Module 6 upper limb Flashcards
what is the pectoral girdle
functions to connect the upper limb to the thorax
- sternum, clavicle, scapula, humerus articulate at 3 main joints
scapulothoracic joint
scapula and posterior thoracic cage
joints of the pectoral girdle
- glenohumeral joint
- acromioclavicular joint
- sternoclavicular joint
ligaments of the pectoral girdle
- acromioclavicular ligament
- coracoacromial ligament
- coracoclavicular ligament
- glenohumeral ligament
Acromioclavicular Ligament
located between the acromion process of the scapula and the
clavicle. It reinforces the acromioclavicular joint and supports the superior surface of the shoulder.
Coracoacromial Ligament
- The coracoacromial ligament connects the acromion and coracoid process of the scapula.
- forms a “vault” that prevents the displacement of the humeral head superiorly.
Coracoclavicular Ligament
main stabilizer of the acromioclavicular joint as it anchors the clavicle to the coracoid process of the scapula.
Glenohumeral Ligaments
- are the largest ligaments in the pectoral girdle.
- stabilize the glenohumeral joint, especially during adduction of the arm.
what ligament isnt visible from the superior view
glenohumeral ligament
what is anterior should subluxation
- occurs when the head of the humerus is partially displaced anteriorly out of the glenoid cavity
- result of fall on an outstrecthed arm or sports injury
symptoms of anterior shoulder subluxation
- Pain in the affected shoulder
- Limited range of movement
- A palpable gap between the acromion and humeral head due to the partially displaced
humeral head - Swelling and bruising from broken blood vessels
what is the glenohumeral joint
is a ball and socket joint between the shallow glenoid cavity of the scapula and the large head of the humerus
- very mobile bc of poor fit, loose fibrous capsule bad stabilzing
the glenoid labrum
- stabilizing feature of the glenohumeral joint
- the rim of fibrocartilage that deepens that glenoid cavity improving stability of the joint
rotator cuff
help stabilize the glenohumeral joint
- they make up for the lack of supportive ligaments and are important in balancing the forces from movement at the should joints
muscles of the rotator cuff
- supraspinatus
- infraspinatus
- teres minor
- subscapularis muscles
whats another muscles that support the shoulder joint
biceps brachii (LONG HEAD)
- where it attaches to the superior glenoid tubercle of the scapula
what’s the bursae
- fluid filled sacs found between tissues (synovial fluid) that provide cushioning between bones, tendons and muscles and prevent friction between them
main bursa of shoulder
subacromial bursa
subdeltoid bursa
subacromial bursa
- separates the superior surface of the supraspinatus tendon from the acromion, the coracoid and the coracoacromial ligament superiorly
subdeltoid bursa
- seperates the deep surface of the deltoid muscles from the shoulder joint
what do both bursa do?
protect supraspinatus muscle from friction with overlying structures
shoulder bursitis
- it gets inflamed
- common cause of shoulder pain
- inflammation and thickening of the bursae due to increased amount of friction
causes of shoulder buritis
- too much fritcion on the subacromial or subdeltoid bursae
- baseball player always throwing the ball
symptoms of shoulder bursitis
- excessive swelling in the region of the shoulder from inflamed bursae
- warmth at the sight of inflammation
- pain with movement/pressure at the shoulder
scapulohumeral muscles
connect the humerus to the scapula and function to stabilize the glenohumeral joint
2 scapulohumeral muscles
teres major
supraspinatus
teres major Origin
Inferior part of the lateral border of the scapula.
Teres Major Insertion:
The medial lip of the intertubercular sulcus on the humerus.
Teres Major Action
Extension and medial rotation of the humerus (arm).
Supraspinatus Origin
The supraspinous fossa of the superior part of the scapula.
Supraspinatus Insertion:
The greater tubercle of the humerus.
