Module 2: Upper limb Anatomy Flashcards

Question 1

Q

What is the shoulder girdle the site of?

What is the shoulder girdle comprised of?

What 3 joints does it contain?

Label image

Answer

A

Site of the superior appendicular skeleton attachment to the axial skeleton
Comprised of 2 important bones; Scapula and Clavicle
Contains 3 important joints
- Sternoclavicular joint green (sternum articulates with clavicle)
  - Bone to bone connection; only place upper limb has a bony attachment to axial skeleton
- Acromioclavicular joint red (acromion of scapula articulates with clavicle)
- Scapulothoracic joint blue (anterior surface of the scapula against the posterior region of the thorax (costal ribs)

Question 2

Q

The clavicle; key features

label the diagram

Answer

A

The “strut” of the upper limb
- The only site of bony contact between the upper limb and trunk
Long cylindrical bone
- S-shaped
Acromial end (called this because it is near the acromion) is the more bulbous end, therefore does not fit perfectly with the acromion = the reason for dislocation sometimes

Question 3

Q

“Common sites of tendon/ligament attachment”

Answer

A

Ligament = connection between bone and bone
Tendon = connection between bone and muscle

Tubercle: small protection of eminence
Tuberosity: slightly larger roughened surface
Trochanter: large rough raised surface

Question 4

Q

How does the collagen fibres of the tendon or ligament actually attach to the bone?

Answer

A

At a molecular level the fibres infuse into the bone of the bone matrix and bind to the fibres

Question 5

Q

Label the clavicle

Question 6

Q

Label colours

Answer

A

Red line = acrioclavicular joint
orange line = conoid tubercle
blue = corcoid process = where ligaments tie clavicle down to this process
black lines = liagements
green line = costal tuberosity
red outline = manubrium

Question 7

Q

The sternoclavicular joint (sc)

Answer

A

sternum + clavicle
The medial end of the clavicle articulates with the manubrium of the sternum
Synovial Saddle Joint
- Diathrotic (quite a bit of movement)
- Synovial Joint has capsule, space, synovial fluid
4 ligaments
3 movements (Multiaxial)
- Elevation and Depression; lift hands to sky
- Protraction and Retraction; (arms reaching forward = protraction of the scapula) ( elbows behind you = retraction)
- Rotation (rotating hands with arms out to the side)
Movement from arm and shoulder all transmitted down the clavicle; therefore quite freely moveable joint enabling different arm movements

Question 8

Q

Label joints on the image

Answer

A

Interclavicular: ligaments between both clavicles, holds them together
Anterior/posterior sternoclavicular = sternum articulating with the clavicle
Costovicular = connects costal cartilage of the first rib with the clavicle

Question 9

Q

Label image

Question 10

Q

The scapula; key features (shape)

label image

Answer

A

The “shoulder blade”
- Triangular bone with 3 angles and 3 borders
  - Flat irregular bone
  - Boarders: Superior, medial and lateral
  - Angles: Superior, lateral and inferior
Green = acromion; where the clavicle would join to
Purple = Glenoid fossa; Flattened area where head of humerus meets the scapula (where shoulder joint is)
Red = scapula spine
Superior angle = where superior and medial boarder meet
Medial boarder = closest to the spine

Question 11

Q

What is the acromion?

Answer

A

Anterolateral extension of the scpula spine
Sight of acromioclavicular joint

Question 12

Q

What is only on the posterior surface of the scapula?

Answer

A

The scapula spine
- Originates at medial boarder extending laterally
- Lateral portion hooks anteriorly, known as the Acromion
- Is not on the anterior surface because it would grind against the thorax (ribs); thus it is the feature that distinguishes the anterior vs posterior surface.

Question 13

Q

What joint is this?

Answer

A

Acromioclavicular Joint
- Lateral end of clavicle articulates with the acromion of the scapula
- Synovial Plane Joint
  - Diathrotic
- 2 ligaments
  - Superior and Inferior AC ligament
- 2 Movements
  - Gliding (nonaxial)
  - Rotation

Question 14

Q

What is this feature?

