ANATOMY - Upper limb p2 Flashcards
1
Q
which 2 structures pass through the 2 heads of the flexor digitorum superficialis?
A
median nn
ulnar aa
2
Q
origin/insertion flexor digitorum superficialis
A
medial condyles humerus + radius –> 4 tendons –> through carpal tunnel –> base mid phalanges 4 digits
3
Q
action flexor digitorum superficialis
A
flexes MCPJ + PIPJ 4 fingers
flexes at wrist
4
Q
innervation flexor digitorum superficialis
A
median nn
5
Q
origin/insertion pronator quadratus
A
anterior surface ulna –> anterior surface radius
6
Q
action pronator quadratus
A
pronates forearm
7
Q
innervation pronator quadratus
A
anterior interosseous branch median nn
8
Q
which is the deepest muscle in the anterior forearm
A
pronator quadratus
9
Q
origin/insertion flexor digitorum profundus
A
ulna + interosseous membrane –> 4 tendons –> carpal tunnel –> distal phalanges
10
Q
action flexor digitorum profundus
A
flex DIPJ
flex MCPJ
flex wrist
11
Q
innervation flexor digitorum profundus
A
med half = ulnar nn
lat half = anterior interosseous branch median nn
12
Q
origin/insertion flexor pollicis longus?
A
anterior surface radius + interosseous membrane –> base distal phalanx thumb
13
Q
action flexor pollicis longus
A
flex IPJ + MCPJ thumb
14
Q
innervation flexor pollicis longus
A
anterior interosseous branch median nn
15
Q
borders cubital fossa
A
superior - line between 2 epicondyles
medial - lateral border pronator teres
lateral - medial border brachioradialis
roof - bicipital aponeurosis fasica, SCT fat + skin
floor - brachialis, supinator
16
Q
contents cubital fossa (lateral to medial)
A
Really Need a Beer To Be At My Nicest
Radial nn
Biceps tendon
Brachial aa
Median nn
17
Q
what veins are contained within the roof of the cubital fossa
A
median cubital vein
18
Q
role of ulnar tunnel
A
transmits ulnar nerve to forearm
19
Q
borders of the ulnar tunnel
A
medial - medial epicondyle humerus
lateral - olecranon ulna
floor - elbow joint capsule, medial collateral ligament elbow
roof - ligament between medial epicondyle + olecranon aka cubital tunnel
20
Q
contents ulnar tunnel
A
ulnar nn
21
Q
what is the 2nd most common upper limb peripheral neuropathy?
A
cubital tunnel syndrome
22
Q
symptoms cubital tunnel syndrome
A
change sensation meidal 1/2 fingers + palm
change motor - weakness and wasting intrinsic hand mm
23
Q
what elbow movement exacerbates cubital tunnel syndrome
A
elbow flexion
24
Q
innervation posterior forearm muscles
A
radial nerve
25
muscles in the superficial posterior forearm compartment (6)
brachioradialis
extensor carpi radialis longus + brevis
extensor digiti mimini
extensor carpi ulnaris
anconeus
26
muscles in the deep posterior forearm compartment
supinator
abductor pollicis longus
extensor pollicis longus + brevis
extensor indicis
27
origin/insertion brachioradialis
proximal lateral supracondylar ridge humerus --> distal radius
28
action brachioradialis
flexes at elbow
29
innervation brachioradialis
radial nerve
30
origin/insertion extensor carpi radialis longus
lat supracondylar ridge --> MC II, III
31
origin/insertion extensor carpi radialis brevis
lateral epicondyle --> MC II + III
32
action extensor carpi radialis longus + brevis
extend + abduct wrist
33
innervation extensor carpi radialis longus + brevis
radial nerve
34
which is the main extensor muscle of the forearm?
