MSK: upper limb Flashcards
palmaris longus muscle: origin, insert, action
- originates from the medial epicondyle of the humerus
- inserts into the flexor retinaculum and palmar aponeurosis of the hand.
- Its main action is flexion of the wrist/hand.
Describe the brachial plexus
- (5)Root -> (3)Trunk -> (6)Divisions -> (3)Cords -> (5)branches
mnemonic = Read That Damn Cadaver Book
- The brachial plexus is formed by the anterior rami of C5, C6, C7, C8 and T1 (roots).
- These roots form 3 trunks: upper, middle, lower
- These trunks become 6 divisions (anterior and posterior for each trunk).
- These form 3 cords: lateral, posterior, medial
- These five terminal branches (in order MAMRU): musculocutaneous, axillary, median, radial, ulnar.
Anatomical borders of the axilla (anterior, posterior, lateral, medial, apex)
(1. ) Anterior = pec.major and minor
(2. ) Posterior = subscapularis, teres major, latissimus dorsi
(3. ) Lateral = humerus, bicep brachii, coracobrachialis
(4. ) Medial = serratus anterior, ribcage
(5. ) Apex = 1st rib, clavicle, scapula
Name the four rotator cuff muscles and their origin, insertion, action
(1. ) Supraspinatus
- origin = supraspinatus fossa
- inserts = greater tuberosity of humerus.
- action = abduction of the humerus
(2. ) Infraspinatus
- origin = infraspinatus fossa
- inserts = greater tuberosity of humerus.
- action = lateral rotation
(3. ) Teres minor
- origin = lateral border of scapula
- inserts = greater tuberosity of humerus.
- action = lateral rotation
(4. ) Subscapularis
- origin = subscapularis fossa
- inserts = lesser tuberosity of humerus.
- action = medial rotation and adduct
Whats parts of the scapula articulates with humerus and clavicle
(1. ) Head of humerus articulates with coracoid process and glenoid fossa
(2. ) Clavicle articulates with acromion process
Whats muscles elevate and retract the scapula (3.)
(1. ) Levator scapulae
(2. ) Rhomboid major and minor
Deltoid: origin, insertion, action, innervation
- Origin = clavicle, acromion process, spine of scapula
- Inserts = deltoid tuberosity on humerus
- action = flex, abduct, extend arm
- innervation = axillary nerve
What is a frozen shoulder?
(1. ) Inflamed tendon of supraspinatus that causes pain when it passes through the gap between humerus and acromion.
(2. ) Pain is felt when raising arm to a certain height and after that it is pain free
What causes an axillary nerve palsy? and what sensory and motor loss is seen?
(1. ) Axillary nerve runs along the neck of the humerus
(2. ) Posterior dislocation or fracture to humerus neck can damage nerve
(3. ) This causes paralysis of deltoid and patch of numb skin on lateral arm
What causes a radial nerve palsy?
(1. ) Radial nerve run in the groove of the humerus
(2. ) This can be easily damaged by fracture or direct pressure
What causes an ulnar nerve palsy?
(1. ) Bang to the funny bone/medial epicondyle where the ulnar nerve passes behind it
(2. ) Leads to severe pins and needle in skin supplied by nerve.
What is found within the axilla?
(1. ) Fat and lymph nodes
(2. ) Axillary artery and vein
(3. ) Brachial plexus
Tricep brachii: origin, insertion, innervation, blood supply
Origin
- Infragrlenoid tubercle of scapula (Long head)
- Posterior humerus below radial groove (Medial head)
- Posterior humerus above radial groove (Lateral head)
Insert
- Olecranon process of ulna
Innervation
- Radial Nerve
Blood supply
- brachial artery
Name 3 branches that come off the posterior cord? and what do they supply?
(1. ) Axillary nerve = deltoid
(2. ) Radial nerve = extensors of arm and forearm
(3. ) Thoracodorsal nerve = lats
Name 2 branches that come off the lateral cord?
(1. ) Musculocutaneous
2. ) Median nerve (both lateral + medial cord
Name 2 branches that come off the medial cord?
(1. ) Median nerve (both lateral + medial cord)
(2. ) Ulnar nerve
Describe the relationship between the brachial plexus’ cords and axillary artery
(1. ) Lateral cord is found lateral to the axillary artery
(2. ) Medial cord is found medial to the axillary artery
What provides stability to the shoulder joint?
