Gross Anatomy Exam II Flashcards
Name the 5 parts of the clavicle
- Shaft 2. Sternal end 3. Acromial end 4. Superior surface 5. Inferior surface
How is the shaft of the clavicle curved?
Medial half is convex anteriorly. Lateral half is concave anteriorly.
What does the sternal end of the clavicle articulate with?
Articulates with the manubrium
What does the Acromial end of the clavicle articulate with?
Articulates with acromion of scapula
What are the two features found on the inferior surface and at the acromial end of the clavicle?
conoid tubercle and trapezoid line
The subclavian groove found on the inferior surface of the clavicle is the site of attachment for what muscle?
Subclavius m
What is the most common reason for a fractured clavicle?
Fall on an outstretched hand (FOOSH)
What is the weakest part of the clavicle?
The junction between its middle and lateral thirds
What happens to the muscles and shoulder after a clavicle fracture?
SCM elevates the medial portion of clavicle. Trapezius m unable to hold up lateral clavicle, shoulder drops
Which ribs does the scapula overly?
Ribs 2-7
The spine of the scapula contains what 3 aspects?
Deltoid tubercle, acromion, spinoglenoid notch
The glenoid fossa of the scapula contains which two tubercles?
Supraglenoid, infraglenoid
The humerus articulates with which aspect of the scapula?
Glenoid fossa (glenohumeral joint)
What is the anterolateral projection of the scapula, superior to the glenoid fossa?
Coracoid process
What is the largest bone in the upper limb?
Humerus
The distal condyle of the humerus is formed by what 5 aspects?
Capitulum, radial fossa, trochlea, coronoid fossa, and olecranon fossa
What type of humerus fracture occurs due to a severe fall on a flexed elbow?
Intercondylar fracture (may damage median or ulnar n)
What type of fracture occurs as a result from a direct blow?
Transverse fractures of shaft (radial n at risk for damage)
What type of humerus fracture is most common in elderly?
Proximal fracture at surgical neck. Due to fall on hand. Axillary n at risk.
What type of humerus fracture is due to a FOOSH?
Spiral fracture of shaft. Radial n at risk.
What is the stabilizing bone of the forearm?
Ulna
Which forearm bone participates in the wrist joint?
Radius, the ulna does not participate in the wrist
Which forearm bone crosses over the other in pronation?
The radius crosses the ulna in pronation
Which end of the ulna is the largest?
The proximal end of the ulna is the largest, it is specialized for articulation with humerus proximally and radius laterally
A complete transverse fracture of the distal 2cm of radius is what kind of fracture?
Colle’s fracture
Fracture of radius and ulna is most common in what age group?
Adults 50 and over - more common in women due to osteoporosis
A “dinner fork deformity” occurs with what type of fracture?
Fracture of radius and ulna: distal fragment of radius is displaced posteriorly, a posterior angulation happens in the forearm just proximal to the wrist
What are the 8 carpal bones?
Proximal: Scaphoid, lunate, triquitrum, pisiform
Distal: Trapezium, trapezoid, capitate, hamate
Trapezium articulates with which metacarpals?
1st and 2nd metacarpals
Which carpal bone articulates with the 3rd metacarpal?
Capitate
Which carpal bone only articulates with the 2nd metacarpal?
Trapezoid
The hamate articulates with which metacarpals?
4th and 5th metacarpals
What is the most common fractured carpal bone?
Scaphoid
A scaphoid fracture is the result of what type of fall?
Fall on the palm when hand is ABD
What might occur after the scaphoid has healed from a fracture?
Avascular necrosis
What are the 3 joints of the upper limb?
Scapulothoracic, sternoclavicular, acromioclavicular joints
What joint is located between the anterior scapula and posterior ribs?
Scapulothoracic joint (not really a true joint)
What joint is the only articulation between upper limb and axial skelton?
Sternoclavicular joint
What joint type is the sternoclavicular joint?
Synovial joint, saddle-joint between manubrium and clavicle (functions as ball and socket)
The sternoclavicular joint is divided into two compartments by what?
Fibrocartilage articular disc
The costoclavicular ligament is part of which joint?
