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Year Two - Anatomy > MSK System - Upper Limb > Flashcards

MSK System - Upper Limb Flashcards

1
Q

Where does the upper limb extend from?

A

The shoulder girdle to the hand

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2
Q

What is the axilla?

A

A pyramidal space below the shoulder joint

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3
Q

What is the function of the axilla?

A

It provides a passageway for vessels and nerves going to and from the upper limb

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4
Q

What are the six boundaries of the axilla?

A

Apex

Anterior wall

Medial wall

Lateral wall

Posterior wall

Base

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5
Q

What two muscles form the anterior wall of the axilla?

A

Pectoralis major muscle

Pectoralis minor muscle

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6
Q

What three muscles form the posterior wall of the axilla?

A

Subscapularis muscle

Teres major muscle

Latissimus dorsi muscle

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7
Q

What two structures form the medial wall of the axilla?

A

Thoracic wall

Serratus anterior muscle

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8
Q

What structures form the lateral wall of the axilla?

A

Intertubercular sulcus of the humerus

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9
Q

Name the four contents of the axilla

A

Axillary Artery

Axillary Vein

Axillary Lymph Nodes

Brachial Plexus

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10
Q

What is the axillary artery a continuation of?

A

Subclavian artery

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11
Q

At what anatomical point does the axillary artery begin?

A

The lateral border of the 1st rib

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12
Q

Which muscle divides the axillary artery into three divisions?

A

Pectoralis minor muscle

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13
Q

Which vessel does the axillary artery continue as?

A

Brachial artery

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14
Q

At what anatomical point does the brachial artery begin?

A

The inferior border of the teres major

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15
Q

What are the two main causes for enlargement of the axillary lymph nodes?

A

Infection in the upper limb

Malignant processes involving breast tissue

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16
Q

Which artery should be compressed when individuals experience profuse bleeding of the upper limb?

A

Axillary artery

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17
Q

What nerve plexus is found in the upper limb?

A

Brachial plexus

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18
Q

Where does the brachial plexus begin? Where does it extend into?

A

Cervical region

Axilla

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19
Q

What ventral rami form the brachial plexus?

A

C5 to T1

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20
Q

What are the five components of the brachial plexus?

A

Roots

Trunks

Divisons

Cords

Terminal branches

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21
Q

How many roots make up the brachial plexus?

A

Five

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22
Q

What forms the roots of the brachial plexus?

A

Ventral rami of the C5-T1 nerves

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23
Q

How many trunks make up the brachial plexus?

A

Three - superior, middle, inferior

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24
Q

What forms the superior trunk of the brachial plexus?

A

The union of the C5 and C6 roots

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25
Q

What forms the middle trunk of the brachial plexus?

A

The continuation of the C7 root

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26
Q

What forms the inferior trunk of the brachial plexus?

A

The union of the C8 and T1 roots

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27
Q

What vessels are the trunks of the brachial plexus closely related to?

A

Axillary artery

Axillary vein

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28
Q

What does each trunk of the brachial plexus divide into?

A

Anterior division

Posterior division

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29
Q

What do the anterior divisions of the brachial plexus supply?

A

Anterior (flexor) compartment of the upper limb

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30
Q

What do the posterior divisions of the brachial plexus supply?

A

Posterior (extensor) compartment of the upper limb

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31
Q

How many divisions of the brachial plexus are there?

A

Six

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32
Q

How many cords of the brachial plexus are there?

A

Three - lateral, medial, posterior

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33
Q

What forms the lateral cord of the brachial plexus?

A

The anterior divisions of the superior and middle trunks

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34
Q

What forms the medial cord of the brachial plexus?

A

The anterior division of the inferior trunk

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35
Q

What forms the posterior cord of the brachial plexus?

A

The posterior divisions of all three trunks

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36
Q

How are the cords of the brachial plexus named?

A

They are named based on their relation to the axillary artery

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37
Q

How many terminal branches of the brachial plexus are there?

A

Five

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38
Q

What are the five terminal branches of the brachial plexus?

A

Musculocutaneous nerve

Axillary nerve

Median nerve

Radial nerve

Ulnar nerve

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39
Q

What cord forms the musculocutaneous nerve? What are the roots of this nerve?

A

Lateral

C5-C7

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40
Q

What cord forms the axillary nerve? What are the roots of this nerve?

A

Posterior

C5-C6

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41
Q

What cord forms the median nerve? What are the roots of this nerve?

A

Lateral and medial

C5-T1

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42
Q

What cord forms the radial nerve? What are the roots of this nerve?

A

Posterior

C5-T1

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43
Q

What cord forms the ulnar nerve? What are the roots of this nerve?

A

Medial

C8-T1

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44
Q

What three terminal nerve branches form the M shape?

A

Musculocutaneous nerve

Median nerve

Ulnar nerve

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45
Q

What is the clinical presentation of Erb’s palsy?

A

Waiter’s tip appearance - medial rotation of the arm with wrist flexion

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46
Q

What causes Erb’s palsy?

A

An injury to the upper trunk of the brachial plexus, specifically a hyperextension injury of the head from the shoulder

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47
Q

What group of muscles are affected by Erb’s palsy? What nerve roots supply this group of muscles?

A

Anterior (flexor) compartment

C5-C6

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48
Q

Where is Erb’s point located?

A

Superior trunk, where the C6 and C7 roots combine together

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49
Q

What is the clinical presentation of Klumpke’s palsy?

A

A condition which results in the intrinsic muscles of the hand are damaged, resulting in a claw hand

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50
Q

What causes Klumpke’s palsy?

A

An injury to the lower trunk of the brachial plexus, specifically shoulder dystocia at birth or other arm abduction injuries

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51
Q

In addition to the musculocutaneous nerve, what other two nerve branches arise from the lateral cord?

A

Lateral pectoral nerve

Lateral root of median nerve

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52
Q

In addition to the ulnar nerve, what other four nerve branches arise from the medial cord?

A

Medial pectoral nerve

Medial cutaneous nerve of the arm

Medial cutaneous nerve of the forearm

Medial division of median nerve

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53
Q

In addition to the axillary and radial nerve, what other two nerve branches arise from the posterior cord?

A

Thoracodorsal nerve

Subscapular nerve

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54
Q

What is the dorsal venous arch?

A

A complex network of veins lying at the distal aspect of the upper limb

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55
Q

What two veins arise from the dorsal venous arch?

