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MSK upper limb Flashcards

1
Q

Describe the axilla

A

A pyramidal space below the shoulder joint

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2
Q

At which anatomical point does the axillary artery begin

A

Lateral border of 1st rib

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3
Q

The axillary artery continues beyond the axilla as which vessel

A

Brachial artery

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4
Q

Which ropes form the brachial plexus

A

Ventral rami of C5 to T1

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5
Q

Which nerve roots form the upper trunk

A

C5 and C6

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6
Q

Which roots of the plexus contribute to the lower trunk

A

C8 and T1

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7
Q

Which root forms the middle trunk

A

C7

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8
Q

What is caused by injury to upper trunk

A

Erbs palsy- waiters tip- medial rotation of the arm with wrist flexion

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9
Q

What is caused by injury to the lower trunk

A

Klumpkes palsy - claw hand

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10
Q

Where does the axillary nerve originate

A

Posterior cord of C5/c6

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11
Q

Where does the radial nerve orginate

A

Posterior cord C5/c6/c7/c8/t1

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12
Q

Where does the musculocutaneous nerve orginate

A

Lateral cord C5/c6/c7

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13
Q

Where does the ulnar nerve orginate

A

Medial cord c8/t1

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14
Q

Where does the median nerve orginate

A

Lateral and medial cord C5/c6/c7/c8/t1

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15
Q

What is the dorsal venous arch

A

Complex network of veins lying at the distal aspect of the upper limb

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16
Q

What is the median cubital vein

A

Large communicating vein which shunts blood from the cephalic vein to the basilic vein

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17
Q

Describe the cephalic vein

A

Ascends the arm on its lateral aspect, piercing the clavipectoral fascia draining into the axillary vein

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18
Q

Describe the basilic vein

A

Ascends on the medial side of the arm, passing deep at the mid-numeral level and eventually becoming the axillary vein at the lower border of theres minor

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19
Q

Define a dermatome

A

An area of skin supplied by one spinal segment is called a dermatome

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20
Q

Describe lymphatic drainage of upper limb

A

All lymphatic vessels from the upper limb drain into axillary nodes

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21
Q

Name the 5 groups of axillary nodes

A
  1. Anterior or pectoral group
  2. Posterior of subscpaular group
  3. Apical group
  4. Central group
  5. Lateral or brachial group
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22
Q

At which small joint do the entire upper limb and pectoral girdle

A

Sternoclavicular joint

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23
Q

What type of joint is the acromioclavicukar joint

A

Synovial plane

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24
Q

What type of joint is the sternoclavicular joint

A

Synovial saddle

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25
Q

Name the rhythm used when the scapular moves

A

Scapulo-numeral rhythm

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26
Q

State the muscles involved in scapular elevation

A

Trapezius
Levator scapulae
Rhomboid

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27
Q

State the muscles involved in scapular depression

A

Latissumus dorsi
Serrated anterior
Pectoralis
Trapezius

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28
Q

State the muscles involved in scapular protraction

A

Serratus anterior

Pectoralis

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29
Q

State the muscles involved in scapular retraction

A

Trapezius

rhomboid

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30
Q

State the muscles involved in lateral scapular rotation

A

Infraspinatus
Teres minor
Trapezius

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31
Q

State the muscles involved in medial scapular rotation

A

Gravity
Levator scapulae
Rhomboid
Pectoralis minor

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32
Q

What type of joint is the shoulder joint

A

Synovial ball and socket

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33
Q

What is the name of the ring of cartilage surrounding the socket

A

Glenoid labrum

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34
Q

State the role of the glenohumeral ligaments

A

Strengthen the stability aspect of the joint capsule

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35
Q

State the role of the transverse humeral ligament

A

Forms the roof of the bicipital grove

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36
Q

State the role of bursae

A

Act as shock absorbers

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37
Q

Name the 2 main bursa in the shoulder

A

Subacromial ( sub deltoid) bursa

Subscapular bursa

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38
Q

What is the role of subacromial bursa

A

Reduces friction beneath deltoid, promoting free motion of the rotator cuff tendons

