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Anatomy > Lecture 22-24: Upper limb > Flashcards

Lecture 22-24: Upper limb Flashcards

1
Q

Describe the basic mammalian form of a limb.

A

A girdle attaching the limb to the axial skeleton, then a single proximal long bone, then two distal long bones, then pentadactyl hand/foot

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2
Q

What vertebrae supply the upper limb?

A

C5-T1

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3
Q

What is the rotation of the upper limb relative to the lower limb?

A

Upper limb: 90º external lateral rotation.

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4
Q

What are most features of the scapula for?

A

Muscular attachments.

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5
Q

What sacrifice does the shoulder joint make in return for such a broad range of motion?

A

It sacrifices stability.

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6
Q

What part of the scapula is labelled (1)?

A
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7
Q

What part of the scapula is labelled (11)?

A
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8
Q

What part of the scapula is labelled (8)?

A
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9
Q

What are the 3 posterior rotator cuff muscles? Where on the diagram are they located?

A
  • Supraspinatus: located at (9) supraspinous fossa
  • Infraspinatus: located at (7) infraspinous fossa and attaching along the medial border
  • Teres minor: located at (7) along the lateral border
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10
Q

What is the anterior rotator cuff muscle? Where on the diagram is it located?

A

Subscapularis: located at (12) the scapula fossa

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11
Q

Where do bones normally fracture?

A

At their weakest site.

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12
Q

Where on the clavicle is most likely to fracture? How does this happen?

A

On the biggest curve: lateral 1/3 and medial 2/3. Medial end stays attached to the sternum and the lateral end moves with the upper limb

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13
Q

What type of bone is the humerus?

A

Long bone

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14
Q

Where do vessels and nerve enter a long bone?

A

The nutrient foramen, in the middle of the shaft (diaphesis)

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15
Q

What is the difference between the anatomical neck and the surgical neck?

A

Anatomical neck is usually the position of the growth plate
Surgical neck is the most common site of fracture of the humerus

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16
Q

What is the name of the articular surface at the ends of long bones?

A

Epiphysis

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17
Q

What separates the metaphysis and the epiphysis?

A

The epiphysial growth plate

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18
Q

Identify the lesser, greater, and deltoid tuberosities. What are their purposes?

A

1 - greater

2 - lesser

7 - deltoid

Sites of muscle attachment

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19
Q

What is the name and role of the groove between the lesser and greater tuberosities?

A

Bicipetal groove - groove for bicep ligaments.

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20
Q

Identify and name the epicondyles. What are their purposes?

A

10 - medial epicondyle; site of attachment for anterior/flexor muscles in the forearm

12 - lateral epicondyle; site of attachment for posterior/extensor muscles in the forearm

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21
Q

What are the bones of the forearm? Which is lateral and which is medial?

A

Ulnar (medial) and radius (lateral)

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22
Q

Which of the bone of the forearm articulates at the wrist?

A

Radius

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23
Q

Which of the bone of the forearm articulates at the elbow?

A

Ulnar

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24
Q

The bones of the wrist are organised in two rows; what are the bones in the proximal row (from lateral to medial)?

A

Scaphoid (anatomical snuff box), lunate, triquetrum, pisiform

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25
Q

The bones of the wrist are organised in two rows; what are the bones in the distal row (from lateral to medial)?

A

Trapezium (beneath the thumb), trapezoid, capitate, hamate

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26
Q

Which is the last carpal bone to ossify and at approximately what age?

A

Pisiform at about 13 years

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27
Q

By what age do all the carpal bones (except the pisiform) ossify?

A

7

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28
Q

What 3 humeral structures are endangered of fracture?

A

Surgical neck

Midshaft

Supracondylar

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29
Q

Describe how one may most likely dislocate their elbow.

A

Falling backwards onto a supinated hand. This fall causes a classic posterior dislocation at the elbow joint where the results in the olecranon in a posterior posiiton and the distal end of the humerus in an anterior position.

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30
Q

What boney structure is at risk of fracture in an elbow dislocation?

A

The coronoid process of the proximal ulnar.

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31
Q

Describe the path of the vascular supply on the scaphoid.

A

Scaphoid gets its blood supply at distal end, which then tracts back and supplies proximal end of the scaphoid.

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32
Q

What complication may arise from scaphoid fractures?

A

Scaphoid fractures can cause avascular necrosis of the proximal end.

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33
Q

What fracture of the upper limb is the most common in the elderly? Why?

