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Anatomy > Chapter 6: Upper Limb > Flashcards

Chapter 6: Upper Limb Flashcards

1
Q

How are clavicular fractures often caused? (2)

A

1) indirect force transmitted via an outstretched hand through the bones of the forearm/ arm to the shoulder during a fall
2) fall directly on the shoulder

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2
Q

T/F: The clavicle is one of the most frequently fractured bones.

A

true

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3
Q

Where is the weakest part of the clavicle?

A

the junction of its middle and lateral thirds

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4
Q

Clavicular fractures are especially common in what population?

A

children

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5
Q

What anatomy differences occur following a clavicle break?

A
  • the sternocleidomastoid muscle elevates the medial clavicle, making it palpable
  • trapezius is unable to elevate the lateral clavicle anymore due to the weight of the arm, so the shoulder drops
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6
Q

What ligament usually prevents dislocation of the acromioclavicular joint?

A

coracoclavicular ligament

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7
Q

What is a greenstick fracture?

A
  • where one side of a bone is broken and the other is bent; a bone just bends and cracks, doesn’t break into two parts
  • this kind of fracture will occur in younger kids with their clavicles
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8
Q

How does a fracture of the scapula occur? How do you treat?

A
  • only through severe trauma (pedestrian vs. car accident), and usually ribs are fractured as well
  • little treatment because scapula is surrounded on both sides by muscles
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9
Q

Where do most injuries of the proximal humerus occur, and who are they most common in?

A

surgical neck; older people with osteoporosis

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10
Q

T/F: Fractures of the radius and ulna are not that hard to do.

A

false, usually the result of severe injury

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11
Q

Due to the interosseus membrane holding together the radius and ulna, a fracture of one of those bones is likely to be associated with what other injury?

A

dislocation of the nearest joint

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12
Q

What is the most common fracture of the forearm? How does it result?

A
  • colles fracture; complete transverse fracture of the distal 2cm of the radius
  • results from forced extension of the hand, usually trying to ease a fall
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13
Q

How does a “dinner fork deformity” result?

A

colles fracture; posterior angulation results

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14
Q

What is the most frequently fractured carpal bone? How does it usually happen?

A
  • scaphoid; fallling on palm when hand is abducted
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15
Q

When fracturing the hamate, what nerve can be injured? What motions will this limit?

A

ulnar nerve, causing decreased grip strength

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16
Q

T/F: Fractures of the metacarpals tend to heal slowly.

A

false, heal pretty rapidly if they are isolated and stable, and because they have a good blood supply

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17
Q

What’s a boxers fracture, and how does it happen?

A

fracture of the 5th metacarpal, occurs when an unskilled person punches someone with a closed and abducted fist

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18
Q

T/F: Crushing injuries of the distal phalanges are common.

A

true, think car door slamming on fingers

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19
Q

What is a comminuted fracture?

A

fractured into more than two pieces

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20
Q

What is the first long bone to ossify and the last to be fully formed?

A

clavicle

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21
Q

What bone connects the upper limb to the trunk?

A

clavicle (AC joint)

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22
Q

T/F: The ulna doesn’t meet the wrist.

A

true; all forces received by the hand are transmitted from radius to ulna via interosseous membrane

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23
Q

Surface anatomy: what landmarks are at the following spots

1) T2
2) T3
3) T7/ rib 8

A

1) superior angle @ T2
2) root of scapular spine (medial) @ T3
3) inferior angle @ T7/rib 8

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24
Q

What four joints make up the upper extremity? What types of joints are they?

A

1) sternoclavicular (synovial, saddle)
2) acromioclavicular (synovial, plane)
3) scapulothoracic (physiological joint, not real)
4) glenohumeral (synovial, ball and socket)

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25
Q

What are the three ligaments involved in the sternoclavicular joint?

A

anterior sternoclavicular joint, interclavicular joint, and costoclavicular joint

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26
Q

What are the two divisions of the coracoclavicular ligament, and which one is medial?

A 
trapezoid ligament (lateral)
conoid ligament (medial)
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27
Q

What is the only true joint between the upper extremity and axial skeleton?

A

sternoclavicular joint

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28
Q

When a clavicle moves up and down, where does most motion occur? When it protracts and retracts, where does most movement occur?

A

1) between the clavicle and the disk (for elevation and depression)
2) between the disk and the sternum

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29
Q

Where does the costoclavicular ligament specifically attach, and when is it taut?

A
  • attaches to first rib and costal tubercle on the clavicle

- taut when arm elevated or shoulder is protracted (so when clavicle would be up)

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30
Q

T/F: The sternoclavicular joint is very stable.

A

true, because of all the ligaments and the way the bones articulate

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31
Q

Where are you most likely to fracture your clavicle?

