MSK - Upper Limb 1 Flashcards
what is the upper limbs attatcehd to?
only the clavicle
what are the diff parts of the upper limb
Shoulder
Scapula and glenohumeral joint
Clavicle and trunk
Arm
Humerus
Forearm
Ulna and radius
Hand
Carpal bones
Metacarpals
Phalanges
What is the pectoral girdle?
scapula and clavicle
label the scapula
What are the anatomical places on the scapula?
- supraspinous fossa
- scapular spine
- infraspinous fossa
- scapular notch
What are the movements of the scapula?
- retraction
- protraction
- abduction
- adduction
Where does the scapular spine end?
acromion process
all teh joints of scapula
glenohumeral - between glenoid fossa of scapula and humerus = allows abduction, adduction and extension, flexion
acromioclavicular - between clavicle and accromion of scapula
Which muscles does the scapular fossa host?
Subscapularis muscle on subscapular fossa
Supraspinatus on supraspinous fossa
Infraspanatous muscle on infrasponous fossa
How is the clavicle held to the scapula?
How is the clavicle articulating with the sternum?
through acromioclavicular joint and through ligaments such as plane ligaments
sternoclavicular joint which contains articular disc of the joint = even if it is a saddle joint and ligaments = ICA
What are the 3 ligaments involved in holding the clavicle?
- anterior sternoclavicular ligament
- interclavicular ligament
- costoclavicular ligament (hold the weight)
What three joints make up the shoulder joint?
Glenohumeral joint
Acromioclavicular
Sternoclavicular joint
GAS!!!!!!
What is the glenohumeral joint?
Ball and socket joint : head of humerus with glenoid fossa of scapula which is outlined by glenoid labrum (fibrous structure)
Most freely moving joint: stability sacrificed
articulation of humerus with glenoid fossa of scapula allowing for high mobility and low stability
label and what atttaches to the tubercle
muscles
label and what runs in the radial groove
radial nerve
label and what is the diff between glenoid cavity and labrum
cavity = cartilage
labrum = fibrous
What ligaments stabilise the glenohumeral joint?
capsular ligaments which are surrounded by and reinforced by muscle and ligaments
label the ligaments of the shoulder
- capsular ligament which is for the glenohumeraln joint
- corocoacriminal joint - prevents superior displacement of head of humerus
- acromoclavicular joint
- coracoclavicular joint
person experiences superior displacement of shoulder, what ligament is responsible for preventing this
Coracoacromial ligament = Prevents superior displacement of head of humerus
Identify the coracoclavicular ligament
Composed of Trapezoid and Conoid ligament
Runs from clavicle to posterior aspect of coracoid process of scapula
What are the movement which are allowed by the glenohumeoral joint?
- abduction and adduction
- medial rotation and lateral rotation
- flexion and extension
FLAME
What are the anterior axio-appendicular muscles?
pectoralis major, pectoralis minor, subclavius, serratus anterior
Which dislocation is most common at the glenohumeral joint?
Anterior dislocation
Due to excessive abduction and external rotation
Damage to glenohumeral ligament
What type of joint is the acromioclavicular joint?
Plane gliding synovial joint
Formed by the acromion and the clavicle
Acromioclavicular articular synovial capsule will encase the joint
What is present in the glenohumeral joint to reduce friction.
Synovial bursae
These are fluid filled sacs that acts as a cushion between tendons and other joint structures
pec major:
2 heads? function?
function of pec major?
innervation?
clavicular head (medial half of clavicle) = flex arm
sternocostal head (anterior sternum and external oblique apopneurosis) = extend arm in flexed position
function = adducts and medially rotates humerus
- scapula = draws antero-inferiorly
innervation = medial and lateral pectoral nerves
Where does the serratus anterior run?
starts of on the rib 2-9 and continuses laterally running underneath the scapula
Where does the pectoralis minor attach and insert?
What is the function of the pectoralis minor?
attach onto rib 2 - 5 and insert into coracoid process
bring shoulder forward and stablise
What are the posterior axio-appendicular muscles?
trapezius, latissimus dorsi, levator scapulae, rhomboid major and minor
what are the posterior axio appendicular muscles innervated by?
ventral branches of spinal nerves
label
What shape is the trapzieus muscle and what are the divison?