A

Cephalic vein

Basilic vein

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56
Q

What vein arises from the lateral aspect of the dorsal venous arch?

A

Cephalic vein

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57
Q

What vein arises from the medial aspect of the dorsal venous arch?

A

Basilic vein

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58
Q

What is the median cubital vein?

A

A large communicating vein which shunts blood from the cephalic vein to the basilic vein

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59
Q

Where is the median cubital vein located?

A

Antecubital fossa

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60
Q

Where is the most common site of venepuncture?

A

Median cubital vein

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61
Q

Where is the cephalic vein located?

A

On the lateral aspect of the arm (thumb)

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62
Q

What does the cephalic vein pierce into?

A

Clavipectoral fascia

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63
Q

Which facial layer is divided during surgical approach to the axilla?

A

Clavicopectoral fascia

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64
Q

What vein does the cephalic vein drain into? What groove does this vein enter before draining into this vein?

A

Axillary vein

Deltopectoral groove

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65
Q

Where is the basilic vein located?

A

On the medial aspect of the arm (pinkie)

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66
Q

What vein does the basilic vein eventually become? Where does this transition occur?

A

Axillary vein

Inferior border of the teres major

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67
Q

List the order of neurovascular structures before they enter the axilla - superior to inferior

A

Brachial plexus

Subclavian artery

Subclavian vein

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68
Q

Where does the subclavian artery originate from on the right hand side of the body?

A

Brachiocephalic trunk

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69
Q

Where does the subclavian artery originate from on the left hand side of the body?

A

Aorta

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70
Q

Which two muscles are the subclavian artery and brachial plexus located between?

A

Scalenus anterior

Scalenus medius

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71
Q

Where does the subclavian vein lie in relation to the scalenus anterior?

A

Medial

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72
Q

What rib do the brachial plexus, subclavian artery and subclavian vein lie on?

A

First rib

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73
Q

What three muscles do the musculocutaneous nerve supply?

A

Brachialis muscle

Biceps muscle

Coracobrachialis muscle

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74
Q

What is a dermatome?

A

The area of skin supplied by one spinal segment

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75
Q

What is the anterior dermatome area of C3?

A

Shoulder

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76
Q

What is the anterior dermatome area of C4?

A

Shoulder

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77
Q

What is the anterior dermatome area of C5?

A

The middle (lateral) aspect of the arm and forearm

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78
Q

What is the anterior dermatome area of C6?

A

The lateral aspect of the arm and forearm

The first digit (thumb) of the hand

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79
Q

What is the anterior dermatome area of C7?

A

The second digit of the hand

The third digit of the hand

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80
Q

What is the anterior dermatome area of C8?

A

The medial aspect of the arm and forearm

The fourth digit of the hand

The fifth digit (pinkie) of the hand

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81
Q

What is the anterior dermatome area of T1?

A

The middle (medial) aspect of the arm and forearm

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82
Q

What is the posterior dermatome area of C4?

A

Shoulder

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83
Q

What is the posterior dermatome area of C5?

A

Shoulder

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84
Q

What is the posterior dermatome area of C6?

A

The lateral aspect of the arm and forearm

The first digit (thumb) of the hand

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85
Q

What is the posterior dermatome area of C7?

A

The middle aspect of the arm and forearm

The second digit of the hand

The third digit of the hand

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86
Q

What is the posterior dermatome area of C8?

A

The medial aspect of the arm and forearm

The fourth digit of the hand

The fifth digit (pinkie) of the hand

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87
Q

What occurs when there is injury to a spinal root?

A

There will be sensory loss (paraesthesia) corresponding to that specific dermatome

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88
Q

What occurs when there is injury to a terminal branch?

A

There will be sensory loss corresponding to the area of distribution that nerve

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89
Q

What lymph nodes do the upper limb drain into?

A

Axillary lymph nodes

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90
Q

What are the five groups of the axillary lymph nodes?

A

Apical axillary lymph nodes

Central axillary lymph nodes

Brachial (lateral) axillary lymph nodes

Pectoral (anterior) axillary lymph nodes

Subscapular (posterior) axillary lymph nodes

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91
Q

Where do lymphatics from the right upper quadrant of the body drain into the venous system?

A

The angle between the right internal jugular and right subclavian vein

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92
Q

What is the function of the pectoral (shoulder) girdle?

A

It connects the upper limb to the axial skeleton on each side

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93
Q

What two bones make up the pectoral girdle?

A

Scapula

Clavicle

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94
Q

What two joints make up the pectoral girdle?

A

Acromioclavicular joint

Sternoclavicular joint

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95
Q

At what joint does the entire limb articulate with the pectoral girdle?

A

Sternoclavicular joint

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96
Q

What is the acromioclavicular joint?

A

Where the clavicle articulates with the scapula

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97
Q

What is the sternoclavicular joint?

A

Where the sternum articulates with the clavicle

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98
Q

What are the two ends of the clavicle?

A

Acromial end

Sternal end

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99
Q

What are the two convexities of the clavicle?

A

Lateral convexity

Medial convexity

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100
Q

At what end of the clavicle of the lateral convexity?

A

Acromial end

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101
Q

At what end of the clavicle of the medial convexity?

A

Sternal end

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102
Q

What aspect of the clavicle is flatter - lateral or medial?

A

Lateral aspect

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103
Q

What surface of the clavicle is smoother - superior or inferior?

A

Superior surface

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104
Q

What is the conoid tubercle?

A

The attachment for the conoid ligament on the inferior, lateral aspect of the clavicle

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105
Q

Which part of the clavicle is weakest and commonly fractures during a fall?

A

The junction between the medial and lateral convexity

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106
Q

What vessel is likely to be damaged in a fracture within the medial third of the clavicle?

A

Subclavian vein

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107
Q

What type of joint is the acromioclavicular joint?

A

Synovial plane joint

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108
Q

What type of joint is the steronoclavicular joint?

A

Synovial saddle joint

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109
Q

What are the two stages of arm abduction, also known as the scapulo-thoracic movement?

A

The first 30 degrees of abduction is caused by muscles acting at the shoulder joint (glenohuemral joint)

Beyond 30 degrees, abduction relies on the scapula being elevated and lateral rotating on the chest wall (scapula-thoracic movements)

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110
Q

What is the arm abduction ratio?

A

2:1

For every 3 degrees of abduction (past the initial 30 degrees), 2 degrees occurs at the glenohumeral joint and 1 degree occurs due to scapula-thoracic movement

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111
Q

What is the scapulothoracic joint?