Answer

A

• The Anterior Surface (Costal Surface) contains

The Coracoid Process
- Originates at lateral angle extending anterolateral
- Sight of coracoclavicular joint
- Trapezoid ligaments extend from the clavicle to the coracoid process
- Also a site of muscle attachment e.g. bicep braci (movement: flexion of shouldered )

Question 15

Q

Label this joint and the bones/features around it

Answer

A

Acromioclavicular joint
Acromion
Clavicle
Coracoclavicular joint (conoid & trapezoid lig.)

Question 16

Q

What is the joint name between the scapula and thorax?

Answer

A

Scapulathoracic joint
- Costal surface of scapula + the posterolateral thorax
- Lots of movement, but not a true synovial
  - Moves like a diarthrotic
  - Because this joint does not have a capsule, synovial fluid or a synovial membrane = not a true synovial joint
- Movement depends on SC & AC joints
- Supported by muscles; keeps joint in place.
- Movements:
  - Elevation & Depression (shrugging shoulders up and down)
  - Protraction & Retraction (Shoulders going back, shoulders going forward)
  - Upward & Downward Rotation (arm abducting over 90 degrees from the side of the body; scapula is forced to rotate upwards)

Question 17

Q

Terms for “Bone sites for articulations or support”

Answer

A

Facets: smooth surface/grove the forms a joint
Fossa: shallow depressions for joint or support
- Muscles attach into a fossa
- Area where two bones come into contact

Question 18

Q

Label these surfaces

Answer

A

Costal (surface closest to costals (anterior surface)) surface
- Subscapular fossa
  - Associated with subscapularis muscle
Posterior surface divided into two parts
- Above the spine
  - Supraspinous fossa
    - Supraspinatus muscle
- Below the spine
  - Infraspinous fossa
    - Infraspinatus muscle

Question 19

Q

What is the features/angle being annotated?

Answer

A

The lateral angle is flattened
- Contains the Glenoid Fossa
Site of the glenohumeral joint (shoulder joint)
- Articulation with the proximal head of the humerus
- Shallow ball and socket joint
  - Very shallow for function; shallow socket allows the head of the humerus to be locked into place; a range of movement increases
- Supported by glenoid labrum (Keeps the head of the humerus in place of the GJ)
  - Fibrocartilage rim to increase depth and width of fossa

Question 20

Q

Label the scapula diagram

Answer

A

Anterior surface

Acromion
- Dark green spot; where acromioclavicular joint starts
Coracoid process
Glenoid fossa
Subscapular fossa

Posterior surface

Acromion
glenoid fossa
Coracoid process
Superspinous fossa AKA Supraspinatus fossa
Spine
Infraspinous fossa (infraspinatus fossa)

Question 21

Q

What bones form the shoulder joint?

Answer

A

The shoulder joint = The glenohumeral joint = Glenoid fossa of the scapula + humerus (black lines of image are ligaments)
Synovial, ball and socket joint
Articulation between: proximal head of humerus + Glenoid fossa of scapula
Joint is surrounded by fibrous capsule (because it is a synovial joint ) and strengthen by 3 glenohumeral ligaments
- Superior, middle, inferior
- Present with a distinct “Z” shape

Question 22

Q

Label this shoulder girdle

Question 23

Q

Label the ligaments/tendon associated with the glenohumeral joint

Question 24

Q

Label the proximal end of the humerus with its key features

What joint is outlined by the green line?

Answer

A

Humerus = the long bone extending from shoulder to elbow
Proximal end features include;
- Head
- Anatomical neck
  - Where the head of the body attaches to the body of the bone
- Greater and Lesser tuberosity
  - Greater tuberosity is more lateral and posterior than lesser tuberosity
  - Muscles of rotating cuff attach to the lesser tuberosity
- Intertubercular sulcus (groove)
  - In between the lesser and greater tuberosity
  - Tendons, blood vessels run through here
- Surgical neck
  - Surgical neck is called this because it is the most common site of fracture.
The joint outlined in green is the glenohumeral joint
Image is an anterior view

Question 25

Q

Label the humerus

Question 26

Q

What feature of the humerus is this?

Answer

A

The diaphysis “shaft”
- Deltoid tuberosity
  - Lateral surface
    - Where deltoid muscle inserts, helps with abduction
- Radial (spiral) groove
  - Posterior surface
  - Where the radial nerve ‘sits’ on the bone in this groove.