A

Colle’s fracture: a fracture of the distal radius characterised by the dorsal displacement of the wrist and hand. A common fracture in the elderly because of osteoporosis.

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34
Q

What is a ‘parry fracture’?

A

Fracture at the shaft of the ulnar.

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35
Q

What important non-skeletal structure makes up for the shoulder joint’s lack of stability?

A

Fixator muscles of the rotator cuff.

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36
Q

What injury(s) is commonly associated with ball and socket joints?

A

Dislocations and subluxations

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37
Q

What are the three joints of the shoulder complex and what bones are involved?

A

Sternoclavicular joint

Acromioclavicular joint

Glenhumeral (shoulder) joint

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38
Q

What are the key features of the sternoclavicular and acromioclavicular joints?

A

Sternoclavicular - intra-articular disc, very strong capsule, limitation of movement by accessory costoclavicular ligament.

Acromioclavicular - weak capsule, mainly stabilized by coracoclavicular ligament that prevents upward rotation of the clavicle

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39
Q

What is the weakest point of the shoulder joint?

A

Area inferior to the glenohumeral joints because it is minimally reinforced.

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40
Q

What is the most common direction of dislocation/subluxation of the shoulder? Why?

A

Downward - as in the direction that a rugby tackle would push the humerus - because it is minimally reinforced inferior to the glenohumeral joint.

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41
Q

Why is the glenohumeral joint ‘intrinsically unstable’?

A

Large head with shallow/smaller socket

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42
Q

What structure helps deepen the glenoid fossa?

A

The glenoid labrum

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43
Q

Of what if the glenoid fossa made?

A

Fibrocartilage

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44
Q

What structure allows the shoulder joint so mobile?

A

The small fold in the inferior aspect of the joint capsule that allows a large range of abduction.

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45
Q

What three structures strengthen the shoulder joint?

A

Coracoacromial ligament protects the superior aspect.

Long head of the biceps.

The rotator cuff muscles that help stabilize and pull-in the head of the humerus.

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46
Q

What 2 structures may be irritated by upward movement of the humerus?

A

The sub-acromial bursa and the supraspinatus via an ‘impingement’ between the head of the humerus and the scapula.

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47
Q
A
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48
Q

How do the muscles of the rotator cuff increase the stability of the joint?

A

By blending with the joint capsule they pull the head of the humerus into the glenoid fossa.

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49
Q

What is the weakest aspect (view) of the rotator cuff muscles.

A

Inferior aspect of the rotator cuff muscles; reason for so many downward dislocations/subluxations.

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50
Q

With which joint is the subacromial bursa associated? Does it communicate?

A

It is superior to the glenohumeral joint and it does not communicate.

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51
Q

What may irritate the subacromial bursa?

A

Over head rotation of the upper limb.

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52
Q

What is bursitis? What is the arc of pain.

A

Bursitis - inflammation of the bursa by compression between bones, tendons, or muscles

Arc of pain – between 60-120º of abduction

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53
Q

What may happen to the joint capsule as a consequence of dislocation/subluxation?

A

Stretching or tearing

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54
Q

What non-synovial structure is at risk of damage in inferior shoulder dislocation?

A

Impingement of the axillary nerve

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55
Q

Hinge joints are always in what plane? What movements does this allow?

A

Saggittal; flexion/extension

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56
Q

What are collateral ligaments?

A

Those ligaments that run down the side of the hinge/hinge-like joint.

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57
Q

What structure at a hinge joint is always easy to identify and name?

A

The collateral ligaments

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58
Q

What pivot joint is located in the upper limb? What bone articulates? What movement does it allow?

A

The ulnar-radial joint just distal to the elbow joint; the radius (most lateral) pivots on the ulnar (most medial); It allows pronation and supination.

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59
Q

Name three places in the upper limb that have collateral ligaments.

A

Elbow

Fingers (interphalangeal joints)

Wrist (distal radius, scaphoid, and lunate)

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60
Q

Are collateral ligaments only found at hinge joints?

A

No; also found at hinge-like joints.

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61
Q

Fill in the blank: Muscle a located in __________, surrounded by ___________

A

Compartments; deep fascia

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62
Q

What are the fascia of the arm and forearm each called

A

Arm/upper arm: bracial fascia

Forearm: antebraial facia

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63
Q

What separates muscle comparments, eg in the forearm?

A

Interosseus membrane

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64
Q

What is the role of the facial septa?

