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anatomy year 3 > MSK 1 - Upper Limbs 1 > Flashcards

MSK 1 - Upper Limbs 1 Flashcards

1
Q

What shape is the axilla?

A

The axilla is roughly pyramidal in shape and has an apex, base, and 4 walls.

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2
Q

What are the following walls of the axilla formed by:

  • anterior
  • posterior
  • medial
  • lateral
A
  • Anterior
    • Pectoralis major and pectoralis minor
  • Posterior
    • Subscapularis, tere major and latissmus dorsi
  • Medial
    • Thoracic wall and serratus anterior
  • Lateral
    • Intertubercular of the humerus
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3
Q

What is A?

A

Brachial plexus

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4
Q

What is B?

A

Axillary lymph nodes

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5
Q

What is C?

A

Axillary vein

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6
Q

What is D?

A

Axillary artery

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7
Q

The axillary artery is the continuation of which artery?

A

Subclavian artery

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8
Q

At what anatomical point does the axillary artery begin?

A

Lateral border of first rib

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9
Q

The axillary artery continues beyond the axilla as which vessel?

A

Brachial artery

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10
Q

At what anatomical point does the name of the axillary artery change?

A

Lower margin of teres major

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11
Q

The enlargement of the axillary lymph nodes is common in what?

A

The enlargement of axillary lymph nodes is common in infection of the upper limb, and in malignant processes involving the breast tissue.

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12
Q

What can happen to the axillary artery in response to perfuse bleeding of upper limb?

A

The axillary artery is a point where vasculature can be compressed (via a tourniquet) in response to profuse bleeding to the upper limb – for example after tissue trauma

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13
Q

Brachial plexis is formed by the ventral rami of what?

A

C 5 to T 1

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14
Q

What are the different trunks of the brachial plexus?

A

Upper trunk

Lower trunk

MIddle trunk

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15
Q

What nerve roots form the upper, middle and lower trunks of brachial plexus?

A
  • Upper
    • C5 and C6
  • Middle
    • C7
  • Lower
    • C8 and T1
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16
Q

What can the brachial plexus be further subdivided into?

A

Roots > trunks > divisions > cords > terminal branches

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17
Q

What is A?

A

Roots of brachial plexus

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18
Q

What is B?

A

Trunks of brachial plexus

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19
Q

What is C?

A

Divisions of brachial plexus

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20
Q

What is E?

A

Cords of brachial plexus

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21
Q

What is E?

A

Terminal branches of brachial plexus

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22
Q

The cords of the brachial plexus are named according to what?

A

their position in relation to the axillary artery in the axilla.

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23
Q

Injury to the upper trunk of brachial plexus causes what?

A

Erb’s palsy

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24
Q

What is the presentation of Erb’s palsy?

A
  • Waiters tip appearance of upper limb
    • Medial rotation of the arm and wrist flexion
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25
Q

What groups of muscles are affected by Erb’s palsy?

A

Shoulder (deltoid, infraspinatus, levator scapulae), arm flexors (biceps, brachialis) and supinator

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26
Q

What causes Erb’s palsy?

A

This is caused by a hyper-extension injury of the head from the shoulder

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27
Q

Injury to the lower trunk causes what?

A

Klumpke’s palsy

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28
Q

What muscles are affacted in Klumpe’s palsy?

A
  • Intrinsic muscles of hand (typically claw hand)
  • Flexors of wrist and flexors of fingers
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29
Q

What at birth can commonly cause Erb’s palsy and/or Klumpke’s palsy?

A

Shoulder dystocia

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30
Q

What are the 5 terminal branches of the cords from the brachial plexus?