(1. ) Rotator cuff muscles
(2. ) Glenoid labrum
(3. ) Ligaments
What borders make up the cubital fossa
(1. ) Medial border = pronator teres
(2. ) Lateral border = brachioradialis
(3. ) Superior border = line between epicondyles
What is found in the cubital fossa
(1. ) Tendon of bicep
(2. ) Brachial artery
(3. ) Median nerve
(4. ) Superficial veins (basilic v = medially, cephalic v = laterally)
What is the blood supply and innervation of the coracobrachialis, bicep brachii, brachialis?
(1. ) Brachial A
(2. ) Musculocutaneous N
What drains into the axillary lymph node
(1. ) Upper limb
(2. ) Thorax
(3. ) Abdominal wall above the umbilicus
What would you see if the there was damage to the upper trunk of the brachial plexus (C5 + C6)
(1. ) Erb’s palsy
(2. ) Humerus internally rotated (due to paralysis of shoulder’s extensors), hands are flexed (due to paralysis of extensors) -> this can be described as a ‘waiter’s tip’
What would you see if the there was damage to the lower trunk of the brachial plexus (T1 + C8)
(1. ) Klumpke palsy due to excessive pull of upper limb e.g. hanging off tree
(2. ) ‘Claw’ appearance i.e. wrist and MCP is extended but DIP and PIP are in flexed position due to damage to MN and UN.
(3. ) Involvement of T1 may result in Horner’s syndrome,
What would you see if there was damage to T1?
(1. ) Horner’s Syndrome
(2. ) This is a triad of:
- Miosis (constriction of pupils)
- Ptosis
- Anhidrosis (inability to sweat)
(3. ) This is because T1 carries sympathetic fibres.
Most commonly injured bones
(1. ) Scaphoid
(2. ) 5th metacarpal (boxer’s fracture, result of a closed fist striking a hard object)
(3. ) Distal radius bone - in menopausal or osteoporosis
Course and distribution of major arteries in upper limb
(1. ) Subclavian artery
(2. ) Axillary artery
(3. ) Brachial artery
(4. ) At the cubital fossa brachial artery becomes the following:
- radial artery = supplies lateral forearm
- ulnar artery = supplies medial forearm
Bicep brachii: origin, insertion, action, innervation, blood supply
- Origin = Coracoid process (short head) + supraglenoid tubercle of scapula (long head)
- Insert = Radial tuberosity and bicipital aponeurosis
- Action = flexion and supination
- Innervation = Musculocutaneous nerve
- Blood = brachial artery
What is the common origin for flexors of the forearm
Medial epicondyle
Cutaneous (sensory) innervation of the hand
Anterior aspect:
(1. ) Medial nerve supplies the thumb, lateral two fingers, half of ring finger
(2. ) Ulnar nerve = supplies little finger and half of ring finger
Posterior aspect
(1. ) Ulnar nerve = supplies little finger and half of ring finger
(2. ) Radial nerve = supplies the thumb, lateral two and half of ring finger
(3. ) Medial nerve = supplies tips of thumb, lateral two and half of ring finger
What is the common origin for flexors of the forearm? What muscles do not fall in this?
(1. ) Medial epicondyle
(2. ) FDP and Pronator quadratus = ulna
(3. ) FPL = radius
Cutaneous (sensory) innervation of the hand
Anterior aspect:
(1. ) Medial nerve supplies the thumb, lateral two fingers, half of ring finger
(2. ) Ulnar nerve = supplies little finger and half of ring finger
Posterior aspect
(1. ) Ulnar nerve = supplies little finger and half of ring finger
(2. ) Radial nerve = supplies the thumb, lateral two and half of ring finger
(3. ) Medial nerve = supplies tips of thumb, lateral two and half of ring finger
List the nerves that innervate the forearm
(1. ) Medial nerve innervates everything except for the brachioradialis, FDP [medial half], FCU
(2. ) Ulnar nerve innervates FDP and FCU
(3. ) Radial nerve innervates brachioradialis
What muscles are found in the flexor compartment? (1.) superficial (2.) middle, (3) deep planes.