A

It is the movement of the scapula on the thoracic wall

It is not a true anatomical joint, meaning that movement occurs around a joint (axis), but no joint surfaces or joint structures are present

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112
Q

What are the nine muscles attached to the scapula posteriorly?

A

Trapezius

Levator scapulae

Rhomboid minor

Rhomboid major

Supraspinatus

Infraspinatus

Teres major

Teres minor

Latissimus dorsi

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113
Q

What are the three fibres that make up the trapezius?

A

Superior (Descending)

Middle

Inferior (Ascending)

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114
Q

What two muscles are involved in scapular elevation?

A

Trapezius (Superior)

Levator Scapulae

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115
Q

What muscle is involved in scapular depression?

A

Trapezius (Inferior)

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116
Q

What muscle is involved in scapular protraction? What is scapular protraction?

A

Serratus Anterior

Scapula pushing up against the thoracic wall

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117
Q

What nerve innervates the serratus anterior?

A

Long thoracic nerve

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118
Q

What is the clinical sign that presents when the long thoracic nerve has been damaged?

A

Winged scapula

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119
Q

What movement are patients unable to conduct when they have a winged scapula?

A

Arm abduction

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120
Q

What three muscles are involved in scapular retraction? What is scapular retraction?

A

Trapezius (Middle)

Rhomboid Major

Rhomboid Minor

Scapula moving away from the thoracic wall

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121
Q

What three muscles are involved in scapular medial (downward) rotation?

A

Levator Scapulae

Rhomboid Major

Rhomboid Minor

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122
Q

What muscle is involved in scapular lateral (upward) rotation?

A

Trapezius (Superior, Inferior)

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123
Q

What are the attachments of the levator scapulae?

A

The spine of the scapula

The transverse processes of C1-C4

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124
Q

What are the attachments of the rhomboid minor?

A

The spine of the scapula

The spinous processes of C7 and T1 vertebrae

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125
Q

What are the attachments of the rhomboid major?

A

The medial border of the scapula

The spinous processes of T5-T8 vertebrae

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126
Q

What are the attachments of the infraspinatus?

A

The infraspinous fossa of the scapula

The greater tubercle of the humerus

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127
Q

What are the attachments of the supraspinatus?

A

The supraspinous fossa of the scapula

The greater tubercle of the humerus

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128
Q

What are the attachments of the teres minor?

A

The lateral border of the scapula

The lesser tubercle of the humerus

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129
Q

What nerve supplies the teres minor? What one other muscle does this nerve supply?

A

Axillary nerve

Deltoid

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130
Q

What are the attachments of the teres major?

A

The lateral border of the scapula

The medial lip of the humerus

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131
Q

What nerve supplies the teres major?

A

Lower subscapular nerve

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132
Q

What are the attachments of the latissimus dorsi?

A

The spinous processes of T6-T12

The intertubercle sulcus of the humerus

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133
Q

What type of joint is the glenohumeral (shoulder) joint?

A

Synovial ball and socket joint

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134
Q

Describe the articulation of the shoulder joint

A

Ball - The head of the humerus

Socket - The glenoid cavity of the scapula

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135
Q

What is the rim of cartilage that surround the socket of the shoulder joint? What is its function?

A

Glenoid labrum

To stabilise the joint

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136
Q

What is the function of the ligaments of the shoulder joint?

A

They strengthen and ease movements at the joint

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137
Q

What are the four ligaments of the shoulder joint?

A

Coracoacromial ligament

Coracohumeral ligament

Glenohumeral ligaments

Transverse humeral ligament

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138
Q

Where does the coracoacromial ligament extend?

A

Between the coracoid process and acromion

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139
Q

Where does the coracohumeral ligament extend?

A

Between the coracoid process and greater tubercle of the humerus

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140
Q

Where does the glenohumeral ligament extend?

A

Between the glenoid cavity of the scapula and greater tubercle of the humerus

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141
Q

Where does the transverse humeral ligament extend?

A

Between the greater and lesser tubercle of the humerus

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142
Q

What is the function of the glenohumeral ligaments?

A

To strengthen the inferior aspect of the shoulder joint capsule

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143
Q

What is the function of the coracohumeral ligament?

A

To strengthen the superior aspect of the shoulder joint capsule

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144
Q

What is the coraco-acromial arch?

A

The acromion, coracoid process and coraco-acomial ligament

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145
Q

What is the function of the coraco-acromial arch?

A

To prevent superior displacement of the humeral head

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146
Q

Which part of the shoulder joint is weakest? Why?

A

The inferior anterior region

It is not protected by muscles or ligaments

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147
Q

What are the two functions of bursae?

A

To provide cushioning around joints via their synovial fluid filled interior

Shock absorbers

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148
Q

What are the two main bursa of the shoulder joint?

A

Subacromial (subdeltoid) bursa

Subscapular bursa

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149
Q

Where is the subacromial bursa located?

A

It sits between the infraspinatus, supraspinatus and deltoid muscles, extending superiorly to lie below the acromion and coracoacomial ligaments

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150
Q

Which bursa communicates with the shoulder joint cavity?

A

Subscapular bursa

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151
Q

What is the function of the subacromial bursa?

A

It protects the supraspinatus muscle from wear

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152
Q

What common sporting injury damages the subacromial bursa?

A

Overhead athletes - swimming, weightlifting, tennis

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153
Q

What are the four rotator cuff muscles?

A

Subscapularis

Supraspinatus

Infraspinatus

Teres minor

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154
Q

What is the only anterior rotator cuff muscle?

A

Subscapularis

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155
Q

What rotator cuff muscle tendon is most likely to rupture?

A

Supraspinatus

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156
Q

What are the attachments of the subscapularis muscle?

A

The medial border of scapula

The lesser tuberosity of the humerus

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157
Q

What is the function of the rotator cuff muscles?

A

To prevent sliding of the humerus head during arm movements

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158
Q

What is the cause of rotator cuff injuries?

A

Repetitive overhead motions

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159
Q

What are the four shoulder joint muscles?

A

Deltoid

Pectoralis major

Pectoralis minor

Serratus anterior

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160
Q

What are the attachments of the deltoid muscle?

A

The spine of the scapula

The acromion

The clavicle

The deltoid tuberosity of the humerus

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161
Q

What are the three fibres of the deltoid muscle?

