Clinical anatomy of the upper limb - 29/10/18 Flashcards
What are the bony anatomy points of the upper limb?
Shoulder girdle humerus Elbow joint Radius Ulna Wrist Carpus Hand
What makes up the shoulder girdle?
Clavicle Scapula Sternoclavicular joint Acromioclavicular joint Glenohumeral
What keeps the clavicle and scapula in line and prevents sprung shoulder?
The coracoclavicular ligaments
What muscles move the shoulder girdle?
Trapezius
What are the characteristics of the trapezius?
Origin - spinous process
Insertions - occiput, spine of scapula
What is the function of the trapezius?
Elevates and depresses scapula
What 3 things are the gleno-humeral joint susceptible to?
OA/RA
Dislocation
Adhsive capsulitis
What is the function of the labrum?
Increases capture of the humeral head (increases stability)
What is the labrum susceptible to?
Labral tears
What are two types of labral tears?
SLAP tear (throwing) Bankart lesion
What are the 2 functions of the rotator cuff muscles?
Stabilise the shoulder girdle
Move the arm
What are the 4 rotator cuff muscles/
Supraspinatous
Infraspinatus
Teres minor
Subscapularis
What is the origin, insertion, innervation and function of the supraspinatous muscle?
O - supraspinous fossa
I - Greater tuberosity of humerus
In - Suprascapular nerve
F - Abducts arm
What is the origin, insertion, innervation and function of the infraspinatous muscle?
O - Infraspinous fossa
I - Greater tuberosity of humerus
In - Suprascapular nerve
F - Externally rotates the arm
What is the origin, insertion, innervation and function of the Teres minor muscle?
O - Dorsal surface of the lateral scapula border
I - Greater tuberosity of humerus
In - Axillary n
F - Externally rotates the arm
What is the origin, insertion, innervation and function of the subscapularis muscle?
O - anterior surface of scapula
I - Lesser tuberosity of humerus
In - Upper and lower subscapular n
F - Internally rotates the arm
What 2 things are the rotator cuff muscle susceptible to?
Tears
Impingement
What is the origin, insertion, innervation and function of the deltoid muscle?
O - Clavicle, acromion, spine of scapula
I - Deltoid tuberosity on lateral aspect of humerus
In - Axillary nerve
F - Abducts the arm
What is the origin, insertion, innervation and function of the biceps brachii?
O - Short - Coracoid process, Long - Labrum/ Glenoid
I - Tuberosity of radius
In - Musculocutaneous n
F - flexes elbow, supinates forearm
What is the biceps brachii susceptible to?
Tendonitis
Which is always lateral, radial or ulnar head?
Radial
What is the elbow joint susceptible to?
OA/RA
Elbow dislocation
Olecranon fracture
What is the most common way of the elbow dislocating?
Ulna moves posteriorly
What is the supracondylar region?
Area above the medial and lateral epicondyles
What is the supracondylar region susceptible to, and in what patients?
Fractures
Children
What is the olecranon bursa susceptible to and where is it?
Bursitis
Over the olecranon
What are the three ligaments of the elbow?
Medial collateral
Lateral collateral
Annular ligaments
What are the elbow ligaments susceptible to?
Strains and tears
What is the lateral epicondyles the sit of insertion for?
All the extensor muscles of the forearm
What is the lateral epicondyle susceptible to?
Enthesiopathies
lateral epicondylitis
Where do all the flexor muscles of the forearm insert?
Medial epicondyle
Where is the radial head?
At the elbow
Where is the ulnar head?
At the wrist
What are the bones of the hand?
Some - Scaphoid Lovers - Lunate Try - Triquetrum Postions - Pisiform That - Trapezium They - Trapeziod Cannot - Capitate Handle - Hamate
What are the ligaments of the hand/wrist?
Scaphoid lunate ligament
Luno-triquetral ligament
What are the wrist joints susceptible to?
PA/RA
Fractures
dislocations
What is a Colly’s Fracture?
Extra articular
Dorsally displaced
Shortened bone
Dinner Fork deformity
What is the blood supply of the scaphoid?
Retrograde blood supply
Which fracture in the scaphoid is more likely to heal, proximal or distal?
Distal
What are the five types of bone in the hand?
Carpal Metacarpals Proximal phalanges Intermediate phalages Distal phalanges
How is the scaphoid bone examined?
Ulnar deviate
Feel in Anatomical snuff box
-extensor policus longus
-Abductor policus longus
Which bone is the thumb missing?
Intermediate phalanges
What are the two types of muscles in the hand?
Extrinsic
Intrinsic
Where are the intrinsic muscles and what are they responsible for?
IN the hand
Fine motor functions
Where are the extrinsic muscles and what are they responsible for?
Anterior and Posterior compartments of the forearm
Finger flexion
Extention
Movements of the wrist
What are the thenar muscles, what do they do and how are they innervated?
Move the thumb Opponens pollicis Flexor pollicus brevis Abductor pollicis brevis Median nerve
What are the Hypothenar muscles, what do they do and how are they innervated?
Move the little finger
Abductor digiti minimi
Ulnar nerve
What are the interossei muscles, what do they do and how are they innervated?
Move the fingers All flex @ MCPJs and extend @ IPJs Ulnar nerve Dorsal interossei (abduct) Palmar interossei (adduct)
What are the Lumbrical muscles, what do they do and how are they innervated?
One for each finger Crucial Link extensor and flexor tendons Lateral x 2 Median Medial x2 ulnar
What are the flexor tendons, what do they do and how are they innervated?
Flexor digitorum superficialis Flexor muscle of fingers Flexes fingers at PIPs Median NErve Flexor digitorum profundus Extrinsic flexor of fingers Flexes fingers at DIPJs Median nerve - digits 2 and 3 Ulnar nerve - digits 4 and 5
What are the flexor pulleys and what do they do?
Annular ligaments A2 and A4 - prevent bowstring A1,A3,A5 - overlie the MP, PIP and SIP A1 pulley - trigger finger Cruciate pulleuys - prevent sheath collapse
What is the function of the plantar fascia and whaat is it susceptible to?
Separates the palmar muscles and flexor tensons from the skin
Susceptible to hypertrophy and fibrosis
What does each digit have for blood supply?
Ulnar and radial artery
What are the three peripheral nerves of the hand and what do they supply?
Median Ulnar Radial Diagram xo Cutaneous sensation Extrinsic and intrinsic muscle of hand
What does the median nerve supply and how is it tested?
Flexors of forearm LOAF muscles Abductor pollicis brevis Radial 31/2 digits Tip index finger and base of thenar muscels
What does the ulnar nerve supply and how is it tested?
Small muscles of the hand intrinsics
Abductor digit minimi
Ulnar 1 1/2 digits
Dorsum and volar little finger
What does the radial nerve supply and how is it tested?
Extensors of forearm Externsor digitorum commiunis Extensor indicis Variable portion of dorsum of hand Dorsum of 1st web space
Where does cubital tunnel syndrome affect and what is the characteristics of it?
Elbow
The ulnar nerve passes posterior to the medial epicondyle
It then enters an arch formed by the two heads of flexor carpi ulnaris
Underneath arcuate ligament
Where does carpal tunnel syndrome affect and what is the characteristics of it?
Median nerve
Boundaries are carpal bones
Flecor retinaculum/ transverse carpal ligament
What is the brachial plexus?
Netwrk f ventral rami of the lower four cervical nerves
Proceeds through neck axilla and into arm
What is the acronym for the brachial plexus?
Real - Roots Texans - Trunks Drink - DIvisions Cold - Cords Beer - Branches