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39
Q

What is the movement of the subscapularis

A

Adductor medial rotator

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40
Q

What is the movement of the supraspinatus

A

Abduction

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41
Q

What is the movement of the infraspinatus

A

Lateral rotator of humerus

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42
Q

What is the movement of the teres minor

A

Adductor lateral rotator

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43
Q

What is the primary function of the rotator cuff muscles

A

Resting tone of muscles act to “pull” the humeral head into the glenoid fossa - additional stability

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44
Q

What do anterior fibres of deltoid do at shoulder joint

A

Flexion and medial rotation

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45
Q

What do middle fibres of deltoid do at shoulder joint

A

Abduct the arm

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46
Q

What do posterior fibres of deltoid do at shoulder joint

A

Extension and lateral rotation

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47
Q

What is the neve supply to deltoid

A

Axillary nerve

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48
Q

What is the role of the pectoralis major at the shoulder joint

A

Adduct the shoulder and medially rotate the humerus at the glenohumeral joint

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49
Q

What is the role of the pectoralis minor

A

Along with the serrratus anterior it serves to stabilise the scapula during limb movement by keeping it pulled against thoracic cage

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50
Q

What is the role of Serratus anterior

A

Protraction of scapula in

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51
Q

What do superior fibres of trapezius do

A

Elevate the scapula and rotate it during abduction

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52
Q

What do middle fibres of trapezius do

A

Retract the scapula

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53
Q

What do interior fibres of the trapezius do

A

Pull the scapula inferiorly

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54
Q

What muscles are involved in flexion of shoulder

A

Pectoralis major
Anterior deltoid
Coracobrachialis

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55
Q

What muscles are involved in extension of shoulder

A

Posterior deltoid
Latissimus dorsi
Teres major

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56
Q

What muscles are involved in adduction of shoulder joint

A

Pectoralis major
Lattismus dorsi
Teres major

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57
Q

What muscles are involved in abduction of shoulder joint

A 
0-90°
Supraspinatus 
Middle fibres of deltoid 
90-180°
Trapezius 
Serratus anterior
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58
Q

What muscles are involved in medial or internal rotation

A

Subscapularis
Latissimus dorsi
Pectoralis major
Teres major

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59
Q

What muscles are involved in lateral or external rotation

A

Infraspinatus

Teres minor

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60
Q

Name the muscles in the anterior compartment of the arm

A

Brachialis
Corachobrachialis
Biceps brachii

61
Q

What is the action of biceps brachii

A

Flexes shoulder and elbow joint

Supination at superior radio-ulnar joint

62
Q

What is the action of the coracobrachialis

A

Flex arm at shoulder joint

63
Q

What is the role of the brachialis muscle

A

Flex the elbow joint

64
Q

What two arteries does the brachial artery form

A

Radial and ulnar

65
Q

Describe the median nerve in the arm

A

Arises from medial cord and lateral cord of brachial plexus

66
Q

Describe the ulnar nerve in the arm

A

Arises from medial cord of brachial plexus

67
Q

State the insertion of the common tendon of triceps

A

Olecranon process of ulna

68
Q

What is the main action of triceps on elbow joint

69
Q

Name the muscle at the elbow which aids the triceps at elbow joint

A

Anconeus muscle

70
Q

What is the nerve supply to triceps and anoconeus

A

Radial nerve

71
Q

What does the radial nerve innervate

A

All the intrinsic muscles of elbow and wrist joint

72
Q

What is the root value of the radial nerve

73
Q

What is the characteristic clinical sign of radial nerve injury

A

Wrist drop

74
Q

What is the ante cubital fossa

A

Triangular depression or hollow lying in front of the elbow

75
Q

What is the role of the ante cubital fossa

A

Acts as a conduit for passage of major neuro vascular structures from the arm down to the forarm

76
Q

What type of joint is the elbow joint

A

Synovial hinge joint

77
Q

Which ligament holds the ulnar in place

A

Ulnar collateral ligament (medial)

78
Q

Which ligament holds the head of the radius

A

Radial collateral ligament (lateral)