A

Anterior fibres

Middle fibres

Posterior fibres

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162
Q

What nerve supplies the deltoid?

A

Axillary nerve

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163
Q

What injury tends to affect the axillary nerve?

A

Shoulder dislocation

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164
Q

How to we test for axillary nerve damage?

A

We test for a loss of sensation over the badge area of the shoulder

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165
Q

What are the attachments of the pectoralis major?

A

The clavicle

The sternum

The costal cartilage of the first six ribs

The lateral lip of the humerus

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166
Q

What is most anterior - pectoralis major or minor?

A

Pectoralis major

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167
Q

Why is the pectoralis minor muscle anatomically important?

A

It divides the axillary artery into three parts

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168
Q

What are the attachments of the pectoralis minor?

A

The 3rd to 5th ribs

The coracoid process of the scapula

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169
Q

What are the attachments of the serratus anterior?

A

The 1st to 8th ribs

The medial border of the scapula

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170
Q

What are the attachments of the trapezius?

A

The spinous processes of C7-T12 vertebrae

The clavicle

The acromion

The spine of the scapula

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171
Q

What are the three fibres of the trapezius?

A

Superior fibres

Middle fibres

Inferior fibres

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172
Q

Which nerve innervates the trapezius?

A

CN XI (accessory)

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173
Q

An injury to the CN XI will affect which movement of the scapula?

A

Upward rotation

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174
Q

What foramen of the skull does CN XI pass through?

A

Jugular foramen

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175
Q

How do we test CN XI function?

A

We ask patients to shrug their shoulders

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176
Q

What three muscles are involved in shoulder flexion?

A

Deltoid (Anterior)

Pectoralis Major

Coracobrachialis

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177
Q

What three muscles are involved in shoulder extension?

A

Deltoid (Posterior)

Latissimus Dorsi

Coracobrachialis

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178
Q

What four muscles are involved in shoulder adduction?

A

Subscapularis

Teres Major

Pectoralis Major

Triceps

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179
Q

What two muscles are involved in shoulder abduction?

A

Deltoid (Middle) - after 15 degrees

Supraspinatus - first 15 degrees

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180
Q

Which muscle initiates abduction of the shoulder?

A

Supraspinatus

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181
Q

What four muscles are involved in shoulder internal rotation?

A

Subscapularis

Teres Major

Pectoralis Major

Latissimus Dorsi

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182
Q

What two muscles are involved in shoulder external rotation?

A

Infraspinatus

Teres Minor

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183
Q

What is the deltopectoral triangle?

A

The triangular space below the clavicle, between deltoid and pectoralis major muscle

184
Q

What vein travels in the deltopectoral triangle/groove?

A

Cephalic vein

185
Q

Which four structures form the quadrangular space in the shoulder?

A

Triceps brachii (long head)

Teres minor

Teres major

Humerus

186
Q

Which structure passes through the quadrangular space near the humeral head?

A

Axillary nerve

187
Q

What are the two tubercles of the humerus? Where are the located?

A

Greater tubercle

Lesser tubercle

Humeral neck

188
Q

Where is the intertubercular groove of the humerus located?

A

Between the greater and lesser tubercle

189
Q

Where is the olecranon fossa of the humerus located?

A

On the posterior, distal aspect of the humerus

190
Q

Which two fossa are located on the anterior aspect of the humerus?

A

Coronoid fossa

Radial fossa

191
Q

Where is the coronoid fossa of the humerus located?

A

On the medial, distal aspect of the humerus - above the trochlea

192
Q

Where is the radial fossa of the humerus located?

A

On the lateral, distal aspect of the humerus - above the capitulum

193
Q

Where is the trochlea of the humerus located?

A

On the medial, distal aspect of the humerus - below the coronoid fossa

194
Q

Where is the capitulum of the humerus located?

A

On the lateral, distal aspect of the humerus - below the radial fossa

195
Q

How do we remember how the teres major, latissimus dorsi and pectoralis major insert into the intertubercular groove?

A

Lady Between Two Majors

Lady - Latissimus Dorsi

Majors - Pectoralis (Lateral), Teres (Medial)

196
Q

What are the three muscles contained within the anterior compartment of the arm?

A

Biceps brachii

Brachialis

Corachobrachialis

197
Q

What nerve supplies the muscles in the anterior compartment of the arm?

A

Musculocutaenous nerve

198
Q

What three joints do the muscles in the anterior compartment of the arm act on?

A

Elbow joint

Shoulder

Radio-ulnar joints

199
Q

What is the most superficial muscle in the anterior compartment of the arm?

A

Biceps brachii

200
Q

Where do the heads of the biceps brachii unite? What do they form?

A

At the distal third of the upper arm

A short tendon that inserts onto the radial tuberosity of the radius

201
Q

Where does the short head of the biceps originate?

A

The coracoid process of the scapula

202
Q

Where does the long head of the biceps originate?

A

The supraglenoid tubercle of the scapula

203
Q

Where does the long head biceps tendon run?

A

Bicipital groove (intertubercular sulcus) of the humerus

204
Q

Which ruptured tendon produces a condition called Popeye deformity?

A

Long head of the biceps brachii

205
Q

What is the function of the biceps brachii at the shoulder joint?

A

Flexion

206
Q

What is the function of the biceps brachii at the elbow joint?

A

Flexion

207
Q

What is the function of the biceps brachii at the superior radio-ulnar joint?

A

Supination - radius rotates over the ulna

208
Q

What are the attachments of the corachobrachialis?

A

The coracoid process of the scapula

The mid-shaft of the humerus

209
Q

What are the attachments of the brachialis?

A

The distal shaft of the humerus

The coronoid process of the ulna

210
Q

What is the most deep muscle in the anterior compartment of the arm?

A

Brachialis

211
Q

What is the main function of the brachialis?

A

Flexion of the elbow joint

212
Q

How does the musculocutaneous nerve enter the arm?

A

It perforates the coracobrachialis, descending distally between the biceps brachii and brachialis muscles

213
Q

Does the musculocutaneous nerve supply any muscles in the forearm or hand?

A

No

214
Q

What aspect of the forearm does the musculocutaneous nerve supply cutaneous innervation to?

A

Lateral

215
Q

What are the four arteries located within the arm?

A

Axillary artery

Brachial artery

Profunda brachii artery

Posterior and anterior circumflex humeral arteries

216
Q

What are the five nerves located within the arm?