Question 27

Q

Label the anterior distal end of the humerus?

Answer

A

Distal End (anterior)
- Lateral and medial supracondylar (‘above the condyle’) ridges
- Lateral and medial epicondyles (no bone to bone contact aka no articulation)
- Radial and coronoid fossa
  - For the head of radius and ulna (coronoid process) during flexion
- Capitulum and trochlea
  - Articular surface with radius (articulates w/ capitulum) and ulna (articulates w/ trochlea)

Question 28

Q

Label

What is this?

Question 29

Q

Label the posterior distal humerus

Any unique features?

Answer

A

Distal end of humerus (Posterior)
- Olecranon fossa
  - For the olecranon process of ulan during extension
- Ulna bone fits in this fossa when elbow flexion occurs
- The ulna articulates with the posterior surface of the trochlea
  *

Question 30

Q

Label

Answer

A

posterior distal humerus

Question 31

Q

What is the name of the elbow joint?

What bones make up the joint?

Answer

A

Humero-ulnar joint = Humerus and ulna
Radiohumeral joint = Radius and humerus

Question 32

Q

What bony features is the movement of the elbow mainly between?
What does the radius connect with?
What does the full extension of the elbow joint do?
What supports the elbow joint?

Answer

A

Elbow movement mainly between Humeral Trochlea & Trochlear notch of ulna
Head of Radius relatively small contact with Capitulum of Humerus
- Because radius is important for other important actions of the foreman
Full extension locks olecrenon process of ulna into olecrenon fossa of humerus
Elbow supported by Lateral (radial) and Medial (ulnar) collateral ligaments

Question 33

Q

What joint is this?

Label

Answer

A

The elbow joint

Question 34

Q

Question 35

Q

The Radius and Ulna Key features (proximal end)

Answer

A

Radius: Head, Neck Radial Tuberosity
- Radial tuberosity for muscle attachment
Ulna: Head, Trochlear notch, Coronoid process, Radial notch, Ulnar tuberosity, Olecranon process (posterior) & Supinator Crest (posterior)
- Trochlea notch articulates with the trochlea
- Coronoid process going into the coronoid fossa when inflexion occurs
During pronation of the forearm, the head of the radius slides over into the ulnar notch
In extension, olecranon process goes into the olecranon fossa of the humerus

Question 36

Q

What bones are these?

Label the features

Which surface is posterior and which is anterior?

Question 37

Q

Question 38

Q

Question 39

Q

The radius and ulna key features (distal end)

Answer

A

Radius: Head, Ulnar notch, Styloid process (on the lateral side of radius)
- Styloid process; bony mass with muscle attachments to help hand movement
- Radius has ‘puck’ like proximal end and a bulbous distal end (connected to the wrist)
Ulna: Head, Styloid process (on the lateral side of the ulna)

Question 40

Q

How to identify Ulna from radius when the bones are by themselves?

Answer

A

Look for olecranon process and trochlear notch = the ulna
Has the majority of articulating surface with the wrist = radius

Question 41

Q

Question 42

Q

What bone is this?

Which is the posterior/anterior face?

Answer

A

Anatomical neck
Greater tuberosity, because it is on the posterior lateral side
Surgical neck
Humeral head
Intertubercular groove
Lesser tuberosity, medial anterior side
Deltoid tuberosity

Question 43

Q

What bones are these?

What end of the bones?

Answer

A

olecranon
trochlear notch; trochlear notch articulates with the trochlear
coronoid process
radial notch; where the radial head rotates over during pronation and supination
head
radial tuberosity; muscle attachment sites, help with pronation
neck
shaft

Proximal end of ulna and radius

Question 44

Q

Which part of the distal end of the humerus articulates with the head of the radius?

Answer

A

capitulum

Round bulbous end of the lateral side of the humorous

Question 45

Q

What are the articulations of the wrist?

How many are there?

Answer

A

3 articulations
- Radiocarpal joint (wrist) – between forearm and hand
- Midcarpal joints – between proximal and distal rows of carpals
- Carpometacarpal – between distal carpal row and bones of hand

Question 46

Q

How many carpal bones are there?

How are they orientated?

