MSK 1 - Upper Limbs Flashcards
1
Q
what is the axilla?
A
Is a pyramidal space below the shoulder joint. It provides a passageway for vessels and nerves going to and from the upper limb
2
Q
what is the shape of the axilla?
A
The axilla is roughly pyramidal in shape and has an apex, base, and 4 walls
3
Q
The anterior wall of axilla is formed by what?
A
Pectoralis major muscle and Pectoralis minor muscle
4
Q
The posterior wall of the axilla is formed by what 3 muscles?
A
subscapularis, Teres major and Latissimus dorsi
5
Q
Medial wall of the axilla is formed by what?
A
the thoracic wall and serratus anterior muscle
6
Q
Lateral wall of the axilla is formed by what?
A
the intertubercular groove of the humerus
7
Q
a
A
Brachial plexus
8
Q
b
A
Axillary lymph nodes (apical group on left and central group more lateral on the right)
9
Q
c
A
Axillary artery
10
Q
d
A
Axillary vein
11
Q
The axillary artery is the continuation of which artery?
A
Subclavian artery
12
Q
At what anatomical point does the axillary artery begin?
A
Outer boarder of the first rib
13
Q
The axillary artery continues beyond the axilla as which vessel?
A
Brachial artery
14
Q
At what anatomical point does the name of this vessel change
A
lower border of teres major
15
Q
CLinical:
The enlargement of ________________ is common in infection of the upper limb, and in malignant processes involving the breast tissue.
The ____________ is a point where vasculature can be _________ (via a tourniquet) in response to profuse bleeding to the upper limb – for example after tissue trauma
A
axillary lymph nodes
axillary artery
compressed
16
Q
_______________\_ is the major network of nerves innervating the upper limb. It begins in the cervical region and extends into axilla.
A
The Brachial Plexus
17
Q
what ofrms the brachial plexus?
A
Brachial plexus is formed by the ventral rami of
C 5 to T 1
18
Q
Which nerve roots form the upper trunk? (of brachial plexus?
A
C5 and C6
19
Q
Which roots of the plexus contribute to the lower trunk? (brachial plexus)
A
C8 and T1
20
Q
Which root forms the middle trunk? (brachial plexus)
A
C7
21
Q
The brachial plexus can be further sub divided into trunks, divisions, cords and terminal branches as it passes down into the arm
what is purple
A
roots
22
Q
The brachial plexus can be further sub divided into trunks, divisions, cords and terminal branches as it passes down into the arm
what is oragne
A
trunks
23
Q
The brachial plexus can be further sub divided into trunks, divisions, cords and terminal branches as it passes down into the arm
what is yellow
A
division
24
Q
The brachial plexus can be further sub divided into trunks, divisions, cords and terminal branches as it passes down into the arm
what is pink
A
cords
25
The brachial plexus can be further sub divided into trunks, divisions, cords and terminal branches as it passes down into the arm
what is green
terminals
26
The division of the trunks form three cords of the brachial plexus in the axilla. The cords are named for their position in relation to the \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
axillary artery in the axilla
27
**_Clinical_**_: **Erb’s**_
Injury to upper trunk causes **Erb’s** Palsy, this results in a characteristic ‘waiter’s tip’ appearance of the upper limb - medial rotation of the arm with wrist flexion. This is caused by a hyper-extension injury of the head from the shoulder
Which group of muscles are affected in this condition? They are supplied by the nerve roots C5 -C6 (you should answer this question after studying the relevant regions)
rotator cuff muscles
28
Clinical: Klumpke’s Palsy
Injury to the lower trunk causes **Klumpke’s** Palsy
what does this affect
This mainly affects the intrinsic muscles of the hand (typically a claw hand), flexors muscles of the wrist and flexor muscles of the fingers (you will study these muscles later)
Both injuries are most commonly caused by shoulder dystocia at birth or following traumatic injury (e.g. motor vehicle accident)
29
1. _______ nerve from the posterior cord
2. ______ nerve from the posterior cord
3. ______________ nerve from the lateral cord
4. _____ nerve from the medial cord
5. ______ nerve from both the lateral and medial cord
Axillary
Radial
Musculocutaneous
Ulnar
Median
https://geekymedics.com/brachial-plexus/
30
a
Subclavian artery
31
b
Axillary artery
32
c
Brachial artery
33
d
Ulnar artery
34
e
Radial artery
35
a
Cephalic vein
36
b
Basilic vein
37
c
Median cubital vein
38
**Clinical:**
Throughout your medical career you will become **very** accustomed to finding the superficial veins of the upper arm. They are the most common place for ___________ (taking blood) and _________ (allowing for intra-venous medications and blood transfusions to be delivered)
venepuncture
cannulation
39
**The \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** is a complex network of veins lying at the distal aspect of the upper limb
All the superficial veins of the upper limb lie in the \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_, just underneath the skin making them easy to access for various procedures
**dorsal venous arch**
subcutaneous tissue
40
The _________ vein arises at the lateral end of the dorsal venous arch and _______ vein arises at the medial end of the dorsal venous arch
Cephalic
Basilic
41
Median cubital vein is a large communicating vein which shunts blood from the ________ vein to the ________ vein
Often the median cubital vein is in a fixed position in the ante-cubital fossa – this is handy as it is the most common site for venepuncture
cephalic
basilic
42
The **\_\_\_\_\_\_\_\_** vein ascends the arm on its lateral aspect, piercing the clavipectoral fascia draining into the axillary vein
The **\_\_\_\_\_\_\_** vein ascends on the medial side of the arm, passing deep at the mid-humeral level and eventually becoming the axillary vein at the lower border of teres minor
**cephalic**
**basilic**
43
\_\_\_\_\_\_\_\_ is more superficial compared to the ______ vein, blood drains deeper
Cephalic
basilic
44
The area of skin supplied by one spinal segment is called a **\_\_\_\_\_\_\_\_\_\_**
**dermatome**
45
In the upper limb each brachial plexus root (C5 to T1) can be mapped to a specific dermatome
where about are they?