Supraspinatus Action:
Initiates abduction of the humerus (arm).
the ______ originates in the supraspinous fossa of the scapula, superior to the scapular spine
supraspinatus muscle
the ____ muscle originate in the infraspinous fossa of the scapula, inferior to the scapular spine and superior to the ______
infraspinatus, teres minor
the ______ oringinates in the subscapular fossa and is ____ to the other 3 rotator cuff muscles. it is ____ to the coracoid process
subscapularis muscles , anterior, inferior
the ___ originates from the middle of the lateral border of the scapula
teres minor
supraspinatus tear
- involves a rupture of the tendon near the site of insertion
- tears are common as the tendon of the supraspinatus can be easily pinched or torn because the greater tubercle of the humerus, where it inserts and the acromion of the scapula
causes of supraspinatus tear
A history of trauma and increased age are the most common risk factors. Supraspinatus tears typically
occur when lifting something heavy (like a couch), or when lifting something heavy too quickly.
Symptoms of supraspinatus tear
audible “pop” at the time of injury, rapid onset of shoulder pain, swelling at the shoulder, and reduced range of motion as a result from the tear. Diagnostic imaging may be required
to confirm this diagnosis.
muscles of the arm
there is anterior and posterior compartments
anterior compartment of arm muscles
- biceps brachii
- coracobrachialis
- brachialis
flexion of the forearm
facilitated by primarily biceps brachii and brachialis of the arm whereas coracobrachilais flexes the arm at the glenohumeral joint
muscles of the posterior compartment of the arm
- triceps brachii
triceps brachii origin
from three heads
long head: infraglenoid tubercle of the scapula
lateral and medial head: posterior surface of humerus
triceps brachii insertion
all head insert of a common tendon, the triceps tendon at the olecranon of the ulna
what is elbow flexion mainly by
triceps brachii
what is the cubital fossa
- triangular depression located on the anterior surface of the elbow
- contains important neurovascular structures- analogous to the popliteal fossa
what does the cubital fossa contain
- tendon of the biceps brachii and brachial artery, which bifurcates into the ulnar and radial artery as well as the median nerve
superior border of cubital fossa
imaginary line between the humoral epicondyles
lateral border of cubital fossa
brachioradialis
medial border of cubital fossa
pronator teres
contents of the cubital fossa
- brachial artery
- biceps brachii tendon
- radial artery
- median nerve
- ulnar artery
main things in the cubital fossa
- tendon of the biceps brachii
- brachial artery
- median nerve
the popeye deformity
- budge in the upper arm
- may result due to rupture of a muscle at the sits of its origin and/or insertion
distal biceps tendon rupture
- a buldge at the distal aspect of the arm is created by the recoiled shortened biceps brachii muscle
- it travels through the cubital fossa to insert on the radial tuberoisty
symptoms of distal biceps tendon rupture
- pain
- swelling
- visible bruising at the site of rupture
- weakness of elbow flexion
three articulation of elbow joint
- humeroroadial joint
- humeroulnar joint
- superior (proximal) radioulnar jount
Humeroradial Joint
Joint between the capitulum of the humerus and the concave upper surface of the head of the radius.
Humeroulnar Joint
Joint between the trochlea of the humerus and the trochlear notch of the ulna.
Superior (proximal) Radioulnar Joint
A synovial joint between the head of the radius and the radial notch of the ulna.
lateral epicondylitis
tennis elbow
- common overuse injury of the elbow related to the extensor muscles of the forearm
- tiny tears from overuse may occur at the tendinous origin of the extensor muscles at the lateral epicondyle
most common tendon implicated in lateral epicondylitis
extensor carpi radialis brevis
Symptoms of lateral epicondylitis include:
- Pain and tenderness at the lateral elbow from the tiny tears that develop over time at the origin of the extensor muscles. Pain and tenderness may be felt at rest and during movement
of the elbow joint. - Limited mobility and reduced strength - especially during of extension of the elbow.
Triceps Tendonitis
An overuse injury resulting in inflammation of the triceps tendon at its insertion
point. Symptoms include reduced motility and strength of elbow during extension, pain, swelling, and
hardening at the point of insertion of the triceps brachii muscle.
electronic health record
an electronic health record is a digital version of a patients paper chart
joints of the forearm
- proximal radioulnar joint
- distal radioulnar joint
ligaments of the forearm
Annular Ligament
Interosseous Membrane
Proximal Radioulnar Joint
t is formed between the head of the radius and the
radial notch of the ulna.