Superficial
- Pronator teres
- Flexor carpi radialis
- Palmaris longus
- Flexor carpi ulnaris
Middle
- Flexor digitorium superficialis
Deep
- Flexor digitorium profundus
- Flexor pollicis longus
- Pronator quadratus
What is carpal tunnel syndrome?
(1. ) Carpal tunnel is formed by the flexor reticulum and carpal bones. The tunnel transmits eight flexor tendons and median nerve.
(2. ) Swelling of tendon or arthritis of carpal bones can increase pressure in the tunnel. This can compress the median nerve.
(3. ) This manifests as pain and diminshed sensation on the skin. There may also be weakness of the hand muscles. Little finger in not affected
What is a ganglion cyst?
- Synovium surrounds the joints or tendons to provide friction free movement
- A ganglion cyst occurs when the synovium undergoes hypertrophy and presents a soft ‘squidgy’ bulge.
- They are often near the dorsal aspect of the wrist
Pronator Quadratus: origin, insertion, action, innervation
- origin = ulna
- insert = radius
- action = pronates forearm
- innervation = median nerve
Name the carpal bone of the left hand in order
Some Lovers Try Positions That They Can’t Handle
Lateral to medial and proximal (1-4) to distal (5-8)
(1. ) Scaphoid
(2. ) Lunate
(3. ) Triqiuetrium
(4. ) Pisiform
(5. ) Trapezium
(6. ) Trapezoid
(7. ) Capitate
(8. ) Hamate
For trapeziuM and trapezoiD remember thuMb and Digits.
What actions are produced from the interosseus? Innervation?
‘PAD DAB’
(1. ) Palmar interossues = adduct
(2. ) Dorsal interosseus = abduct
(3. ) Innervated by ulnar nerve
Where may you find tendon sheaths in the hand?
Around tendons of FDS, FDP, FPL
What muscles make up the thenar group? Innervation?
Thenar muscles innervated by medial nerve
(1. ) Abductor pollicis brevis
(2. ) Flexor pollicis brevis
(3. ) Opponens pollicis
(4.) Adductor pollicis - innervated by ulnar nerve
What muscles make up the hypothenar group? Innervation?
Innervated by the ulnar nerves
(1. ) Abductor digiti minimi
(2. ) Flexor digiti minimi
(3. ) Opponens digits minimi
Attachment of lumbricals? Innervation?
There are four lumbricals
(1. ) Attachments = FDP’s tendons and dorsal digital expansions on posterior of finger
(2. ) Medial two = Ulnar N. Lateral two = Median N
What does the median nerve innervate?
(1. ) Flexor forearm compartment (except: FCU, 1/2 FDP)
(2. ) Hand: LLOAF
- lateral two lumbricals
- Opponenes pollicis
- Abductor pollicis brevis
- Flexor pollicis brevis
What makes up the snuffle box? Whats found in it?
Made up of:
- Abductor pollicis longus (lateral border)
- Extensor pollicis brevis (lateral border)
- Extensor pollicis longus (medial border)
Contains scaphoid and radial artery
What is Dupuytren’s contracture?
(1. ) Scarring and shortening of palmer fascia
(2. ) This pulls the finger into flexion
(3. ) Causes is unknown but is associated with manual workers and liver disease
What is trigger finger?
(1. ) Inflammation of tendon and synovial sheath (surrounds tendon) this causes narrowing of the space within the sheath. So tendon does not slide freely.
(2. ) This creates pain and stiffness when moving finger and then eventually get stuck in a ‘trigger’ position
What is Gamekeeper (skier’s) thumb?
(1. ) Tear of medial ligament (that attaches metacarpal to proximal phalanx on thumb).
(2. ) This happens when thumb is forced rapidly away from the hand e.g. falling when skiing
(3. ) This causes instability of the joint and thumb grip weaker
Why may you get avascular necrosis of the scaphoid?
(1. ) Scaphoid forms in two parts and receives blood supply from single artery
(2. ) Fracture on proximal end loses blood supply causes death of tissue
(3. ) This is a common complication of scaphoid fracture
What supplies the posterior compartment of the forearm?
Radial Nerve
What 12 muscles make up the posterior compartment of the forearm?
Remember 4 groups of 3!!!!