What does the trapezius cover?
What are the functions of the different parts of the trapezius?
diamond shaped which is divided into 3 parts;
- ascending part of trapezius
- middle part of trapezius
- descending part of trapezius
all the way from the spinous process of vertebrae to nucheal line and converge on the spine of the scapula
- Descending (superior) part - elevate and rotate the scapula upwards;
- Middle part - retract the scapula;
Ascending (inferior) part - medially rotate and depress the scapula
What does the latissimus dorsi do?
Where does the lattisimus dorsi attach and insert?
adduct arm (with pec major) and laterally rotate the arm
lattis=laterally rotate
attach = thoracolumbar aponeurosis
insert = floor of intertubercular groove of humerus
What are the intrinsic shoulder muscles (scalpohumeral)?
- deltoid
- teres major
- rotator cuff (teres minor, supraspinatus, infraspinatus, subscapularis)
What are the 3 parts of the deltoid?
anterior (clavicular), middle, posterior (spinal)
What does the clavicular part of deltoid attach, insert and what is the function?
What does the middle part of deltoid attach, insert and what is the function?
What does the spinal part of deltoid attach, insert and what is the function?
attach = lateral 1/3 of clavicle
insert = deltoid tuberosity of humerus
function = medially rotate arm
attach = lateral border of acromion process
insert = deltoid tuberosity of humerus
function = abduction
attach = spine of scapula
insert = deltoid tuberosity of humerus
function = laterally rotate arm
whats this, what runs in it?
deltopec groove
cephallic vein
what is deltoid innervated by?
axillary nerve
is teres major part of rotator cuff muscles?
no!
SITS- supra, infra, teres minor, subsclpularis
Where do the rotator cuff muscles insert?
label
greater tubercle of humerus
When all of the 4 rotator cuff muscles come together was is the function?
pull the humerus towards the glenoid fossa to stop it from popping out
what is innervation of rotator cuff msucles
what happens if supraspinatous msucle is fucked
Teres Minor = Axillary nerve
Other 3 muscles = suprascapular nerve
u cant abduct bc supraspinatous muscle is for abduction
label and What is the function of the synovial sheath?
reduce friction on a tendon as it crosses a number of joint allowing the long head of biceps brachii tendon to travel up and down without generating fricition
How is the glenoid joint portected?
fibrous membrane of joint capsule, synovial fluid. synovial sheath,
Subscapular bursa - is located between the tendon of the subscapularis muscle and the capsule. It functions to reduces frictional damage to the subscapularis muscle during movement of the glenohumeral joint, particularly during internal rotation.
What is the subtendinous bursa of subscapularis?
minimises the friction over the joint when lots of muscle run over the top of it
What is the clinical importance of the surgical/anatomical neck of the humerus?
Posterior circumflex artery and axillary artery runs here
Fracture to the surgical neck can lead to damage of these structures
Axillary nerve damage can lead to paralysis of the teres minor and deltoid muscles. (Therefore difficulty performing abduction)
What are the 3 shoulder spaces and what do they allow for?
triangular space, triangular interval, quadrangular space = allows for important arteries, nerves and veins to travel through
What travels through the triangular space?
circumflex scapular artery
What travels through the triangular interval?
- radial nerve
- profunda brachii artery
What runs through the quadrangular space?
- axillary nerve
- posterior circumflex humeral artery and vein
What is the axilla?
pyramidal space inferior to the glenohumeral joint and superior to the axillary fascia at the junction of the arm and thorax
What are the 3 joint that make up the elbow?
- humeroulnar (hinge joint)
- humeroradial (limited ball and socket )
- proximal radioulnar joint (pivot joint)
What are the 2 important articular surfaces for humerus to attach to radius?
- capitulum
- trochlea
CAPS R TRU UMBRELLAS
What does the trochlea do?
articulates with the ulnar forming a almost hook joint
What does the capitulum of the humerus do?
articulates with radius through a ball and socket
What are the structures stabilising the interaction between the distal humerus and the radius and ulna? (3)
- fat pads for stability
- radial collateral ligament )stops elbow from dislocating)
- ulnar collateral ligament
- angular ligament of radius (for proximal radioulnar joint)
What is the recess found in the synovial membrane?
sacciform recess of synovial membrane
What is used in pronation?