Annular Ligament
The annular ligament encircles the head of the radius, holding it against the radial notch of the ulna.
Interosseous Membrane
forms a fibrous joint that spans the space between the ulna and radius
and divides the forearm into anterior and posterior compartments.
Distal Radioulnar Joint
The distal radioulnar joint is formed between the head of the ulna and the ulnar notch of the radius.
radial head subluxation
“nursemadis elbow”
- common painful injury typically seen in young children (because ligament arnet fully formed)
- partial dislocation of the radioulnar joint
radial head subluxation occurs when
- when the upper limb is jerked superiorly and is pronated resulting in
the partial dislocation of the head of the radius from the annular ligament.
Symptoms radial head subluxation
- audible pop as the radial head becomes dislocated
- pain with supination and pronation.
- Limited extension and flexion of the forearm at the elbow joint
what can the anterior compartment of the forearm muscles be further divided into?
superficial, intermediate, deep
superifical; anterior forearm muscles
- pronator teres
intermediate ; superifical forearm muscles
- flexor digitorum superfificalis
deep ; anterior forearm muscles
- flexor digitorum profundus
- flexor pollicis longus
- pronator quadratus
what is pronator teres syndrome
- repetitive pronation of the forearm may cuase the pronator teres hypertrophy, which can entrap the median nerve
what facilitates pronation and supination of the forearm
proximal and distal radioulnar joints
during pronation
the head of the radius rotates within the annular ligament
- primarily done by the pronator teres
Symptoms of Pronator Teres Syndrome
- The median nerve provides motor innervation to the anterior compartment of the forearm and motor and sensory innervation to the hand when compressed it can lead to :
- Pain in the anterior forearm along the path of the median nerve, which may be aggravated by resisted pronation of the forearm and flexion of the elbow;
- Significant weakness when flexing the wrist due to impaired motor innervation;
- Weakness in movements of the thumb and numbness and tingling of the skin on the hand and
first four digits.
what can the posterior compartment of the forearm be further divided into
superficial and deep layer
what muscle makes the superficial ; posterior compartment
extensor digitorum muscle
- extensor carpi ulnaris
- extensor carpi radialis longus and brevis
extensor digitorum muscle
strain
the extensor digitorum muscle functions to extend the digits, specifically digits 2-5. It also extends the hand at the wrist. If the muscle is overused it can strain
symptoms of extensor digitorum muscle strain
reduced grip strength and stiffness in the fingers
causes of extensor digitorum muscle
strain
associated with this overuse include knitting, playing piano, and using a
hammer/screwdriver
what are the bones of the wrist and hand called
carpal bones
proximal row of carpal bones from lateral to medial
- scaphoid
- lunate
- triquetrum
- pisiform
distal row of carpal bones from lateral to medial
- trapezium
- trapezoid
- capitate
- hamate (hook on it)
what is the most fractured carpal bone
scaphoid as its the largest and articulates with the radius
fracture of scaphoid bone
- fall on extended wrist
- pain will reflect the anatomical location of the bone
- pain tenderness in the area just below the base of the thumb
- bone may be out of alignment from the impact
- great pain with abduction and adduction of thumb
what are the 3 joints involving the carpal bones of the wrist
Intercarpal Joints
Midcarpal Joints
Radiocarpal (Wrist) Joint
Intercarpal Joints
Synovial plane joints between the carpal bones. These joints are capable of slight gliding movements.
Midcarpal Joints
The articulation between the proximal and distal rows of carpal bones. This joint is also capable of
slight gliding movements.