A
  1. Axillary nerve from the posterior cord
  2. Radial nerve from the posterior cord
  3. Musculocutaneous nerve from the lateral cord
  4. Ulnar nerve from the medial cord
  5. Median nerve from both the lateral and medial cord
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31
Q

What cords of the brachial plexus do the following come from:

  • axillary nerve
  • radial nerve
  • musculocutaneous nerve
  • ulnar nerve
  • median nerve
A
  • Axillary nerve
    • Posterior cord
  • Radial nerve
    • Posterior cord
  • Musculocutaenous nerve
    • Lateral cord
  • Ulnar nerve
    • Medial cord
  • Median nerve
    • Both lateral and medial cord
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32
Q

What is A?

A

Subclavian artery

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33
Q

What is B?

A

Axillary artery

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34
Q

What is C?

A

Brachial artery

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35
Q

What is D?

A

Ulnar artery

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36
Q

What is D?

A

Ulnar artery

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37
Q

What is E?

A

Radial artery

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38
Q

What is A?

A

Cephalic vein

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39
Q

What is B?

A

Median cubital vein

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40
Q

What is C?

A

Basilic vein

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41
Q

What is D?

A

Cephalic vein

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42
Q

What is E?

A

Basilic vein

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43
Q

What is F?

A

Dorsal venous network

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44
Q

What is the most common place for venopuncture and cannulation?

A

Upper limb veins

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45
Q

Where do all of the superficial veins of the upper limb lie?

A

in the subcutaneous tissue, just underneath the skin making them easy to access for various procedures.

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46
Q

Which of the cephalic and basilic vein arises from the medial and lateral ends of the dorsal venous arch?

A
  • Cephalic vein
    • Lateral end
  • Basilic vein
    • Medial end
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47
Q

What does the median cubital vein shunt blood between?

A

Median cubital vein is a large communicating vein which shunts blood from the cephalic vein to the basilic vein

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48
Q

Which of the cephalic and basilic veins ascends on the lateral and medial aspect of arm?

A
  • Cephalic vein
    • Lateral aspect
  • Basilic
    • Median aspect
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49
Q

Where does the cephalic vein pass deep and what does it drain into?

A

Piercing the clavipectoral fascia draining into the axillary vein

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50
Q

Where does the basilic vein pass deep and what does it become?

A

Passing deep at the mid-humeral level and eventually becoming the axillary vein at the lower border of teres minor.

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51
Q

Where does the basilic vein become the axillary vein?

A

Lower border of teres minor

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52
Q

What is the area of skin supplies by one spinal segment called?

A

Dermatome

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53
Q

What dermatomes are the following:

  • thumb
  • index finger
  • middle finger
  • ring finger
  • pinky
A
  • Thumb
    • C6
  • Index finger
    • C7
  • Middle finger
    • C7
  • Ring finger
    • C8
  • Pinky
    • C8
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54
Q

What is:

  • A
  • B
  • C
A

A - C6

B - C7

C - C8

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55
Q

What is:

  • D
  • E
A

D - T1

E - C5

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56
Q

What is:

  • F
  • G
  • H
  • I
  • J
A

F - C5

G - C6

H - C7

I - C8

J - T1

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57
Q

What is:

  • K
  • L
  • M
A

K - C8

L - C7

M - C6

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58
Q

What happens following an injury to a spinal root?

A

Following an injury to a spinal root a sensory loss (paraesthesia) will be mapped on the skin corresponding to that specific dermatome.

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59
Q

What do all lymphatic vessels of the upper limb drain into?

A

Axillary nodes

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60
Q

What are the 5 groups of the axillary lymph nodes?

A
  1. Anterior or pectoral group
  2. Posterior of subscapular group
  3. Apical group
  4. Central group
  5. Lateral or brachial group
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61
Q

What lymph nodes of axillary, internal thoracic or superficial inguinal will be involved in spread of cancer/infection that begins in the following areas:

  • little finger
  • scapular region
  • medial part of the breast
  • lateral part of breast
  • infection around umbillicus
A
  • Little finger
    • Axillary
  • Scapular
    • Axillary
  • Medial breast
    • Internal thoracic
  • Lateral breast
    • Axillary
  • Umbillicus
    • Both axillary and superficial inguinal groups
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62
Q

Why can infections/tumours around umbillicis spread to both auxillary and superficial inguinal nodes?

