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Functional Anatomy > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

5 static stabilizers of shoulder complex

A
  1. Superior GH ligament (weak)
  2. Inferior GH ligament (strong)
  3. Coracohumeral ligament (strong)
  4. Bones
  5. Labrum
    (May be additional ligaments)
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2
Q

3 Dynamic Stabilizers of the shoulder complex

A
  1. deltoid
  2. rotator cuff complex
  3. long head of biceps
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3
Q

T/F

The glenohumeral joint has the greatest mobility of any joint in the body. It is a ______ type of joint with ___ dof.

A

True
ball and socket joint
3 dof

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4
Q

The fibrocartilage glenoid labrum enhances total available articular surface of the ______. It is the attachment site for ________ and _______.

A

glenoid fossa
GH ligaments
long head of biceps brachii

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5
Q

The sternoclavicular (SC) joint connects shoulder complex to ______. It is a _______ type of joint with ___ dof.

A

axial skeleton
plane synovial joint
3 dof

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6
Q

The _________ provides stability by increasing joint congruence and by absorbing forces transmitted along the clavical from its lateral end to the sternoclavicular joint. It protect the manubrial facet.

A

sternoclavicular disk

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7
Q

3 ligament complexes of SC joint

A
  1. Ant/Post SC ligaments
  2. Costoclavicular ligament
  3. Interclavicular ligament
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8
Q

Ant/Post SC ligaments
Reinforce what?
Limit what movements?

A

Reinforce capsule

Check A/P translatory movement of the medial end of the clavicle

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9
Q

Costoclavicular Ligament
Located between clavicle and ___ rib.
Limits what movements?

A

between clavicle and 1st rib
has 2 laminae that limit elevation of the lateral end of the clavicle and superiorly directed forces applied to clavicle by SCM and sternohyoid muscles

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10
Q

Interclavicular Ligament
limits what movements?
protects what?

A

limits excessive depression of the distal clavicle and superior gliding of medial clavicle on manubrium
Protects brachial plexus and subclavian artery, which passes under clavicle and over 1st rib

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11
Q

The Acromioclavicular (AC) joint is a _____ type of joint with ___ dof. Its articular facets are ____. Its weak capsule relies on reinforcement by which ligaments?

A

plane synovial
3
incongruent
superior and inferior AC ligaments, coracoclavicular ligaments

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12
Q

The scapulothoracic joint is considered a ______ joint. It is located between the scapula and ribs 1-7. It has no ligaments.

A

functional

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13
Q

Planes of Scapula (in resting position)
Internally rotated _____* anterior to coronal plane.
Tilted anteriorly 10-20* to ______ plane.
Medial border of scapula is upwardly rotated ___* from vertical.

A

35-45* anterior to coronal plane
tilted anteriorly 10-20* to vertical plane
upwardly rotate 5-10* from vertical

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14
Q

Dynamic Stability

A

exists when a moving segment or set of segments is limited very little by passive forces such as articular surface configuration, capsule, or ligaments and instead relies heavily on active forces or dynamic muscle control

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15
Q

The competing _______ demands make the shoulder complex highly susceptible to dysfunction and instability.

A

mobility/stability

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16
Q

Elevation of the UE refers to the combination of ___, ___, and ___ motion that occurs when the arm is raised either forward or to the side.

A

scapular, clavicular, humeral

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17
Q 
Initial phase of UE elevation (0-60*)
prime mover ?
motional primarily at which joint?
GH:ST
Force couples?
GH Arthrokinematics?
Stabilization by?
Presence of clavicular elevation?
A 
Prime mover: deltoid
Deltoid/Supraspinatus force couple
Motion primarily at GH joint
3:1 GH to ST
UT and SA (upper) force couple
GH arthrokinematics: superior glide, roll
Stabilization by: subscapularis, infraspinatus, and teres minor
yes, presence of clavicular elevation
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18
Q

Middle or Critical Phase of UE elevation (60-140)
Shearing forces increase from the initial phase of movement to ___ when shear and compressive forces are approximately equal
Scapular rotators:
Clavicular elevation/posterior rotation about SC joint continues?
Upward rotation about the AC joint?

A

90*
UT, LT, SA (lower)
Yes
Yes

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19
Q

Final phase of UE elevation (140-180*)
Force couple?
Extensibility of what muscles are important for “dissociation?”

A

force couple: LT and SA
Extensibility of lats, pec major, teres major, teres minor, infraspinatus, and subscapularis important for “dissociation.”

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20
Q

In general, there is a ___:___ ratio, GH:ST

A

2:1

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21
Q

Ultimate functions of scapular motion

A
  • orient glenoid fossa for optimal contact with maneuvering arm
  • and range to elevation of arm
  • provide stable base for controlled motions between humeral head and glenoid fossa
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22
Q

The coracoacromial arch prevents ________.

