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Medicine > C&M Upper limb- movement > Flashcards

C&M Upper limb- movement Flashcards

1
Q

Origin, insertion and function of superior fibres of trapezius

A

Origin: external occipital protuberance, superior nuchal line, ligamentum nuchae & spinous process of C7
Insertion: lateral 1/3 of clavicle and acromion process
Function: Elevate scapula

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2
Q

Origin, insertion and function of middle fibres of trapezius

A

Origin: T1-T5 spinous processes
Insertion: superior border of spine of scapula (lateral 2/3)
Function: Retract scapula

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3
Q

Origin, insertion and function of inferior fibres of trapezius

A

Origin: T6-T12 spinous processes
Insertion: medial 1/3 of spine of the scapula
Function: Depress scapula

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4
Q

Innervation of trapezius

A

Accessory cranial nerve 11

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5
Q

Origin, insertion and function of levator scapulae

A

Origin: Transverse processes C1-C4
Insertion: medial border of scapula superior to root of spine
Function: elevate scapula and rotates scapula medially (downwards).

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6
Q

Origin, insertion and function of rhomboid major

A

Origin: spinous processes T2-T5
Insertion: medial border of scapula inferior to level of spine
Function: retract the scapula medially and superiorly. Used in squaring the shoulders

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7
Q

Origin, insertion and function of rhomboid minor

A

Origin: spinous processes of C7-T1
Insertion: medial border of scapula at the level of the spine
Function: retract the scapula medially and superiorly. Used in squaring the shoulders

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8
Q

Innervation of deep dorsal muscles (LS, RMa, Rmi)

A

Dorsal scapular nerve (C5)

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9
Q

Origin, insertion, function and innervation of serratus anterior

A

Origin: Ribs 1-9
Insertion: Medial border of scapula
Function: Protract scapula, rotate scapula laterally
Innervation: Long thoracic nerve (C5-C7)

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10
Q

Causes of winged scapula (medial border and inferior angle of scapula pull away from posterior thoracic wall)

A

Long thoracic nerve damage (superficial)
Penetrating injuries when arm abducted e.g. knife wound
Accidentally e.g. insertion of chest drain, during breast surgery (iatrogenic)
Neuritis (inflammation of the nerve)

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11
Q

How is the stability of the glenohumeral joint improved

A

Glenoid labrum- ring of cartilage
Ligaments
Biceps tendon
Rotator cuff muscles

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12
Q

Where is the glenohumeral joint weakest (therefore more likely to dislocate in this direction)

A

inferiorly

95% of shoulder (glenohumeral joint) dislocations occur in an anteroinferior direction

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13
Q

What structures prevent superior displacement of the humerus in the glenohumeral joint

A

Coracoacromial arch: Made up of the acromion, coracoid process + coracoacromial ligament

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14
Q

What is painful arc syndrome

A

Calcific Bursitis
Caused by inflammation e.g. after excessive use of glenohumeral joint
Pain during 50-130 degrees of shoulder abduction

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15
Q

Rotator cuff muscles

A

Supraspinatus
Infraspinatus
Teres Minor
Subscapularis

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16
Q

What is the only muscle that can initiate arm abduction

A

Supraspinatus

Abducts from 0-15 degrees then deltoid takes over

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17
Q

Origin, insertion, function and innervation of supraspinatus

A

Origin: Supraspinous fossa
Insertion: Greater tubercle
Function: Initiates abduction of arm (first 15°) and Stabilises glenohumeral joint
Innervation: Suprascapular nerve

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18
Q

Origin, insertion, function and innervation of infraspinatus

A

Origin: Infraspinous fossa
Insertion: Greater tubercle
Function: Lateral rotator of humerus and stabilises glenohumeral joint
Innervation: Suprascapular nerve

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19
Q

Origin, insertion, function and innervation of teres minor

A

Origin: Middle part of lateral border of scapula
Insertion: Greater tubercle
Function: Laterally rotates and adducts humerus (with infraspinatus) and Stabilises glenohumeral joint
Innervation: Axillary nerve

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20
Q

Origin, insertion, function and innervation of subscapularis

A

Origin: subscapular fossa
Insertion: Lesser tubercle
Function: Medial rotator and adductor of humerus and stabilises glenohumeral joint
Innervation: Upper and Lower sub scapular nerves (C5-C6)

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21
Q

Origin, insertion, function and innervation of teres major

A

Origin: inferior angle of scapula
Insertion: Medial lip of intertubercular of humerus
Function: Adducts and medially rotates humerus
Innervation: Lower subscapular nerve (C5 – C6)

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22
Q

Which muscle is most likely to be torn in a rotator cuff injury

A

Supraspinatus
Symptoms- pain when arm is overhead and weakness
Test - abduct arm fully, lower arm slowly with control. At about 90°, arm will fall suddenly to side.

