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MRCS A > ANATOMY - Upper limb p2 > Flashcards

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

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2
Q

origin/insertion flexor digitorum superficialis

A

medial condyles humerus + radius –> 4 tendons –> through carpal tunnel –> base mid phalanges 4 digits

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3
Q

action flexor digitorum superficialis

A

flexes MCPJ + PIPJ 4 fingers
flexes at wrist

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4
Q

innervation flexor digitorum superficialis

A

median nn

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5
Q

origin/insertion pronator quadratus

A

anterior surface ulna –> anterior surface radius

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6
Q

action pronator quadratus

A

pronates forearm

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7
Q

innervation pronator quadratus

A

anterior interosseous branch median nn

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8
Q

which is the deepest muscle in the anterior forearm

A

pronator quadratus

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9
Q

origin/insertion flexor digitorum profundus

A

ulna + interosseous membrane –> 4 tendons –> carpal tunnel –> distal phalanges

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10
Q

action flexor digitorum profundus

A

flex DIPJ
flex MCPJ
flex wrist

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11
Q

innervation flexor digitorum profundus

A

med half = ulnar nn
lat half = anterior interosseous branch median nn

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12
Q

origin/insertion flexor pollicis longus?

A

anterior surface radius + interosseous membrane –> base distal phalanx thumb

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13
Q

action flexor pollicis longus

A

flex IPJ + MCPJ thumb

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14
Q

innervation flexor pollicis longus

A

anterior interosseous branch median nn

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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

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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

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17
Q

what veins are contained within the roof of the cubital fossa

A

median cubital vein

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18
Q

role of ulnar tunnel

A

transmits ulnar nerve to forearm

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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

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20
Q

contents ulnar tunnel

A

ulnar nn

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21
Q

what is the 2nd most common upper limb peripheral neuropathy?

A

cubital tunnel syndrome

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22
Q

symptoms cubital tunnel syndrome

A

change sensation meidal 1/2 fingers + palm
change motor - weakness and wasting intrinsic hand mm

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23
Q

what elbow movement exacerbates cubital tunnel syndrome

A

elbow flexion

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24
Q

innervation posterior forearm muscles

A

radial nerve

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25
Q

muscles in the superficial posterior forearm compartment (6)

A

brachioradialis
extensor carpi radialis longus + brevis
extensor digiti mimini
extensor carpi ulnaris
anconeus

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26
Q

muscles in the deep posterior forearm compartment

A

supinator
abductor pollicis longus
extensor pollicis longus + brevis
extensor indicis

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27
Q

origin/insertion brachioradialis

A

proximal lateral supracondylar ridge humerus –> distal radius

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28
Q

action brachioradialis

A

flexes at elbow

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29
Q

innervation brachioradialis

A

radial nerve

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30
Q

origin/insertion extensor carpi radialis longus

A

lat supracondylar ridge –> MC II, III

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31
Q

origin/insertion extensor carpi radialis brevis

A

lateral epicondyle –> MC II + III

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32
Q

action extensor carpi radialis longus + brevis

A

extend + abduct wrist

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33
Q

innervation extensor carpi radialis longus + brevis

A

radial nerve

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34
Q

which is the main extensor muscle of the forearm?

A

entensor digitorum

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35
Q

origin/insertion extensor digitorum

A

lateral epicondyle –> extensor hook each finger

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36
Q

action extensor digitorum

A

extends digits at IPJ + MCPJ

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37
Q

innervation extensor digitorum

A

deep branch radial nerve

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38
Q

extensor digiti minimi origin/insertion

A

originates from extensor digitorum –> hook little finger

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39
Q

action extensor digiti minimi

A

extends little finger
contributes to wrist extension

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40
Q

inn extensor digiti minimi

A

deep branch radial nn

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41
Q

which muscle in the superficial posterior forearm is the most medial hence assists with adduction