(anterior)
(posteiror)
46
**Clinical:**
Following an injury to a **\_\_\_\_\_\_\_\_\_\_\_** a sensory loss (paraesthesia) will be mapped on the skin corresponding to that specific **\_\_\_\_\_\_\_\_\_\_.**
Injury to a terminal branch produces sensory loss corresponding to the area of **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.** This will become clearer through the workbook!
Remember these dermatomes as you require this knowledge to detect peripheral nerve injuries
**spinal root**
**dermatome**
**distribution of that nerve**
47
Some simple embryology will help to explain their organisation: imagine the limb abducted to 90 degrees, resembling the arrangement in the embryo. The dermatomes are then roughly arranged from upper to lower; C5-T1.
As the limb bud expands the middle levels become squeezed out towards the tip of the limb, to form the adult pattern
Early stages of development in left photo
Later stages of development in right photo
48
All **lymphatic** vessels from the upper limb drain into **\_\_\_\_\_\_\_\_\_\_\_ (lymph nodes are difficult to see in the dissected cadaver)**
**axillary nodes**
49
Axillary lymph nodes are divided into 4-5 distinct groups, what are they?
1. Anterior or pectoral group
2. Posterior or subscapular group
3. Apical group
4. Central group
5. Lateral or brachial group
50
Which group of lymph nodes will be involved if the lymphatic spread of infection/cancer begins in the following areas of the body?
Choose your answer to the below from the following lymph node groups
* *1) Axillary
2) Internal thoracic (internal mammary)
3) Superficial Inguinal**
1. Infection of the little finger
2. Boil in the scapular region
3. Medial part of the breast (close to sternum)
4. Lateral part of breast (close to axilla)
5. Infection around the umbilicus: This infection can spread to both axillary and superficial inguinal groups of both sides? Why?
a = 1
b = 1
c = 2
d = 1
e = Equidistance between the nodes so top half goes up and bottom half down, due to the amount of blood vessels and lymph around the umbilicus
51
Clinical:
\_\_\_\_\_\_\_\_\_\_\_ of the ________ nodes is frequent in malignant disease and infective processes affecting the upper back and shoulder, the front of the chest and mammary gland, upper anterolateral abdominal wall and upper limb
Enlargement
axillary
52
**The pectoral girdle or (shoulder girdle)** is the set of bones which connects the upper limb to the axial skeleton on each side
what makes it up?
53
what is the structure of the clavicle
To attempt to orientate and ‘side’ a clavicle there are a number of features which can help do so
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
54
diagram which part of the clavicle is weakest and commonly breaks (fractures) during a fall. Why is this?
Middle third of the clavicle is the thinnest and most outermost part and has a lack of support by muscles and ligaments, so its more vulnerable to injury
Junction between middle and lateral thirds of the clavicle due to the weight of the arm
55
a
Supraspinous fossa
56
b
Spine of the scapula
57
c
Infraspinous fossa
58
d
Superior angle
59
e
Medial border
60
f
Subscapular fossa
61
g
Lateral border
62
h
Inferior angle
63
i
Acromion
64
j
Coracoid process
65
k
Supraglenoid tubercle
66
l
Glenoid cavity
67
m
Infra-glenoid tubercle
68
What type of synovial joint are the acromioclavicular (AC) and sternoclavicular (SC) joints?