79
Q

Which muscles cause flexion of the elbow joint

A

Brachialis
Biceps brachii
Brachioradialis

80
Q

What type of joints are the radio-ulnar joints

A

Pivot type synovial joints

81
Q

What is the role of the radio-ulnar joint

A

Allow supination and pronation of the forearm

82
Q

What ligament supports the proximal radio-ulnar joint

A

Annular radial ligament

83
Q

Which muscles are involved in supination

A

Supinator

Biceps brachii

84
Q

Which muscles are involved in pronation

A

Pronatior quadratus

Pronatior teres

85
Q

what is the role of anterior compartment muscles of forearm

A

these muscles are flexors of the wrist and digits and facilitate pronation of the foramen at the radio-ulnar

86
Q

what does the medial epicondyle act as

A

the common flexor origin for the superficial and intermediate flexors

87
Q

which four muscles fan out from the common flexor orgiin

A

pronator teres
flexor carpi radialis
palmaris longus
flexor carpi ulnaris

88
Q

what is the action of pronator teres

A

pronates and flexes forearm

89
Q

where does the FDS flex

A

wrist, metacarpophalangeal and proximal interphalangeals joints

90
Q

what nerve innervates FDS

A

median nerve C7,C8,T1

91
Q

what is the main action of the brachioradialis

A

weak flexion of elbow joint, maximal when forearm is in midpronated position

92
Q

which nerve innervates the brachioradialis muscle

A

radial nerve, C5,C6,C7

93
Q

what is the main action of FDP on the wrist and finger joints

94
Q

which part of the FDP is supplied by ulnar nerve

A

medial part to digits 4 and 5

95
Q

which part of the FDP is supplied by median nerve

A

lateral part to digits 2 and 3

96
Q

what does pollicis mean

97
Q

which nerve innervated the flexor pollicis longs

A

anterior interosseous nerve, from median nerve (C8,T1(

98
Q

what does the pronator quadratus do

A

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

99
Q

which muscles does the median nerve not supply in the anterior forearm

A

flexor carpi ulnaris and medial half of flexor digitorum profundus

100
Q

which two arteries does the brachial artery divide into

A

ulnar and radial arteries at the neck of the radius

101
Q

which arterial pulse can you feel at the distal third of forum medial to the tendon of flexor carpi radialis

102
Q

which test is used to determine the patency of the arteries in the distal forearm

A

Allens test

103
Q

what is the carpal tunnel

A

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

104
Q

what is the fibrous retinaculum

A

a strong fibrous band which stabilises the concavity of the palmar surface of the carpus

105
Q

what is the contents of the carpal tunnel

A

4 tendons of the flexor digitorum profundus
4 tendons of flexor digitorum superficialis
1 tendon of flexor pollicis longs
median nerve

106
Q

describe carpal tunnel syndrome and the treatment

A

any reduction in the space within the carpal tunnel can result in weakness and tingling in the muscles and skin supplied by the median nerve.
fixed with a procedure in which the flexor retinaculum is dissected under local or general anaesthetic and the nerve is freed

107
Q

which muscle of the forearm is continuous with the fascia of the palm

A

palmaris longus

108
Q

state the 5 muscle compartments of the hand

A 
thenar compartment 
hypothenar compartment
lumbricals and long flexor tendons - central compartment 
adductor compartment 
interosseous compartment
109
Q

name the three thenar muscles

A

abductor pollicis brevis
flexor pollicis brevis
opponents pollici

110
Q

which nerve segments from the brachial plexus serves to provide the majority of the innervation to the thenar muscles

111
Q

name the hypothenar muscles

A

abductor digiti minimi
flexor digiti minimi
opponens digiti minimi

112
Q

which nerve innervates the hypothenar muscles

A

ulnar nerve C8,T1

113
Q

what does opponens mean

A

related to the function of the muscles- contraction causes opposition - movement of the thumb or little finger towards the other fingers

114
Q

what is the role of the lumbricals

A

flex the fingers at the metacarophalangeal joints and extend the interphalangeal joint of 2nd to 5th digits