3 to digits
(1. ) Extensor digitorum
(2. ) Extensor digit minimi
(3. ) Extensor indicis
3 to the thumb
(1. ) Extensor pollicis brevis
(2. ) Extensor pollicis longus
(3. ) Abductor pollicis longus
3 to the wrist
(1. ) Extensor carpi radialis brevis
(2. ) Extensor carpi radialis longus
(3. ) Extensor carpi ulnaris
3 to the arm
(1. ) Brachiradialis
(2. ) Anconeus
(3. ) Supinator
Where do the extensor carpi radialis longus and brevis and extensor carpi ulnaris insert into?
CARPI muscles insert into the metacarpals
What muscles have origin at the lateral epicondyle? (7).
(1. ) Brachioradialis
(2. ) Anconeus
(3. ) Extensor carpi radialis longus
(4. ) Extensor carpi radialis brevis
(5. ) Extensor carpi ulnaris
(6. ) Extensor digitorium
(7. ) Extensor digiti minimi
Muscles that don’t = supinator, extensor indicies, thumb muscles
what forms the extensor expansion and what muscles insert into it?
(1. ) Tendons of the extensor digitorium form hoods over the dorsum of digits 2-5.
(2. ) The hoods (aka slips) insert into the middle and distal phlanx.
(3. ) The interossei and lumbricals are inserted into the proximal part of the extensor expansion
What is tennis and golfer’s elbow?
(1. ) Tennis = Lateral epicondylitis, pain may extend into the back of the forearm and grip strength may be weak
(2. ) Golfer = Medial epicondylitis that causes pain and inflammation in the tendons that connect the forearm to the elbow
Causes = Overusing forearm due to a repetitive or strenuous activity. It can also sometimes occur after banging or knocking your elbow.
Rupture of extensor tendon on distal phalanx - what would you expect to see?
(1. ) This is a Mallet Finger (acute injury)
(2. ) Distal IP joint will be held in flexion
How may a swan neck finger injury come about?
(1. ) This is a chronic injury, and may be as a result of a mallet finger
(2. ) Distal IP joint is held in flexion (due to distal phalanx rupture of extensor tendon), will cause extensor tendon on middle phalanx to work harder.
(3. ) Eventually proximal IP joint is held in extension so finger looks like a swan neck
What is boutonneire deformity?
(1. ) Rupture of extensor tendon at the middle phalanx (could be due to central slip)
(2. ) This causes flexion at PIP joint
(3. ) Tendon at distal phalanx will try and compensate for this by pulling hard.
(4. ) This causes DIP joint to be held in extension
What muscles are responsible for pronation of forearm
Pronator teres and pronator quadratus
What muscles are responsible for supination when the elbow is (1.)fully extended and (2.)flexed at 90 degrees?
(1. ) Supinator
(2. ) Bicep
Describe the articulations at the elbow joint
(1. ) Head of radius articulates with capitulum of humerus
(2. ) Trochlear notch and coronoid process of ulna articulates with trochlear of humerus
(3. ) Olecrannon process of ulna articulates with olecrannon fossa of humerus
(4. ) Head of radius articulates with the radial notch of the ulna. The two are held by the annular ligament.
Describe articulation at the wrist joint
(1. ) Scaphoid and lunate articulates with distal radius
(2. ) Triangular fibrocartilage connects distal radius and ulna
What carpal bone is at the base of the thumb?
trapeziUm
What muscle contributes to the first 90 degrees of abduction of the shoulder joint?
The supraspinatus muscle contributes to shoulder abduction between 0-90 degrees (along with the deltoid muscle).
The trapezius take over shoulder abduction beyond 90 degrees.
Damage to which nerve can cause a winged scapula?
The long thoracic nerve innervates serratus anterior. Damage to it can result in a winged scapula.
What four muscles attach to the medial border of the scapula
serratus anterior
levator scapulae
rhomboid minor
rhomboid major
What nerve would be damaged in a mid shaft and neck fracture of the humerus? and damage to medial epicondyl?
(1. ) Midshaft = radial nerve (Saturday night palsy)
(2. ) Neck = axillary nerve -> paralysis of deltoid and patch of numb skin on lateral arm
(3. ) medial epicondyl = ulnar nerve