Sternoclavicular joint
Which ligament limits elevation of pectoral girdle and limits clavicle from lifting up?
Costoclavicular ligament
What are the four ligaments of the sternoclavicular joint?
Costoclavicular, anterior sternoclavicular, posterior sternoclavicular, and interclavicular (superior)
Where is the AC joint located?
2-3cm from “point of shoulder”
What type of joint is the AC joint?
Synovial joint, plane joint between clavicle and acromion
The coracoclavicular ligament is composed of what two ligaments?
Trapezoid ligament, conoid ligament
What are the two main ligaments of the AC joint?
coracoclavicular ligament, the acromioclavicular ligament
Is the sternoclaviular joint weak or strong?
Strong
Is the AC joint weak or strong?
Weak
How does a separated shoulder occur?
Direct blow to AC joint in contact sports, FOO upper limb or shoulder
How many “types” of separated shoulder injuries are there?
- Type 3 being total separation
The upper limb is composed of what fascial layers?
Superficial fascia (fat), Deep fascia
What is the primary joint of the scapular region?
Glenohumeral joint
The glenoid fossa accepts how much of the humeral head in the glenohumeral joint?
a little more than a third
The glenohumeral joint is held in the glenoid fossa by which four muscles?
Supraspinatus, infraspinatus, teres minor, subscapularis (rotator cuff)
The glenoid fossa is deepened by what feature?
glenoid labrum
What are the four ligaments of the glenohumeral joint?
Glenohumeral ll, coracohumeral l, coracoacromial l, transverse humaral l
Which ligament strengthens the glenohumeral joint superiorly?
coracohumeral l
The coracoacromial arch is made up of what 3 aspects?
Inferior acromion and coracoid process and the coracoacromial ligament
Where does the transverse humeral ligament pass?
Passes obliquely from lesser to greater tubercles of humerus
What are the 3 parts of the glenohumeral deep fascia?
Deltoid fascia, supraspinous fascia and infraspinous fascia
Which scapulohumeral muscle acts as a shunt muscle?
Deltoid. Helps resist dislocating forces
The quadrangular space is made of up what borders?
Superior: teres minor
Inferior: teres major
Lateral: surgical neck of humerus
medical: long head triceps brachii
What artery and nerve reside in the quadrangular space?
Axillary n. & posterior humeral circumflex a.
The long head triceps brachii m, teres minor m, and teres major m are the borders of what muscular space?
Triangular space
What artery is located in the triangular space?
Circumflex scapular a
The teres major m, long head triceps brachii m, and lateral head triceps brachii m make up which muscular space?
Triangular interval
The radial n and profunda brachii a can be found in which muscular space?
Triangular interval
The deltoid m will atrophy due to injury to which nerve?
Axillary n
What are main causes of injury to the axillary n?
Fracture of surgical neck, dislocation of the GH joint, compression by improper use of crutches, intramuscular injections
If the axillary n is injured, where would a patient feel loss of sensation?
Lateral part of proximal arm
Which muscle tendon of the rotator cuff muscles is most commonly injured?
Supraspinatus tendon. Deltoid will take over
What are the two main deep fascias of the pectoral region?
Pectoral fascia & clavipectoral fascia
What are the four muscles that moves the pectoral girdle?
Pectoralis major, pectoralis minor, subclavius, and serratus anterior
The deltopectoral groove is formed by which two muscles?
Pectoralis major and deltoid m - contains cephalic v
What are the borders of the clavicpectoral (deltopectoral) triangle?
Superior: clavicle
Medial: pectoralis major
Lateral: deltoid
Which muscle is nicknamed the “boxer’s muscle?”
Serratus anterior (pushing away, punching)
A winged scapula is due to injury to which nerve?
Long Thoracic n
Which nerve is most at risk for injury during a knife fight?
Long thoracic n
What is the Apex of the axilla bounded by?
1st rib, clavicle, and superior border of scapula
The Base of the axilla forms what structure?
Axillary fossa (armpit) bounded by anterior and posterior axillary folds
The posterior wall of the axilla is formed by what structures?
scapula, subscapularis, teres major, and latissimus dorsi
What does the medial wall of the axilla contain?