A

Equidistance from axillary and inguinal nodes so could go to either

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63
Q

What is the pectoral girdle?

A

The pectoral girdle or (shoulder girdle) is the set of bones which connects the upper limb to the axial skeleton on each side.

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64
Q

What is A?

A

Scapula

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65
Q

What is B?

A

Clavicle

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66
Q

What is C?

A

Acromioclavicular joint

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67
Q

What is D?

A

Sternoclavicular joint

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68
Q

What are the bones and joints of the pectoral girdle?

A
  • Bones
    • Scapula
    • Clavicle
  • Joints
    • Acromioclavicular joint
    • Sternoclavicular joint
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69
Q

What is the joint where the upper limb and pectoral girdle articulate?

A

Glenohumeral joint

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70
Q

What can help you to orientate and ‘side’ the clavical?

A
  1. The lateral aspect of a clavicle is flatter than the medial aspect
  2. The superior surface is smoother than the inferior surface
  3. The conoid tubercle – attachment for the conoid ligament – is on the inferior aspect of the lateral portion of the clavicle
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71
Q

How do the following surfaces of clavicle compare to each other:

  • lateral to medial
  • superior to medial
A
  • Lateral flatter than medial
  • Superior smoother than inferior
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72
Q

What is the attachment for the conoid ligament on the clavicle?

A

Conoid tubercle

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73
Q

Where is the conoid tubercle located on the clavicle?

A

Inferior aspect of the lateral portion

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74
Q

Which part of the clavicle is the weakest and commonly breaks during falls?

A

Middle third of clavicle - thinnest and weakest part

75
Q

What is A?

A

Supraspinous fossa

76
Q

What is B?

A

Spine of scapula

77
Q

What is C?

A

Infraspinous fossa

78
Q

What is D?

A

Acromion

79
Q

What is E?

A

Coracoid process

80
Q

What is F?

A

Supraglenoid tubercle

81
Q

What is G?

A

Glenoid cavity

82
Q

What is H?

A

Infraglenoid tubercle

83
Q

What is I?

A

Inferior angle of scapula

84
Q

What is J?

A

Lateral border of scapula

85
Q

What is K?

A

Body of scapula

86
Q

What is L?

A

Medial border of scapula

87
Q

What is M?

A

Superior angle of scapula

88
Q

What kind of joints are:

  • acromioclavicular (AC) joint
  • sternoclavicular (SC) joint
A
  • Acromioclavicular joint
    • Plane synovial joint
  • Sternoclavicular joint
    • Saddle synovial joint
89
Q

Movement of the pectoral girdle uses that joints?

A

Movement of the pectoral girdle involves SC, AC and shoulder joints, all moving simultaneously. Functional defects of any one of these joints impair movements of the pectoral girdle. Mobility of the scapula is essential for the freedom of movement of upper limb.

90
Q

What are the 2 stages of abduction of the arm?

A

The first 30 degrees of abduction is caused by muscles acting at the shoulder joint (gleno-humeral joint).

Beyond 30 degrees, abduction relies on the scapula being pulled upwards (elevated) and laterally rotating on the chest wall (“scapula-thoracic” movement).

91
Q

What are the 2 stages of abduction of the arm refered to as?

A

Scapulo-humeral rhythm

92
Q

Past the initial 30o of arm abduction, what is the ratio of movement of the gleno-humeral joint relative to the “scapula thoracic” movement?

A

For every 3 degrees of abduction past the initial 30 degrees – 2 degrees occurs at the gleno-humeral joint, and 1 degree occurs due to “scapula-thoracic” movement (2:1 ratio).