What is used in supination?
radius crossing over ulna
pivot joint between the distal humerus an radius and ulna
What part of the ulna limits hyperextension of the elbow?
Olecranon process
What is important about the head of the radius in pronation and supination?
Head of the radius acts like a wheel
Will enable supination (palm facing upwards) and pronation (palm facing downwards)
What movements can be carried out at the elbow joint?
Supination and pronation
Flexion and extension
label the ulna
what ligament allows supination of the elbow?
anular ligament
what are the medial and lateral epicondyte for?
muscular atttachements
label the various muscluar compartments of the arm
what is the purpose of teh deep fascia in the muscles of the arm?
seperates musculature, veins, arteries from skin, fat etc
what is the lateral intermuscular septum?
where fascia inserts and joins bone to form an anterior and posterior compartment
How do the axillary lymph nodes drain?
What are the 5 groups
PHACS -
pectoral
humeral
apical
central
subscapular
What muscles are located in the anterior compartment of the arm? (BBC)
What is the muscle action of the anterior compartment of the arm?
What nerve innervates these muscles?
WHAT ARE THE 3 ATTATCHMENST OF TEH COROCOID PROCESS
Biceps brachii, Brachialis, Coracobrachialis
Flexion
(Biceps brachi = Supination
Coracobrachialis = Flexion at shoulder and adduction)
Musculocutaneous nerve
TEH 3 ATTTACHMENST ARE:
- PEC MINOR
- CAROCOIBRACHIALIS
- SHORT HEAD OF BICEPS BRACHII
What are the categories of the muscle of the arm?
anterior (flexor) and posterior (extensor) compartment
What does the deep fascia in the arm separate?
What does the lateral intermuscular septum do?
separate muscle and deep arteries and veins and from skin, subepithelial fat
fascia goes inwards joining to the bone
What are the 3 muscles in the anterior compartment of the arm?
- biceps brachii (short and long head)
- brachialis
- coracobrachialis
Where does the short and long head of the biceps brachii attach?
short = simple route onto the coracoid process
long = goes through intertubecular groove attaching to supraglenoid tubercle
What is the function of the brachialis?
Where does the brachialis attach to and insert?
flexion of elbow
attach = deltoid tuberosity
insert = coranoid process on ulna
What is the function of the coracobrachilais?
What is the attachment and insertion of coracobrachialis?
flexion of shoulder
attach = coracoid process
insert = humeral shaft
What muscle is in the posterior compartment of the arm?
triceps brachii which is made of 3 branches: lateral, medial and long head
What is the attachment and insertion of long head of triceps brachii?
What is the attachment and insertion of middle head of triceps brachii?
What is the attachment and insertion of lateral head of triceps brachii?
attach = infraglenoid tubercle of scapula
insertion = olecranon
attach = posterior surface of humerus
insertion = olecranon
attach = posterior surface of humerus
insertion = olecranon
What is the vasculature of the upper limb?
mainly branches of the subclavian artery which come from the arch of aorta
- subclavian turns into axillary artery AT RIB 1
- axillary becomes brachialis at lower border of teres
What are the divisions of the axillary artery?
1st: super thoracic
2nd: thoracoacromial
3rd: subscapular
When does the subclavian artery become the axillary artery?
at the lateral margin of rib 1
What are the branches of the axillary artery?
thoracoacromial artery, deltoid branch, pectoral branch, circumflex arteries (supply alot of blood for the shoulder)
What are the divisions of the brachial artery posteriorly?
- ulnar collateral (superior and inferior)
- radial collateral artery
- radial recurrent artery
- ulnar recurrent (anterior and posterior)
What is the venous drainage of the upper arm?
axillary vein
basilic vein
cephalic vein
ABC
What is the feature of the cephalic vein?
stays superfisical the whole way and will pierce the deep fascia and drain straight into subclavian vein
What is the feature of the basilic vein?
run on the inside of the arm from ulna and pierces the deep fascia
What does the radial nerve supply?
all muscle in posterior compartment
What are the axillary lymph nodes?
- humoural
- pectoral
- scapular
- central
- apex
- subclavicular