1st-4th ribs, intercostal mm, and serratus anterior m
The intertubercular groove of the humerus forms which wall of the axilla?
Lateral wall
The axillary artery is a continuation of which artery?
Subclavian a
The axillary artery ends at inferior border of teres major and becomes which artery?
Brachial a
The axillary artery is divided into 3 parts by which muscle?
Pectoralis minor
What is the only branch of the 1st part of the axillary artery?
Superior thoracic a
The second part of the axillary artery contains what two branches?
Thoracoacromial trunk and lateral thoracic a
What are the four branches of the thoracoacromial trunk?
Clavicular, acromial, deltoid, and pectoral
What are the three branches of the third part of the axillary artery?
Subscapular a, anterior humeral circumflex a, posterior humeral circumflex a
3 Functions of the clavicle
- Moveable strut that suspends scapula and free limb
- One of the boundaries of the cervico-axillary canal
- Transmits shocks to axial skeleton
Scapular anastomosis involves which 3 arteries?
Dorsal scapular a, suprascapular a, circumflex scapular a
What are the 5 groups of axillary lymph nodes?
pectoral (anterior) nodes, subscapular (posterior) nodes, humeral (lateral) nodes, central nodes, apical nodes
Which axillary lymph nodes receive lymph from 75% of the breast?
Pectoral nodes
Which node group is located in the apex of the axilla?
Apical nodes
The brachial plexus is formed by the union of VPR of which vertebral nerves?
C5-C8 and T1
The brachial plexus is divided into what 5 groups?
Roots, Trunks, Divisions, Cords, Branches (rugby teams drink cold beer)
Brachial plexus lesions can occur as far up as what aspects?
Roots or trunks
Are complete lesions or partial lesions more common in the brachial plexus?
Partial lesions
Damage to superior trunk of the upper brachial plexus is also known as…?
Eer-Duchenne palsy
What is the result of Erb-Duchenne palsy?
Paralysis of muscles of shoulder and arm
What is the clinical representation of “waiter’s tip position” in a patient with an upper brachial plexus injury?
ADD upper limb, medially rotated arm, extended elbow
Is there sensory loss in upper brachial plexus injuries?
Yes, loss dues to superior lateral brachial cutaneous n., lateral antebrachial cutaneous n
What type of cause of injury affects the lower brachial plexus?
Upper limb is suddenly pulled superiorly
Klumpke palsy is an injury to what part of the brachial plexus?
Inferior trunk (C8-T1)
How is the hand affected after a lower brachial plexus injury?
short muscles of the hand are affected resulting in “claw hand”
What two movement occur at the elbow joint?
flexion/extension
supination/pronation
What 4 muscles perform the movements that occur at the elbow joint?
biceps brachii, brachialis, coracobrachialis, triceps brachii
What are the two articulations of the elbow joint?
Humeroulnar, humeroradial
At the humeroulnar joint, the coronoid process of ulna contacts cornoid fossa of humerus during what action?
Flexion
At the humeroulnar joint, the olecranon of ulna contacts olecranon fossa of humerus during what action?
Extension
What type of joint is the elbow joint?
Synovial, hinge joint
The ulnar collateral ligament is formed by what 3 parts?
Anterior band, posterior band, inferior (oblique) band
The radial collateral ligament is the main ligament for which joint?
Humeroradial joint
What are the 3 types of bursae around the elbow joint?
Subtendinous olecranon bursa, intratendinous olecrenon bursa, subcutaneous olecranon bursa
“Student’s elbow” is a result of bursitis of which elbow bursa?
Subcutaneous olecranon bursa, repeated excessive pressure and friction cause bursa to become inflamed
A dislocation of the elbow joint typically results from what type of actions?
Fall to the hand when elbow is flexed, hyperextension, blow that drives ulna posterior and posterolateral
What ligament is often torn after a dislocation of the elbow joint?
Ulnar collateral ligament, ulnar n might be injured as well
If the ulnar n. is injured as a result from a dislocation of the elbow joint, what symptoms might occur?