Radiocarpal (Wrist) Joint
- biaxial, synovial, ellipsoidal (condyloid) joint formed between the distal end of the radius and the
proximal row of carpal bones, with the exception of the pisiform
functions of Radiocarpal (Wrist) Joint
in extension, flexion,
abduction, adduction, and circumduction.
what is the carpal tunnel
- its on the anterior surface
- carpal bones form a concave
what is the carpal tunnel covered by
bridge of deep fascia (flexor retinaculum)
what does the carpal tunnel allow passage for
- median nerve
- nine flexor tendons (4 flexor digitorum superificialis, 4 flexor digitorum profundus, and flexor pollicis longus)
carpal tunnel syndrome
occurs when the tunnel becomes narrowed or when structures surrounding the median nerve (flexors) put pressure on the median nerve
what is carpal tunnel syndrome linked to
repetitive movements of the wrist during flexion and extension
symptoms of carpal tunnel syndrome
- pain in the anterior wrist
- hand with worse wrist movement
- numbness and tingling of the thumb, index, middle and 1/2 of the 4th finger on palmar side
proximal impingement of the median nerve
resutls in motor/sensory defects in both the forearm and hand
distal impingement of the median nerve
motor/sensory changes confined to the hand
what are the extrinsic muscles of the hand
- long flexor and extensor msucles of the forearm which insert onto the hand
(origin outside of the hand)
where do the extensor muscle tendons pass
deep to the extensor retinaculum (ligamentous sheet located at the dorsal aspect of the wrist)
- hold the tendons in place
intrinsic muscles of the hand
originate and insert within the hand and are responsible for fine and skilled movements
examples of intrinsic muscles of hand
- hypothenar muscles
- thenar muscles
- interosseous muscles (dorsal, palmar)
hypothenar muscles
responsible for the movement of the 5th digit.
thenar muscles
are responsible for the movements of the thumb.
Interosseous Muscles ; dorsal interossei
are responsible for finger abduction
Interosseous Muscles ; palmar interossei
responsible for finger adduction
tight palmar interosseous
can become tight due to overuse, injury, dehydration, or stress. It has the potential to result
in a spasm of this muscle, which can be quite painful.
symptom tight palmar interosseous
inability to bear weight on the affected hand. Pain would also be
experienced when specifically palpating or pressing on the tight muscle, for example when pushing on
the handle of a shovel into the ground
what are the superifical and deep palmar arches formed by
radial and ulnar arteries at their terminal end
the superficial palmar arch
- ulnar artery passes superifical to the flexor retinaculum, entering the palm to form the arch
medially of superficial palmar arch
completed by the radial arch
what does the superficial arch supply
four branches of it supply the medial 3 and a half fingers
the deep palmar arch
- radial artery curves dorsally to enter the deep part of the palm as the deep palmar arch which is completed by the deep branch of the ulnar artery
what does the deep palmar arch suppy
gives off branches which supply the thumb and lateral and half of the 2nd finger
hypothenar hammer syndrome.
. Due to the superficial nature
of the ulnar artery in the palmar region, trauma to the palmar portion of the ulnar artery may occur
with repetitive movements or physical trauma to the hypothenar region, such as hammering. With
palmar trauma, the ulnar artery can be compressed against the adjacent boney hook of the hamate.
what could hypothenar hammer syndrome result in
if blood flow in the ulnar artery was interrupted you could see ischemia, discolouration, paresthesia and temperature sensitivity in digits 2-5
ischemia
inadequate blood supply to an organ or part of the body
paresthesia
refers to the pins and needles sensation in the skin
what 3 terminal nerves of the brachial plexus provide cutaneous innervation to the hand?
median
ulnar
radial
Ulnar Nerve hand
Cutaneous branches of the ulnar nerve provide sensation to the skin of the palmar and dorsal aspects
of the medial 1 ½ digits (digits 4 and 5) and adjacent palm.
Median Nerve hand
The median nerve supplies cutaneous innervation to the skin of the lateral two thirds of the palm, the
palmar surfaces of the lateral three and a half digits, and the dorsum of the distal halves of the same
digits.
Radial Nerve hand
The superficial branch of the radial nerve passes from the anterolateral aspect of the forearm to the
dorsum of the hand, giving cutaneous branches to the skin of the lateral half of dorsal aspect of the
hand, the proximal portions of the dorsal aspects of digits 1, 2, 3, and of the lateral half of digit 4.
