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.
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
3
Q
What is A?
A
Brachial plexus
4
Q
What is B?
A
Axillary lymph nodes
5
Q
What is C?
A
Axillary vein
6
Q
What is D?
A
Axillary artery
7
Q
The axillary artery is the continuation of which artery?
A
Subclavian artery
8
Q
At what anatomical point does the axillary artery begin?
A
Lateral border of first rib
9
Q
The axillary artery continues beyond the axilla as which vessel?
A
Brachial artery
10
Q
At what anatomical point does the name of the axillary artery change?
A
Lower margin of teres major
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.
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
13
Q
Brachial plexis is formed by the ventral rami of what?
A
C 5 to T 1
14
Q
What are the different trunks of the brachial plexus?
A
Upper trunk
Lower trunk
MIddle trunk
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
16
Q
What can the brachial plexus be further subdivided into?
A
Roots > trunks > divisions > cords > terminal branches
17
Q
What is A?
A
Roots of brachial plexus
18
Q
What is B?
A
Trunks of brachial plexus
19
Q
What is C?
A
Divisions of brachial plexus
20
Q
What is E?
A
Cords of brachial plexus
21
Q
What is E?
A
Terminal branches of brachial plexus
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.
23
Q
Injury to the upper trunk of brachial plexus causes what?
A
Erb’s palsy
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
25
What groups of muscles are affected by Erb's palsy?
Shoulder (deltoid, infraspinatus, levator scapulae), arm flexors (biceps, brachialis) and supinator
26
What causes Erb's palsy?
This is caused by a hyper-extension injury of the head from the shoulder
27
Injury to the lower trunk causes what?
Klumpke's palsy
28
What muscles are affacted in Klumpe's palsy?
* Intrinsic muscles of hand (typically claw hand)
* Flexors of wrist and flexors of fingers
29
What at birth can commonly cause Erb's palsy and/or Klumpke's palsy?
Shoulder dystocia
30
What are the 5 terminal branches of the cords from the brachial plexus?
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
31
What cords of the brachial plexus do the following come from:
- axillary nerve
- radial nerve
- musculocutaneous nerve
- ulnar nerve
- median nerve
* Axillary nerve
* Posterior cord
* Radial nerve
* Posterior cord
* Musculocutaenous nerve
* Lateral cord
* Ulnar nerve
* Medial cord
* Median nerve
* Both lateral and medial cord
32
What is A?
Subclavian artery
33
What is B?
Axillary artery
34
What is C?
Brachial artery
35
What is D?
Ulnar artery
36
What is D?
Ulnar artery
37
What is E?
Radial artery
38
What is A?
Cephalic vein
39
What is B?
Median cubital vein
40
What is C?
Basilic vein
41
What is D?
Cephalic vein
42
What is E?
Basilic vein
43
What is F?
Dorsal venous network
44
What is the most common place for venopuncture and cannulation?
Upper limb veins
45
Where do all of the superficial veins of the upper limb lie?
in the subcutaneous tissue, just underneath the skin making them easy to access for various procedures.
46
Which of the cephalic and basilic vein arises from the medial and lateral ends of the dorsal venous arch?
* Cephalic vein
* Lateral end
* Basilic vein
* Medial end
47
What does the median cubital vein shunt blood between?
**Median cubital vein** is a large communicating vein which shunts blood from the cephalic vein to the basilic vein
48
Which of the cephalic and basilic veins ascends on the lateral and medial aspect of arm?
* Cephalic vein
* Lateral aspect
* Basilic
* Median aspect
49
Where does the cephalic vein pass deep and what does it drain into?
Piercing the clavipectoral fascia draining into the axillary vein
50
Where does the basilic vein pass deep and what does it become?
Passing deep at the mid-humeral level and eventually becoming the axillary vein at the lower border of teres minor.
51
Where does the basilic vein become the axillary vein?
Lower border of teres minor
52
What is the area of skin supplies by one spinal segment called?