Answer

A

8 carpal bones orientated in two rows
- Proximal Row (from lateral to medial)
  - Scaphoid, Lunate, Triquetrum, Pisiform
- Distal Row (from lateral to medial)
  - Trapezium, Trapezoid, Capitate, Hamate

Question 47

Q

Label bones of the wrist

What side is this?

Answer

A

Posterior (pronation)

Question 48

Q

label the wrist bones

What side is this?

Answer

A

Anterior (supination)

Question 49

Q

What makes up the hand

what are the articulations of the hand (4)?

How many bones are in the hand?

What groups are they divided into?

Answer

A

4 articulations
- Carpometacarpal joints
- Metacarpophalangeal joints (knuckles) •
- Interphalangel joints •
  - Proximal & Distal •
19 bones separated into 2 groups
- 5 Metacarpals
- 14 Phalanges (fingers and thumb)

Question 50

Q

Label the bones and articulations of the hand

What way is the hand facing?

Question 51

Q

Answer

A

Clavicle
sternum
scapula
humerus
radius
ulna
carpals
metacarpals
proximal phlanges
intermediate phlanges
Distal phalanges

Question 52

Q

How to tell if you are looking at the palma (anterior) surface of the distal surface.

Answer

A

Hook of the hamate is on the anterior side
If you can visualise the pisiform and the hook of the hamate; only on the anterior side

Question 53

Q

The shoulder girdle; movements (scapula -> clavicle)

Answer

A

To identify movements of the shoulder girdle, focus on bony landmarks
- Posterior Perspective: Medial Boarder & Inferior Angle
- Lateral Perspective: Glenoid fossa
- Anterior Perspective: Acromion & Clavicle
All movements of the shoulder girdle have the same pivot point
- The Sternoclavicular Joint

Question 54

Q

What movements are these?

Answer

A

Abduction (protraction)
- Abduction of the scapula; moving away from the midline
Adduction (retraction)
- Bring the scapula closer to the midline
Elevation
- Glenoid fossa also raises up
- Superior angle goes up
Depression
- Inferior angle drops down
- Scapula is being depressed
Upward
Upward rotation
Downward rotation

Question 55

Q

The shoulder girdle: A support system for the glenohumeral joint

Answer

A

Movements of scapula orientate, stabilize & synergize the Glenohumeral Joint; so you can do arm movements
- Position glenoid fossa for range of humeral movements
- Stabilize shoulder girdle to axial skeleton during humeral movements
- Add to range and power of humeral movements

Question 56

Q

Shoulder Abduction

Answer

A

90-100 Degrees of humeral abduction at glenohumeral joint before humerus contacts acromion
Remaining 60-90 degree of shoulder abduction is a result of upward rotation of scapula (shoulder girdle rotates upwards so glenoid fossa can move up further.
- Shoulder joint can only to 90 degrees
- Therefore shoulder girdle rotates upwards so the glenoid fossa is forced to rise up further
- Therefore the arm can rise to the ceiling
- Head of the humerus comes into contact with the arch locks joint into place allows to reach up

Question 57

Q

What are the shoulder Girdle muscles

Answer

A

The shoulder girdle muscles all originate on the axial skeleton
Insertion are located on the scapula and/or the clavicle
Primary movers include:
- Anterior
  - Pectoralis Minor
  - Serratus Anterior
- Posterior
  - Trapezius
  - Rhomboids
  - Levator Scapulae
  - All attach to the scapula

Question 58

Q

Will muscles of the shoulder girdle move the humerus?

Answer

A

No. None of them cross the glenohumeral joint to insert into the humerus

Question 59

Q

What muscles are these?

What muscle group are they apart of?

Answer

A

Pectoralis minor = deep to pectoralis major

Question 60

Q

Answer

A

Levator scapulae muscle lifts the scapula
Levator scapulae and rhomboids are deep to trapezius

Question 61

Q

What muscle is this?

Where does it insert?

Where does it originate?

What actions (of the scapula) does it perform?

Answer

A

Pectoralis Minor:

Anterior muscle of the shoulder girdle
Origin: anterior surface of 3rd-5 th rib
Insertion: coracoid process of scapula
- inserts kinda posteriorly
- Contraction of muscle will forward -> “around the ribs”
Action (of scapula):
- Protraction (Abduction)
  - Medial border of the will pulled laterally -> this is abduction of the scapula
- Downward rotation
  - The coracoid process is pulled down towards the muscle origin
  - Therefore, glenoid fossa will go down
- Depression

Question 62

Q

What muscle is this?