A

Axillary nerve

Median nerve (M shape)

Musculocutaneous nerve (M shape)

Radial nerve

Ulnar nerve (M shape)

217
Q

What is the brachial artery a direct continuation of?

A

Axillary artery

218
Q

Where does the brachial artery begin and end?

A

The lower border of the teres major

The cubital fossa

219
Q

What two arteries do the brachial artery divide into at the cubital fossa, near the neck of the radius?

A

Radial artery

Ulnar artery

220
Q

What condition arises when the brachial artery is completely occluded or lacerated?

A

Volkmann ischaemic contracture

221
Q

What are the three clinical features of Volkmann’s ischaemic contracture?

A

A permanent shortening of forearm muscles

A loss of hand power

A loss of finger flexion

222
Q

Which arteries branches off the axillary artery?

A

Circumflex humeral arteries

223
Q

What artery branches off the brachial artery?

A

Profunda brachii

224
Q

Which artery is used to measure blood pressure?

A

Brachial artery

225
Q

Describe the course of the median nerve in the arm

A

It descends on the lateral side of the axillary artery and the upper part of the brachial artery

In the middle part of the arm, the nerve crosses to the medial aspect of the brachial artery and enters the cubital fossa

226
Q

Does the median nerve give off any branches in the axilla or arm?

A

No

227
Q

Describe the course of the ulnar nerve in the arm

A

It descends along the medial side of the brachial artery and then it enters the flexor compartment of the arm

It runs along the medial head of the triceps, where it lies behind the medial epicondyle at the elbow

228
Q

How does the ulnar nerve enter the flexor compartment of the arm?

A

Medial intermuscular septum

229
Q

Does the ulnar nerve supply any muscles in the arm?

A

No

230
Q

Does the median nerve supply any muscles in the arm?

A

No

231
Q

Which nerve is responsible for the ‘funny feeling’ depicted by the humerus?

A

Ulnar nerve

232
Q

Name the muscle located in the posterior compartment of the arm

A

Triceps brachii

233
Q

What are the three heads of the triceps brachii?

A

Lateral head

Long head

Medial head

234
Q

Where does the long head of the triceps brachii originate from?

A

The infraglenoid tubercle of the scapula

235
Q

Where does the lateral and medial head of the triceps brachii originate from?

A

Humerus

236
Q

Where does the triceps brachii tendon insert?

A

The olecranon process of the ulna

237
Q

What is the action of the triceps?

A

Extension of the elbow joint

238
Q

Which head of the triceps acts as both an extensor of the shoulder and elbow joint?

A

Long head of the triceps brachii

239
Q

What is the anconeus muscle?

A

A small muscle at the elbow

240
Q

What is the function of the anconeus muscle?

A

To aid extension of the elbow joint

241
Q

What nerve supplies the posterior compartment of the arm?

A

Radial nerve

242
Q

How does the radial nerve enter the arm?

A

It enters the arm anterior to the medial head of the triceps

243
Q

What artery does the radial nerve follow?

A

It runs with the profunda brachii artery

244
Q

Describe the course of the radial nerve

A

It descends down the humerus in the radial groove, lying between the brachioradialis and FCR

245
Q

What is the clinical sign of radial nerve injury?

A

Wrist drop

246
Q

Which humeral fracture tends to damage the radial nerve?

A

Fracture to radial (spiral) groove, which is located in the mid-shaft of the humerus

247
Q

Which humeral fracture tends to damage the ulnar nerve?

A

Fracture to the medial epicondyle

248
Q

Which humeral fracture tends to damage the axillary nerve?

A

Fracture to the surgical neck

249
Q

What is the cubital fossa?

A

A triangular depression in front of the elbow

250
Q

What is the function of the cubital fossa?

A

A conduit for passage of major neurovascular structures from the arm down to the forearm

251
Q

What forms the base of the cubital fossa?

A

An imaginary line that runs from the medial epicondyle of the humerus to the lateral epicondyle of the humerus

252
Q

What muscle forms the medial border of the cubital fossa?

A

Pronator teres

253
Q

What muscle forms the lateral border of the cubital fossa?

A

Brachioradialis

254
Q

List the four contents of the cubital fossa from lateral to medial

A

‘Really Need Beer To Be At My Nicest’

Radial Nerve
Brachial Tendon
Brachial Artery
Median Nerve

255
Q

Which structure separates the cephalic vein and the brachial artery in the antecubital fossa?

A

Biceps brachii

256
Q

What vein lies anterior to the roof of the antecubital fossa?

A

Basilic vein

257
Q

Which muscle separates the ulnar artery from the median nerve?

A

Pronator teres

258
Q

What type of joint is the elbow joint?

A

Synovial hinge

259
Q

Describe the articulation of the elbow joint

A

The trochlea of the humerus articulates with the trochlear notch of the ulnar

The capitulum of the humerus articulates with the radial head

260
Q

What two ligaments hold the elbow joint in place?

A

Radial collateral ligament

Ulnar collateral ligament

261
Q

What is the function of the radial collateral ligament?

A

It holds the radius in place

262
Q

What is the function of the ulnar collateral ligament?

A

It holds the ulnar in place

263
Q

What three muscles cause flexion of the elbow joint?

A

Biceps brachii

Brachioradialis

Brachialis

264
Q

What muscle is the main flexor of the elbow joint?

A

Brachialis

265
Q

What two muscles cause extension of the elbow joint?

A

Triceps

Anconeus

266
Q

What is student’s elbow?

A

A condition in which the subcutaneous olecranon bursa is damaged through excessive pressure and friction. This inflammation is called olecranon bursitis

267
Q

What is tennis elbow?

A

A condition in which there is inflammation of the muscle tendons attached to the lateral epicondyle of the humerus. This is caused by repetitive overuse of the forearm muscles

268
Q

What is golfer’s elbow?

A

A condition in which there is inflammation of the muscle tendons attached to the medial epicondyle of the humerus. This is caused by repetitive overuse of the forearm muscles

269
Q

What two joints connect the radius and ulnar bones?

A

Proximal radio-ulnar joint

Distal radio-ulnar joint

270
Q

What type of joint are the radio-ulnar joints?

A

Synovial pivot

271
Q

What ligament keeps the head of the radius in place, supporting the proximal radio-ulnar joint?

A

Annular radial ligament

272
Q

What is the function of the proximal radio-ulnar joints?

A

Supination

Pronation

273
Q

What two muscles are involved in supination?