A

the weak middle portion

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32
Q

What ligament(s) resist(s) vertical displacement of clavicle?

A
  • coracoclavicular ligament: trapezoid and conoid portions

- this means it resists upward movement

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33
Q

T/F: The conoid portion of the coracoclavicular ligament allows for some rotation.

A

true, need this for arm elevation

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34
Q

When we abduct/elevate our arm, what happens to the clavicle?

A

it rotates backwards a bit on the sternum

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35
Q

What ligaments resist upward movement of the clavicle?

A

coracoclavicular ligament, costoclavicular ligament, sternoclavicular ligament

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36
Q

What ligament is taut when the clavicle is depressed?

A

interclavicular ligament

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37
Q

What ligament prevents upward rotation of the clavicle?

A

anterior sternoclavicular ligament

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38
Q

Movement of the pectoral girdle involves what three joints?

A

sternoclavicular, acromioclavicular, and glenohumeral joints

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39
Q

How many degrees of abduction are allowed without movement of the scapula?

A

30 degrees

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40
Q

When the arm is fully elevated at 180 degrees, how much is the scapula’s doing and how much is the humerus?

A

60 degrees rotation of scapula, 120 degrees of rotation of humerus at shoulder joint (more movement in the humerus)

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41
Q

Which muscles are active in fist clenching?

A

extensor carpi radialis longus (ECRL) and extensor carpi ulnaris (ECU)

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42
Q

If the spinal accessory nerve is damaged, what impairment follows?

A

(trap and sternocleidomastoid) ipsilateral weakness when the shoulders are elevated against resistance

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43
Q

What impairment follows a dorsal scapular nerve injury?

A

(rhomboids and levator scapulae) scapula is farther from midline, weak retraction of scapula

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44
Q

What muscles/areas does suprascapular nerve innervate?

A

supraspinatus, infraspinatus, GH and AC joint capsules

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45
Q

What impairment results from a torn suprascapular nerve?

A

weak external rotation at the GH joint

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46
Q

If a patient is struggling with adduction and internal rotation of their arm, what muscles do you suspect aren’t firing? What nerve(s) are the cause of this?

A

pec major and minor, with the medial and lateral pectoral n. potentially injured

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47
Q

A winging scapula indicates damage to what nerve?

A

long thoracic, innervates the serratus anterior

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48
Q

What can happen when the nerve to subclavius is injured?

A

you lose the subclavius muscle innervation, so clavicle can become unstabilized

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49
Q

What muscle does the upper subscapular n. innervate?

A

superior subscapularis

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50
Q

What muscle does the lower subscapular n. innervate?

A

inferior subscapularis and the teres major

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51
Q

What nerve innervates teres major?

A

lower subscapular nerve

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52
Q

If a patient is unable to raise their trunk with their upper limbs, what nerve may be damaged?

A

(latissimus dorsi), thoracodorsal nerve

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53
Q

What nerve pierces through the pronator teres?

A

median

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54
Q

What nerve forms the anterior interosseous nerve?

A

median

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55
Q

What nerve forms the posterior interosseous nerve?

A

radial

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56
Q

What motion does the acromioclavicular ligament limit?

A

posterior translation of clavicle

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57
Q

What is the function of the labrum?

A

holds the humeral head in the glenoid cavity; increases the surface area of the glenoid cavity for more contact with the head

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58
Q

What is the most injured rotator cuff muscle? Why?

A

Supraspinatous, because there’s such little room where it’s tendon is coming out that it can get rubbed and pinched

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59
Q

What ligaments prevent anterior translation of the humerus?

A

the glenohumeral ligament, all parts

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60
Q

T/F: Baseball players tend to have excessive external rotation going on.

A

false, internal rotation

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61
Q

If the labrum is torn, what can also be affected? Why?

A

the biceps brachii because its insertion is 50% on tubercle, 50% on the superior labrum; have to make sure your patient is cleared for bicep activities

62
Q

What is found in the supraspinatus outlet?

A

supraspinatus tendon, artery, and nerve

63
Q

What is the purpose of a bursa?

A

to reduce friction

64
Q

What’s the biggest external rotator of the rotator cuff?

A

infraspinatus

65
Q

What does the coracohumeral ligament do?

A

strengthens the superior aspect of the joint, prevents humeral head from hanging down (same as SGHL)

66
Q

What is the axillary recess?

A

pouch created by the inferior GH ligament; humeral head moves into here during elevation

67
Q

10-15% of people are missing which GH ligament?

A

middle glenohumeral ligament

68
Q

Which glenohumeral ligament is the thickest?

A

inferior GH ligament

69
Q

What is the purpose of the rotator cuff?

A

stabilizes the GH joint

70
Q

What is the main blood supply to the GH area and muscles?