Where does it originate?

Where does it insert?

What actions of the scapula doe it perform?

Answer

A

Serratus Anterior:

Looks like a serrated knife
Sits on the anterior side so does underneath scapula and attaches to medial boarder
Origin: lateral surface of ribs 1-9
Insertion: medial border of scapula (costal surface)
- Contraction (bring insertion site closer to origin)
  - Will cause medial border to move towards the lateral anterior aspect
Action (of the scapula):
- Protraction (Abduction)
- Upward rotation
  - Pulls inferior angle and brings it upwards
  - Causes gelnoid fossa to also point up
  - Important for reaching up to the sky

Question 63

Q

What are these muscles?

Answer

A

Pectoralis minor inserts deep to the deltoid muscle
Serratus anterior is inferior to pectoralis minor

Question 64

Q

What muscles of the shoulder girdle are involved in a push up?

Answer

A

Protraction/abduction - The push up
Abduction is required because the body needs to move away from midline, so the glenohumeral joint and arm can reach forward
Pectoralis Minor is pulling the coracoid process anteriorly
Serratus Anterior is pulling the medial boarder (costal surface) of the scapula latero-anteriorly

Answer 53

A

The posterior muscles of the shoulder girdle

Answer 54

A

Trapezius (‘top layer’)

Divided into 3 groups based on direction of myofibres
Spans from superior aspect of the cervical spin to the base of the thoracic vertebrae
- Fibres originate around the scapula therefore the fibres will change directions.
Upper fibres
- Run in superior to inferior direction
- Origin: Occipital protuberance and posterior neck
- Insertion: Acromial end of the clavicle
- Actions (of the scapula)
  - Elevation
    - Pulls scapula up from where they originate from
  - Upward rotation
    - Because insertion sight is near the acromial end of the clavicle
Middle fibres (run laterally)
- Origin: Spinous process of C7-T3
- Insertion: medio-superior acromion and scapular spine
- Action (of scapula):
  - Elevation
  - Retraction (adduction)
    - Bring the scapula medial boarder closer to the middle
Lower fibres (run in superior to inferior direction
- Origin: Spinous process of T4-T12
- Insertion: Triangular space/base of scapular spine
- Action (of scapula):
  - Depression
  - Retraction (adduction)
  - Upward rotation
    - Originates below insertion point = when fibres contract bone is going to be pulled backward
      - pulling on medial boarder downwards causes glenoid fossa to ruse up (upward rotation)

Answer 55

A

Rhomboids: found anterior to trapezius
Rhomboid Minor (UPPER) & Major (LOWER larger section)
- Origin: Spinous process of C7-T5
- Insertion: Medial boarder of scapula (below scapular spine)
- Action (of scapula):
  - Retraction (adduction)
  - Downward rotation (glenoid fossa drops)
  - Elevation

Answer 56

A

Levator Scapulae

Origin: Transverse process of C1-C4
Insertion: Superior angle of scapula
- Pulls up on superior angle
Action (of scapula):
- Elevation
- Downward rotation
  - Lateral angle will drop causing downward rotation

Answer 57

A

Flexion
extension
abduction
adduction
Internal rotation
External rotation

Answer 58

A

Glenohumeral joint
- Multiaxial ball and socket joint
- The most mobile of all joints in the human body
  - Reduce ligament tautness, allows more movement
  - Price to pay =stability, higher risk of dislocation as a result
Rotator Cuff: provides mobility, strength & stability of this joint because the ligaments and joint aren’t very strong alone muscle helps stabilise and strengthen
- Maintains head of humerus within the glenoid fossa]
- Allowing other more powerful muscles to effectively move the humerus

Answer 59

A

Primary movers include:
- Anterior
  - Pectoralis Major
  - Coracobrachialis
  - Subscapularis
- Superior
  - Deltoid
  - Supraspinatus
- Posterior
  - Latissimus dorsi
  - Teres major
  - Teres minor
  - Infraspinatus

Answer 60

A

Pectoralis Major (2 groups based on direction of myofibres)