93
Q

What are the main muscles for the following of the scapula:

  • elevation
  • depression
A
  • Elevation
    • Levator scapulae
    • Trapezius (superior fibres)
  • Depression
    • Trapezius (inferior fibres)
94
Q

What are the main muscles for the following movements of the scapula:

  • protraction
  • retraction
A
  • Protraction
    • Serratus anterior
  • Retraction
    • Trapezius (middle fibres)
    • Rhomboids
95
Q

What is movement forwards and backwards of the scapula called?

A
  • Forwards
    • Protraction
  • Backwards
    • Retraction
96
Q

What are the main muscles for the following movements of the scapulaa:

  • lateral (upwards) rotation
  • medial (downwards) rotation
A
  • Lateral (upwards) rotation
    • Trapezius (descending)
  • Medial (downwards) rotation
    • Gravity
    • Levator scapulae
    • Rhomboid major and minor
    • Pectoralis minor
97
Q

What are the different movements of the scapula?

A
  1. Elevation
  2. Depression
  3. Protraction
  4. Retraction
  5. Lateral rotation
  6. Medial rotation
98
Q

What is lateral and medial rotation of the scapula?

A
  • Lateral rotation
    • Rotating your shoulders upwards
  • Medial rotation
    • Rotating your shoulders downwards
99
Q

What is 1?

A

Trapezius

100
Q

What is 2?

A

Levator scapulae

101
Q

What is 3?

A

Rhomboideus minor

102
Q

What is 4?

A

Rhomboideus major

103
Q

What is 5?

A

Supraspinatus

104
Q

What is 6?

A

Infraspinatus

105
Q

What is 7?

A

Teres minor

106
Q

What is 8?

A

Teres major

107
Q

What is 9?

A

Latissimus dorsi

108
Q

What kind of joint is the gleno-humeral joint?

A

Synovial ball and socket joint

109
Q

What is the correct name for the shoulder joint?

A

Gleno-humeral joint

110
Q

What is the ‘ball’ and ‘socket’ in the gleno-humeral joint?

A

Ball - head of humerus

Socket - glenoid cavity

111
Q

What rim of cartilage surrounds the gleno-humeral joint?

A

Glenoid labrum

112
Q

What is the function of the glenoid labrum?

A

Stabilise joint

113
Q

What is A?

A

Scapula - acromial angle

114
Q

What is B?

A

Scapula - spine

115
Q

What is C?

A

Scapula - margin of glenoid cavity

116
Q

What is D?

A

Scapula - glenoid cavity (fossa)

117
Q

What is E?

A

Scapula - infraglenoid tubercle

118
Q

What is F?

A

Scapula - lateral border

119
Q

What is G?

A

Scapula - subscapular fossa

120
Q

What is H?

A

Scapula - coracoid process

121
Q

What is I?

A

Scapula - neck of glenoid

122
Q

What is K?

A

Humerus - head

123
Q

What is L?

A

Humerus - anatomical neck

124
Q

What is M?

A

Humerus - greater tubercle

125
Q

What is N?

A

Humerus - lesser tubercle

126
Q

What is O?

A

Humerus - intertubercular groove

127
Q

What is P?

A

Humerus - deltoid tuberosity

128
Q

What is Q?

A

Humerus - shaft

129
Q

What is R?

A

Humerus - surgical neck

130
Q

What forms the ligaments of the shoulders?

A

The joint capsule of the glenohumeral joint is thickened to form definable ligaments, but true ligaments are also present between other bony elements. Together these strengthen and ease movements at the joint.

131
Q

What is A?

A

Joint capsule

132
Q

What is B?

A

Caraco-acromial ligament

133
Q

What is C?

A

Coracohumeral ligament

134
Q

What is D?

A
  • Glenohumeral ligaments
    • Strenghthen anterior aspect of joint capsule
135
Q

What is E?

A
  • Transverse humeral ligament
    • Forms roof of bicipital groove
136
Q

What are the true ligaments of the shoulder?

