Limbs Upper Flashcards
capitulum and trochlea
capitulum anterior more lateral
joints of pectoral girdle
sternoclavicular
acromioclavicular
glenohumeral joint
scapulothoracic joint
sternoclavicular joint ligaments
sternoclavicular
costoclavicular
acromioclavicular joint ligaments
acromioclavicular
coracoclavicular= conoid trapezoid
coracoacromial
how is acromioclavicular joint commonly injured
falls onto outstretched hand
acromioclavicular = minor
coracoclavicular = major
subacromial bursa
fibrous capsule extends above the humeral head
what tendon goes through the glenohumeral joint
long head of biceps
important ligaments in the capsule of glenohumeral
2 glenohumeral ligaments
coracohumeral
transverse humeral
inflmmation of glenohumeral ==
frozen shoulder
what tendon can get trapped in glenohumeral
supraspinatus
2 functions of rotator cuff
hold humerus in glenoid cavity
depress humeral head to minimise risk of dislocation
anterior dislocation of humerus…
tearing of glenoid labrum
compression of axillary nerve
Pec major**
sternum, MEDIAL third clavicle, rectus abdominis, COSTAL CARTILAGES 108-> LATERAL lip of intertubercular groove
Lateral and MEDIAL pectoral nerve (c567)
adduction and medial rotation and FLEXION all at GLENOHUMERAL
pec minor*
RIBS 3-5 costochondral joints to coracoid process
PROTRACTION AT SCAPULOTHORACIC
medial pectoral nerve c8t1
serratus anterior **
ribs 1-8 MEDIAL BORDER OF SCAPULA PROTRACTION AT SCAPULOTHORACIC ELEVATE GLENOID FOSSA long thoracic nerve 5,6,7
trapezius **
shrug shoulders ELEVATION ROTATION RETRACTION DEPRESSION spinal accessory LIGAMENTUM NUCHAE AND THORACIC SPINE acromion, POST THIRD clavicle, spine of scapula
lat dorsi**
thoracolumbar fascia iliac crest intertubercular groove = FLOOR thoracodorsal nerve ADDUCTION MEDIAL ROTATION EXTENSION ***relate to pec major
deltoid **
spine of scapula, acromion, POSTERIOR THIRD clavicle to deltoid tuberosity
axillary nerve c56
abduction
teres major **
inferior angle of scapula -> MEDIAL LIP INTERTUBERCULAR GROOVE
MEDIAL ROTATION, ADDUCTION
INFERIOR SUBSCAPULAR
supraspinatus *
infraspinatus
fossae -> greater tubercle
SUPRA = ABDUCTION
INFRA = LATERAL ROTATION
suprascapular nerve
teres minor *
lateral inferior border of scapula -> greater tubercle
LATERAL ROTATION
AXILLARY
subscapularis *
fossa -> LESSER TUBERCLE
subscapular nerve
MEDIAL ROTATION
biceps brachi *
supraglenoid tubercle and coronoid process
radial tuberosity
musculocutaneous
flexion and supination
brachialis *
shaft of humerus -> ULNAR TUBEROSITY
FLEXION AT ELBOW
coracobrachialis *
coronoid process -> shaft of humerus
FLEXION WEAK ADDUCTION
triceps *
infraglenoid tubercle
shaft of humerus above groove and then below groove
OLECRANON ULNA
when can serratus anterior be damaged
lymph node exploration during mastectomies
axilla boundaries
clavicle , first rib humerus pec major lat dorsi SUBSCAPULARIS TERES MAJOR rib cage SERRATUS ANTERIOR
contents of axilla
axillary artery vein
lymphatics
brachial plexus
what does musculocutaneous continue as
lateral cutaneous nerve of the forearm
where does the ulnar nerve run
anterior compartment, piercies intermuscular septum
distally in posterior compartment
posterior to medial epicondyle
what does radial nerve divide into
superficial radial nerve
posterior interosseous
median nerve path
anterior compartment in upper arm
MEDIAL TO BRACHIAL ARTERY can be damaged in supracondylar fracture
where does axillary become brachial artery
inferior border of teres major
brachial artery where, branch, nutrient, divides
lateral to median nerve
profunda brachii -> runs alongside radial nerve
nutrient artery to humerus
divides into radial and ulnar
profunda brachii supplies
posterior compartment arm
where does basilic vein joint brachial vein to form axillary
inf border of teres major
lymphatic drainage in the arm
cubital
delto pectoral
-> axillary (also breast drainage
axillary lymph nodes
pectoral apical central SUBSCAPULAR HUMERAL CHAPS
where do axillary lymph nodes drain into and what nerves can be injured
subclavian lymphatic trunk
LONG THORACIC and thoracodorsal
elbow joint
hinge
trochlea + ulna
capitulum + radius
proximal radioulnar joint
supination
elbow joint ligaments
radial collateral
ulnar collateral
annular ligament
borders of cubital fossa
line between medial epicondyles
brachioradialis
pronator teres
cubital fossa contents
median cubital vein median and lateral cutaneous nerve of the forearm median nerve radial nerve brachial artery biceps tendon
distal radioulnar joint ligaments etc
palmar radio-ulnar ligament
dorsal radio-ulnar ligament
articular disc = triangular fibrocartilage
FCR
medial epicondyle of humerus to base of SECOND AND THIRD metacarpal
ABDUCTION OF WRIST
flexion
FCU
medial epicondyle of humerus to pisiform + hamate
ADDUCTION OF WRIST
extension
FDS insertion
middle phalanx
FDP
ulna and interosseous membrane
DISTAL phalanges
supinator
lateral epicondyle of humerus
proximal 1/3 radius
brachioradialis
distal humerus
lateral distal radius
ELBOW FLEXION
ulnar artery
common interosseous -> anterior and posterior
anastamose to form dorsal carpal arch
into hand over flexor retinaculum
radial artery
floor of snuffbox
palmar arches
dorsal vs palmar venous arch
dorsal -> cephalic basilic
palmar -> venous comitantes
median nerve
damaged at supracondylar elbow fractures or dislocations
enters below pronator teres
palmar cutaneous branch
CARPAL TUNNEl
ulnar nerve relations at the wrist
medial to FCU
lateral to ulnar artery
how does posterior interosseous get into extensor compartment
head of supinator
supracondylar fracture due to and problem
hyperextension of humerus
tear/entrap/compress brachial artery
COMPARTMENT SYNDROME
compress median nerve
colles fracture
fall onto outstretched hand
wrist pain, swelling
distal radius just above the wrist
which bones articulate with the radius
scaphoid and lunate
hamate hook which side
palmar
what passes superficially to flexor retinaculum
palmaris longus
ulnar nerve is medial to ulnar artery
scaphoid fracture can lead to
avascular necrosis of the scaphoid
distal radio ulnar joint
pivot = pronation and supination
intercapal joints
gliding movement
between each row and then joining the rows = midcarpal joint
1st carpo metacarpal metacarpal
trapezium and metacarpal I
saddle joint
osteoarthrtic
intermetacarpal joints
deep transverse metacarpal ligaments
what are MCP joints reinforced by
palmar ligament
medial and lateral MCP collateral ligaments
Palmar fascia is..