AC joint - Synovial plane
SC joint - Synovial saddle
69
Clinical:
Movement of the pectoral girdle involves _____________ joints, all moving simultaneously. Functional defects of any one of these joints impair movements of the pectoral girdle. Mobility of the _______ is essential for the freedom of movement of upper limb.
SC, AC and shoulder
scapula
70
Abduction of the arm occurs in 2 stages: what are they?
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)
This is called the **scapulo-humeral rhythm**
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)
71
Review the movements of the scapula and therefore the pectoral girdle described below. These are essential in clinical testing of muscle function.
Scapular movement = elevation
what are the main muscles involved?
upper trapezius
levator scapulae
72
Scapular movement = depression
what are the main muscles involved?
lower trapezius
73
Scapular movement = Protraction (forward movement)
what are the main muscles involved?
serratus anterior
74
Scapular movement = Retraction (backward movement)
what are the main muscles involved?
Trapezius (middle fibres) and Rhomboids
75
Scapular movement = Lateral (upward) rotation: Elevating Glenoid Cavity - Shrugging your shoulders!
what are the main muscles involved?
upper and middle trapezius ??
76
Scapular movement = Medial (downward) rotation: Depressing Glenoid Cavity
what are the main muscles involved?
1. Gravity
2. Levator scapulae
3. Rhomboid Maj. and Min.
4. Pectoralis minor
77
1
Trapezius
78
2
Levator scapulae
79
3
Rhomboideus minor
80
4
Rhomboideus major
81
5
Supraspinatus
82
6
Infraspinatus
83
7
Teres minor
84
8
Teres major
85
9
Latissimus dorsi
86
The shoulder joint is a synovial ball and socket joint, where the ball is the head of the ________ and socket is the _______ cavity. The rim of cartilage surrounding the socket is the glenoid \_\_\_\_\_\_\_
humerus
glenoid
labrum
87
What is the function of this cartilage? (glenoid labrum)
Deepens the cavity, increases surface area of shoulder joint
88
whata re the ligaments like of the shoudler joint?
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
89
a
The Coracoacromial ligament
90
b
Coracohumeral ligament
91
c
Glenohumeral ligaments – strengthen the anterior aspect of the joint capsule
92
d
The transverse humeral ligament – forms the roof of the bicipital groove
93
The coracohumeral ligament strengthens _______ aspect of the joint capsule
superior
94
The coraco-acromial arch is made up of the _______ and ________ process of scapula and ___________ ligament
It prevents __________ displacement of the humeral head
acromion
coracoid
95
Which part of the shoulder joint capsule is weakest, as it is not protected by muscles or ligaments?
inferior
96
**_Bursae Around the Shoulder Joint:_**
what is their function
Bursae are important as they provide cushioning around joints via. their synovial fluid filled interior – they essentially act as shock absorbers!
97
The 2 main bursa in the shoulder are what?
The 2 main bursa in the shoulder are the subacromial[](https://www.anatomy.tv/anatomytv/html5ui_2018/#/product/har_shoulder_2014/type/Views/id/43081/layer/10/angle/10/structureID/291848)(subdeltoid)[](https://www.anatomy.tv/anatomytv/html5ui_2018/#/product/har_shoulder_2014/type/Views/id/43081/layer/10/angle/10/structureID/291848)bursa and subscapular bursa
98
where is the subacromial bursa located?
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
99
Which bursa communicates with the joint cavity?
Subscapular bursa
100
What is the role of subacromial bursa?
Sevres as a gliding mechanism between the rotator cuff and coracoacromial arch. Reduce friction in the space under the acromion
101
What common sporting injury damages the subacromial bursa?
Subacromial bursitis, torn rotator cuff
102
what muscle is shown, what is its proximal and sital attachment and what movement does it cause at the shoulder joint?
subscapularis
Medial 2/3 of costal aspect of scapula
Lesser tuberosity, shoulder joint capsule, and the front of the upper shaft of the humerus
Adductor and medial rotator of the humerus
103
what muscle is shown, what is its proximal and sital attachment and what movement does it cause at the shoulder joint?
supraspinatus
Supraspinous fossa of the scapula and from fascia overlying the muscle
Greater tuberosity of humerus
abduction
104
what muscle is shown, what is its proximal and sital attachment and what movement does it cause at the shoulder joint?
infraspinatus
Infraspinous fossa of scapula
Middle facet of the greater tuberosity of the humerus
Lateral rotator of the humerus
105
what muscle is shown, what is its proximal and sital attachment and what movement does it cause at the shoulder joint?
teres minor
Upper two thirds of the lateral border of the scapula
Lesser tuberosity of humerus
Adductor and lateral rotator of the humerus
106
Although the rotator cuff muscles have a role in movement at the glenohumeral joint, what is their primary function?
