Gross Anatomy of Upper Limb Flashcards
What are the components of the upper limb?
scapular region
extensor compartment of arm and forearm
dorsum of hand
pectoral region
flexor compartment of arm, forearm, and palm
joints of upper limb
What makes up the pectoral (shoulder) girdle?
clavicle and scapulae
What is the purpose of the pectoral girdle?
attach the upper limbs to the axial skeleton
provide attachment sites for muscles that move the upper limbs
holds the upper extremity to the skeleton
Where does the flattened acromial (lateral) end of the clavicle articulate?
the scapula - the acromial process
Where does the cone-shaped sternal (medial) end of the clavicle articulate?
the sternum
What is the purpose of the clavicle (collarbones)?
act as braces to hold the scapulae and arms out laterally
Where is the scapulae located?
the dorsal (posterior) surface of the rib cage between ribs 2-7
How many bones form the skeletal framework of each upper limb?
30
What are the bones of the upper limb?
upper arm - humerus
forearm - radius and ulna
hand/wrist - 8 carpal bones in the wrist, 5 metacarpal bones in the palm, 14 phalanges in the fingers
Where does the humerus articulate?
superiorly with the glenoid cavity of scapula and inferiorly with the radius and ulna
Which bone in the forearm is medial?
ulna
Which bone in the forearm is lateral?
radius
What is the purpose of the ulna?
forms major portion of the elbow joint with the humerus
Where does the head of the radius articulate?
the capitulum of humerus and radial notch of the ulna
What connects the radius and ulna?
interosseous membrane
What is maids elbow?
dislocation of the elbow
What is the distal row of the carpal bones from lateral to medial?
trapezium, trapezoid, capitate, and hamate
What is the proximal row of the carpal bones from lateral to medial?
scaphoid, lunate, triquetrum, pisiform
Which carpal bones articulate with radius to form the wrist joint?
scaphoid and lunate
What are the 3 phalanges?
distal, middle, and proximal
What is the pollex?
thumb
What finger does not have a middle phalanx
thumb
What is the purpose of the deep fascia of the arm?
sends out strong intermuscular septa to the corresponding supracondylar line
divides arm into 2 distinct compartments - anterior/posterior
What is deep fascia of the anterior wrist?
flexor retinaculum
What is the deep fascia of the posterior wrist?
extensor retinaculum
What is the deep fascia of the palm?
palmar aponeurosis
What is the brachial plexus formed by?
ventral rami of C5-C8 and T1
What are the major branches of the brachial plexus?
roots
trunks
divisions
cords
What are the roots of the brachial plexus?
C5-C8 and T1
What are the trunks of the brachial plexus?
upper, middle, lower
What are the divisions of the brachial plexus?
anterior and posterior
What are the cords of the brachial plexus?
lateral, medial, posterior
Where does the axillary nerve wrap around?
the surgical neck of the humerus with the post circumflex humeral artery
What does the axillary nerve innervate?
deltoid
teres minor
skin over deltoid region
joint capsule of the shoulder
What are the roots of the axillary nerve?
C5 and C6
What is the cord of the axillary nerve?
posterior cord
What are the roots of the radial nerve?
C5-C8 and T1
What is the cord of the radial nerve?
posterior cord
What does the radial nerve wrap around?
the shaft of the humerus to the lateral epicondyle
What are the 2 branches of the radial nerve?
deep and superficial
What does the deep branch of the radial nerve supply?
extensor muscles of the forearm
What does the superficial branch of the radial nerve supply?
skin over the lateral 3 and 1/2 fingers
What nerve does the deep artery of the arm accompany?
radial nerve
What nerve does the post circumflex humeral arty accompany?
axillary nerve
What does the axillary artery begin as?
continuation of 3rd part of subclavian artery
What does the axillary artery become?
brachial artery
What are the branches of the axillary artery?
first part: sup thoracic artery
second part: thoraco-acromial, lateral thoracic, alar thoracic (occasionally)
third part: subscapular, anterior and posterior circumflex humeral
What is venous drainage?
carry blood towards the heart
What vein do we draw blood from?
median cubital vein
What is the most common vein?
median cubital vein
What is the cephalic vein a continuation of?
lateral end of dorsal venous arch
Where does the cephalic vein terminate?
subclavian vein
Where does the basilic vein drain?
brachial vein
Explain the dorsal venous arch.