A

superior dislocation

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23
Q

Subacromial space/suprahumeral space/supraspinatus outlet is located where? When narrowed, the likelihood of _____ of rotator cuff tendons and subacromial bursa during elevation of arm increases. Repetitive impingement can create tendonitis and progress to partial/full thickness rotator cuff tears. Subacromial bursitis is most commonly secondary to inflammation or degeneration of ___ tendon.

A

are between humeral head and coracoacromial arch
impingement
supraspinatus

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24
Q

Which of the following flexors produces the greatest amount of compression in the elbow joint and therefore is a good stabilizer of the elbow?

A

Brachioradialis

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25
Q

Mrs. Smith is having difficulty with elevation secondary to altered scapular mechanics. A likely explanation for this includes:

A

Inefficient force couple between the serratus anterior and lower traps (important for final phase of elevation)

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26
Q

The most important static stabilizer of the AC joint is the:

A

coracoclavicular ligament

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27
Q

Which of the following statements best describes the biceps brachii muscle?

A

A muscle that is affected by passive and active insufficiency

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28
Q

The best way to emphasize the 2nd digit’s FDS is by:

A

stabilized all digits in extended position except 2nd digit

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29
Q

Which of the following best describes the structure of the GH joint?

A

glenoid labrun enhances depth of glenoid fossa

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30
Q

Which of the following is a function of the rotator cuff during shoulder girdle elevation?

A

Balances the deltoid activity by providing a slight inferior translatory force of the humeral head during shoulder girdle elevation

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31
Q

In full elbow extension, varus stability is provided by which of the following bony and/or noncontractile soft tissue structures?

A

configuration of the joint surfaces, joint capsule, LCL

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32
Q

Which of the following would you consider to be a limiter of motion when a patient cannot achieve full elbow extension?

A

Passive tension of the flexor muscles

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33
Q

Due to its anatomical position, which ligament below is the most important in providing resistance to stretch for glenohumeral abduction and external rotation?

A

Inferior GH ligament

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34
Q

Skin at dorsal hand is ____ and easily separated from deep fascia, contributing to dorsal skin’s ability to adjust to the extremes of finger flexion and extension. Skin at volar hand is ____, ___, rich in ____, supplied with sweat glands. It is firmly attached to the underlying CT (_______).

A 
mobile
thick
inelastic
sensory receptors
palmar aponeurosis
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35
Q

______ are flexion folds or skin joints, located where skin adheres to deeper fascia. They permit the hand to close without the skin bunching up into folds.

A

course lines

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36
Q

Papillary ridges are located at volar pulps of digits and over the thenar/hypothenar eminences. They provide ____ to increase the efficacy of the hand during grip. The are rich with _____. Example: fingerprints

A

friction

sensory nerve endings

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37
Q

Unless affected, fingers should converge toward _____ with flexion.

A

scaphoid tuberosity

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38
Q

During grip, there will be a tighter closure on the ulnar or radial side of the hand?

A

ulnar

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39
Q

Wrist and digits are arranged in a group of integrated arches with the concavities facing _____ and forming the hand into a cup.

A

volarly

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40
Q

(Hand)
The proximal transverse arch passes though the ____.
The distal transverse arch passes through the ___.
The longitudinal arch passes through the length of the _____.

A

The proximal transverse arch passes though the distal carpus.
The distal transverse arch passes through the metacarpal heads.
The longitudinal arch passes through the length of the digits and carpus.

41
Q

Does the ulna directly articulate with the carpus? What does?

A

No

triangular fibrocartilage complex (TFCC)

42
Q

The TFCC is made up of CT structures and is considered an extension of the distal radius. It consists of a _____ & ____, which combined provide the primary support for the distal radioulnar joint.

A

radioulnar articular disk & ligaments

43
Q

When compressive force is applied longitudinally to neutral wrist the TFCC receives approximately 20% of the load, whereas the ___ & ___ receive 80%

A

scaphoid & lunate

44
Q

Pisiform is a ___ bone that articulates with the triquetrum. It does not participate in the radiocarpal or midcarpal articulations. It functions to _______________.

A

pisiform = sesamoid bone

It functions to increase the moment arm of the FCU that envelops it.

45
Q

Due to the size and structure of the radius, the hand/wrist has (more or less) flexion than extension, and (more or less) ulnar deviation than radial deviation.

A

More flexion than extension & more UD than RD

46
Q

In the wrist, there is more flexion than extension because of the ___ tilt of the radius.

A

volar

47
Q

A Colle’s fracture is the most common skeletal fracture. It is a complete fracture of the distal ___) with dorsal displacement of the distal fragment. Common cause: FOOSH (fall on outstretched hand).
Another somewhat common fracture is a fracture of the _____.