Dermatome
53
What dermatomes are the following:
- thumb
- index finger
- middle finger
- ring finger
- pinky
* Thumb
* C6
* Index finger
* C7
* Middle finger
* C7
* Ring finger
* C8
* Pinky
* C8
54
What is:
- A
- B
- C
A - C6
B - C7
C - C8
55
What is:
- D
- E
D - T1
E - C5
56
What is:
- F
- G
- H
- I
- J
F - C5
G - C6
H - C7
I - C8
J - T1
57
What is:
- K
- L
- M
K - C8
L - C7
M - C6
58
What happens following an injury to a spinal root?
Following an injury to a **spinal root** a sensory loss (paraesthesia) will be mapped on the skin corresponding to that specific **dermatome.**
59
What do all lymphatic vessels of the upper limb drain into?
Axillary nodes
60
What are the 5 groups of the axillary lymph nodes?
1. Anterior or pectoral group
2. Posterior of subscapular group
3. Apical group
4. Central group
5. Lateral or brachial group
61
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
* Little finger
* Axillary
* Scapular
* Axillary
* Medial breast
* Internal thoracic
* Lateral breast
* Axillary
* Umbillicus
* Both axillary and superficial inguinal groups
62
Why can infections/tumours around umbillicis spread to both auxillary and superficial inguinal nodes?
Equidistance from axillary and inguinal nodes so could go to either
63
What is the pectoral girdle?
**The pectoral girdle or (shoulder girdle)** is the set of bones which connects the upper limb to the axial skeleton on each side.
64
What is A?
Scapula
65
What is B?
Clavicle
66
What is C?
Acromioclavicular joint
67
What is D?
Sternoclavicular joint
68
What are the bones and joints of the pectoral girdle?
* Bones
* Scapula
* Clavicle
* Joints
* Acromioclavicular joint
* Sternoclavicular joint
69
What is the joint where the upper limb and pectoral girdle articulate?
Glenohumeral joint
70
What can help you to orientate and 'side' the clavical?
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
71
How do the following surfaces of clavicle compare to each other:
- lateral to medial
- superior to medial
* Lateral flatter than medial
* Superior smoother than inferior
72
What is the attachment for the conoid ligament on the clavicle?
Conoid tubercle
73
Where is the conoid tubercle located on the clavicle?
Inferior aspect of the lateral portion
74
Which part of the clavicle is the weakest and commonly breaks during falls?
Middle third of clavicle - thinnest and weakest part
75
What is A?
Supraspinous fossa
76
What is B?
Spine of scapula
77
What is C?
Infraspinous fossa
78
What is D?
Acromion
79
What is E?
Coracoid process
80
What is F?
Supraglenoid tubercle
81
What is G?
Glenoid cavity
82
What is H?
Infraglenoid tubercle
83
What is I?
Inferior angle of scapula
84
What is J?
Lateral border of scapula
85
What is K?
Body of scapula
86
What is L?
Medial border of scapula
87
What is M?
Superior angle of scapula
88
What kind of joints are:
- acromioclavicular (AC) joint
- sternoclavicular (SC) joint
* Acromioclavicular joint
* Plane synovial joint
* Sternoclavicular joint
* Saddle synovial joint
89
Movement of the pectoral girdle uses that joints?
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
What are the 2 stages of abduction of the arm?
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
What are the 2 stages of abduction of the arm refered to as?
Scapulo-humeral rhythm
92
Past the initial 30o of arm abduction, what is the ratio of movement of the gleno-humeral joint relative to the "scapula thoracic" movement?
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
What are the main muscles for the following of the scapula:
- elevation
- depression
* Elevation
* Levator scapulae
* Trapezius (superior fibres)
* Depression
* Trapezius (inferior fibres)
94
What are the main muscles for the following movements of the scapula:
- protraction
- retraction
* Protraction
* Serratus anterior
* Retraction
* Trapezius (middle fibres)
* Rhomboids
95
What is movement forwards and backwards of the scapula called?
* Forwards
* Protraction
* Backwards
* Retraction
96
What are the main muscles for the following movements of the scapulaa:
- lateral (upwards) rotation
- medial (downwards) rotation
* Lateral (upwards) rotation
* Trapezius (descending)
* Medial (downwards) rotation
* Gravity
* Levator scapulae
* Rhomboid major and minor
* Pectoralis minor
97
What are the different movements of the scapula?