A

Attaches to bone and separates individual muscles

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65
Q

What are the three roles of the interosseus membrane of the forearm?

A

Binds radisu and ulnar, provides attachments for muscles in the flexor and externsor compartments of the forearm, directs forces between the radius and the ulnar (eg, during a fall the force will be transfered from the radius to the ulnar and elbow joint)

66
Q

What is Colle’s fracture?

A

Fracture at the wrist from landing on an open palm when falling.

67
Q

What is the retinaculae?

A

Deep fascia at the wrist

68
Q

What is the role of the retinaculae?

A

Holds tendons in place (ie, prevents them from bostringing) and protects nerves and vessels

69
Q

What structure forms the roof of the carpal tunnel?

A

The flexor retinaculae

70
Q

What is the contents of the carpal tunnel?

A

Tendons of the flexor compartment (9), 2 arteries, and the median nerve

71
Q

The proximal border of the flexor retinaculae corresponds with what feature of the skin of the wrist?

A

The most distal wrist crease

72
Q

What is the cause of ‘carpal tunnel syndrome’?

A

Compression of the carpal tunnel, eg from effusion, and thus compression of the median nerve

73
Q

Why are pregnant women prone to carpal tunnel syndrome?

A

Increased systemic fluid retention

74
Q

What are the four roles that muscles can take? (eg, primemover)

A

Primemovers, antagonists (opposing movement at a joint compared to the agonist), synergists (helps perform the same movement at a joint as the agonist), fixators

75
Q

Why are superficial/extrinisic muscle of the back not considered to be true back muscles?

A

They have one attachment on the back and one attachment on the upper limb. They are primemovers of the shoulder girdle and at the shoulder joint.

76
Q

What are the four extrinsic muscles of the back?

A

Levator scapulae, trapezius, latissimus dorsi, rhomboids

77
Q

What are the three muscles of the anterior chest wall that act on the upper limb?

A

Pectoralis major, pectoralis minor, serratus anterior

78
Q

What is the action of pectoralis major?

A

Powerful flexion at the shoulder

79
Q

What is the action of pectoralis minor?

A

Protraction of the scapula

80
Q

What is the action of serratus anterior?

A

Stabilizes the scapula against the chest wall

81
Q

Why is there a risk of having a ‘winged’ scapula as a consequence of mastectomy?

A

May accidently damage a nerve and cause paralysis of the serratus anterior, thus it will not hold the scapula against the posterior chest wall and it will ‘wing’

82
Q

What type of muscle are the scapula/rotator cuff muscles?

A

Fixators

83
Q

What is the role of the rotator cuff muscles?

A

Since they blend with the joint capsule, they pull the head of the humerus deeper into the glenoid fossa. Therefore increasing compression and stability of the joint.

84
Q

What are the muscle of the anterior arm/upper arm?

A

Biceps (long head and short head), brachialis, and coracobrachialis

85
Q

What are the movements of the biceps?

A

Flexion at the shoulder joint and flexion at the elbow joint

86
Q

What is the movement of the brachialis?

A

Flexion at the elbow

87
Q

Are the superificial or the deep muscles of the forearm longer?

A

Superficial

88
Q

What are the action of the anterior and posterior muscles of the forearm?

A

Anterior: extension at the wrist and fingers

Posterior: flexion at the wrist and fingers

89
Q

Are the extensors or flexors in the forearm weaker?

A

Extensors are weaker, flexors are stronger

90
Q

What are the four muscles of the flexor compartment of the forearm?

A

P.F.P.F

Pronator teres (PT)

Flexor carpi radialis (FCR)

Palmaris longus (PL)

Flexor carpi ulnaris (FCU)

91
Q

Where is the common flexor origin of the forearm located?

A

Superficial flexor muscles of the forearms originate from the medial epicondyle.

92
Q

Which of the superficial muscles of the flexor compartment of the forearm do NOT cross the wrist?

A

PT - pronator teres

93
Q

What is the muscle of the intermediate layer of the forearm?

A

The flexor digitorum superficialis (FDS)

94
Q

What are the three muscles of the the deep layer of the forearm?

A

Flexor pollicis longus (thumb) (FPL), flexor digitorum profundus (FDP), and pronator quadratus (PQ)

95
Q

How many layers of muscle are there in the extensor compartment of the forearm?

A

2: superficial and deep

96
Q

Where is the common extensor origin (CEO) of the muscles in the forearm?