Convergent muscle, fans out

Upper fibres (Clavicular head)
- Origin: Anterior surface of clavicle (sternal half)
- Insertion: Lateral lip of intertubercle groove of humerus
- Action:
  - Internal rotation
  - Horizontal adduction
  - Flexion
  - Lateral adduction (90°)
  - Lateral abduction (>90°)
Lower fibres (Sternal head)
- Origin: Anterolateral boarder of sternum
- Insertion: Lateral lib of intertubercle groove of humerus (flat tendon)
- Action (of humerus):
  - Internal rotation
  - Horizontal adduction

Answer 61

A

Pectoralis Major

Answer 62

A

Coracobrachialis:

Origin: Coracoid process of scapula
Insertion: Medial border of humerus shaft
Action (of humerus):
- Flexion (caused by contraction)
- Lateral Adduction
- Horizontal Adduction

Answer 63

A

Subscapularis:

*Very important muscle for stabilisation
Origin: Entire subscapular fossa (entire coastal aka anterior surface of the scapula)
Insertion: Lesser tubercle of humerus
Action (of humerus):
- Internal rotation of the head of the humerus
- Lateral Adduction
- Extension
- Stabilization of humeral head*

Answer 64

A

Deltoid (3 groups based on direction of myofibres)

Anterior Fibres
- Origin: Anterior, acromial end of clavicle
- Insertion: Deltoid tuberosity
- Action (of humerus):
  - Lateral abduction
  - Flexion • Horizontal adduction
  - Internal rotation
Middle Fibres
- Origin: Lateral side of acromion
- Insertion: Deltoid tuberosity
- Action (of humerus):
  - Lateral abduction
Posterior Fibres
- Origin: Inferior edge of scapular spine
- Insertion: Deltoid tuberosity
- Action (of humerus):
  - Lateral Abduction
  - Extension
  - Horizontal Abduction
  - External rotation

Answer 65

A

Deltoid muscle

Answer 66

A

Supraspinatus:

Origin: Medial supraspinous fossa
Insertion: Superior rim of greater tubercle of humerus
Action (of humerus):
- Lateral Abduction
- Stabilisation of humeral head

Answer 67

A

Supraspinatus

Answer 68

A

Latissimus Dorsi:

Origins: T6-Mid sacrum, the posterior crest of ilium, the lateral curve of last 3 ribs,
Insertion: Medial lip of intertubercular groove of the humerus
Action (of the humerus):
- Lateral Adduction
  - Pulling arm closer to the midline
- Extension
  - Going from posterior to anterior direction
- Internal rotation

Answer 69

A

Teres major:

Origins: Posterior surface, just superior to inferior angle on the scapula
Insertion: Medial lip of intertubercular groove of the humerus
- Inserts lower than teres minor
Action (of the humerus):
- Extension
- Internal rotation
- Lateral adduction
- Has essentially the same function as latissimus dorsi

Answer 70

A

Teres major

Latissimus dorsi

Answer 71

A

Teres minor:

Origin: Upper middle aspect of lateral boarder of scapula
Insertion: Posterior side of greater tubercle of humerus
- Also important for stabilisation
Action (of humerus):
- External rotation
- Horizontal abduction
- Extension
- Stabilization of humeral head*

Answer 72

A

Infraspinatus

Origins: Posterior surface of scapula below spine
Insertion: Posterior side of greater tubercle of humerus
Action (of humerus):
- External rotation
- Horizontal abduction
- Extension
- Stabilization of humeral head*

Answer 73

A

Infraspinatus

Teres minor

Answer 74

A

Infraspinatus

Teres minor

Answer 75

A

7 Scapulohumeral
- Deltoid
- Coracobrachialis
- Teres major
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis
Scapulohumeral: Muscles that originate at the scapula and insert into the humerus
Rotator Cuff:
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis

Answer 76

A

The Rotator Cuff provides mobility, strength & stability of this joint
Maintains/stabilizes head of humerus within the glenoid fossa
Produces/supports all the rotations required for everyday life

Answer 77

A

Rotator cuff impingement syndrome
- One of the most common causes of shoulder pain
- Tendons of these muscles become irritated/inflamed
  - Mainly supraspinatus & infraspinatus
- Pain, weakness & loss of movement