A
  1. Coraco-acromial ligament
  2. Coracohumeral ligament
  3. Glenohumeral ligaments
  4. Transverse humeral ligament
137
Q

What aspect of the joint capsule does the coracohumeral ligament strengthen?

A

Superior aspect

138
Q

What aspect of the joint capsule does the glenohumeral ligaments strengthen?

A

Anterior aspect

139
Q

What is the coraco-acromial arch made up of?

A

The coraco-acromial arch is made up of the coracoid and acromion process of scapula and coracoacromial ligament

140
Q

What is the function of the coraco-acromial arch?

A

Prevents superior displacement of the humeral head.

141
Q

Which part of the shoulder joint capsule is weakest, as it is not protected by muscles or ligaments?

A

Infraglenoid tubercle, most dislocations happen here

142
Q

Where do most dislocations of the shoulder happen?

A

Infraglenoid tubercle

143
Q

Why are bursae important?

A

Bursae are important as they provide cushioning around joints via. their synovial fluid filled interior – they essentially act as shock absorbers!

144
Q

What are the 2 main bursa in the shoulder?

A
  1. Subacromial (subdeltoid) bursa
  2. Subscapular bursa
145
Q

What does the subacromial burse sit between and what does it extend to lie below?

A

Notice how the subacromial bursa sits between the infra-/supra-spinatus muscles and the deltoid, extending superiorly to lie below the acromion and coracoacromial ligaments

146
Q

Which bursa communicates with the joint cavity of the shoulder?

A

Subscapular bursa

147
Q

What is the role of the subacromial bursa?

A

Facilitates movement of supraspinatus tendon under the coraco-acromial arch and of deltoid over joint capsule and the greater tubercle of humerus

148
Q

What common sporting injury damages the subacromial bursa?

A

Subacromial bursitis caused by repetitive action such as tennis

149
Q

What are the 4 rotary cuff muscles?

A
  1. Subscapularis
  2. Supraspinatus
  3. Infraspinatus
  4. Teres minor
150
Q

What is 1?

A

Subscapularis

151
Q

What is 2?

A

Supraspinatus

152
Q

What is 3?

A

Infraspinatus

153
Q

What is 4?

A

Teres minor

154
Q
A
155
Q

For subscapularis:

  • proximal attachment
  • distal attachment
  • movement at shoulder
A
  • Proximal attachment
    • Medial 2/3 of costal aspect of scapula
  • Distal attachment
    • Lesser tubercle of humeus
  • Movement at shoulder
    • Medial rotation
156
Q

For supraspinatus:

  • proximal attachment
  • distal attachment
  • movement at shoulder joint
A
  • Proximal attachment
    • Supraspinous fossa of scapula
  • Distal attachment
    • Greater tuberosity of humerus
  • Movement at shoulder joint
    • Assists in adduction
157
Q

For infraspinatus:

  • proximal attachment
  • distal attachment
  • movement at shoulder joint
A
  • Proximal attachment
    • Infraspinous fossa of scapula
  • Distal attachment
    • Middle facet of greater tubercle of humerus
  • Movement at shoulder joint
    • Lateral rotation
158
Q

For teres minor:

  • proximal attachment
  • distal attachment
  • movement at shoulder joint
A
  • Proximal attachment
    • Middle part of lateral border of scapula
  • Distal attachment
    • Lesser tuberosity of humerus
  • Movement at shoulder joint
    • Lateral rotation
159
Q

Although the rotator cuff muscles have a role in movement at the glenohumeral joint, what is their primary function?

A

Stabilising the joint

160
Q

What are rotator cuff injuries usually caused by?

A

These are caused by repetitive overhead motions, e.g. serving in tennis; or throwing motions, e.g. pitching a baseball. Over time the increased stress on the ligaments and muscles weakens them, making them more likely to tear.

