MSK upper limb 1 Flashcards
Complete the diagram
Which ligament holds the ulnar in place?
Which ligament holds the head of the radius in place?
Ulnar collateral ligament
Annular ligament
Which muscles cause flexion of the elbow joint
Biceps brachii, brachioradialis and brachialis
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Muscles involved insupination of the elbow
- Supinator
- Biceps brachii
Muscles invovled in pronation of the elbow
Pronator teres
Pronator quadratus
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Insersion for pec minor
Coracoid process (Also biceps short head & coracobrachialis)
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Name branches of brachial plexus & what cords they come from
Ulnar- Medial
Median- lateral & medial
Radial- posterior
Musculocutaneous- lateral
Axillary- posterior
Insersion and origin for biceps brachi, two heads and deltoid
Biceps brachi
Long head: supraglenoid tubercle of scapula
Short head: coracoid process
Insersion: Tuberosity of radius
Deltoid
Insertion: Clavicle, acromion & spine of scapula
Origin: Deltoid tuberosity on the humerus
What is the Common flexor origin & what muscles originate here
Medial epicondyle of the humerus
- Pronator teres
- Flexor carpi ulnaris
- Flexor digitorum superficialis
- Flexor carpi radialis
- Palmaris longus
What is the Common extensor origin & what muscles originate here
Lateral epicondyle of the humerus
- Extensor digitorum
- Extensor digiti-minimi
- Extensor carpi ulnaris
- Extensor radialis brevis
Biceps brachii insertion & origin
Origin: Long head:
LH: supraglenoid tubercle of scapula
SH: coracoid process
Insersion: tendon, into the radial tuberosity
Brachioradialis insertion & origin
Humerus
inserts into Radial styloid process
What attaches onto green & blue parts
Pec minor- green (the inserts onto coracoid process)
Serratus anterior- blue
Green & blue attachments
Pec major
Origin= Clavicular & sternocostal heads
Insertion= intertubercular groove
Teres major
Origin= Inferior angle & lateral border of the scapula
Insertion= intertubercular groove
Coracobrachilis insertion & origin
Origin= coracoid process
Insertion= mid shaft of humerus
Deltoid attachments
Origin= Clavicle, acromion & spine of scapula
Insertion= Deltoid tuberosity
What attaches onto the infra-glenoid tubercle of the scpula
Attachment of triceps brachii: long head
Insertion- Olecranon process of the ulna
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Complete diagram
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What does the radial nerve innervate & what are its nerve roots
Sensory – Innervates most of the skin of the posterior forearm, the lateral aspect of the dorsum of the hand, and the dorsal surface of the lateral three and a half digits.
Motor – Innervates the triceps brachii and the extensor muscles in the forearm.
nerve roots C5-T1
Complete diagram
Note that the axillary artery turns into the brachial artery at the lower border of the pec major
Label the contents of the axilla
At what anatomical point does the axillary artery begin and end and from which artery?
lateral margin of the first rib and then lower border of teres major
subclavian artery
Roots & cords of the brachial plexus
Ulnar- C8 & T1 Medial branch
Median- C6, 7, 8, T1 Lateral & medial branch
Radial- C5-T1 Posterior branch
Musculocutaneous- C5, 6 & 7 Lateral branch
Axillary- C5 & 6 Posterior branch
What is Erb’s palsy
Erb’s palsy refers to an injury to the upper roots of the brachial plexus (typically C5-6). It most commonly occurs as a result of a stretching injury during a difficult vaginal delivery.
Nerves affected – the peripheral nerves derived from C5-6 roots are most affected. This includes the musculocutaneous, axillary, suprascapular, and nerve to subclavius.
Muscles affected – supraspinatus, infraspinatus, subclavius, biceps brachii, brachialis, coracobrachialis, deltoid and teres minor.
Motor functions affected – abduction at shoulder, lateral rotation of arm, supination of forearm, and flexion at shoulder.
Sensory functions affected – sensation over the lateral aspect of upper limb (C5-6 dermatomes).
The affected limb hangs limply, medially rotated by the unopposed action of pectoralis major. The forearm is pronated due to the loss of biceps brachii. The wrist is weakly flexed due to the normal tone of the wrist flexors relative to the weakened wrist extensors. This is position is known as ‘waiter’s tip’ and is characteristic of Erb’s palsy
What is Klumpke’s Palsy
Claw hand= Ulnar nerve
Injury of the lower roots of the brachial plexus (C8-T1).
Nerves affected – the peripheral nerves derived from T1 root are most affected; the ulnar and median nerves
Muscles affected – the intrinsic hand muscles
Sensory functions affected – sensation along medial side of upper limb (C8-T1 dermatomes).
The primary feature of Klumpke’s palsy is a clawed hand. This occurs due to paralysis of the lumbrical muscles, which normally act to flex the metacarpophalangeal joints (MCPJs) and extend the interphalangeal joints (IPJs). When paralysed, the fingers subsequently become extended at the MCPJs and flexed at the IPJs, producing a clawed appearance.
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Where does lymph from the medial & lateral part of the breast drain?
- Medial part of the breast (close to sternum): internal mammary nodes
- Lateral part of breast (close to axilla): axillary lymph nodes
The main lymph drainage of the breast is to axillary nodes and to the parasternal nodes along the internal thoracic artery inside the thoracic cavity. The lymphatics of the breast originate in the lymph capillaries of the mammary connective tissue, which surrounds the mammary structures, and drain through the deep substance of the breast.
Orientating the clavicle:
The lateral aspect of a clavicle is x than the medial aspect
The superior surface is x than the inferior surface
The conoid tubercle is on the x aspect of the x portion of the clavicle
The lateral aspect of a clavicle is flatter than the medial aspect
The superior surface is smoother than the inferior surface
The conoid tubercle – attachment for the conoid ligament – is on the inferior aspect of the lateral portion of the clavicle
How is the underside of the clavicle fixed to the coracoid process
Trapezoid ligament in front and conoid ligament behind
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What type of synovial joint are the acromioclavicular (AC) and sternoclavicular (SC) joints?
AC joint: Synovial Plane joint
SC joint: Saddle shaped synovial joint
What attachement is this showing
Long head of biceps brachi to the supraglenoid tubercle
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Where does the axillary nerve lie on the humerus
directly posterior, along humeral neck