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23
Q

What is the most common cause of glenohumeral dislocation

A

excessive extension and lateral rotation of humerus

usually in young adults

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24
Q

Which nerve can be damage in shoulder dislocation

A

Axillary nerve - passes inferior to the humeral head and winds round the surgical neck of the humerus.
Leads to deltoid atrophy + regimental badge anaesthesia

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25
Q

Nerve roots of Musculocutaneous nerve

A

C5-C7

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26
Q

Nerve roots of Median nerve

A

C6-T1

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27
Q

Nerve roots of ulnar nerve

A

C7-T1

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28
Q

Nerve roots of axillary nerve

A

C5-C6

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29
Q

Nerve roots of radial nerve

A

C5-T1

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30
Q

Boundaries of the quadrangular space

A

Superior: Teres minor
Inferior: Teres major
Medial: Long head of triceps brachii
Lateral: Surgical neck of the humerus

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31
Q

Contents of the quadrangular space

A

Axillary nerve

Posterior circumflex humeral artery and vein

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32
Q

Quandrangular space syndrome- Transient blockage of the posterior humeral circumflex artery and axillary nerve

A

Typically occurs when the arm lies in a position of abduction, extension, and external rotation
Patients note shoulder pain and paraesthesia down the arm
Often associated with fibrotic bands in quadrangular space
Uncommon condition that mostly affects athletes who perform overhead movements e.g. tennis

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33
Q

When does limb development occur

A

Mid to late embryonic phase: 4 to 8 weeks

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34
Q

Origin of limb buds

A

Buds consist of a core of tissue = lateral plate mesoderm
Mesoderm core differentiates into mesenchyme = bones and connective tissue of the limbs
Skeletal muscle of the limbs = paraxial mesoderm/somites

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35
Q

Somite Differentiation

A

Ventral part= sclerotome = vertebral column

Dorsolateral part = dermamyotome = dermis + skeletal muscles

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36
Q

Myotome differentiation

A

Dorsal epimere = back muscles which are innervated by the dorsal rami of spinal nerves
Ventral hypomere = muscles of thoracic and abdominal walls and muscles of limbs which are innervated by the ventral rami of spinal nerves

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37
Q

What does the posterior condensation of the hypomere become

A

Extensors and supinators of the upper limbs

Extensors and abductors of lower limb

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38
Q

What does the anterior condensation of the hypomere become

A

Flexors and pronators of the upper limbs

Flexors and adductors of the lower limb

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39
Q

When does limb rotation occur

A

6-8 weeks

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40
Q

What direction do upper limbs rotate

A

90° laterally so flexors lie anteriorly

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41
Q

What direction do lower limbs rotate

A

90° medially so flexors lie posteriorly

42
Q

What are the 3 axes that limb development occurs along

A
  1. Craniocaudal- the thumb is most cranial digit and the little finger is most caudal
  2. Proximodistal- from the shoulder/hip to the hand/foot
  3. Dorsoventral-
43
Q

How is proximodistal growth controlled

A

By growth factors secreted by the Apical ectodermal ridge (AER)

44
Q

How is the AER formed

A

The lateral plate mesoderm forming the mesenchymal core of the limb bud secretes a fibroblast growth factor Fgf 10
This induces thickening of the overlying ectoderm along the tip of the limb bud - the AER

45
Q

What FGFs does the AER express

A

Fgf 4 and 8
Causes rapid proliferation of mesenchymal cells underlying the AER – the progress zone (this maintains proximodistal growth).