flexor retinaculum –> palamar aponeurosis (deep) which is over the long flexor tendons in the common synovial sheaths –> fibrous digital sheaths –> annular and cruciate ligaments
osseofibrous tunnels
palamar aspects
= fibrous digital sheaths and underlying bone
inside = long flexor tendons + digital synovial sheaths
path of FD tendons
under flexor retinaculum common synovial sheath osseofibrous tunnel within digital synovial sheath FDS splits around FDP FDS middle FDP distal phalanx
dorsal tendons
extensor tendons under extensor retinaculum
connected by intertendinous bands
covered by synovial sheaths
extensor hoods are
tendons expand over proximal phalanges to form hoods
interossie attach to these
distal attachment of lumbricals = extensor hood
mallet finger
extensor tendon and finger tip is stretched/torn
trigger figger
inflammation of tendon/tenosynovium -> nodules so hard to move tendon
skier’s thumb or gamekeepers thumb
UCL torn or stretched so instability of MCP
helps in grasping and pitching
snuffbox
Lateral = EPL
Medial = EPB, APL
scaphoid radial artery
cephalic vein
anterior compartment of the hand
thenar = 3 FPB, ABpb, OP hypo thenar = 3 lumbricals palmar interossei (3/4) palmaris brevis adductor pollicis
what does (recurrent) median nerve innervate in the hand
LOAF lumbricals 3-4 opponens policis abductor policis brevis flexor policis brevis
lumbricals
sides of FDP
lateral side of extensor hoods
flexion at MCP extension at IPJ
ulnar deep and median
dorsal interossei
sides of 2 metacarpals
sides of extensor hoods
palmar interossei
sides of metacarpals
extensor hoods
power grip
long forearm flexors
intrinsic palm
stabilised by extensors
precision grip
intrinsic hand (+ flexors and extensors)
hook grip
long flexors of digits
superficial and deep palmar arch
deep = radial superficial = ulnar
median nerve what branch before tunnel
palmar cutaneous branch
median nerve sensation
palmar skin
dorsal nail beds lateral 3 1/2 digits
ulnar nerve relations at the wrist
FCU nerve artery (medial to lateral)
Erb’s palsy
C5/6 shoulder dystocia Axillary and MC pronated, medially rotated, elbox extended waiters tip
klumpke’s
c8/T1 traction to abducted arm ulnar (and median) possible horners claw hand supinated forearm
when is musculuocutaneous injured + effect
surgery shoulder dislocation weight lifter compression weak elbow flexion and supination no biceps reflex lateral forearm sensory loss
when is axillary nerve damaged
dislocations of shoulder
humeral neck fractures
radial nerve damaged where and effects
axilla/humeral shaft fracture/below elbow in neck of radius fracture
wrist drop bc cannot extend wrist, elbow fingers depends
sensory loss to post forerarm and dorsum of hand
when is median nerve damaged and effect
supracondylar humeral fractures wrist laceration carpal tunel syndrome loss of sensation lateral 3.5 loss of wrist flexion elbow pronation benediction sign = cant flex 2/3 MCP ape hand
where is ulnar nerve damaged and effect
elbow fracturs funny bone wrist sensory loss in medial 1.5 ulnar claw = extended 4 5 MCP, flexed 4 5 at IPJ cants adduct, abduct claw worse on extension
why does damage to long thoracic cause winging of scapula
rhomboids are unpposed so scapula is pished back instead of moving forward anteriorly around ribs when protracted
shoulder abduction
c5
shoulder adduction
c6/7/8
elbox flextion
c5
elbox extension
c7
wrist flexion extension
c6/7
finger flexion
c8
finger extension
c7
finger abduction
t1
abductor pollicis brevis
t1
when do you see babinski’s signs
UML
shoulder impingement
tendons of rotator cuff become inflamed as they pass under acromion
leads to weakness, pain reduced movment
4 fracturs in arm and forearm
supracondylar = medial
humeral mid shaft = radial
medial epicondyle = ulnar
surgical neck of humerus = axillary