entensor digitorum
35
origin/insertion extensor digitorum
lateral epicondyle --> extensor hook each finger
36
action extensor digitorum
extends digits at IPJ + MCPJ
37
innervation extensor digitorum
deep branch radial nerve
38
extensor digiti minimi origin/insertion
originates from extensor digitorum --> hook little finger
39
action extensor digiti minimi
extends little finger
contributes to wrist extension
40
inn extensor digiti minimi
deep branch radial nn
41
which muscle in the superficial posterior forearm is the most medial hence assists with adduction
extensor carpi ulnaris
42
origin/insertion extensor carpi ulnaris
lat epicondyle humerus --> base MC 5
43
action extensor carpi ulnaris
extends + adducts wrist
44
inn extensor carpi ulnaris
deep branch radial nn
45
which mm does the anconeus blend with
triceps
46
origin/insertion anconeus
lat epicondyle --> lat + post olecranon
47
action anconeus
extends/stabilises elbow
abducts wrist during pronation
48
inn anconeus
radial nn
49
peak age lateral epicondylitis (tennis elbow)
40-50
50
cause tennis elbow
repeated superficial extensor mm use
51
what are the 5 deep posterior forearm muscles
supinator
abductor pollicis longus
extensor pollicis brevis
extensor pollicis longus
extensor indicis
52
inn of the deep posterior forearm mm
posterior interosseous branch radial nn
(except supinator = deep branch radial nn)
53
which nerve passes between the 2 heads of the supinator
deep branch of bradial nn
54
origin/insertion supinator
lateral epicondyle humerus + posterior surface ulna --> post surface forearm
55
action supinator
supinates forearm
56
inn supinator
deep branch radial nn
57
abductor pollicis longus contributes to which part of the anatomical snuffbox
lateral border
58
origin/insertion abductor pollicis longus
interosseous membrane + adjacent post surfaces R+U --> lat base MC1
59
action abductor pollicis longus
abducts thumb
60
inn abductor pollicis longus
post interosseous branch radial nerve
61
EPB in relation to EPL
EPB is medial and deep to EPL
62
which part of the anantomical snuffbox does EPB contribute to
lateral border
63
origin/insertion EPB
posterior radius + IO membrane --> base prox phalynx thumb
64
action EPB
extends MCPJ + CMCJ thumb
65
inn EPB
post interosseous branch radial nn
66
which part of the anatomical snuffbox does EPL contribute to
medial border
67
origin/insertion EPL
post ulnar + IO membrane --> distal phalynx thumb
68
action EPL
extends all thumb joints
69
inn EPL
post interosseous branch radial nn
70
origin/insertion extensor indicis
post ulna + IO membrane --> extensor roof index finger
71
action extensor indicis
allows for index finger to be independent during extension
72
inn extensor indicis
post interosseous branch radial nn
73
wrist drop is 2' to
radial nn lesion
74
what are the 2 characteristic sites of damage in wrist drop
axilla - humeral dislocation/fracture
radial groove humerus
distal radial fracture
75
how many extensor tendon compartments
6
76
how are the extensor tendon compartments separated from eachother
fibrous septa
77
contents extensor compartment 1
extensor pollicis brevis
abductor pollicis brevis
aka lat border anatomical snuffbox
78
contents extensor compartment 2
extensor carpi radialis
79
what structure separates extensor compartments 2+3
Listers tubercle radius
80
contents extensor compartment 3
extensor policis longus
aka medial border anatomical snuffbox
81
contents extensor compartment 4
externsor digitorum + extensor indices
82
contents extensor compartment 5
extensor digiti minimi
83
contents extensor compartment 6
extensor carpi ulnaris
84
which extensor compartment is inflamed in De Quervain's tenosynovitis
extensor 1
85
what type of joint is the elbow joint?
hinge type synovial joint
86
what are the 2 separate articulations of the elbow joint
trochlear notch ulnar + trochea of humerus
head radius + capitulum humerus
87
what does the joint capsule of the elbow thicken medially and laterally to be come
collateral ligaments
88
what are the 3 bursa of the elbow joint
intratendinous (within tendon triceps)
subtendinous (betw olecranon + triceps)
subcutaneous (betw olecranon + overlying CT)
89
what are the 3 ligaments of the elbow joint
ulnar collateral ligament
radial collateral ligament
annular ligament
90
where. does the ulnar collateral ligament extend between?
medial epicondyle --> coronoid process ulnar
91
where does the radial collateral ligament extend between
lat epicondyle --> blend with annular ligament
92
aa supply elbow joint
brachial aa branches
93
nn supply elbow joint
meidal, MSC, radial + ulnar nn branches
94
cause of elbow joint dislocaton
young child FOOSH w/ flexed elbow
95
which ligament tends to tear in an elbow dislocation + what way do the radius + ulnar move in relation to the humerus
humerus driven through anterior joint capsule --> ulnar collat ligament torn
hence R+U mmove post
'posterior' joint dislocation
96
which ligament holds the radial head in place of the proximal RUJ
annular ligament
97
which part of the radius slides over the ulnar head distally in pronation and supination
ulnar notch
98
which structure binds the R+U together at the distal RUJ and separates them from the wrist joint?