A

radius

ulnar styloid process

48
Q

Colle’s Fracture:

Reduction results in a loss of the volar angulation of the radius. Which motion is thereby reduced?

A

Flexion

Patients lose volar tilt and can actually gain more extension than baseline

49
Q

What is ulna positive variance.
What might cause it?
Potential risk?

A

long ulna in comparison to distal radius
Can occur if distal radius fracture resulted in shortening of the radius
Potential to impinge of TFCC due to ulna taking more force/weight than radius.

50
Q

What is ulna negative variance?
What might cause it?
Potential risk?

A

short ulna in comparison to distal radius
Can occur due to Kienbock’s disease (avascular necrosis of lunate)
May cause abnormal force destruction and degeneration at radiocarpal joint.

51
Q

Largest carpal bone?

A

capitate

52
Q

2 structures that travel around the hook of the hamate?

A

ulnar artery & ulnar nerve

53
Q

Interosseous joints of the proximal row of carpals are smaller than those of the distal carpal row to allow motion between mutually articulating bones in the flex/extend plane. Interosseuous joints of the distal carpal row are more complex geometrically and allow substantially ___ interosseous motion than the proximal row.

A

less

54
Q

Roles of wrist ligaments:
Intrinsic wrist ligaments connect ___ to ___.
Extrinsic wrist ligaments connect ___ to ___ proximally or ___ distally.

A

Toles of wrist ligaments: stability, guiding and checking motion between carpals
carpals to carpals
carpals to radius/ulna or carpals to metacarpals

55
Q

When scapholunate ligament is injured, the scaphoid follows natural tendency to collapse into ___. The lunate and triquetrum are released from scaphoid stabilization and follow their natural tendency to ___. This is called DISI (______).

A

flexion
extend
dorsal intercollated scaphoid instability

56
Q

When lunotriquetral ligament is disrupted, it falls along with the ___ into flexion, while the ____ and ____ extend.

A

scaphoid

triquetrum and distal carpal row

57
Q

3 primary wrist flexors:

3 secondary wrist flexors:

A

Primary wrist flexors: FCU, FCR, PL

Secondary wrist flexors: FDS, FDP, FPL

58
Q

Which 4 of the 6 volar wrist muscles pass underneath flexor retinaculum, preventing bowstringing of long flexor tendons, contributing to maintaining length-tension relationship.

A

FCR, FDS, FDP, FPL

59
Q

FCU acts on ___ and ___ indirectly through the pisiform ligaments, resulting in flexion and UD.

A

hamate and 5th metacarpal

60
Q

Work Capacity:

A

muscle ability to generate force per unit of cross-section

61
Q

Is work capacity greater in wrist flexors or wrist extensors?

A

Work capacity is 2X greater in wrist flexors than wrist extensors.

62
Q

The flexor retinaculum is thought to be made up of a proximal portion and a distal portion, with the distal portion known more commonly as the ______. This is the ligament that is cut in carpal tunnel surgeries.

A

transverse carpal ligament

63
Q

Palmaris Longus:
Found unilaterally or bilaterally in ___% of population, though there is no apparent strength or functional deficit at wrist for those without PL. BEcause of this, it is often sacrificed for surgical reconstruction, as in a tendon transfer.

A

86%

64
Q 
Name the carpal bones that articulate with the following metacarpals to form the CMC joints.
2nd:
3rd:
4th:
5th:
A

2nd: trapezium, trapezoid, capitate
3rd: capitate
4th: capitate, hamate
5th: hamate

65
Q

T/F
A single joint capsule encloses all of the CMC joints, forming 1 single synovial cavity that extends distally between metacarpal bases and proximally between the distal carpal bones.

A

True

66
Q

The role of the CMC joints is to _____. The 2nd and 3rd CMC joints are ____. The 4th and 5th CMC joints have some mild ____, allowing for cupping.

A

connect hand to wrist
essentially immobile
flexion

67
Q

The 2nd through 4th CMC joints are ______ with 1 dof (flex/extend). The 5th CMC joint is a saddle joint with 2 dof (flex/extend, abd/add). The ____ ligament spans the 2nd through 4th metacarpals and tethers together metacarpal heads to prevent any more than minimal abduction at CMC joints.

A

plane synovial joints

transverse metacarpal ligament

68
Q

A Boxer’s fracture is a fracture of the ___? It is usually caused by ____.

A

metacarpal neck

punching

69
Q 
MP joint:
Metacarpal head is \_\_\_\_\_.
Proximal phalanx base is \_\_\_\_.
It is a \_\_\_\_\_\_ joint with \_\_ dof.
What are the available movements?
A

Metacarpal head is biconvex.
Proximal phalanx base in biconcave.
condyloid joint, 2 dof
flex/extend, abd/add

70
Q

There is (more/less) range in ulnar side of hand. This results in ulnar digits loosing tension with increased flexion as they have a greater range to cover.