1. Elevation
2. Depression
3. Protraction
4. Retraction
5. Lateral rotation
6. Medial rotation
98
What is lateral and medial rotation of the scapula?
* Lateral rotation
* Rotating your shoulders upwards
* Medial rotation
* Rotating your shoulders downwards
99
What is 1?
Trapezius
100
What is 2?
Levator scapulae
101
What is 3?
Rhomboideus minor
102
What is 4?
Rhomboideus major
103
What is 5?
Supraspinatus
104
What is 6?
Infraspinatus
105
What is 7?
Teres minor
106
What is 8?
Teres major
107
What is 9?
Latissimus dorsi
108
What kind of joint is the gleno-humeral joint?
Synovial ball and socket joint
109
What is the correct name for the shoulder joint?
Gleno-humeral joint
110
What is the 'ball' and 'socket' in the gleno-humeral joint?
Ball - head of humerus
Socket - glenoid cavity
111
What rim of cartilage surrounds the gleno-humeral joint?
Glenoid labrum
112
What is the function of the glenoid labrum?
Stabilise joint
113
What is A?
Scapula - acromial angle
114
What is B?
Scapula - spine
115
What is C?
Scapula - margin of glenoid cavity
116
What is D?
Scapula - glenoid cavity (fossa)
117
What is E?
Scapula - infraglenoid tubercle
118
What is F?
Scapula - lateral border
119
What is G?
Scapula - subscapular fossa
120
What is H?
Scapula - coracoid process
121
What is I?
Scapula - neck of glenoid
122
What is K?
Humerus - head
123
What is L?
Humerus - anatomical neck
124
What is M?
Humerus - greater tubercle
125
What is N?
Humerus - lesser tubercle
126
What is O?
Humerus - intertubercular groove
127
What is P?
Humerus - deltoid tuberosity
128
What is Q?
Humerus - shaft
129
What is R?
Humerus - surgical neck
130
What forms the ligaments of the shoulders?
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
What is A?
Joint capsule
132
What is B?
Caraco-acromial ligament
133
What is C?
Coracohumeral ligament
134
What is D?
* Glenohumeral ligaments
* Strenghthen anterior aspect of joint capsule
135
What is E?
* Transverse humeral ligament
* Forms roof of bicipital groove
136
What are the true ligaments of the shoulder?
1. Coraco-acromial ligament
2. Coracohumeral ligament
3. Glenohumeral ligaments
4. Transverse humeral ligament
137
What aspect of the joint capsule does the coracohumeral ligament strengthen?
Superior aspect
138
What aspect of the joint capsule does the glenohumeral ligaments strengthen?
Anterior aspect
139
What is the coraco-acromial arch made up of?
The coraco-acromial arch is made up of the coracoid and acromion process of scapula and coracoacromial ligament
140
What is the function of the coraco-acromial arch?
Prevents superior displacement of the humeral head.
141
Which part of the shoulder joint capsule is weakest, as it is not protected by muscles or ligaments?
Infraglenoid tubercle, most dislocations happen here
142
Where do most dislocations of the shoulder happen?
Infraglenoid tubercle
143
Why are bursae important?
Bursae are important as they provide cushioning around joints via. their synovial fluid filled interior – they essentially act as shock absorbers!
144
What are the 2 main bursa in the shoulder?
1. Subacromial (subdeltoid) bursa
2. Subscapular bursa
145
What does the subacromial burse sit between and what does it extend to lie below?
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
Which bursa communicates with the joint cavity of the shoulder?
Subscapular bursa
147
What is the role of the subacromial bursa?
Facilitates movement of supraspinatus tendon under the coraco-acromial arch and of deltoid over joint capsule and the greater tubercle of humerus
148
What common sporting injury damages the subacromial bursa?
Subacromial bursitis caused by repetitive action such as tennis
149
What are the 4 rotary cuff muscles?
1. Subscapularis
2. Supraspinatus
3. Infraspinatus
4. Teres minor
150
What is 1?