articular disc
99
what are 4 functions of the IO membrane
stability
site of mm attachment
transfers forces from R --> U
small holes for conduit vessels
100
what is the proximal aspect of the wrist joint
distal radius + articular disc
101
what is the distal aspect of the wrist joint
proximal row of carpal bones except pisiform
102
where does the ulna fit into the wrist joint
IT IS NOT PART OF THE WRIST JOINT
103
what are the 2 layres of the wrist joint capsule
fibrous outer layer where the bones attach
synovial inner layer
104
what are the 4 ligaments that make up the wrist joint
palmar radiocarpal ligament
radial collateral ligament
ulnar collateral ligament
dorsal radiocarpal ligament
105
palmar radiocarpal ligament extends between
palmar/anterior hand --> both rows of carpals
106
palmar radiocarpal ligament role
increases stability
ensures hand follows forearm during supination
107
dorsal radiocarpal ligament extends between
posterior side of the radius --> both rows of carpals
108
dorsal radiocarpal ligament role
increases stability
ensure hands follows forearm during pronation
109
radial collateral ligament wrist extends betweeen
radial styloid process --> scaphoid + trapezuyn
110
fct radial collateral ligament of wrist
prevents XS ulnar/med deviation
111
ulnar collateral ligament wrist extends between
ulnar styloid process --> pisiform + triquentum
112
fct ulnar collateral ligament wrist
prevents excess lateral/radial deviation
113
aa supply wrist joint
dorsal + palmar arches radial + ulnar aa
114
inn wrist joint
ant interosseous (median)
post interosseous (radial)
deep + dorsal branches ulnar
115
flexors wrist (3)
FCU
FCR
FDS
116
extensors wrist (4)
ECRL
ECRB
ECU
ED
117
adductors wrist (2(
ECU
FCU
118
abductors wrist
FCR
ECRL + B
APL
119
which muscle group produces the bulges seen on your palm by your thumb?
thenar mm (thenar eminence)
120
role of the thenar mm
fine movements thumb
121
inn thenar mm
median mm (recurrent branch)
122
which is the most medial thumb thenar mm
flexor pollicis brevis
123
which is the most medial thumb thenar mm
flexor pollicis brevis
124
what are the 3 thenar mm
flexor pollicis brevis
opponens pollicis
abductor pollicis brevis
125
flexor pollicis brevis origin/insertion
tubercle trapezium + flexor retinaculum --> prox phalanx thumb
126
action flexor pollicis brevis
flexes MCPJ thumb
127
innervation flexor pollicis brevis
rec median nn
deep head is inn'd by deep branch ulnar nn
128
origin/insertion opponens pollicis
tubercle trapezium + flexor retinaculum --> lateral margin 1st MC
129
action opponens pollicis
opposes thumb
130
inn opponens pollicis
recurrent branch of the median nn
131
origin/insertion abductor pollicis previs
tubercles scaphoid/trapezium _ flexor retinaculum --> lateral prox phalynx thumb
132
action abductor pollicis brevis
abducts thumb
133
innervation abductor pollicis brevis
recurrent branch median nerve
134
what are the 3 hypothenar mm
flexor digiti minimi brevis
abductor digiti minimi
opponens digiti minimi
135
inn hypothenar mm
ulnar nn
136
origin/insertion flexor digiti minimi brevis
hook hamate, flexor retinaculum --> base prox phalynx little finger
137
action flexor digiti minimi brevis
flexes MCPJ little finger
138
innervation flexor digiti minimi brevis
ulnar nn
139
origin/insertion abductor digiti minimi
pisiform + tendon FCU --> base prox phalynx little finger
140
action abductor digiti minimi
abducts little finger
141
inn abductor digiti minimi
ulnar nn
142
origin/insertion opponens digiti minimi
hook hamate + flexor retinaculum --> medial MC 5
143
action opponens digiti minimi
rotates finger towards palm aka opposition
144
inn opponens digiti minimi
ulnar nn
145
which thenar mm is the deepest
opponens pollicis
146
which hypothenar mm is the most superficial
abductor digiti minimi
147
which hypothenar mm is the deepest
opponens digiti minimi
148
how many lumbricals in each hand
4
149
what do the lumbricals link together?
extensor tendons to flexor tendons
150
which lumbricals are unipenate>
I + II
151
inn of unipenate lumbricals
median nn
152
which lumbricals are bipenate >
III + IV
153
inn of bipenate lumbricals
ulnar nn
154
origin/insertion lumbricals
tendon of FDP --> extensor hood
155
action of lumbricals
flex at MCPJ
extend at IPJ each digit
156
where are the interossei?