Stabilise the glenohumeral joint by compressing the humeral head against the glenoid
107
Clinical:
Rotator cuff injuries are an important (and a potentially career-ending) cause of sport injury. These are caused by what?
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.
108
The deltoid[](https://www.anatomy.tv/anatomytv/html5ui_2018/#/product/har_shoulder_2014/type/Text%20articles/id/43080/layer/19/angle/21/structureID/292896)muscle has a long origin spanning ___ bones
two
109
what is the origin and insertion of the dletoid muscle?
It arises from the lateral spine of the scapula, passing across the acromion to the lateral third of the clavicle. Its distal attachment is to the deltoid tuberosity of the humerus
Due to its extensive proximal origin, different parts of the muscle will move the humerus in different directions.
110
what is the function of the deltoid
Anterior fibres of deltoid flex and internally rotates at the shoulder joint
Middle fibres abductor the arm at the shoulder joint
Posterior fibres extend and laterally rotates at the shoulder joint
111
What is the nerve supply to deltoid?
Axillary nerve
112
In what common injury is this nerve often trapped and therefore damaged? (axillary nerve)
Shoulder dislocation (also occurs in fracture of the surgical neck of the humerus as wraps around here)
113
As this is a mixed nerve, where would you test for loss of sensation to determine if a nerve injury had occurred? (axillary nerve)
C5 and 6, lateral arm, forearm, thumb and index finger
Abducted against resistance at approx. 15 degrees - motor
114
what is the proximal and distal attachement of the pectoralis major?
The pectoralis major muscle has an extensive origin from the medial third of the clavicle, sternum and costal cartilage of the first 6 ribs and rectus sheath!
The distal attachment of this muscle is to the lateral lip of the bicipital groove of the humerus
115
what is the action of the pectoralis major?
Its action on the shoulder joint is to adductor the shoulder and internal/medial rotate the humerus at the glenohumeral joint
Pectoralis[](https://www.anatomy.tv/anatomytv/html5ui_2018/#/product/har_shoulder_2014/type/Views/id/43079/layer/3/angle/32/structureID/292884)minor lies deep to the pectoralis major muscle and is important anatomically as it splits the axillary artery into 3 parts. Along with serratus[](https://www.anatomy.tv/anatomytv/html5ui_2018/#/product/har_shoulder_2014/type/Views/id/43079/layer/3/angle/32/structureID/292908)anterior it serves to stabilise the scapula during limb movements by keeping it pulled against the thoracic cage
The latter has an important role in protraction of the scapula
116
**Clinical Case – A Post-Operative Problem…**
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 is vulnerable in breast surgery**
**Supplies the serratus anterior**
117
1
Trapezius
118
2
Latissimus dorsi
119
3
Teres major
120
4
Deltoid
121
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
Superior fibres of trapezius ______ the scapula
Middle fibres of trapezius ______ the scapula (move it back on the thorax)
Inferior fibres of trapezius ________ the scapula
elevate
retracts
depress
122
Trapezius has an unusual innervation from a cranial nerve – which one?
Which foramen of the skull does this nerve pass through?
Accessory nerve
Jugular foramen
123
**Clinical**:
‘Shrugging’ or elevation of the ________ is therefore one of the tests for cranial nerve function
shoulders
124
shoulder joint movement = Flexion of shoulder (sagittal plane)
what are the shoulder joint muscles causing this?
1. anterior fibres of the deltoid
2. pectoralis major
3. coracobrachialis
4. long head of the biceps brachii
125
shoulder joint movement = Extension of shoulder (sagittal plane)
what are the shoulder joint muscles causing this?
1. latissimus dorsi
2. teres major
3. pectoralis major ?????
4. posterior fibres of deltoid
5. Long head of triceps brachii
126
shoulder joint movement = Adduction of shoulder joint
what are the shoulder joint muscles causing this?
1. coracobrachialis
2. pectoralis major
3. latissimus dorsi
4. teres major
5. subscapularis
127
shoulder joint movement = Abduction of shoulder joint
what are the shoulder joint muscles causing this?
0 to 90 degrees:
1. supraspinatus
2. middle fibres of the deltoid
90 to 180 degrees:
1. serratus anterior
2. trapezius
128
shoulder joint movement = Medial or internal rotation
what are the shoulder joint muscles causing this?
1. Subscapularis
2. Latissimus dorsi
3. Pectoralis major
4. Teres major
5. anterior fibres of the deltoid
129
shoulder joint movement = Lateral or external rotation
what are the shoulder joint muscles causing this?
1. posterior fibres of the deltoid
2. teres minor
3. infraspinatus