Numbness of the little finger, weakness of flexion, weakness of ulnar deviation of the wrist
What type of fascia covers the arm & elbow?
Brachial fascia, continuous inferiorly with antebrachial fascia
What percentage of people have a third head to their biceps brachii?
10%
Does the biceps brachii attach to the humerus?
No, Origin: coracoid process, supraglenoid tubercle. Insertion: Tuberosity of the radius
Which muscle is the primary mover of flexion of the forearm?
Brachialis m. Biceps brachii supinates forearm, and flexes it while supinated
Which head of biceps brachii is most prone to biceps tendinitis?
Long head of the biceps brachii, as it moves in the IT groove (inflammation results from repetitive microtrauma)
Popeye Deformity is the result of what type of injury?
Rupture of tendon of the long head of the biceps brachii (tendon torn from supraglenoid tubercle) – distal end
What muscles are affected when the musculocutaneous n. is injured?
Biceps brachii, brachialis, coracobrachialis m. (usually by knife)
If shoulder flexion is weakened, flexion of the elbow joint weakened, and supination of forearm is weakened; what nerve has been injured?
Musculocutaneous n.
Which head of the triceps brachii is the “workhorse?”
Medial head, active in extension at all speeds, active in the presence or absence of resistance
Which head of the triceps brachii is the strongest?
The lateral head. The lateral head is recruited primarily against resistance
Which muscle directly assists the triceps brachii muscle?
Anconeus
Which nerve has been injured if the triceps brachii, brachioradialis, supinator, and extensors of wrist and fingers have been affected?
Radial n
The “wrist drop” is a characteristic of which nerve injury?
Radial n
The cubital fossa is bordered by which 5 elements? (lateral, medial, base, floor, roof)
Lateral- brachioradialis
Medial- pronator teres
Base- line between medial and lateral epicondyles
Floor- supinator & brachialis
Roof- skin, fascia, bicipital aponeurosis
What type of joint is the proximal radio-ulnar joint?
Synovial, pivot joint
What action can the proximal radio-ulnar joint produce?
Supination/pronation
What type of joint is the distal radio-ulnar joint?
Synovial, pivot joint
The deep fascia of the forearm divides the forearm into which compartments?
Antebrachial fascia divides into anterior compartment and posterior compartment
The superficial compartment of the forearm muscles include which four muscles?
Pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris
The flexor digitorum superficialis m is apart of of which flexor compartment?
Intermediate compartment
The deep flexor compartment is made of up what 3 muscles?
Flexor digitorum profundus, flexor pollicis longus, pronator quadratus
Which forearm muscle is the most common site of impingement?
Pronator teres
Does the flexor carpi radialis m pass through the carpal tunnel?
no
What action does flexor carpi radialis provide when acting alone?
Flexion and radial deviation
Which nerve is known as the “funny bone” when nicked?
Ulnar n
How many tendons does the flexor digitorum superficialis give off at the wrist?
4 tendons
How many tendons go through the carpal tunnel?
9 tendons
Golfer’s elbow is also known as what?
Medial epicondylitis. Inflammation of flexor tendons
The “hand of benediction” is a result of injury to which nerve?
Median nerve at elbow/forearm
The inability to make the “okay” sign results in a “pinch” posture due to an impingement of what nerve?
Anterior interosseous nerve
Compression of the median nerve results in what syndrome?
Pronator syndrome
What compresses the median nerve in pronator syndrome?
2 heads of pronator teres m
What injury can mimic carpal tunnel syndrome?
Pronator syndrome
Injury to the ulnar nerve usually occurs in what four places?
Posterior to medial epicondyle of humerus, cubital tunnel, at the wrist, in the hand
“Claw hand” is the result of an injury to which nerve?
Ulnar n
What are the 3 outcropping muscles?
Abducor pollicis longus, extensor pollicis brevis, extensor pollicis longus
Which forearm muscle is the “beer drinking muscle?”
Brachioradialis
Does the brachioradials m cross over the wrist joint?
No
Which extensor muscle is absolutely necessary when clenching a fist?
Extensor carpi radialis longus
Which extensor muscle is the principal extensor of the medial 4 digits?