Subscapularis
151
What is 2?
Supraspinatus
152
What is 3?
Infraspinatus
153
What is 4?
Teres minor
154
155
For subscapularis:
- proximal attachment
- distal attachment
- movement at shoulder
* Proximal attachment
* Medial 2/3 of costal aspect of scapula
* Distal attachment
* Lesser tubercle of humeus
* Movement at shoulder
* Medial rotation
156
For supraspinatus:
- proximal attachment
- distal attachment
- movement at shoulder joint
* Proximal attachment
* Supraspinous fossa of scapula
* Distal attachment
* Greater tuberosity of humerus
* Movement at shoulder joint
* Assists in adduction
157
For infraspinatus:
- proximal attachment
- distal attachment
- movement at shoulder joint
* Proximal attachment
* Infraspinous fossa of scapula
* Distal attachment
* Middle facet of greater tubercle of humerus
* Movement at shoulder joint
* Lateral rotation
158
For teres minor:
- proximal attachment
- distal attachment
- movement at shoulder joint
* Proximal attachment
* Middle part of lateral border of scapula
* Distal attachment
* Lesser tuberosity of humerus
* Movement at shoulder joint
* Lateral rotation
159
Although the rotator cuff muscles have a role in movement at the glenohumeral joint, what is their primary function?
Stabilising the joint
160
What are rotator cuff injuries usually caused by?
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
For deltoid muscle:
- proximal attachment
- distal attachment
- movement at shoulder
* Proximal attachment
* Lateral spine of scapula
* Distal attachment
* Deltoid tuberosity of humerus
* Movement at shoulder
* Various due to extensive proximal origin
162
What movement do the following fibres of the deltoid do to the shoulder joint:
- anterior fibres
- middle fibres
- posterior fibres
* Anterior fibres
* Flexion
* Medial rotation
* Middle fibres
* Abduction
* Posterior fibres
* Extension
* Lateral rotation
163
In what common injury is this nerve often trapped and therefore damaged around the deltoid?
Shoulder dislocation
164
In shoulder dislocation and nerve damage, where do you test for loss of sensation?
‘Regiment badge’ area
165
For pectoralis major:
- origin
- insertion
- movement
* 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
Does the pectoralis minor lie superficial or deep to pectoralis major?
Deep
167
Why is the pectoralis minor important anatomically?
Splits axillary artery into 3 parts
168
What is the function of the pectoralis minor?
Along with serratus anterior, stabilises the scapula during limb movements by keeping it pulled against the thoracic cage
169
**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?
Long thoracic nerve has been damaged
170
What is 1?
Trapezius (middle part)
171
What is 2?
Latissimus dorsi
172
What is 3?
Teres major
173
What is 4?
Deltoid (middle part)
174
Why is the trapezius capable of doing opposing movements
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
What are the actions of the following fibres of the trapezius:
- superior fibres
- middle fibres
- inferior fibres
* Superior fibres
* Elevation of scapula
* Middle fibres
* Retraction of scapula
* Inferior fibres
* Depression of scapula
176
What is the innervation of the trapezius?
Spinal accessory nerve (CN XI)
177
What foramen of the skull does the spinal accessory nerve pass through?
Jugular foramen
178
What muscles are responsible for flexion of shoulder?
1. Anterior deltoid
2. Pectoralis major
3. Coracobrachialis
179
What muscles are responsible for extension of the shoulder?
1. Posterior deltoid
2. Latissimus dorsi
180
What muscles are responsible for adduction of shoulder?
1. Pectoralis major
2. Latissimus dorsi
3. Teres major
4. Subscapularis
181
What muscles are responsible for abduction of shoulder?
* 0 to 90 degrees
* Middle deltoid
* Supraspinatus
* 90 to 180 degrees
* Descending trapezius
* Serratus anterior
182
What muscles are responsible for medial or internal rotation of shoulder?
1. Subscapularis
2. Latissimus dorsi
3. Pectoralis major
4. Teres major
183
What muscles are responsible for lateral or external rotation of shoulder?
1. Posterior deltoid
2. Trapezius middle
3. Infraspinatus