A

more

71
Q

Unlike the MP joints, there is little posterior articular surface at the PIP or DIP joint and therefore little _____.

A

hyperextension

72
Q

Collateral ligament proper attaches from (dorsal/volar) metacarpal to (dorsal/volar) proximal phalanx. This ligament is slack in MP extension and taut in ____. This is why only a small amount of abd/add can be obtained at MP joint in full flexion vs full extension.

A

dorsal metacarpal to volar proximal phalanx

slack in MP extension and taut in flexion

73
Q

One shared characteristic of MCP joints and IP joints is a ____ which limits hyperextension.

A

volar plate

74
Q

How many muscle tendons pass under extensor retinaculum? The extensor retinaculum prevents ___ of the tendons.
Each tendon is wrapped in a synovial sheath responsible for nourishing tendons and ____.
How many tunnels are under extensor retinaculum?

A

9 tendons
bowstringing
decreasing tension
6 tunnels

75
Q

Muscles of the elbow complex are designed to serve _____.

A

the hand

76
Q

Elbow complex includes elbow joint (humeroulnar) and the proximal and distal ________ joints.

A

radioulnar joints

77
Q

The elbow joint has __ dof.

A

1 (flex/extend)

78
Q

Capsule of the elbow is fairly large, loose, and weak ____ & ____ (hint: directions).

A

anteriorly and posteriorly

79
Q

Primary ligamentous restraint of valgus stress from 20* to 120* elbow flexion

A

medial collateral ligament (MCL)

80
Q

The MCL is overlaid by what 3 muscles?

A

FCU, pronator teres, FDS

81
Q

T/F
The MCL limits extension at end of elbow extension ROM, and guides joint motion throughout flexion ROM. It also provides some resistance to longitudinal distraction of joint surfaces.

A

true

82
Q

Name the ligament that stabilizes elbow against varus and combined varus and supination torque.

A

Lateral Collateral Ligament

83
Q

Lateral Collateral Ligamentous Complex includes: (Hint: 2 ligaments)

A

LCL and annular ligament

84
Q

The LCL reinforces the humeroradial joint and helps provide some resistance to longitudinal _____ of the articulating surfaces.

A

distraction

85
Q

The LCL stabilizes the ____, thus providing a stable base for rotation. It also maintains posterolateral rotatory stability.

A

radial head

86
Q

3 major elbow flexors:

A

biceps brachii
brachialis
brachioradialis

87
Q

2 major elbow extensors

A

triceps brachii

anconeus

88
Q

Carrying Angle/Cubitus Valgus: (hint: definition)

It is due to ___ aspect of humeral trochlea extending more distally than ___ aspect.

A

lateral deviation of ulna in relation to the humerus. It is due to medial aspect of humeral trochlea extending more distally than lateral aspect.

89
Q

Functional use of the carrying angle results from a combination of shoulder ____ rotation, elbow ___, and forearm ____, which enables a person to carry a bucket in one hand in such a manner as to avoid contact between the carried load and lower limb on the same side.

A

shoulder external rotation, elbow extension, forearm supination

90
Q

The ________ provides the majority of resistance to anterior displacement of distal humerus out of trochlear notch; the mcl and lcl contribute only slightly.

A

anterior portion of joint capsule

91
Q

Extremes of elbow flexion are limited by approximation of coronoid process with ____ and the rim of the radial head in the radial fossa.

A

coronoid fossa

92
Q

In 90* flexion, anterior part of ___ provides primary resistance to distraction and valgus stress. If anterior portion of this ligament becomes lax due to overstretching, medial instability will result when the elbow is in a __ position.

A

MCL, flexed

93
Q

T/F

Anterior joint capsule contributes only slightly to varus and valgus stretch.

A

True

94
Q

________ of flexor and extensor muscles of the elbow, wrist, and hand help to provide stability for the elbow during forceful motions of the wrist and fingers and in activities in which the arms are used to support the body weight.

A

Co-contractions

95
Q

During pulling activities, such as when a person grips and attempts to pull a fixed rod toward the body, the elbow joints are _____ by the contractions of muscles that cross and elbow and act on the wrist and hand.

A

compressed

96
Q

The annular ligament is a circular ligament lined with ______ that circles rim of radial head.

A

articular cartilage

97
Q

Articulating surfaces of proximal radioulnar joint:

A

ulnar radial notch, annular ligament, head of radius, humeral capitulum

98
Q

Articulating surfaces of distal radial ulnar joint

A

ulnar notch of radius, TFCC, head of ulna

Functional Anatomy (2 decks)

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