Extensor digitorum
The deep branch of the radial n. passes through which muscle and exits as the posterior interosseous n.?
Supinator m.
What are the three muscle tendons that form the borders of the anatomical snuffbox?
Abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus
What two carpal bones form the floor of the anatomical snuffbox?
Scaphoid and trapezium
What artery does the anterior ulnar recurrent a. anastomose with?
Inferior ulnar collateral a.
What artery does the superior ulnar collateral a. anastomose with?
Posterior ulnar recurrent a.
Which artery does the recurrent interosseous a. anastomose with?
Middle collateral a.
What artery does the radial recurrent a. anastomose with?
Radial collateral a.
Does the radial n. supply muscles of the hand?
No, passes over the snuffbox and supplies skin
Lateral epicondylitis is a condition that affects which muscle group?
Repetitive use of superficial extensor mm of forearm. known as “tennis elbow” produces inflammation of the periosteum of lateral epicondyle
What condition is characterized by pain felt over lateral epicondyle, radiating pain down posterior surface of forearm, pain felt when opening a door or lifting a glass?
Lateral epicondylitis, “tennis elbow”
What are the four joints of the wrist and hand?
Radiocarpal joint, carpometacarpal joint, metacarpophalangeal joint, interphalangeal joint
What type of joint is the radiocarpal joint?
Synovial, condyloid joint
What actions does the radiocarpal joint allow?
Flexion/extension, radial/ulnar deviation, circumduction
What type of joint are the carpometacarpal joints?
Synovial, plane joint between digits 2-5. Saddle joint at the thumb
What type of joint are the metacarpophalangeal joints?
Synovial, condyloid joints allowing flexion/extension, ABD/ADD
What type of joints are the interphalangeal joints?
Synovial, hinge joints - permitting flexion/extension
Dupuytren Contracture is a disease of what?
Disease of palmar fascia, results in shortening, thickening and fibrosis of palmar fascia & aponeurosis
What are the 4 contents that pass through the carpal tunnel?
Flexor pollicis longus, 4 tendons of the flexor digitorum profundus, 4 tendons (2-5) of the flexor digitorum superficialis, & median n.
What 6 structures are in the area of flexor retinaculum but do not pass through the carpal tunnel?
Palmar cutaneous branch of median n, radial a, ulnar n & a, FCU tendon, palmaris longus tendon, FCR tendon
What is the tunnel of guyon (ulnar canal) created by?
Depression between pisiform and hook of hamate
What does the tunnel of guyon (ulnar canal) contain?
Ulnar n & a
Compression of the ulnar n. in the tunnel of guyon (ulnar canal) is known as what syndrome?
Ulnar canal syndrome “handlebar palsy”
Flexion/extension of the thenar muscles occur in what plane?
Coronal plane
ABD/ADD of the thenar muscles occur in what plane?
Sagittal plane
What are the two actions of the dorsal and palmar interossei muscles?
Dorsal abduct (DAB) Palmar adduct (PAD)
The dorsal carpal arterial arch gives rise to which two main arteries?
Princeps pollicis a. & radialis indicis a.
The median n passes through the carpal tunnel, does the palmar cutaneous branch of the median n also pass through the tunnel?
No
What branch of the median n supplies 2 1/2 thenar m?
Recurrent branch of median n
What branches of the median n supply the 1st & 2nd lumbricals?
Common palmar digital, proper palmar digital nn of median n
What muscles does the deep branch of the ulnar n supply?
Hypothenar, lumbricals 3-4, all interossei, adductor pollicis & deep head of flexor pollicis brevis mm
Losing the ability to ABD/ADD digits, ADD thumb along with hypothenar eminence atrophy & sensory loss to medial palm and palmar medial 1 1/2 digits is an injury to what nerve at the wrist?
Ulnar n
Carpal tunnel syndrome is a result of injury and inflammation to which nerve?
Median nerve at the wrist
Carpal tunnel syndrome is characterized by what symptoms?
pain, burning, tingling, weakness & atrophy of thenar eminence, inability to oppose thumb, thumb limited to flexion & extension