161
Q

For deltoid muscle:

  • proximal attachment
  • distal attachment
  • movement at shoulder
A
  • Proximal attachment
    • Lateral spine of scapula
  • Distal attachment
    • Deltoid tuberosity of humerus
  • Movement at shoulder
    • Various due to extensive proximal origin
162
Q

What movement do the following fibres of the deltoid do to the shoulder joint:

  • anterior fibres
  • middle fibres
  • posterior fibres
A
  • Anterior fibres
    • Flexion
    • Medial rotation
  • Middle fibres
    • Abduction
  • Posterior fibres
    • Extension
    • Lateral rotation
163
Q

In what common injury is this nerve often trapped and therefore damaged around the deltoid?

A

Shoulder dislocation

164
Q

In shoulder dislocation and nerve damage, where do you test for loss of sensation?

A

‘Regiment badge’ area

165
Q

For pectoralis major:

  • origin
  • insertion
  • movement
A
  • Origin
    • Extensive origin from medial third of clavicle, sternum and costal cartilage of the first 6 ribs and rectus sheath
  • Insertion
    • Lateral lip of bicipital groove of humerus
  • Movement
    • Adduction of shoulder
    • Medial rotation of humerus at glenohumeral joint
166
Q

Does the pectoralis minor lie superficial or deep to pectoralis major?

A

Deep

167
Q

Why is the pectoralis minor important anatomically?

A

Splits axillary artery into 3 parts

168
Q

What is the function of the pectoralis minor?

A

Along with serratus anterior, stabilises the scapula during limb movements by keeping it pulled against the thoracic cage

169
Q

CLINICAL CASE

Mrs Smith is 64 years old and had a left mastectomy with axillary lymph node clearance for breast cancer.
Oddly she’s recently found that she can feel her scapula protruding outwards from her back when she’s been showering, and she is struggling to lift items on her left side.

Why has this occurred, which nerve has been damaged in the procedure?

A

Long thoracic nerve has been damaged

170
Q

What is 1?

A

Trapezius (middle part)

171
Q

What is 2?

A

Latissimus dorsi

172
Q

What is 3?

A

Teres major

173
Q

What is 4?

A

Deltoid (middle part)

174
Q

Why is the trapezius capable of doing opposing movements

A

Trapezius has a long origin meaning that its fibres approach the spine of the scapulae from above, in-line and below it. This results in different movements upon contraction of different parts of the muscle.

175
Q

What are the actions of the following fibres of the trapezius:

  • superior fibres
  • middle fibres
  • inferior fibres
A
  • Superior fibres
    • Elevation of scapula
  • Middle fibres
    • Retraction of scapula
  • Inferior fibres
    • Depression of scapula
176
Q

What is the innervation of the trapezius?

A

Spinal accessory nerve (CN XI)

177
Q

What foramen of the skull does the spinal accessory nerve pass through?

A

Jugular foramen

178
Q

What muscles are responsible for flexion of shoulder?

A
  1. Anterior deltoid
  2. Pectoralis major
  3. Coracobrachialis
179
Q

What muscles are responsible for extension of the shoulder?

A
  1. Posterior deltoid
  2. Latissimus dorsi
180
Q

What muscles are responsible for adduction of shoulder?

A
  1. Pectoralis major
  2. Latissimus dorsi
  3. Teres major
  4. Subscapularis
181
Q

What muscles are responsible for abduction of shoulder?

A
  • 0 to 90 degrees
    • Middle deltoid
    • Supraspinatus
  • 90 to 180 degrees
    • Descending trapezius
    • Serratus anterior
182
Q

What muscles are responsible for medial or internal rotation of shoulder?

A
  1. Subscapularis
  2. Latissimus dorsi
  3. Pectoralis major
  4. Teres major
183
Q

What muscles are responsible for lateral or external rotation of shoulder?

A
  1. Posterior deltoid
  2. Trapezius middle
  3. Infraspinatus

anatomy year 3 (18 decks)

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