A

extensor carpi ulnaris

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42
Q

origin/insertion extensor carpi ulnaris

A

lat epicondyle humerus –> base MC 5

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43
Q

action extensor carpi ulnaris

A

extends + adducts wrist

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44
Q

inn extensor carpi ulnaris

A

deep branch radial nn

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45
Q

which mm does the anconeus blend with

A

triceps

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46
Q

origin/insertion anconeus

A

lat epicondyle –> lat + post olecranon

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47
Q

action anconeus

A

extends/stabilises elbow
abducts wrist during pronation

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48
Q

inn anconeus

A

radial nn

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49
Q

peak age lateral epicondylitis (tennis elbow)

A

40-50

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50
Q

cause tennis elbow

A

repeated superficial extensor mm use

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51
Q

what are the 5 deep posterior forearm muscles

A

supinator
abductor pollicis longus
extensor pollicis brevis
extensor pollicis longus
extensor indicis

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52
Q

inn of the deep posterior forearm mm

A

posterior interosseous branch radial nn
(except supinator = deep branch radial nn)

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53
Q

which nerve passes between the 2 heads of the supinator

A

deep branch of bradial nn

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54
Q

origin/insertion supinator

A

lateral epicondyle humerus + posterior surface ulna –> post surface forearm

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55
Q

action supinator

A

supinates forearm

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56
Q

inn supinator

A

deep branch radial nn

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57
Q

abductor pollicis longus contributes to which part of the anatomical snuffbox

A

lateral border

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58
Q

origin/insertion abductor pollicis longus

A

interosseous membrane + adjacent post surfaces R+U –> lat base MC1

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59
Q

action abductor pollicis longus

A

abducts thumb

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60
Q

inn abductor pollicis longus

A

post interosseous branch radial nerve

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61
Q

EPB in relation to EPL

A

EPB is medial and deep to EPL

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62
Q

which part of the anantomical snuffbox does EPB contribute to

A

lateral border

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63
Q

origin/insertion EPB

A

posterior radius + IO membrane –> base prox phalynx thumb

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64
Q

action EPB

A

extends MCPJ + CMCJ thumb

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65
Q

inn EPB

A

post interosseous branch radial nn

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66
Q

which part of the anatomical snuffbox does EPL contribute to

A

medial border

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67
Q

origin/insertion EPL

A

post ulnar + IO membrane –> distal phalynx thumb

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68
Q

action EPL

A

extends all thumb joints

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69
Q

inn EPL

A

post interosseous branch radial nn

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70
Q

origin/insertion extensor indicis

A

post ulna + IO membrane –> extensor roof index finger

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71
Q

action extensor indicis

A

allows for index finger to be independent during extension

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72
Q

inn extensor indicis

A

post interosseous branch radial nn

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73
Q

wrist drop is 2’ to

A

radial nn lesion

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74
Q

what are the 2 characteristic sites of damage in wrist drop

A

axilla - humeral dislocation/fracture
radial groove humerus
distal radial fracture

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75
Q

how many extensor tendon compartments

A

6

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76
Q

how are the extensor tendon compartments separated from eachother

A

fibrous septa

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77
Q

contents extensor compartment 1

A

extensor pollicis brevis
abductor pollicis brevis
aka lat border anatomical snuffbox

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78
Q

contents extensor compartment 2

A

extensor carpi radialis

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79
Q

what structure separates extensor compartments 2+3

A

Listers tubercle radius

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80
Q

contents extensor compartment 3

A

extensor policis longus
aka medial border anatomical snuffbox

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81
Q

contents extensor compartment 4

A

externsor digitorum + extensor indices

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82
Q

contents extensor compartment 5

A

extensor digiti minimi

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83
Q

contents extensor compartment 6

A

extensor carpi ulnaris

84
Q

which extensor compartment is inflamed in De Quervain’s tenosynovitis

A

extensor 1

85
Q

what type of joint is the elbow joint?