Radial end of the arch continues proximally as cephalic vein and terminates as axillary vein
ulnar end continues as the basilic vein, joins the brachial vein and then the axillary vein
What are the muscles of the scapular region
deltoid
supraspinatus
infraspinatus
teres minor
teres major
What are the rotator cuff muscles?
supraspinatus
infraspinatus
teres minor
subscapularis
What are the 3 heads of the triceps brachii?
lateral head
long head
medial head (deep)
What are the 3 anatomical spaces in the scapular region?
quadrangular
lower triangular
upper triangular
What are the borders of the quadrangular space?
Above: teres minor
Below: teres major
Medially: long head of triceps
Laterally: surgical neck of humerus
What passes through the quadrangular space?
axillary nerve
post circumflex humeral vessels
What are the borders of the upper triangular space?
Above: teres minor
Below: teres major
Laterally: long head of triceps
What passes through the upper triangular space?
circumflex scapular vessels and branches of subscapular vessels
What are the borders of the lower triangular space?
Above: teres major
Medially: long head of triceps
Laterally: shaft of the humerus
What passes through the lower triangular space?
radial nerve
deep artery and vein of arm
What muscles cross the elbow joint?
posterior extensor muscle - triceps brachii and anconeus
What muscles are part of the lateral group of the extensor muscles of the forearm?
brachioradialis
extensor carpi radialis longus
extensor carpi radialis brevis
What muscles are part of the posterior group of the extensor muscles of the forearm?
extensor digitorum
extensor digiti minimi
extensor carpi ulnaris
What are the superficial muscles of the extensor muscles of the forearm?
extensor carpi radialis brevis
extensor digitorum
extensor digiti minimi
extensor carpi ulnaris
What muscles of the extensor compartment of the forearm take origin from the lateral epicondyle of humerus?
extensor carpi radialis brevis
extensor digitorum
extensor digiti minimi
extensor carpi ulnaris
What muscles are part of the deep group of extensor muscles of forearm?
supinator
abductor pollicis longus
extensor pollicis brevis
extensor polliis longus
extensor indicis
What is dequervain tenosynovitis?
inflammation of APL and EPB tendons due to repeated use - usually seen in mothers who are picking up/holding their babies
What nerves are involved in Erb-Duchenne Paralysis?
Erbs point which is the upper trunk, C5, C6 roots
What is the mode of injury for Erb’s paralysis?
traction of infants arm during birth
severe fall on the side of the head and shoulder
What is the effect of Erb’s paralysis?
weakness of elbow flexion and shoulder abduction, flexion and external rotation (policeman’s tip hand)
What nerves are involved in klumpke’s paralysis?
lower trunk of brachial plexus, C8 and T1 roots
What is the mode of injury for klumpke’s paralysis?
forcible breech delivery, leading to upward traction of the arm
What is the effect of klumpke’s paralysis?
intrinsic muscles of the hand are affected leading to claw hand
What nerve is involved in wrist drop?
radial nerve
What is the mode of injury for wrist drop?
fracture shaft of humerus in the region of spiral groove
compression of the nerve against the spiral groove by placing the outstretched hand/arm on an arm-chair (saturday night palsy)
What are the muscles of the pectoral region?
pectoralis major
pectoralis minor
subclavius
serratus anterior
What is winged scapula?
action of serratus anterior is antagonized by the contractions of rhomboids and middle fibers of trapezius
How does winged scapula happen?
paralysis of serratus anterior - long thoracic nerve lesion
What muscles are part of the flexor compartment of the arm?
biceps brachii
coracobrachialis
brachialis
What are the 2 heads of the biceps?
long head
short head
What are the superficial muscles of the flexor compartment of forearm?
pronator teres
flexor carpi radialis
palmaris longus
flexor carpi ulnaris
flexor digitorum superficialis
What are the deep muscles of the flexor compartment of the forearm?
flexor pollicis longus
flexor digitorum profundus
pronator quadratus
What are the functions of the intrinsic muscles of the hand?
control precise movements of metacarpals and fingers
adductors and abductors of the fingers
produce opposition
what is the one subcutaneous intrinsic muscles of the hand?
palmaris brevis
What are the 3 groups of deeper muscles of the intrinsic muscles of the hand?
thenar eminence
hypothenar eminenece
midpalmar muscles
What muscles are part of the thenar eminence?
flexor pollicis brevis
abductor pollicis brevis
opponens pollicis
What muscles are part of the hypothenar eminence?
flexor digiti minimi
abductor digiti minimi
opponens digiti minimi
What muscles are part of the midpalmar muscles?
adductor pollicis
lumbricals
palmar and dorsal interossei
What are some details of the palmaris brevis?
muscle that lies in the sub Q tissue
does not have any bony attachments
Where do the lumbricals originate from?
tendons of the digitorum profundus
What are the deep fascia of the flexor side of the arm?
