Limb anatomy CR

Question 1

1.What bone is the subscapular fossa found in? 2.Which rotator cuff mucle attaches to this area?

Answer 1

1. Scapula, it is the large depression that is located over most the surface
2. Subscapularis muscle

Question 2

Which three musles attach to the coracoid process?

Answer 2

Pectoralis minor, coracobrachialis and the short head of the biceps brachii

Question 2

Which three musles attach to the coracoid process?

Answer 2

Pectoralis minor, coracobrachialis and the short head of the biceps brachii

Question 3

The lateral side of the scapula faces the humerus. In addition to the glenoid fossa which forms the glenohumeral joint.

Where does the long head of the biceps brachii join the scapula?

Where does the long head of the triceps brachii join the scapula?

Answer 3

1. Supraglenoid fossa

2. Infraglenoid fossa

Question 4

The site of origin for most of the rotator cuff muscles are from the posterior surface of the scapula.

Where does the infraspinatus orginate from?

Where does the supraspinatus originate from?

Answer 4

1. infraspinous fossa

2. supraspinous fossa

Question 5

CR- Winging of the scapula:

1. Which muscle keeps the scapula against the ribcage?
2. Where does this muscle orginiate from and which nerve innervates it?
3. How can this nerve become damaged ?
4. What are the treatment options?

Answer 5

1. Serratus anterior
2. It orginiates from ribs 1-8 and is innervated by the long thoracic nerve
3. Trauma to the shoulder or by repetitive movements involving the shoulder. It can also occur after mastectomies.
4. The management option is physiotherapy

Question 5

CR- Winging of the scapula:

1. Which muscle keeps the scapula against the ribcage?
2. Where does this muscle orginiate from and which nerve innervates it?
3. How can this nerve become damaged ?
4. What are the treatment options?

Answer 5

1. Serratus anterior
2. It orginiates from ribs 1-8 and is innervated by the long thoracic nerve
3. Trauma to the shoulder or by repetitive movements involving the shoulder. It can also occur after mastectomies.
4. The management option is physiotherapy

Question 6

The clavical can be divided into three main anatomical regions. These include the sternal end (the medial end), the shaft and the acromial end (the lateral end).

Which ligament that is apart of the sternoclavicular joint attaches to the sternal end?

Answer 6

Costoclavicular ligament

Question 7

What muscles attach to the shaft of the clavical?

Answer 7

Deltoid, Trapezius, Subclavius, Pectoralis Major, Sternocleidomastoid and Sternohyoid

Question 8

The acromial end of the clavical forms the acromioclavicular joint.

What is the coracoclavicular ligament ?

What are the two components of the coracoclavicular ligament called ?

Where do they articulate with the clavical?

Answer 8

1. It is a ligament that connects the clavicle to the coracoid process. It helps the shoulder stay in place while doing complex movements.
2. The conoid ligament and the trapeziod ligament
3. • The conoid ligament is the medial part and attaches to the conoid tubercle
   • The trapezoid ligament is the lateral part and attaches to the trapezoid line

Question 9

CR- Clavical fracture

When do they mostly occur? When do they occur in babies?

Which area of the clavical is commonly fractured ?

What are the signs and symptoms of a clavicular fracture?

What things must be assessed when a patient comes in with this fracture?

What are the non-surgical treatment options?

What are the surgical treatment options? What is one complication that can result druing operation?

Answer 9

1. They mainly occur when there is direct trauma to the shoulder or FOSH. In babies they can occur when they pass through the birth canal.
2. The middle third or mishaft.
3. • Very painful and limit the ability ot move arm
   • Sagging of the shoulder anteriorly and depressed
   • Grinding sensation when trying to raise arm
   • Deformity/bump over the break
   • Bruising/swelling/tenderness over the collarbone
4. A neruological assessment to exclude brachial plexus injury. A vascular assessemnt as subclavian artery runs close to the shoulder.
5. Analgesia, broad arm slings
6. ORIF
   A complication that can arise is loosing senation/numbness over the upper chest and the shoulder due to injury of the supraclavicular nerves

Question 10

What area of the scapula does the humerus articulate with to form the glenohumeral joint?

What area of the radius and the ulnar does the humerus articuate with to form the elbow?

Answer 10

1. The glenoid fossa

2. The head of the radius and the trochlear notch of the ulna

Question 11

What rotator cuff muscles attach to the greater tuberosity of the humerus ?

Answer 11

Supraspinatus, infraspinatus and the teres minor

Question 12

What rotator cuff muscle attaches to the lesser tuberosity?

Answer 12

Subscapulairs

Question 13

1. What tendon runs through the intertubercular groove/sulcus ?
2. The edges of the intertubercular groove are known as the ‘lips’. What muscles insert at the lips?

Answer 13

1.The tendon of the long head of the biceps brachii

2.

• Teres major inserts at the medial lip
• Pectoralis major inserts at the lateral lip
• The latismuss dorsi attaches to the humerus between these two

Question 14

What important neurovasculature lies at the surgical neck of the humerus ?

Answer 14

The axillary nerve and the circumflex artery

Question 15

CR - Surgical neck/Proximal humerus fractures

What population are the most common in?

What are the signs and symptoms?

What are the complications that can arise from this type of fracture? Why?

What are the management options?

Answer 15

1. It is most common in elderly patients and occrs after a FOOSH
2. • pain
   • apprehension of movement
   • limited shoulder movement
   • numbness in arm/hand
   • upper arm deformity
   • bruising/swelling
3. There is a high risk of neruovacular damage occuring. This is due to the fact that the axillary nerve and the posterior cirumfelx artery are located in this region.

There is a high chance of damage to the axillary nerve which will lead to paralysis of the deltoid and the teres minor. Numbness of the regimental badge are and cannot abduct the affected limb.

4. Non surgical management is often used as many of these fractures result in non-displacement. Therefore pain management, sling immoblisation and then physiotherapy as this injury is often linked ot shoulder stiffness.

Surgical management depends really it can be ORIF, CRPP (close reduction percutaneous pinning), Intramedullary nailing, Arthroplasty.

Question 16

Where does the deltoid mucle attach to the shaft of the humerus?

Where is the radial/spiral groove located? What artery and nerve run down it?

What muscles attach to the anterior surface of the shaft?

What muscles attach to the posterior surface of the shaft ?

Answer 16

1. The deltoid muscles
2. It runs on the posterior aspect of the humerus, parallel to the deltoid tuberosity. The radial nerve and the profunda brachii artery lie along it.
3. The coracobrachialis, deltoid, brachialis, brachioradialis
4. The medial and lateral heads of the triceps

Question 17

CR - Mid-Shaft fracture

How do you casue this injury in a younger patient?

What is a common complication to watch out for with this fracture ?

What are the symptoms/signs of this type of fracture?

What are the management options?

Answer 17

1. High energy twisiting force or high enegry bending force
2. Radial nerve injury.

This is because the radial nerve and the profuncda brachii artery are found within the radial groove. It innervates the extensors of the wrist. Injury to this nerve will lead to paralysis of the extensors so the wrist will drop.

There will also numbness over the dorsal aspect of the hand and the proximal ends of the lateral 3 and a half fingers dorsally.

3. • pain
   • swelling/deformity
   • restricted shoulder and arm movement

4.Non surgical management when there is non-displacement. Therefore pain management and sling immoblisation.

Surgical management depends really it can be intramedullary nailing or placement of metal plates .