46
Q

What does inserting FGF soaked beads into embryos cause

A

Supernumerary limb growth

47
Q

How is dorsoventral growth controlled

A

Dorsal ectoderm express Wnt7
Ventral ectoderm expresses Engrailed-1
Engrailed 1 inhibits Wnt7

48
Q

How is craniocaudal growth controlled

A

Zone of Polarising Activity (ZPA) - small region of mesenchyme in the caudal part of the limb bud
Where sonic hedgehog (Shh) gene is expressed

49
Q

Which direction does Shh diffuse to

A

from ZPA in a cranial direction

50
Q

What does Shh do

A

High concentration of Shh induces formation of caudal structures e.g. little finger
Low concentration induces formation of cranial structures e.g. thumb.

51
Q

What happens when you transplant the ZPA so that there are 2 on a limb

A

Mirror image polydactyly of the limb

52
Q

What is amelia

A

Complete absence of a Limb

e.g. early loss of Fgf signalling

53
Q

What is phocomelia

A

Digits develop prematurely.
Proximal elements of limb absent aka flipper limb.
Can be due to genetic factors or teratogen e.g. Thalidomide inhibits Fgf 10 and 8 expression

54
Q

What is meromelia

A

Partial absence of a Limb

e.g. later or partial loss of Fgf signalling

55
Q

What direction do most dislocations of the elbow occur in

A

Posterior dislocation- The distal end of humerus is driven through the weak anterior part of the joint capsule

56
Q

What nerve can be affected in elbow dislocations and what are the symptoms

A

Ulnar nerve injury

Numbness of medial part of palm and medial 1.5 fingers and weakness of flexion and adduction of the wrist

57
Q

What are the 3 flexors of the elbow joint

A

Brachialis- main flexor
Biceps Brachii
Brachioradialis- accessory flexor of elbow joint when forearm is mid-pronated

58
Q

The origins of triceps brachii

A

Long head - Infraglenoid tubercle (scapula)
Lateral head - Posterolateral humerus above spiral groove
Medial head - Posteromedial humerus below spiral groove

59
Q

Insertion of triceps brachii

A

Olecranon process

60
Q

Innervation of triceps brachii

A

Radial nerve (C5-T1)

61
Q

What is the function of the annular ligament of the radius

A

Maintains stability of radius

Allows rotation of the radius during pronation and supination of the forearm.

62
Q

Why is the radius more prone to subluxation/dislocation in childhood

A

Annular ligament relatively weak

63
Q

What nerve controls pronation

A

Median nerve

Pronator teres and pronator quadratus contract

64
Q

What nerves control supination

A

Radial and musculocutaneous nerves

Supinator and biceps brachii contract

65
Q

What is Golfers elbow

A

Inflammation at insertion of wrist flexor tendons into the medial epicondyle

66
Q

What is Tennis elbow

A

Inflammation at insertion of the wrist extensor tendons into the lateral epicondyle

67
Q

What nerve can be damaged when the medial epicondyle is avulsed

A

Ulnar nerve

68
Q

What nerve can be damaged when the surgical neck of the humerus is fractured

A

Axillary nerve

69
Q

What nerve can be damaged when the shaft of the humerus is fractured

A

Radial nerve in the radial groove

70
Q

What structures can be damaged when the supracondylar humerus is fractured

A

Median nerve- supplies flexors of the forearm

Brachial artery - stopping all blood flow past elbow, can lead to necrosis of forearm and possibly amputation

71
Q

Which tendon does not pass through the carpal tunnel and goes straight to the flexor retinaculum

A

Flexor Carpi Radialis

72
Q

Which structures lie above the flexor retinaculum

A

Ulnar nerve + Ulnar artery (in Guyons canal)

Palmaris Longus tendon

73
Q

Which nerve supplies most of the intrinsic hand muscles

A

Ulnar nerve

EXCEPT thenar muscles and 1st and 2nd lumbricals – median nerve

74
Q

Which branch of the median nerve supplies the thenar muscles

A

Recurrent branch

75
Q

Which branch of the median nerve is given off before it enters the carpal tunnel

A

Palmar cutaneous branch- supplies lateral side of palmar skin

76
Q

What do the digital branches of the median nerve supply

A

1st and 2nd lumbricals
Palmer - lateral 3 ½ digits
Dorsal - distal half of lateral 3 ½ digits

77
Q

What is the action of the lumbricals

A

Flexion at metacarpophalangeal joint and extension at interphalangeal joint
“bye-bye” muscles