A

Supinator

Biceps brachii

274
Q

What two muscles are involved in pronation?

A

Pronator quadratus

Pronator teres

275
Q

What happens to the radial and ulnar bones during supination?

A

The radius rotates over the ulna

276
Q

What is the clinical feature of ulnar nerve damage?

A

Claw hand

277
Q

Which lymph nodes recieve lymph from an infection of the little finger?

A

Humeral

278
Q

What compartment of the forearm flex the wrist and digits?

A

Anterior

279
Q

What compartment of the forearm pronate the forearm?

A

Anterior

280
Q

How is the anterior compartment of the forearm arranged?

A

Into three groups; superficial, intermediate and deep

281
Q

What are the four muscles in the superficial, anterior compartment of the forearm?

A

Pronator teres

Flexor carpi radialis (FCR)

Palmaris longus

Flexor carpi ulnas (FCU)

282
Q

Do the superficial, anterior compartment muscles lie on the medial or lateral aspect of the forearm?

A

Medial

283
Q

Where do the superficial, anterior compartment forearm muscles originate from?

A

Medial epicondyle of the humerus

284
Q

What muscle lies on the superficial, lateral aspect of the forearm?

A

Brachioradialis

285
Q

What is the most superficial muscle of the forearm?

A

Palmaris longus

286
Q

What are the two actions of the pronator teres?

A

Pronation of forearm

Flexion at elbow

287
Q

In addition to flexion of the wrist, what is the action of the FCU?

A

Adduction of the wrist joint

288
Q

What is adduction of the wrist - ulnar or radial deviation?

A

Ulnar deviation

289
Q

In addition to flexion of the wrist, what is the action of the FCR?

A

Abduction of the wrist joint

290
Q

What is abduction of the wrist - ulnar or radial deviation?

A

Radial deviation

291
Q

What two nerves supply the anterior compartment of the forearm? What muscles do they supply?

A

Median - Pronator teres, FCR, palmaris longus

Ulnar - FCU

292
Q

What is the muscle in the intermediate, anterior compartment of the forearm?

A

Flexor digitorum superficialis (FDS)

293
Q

Which superficial muscles does the FDS lie under?

A

Palmaris longus

FCR

294
Q

What happens to the FDS as it passes distally down the arm into the hand?

A

It gives rise to four tendons which attach to the medial four digits (2nd to 5th)

295
Q

On which phalanx does the FDS tendon insert?

A

Middle

296
Q

What is the action of FDS?

A

It flexes the wrist, MCP and IP joints

297
Q

What nerve innervates the FDS?

A

Median nerve

298
Q

What is the main action of the brachioradialis?

A

Flexion of arm when the forearm is in the mid-pronated position

299
Q

What joint does the brachioradialis act on?

A

Elbow joint

300
Q

What nerve innervates the brachioradialis?

A

Radial nerve

301
Q

What muscle is the exception to the rule that all flexors lie in the anterior compartment and that the radial nerve only innervates extensor muscles?

A

Brachioradialis

302
Q

What compartment of the forearm is the brachioradialis in?

A

Posterior

303
Q

Where does the brachioradialis insert and attach? Does it act on the wrist joint? Why?

A

Humerus

Radial tuberosity

No - it does not cross the wrist joint

304
Q

What are the three muscles in the deep, anterior compartment of the forearm?

A

Flexor pollicis longus (FPL)

Flexor digitorum profundus (FDP)

Pronator quadratus

305
Q

What deep, anterior muscle of the forearm is related to the radius (lateral)?

A

FPL

306
Q

What deep, anterior muscle of the forearm is related to the ulna (medial)?

A

FDP

307
Q

What deep, anterior muscle of the forearm is related to both the radius and ulna?

A

Pronator quadratus

308
Q

What is FDP covered with?

A

The aponeurosis of FCU

309
Q

Which phalanx do the tendons of FDP insert onto?

A

Distal

310
Q

What is the main action of FDP?

A

Flexion of the wrist

Flexion of all the finger joints - PIP, IP DIP

311
Q

What two nerves supply FDP? Which sections do they supply?

A

Ulnar - medial part

Anterior interosseous - lateral part

312
Q

What nerve innervates the FPL?

A

Anterior interosseous nerve - a branch of the median nerve

313
Q

What are the attachments of the pronator quadratus?

A

Ulna - origin

Radius - insertion

314
Q

What nerve innervates the pronator quadratus?

A

Anterior interosseous nerve - a branch of the median nerve

315
Q

What is the action of the pronator quadratus?

A

It works in synergy with the pronator teres muscle and forms a powerful pair of pronators at both the proximal and distal radioulnar joints

316
Q

What is the main pronator of the forearm

A

Pronator quadratus

The pronator teres is involved when there is resistance

317
Q

On what aspect of the forearm is the radial nerve and artery located?

A

Lateral

318
Q

On what aspect of the forearm is the ulnar nerve and artery located?

A

Medial

319
Q

What other nerve passes through the forearm - apart from radial and ulnar?

A

Median

320
Q

How does the median nerve enter the forearm?

A

Medial to the brachial artery

321
Q

Describe the course of the median nerve in the forearm

A

It heads under the pronator teres muscle and passes down the forearm between FDS and FDP

322
Q

How does the median nerve enter the carpal tunnel?

A

Under the flexor retinaculum

323
Q

What anterior forearm muscles does the median nerve not supply?

A

FCU

Medial half of FDP

324
Q

What condyle of the humerus does the ulnar nerve pass posterior to?

A

Medial

325
Q

How does the ulnar nerve enter the forearm?

A

Between the heads of the FCU muscle

326
Q

At the level of the wrist, what is more medial - ulnar nerve or ulnar artery?

A

Ulnar nerve

327
Q

Between which two muscles does the ulnar artery and ulnar nerve run?

A

FCU

FDP

328
Q

What does the ulnar artery form after passing through the wrist?

A

The superficial palmar arch

329
Q

What does the radial artery form after passing through the wrist?

A

The deep palmar arch

330
Q

Where do we locate the radial pulse?

A

The distal third of the forearm, medial to the tendon of FCR

331
Q

What is Allen’s test?

A

The test used to determine the patency of the arteries In the distal forearm

332
Q

What is the carpal tunnel?

A

The passageway from the forearm to the hand passing deep to the flexor retinaculum

333
Q

What is the function of the flexor retinaculum?

A

To stabilise the carpal bones

334
Q

What four carpal bones is the flexor retinaculum attached to? On what side?