A

The lateral epicondyle

97
Q

How many wrist extensors and how many finger extensors are there in the superficial layer in forearm?

A

Wrist: 3

Finger: 2

98
Q

True or false: the superficial extensor muscles of the forearm are used for broad, crude movements, like grip.

A

True

99
Q

What kind of movement are the extensor muscles in the deep layer of the forearm used for?

A

Delicate, fine movements

100
Q

How many muscles are there in the deep layer of the extensor compartment of the forearm? What are their actions?

A

Five

A supinator, 3 that extend/abduct the thumb, and one that extends the ring finger

101
Q

True or false: when you want to curl your fingers only the muscles in the anterior compartment of the forearm are used. Justify your response.

A

False: the muscles in the posterior compartment act synargistically to prevent unwanted wrist flexion

102
Q

What are the roles of the synovial sheath in the hand?

A

Reduce friction of the tendons and prevent bowstringing

103
Q

What is the role of the intrinsic muscles of the hand?

A

Fine tune muscle of the fingers and thumb

104
Q

What are the movements of the thenar muscles?

A

Flexion, extension, abduction, adduction, and rotation of the thumb

105
Q

Hypothenar muscles are muscle belonging to which finger?

A

The pinky/little finger

106
Q

What are the 4 arteries of the upper limb?

A

Axillary, brachial, radial, ulnar

107
Q

Which artery is occluded when taking a blood pressure reading?

A

The brachial artery

108
Q

True or false: the radial artery forms anastomosis with the ulnar arteries via the deep palmar arch.

A

False: the radial artery forms anastomosis with the ulnar arteries via the superficial palmar arch.

109
Q

Which blood vessel in the wrist is pulpated for heart rate readinings?

A

The radial artery

110
Q

Nail beds are supplied by which arteries?

A

digital arteries

111
Q

Why are the digital arteries susceptible to avascular necrosis and vasospasm?

A

Digital arteries are considered ‘end’ arteries.

112
Q

Why are lacerations of fingers are surgically important?

A

If the digital artery spurts blood then there is a good chance that the digital nerve has been damaged.

113
Q

What is the easiest way to dislocated the elbow?

A

Falling backwards and landing on the hand with the elbow slightly flexed. The ulnar then displaces posteriorly.

114
Q

What part of the ulnar is at risk of fracture in an elbow dislocation?

A

Coronoid process

115
Q

If the coronoid process what blood vessel is at risk of damage?

A

The brachial artery

116
Q

What is Volkman’s ischemia?

A

If there is limited, or no, blood supply to the forearm (radial and ulnar arteries) and leads to avascular necrosis of the forearm.

117
Q

Where do the superficial veins of the arm begin?

A

The dorsal venous arch (back of hand)

118
Q

What are the three main tributaries of the dorsal venous arch?

A

Cephalic, basilic,

119
Q

Which blood vessel of the upper limb are venepunctures most often performed on?

A

The median cubital vein

120
Q

What are venae comitantes?

A

A pair of venes lying either side of and that flow in the opposite direction of an artery.

121
Q

What is the purpose of venae comitantes?

A
  1. Warm venous blood.
  2. Pulpations of the artery help venous return
122
Q

All the lymphatic vessels of the upper limb drain to which lymph node?

A

The axillary lymph node

123
Q

After they drain to the axillary lymph nodes, the lymphatic vessels of the upper limb then drain to which veins?

A

The veins in the necks

124
Q

The right lymphatic duct drains lymph from what area of the body?

A

Right upper arm, right side of the head/neck, right side of the thoracic cavity

125
Q

The thoracic trunk drains lymph from what area of the body?

A

All of the body that is not drained by the right lymphatic duct

126
Q

What is a watershed area of lymph drainage? Where are the two watershed areas of lymph drainage?

A

Watershed area means can drain to both axillary nodes and inguinal nodes.

  1. Cervical-axillary watershed - the area in line with the clavical;
  2. Axillary -inguinal watershed - the area in line with the naval
127
Q

Does lymph drainage cross the midline?

A

Yes

128
Q

What is the clinical significance of the supraclavicular nodes?

A

If a cancer metastasises in the lymp they will collect in the lymph nodes. If your right supraclavicular node has a cancer in it then it will have come from the right thorax/upperlimb/head/neck wheres if your left supraclavicular node has a cancer in it then it could have come from anywhere else in the body.

129
Q

Which spinal cord segments inervates the dermotomes of the skin? Which one inervates the middle three fingers?