A

post/anterior humeral circumflex a.’s, suprascapular a.

71
Q

What is scapular dyskinesia?

A

When scapula doesn’t move along thoracic wall like it should

72
Q

What are the boundaries of the axillary artery divisions?

A

first part begins at 1st rib, ends at superior pec minor
second part is posterior to pec minor
third part is from inferior pec minor to teres major

73
Q

What are the two divisions of the axillary artery in the second part?

A

thoracoacromial and lateral thoracic

74
Q

Scapular circumflex a. anastemoses with what other artery?

A

suprascapular a., a branch off of subclavian a.

75
Q

The roots of the brachial plexus can be compressed by what muscles up in the neck? How could they get tight?

A

anterior and middle scalenes; poor posture

76
Q

What can an extra cervical rib do?

A

cause brachial plexus symptoms; tingling down arm

77
Q

At what point does the subclavian become the axillary artery? At what point does axillary become brachial?

A

1st rib and teres major

78
Q

What are the three trunks of the brachial plexus?

A

superior, middle, inferior

79
Q

What are the supraclavicular branches of the brachial plexus? (4)

A

suprascapular n., NTS, dorsal scapular n., long thoracic n.

80
Q

The lateral cord supplies what group of muscles?

A

flexors

81
Q

The posterior cord supplies what group of muscles?

A

extensors

82
Q

The medial cord supplies what group of muscles?

A

flexors

83
Q

What does the axillary nerve supply?

A

deltoid and teres minor

84
Q

What’s the largest nerve off of the brachial plexus?

A

radial

85
Q

What nerve courses through the dorsum of the hand?

A

superficial branch of radial

86
Q

What injuries cause the waiter’s tip presentation?

A

injury to roots of C5-6, so axillary, musculocutaneous, and suprascapular nerves

87
Q

If the humerus fractures, what nerve is succeptible to damage?

A

radial nerve

88
Q

What muscles are innervated by musculocutaneous?

A

biceps brachii, coracobrachialis, brachialis

89
Q

What is Erb’s palsy?

A

can result from that waiter’s tip position caused during childbirth tear of C5-6

90
Q

What is suprascapular neuropathy?

A

caused by compression/traction of suprascapular nerve at either the notch or spinoglenoid region

91
Q

What are common signs of suprascapular neuropathy?

A

posterior shoulder pain, muscle weakness, atrophy

92
Q

What artery passes through the scalenes along with the roots of the brachial plexus?

A

subclavian artery

93
Q

What nerve is injured in claw hand? What happens in claw hand?

A

ulnar; MCP hyperextended, IPs flexed; smooth flexion pattern is lost when grabbing objects

94
Q

What are the three superficial veins?

A

cephalic, basilic, and median cubital

95
Q

Musculocutaneus n. pierces through what muscle?

A

coracobrachialis

96
Q

What vein is in the deltopectoral triangle?

A

cephalic

97
Q

The transverse humeral ligament that holds down the long head of the bicep is a combination of what three things?

A

subscapular tendon, coracohumeral ligament, and superior glenohumeral ligament (which are parts of the rotator cuff, so rotator cuff injuries could injure bicep)

98
Q

What’s in the quadrangular space?

A

posterior humeral circumflex a., and axillary artery

99
Q

What are the boundaries of the triangular space?

A

teres minor, major, and long head of the tricep

100
Q

What nerve supplies teres major?

A

lower subscapular n.

101
Q

Which head of the triceps is the workhorse? Which head is the strongest?

A

medial; lateral

102
Q

Volkman’s contracture leads to ischemia to where?

A

ischemia to the posterior arm caused by a humeral fracture; this causes deep brachial a. to be severed, leading to pain and loss of power; claw hand can result

103
Q

The tendon of the subscapularis helps form what structure?

A

the transverse humeral ligament

104
Q

Which muscle is very weak after rotator cuff surgery or total shoulder arthroplasty?

A

subscapularis because they cut into that to get into the joint

105
Q

What RTC repair issues should be taken into consideration?

A

size of tear, type of tear, tissue quality (diabetes), age (older tissue), type of surgical repair

106
Q

Strengthening what muscle can help fix a rounded shoulder?

A

pec minor

107
Q

Will you get glenohumeral extension if the radial nerve is cut high?

A

no

108
Q

What muscle does the median nerve pierce?

A

pronator teres

109
Q

What muscle can compress the ulnar?

A

flexor carpi ulnaris

110
Q

The axillary artery becomes the brachial artery at what marker?

A

inferior teres major

111
Q

The bicep tendon is tapped in the cubital fossa for test for the function of what nerve root?

A

C6

112
Q

The tricep tendon is tapped to test for the function of what nerve root?