A

Scaphoid - lateral

Trapezium - lateral

Pisiform - medial

Hamate - medial

335
Q

What are the contents of the carpal tunnel?

A

4 tendons of FDP

4 tendons of FDS

1 tendon of FPL

Median nerve

336
Q

What is carpal tunnel syndrome?

A

A condition in which there is a reduction of space within the carpal tunnel. It results in weakness and tingling in the muscles and skin supplied by the median nerve

337
Q

How do we treat carpal tunnel syndrome?

A

We dissect the flexor retinaculum

338
Q

What is the clinical feature of median nerve damage?

A

Simian hand

339
Q

What palmar surface is more mobile and looser? Why?

A

Dorsum

The palmar surface is stabilised and supported by palmar fascia

340
Q

What muscle of the forearm is continuous with the palmar fascia?

A

Palmaris longus

341
Q

What is the clinical feature of palmar fascia disease?

A

Dupuytren contracture

342
Q

What are the five muscle compartments of the hand - superficial to deep?

A

Thenar

Hypothenar

Central

Adductor

Interosseous

343
Q

Where are the thenar muscles located?

A

On the lateral (radial) aspect of the palm

344
Q

What are the two superficial thenar muscles?

A

Abductor pollicis brevis (APB)

Flexor pollicis brevis (FPB)

345
Q

What is the deep thenar muscle?

A

Opponens pollicis (OP)

346
Q

What nerve supplies the thenar muscles?

A

Median nerve

Except the deep belly of the FPB, which is supplied by the ulnar nerve

347
Q

What nerve segment from the brachial plexus provides the majority of the innervation to the thenar muscles?

A

Medial cord

348
Q

Where are the hypothenar muscles located?

A

On the medial (ulnar) aspect of the palm

349
Q

What are the two superficial hypothenar muscles?

A

Abductor digit minimi

Flexor digiti minimi

350
Q

What is the deep hypothenar muscle?

A

Opponens digiti minimi

351
Q

What nerve supplies the hypothenar muscles?

A

Ulnar nerve

352
Q

What is opposition?

A

The movement of the thumb or little finger towards other fingers

353
Q

What four muscles make up the central compartment of the hand?

A

The tendons of FDS

The tendons of FDP

The tendons of FPL

Lumbricals

354
Q

What are the lumbricals?

A

They arise from the medial and lateral aspects of the FDP tendon, between the 1st to 5th metacarpals

Remember: FDP inserts onto the distal phalanx of digits

355
Q

What are the two actions of the lumbricals?

A

They flex the fingers at the MCP joint

They extend the interphalangeal joint of 2nd to 5th digits

356
Q

What nerve innervates the lateral two lumbricals?

A

Median nerve

357
Q

What nerve innervates the medial two lumbricals?

A

Ulnar nerve

358
Q

Which brachial plexus injury will affect the lumbricals?

A

Klumpke’s

359
Q

What muscle makes up the adductor component of the hand?

A

Adductor pollicis

360
Q

What are the two heads of the adductor pollicis?

A

Oblique

Transverse

361
Q

What is the action of the adductor pollicis?

A

To adduct the thumb

362
Q

What nerve innervates the adductor pollicis?

A

Ulnar nerve

363
Q

Where do the interossei musscle lie?

A

Between proximal phalanx and the extensor digitorum expansion of the same digit

364
Q

How many dorsal interossei are there?

A

4

365
Q

How many palmar interossei are there?

A

3

366
Q

Which two fingers are not a point of attachment for the palmar interossei?

A

Middle finger

Thumb

367
Q

What are the action of the dorsal interossei?

A

Abduct (DAB)

368
Q

What are the action of the palmar interossei?

A

Adduct (PAD)

369
Q

What nerve innervates the interossei?

A

Ulnar

370
Q

Where is the deep palmar arch located?

A

Anatomical snuffbox, passing between the two heads of the 1st dorsal interossei and two heads of the adductor pollicis

371
Q

What two nerves supply the muscles of the hand?

A

Median

Ulnar

372
Q

What muscles within the hand does the median nerve innervate?

A

Thenar muscles - except deep belly of FPB

1st and 2nd lumbricals

373
Q

What muscles within the hand does the ulnar nerve innervate?

A

Deep belly of FPB

3rd and 4th lumbricals

Interossei

Adductor pollicis

Hypothenar

374
Q

What is the interosseous membrane? What is its function?

A

An incomplete fibrous structure

To stabilise the forearm structure and radio-ulnar joints

375
Q

What are the seven carpal bones?

A

She Looks Too Pretty Try To Catch Her

Scaphoid

Lunate

Triquetrum

Pisiform

Trapezium

Trapezoid

Capitate

Hamate

376
Q

What separates the carpal bones from the ulna?

A

Articular disc

377
Q

What two carpal bones does the radius articulate with?

A

Scaphoid

Lunate

378
Q

What fluid is found between the forearm and carpal bones?

A

Synovial fluid

379
Q

What artery lies lateral to the pisiform bone?

A

Ulnar artery

380
Q

Which carpal bone is a sesamoid bone in the tendon of flexor carpi ulnaris?

A

Pisiform

381
Q

What muscle compartment causes wrist flexion?

A

Anterior

382
Q

What muscle compartment causes wrist extension?

A

Posterior

383
Q

What two muscles cause ulnar deviation (adduction)?

A

FCU

ECU

384
Q

What two muscles cause radial deviation (abduction)?

A

FCR

ECR

385
Q

What causes circumduction of the wrist?

A

Combination of ulnar deviation and radial deviation

386
Q

Where are the metacarpal bones located?

A

Between the carpal bones and the phalanges

387
Q

How many metacarpal bones are there?

A

Five

388
Q

Where do the metacarpal bones articulate proximally?

A

Carpal bones at CMC joints

389
Q

Where do the metacarpal bones articulate distally?

A

Phalanges at MP joints

390
Q

How many phalanges are there in the thumb?

A

Distal

Proximal

391
Q

How many phalanges are there in the second to fifth digits?

A

Distal

Middle

Proximal

392
Q

What are the interphalangeal joints?

A

The joints between the phalanges

393
Q

What are the three compartments of the posterior forearm?

A

Muscles that extend and abduct or adduct the wrist

Muscles that extend the medial four digits

Muscles that extend or abduct the thumb

394
Q

What are the three muscles that extend and abduct or adduct the wrist?