78
Q

Symptoms of carpal tunnel syndrome

A

Wasting of thenar eminence because recurrent branch of median nerve is affected
Pins and needles in the cutaneous distribution of digital branches of median nerve e.g. tip of fingers etc

79
Q

What nerve can be damaged in lunate dislocation

A

Median nerve
(FOOSH) Lunate displaced anteriorly
Similar symptoms to carpal tunnel syndrome

80
Q

What does the palmar branch of the ulnar nerve supply

A

Medial palmar skin

81
Q

What does the dorsal branch of the ulnar nerve supply

A

Lateral side of dorsum and lateral 1 ½ digits

82
Q

What does the superficial branch of the ulnar nerve supply

A

Palmer surface of lateral 1 ½ digits

Palmaris brevis

83
Q

What does the deep branch of the ulnar nerve supply

A

Hypothenar muscles, adductor pollicis, palmar and dorsal interossei and 4th + 5th lumbricals.

84
Q

What symptoms does ulnar nerve compression/handlebar neuropathy cause

A

Sensory loss palmer surface of lateral 1 ½ digits
Motor weakness in the intrinsic muscle of the hand (except thenar eminence and lateral 2 lumbricals)
Hyperextension of metacarpophalangeal joints of digits 4 and 5 (extension is unopposed due to paralysis of lumbricals) = clawhand

85
Q

What is the most common bone fractured in the wrist

A

Scaphoid

Causes tenderness in the anatomical snuffbox

86
Q

Why can avascular necrosis occur after a scaphoid fracture

A

Blood enters the scaphoid distally, therefore, in the event of a fracture, blood supply to the proximal part may be disrupted

87
Q

What is Colles fracture

A

Fracture of the distal end of the radius
Most common in old people/ women due to osteoporosis
Usually the result of FOOSH
Often the ulnar styloid process is avulsed
Dinnerfork deformity

88
Q

How do the vertebral arteries become to basilar artery

A

Vertebral artery branches of subclavian artery
Travel upwards through transverse foramina C6-C1
Passes through foramen magnum
Unite to form basilar artery

89
Q

What is subclavian steal syndrome

A

Occlusion of the subclavian artery proximal to the vertebral artery origin (atherosclerosis) causing reversed flow in the ipsilateral vertebral artery
Blood is ‘stolen’ from the circular vertebrobasilar system to supply the distal territory of the occluded or stenosed artery

90
Q

What arteries given off by the axillary artery are at risk of rupture when the surgical neck of the humerus is fracture

A

Anterior and posterior circumflex humeral arteries

91
Q

Where does the axillary artery become the brachial artery

A

Inferior border of teres major

92
Q

What are the 3 main branches given off the brachial artery

A

Profunda brachii artery
Superior ulnar collateral artery
Inferior ulnar collateral artery

93
Q

Where does the brachial artery divide into the radial and ulnar arteries

A

Cubital fossa

94
Q

What does the profunda brachii artery supply and where does it run

A

Posterior muscle compartment of the arm- triceps

Radial groove alongside the radial nerve- can be damaged in fracture of shaft of humerus

95
Q

What are peri-articular anastamoses

A

Network of anastomoses of brachial and profunda brachii arteries in the arm with radial and ulnar arteries in the forearm.
Ensures blood flow to the forearm even if elbow is fully flexed.

96
Q

What are the arteries involved in the peri-articular anastamoses

A

Profunda brachii gives off radial collateral artery which anastamoses with radial recurrent artery
Superior and inferior Ulnar collateral arteries anastamose with Anterior and posterior ulnar recurrent arteries

97
Q

What does the radial artery supply

A

Supplies the anterolateral aspect of the forearm including flexors and extensors

98
Q

What does the ulnar artery supply

A

Supplies the medial side of forearm – mainly flexors and pronators
Gives off common interosseous artery which gives off anterior and posterior interosseous arteries which supply the middle of the flexor and extensor compartments respectively.

99
Q

What does the cephalic vein drain and where does it run

A

Drains lateral side of dorsal venous arch
Runs lateral side of arm into deltopectoral triangle and pierces clavipectoral fascia
Drains into axillary artery

100
Q

What does the basilic vein drain and where does it run

A

Drains medial side of dorsal arch and median cubital vein
Runs medial side of arm
Joins with deep arm veins/venae comitantes to form axillary vein

Medicine (7 decks)

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