A

hinge type synovial joint

86
Q

what are the 2 separate articulations of the elbow joint

A

trochlear notch ulnar + trochea of humerus
head radius + capitulum humerus

87
Q

what does the joint capsule of the elbow thicken medially and laterally to be come

A

collateral ligaments

88
Q

what are the 3 bursa of the elbow joint

A

intratendinous (within tendon triceps)
subtendinous (betw olecranon + triceps)
subcutaneous (betw olecranon + overlying CT)

89
Q

what are the 3 ligaments of the elbow joint

A

ulnar collateral ligament
radial collateral ligament
annular ligament

90
Q

where. does the ulnar collateral ligament extend between?

A

medial epicondyle –> coronoid process ulnar

91
Q

where does the radial collateral ligament extend between

A

lat epicondyle –> blend with annular ligament

92
Q

aa supply elbow joint

A

brachial aa branches

93
Q

nn supply elbow joint

A

meidal, MSC, radial + ulnar nn branches

94
Q

cause of elbow joint dislocaton

A

young child FOOSH w/ flexed elbow

95
Q

which ligament tends to tear in an elbow dislocation + what way do the radius + ulnar move in relation to the humerus

A

humerus driven through anterior joint capsule –> ulnar collat ligament torn
hence R+U mmove post
‘posterior’ joint dislocation

96
Q

which ligament holds the radial head in place of the proximal RUJ

A

annular ligament

97
Q

which part of the radius slides over the ulnar head distally in pronation and supination

A

ulnar notch

98
Q

which structure binds the R+U together at the distal RUJ and separates them from the wrist joint?

A

articular disc

99
Q

what are 4 functions of the IO membrane

A

stability
site of mm attachment
transfers forces from R –> U
small holes for conduit vessels

100
Q

what is the proximal aspect of the wrist joint

A

distal radius + articular disc

101
Q

what is the distal aspect of the wrist joint

A

proximal row of carpal bones except pisiform

102
Q

where does the ulna fit into the wrist joint

A

IT IS NOT PART OF THE WRIST JOINT

103
Q

what are the 2 layres of the wrist joint capsule

A

fibrous outer layer where the bones attach
synovial inner layer

104
Q

what are the 4 ligaments that make up the wrist joint

A

palmar radiocarpal ligament
radial collateral ligament
ulnar collateral ligament
dorsal radiocarpal ligament

105
Q

palmar radiocarpal ligament extends between

A

palmar/anterior hand –> both rows of carpals

106
Q

palmar radiocarpal ligament role

A

increases stability
ensures hand follows forearm during supination

107
Q

dorsal radiocarpal ligament extends between

A

posterior side of the radius –> both rows of carpals

108
Q

dorsal radiocarpal ligament role

A

increases stability
ensure hands follows forearm during pronation

109
Q

radial collateral ligament wrist extends betweeen

A

radial styloid process –> scaphoid + trapezuyn

110
Q

fct radial collateral ligament of wrist

A

prevents XS ulnar/med deviation

111
Q

ulnar collateral ligament wrist extends between

A

ulnar styloid process –> pisiform + triquentum

112
Q

fct ulnar collateral ligament wrist

A

prevents excess lateral/radial deviation

113
Q

aa supply wrist joint

A

dorsal + palmar arches radial + ulnar aa

114
Q

inn wrist joint

A

ant interosseous (median)
post interosseous (radial)
deep + dorsal branches ulnar

115
Q

flexors wrist (3)

A

FCU
FCR
FDS

116
Q

extensors wrist (4)

A

ECRL
ECRB
ECU
ED

117
Q

adductors wrist (2(

A

ECU
FCU

118
Q

abductors wrist

A

FCR
ECRL + B
APL

119
Q

which muscle group produces the bulges seen on your palm by your thumb?

A

thenar mm (thenar eminence)

120
Q

role of the thenar mm

A

fine movements thumb

121
Q

inn thenar mm

A

median mm (recurrent branch)

122
Q

which is the most medial thumb thenar mm

A

flexor pollicis brevis

123
Q

which is the most medial thumb thenar mm

A

flexor pollicis brevis

124
Q

what are the 3 thenar mm

A

flexor pollicis brevis
opponens pollicis
abductor pollicis brevis

125
Q

flexor pollicis brevis origin/insertion

A

tubercle trapezium + flexor retinaculum –> prox phalanx thumb

126
Q

action flexor pollicis brevis

A

flexes MCPJ thumb

127
Q

innervation flexor pollicis brevis

A

rec median nn
deep head is inn’d by deep branch ulnar nn

128
Q

origin/insertion opponens pollicis

A

tubercle trapezium + flexor retinaculum –> lateral margin 1st MC

129
Q

action opponens pollicis

A

opposes thumb

130
Q

inn opponens pollicis

A

recurrent branch of the median nn

131
Q

origin/insertion abductor pollicis previs

A

tubercles scaphoid/trapezium _ flexor retinaculum –> lateral prox phalynx thumb

132
Q

action abductor pollicis brevis

A

abducts thumb

133
Q

innervation abductor pollicis brevis

A

recurrent branch median nerve

134
Q

what are the 3 hypothenar mm

A

flexor digiti minimi brevis
abductor digiti minimi
opponens digiti minimi

135
Q

inn hypothenar mm

A

ulnar nn

136
Q

origin/insertion flexor digiti minimi brevis

A

hook hamate, flexor retinaculum –> base prox phalynx little finger

137
Q

action flexor digiti minimi brevis

A

flexes MCPJ little finger

138
Q

innervation flexor digiti minimi brevis

A

ulnar nn

139
Q

origin/insertion abductor digiti minimi

A

pisiform + tendon FCU –> base prox phalynx little finger

140
Q

action abductor digiti minimi

A

abducts little finger

141
Q

inn abductor digiti minimi

A

ulnar nn

142
Q

origin/insertion opponens digiti minimi

A

hook hamate + flexor retinaculum –> medial MC 5

143
Q

action opponens digiti minimi

A

rotates finger towards palm aka opposition

144
Q

inn opponens digiti minimi

A

ulnar nn

145
Q

which thenar mm is the deepest

A

opponens pollicis

146
Q

which hypothenar mm is the most superficial

A

abductor digiti minimi

147
Q

which hypothenar mm is the deepest

A

opponens digiti minimi

148
Q

how many lumbricals in each hand

A

4

149
Q

what do the lumbricals link together?

A

extensor tendons to flexor tendons

150
Q

which lumbricals are unipenate>

A

I + II

151
Q

inn of unipenate lumbricals

A

median nn

152
Q

which lumbricals are bipenate >

A

III + IV

153
Q

inn of bipenate lumbricals

A

ulnar nn

154
Q

origin/insertion lumbricals

A

tendon of FDP –> extensor hood

155
Q

action of lumbricals

A

flex at MCPJ
extend at IPJ each digit

156
Q

where are the interossei?

A

between the metacarpal bones

157
Q

how many dorsal interossei

A

4

158
Q

origin/insertion dorsal interossei

A

lateral + medial surfaces MC –> extensor hoods prox phalynx

159
Q

action dorsal interossei

A

abduction digit
assists in flexion at MCJP
assists in exntesion at IPJ

160
Q

inn dorsal interossei

A

ulnar nn

161
Q

how many palmar interossei

A

3

162
Q

origin/insertion palmar interossei

A

medial/lateral surface metacarpal –> extensor hood + prox phaylnx same finger

163
Q

action palmar interossei

A

adduction digits
assists in flexion MCPJ
assists in extension IPJ

164
Q

inn palmar interossei

A

ulnar nn

165
Q

origin/insertion palmaris brevis

A

palmar aponeurosis + flexor retinaculum –> dermis skin of med margin hand

166
Q

action palmaris brevis

A

wrinkles skin hypothenar emininece + deepens curvature hand to improve grip

167
Q

inn palmaris brevis

A

ulnar nn

168
Q

origin/insertion adductor pollicis

A

MC III + capitate + adjacent MC II –> prox phalynx thumb

169
Q

action adductor pollicis

A

adducts thumb

170
Q

inn adductor pollicis

A

ulnar nn

171
Q

what structure runs between the 2 heads of adductor pollicis

A

radial aa

172
Q

borders anatomical snufbox

A

medial/ulnar - tendon EPL
lateral/radial - EPB +APL
proximal - styloid process radius
floor - scaphoid + tapezium
Roof- skin

173
Q

contents anatomical snuffbox (3)

A

radial aa
superficial branch radial nn
cephalic vv

174
Q

ulnar canal borders

A

medial/ulnar - pisiform, FCU tendon, abductor digiti minimi
lateral/radial - hook hamate
roof - palmar carpal ligament
floor - flexor retinaculum, pisohamatic ligament, hypothenar nn

175
Q

contens ulnar canal

A

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
Q

most common causes ulnar canal syndrome (3)

A

ganglion cyst
lipoma
trauma

177
Q

what 2 layers form the carpal tunnel

A

deep carpal arch
superficial flexor retinaculum

178
Q

laterally, which carpals form the carpal arch

A

scaphoid +trapezium tubercles

179
Q

medially, which carpals form the carpal arch (3)

A

hook hamate
pisiform

180
Q

which tendon is within the flexor retinaculum

A

Flexor carpi radialis (hence not within the tunnel itself)

181
Q

how many tendons within the carpal tunnel

A

9

182
Q

what are the 9 tendons within the carpal tunnel

A

flexor pollicis longus (own synovial sheath)
flexor digitorum profundus x 4
plexor digitorum superficialis x 4

183
Q

nn contents carpal tunnel

A

median nn - splits into recurrent branch ad palmar digitial branch

184
Q

what does the palmar digitial branch of the median nn supply

A

dorsal nail beds, palmar skin lat 3 ½ digits
motor inn to lateral 2 lumbricals

185
Q

what does the recurrent branch of the median nn supply

A

thenar mm

186
Q

Tinels test

A

tapping elicitis pain in median nn distribution when testing for carpal tunnel

187
Q

Phalens test

A

hold wrist in flexion for 60s to reproduce Sx carpal tunnel

188
Q

what are the 4 components of the flexor pulley system of the hand

A

long flexor tendons
annular pulleys x 5 per finger, 2 per thumb
cruciate pulley-x3 per finger
oblique pulley - 1 assoc w/ thumb

189
Q

what is the role of the flexor pulley system of the hand?

A

to hold the. flexor tendons against the phalanges

190
Q

where do the long flexor tendons arise from

A

FDS + FDP

191
Q

how do the long flexor tendons enter the hand

A

via the carpal tunnel

192
Q

where doe sFDS tendon attach

A

base of middle phalynx

193
Q

where does FDP tendon attach

A

base of distal phalynx

194
Q

what are the annular and cruciate pulleys

A

thickened areas of flexor fibrous sheaths

195
Q

where are annular’s 1-5 on the finger?

A

A1 = MCPJ
A2 = prox aspect prox phalyx
A3 = Prox IPJ
A4 = mid of middle IPJ
A5 = DIPJ

196
Q

where are cruciates 1-3 on the finger?

A

C1 = between A2-3
C2 = between A3-4
C3 = between A4-5

197
Q

where are A1+2 + the oblique pulley on the thumb

A

A1 = MCPJ
oblique= prox 1/2 proximal phalynx
A2 = distal 1/2 prox phalynx

198
Q

where do the superficial lymphatic vessels of the upper limb arise from

A

lymphatic plexuses of the hand and skin

199
Q

where do the lymphatic vessels shadowing the basilic vein drain

A

cubital LN

200
Q

where are the cubital LN

A

medial to the cubital vv, proximal to the medial epicondyle humerus

201
Q

where do the cubital LN drain into

A

lateral axillary LN

202
Q

where do the lymphatic vessels shadowing the cephalic vv drain into?

A

apical axillary LN

203
Q

what vessels do the deep lymphatic vessels follow

A

major deep vv
ie radial, ulnar, brachial

204
Q

where do the deep lymphatic vessels drain into

A

humeral axillary LN

205
Q

ultimately which LN do the LN of the chest wall drain into

A

–> 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

MRCS A (36 decks)

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