Clinical Anatomy of the Upper Limb Flashcards
what attaches the upper limb to the axial skeleton?
clavicle via sternoclavicular joint
stability in the hip vs shoulder joint?
hip = most stability from the boney joint as the acetabulum is deep so soft tissues not as important shoulder = glenoid fossa is very shallow and unstable so soft tissues largely responsible for stability
what is a sprung shoulder?
rupture of the coracoclavicular ligaments
causes clavicle to spring up
what do the coracoclavicular ligaments do?
keep clavicle in line with the acromion
what does the trapezius do?
elevates scapula and depresses scapula
retracts scapula
where does the trapezius originate and insert and what nerve innervates it?
origin = spinous processes (up to T12)
insertion = occiput, spine of scapula
innervated by CNXI (spinal accessory nerve)
list 3 possible problems with the glenohumeral joint?
OA/RA
dislocation
adhesive capsulitis (frozen shoulder)
what is the function of the labrum?
increases capture of the humeral head, increasing stabillity
how can the labrum be injured?
tears
often from throwing injury or humeral head dislocation
what are the 2 types of labrum tear?
SLAP tear = where biceps tendon anchors to the labrum
BANKART tear = inferior anterior labral tear
what are the 4 rotator cuff muscles?
supraspinatous
infraspinatous
teres minor
subscapularis
what do the rotator cuff muscles do?
stabilise the shoulder girdle
move the arm
what is the function of the supraspinatous?
abducts arm
where does the supraspinatous originate and insert and what nerve innervates it?
origin = supraspinatous fossa
insertion = greater tuberosity of humerus
innervated by subscapular nerve
what is the function of the infraspinatous?
externally rotates the arm
where does the infraspinatous originate and insert and what nerve innervates it?
origin = infraspinatous fossa
insertion = greater tuberosity of humerus
innerated by suprascapular nerve
what does the teres minor do?
externally rotates the arm
where does the teres minor originate and insert and what nerve innervates it?
origin = dorsal surface of lateral border of scapula
insertion = greater tuberosity of humerus
innervated by axillary nerve
what does the subscapularis do?
internally rotates the arm
where does the subscapularis originate and insert and what nerve innervates it?
origin = anterior surface of scapula
insertion = lesser tuberosity of humerus/shoulder capsule
innervated by upper and lower subscapular nerve
what are the rotator cuff muscles susceptible to?
tears
impingement
what does the deltoid do?
abducts the arm
where does the deltoid originate and insert and what nerve innervates it?
origin = clavicle, acromion, spine of scapula
insertion = deltoid tuberosity on lateral aspect of humerus
innervated by axillary nerve
what does the biceps brachii do?
flexes elbow
supinates the forearm
where does the originate and insert and what nerve innervates it?
long head =
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where is the radial head always found?
laterally
what is the elbow susceptible to?
OA/RA
dislocation
olecranon fracture
what is the radial head/neck susceptible to?
fracture
what is the most common type of dislocation of the elbow?
ulna moves posteriorly
can usually be reduced in A&E
often occurs with fracture
why must you X ray for a dislocated elbow?
theres often a fracture present so if you reduce elbow onto a fractured elbow it will not be congruent
what elbow injury is common in children?
supracondylar fracture
what bursa is commonly inflamed?
olecranon bursa
susceptible to bursitis
what are the 3 groups of ligaments in the elbow?
medial collaterals
lateral collateral
annular ligaments (over radial head)
what are elbow ligaments susceptible to?
tears
strains
what is the function of the lateral epicondyle of the elbow?
site of insertion for all the extensor muscles of the forearm
(extensor compartment known as the dorsal compartment)
what is the lateral epicondyle susceptible to?
enthesiopathies (lateral epicondylitis) - tennis elbow
what does the medial epicondyle do?
site on insertion of all flexor muscles of forearm (volar compartment)
what is the medial compartment susceptible to?
enthesiopathies (medial epicondylitis)
what are the ends of the radius and ulna which articulate with the carpal bones called?
radius = radial styloid ulna = ulnar head? and styloid
what are the proximal row of carpal bones?
scaphoid (navicular)
lunate
triquetrum?
pisiform
remember hand bones?
some lovers try positions that they cannot handle
what are the bones of the distal row?
trapezium
trapezoid
capitate
hamate
what are the 3 ligaments of the wrist?
TFCC
scapho-lunate ligament
DRUJ
what is colles fracture?
distal radius fracture
extra articular
dorsally displaced
“dinner fork deformity”
blood supply to the scaphoid?
retrograde (same as femoral head)
- supply doubles back on itself
what does the retrograde blood supply to the scaphoid bone predispose it to?
avascular necrosis
how is a scaphoid fracture examined clinically?
feel in anatomical snuff box while ulna deviated
how does the thumb differ to the other phalanges?
doesn’t have an intermediate phalange
what are the 2 groups of muscles of the hand?
intrinsic (all within the hand)
extrinsic (muscle body outside the hand)
what does each group of muscles do?
intrinsic = fine motor function of hand extrinsic = finger flexion and extension and wrist movements
what are the groups of intrinsic muscles?
thenar
hypothenar
interossei
lumbricals
what are the 3 thenar muscles and what do they do?
opponens pollicis
flexor pollicis brevis
abductor pollicis brevis
move the thumb
what nerve innervates the thenar muscles?
median nerve
what is the main hypothenar muscle and what does it do?
abductor digiti minimi
moves the little finger
what nerve innervates the abductor digiti minimi>
ulnar nerve
what are the 2 groups of interoddei muscles and what do they do?
dorsal (X4) = abducts the fingers (DAB)
palmar (X3) = adducts the fingers (PAD)
what nerve innervates the interossei muscles?
ulnar nerve
what do the interossei muscles do?
move fingers
flex at MCP joints and extend at IP joints
what do the lumbrical muscles do?
one for each finger (4)
crucial to finger movement and link flexor and extensor tendons
what nerves innervates the lumbrical muscles?
lateral 2 = median
medial 2 = ulnar
what are the 2 groups of extrinsic muscles?
flexor tendons
flexor pulleys
what are the 2 flexor tendons?
flexor digitorum superficialis
flexor digitorum profundus
where is the flexor digitorum superficialis and what does it do?
passes through carpal tunnel
flexes fingers at the proximal IP joints
what nerve innervates the flexor digitorum superficialis?
median nerve
where is the flexor digitorum profundus and what does it do?
passes through carpal tunnel underneath flexor digitorum superficialis
flexes fingers at DIP joints
what nerve innervates the flexor digitorum profundus?
median nerve (2nd and 3rd digits) ulnar nerve (4th and 5th digits)
what are the flexor pulleys?
annular ligaments
cruciate pulleys
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what does the palmar fascia do?
separates the palmar muscle bellies and flexor tendons from the skin
what is the palmar fascia susceptible to?
hypertrophy and fibrosis (dupuytrens contracture)
describe the arterial supply to the hand
radial and ulnar arteries join to form superficial palmar arch which give common digital arteries which branch to give ulnar (medial) and radial (lateral) digital arteries in each digit
what are the 3 peripheral nerves of the hand?
median ulnar radial supply the extrinsic +/- intrinsic muscles of/affecting the hands supply cutaneous sensation
