervation teres minor

A

axillary nn

123
Q

origin/insertion subscapularis

A

subscapular fossa scapula –> lesser tubercle humerus

124
Q

innervation subscapularis

A

upper + lower subscapular nn

125
Q

action subscapularis

A

medially rotates arm

126
Q

which rotator cuff muscle is most commonly affected in rotator cuff tendonitis ?

A

supraspinatus

127
Q

what 3 ligaments strengthen the SC joint?

A

interclavicular ligament
costoclavicular ligament
anterior + posterior sternoclavicular ligament

128
Q

outer and inner layers of SC joint capsule?

A

outer is fibrous (from epiphysis of clavicle to the articular disc)
inner is synovial membrane (prod fl)

129
Q

aa supply SC joint?

A

internal thoaracic + suprascapular aa

130
Q

innervation SC joint

A

medial supraclavicular nn (C3+ 4)
nn to subclavius (C5+6)

131
Q

does the SC joint more commonly dislocate anteriorly or posteriorly?

A

anteriorly

132
Q

in children, what additional fracture occurs with SC joint dislocation?

A

epiphyseal plate fracture

133
Q

what type of joint is the AC joint?

A

plane synovial joint

134
Q

where does the AC joint extend between?

A

lateral end of clavicle to acromion of the scapula

135
Q

what muscle fibres reinforce the posteioer aspect of the AC joint capsule?

136
Q

which ligament suspends the upper arm from the clavicle?

A

coracoclavicular ligament

137
Q

what are the 2 parts of the coracoclavicular ligament?

A

conoid ligament (coracoid process –> conoid tubercle clavicle)
trapezoid ligament (coracoid process –> trapezium line clavicle)

138
Q

aa supply AC joint

A

suprascapular aa
thoraco-acromial aa

139
Q

suprascapular aa is a branch of

140
Q

thoraco-acromial aa is a branch of?

A

axillary aa

141
Q

inn AC joint

A

suprascapular + lateral pectoral nn

142
Q

what is the name for a AC joint dislocation?

A

separated shoulder

143
Q

what type of joint is the glenohumeral joint?

A

ball and socket joint

144
Q

what structure deepens the glenoid fossa?

A

glenoid labrum

145
Q

where does the coracoacromial ligament extend between?

A

acromion + coracoid process scapula

146
Q

role coracoacromial ligament shoulder

A

prevents superior dislocation of the humeral head

147
Q

which ligament is the main source of stability of the shoulder?

A

glenohumeral ligament

148
Q

role of glenohumeral ligament?

A

prevents shoulder dislocating anteriorly

149
Q

what are the 3 shoulder bursa?

A

subcoracoid bursa
subscapular bursa
subacromial bursa

150
Q

which muscle does the subacromial bursa lie superficial to?

A

Supraspinatus

151
Q

movements shoulder joint

A

extension
flexion
abduction
adduction
internal rotation
external rotation

152
Q

muscles involved in shoulder extension (3)

A

posterior deltoid
latissimus dorsi
teres major

153
Q

muscles involved in shoulder flexion (3)

A

coracobrachialis
anterior deltoid
pectoralis major

154
Q

muscles involved in shoulder abduction (4)

A

0-15’ - supraspinatus
15-90’ - middle deltoid
>90’ - trapezius, serratus anterior

155
Q

muscles involved in shoulder adduction (3)

A

pectoralis major
teres major
latissimus dorsi

156
Q

muscles involved in internal rotation shoulder (5)

A

subscapularis
pectoralis major
latissimus dorsi
teres major
anterior deltoid

157
Q

muscles involved in external/lateral rotation shoulder (2)

A

infraspinatus
teres minor

158
Q

factors contributing to stability shoulder (4)

A

rotator cuff mm
glenoid labrum
ligaments
biceps tendon (minor humeral head depressor)

159
Q

aa supply glenohumeral joint

A

anterior + posterior circumflex humeral aa

160
Q

what are the anterior + posterior circumflex humeral aa a branch of?

A

axillary aa

161
Q

innervation glenohumeral joint

A

axillary, suprascapular + lateral pectoral nn

162
Q

what % of shoulder dislocations are anterior

163
Q

Hills Sachs lesion

A

impaction fracture of posterolateral humeral head against shoulder

164
Q

Bankart lesion

A

detachment of anteroinferior labrum + avulsion fracture

165
Q

which nerve may be damaged in a shoulder dislocation?

A

axillary nn

166
Q

which 3 mm make up the anterior arm compartment?

A

biceps
brachialis
coracobrachialis

167
Q

innervation of mm in anterior arm

A

musculocuteanous nn C,5,6,7

168
Q

arterial supply of mm in anterior arm

A

brachial aa

169
Q

biceps reflex root

170
Q

which muscles is the coracobrachialis deep to?

171
Q

origin/insertion coracobrachialis

A

coracoid process scapula –> medial side humeral shaft at level of deltoid tubercle

172
Q

action coracobrachialis

A

flex arm at shoulder
weak adduction shoulder

173
Q

origin/insertion biceps

A

short head - coracoid process scapula
long head - supraglenoid tubercle scapula
to tuberosity via the aponeurosis

174
Q

action biceps brachii

A

supination forearm
flexion arm and elbow + shoulder

175
Q

origin/insertion brachialis

A

medial + lateral humeral shaft –> ulnar tuberosity

176
Q

action brachialis

A

flex elbow

177
Q

innervation brachialis

A

musculocutaneous nn
also contrib from radial nn

178
Q

which tendon of the biceps is more likely to rupture

179
Q

what sign do you get with a biceps tendon rupture?

A

popeye sign

180
Q

origin tricep - medial head

A

humerus, inferior to radial groove

181
Q

origin tricep - lateral head

A

humerus, superior to radial groove

182
Q

origin triceps - long head

A

infraglenoid tubercle

183
Q

insertion triceps

A

tendon onto olecranon

184
Q

action triceps

A

extends arm at elbow

185
Q

innervation triceps mm

186
Q

triceps reflex nn root

187
Q

what muscles are in the anterior forearm - superficial layer (4)

A

Flexor carpi ulnaris
palmaris longus
flexor carpi radialis
pronator teres

188
Q

what muscles are in the anterior forearm - intermediate layer (1)

A

flexor digitorum superficialis

189
Q

what muscles are in the anterior forearm - deep layer (3)

A

flexor pollicis longus
flexor digitorum profundus
pronator quadratus

190
Q

innervation mm anterior forearm

A

mostly median nn
except FCU + medial half FDP= ulnar nn

191
Q

actions anterior forearm mm

A

pronation, flexion wrists and fingers

192
Q

common origin point muscles superficial flexor compartment forearm

A

medial epicondyle humerus

193
Q

pronator teres origin/insertion

A

medial epicondyle + coronoid process ulna –> midshaft radius

194
Q

action pronator teres

A

pronation forearm

195
Q

innervation pronator teres

196
Q

origin/insertion flexor carpi radialis

A

medial epicondyle –> base MC 2 + 3

197
Q

action FCR

A

flex + abduct wrist

198
Q

innervation FCR

A

medial nerve

199
Q

origin/insertion Flexor carpi ulnaris

A

medial epicondyle humerus + olecranon ulnar –> pisiform bone, hook hamate + base 5th MC

200
Q

action FCU

A

flexion + adduction wrist

201
Q

innervation FCU

202
Q

origin/insertion palmaris longus

A

medial epicondyle –> flexor retinaculum wrist

203
Q

action palmaris longus

A

flexion wrist

204
Q

innervation palmaris longus

205
Q

what % population is palmaris longus absent in?

MRCS A (36 decks)

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