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Anatomy > MSK: upper limb > Flashcards

MSK: upper limb Flashcards

1
Q

palmaris longus muscle: origin, insert, action

A
  • 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.
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2
Q

Describe the brachial plexus

A
  1. (5)Root -> (3)Trunk -> (6)Divisions -> (3)Cords -> (5)branches

mnemonic = Read That Damn Cadaver Book

  1. The brachial plexus is formed by the anterior rami of C5, C6, C7, C8 and T1 (roots).
  2. These roots form 3 trunks: upper, middle, lower
  3. These trunks become 6 divisions (anterior and posterior for each trunk).
  4. These form 3 cords: lateral, posterior, medial
  5. These five terminal branches (in order MAMRU): musculocutaneous, axillary, median, radial, ulnar.
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3
Q

Anatomical borders of the axilla (anterior, posterior, lateral, medial, apex)

A

(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

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4
Q

Name the four rotator cuff muscles and their origin, insertion, action

A

(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

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5
Q

Whats parts of the scapula articulates with humerus and clavicle

A

(1. ) Head of humerus articulates with coracoid process and glenoid fossa
(2. ) Clavicle articulates with acromion process

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6
Q

Whats muscles elevate and retract the scapula (3.)

A

(1. ) Levator scapulae

(2. ) Rhomboid major and minor

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7
Q

Deltoid: origin, insertion, action, innervation

A
  • Origin = clavicle, acromion process, spine of scapula
  • Inserts = deltoid tuberosity on humerus
  • action = flex, abduct, extend arm
  • innervation = axillary nerve
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8
Q

What is a frozen shoulder?

A

(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

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9
Q

What causes an axillary nerve palsy? and what sensory and motor loss is seen?

A

(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

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10
Q

What causes a radial nerve palsy?

A

(1. ) Radial nerve run in the groove of the humerus

(2. ) This can be easily damaged by fracture or direct pressure

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11
Q

What causes an ulnar nerve palsy?

A

(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.

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12
Q

What is found within the axilla?

A

(1. ) Fat and lymph nodes
(2. ) Axillary artery and vein
(3. ) Brachial plexus

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13
Q

Tricep brachii: origin, insertion, innervation, blood supply

A

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

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14
Q

Name 3 branches that come off the posterior cord? and what do they supply?

A

(1. ) Axillary nerve = deltoid
(2. ) Radial nerve = extensors of arm and forearm
(3. ) Thoracodorsal nerve = lats

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15
Q

Name 2 branches that come off the lateral cord?

A

(1. ) Musculocutaneous

2. ) Median nerve (both lateral + medial cord

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16
Q

Name 2 branches that come off the medial cord?

A

(1. ) Median nerve (both lateral + medial cord)

(2. ) Ulnar nerve

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17
Q

Describe the relationship between the brachial plexus’ cords and axillary artery

A

(1. ) Lateral cord is found lateral to the axillary artery

(2. ) Medial cord is found medial to the axillary artery

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18
Q

What provides stability to the shoulder joint?

A

(1. ) Rotator cuff muscles
(2. ) Glenoid labrum
(3. ) Ligaments

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19
Q

What borders make up the cubital fossa

A

(1. ) Medial border = pronator teres
(2. ) Lateral border = brachioradialis
(3. ) Superior border = line between epicondyles

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20
Q

What is found in the cubital fossa

A

(1. ) Tendon of bicep
(2. ) Brachial artery
(3. ) