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MSK > Arm and Shoulder Joint > Flashcards

Arm and Shoulder Joint Flashcards

1
Q

_____ for attachment of the long head of the biceps

A

Supraglenoid tubercle

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2
Q

_______ for attachment of the long head of the triceps

A

Infraglenoid tubercle

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3
Q

Distal humerus has two articular surfaces:

A
  1. Capitulum (lateral) for articulation with the head of the radius
  2. Trochlea (medial) for articulation with the ulna
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4
Q

______ receives the coronoid process of ulna during flexion of elbow

A

Coronoid fossa

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5
Q

_____ receives radial head during flexion of elbow

A

Radial fossa

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6
Q

_______ located on the posterior surface for passage of the radial nerve and the deep brachial artery

A

Radial groove

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7
Q

_______ on posterior aspect of the medial epicondyle for the passage of the ulnar nerve (common site for ulnar nerve impingement)

A

Ulnar groove

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8
Q

_____ are incorporated into these veins at regular intervals to increase the efficiency of venous return

A

Valves

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9
Q

_____ are located within the subcutaneous tissues (easily visible)

A

Superficial veins

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10
Q

Cephalic Vein- ascends the anterior lateral aspect of the arm- courses through the _____ where it joins the axillary vein (a deep vein)

A

Deltopectoral Triangle

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11
Q

_____ ascends the anterior medial aspect of arm- then pierces the deep (brachial) fascia in the middle of arm to join the brachial veins (which are deep veins)

A

Basilic vein-

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12
Q

Both superficial veins communicate via the _____ anterior to the elbow- a common site for phlebotomy

A

median cubital vein

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13
Q

Sheath of deep fascia that encloses the arm like a sleeve- continuous from the deltoid, pectoral, and axillary fascia proximally

A

Brachial Fascia

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14
Q

The brachial fascia continues distally into the forearm as _____

A

antebrachial fascia

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15
Q

Strong septa arise from this brachial fascia and attach to the shaft of the humerus and …

A

These medial and lateral intermuscular septa divide the arm into an anterior (flexor) and posterior (extensor) compartments

These compartments share muscles with similar function and innervation

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16
Q

muscles of the anterior arm compartment and what they are innervated by

A

biceps, brachialis, coracobrachialisis; muscuolocutanous nerve

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17
Q

The Biceps Brachii orginates from two heads

A
  1. short head from the coracoid process of scapula
  2. long head from the supraglenoid tubercle of scapula (tendon courses in the intertubercular sulcus or bicpital groove)
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18
Q

The biceps brachii inserts into the _____ and the ______ via the bicipital aponeurosis

A

proximal radius (radial tuberosity); antebrachial fascia

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19
Q

Bicep muscles crosses two joints (shoulder and elbow)…hence it acts on both joints

A
  1. Flexes the shoulder joint
  2. Powerful supinator of the forearm but also a flexor of forearm (elbow joint)
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20
Q

Ruptured Biceps

A

Rupture of the long head of the biceps generally occurs due to “wear and tear” or prolonged tendonitis (baseball pitchers, weight lifters) or chronic arthritis (i.e. rheumatoid arthritis) within the joint

Tendon commonly tears from the supraglenoid tubercle of the scapula (audible “snap or pop” can often be heard)

Detached muscle belly forms a prominent “ball” near the center of the anterior arm

Hence the description… “Popeye deformity”

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21
Q

Located deep to the Biceps

Originates from distal ½ of the humerus

nInserts into the proximal ulna (tuberosity of the ulna)

Prime flexor of the forearm (elbow)

Innervated by (C5 & C6) of the musculocutaneous nerve

A

Brachialis

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22
Q

Coracobrachialis orginates from the

A

ncoracoid process

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23
Q

Coracobarchiallis inserts in the

A

middle 1/3rd of the humerus

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24
Q

coracobrachiallis motion

A

nBoth a flexor and adductor of the arm

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25
Q

Musculocutaneous Nerve arises from ___ and innervates anterior/posterior compartments of the anterior arm and continues as the ____

A

Arises from the lateral cord of the brachial plexus; anterior; Continues as the lateral cutaneous nerve of the forearm (aka the lateral antebrachial cutaneous nerve)

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26
Q

Subclavian artery passes the 1st rib it becomes the _____

A

axillary artery

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27
Q

Axillary traverses the teres major muscles it becomes the ____

A

brachial artery

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28
Q

The axillary artery which turns into the brachial artery accompanies the ___ nerve

A

median nerve

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29
Q

It is clinically significant in that the brachial artery can sometimes be ligated (tied-off) just above the elbow (i.e. to control heavy post traumatic bleeding) because of the _______

A

extensive collateral branches can continue to perfuse the forearm and hand

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30
Q

_____ artery -largest branch and accompanies the radial nerve through the radial groove

A

Deep (Profunda) Brachial Artery

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31
Q

Superior Ulnar Collateral Artery- accompanies the _____ nerve posterior to medial epicondyle of humerus

A

ulnar

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32
Q

Collateral vessels provide also

important anastomoses

(alternate route for blood

flow) around the elbow joint during flexion/extension

A

during limb flexion

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33
Q

only one muscle located in posterior compartment of the arm

A

Triceps Brachii

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34
Q

the three heads of the triceps brachii; and which ones in respect to radial groove

A

1.Long head originates from the infraglenoid tubercle of scapula

2.Lateral head originates from the posterior surface of humerus superior to radial groove

3.Medial head originates from the posterior surface of humerus inferior to radial groove

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35
Q

all three heads of the tricep brachii insert into the

A

olecranon process of ulna

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36
Q

motion of the tricep brachii

A

Prime extensor of the forearm

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37
Q

innervation of tricep brachii

A

Innervated by (C6, C7 & C8) of the radial nerve

38
Q

________ nerve courses through the posterior compartment in the radial groove beside the profunda (deep) brachial artery (triangular interval)

A

radial nerve

39
Q

Radial nerve then gives rise to the __________ of the arm and forearm which supply sensation to the skin along the posterior (dorsal) aspect of the upper limb

A

Posterior cutaneous nerves

40
Q

Mid Shaft Humeral Fractures

A

Frequently result from direct trauma (auto accidents)

Proximal fragment often displaces laterally due to pull of the deltoid muscle

Radial nerve can be stretched or transected along the radial groove leading to permanent damage and loss of function

As you will soon learn, the radial nerve ALSO innervates all the muscles that “extend” the wrist…patients typically present with wrist drop due to loss of innervation of the extensors muscles of the forearm and hand

“Saturday Night Palsy”…compression of radial nerve against the humerus can cause a temporary wrist drop

41
Q

Surgical
Neck Fractures

A

nSurgical neck located just distal to the tuberosities

nThese fractures an be associated with injure to the axillary nerve

nAxillary nerve damage can result in paralysis and atrophy of deltoid-loss of rounded shoulder contour

42
Q

______ vessels drain lymph fluid from the skin and subcutaneous tissues and converge to follow the cephalic and basilic veins (superficial veins)

A

Superficial lymphatic

43
Q

_______ drain lymph fluid from joints, muscles, and bones and accompany _______ veins

A

Deep lymphatic vessels; deep

44
Q

Lymph from these nodes then joins the venous system via the _______ or the _________ which both convey the lymph fluid into the venous system (via the subclavian veins)

A

right lymphatic duct (right upper limb); thoracic duct (left upper limb)

45
Q

Glenohumeral Joint

A

nBall-and-socket type synovial joint

nExtremely mobile joint-but relatively unstable

nLarge humeral head articulates with the small, shallow glenoid cavity

46
Q

______ a fibrocartilagenous “ring” that surrounds and deepens the glenoid cavity- providing greater stability

A

Glenoid Labrum

47
Q

_______ helps stabilize and hold the humeral head within glenoid cavity

A

Musculotendinous Rotator Cuff

48
Q

___________ holds long head of bicep tendon in the bicipital groove

A

Transverse humeral ligament

49
Q

_______ lines the inside of the joint capsule and reflects/surrounds the tendon of the long head of the biceps

A

Synovial membrane

50
Q

Shoulder Dislocations

A

The glenohumeral joint is extremely mobile- providing a wide range of movements at the expense of stability

For this reason- it is the most frequently dislocated major joint in the body

Structurally- the inferior aspect of the joint is the weakest

Dislocations due to trauma are most common in the anterior-inferior direction…often tearing the labrum and anterior joint capsule/subscapularis tenson

Humeral head often ends up beneath the coracoid process (sub-coracoid)

Once dislocated, the joint is susceptible to frequent dislocations

51
Q

Other cutaneous nerves arise directly from the major branches of the plexus:

A

Lateral cutaneous nerve of the forearm (from the musculocutaneous nerve)

Superior lateral cutaneous nerve (from the axillary nerve)

52
Q

Some of these “cutaneous nerves” arise directly from the medial cord of the plexus:

A

Medial cutaneous nerve of the arm

Medial cutaneous nerve of the forearm

53
Q

nSimilarly, most of the cutaneous nerves on the posterior aspect of the upper limb arise from the radial nerve:

A

nPosterior cutaneous nerve of the arm

nPosterior cutaneous nerve of the forearm

nSuperficial branch of the radial nerve

54
Q

___ are relatively common and tend to occur in an anterior-inferior direction

A

nShoulder dislocations

55
Q

nShoulder dislocations can tear/damage the _______ which results in a high incidence of recurrence

A

glenoid labrum

56
Q

Mid-shaft fractures of the humerus can injure the ______ resulting in loss of function (wrist drop)

A

radial nerve

57
Q

______ is susceptible to tendonitis and subsequent tears due to its course thru the bicipital groove and intra-articular position within the shoulder

A

Long head of the bicep

58
Q

Beatrice Long, a 77 year-old female with a 20 year history of rheumatoid arthritis presents to the

orthopedic clinic. She has been on steroid medication for ~ 10 years to help control chronic

arthritis in her joints. 3 months ago, she had a cortisone injection into her right shoulder to

help alleviate serve pain and inflammation.

Beatrice explains to her orthopedic physician that while attempting to lift a heavy box yesterday,

she felt something “give-way” in her right shoulder area. She also complains that now she feels

a “lump’ in the middle of her upper arm.

Which of the following is likely to have occurred?

A. Torn acromioclavicular ligament

B. Torn rotator cuff muscle

C. Torn deltoid muscle

D. Torn biceps muscle

A

D. Torn biceps muscle

59
Q

Whalen, a 30 year-old man is inebriated and falls asleep on a park bench on Franklin

Street in Chapel Hill. When he awakes, he realizes he had been sleeping there

for nearly 6 hours.

Which of the following nerves was most likely compressed/damaged with his arm

lying against the hard wooden bench for 6 hours? Think…Pair…and Share

A.Axillary

B.Musculocutaneous

C.Radial

D.Median

E.Ulnar

A

C.Radial

60
Q

Imaging: Physician orders X-rays to evaluate osseous and/or ligamentous damage

Diagnosis: Traumatic left subcoracoid dislocation of the glenohumeral joint

Treatment: Under sedation, the dislocation is reduced (X-rays confirm), Sheryl is placed in a

splint for several weeks followed by rehabilitation physical therapy

Sheryl returns 3 months post reduction. She denies any pain in the shoulder joint…

but she mentions that she is still experiencing some tingling sensations along her left forearm.

Based on these new symptoms, which nerve could she have damaged? Think…Pair..and Share

A.Axillary

B.Radial

C.Long Thoracic

D.Musculocutaneous

E.Suprascapular

A

D.Musculocutaneous

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radial nerve

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75
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Surgical
Neck Fractures

76
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Mid Shaft Humeral Fractures

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MSK (10 decks)

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