Module 6: The upper limb Flashcards
Pectoral girdle function
Connects upper limb to thorax
Joints of pectoral girdle
- Glenohumeral joint
- Acromioclavicular joint
- Sternoclavicular joint
Ligaments of pectoral girdle
Acromioclavicular ligament
Coracoacromial ligament
Coracoclavicular ligament
Glenohumeral ligament
Acromioclavicular ligament
Btwn acromion process of scapula and clavicle
Coracoacromial ligament
Connects acromion and coracoid process of scapula; forms a vault that prevents displacement of humeral head superiorly
Coracoclavicular ligament
Main stabilizer of acromoclavicular joint as it anchors the clavicle to the coracoid process of scapula
Glenohumeral ligaments
Stabilize glenohumeral joint especially during adduction of the arm
Anterior shoulder sublaxation
When head of humerus is partially displaced anteriorly out of glenoid cavity
Results from a fall on outstretched arm or sport-related injury
Symptoms of anterior shoulder sublaxation
Pain
Limited ROM
Palpable gap btwn acromion and humeral head
Swelling and bruising
The glenohumeral joint
Ball and socket btwn shallow glenoid cavity and head of humerus
The glenoid labrum
Rim of fibrocartilage that deepens and stabilizes glenohumeral joint
Rotator cuff or dynamic ligaments
Supraspinatus
Infraspintus
Teres minor
Subscapularis
Bursae
Fluid filled sacs lined by synovial membrane that provide cushioning btwn bones, tendons and muscles, prevent friction
Types of bursa in shoulder joint
- Subacromial bursa
- Subdeltoid bursa
Subacromial bursa
Separates superior surface of supraspinatus tendon from acromion, coracoid and coraco-acromial ligament superiorly
Subdeltoid bursa
Separates deep surface of deltoid muscle from shoulder joint
Shoulder bursitis
Inflammation and thickening of bursae due to an increased amount of friction
Symptoms of shoulder bursitis
Excessive swelling
Warmth
Pain/pressure
Teres major
O: Inferior part of lateral border of scapula
I: Medial lip of intertubercular sulcus on humerus
A: extension and medial rotation of humerus
Supraspinatus
O: Supraspinous fossa of superior part of scapula
I: greater tubercle of humerus
A: Abduction of humerus
Rotator cuff muscles
Supraspinatus
Infraspinatus
Subscapularis
Teres minor
Supraspinatus origin
In supraspinous fossa, superior to scapular spine
Infraspinatus origin
In infraspinous fossa
Subscapularis origin
Subscapular fossa
Teres minor origin
Middle of lateral border of scapula
Surpaspinatus tear
Rupture of tendon near site of insertion
Symptoms of supraspinatus tear
Audible pop, rapid onset of shoulder pain, swelling and reduced ROM
Muscles of anterior compartment of the arm
Biceps brachii
Coracobrachialis
Brachialis
Action of muscles of anterior compartment of arm
Flexion of forearm at elbow
Flexion of arm at glenohumeral joint
Muscles of posterior compartment of arm
Triceps brachii
Three heads of triceps brachii
- Long head
- Lateral head
- Medial head
Origin of long head of triceps
Infraglenoid tubercle
Insertion of triceps
Common tendon at olecranon of ulna
Action of posterior compartment of arm
Extension
Cubital fossa
Triangular depression on anterior surface of elbow joint
What does the cubital fossa contain?
(lateral to medial)
Tendon of biceps brachii, brachial artery and median nerve
Superior border of cubital fossa
Imaginary line btwn humeral epicondyles
Lateral border of cubital fossa
Brachioradialis
Medial border of cubital fossa
Pronator teres
The popeye deformity/distal biceps tendon rupture
Budge in upper arm resulting due to the rupture of a muscle at the site of its origin/insertion
Where does the biceps tendon insert?
Radial tuberosity
Symptoms of popeye deformity
Pain, swelling, bruising, weakness in elbow flexion
Three articulations of the elbow joint
- Humeroradial joint
- Humeroulnar joint
- Superior (proximal) radioulnar joint
Humeroradial joint
Btwn capitulum of humerus and concave upper surface of head of radius
Humeroulnar joint
Btwn trochlea of humerus and trochlear notch of ulna
Superior radioulnar joint
Synovial joint btwn head of radius and radial notch of ulna
Lateral epicondylitis (tennis elbow)
Common overuse injury resulting in tiny tears at tendinous origin of extensor muscles at lateral epidocondyle
What muscle is most commonly implicated in lateral epicondylitis?