115
Q

which nerve innervates adductor pollicis

A

median nerve C8,T1

116
Q

where do the interossei muscles lie

A

between the metacarpal bones

117
Q

what are the actions of the interossei muscles

A

DAB- dorsal interossei abduct the fingers

PAD- Palmar interossei adduct the fingers

118
Q

which nerve innervates the dorsal and palmar intersossei muscles

A

ulnar nerve, C8,T1

119
Q

which artery is the main contributor of the superificial palmar arch

A

ulnar artery

120
Q

which artery is the main contributor of the deep palmar arch

A

radial artery

121
Q

what is the motor supply to of the hand

A

median and ulnar nerves

122
Q

what does the median nerve supply

A

majority of the thenar eminence apart from the deep belly of flexor pollicis braves and the 1st and 2nd lumbricals

123
Q

what does the ulnar nerve innervate

A

rest of the intrinsic muscles of the hand

124
Q

what are the spinal roots of the medial and ulnar nerve

125
Q

the ulnar nerve is a branch of which cord of the brachial plexus

A

medial cord

126
Q

describe motor testing

A

axillary - abduct the shoulders -deltoid
musculocutaneous - flex the elbow - biceps, brachial
radial - extend the wrist - posterior compartment of forearm
ulnar - spread your fingers - intrinsic muscles of the hand
median - move your thumb towards your nose - abductor politic brevis

127
Q

describe sensory testing

A

axillary - outer aspect of shoulder
radial - posterior arm, forearm and dorsal aspect of lateral 3 and a half fingers
musculocutaneous - lateral aspect of forearm
median - palmar aspect of lateral 3 and a half fingers
ulnar - palmar and dorsal aspect of medial 1 and a half fingers

128
Q

what is the interosseous membrane

A

an incomplete fibrous structure, conforming stability to the forearm structure in addition to the proximal and distal and radio-ulnar joints. It is lax enough to allow supination and pronation at the radioulnar joints

129
Q

what sits between the ulna and carpal bones

A

articular disc

130
Q

what does the radius articulate with

A

scaphoid and lunate (carpal bones)

131
Q

what type of fluid os found between the forearm and carpal bones

A

synovial fluid

132
Q

where do the metacarpals sit

A

sit between the carpal bins and the phalanges, there are 5 in total

133
Q

what are the 3 groups of muscles in the posterior forearm

A

1) muscles that extend and abduct or adduct the hand at the wrist joint
2) muscles that extend the medial four digits
3) muscles that extend of abduct the thumb

134
Q

which muscles extend and abduct or adduct the hand at the wrist joint

A

extensor carpi radialis longus
extensor carpi radialis brevis
extensor carpi ulnaris

135
Q

which muscles extend the medial four digits

A

extensor digitorum
extensor indicis
extensor digiti minimi

136
Q

which muscles extend of abduct the thumb

A

abductor pollicis longus
extensor pollicis brevis
extensor politic longus

137
Q

what is the action of the supinator

A

supinates forearm, rotates radius to turn palm anteriorly or superiorly

138
Q

what is the common intervention of extensor muscles

A

radial nerve

139
Q

what is the role of the deep branch of the radial nerve

A

main motor nerve of the extensors of the forearm

140
Q

what is the function of the superficial branch of the radial nerve

A

purely sensory

141
Q

what does extensor retinaculum provide

A

stability and a tunnel for the extensor tendons, which are wrapped in synovial sheaths

142
Q

what are ganglion

A

non-tender cysts on the synovial sheaths found on the back of the hand

143
Q

define anatomical snuff box

A

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

144
Q

what is the medial border of the anatomical snuffbox

A

tendon of extensor pollicis longus

145
Q

what is the lateral border of the anatomical snuffbox

A

extensor pollicis brevis and abductor pollicis longus

146
Q

what is the floor of the anatomical snuffbox

A

scaphoid and trapezium

147
Q

what is colles fracture

A

fracture of distal radius in which there is anterior displacement, fall onto extended wrist

148
Q

what is smiths fracture

A

posterior displacement, falling into flexed wrist or direct blow to forearm

anatomy (12 decks)

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