A

C8

113
Q

What 3 nerves are injured in the waiter’s tip presentation?

A

axillary, musculocutaneous, suprascapular

114
Q

What’s an example of an injury to the inferior parts of the brachial plexus?

A

clawhand: C8-T1

115
Q

How does an infant with waiter’s tip present?

A
  • internally rotated: external rotators from suprascapular n.(infra and supra) and axillary (teres minor) are gone
  • extended: flexors from musculocutaneus are gone
  • adducted: abductor from suprascapular n. (supra) is gone
116
Q

When can the axillary nerve be compressed? What muscles would suffer?

A

while using crutches; delt and teres minor

117
Q

What is teres major innervated by?

A

lower subscapular n.

118
Q

How does clawhand present?

A

extended MP and flexed IPs (ulnar nerve injury)

119
Q

What are the two compression sites for the suprascapular nerve?

A

under the transverse scapular ligament or the spinoglenoid region

120
Q

When can the long head of the biceps be a depressor?

A

during extreme external rotation

121
Q

What is all in the cubital fossa? (5)

A
  1. biceps tendon
  2. brachial artery
  3. median nerve
  4. radial nerve
  5. MABC (from brachial plexus) and LABC (from musculocutaneus)
122
Q

What is the covering of the cubital fossa?

A

aponeurosis of bicep

123
Q

What’s the floor of the cubital fossa?

A

brachialis and supinator; radial artery and scaphoid

124
Q

What do the collateral branches of the brachial artery supply? What about the nutrient branches?

A

collateral branches = supply elbow jt

nutrient branches = supply humerus

125
Q

What’s the carrying angle of the elbow and what does it allow?

A

17.8 degrees, allows for your arm to swing alongside your trunk

126
Q

The capitulum articulates with what?

A

head of the radius

127
Q

The radial collateral ligament connects what to what?

A

lateral epicondyle to head of radius, blending with the annular ligament

128
Q

With what kind of motion is the RCL stressed?

A

VERRIS motion (moving forearm toward trunk)

129
Q

The ulnar collateral ligament connects what to what?

A

medial epicondyle to coronoid and olecranon; has three bands

130
Q

Which of the three bands of the UCL is the strongest? The weakest?

A

anterior; posterior

131
Q

Which motion stresses the UCL?

A

VALGUS motion (moving forearm away from trunk)

132
Q

What does the annular ligament of the elbow do?

A

wrap around the head of the radius, supports proximal radioulnar joint

133
Q

What is Cooper’s ligament?

A

the transverse bundle of the UCL

134
Q

What is pronator syndrome?

A

When the pronator teres is too tight, maybe from repetitive motion, causing the median nerve to be compressed

135
Q

What makes up the cubital tunnel and what goes through it?

A

MCL and arcuate ligament; ulnar nerve passes through here and goes through FCU

136
Q

What nerve supplies the brachioradialis?

A

Radial

137
Q

What kind of joint is the radiocarpal joint?

A

condyloid joint w/ synovial membrane

138
Q

At what joint does pronation/supination occur?

A

distal radioulnar joint

139
Q

What is the primary stabilizer of the radioulnar joint?

A

triangular fibrocartilage complex (gymnasts and hockey players tear this with falls)`

140
Q

Radial carpal collateral ligament connects what to what?

A

radius to scaphoid

141
Q

Ulnar carpal collateral ligament connects what to what?

A

ulna to triquetrum

142
Q

What do the vincula do?

A

blood supply to the tendons; connect tendons to anterior surface of phalange

143
Q

How is carpal tunnel caused?

A

repetitive movements tighten the flexor retinaculum, compressing the median nerve

144
Q

What do the synovial sheaths on the extensor side of the hand do?

A

help reduce friction on tendons

145
Q

What is the purpose of the flexor retinaculum?

A

holds down tendons for efficient biomechanics on fingers

146
Q

What is the purpose of the palmar aponeurosis?

A
  • separates the hand into compartments; thumb, medial, lateral
  • also protects tiny hand muscles/vessels
147
Q

If the hand is infected on the lateral side, will it likely spread to the medial side?

A

NO because the palmar aponeurosis separates the hand into compartments, making them distinct and separate

148
Q

What artery makes up the superficial palmar arch?

A

ulnar a.

149
Q

The pisohamate ligament is also known as what?

A

tunnel of guyon, where ulnar n. and a. pass under

150
Q

Lumbricals insert on what tendon?

A

flexor digitorum profundus, so they have the same innervation (half ulnar, half median)

151
Q

What is the innervation of the flexor pollicis brevis?

A

deep head = ulnar

superficial head = median

152
Q

What is the innervation of the adductor pollicis?

A

ulnar

Anatomy (9 decks)

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