Extensor carpi radialis brevis
Symptoms of lateral epicondylitis
Pain and tenderness at rest and during movement
Limited mobility and reduced strength
Proximal radioulnar joint
Head of radius and radial notch of ulna
Annular ligament
Encircles head of radius, holding it against radial notch of ulna
Interosseous membrane
Fibrous joint btwn ulna and radius
Divides forearm into anterior and posterior compartments
Distal radioulnar joint
Head of ulna and ulnar notch of radius
Radial head sublaxation
Occurs when upper limb is jerked superiorly and is pronated resulting in partial disclosure of the head of the radius from the annular ligament
Symptoms of radial head sublaxation
Audible pop, pain with supination and pronation, limited extension and flexion of forearm and elbow
Superficial muscles of anterior compartment of forearm
Pronator teres
Intermediate muscles of anterior compartment of forearm
Flexor digitorum superficialis
Deep muscles of anterior compartment of forearm
Flexor digitorum profundus
Flexor pollicis longus
Pronator quadratus
Pronator teres syndrome
Pronator teres hypertrophy resulting from repetitive pronation of the forearm causing median nerve entrapment
Symptoms of pronator teres syndrome
Pain in anterior forearm
Weakness when flexing wrist
Weakness in thumb and numbness and tingling of skin on hand of first 4 digits
Muscles of superficial layer of posterior compartment of forearm
Extensor digitorum
Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor digitorum action
Extends digits 2-5 and hand at wrist
Extensor digitorum muscle strain
Overuse of extensor digitorum
Symptoms of extensor digitorum muscle strain
Reduced grip strength and stiffness in fingers
What is the most commonly fractured carpal bone?
Scaphoid bone as it is the largest bone that articulated with the radius
When does a fracture of scaphoid bone commonly occur?
From a fall on an extended wrist
Symptoms of a fractured scaphoid bone
Pain with abduction and adduction of thumb
Joints of the hand and wrist
- Intercarpal joints
- Midcarpal joints
- Radiocarpal joint
Intercarpal joints
Synovial plane joints btwn carpal bones; perform gliding movement
Midcarpal joints
Articulation btwn proximal and distal rows of carpal bones; gliding
Radiocarpal joint
Biaxial, synovial, ellipsoidal joint formed btwn distal end of radius and proximal row of carpal bones (not pisiform)
What actions can the radiocarpal joint perform?
Extension
Flexion
Abduction
Adduction
Circumduction
The carpal tunnel
Formed by the concavity of the carpal bones covered by a bridge of deep fascia (flexor retinaculum)
What does the carpal tunnel allow for the passage of?
Median nerve and 9 flexor tendons
9 flexor tendons that pass through the carpal tunnel
4 flexor digitorum superficialis
4 flexor digitorum profundus
Flexor pollicis longus
Carpal tunnel syndrome
Tunnel becomes narrowed or structures surrounding the median nerve put pressure of median nerve
Symptoms of carpal tunnel syndrome
Pain in anterior wrist and hand
Numbness and tingling of thumb, index, middle and 1/2 of 4th finger on planar side
Extrinsic muscles of hand
Long flexor and extensor muscles of forearm
Pass deep to extensor retinaculum
Intrinsic muscles of the hand
- Hypothenar muscles
- Thenar muscles
- Dorsal interossei
- Palmar interossei
Hypothenar muscles
Movement of 5th digit
Thenar muscles
Movements of thumb
Dorsal interossei
Finger abduction
Palmar interossei
Finger adduction
Tight palmar interossei causes
Caused by overuse, injury, dehydration, stress, spasm
Symptoms of tight palmar interossei
Inability to bear weight, pain with palpation
Superficial palmar arch
Formed by radial artery joining ulnar artery medially
Superficial to long flexor tendons of hand
Branches of superficial palmar arch
4 branches supply medial three and a half fingers
Deep palmar arch
Radial artery enters deep part of palm, completed by deep branch of ulnar artery
Branches of deep palmar arch
Branches to thumb and lateral half of 2nd finger
Hypothenar hammer syndrome
Ulnar artery compressed against bony hook of hamate
Symptoms of hypothenar artery syndrome
Ischemia, discolouration, parethesia, temperature sensitivity of digits 2-5
Ulnar nerve innervation of hand
Cutaneous branches provide sensation to skin of palmar and dorsal aspects of digits 4 and 5 and adjacent palm
Median nerve innervation of hand
Palmar surface- lateral 3 and 1/2 digits
Dorsal surface- distal halves of lateral 3 and 1/2 digits
Radial nerve innervation of hand
Dorsal surface- proximal portion of digits 1, 2 and 3 and lateral 1/2 of digit 4
What intrinsic muscles of the hand does the ulnar nerve supply?
Medial two lumbricals
Hypothenar muscles
Palmar and dorsal interossei
Adductor pollicis
Flexor pollicis brevis