between the metacarpal bones
157
how many dorsal interossei
4
158
origin/insertion dorsal interossei
lateral + medial surfaces MC --> extensor hoods prox phalynx
159
action dorsal interossei
abduction digit
assists in flexion at MCJP
assists in exntesion at IPJ
160
inn dorsal interossei
ulnar nn
161
how many palmar interossei
3
162
origin/insertion palmar interossei
medial/lateral surface metacarpal --> extensor hood + prox phaylnx same finger
163
action palmar interossei
adduction digits
assists in flexion MCPJ
assists in extension IPJ
164
inn palmar interossei
ulnar nn
165
origin/insertion palmaris brevis
palmar aponeurosis + flexor retinaculum --> dermis skin of med margin hand
166
action palmaris brevis
wrinkles skin hypothenar emininece + deepens curvature hand to improve grip
167
inn palmaris brevis
ulnar nn
168
origin/insertion adductor pollicis
MC III + capitate + adjacent MC II --> prox phalynx thumb
169
action adductor pollicis
adducts thumb
170
inn adductor pollicis
ulnar nn
171
what structure runs between the 2 heads of adductor pollicis
radial aa
172
borders anatomical snufbox
medial/ulnar - tendon EPL
lateral/radial - EPB +APL
proximal - styloid process radius
floor - scaphoid + tapezium
Roof- skin
173
contents anatomical snuffbox (3)
radial aa
superficial branch radial nn
cephalic vv
174
ulnar canal borders
medial/ulnar - pisiform, FCU tendon, abductor digiti minimi
lateral/radial - hook hamate
roof - palmar carpal ligament
floor - flexor retinaculum, pisohamatic ligament, hypothenar nn
175
contens ulnar canal
ulnar nn - splits in canal into superficial (sensory) + deep (motor) branches
ulnar aa (lateral to nn) - branches off deep palmar + continues at superficial palmar arch
venae
lymphatics
176
most common causes ulnar canal syndrome (3)
ganglion cyst
lipoma
trauma
177
what 2 layers form the carpal tunnel
deep carpal arch
superficial flexor retinaculum
178
laterally, which carpals form the carpal arch
scaphoid +trapezium tubercles
179
medially, which carpals form the carpal arch (3)
hook hamate
pisiform
180
which tendon is within the flexor retinaculum
Flexor carpi radialis (hence not within the tunnel itself)
181
how many tendons within the carpal tunnel
9
182
what are the 9 tendons within the carpal tunnel
flexor pollicis longus (own synovial sheath)
flexor digitorum profundus x 4
plexor digitorum superficialis x 4
183
nn contents carpal tunnel
median nn - splits into recurrent branch ad palmar digitial branch
184
what does the palmar digitial branch of the median nn supply
dorsal nail beds, palmar skin lat 3 ½ digits
motor inn to lateral 2 lumbricals
185
what does the recurrent branch of the median nn supply
thenar mm
186
Tinels test
tapping elicitis pain in median nn distribution when testing for carpal tunnel
187
Phalens test
hold wrist in flexion for 60s to reproduce Sx carpal tunnel
188
what are the 4 components of the flexor pulley system of the hand
long flexor tendons
annular pulleys x 5 per finger, 2 per thumb
cruciate pulley-x3 per finger
oblique pulley - 1 assoc w/ thumb
189
what is the role of the flexor pulley system of the hand?
to hold the. flexor tendons against the phalanges
190
where do the long flexor tendons arise from
FDS + FDP
191
how do the long flexor tendons enter the hand
via the carpal tunnel
192
where doe sFDS tendon attach
base of middle phalynx
193
where does FDP tendon attach
base of distal phalynx
194
what are the annular and cruciate pulleys
thickened areas of flexor fibrous sheaths
195
where are annular's 1-5 on the finger?
A1 = MCPJ
A2 = prox aspect prox phalyx
A3 = Prox IPJ
A4 = mid of middle IPJ
A5 = DIPJ
196
where are cruciates 1-3 on the finger?
C1 = between A2-3
C2 = between A3-4
C3 = between A4-5
197
where are A1+2 + the oblique pulley on the thumb
A1 = MCPJ
oblique= prox 1/2 proximal phalynx
A2 = distal 1/2 prox phalynx
198
where do the superficial lymphatic vessels of the upper limb arise from
lymphatic plexuses of the hand and skin
199
where do the lymphatic vessels shadowing the basilic vein drain
cubital LN
200
where are the cubital LN
medial to the cubital vv, proximal to the medial epicondyle humerus
201
where do the cubital LN drain into
lateral axillary LN
202
where do the lymphatic vessels shadowing the cephalic vv drain into?
apical axillary LN
203
what vessels do the deep lymphatic vessels follow
major deep vv
ie radial, ulnar, brachial
204
where do the deep lymphatic vessels drain into
humeral axillary LN
205
ultimately which LN do the LN of the chest wall drain into
--> pectoral/ant, post/subscapular + humeral/lateral --> cerntral --> apical LN
apical then --> cervico-axillary canal --> subclavian lymhpatic trunk
--> R +L
R: --> R lymphatic duct --> R vv angle at IJV + SCV
L: --> directly into thoracic duct