A

Extensor carpi radialis longus (ECRL)

Extensor carpi radialis brevis (ECRB)

Extensor carpi ulnas (ECU)

395
Q

What are the actions of the ECRL and ECRB?

A

They extend and abduct the wrist joint, causing radial deviation

396
Q

What muscle lies lateral to the brachioradialis?

A

ECRL

397
Q

What are the three muscles that extend the medial four digits?

A

Extensor digitorum

Extensor indicis

Extensor digiti minimi

398
Q

What is the common extensor origin?

A

The lateral epicondyle of the humerus

399
Q

Where does the extensor digitorum arise?

A

The lateral epicondyle of the humerus

400
Q

What happens to the extensor digitorum as it passes through the extensor retinaculum?

A

It divides into four tendons for the fingers

401
Q

What is the action of extensor digitorum?

A

It extends the wrist joint

It extends the medial four digits at MCP and IP joints

402
Q

What three muscles extend or abduct the thumb?

A

Abductor pollicis longus (APL)

Extensor pollicis brevis (EPB)

Extensor pollicis longus (EPL)

403
Q

What is the action of APL?

A

Abducts thumb

404
Q

What is the action of EPB?

A

Extends thumb

405
Q

What is the action of EPL?

A

Extends thumb

406
Q

Where is the supinator located?

A

The proximal part of the extensor forearm compartment

407
Q

What is the action of the supinator?

A

To supinate the forearm

408
Q

What muscle is the main supinator of the forearm?

A

Supinator

The brachial brachii is involved when there is resistance

409
Q

What is the action of extensor digiti minimi?

A

To extend the 5th finger at the MP joint

410
Q

What nerve innervates the extensor compartment of the forearm?

A

Radial nerve

411
Q

What is another name for the deep branch of the radial nerve?

A

Posterior interosseous

412
Q

What is the main motor nerve of the forearm extensors?

A

Deep radial nerve

413
Q

Which muscle does the deep radial nerve lie under and pierce?

A

Supinator

414
Q

What is the function of the superficial radial nerve?

A

Sensory distribution to the skin on the dorsal of the hand

415
Q

Which muscle does the superficial radial nerve lie under?

A

Brachioradialis

416
Q

What two arteries supply the extensor forearm compartment?

A

Posterior interosseous artery

Recurrent interosseous artery

417
Q

What does the posterior interosseous artery arise from?

A

Radial artery

418
Q

What does the recurrent interosseous artery arise from?

A

Posterior interosseous artery

419
Q

What is the role of the extensor retinaculum?

A

It provides stability and a tunnel for the extensor tendons

420
Q

What are ganglion?

A

Non-tender cysts on the synovial sheaths of the hand dorsum

421
Q

What two veins drain the dorsal venous arch?

A

Cephalic vein

Basilic vein

422
Q

On what aspect of the hand does the cephalic vein lie?

A

Lateral

423
Q

On what aspect of the hand does the basilic vein lie?

A

Medial

424
Q

What is the anatomical snuffbox?

A

A shallow depression on the lateral aspect of the wrist when the thumb is extended fully

425
Q

What forms the medial border of the anatomical snuffbox?

A

EPL tendon

426
Q

What forms the lateral border of the anatomical snuffbox?

A

EPB tendon

APL tendon

427
Q

What forms the floor of the anatomical snuffbox?

A

Scaphoid

Trapezium

428
Q

Which artery is found on the anatomical snuffbox floor?

A

Radial

429
Q

What nerve innervates the thumb extensors and abductors?

A

Posterior interosseous nerve

430
Q

What is the action of EPL?

A

To extend DIP joints of thumb

431
Q

What is the action of EPB?

A

To extend PIP joints of thumb

432
Q

What is the action of APL?

A

To extend and abduct CMC joints of thumb

433
Q

How do distal forearm fractures occur?

A

Falling on outstretched hand

434
Q

What are the two types of distal forearm fractures?

A

Colle’s

Smith’s

435
Q

What are Colle’s fractures?

A

Fracture of distal radius, where there is anterior displacement of the radius shaft on the distal bone

436
Q

What is the cause of Colle’s fractures?

A

Falling on an extended wrist

437
Q

What are Smith’s fractures?

A

Fracture of distal radius, where there is posterior displacement of the radius shaft on the distal bone

438
Q

What is the cause of Smith’s fractures?

A

Falling on a flexed wrist or direct blow to the forearm

439
Q

What distal forearm fracture is more common?

A

Colle’s

440
Q

What is the most fractured carpal bone?

A

Scaphoid

441
Q

What nerve injury causes a wrist drop?

A

Radial

442
Q

What is a clinical feature of carpal bone fractures?

A

Pain in anatomical snuffbox

443
Q

What is a common complication of carpal fractures?

A

Risk of avascular necrosis, which can lead to necrosis

444
Q

Which common fracture in children increases the risk of Volkmaan’s ischemic contractures?

A

Supracondylar fracture of the humerus

445
Q

What type of joint are the CMC joint at the thumb? What type of joints are the CMC joint at the digits?

A

Synovial Saddle

Synovial Plane

446
Q

What type of joint is the MCP joint?

A

Synovial Condyle

447
Q

What type of joints are the IP joints?

A

Synovial Hinge

448
Q

What is the IP joint?

A

The IP joint is located between the proximal and distal phalanges of the thumb

449
Q

What is the MCP joint?

A

The MCP joint is located between the metacarpalbones and the proximal phalanges

450
Q

What is the CMC joint?

A

The CMC joint is located between the carpal bones and the metacarpals

451
Q

What is the PIP joint?

A

The PIP joint is located between the proximal phalanges and the intermediate phalanges of the four digits

452
Q

What is the DIP joint?

A

The DIP joint is located between the intermediate phalanges and the distal phalanges of the four digits

453
Q

What type of joints exist between the metacarpal bones?

A

Synovial plane

454
Q

What two fascia protect the neurovascular structures entering the arm in the flexor compartment and the extensor compartment?

A

Flexor retinaculum

Extensor retinaculum

455
Q

What cutaenous innervation does the median nerve supply in the hand?

A

Lateral three and a half fingers

456
Q

What cutaenous innervation does the radial nerve supply in the hand?

A

Dorsal aspect of the base of lateral three and a half fingers

457
Q

What cutaenous innervation does the ulnar nerve supply in the hand?

A

Medial one and a half fingers

Year Two - Anatomy (7 decks)

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