flexor retinaculum
palmar aponeurosis
What is the flexor retinaculum?
strong fibrous band
What is the function of the flexor retinaculum?
acts as a tie-beam and converts the anterior concave surface of the carpus into an osseofibrous carpal tunnel
What does the tunnel of the flexor retinaculum contain?
digital flexor tendons and median nerve
What structures pass superficial to the retinaculum?
palmaris longus tendon
palmar cutaneous branch of median nerve
palmar cutaneous branch of ulnar nerve
superficial palmar branch of radial artery
ulnar nerve and vessels
What is the palmar aponeurosis?
central part is thick and protects the underlying long flexor tendons from bow-stringing
What is dupuytrens contracture?
thickening of palmar aponeurosis on the ulnar side (most commonly affected)
What is the pulp space?
space between palmar skin and distal phalanges comprised of tendon and fatty tissue
What is a felon?
infection of the pulp space
needs to be treated immediately in order to not infect the bone
How is the pulp space created?
skin is connected to the periosteum of the distal phalanx by numerous radiating fibrous septa subdividing the space into a number of tight compartments
What are the roots of the musculocutaneous nerve?
C5-C7
What cord is the musculocutaneous nerve derived from?
lateral cord
What does the musculocutaneous nerve continue as below the elbow?
lateral cutaneous nerve of the forearm
What is the most common area of injury for the ulnar nerve?
elbow
What are the roots of the ulnar nerve?
C7, C8, T1
What cord is the ulnar nerve derived from?
medial cord
What does the ulnar nerve become at the medial epicondyle?
a cutaneous nerve
What accompanies the ulnar nerve?
ulnar artery
What are the roots of the median nerve?
C6-C8, T1
What cords of the brachial plexus for the median nerve?
medial and lateral cords
What is the deep palmar arch mostly formed by?
radial artery
What is the superficial palmar arch mostly formed by?
ulnar artery
What type of joint is the shoulder joint?
multi-axial ball-and-sockey type of synovial joint
What are the articulating surfaces of the shoulder joint?
head of humerus
glenoid cavity of scapula (deepened by glenoidal labrum)
What are the ligaments of the shoulder joint?
fibrous capusle
gleno-humeral ligaments
glenoidal labrum
coraco-humeral ligament
transverse humeral ligament
What is the function of the glenoid labrum?
deepens glenoid cavity allowing for more stabilization
What are bursae?
part of synovial joint
fluid filled sacs
What are the bursae in relation to the shoulder joint?
subscapular bursa
infrascapular bursa
subacromial bursa
synovial sheath around the long tendon of biceps
What is the arterial supply of the shoulder joint?
anterior and posterior circumflex humeral artery
What is the nerve supply of the shoulder joint?
axillary nerve
suprascapular nerve
lateral pectoral nerve
In regards to the shoulder, what is dislocation and how does it happen?
common due to laxity of the ligaments and disproportionate articular surfaces
inferior or subglenoid dislocation is common
What is painful arc syndrome?
characterized by chronic thickening of the tendon of the supraspinatus and its impingement against the coraco-acromial arch
What is frozen shoulder?
results from tendonitis involving rotator cuff
What 9 muscles cross the shoulder joint to insert on and move the humerus?
pectoralis major
latissimus dorsi
deltoid
supraspinatus
infraspinatus
teres minor
subscapularis
coracobrachialis
teres major
What type of joint is the elbow joint?
hinge joint (2 movements possible), synovial joint
What are the articulating surfaces of the elbow joint?
Humero-ulnar part: formed by trochlea of humerus and the trochlear notch of ulna
Humero-radial part: formed by capitulum of humerus and head of radius
What are the ligaments of the elbow joint?
fibrous/articular capsule
ulnar collateral (medial) ligament
radial collateral (lateral) ligament
annular ligament
Where are the bursae in relation to the elbow joint?
between the triceps tendon and capusle of the joint
subcutaneous bursa on the dorsal triangular surface of olecranon process
between the biceps tendon and radial tuberosity
What is the arterial supply of the elbow joint?
anastomosis around elbow joint
What is the nerve supply of the elbow joint?
musculocutaneous, radial, and ulnar nerves
In regards to the elbow, what is dislocation and how/where does it occur?
disrupts the triangular relationship between 2 humeral epicondyles and the olecranon process
What is supra-condylar fracture?
does not disrupt the triangular relationship between 2 humeral epicondyles and the olecranon process
What is tennis elbow?
tear of the radial collateral ligament
What is the mode of injury of tennis elbow?
abrupt pronation during tennis play