A

C4-T2; C7

130
Q

What is the name of the plexus that supplies the upper limb?

A

The brachial plexus

131
Q

Which splinal cord segments supply the brachial plexus?

A

C5-T1

132
Q

True or false: counter-intuitively, the posterior branches of the brachial plexus supply the flexor compartments and the anterior branches supply the extensor compartments of the upper limb.

A

False: the posterior branches of the brachial plexus supply the extensor compartments and the anterior branches supply the flexor compartments.

133
Q

What are the 5 nerves of the brachial plexus? Which compartments do they supply?

A

3 * flexor compartment nerves: musculocutaneous, median, ulnar

2 * extensor compartment nerves: axillary, radial

134
Q

Which spinal cord segments supply the musculocutaneous nerve? What muscles does it innervate?

A

C5, C6; supplies the flexors of the elbow and the lateral aspect of the forearm

135
Q

Which spinal cord segments supply the median nerve? What muscles and skin segments does it innervate?

A

C5-T1; most muscles of the anterior compartment of the forearm, the skin and nail beds of the lateral 3.5 digits

136
Q

What structure in the wrist does the median nerve pass through? Therefore, the median nerve is particularly susceptible to what injury?

A

Compression, especially in carpal tunnel syndrom.

137
Q

Which spinal cord segments supply the ulnar nerve? What muscles and skin segments does it innervate?

A

C8, T1; remaining muscles of anterior compartment of the forearm and hand (except thumb), medial 1.5 digits (palmar and dorsal surfaces)

138
Q

The ulnar nerve is particularly susceptible to what injury? (Think funny bone.)

A

Compression or stretch across the medial epicondyle

139
Q

Does the ulnar nerve pass deep to or superficial to the retinaculum

A

Superficial

140
Q

Which spinal cord segments supply the axillary nerve? What muscles and skin segments does it innervate?

A

C5 & C6; deltoids, skine over the should (military badge area)

141
Q

The axillary nerve is susceptible to damage in what two injuries?

A

Shoulder dislocation and fracture to surgical neck of the humerus.

142
Q

Which spinal cord segments supply the radial nerve? What muscles and skin segments does it innervate?

A

C5-T1; extensor muscles of the arm and forearm; skin of arm, forearm, and back of hand (including the lateral 3.5 digits)

143
Q

The radial nerve is susceptible to damage in what injury of the upper limb?

A

Fracture of the shaft of the humerus.

144
Q

What is Saturday night palsy?

A

Acute trauma to the radial nerve (eg, extended compression after a big one) that causes normally temporary, indefinite loss of sensation of the back of the forearm and hand and loss of control of extensor muscle. Results in ‘wrist drop.’

145
Q

Define “dermotome.”

A

Area of skin supplied by a single spinal cord segment

146
Q

What is Erb’s palsy? What position does the upper limb take?

A

‘Waiter’s tip’ position: paresthesia in dermatomes C5 & C6, paralysis of myotomes C5 & C6 (ie, elbow flexors and wrist extensors)

147
Q

What is Klumpke’s palsy? What position does the upper limb take?

A

Paraesthesia in C8 & T1, paralysis of intrinsic hand muscles: creates a ‘claw’ hand and causes loss of fine motor control

148
Q

Injury to what nerve structure may cause Erb’s palsy? Give an example of how this might happen.

A

Damage to the upper trunk of the brachial plexus. Eg, during forceful lateral flexion of the head on shoulder during a car crash or birth

149
Q

Injury to what nerve structure may cause Klumpke’s palsy? Give an example of how this might happen.

A

Damage to the lower trunk of the brachial plexus. Eg, Sudder traction when arm is caught/hangning/during birth.

150
Q

True or false: the brain is encoded for specific muscles?

A

False: the brain is encoded for specific movements

151
Q

True or false: two muscles at the same joint with the same movement have the same myotome.

A

True

152
Q

Snakes alive…

A

it’s C5

153
Q

6 & 7…

A

down from heaven

154
Q

5 & 6…

A

pick up sticks

155
Q

7 & 8…

A

in the grate

156
Q

Supine flicks…

A

that’s C6

157
Q

7 & 8 (again)…

A

pronate

158
Q

Royal wavin’…

A

6 & 7

159
Q

7, 8…

A

Masturbate

160
Q

T1…

A

adduction and abduction of the thumb and fingers

Anatomy (21 decks)

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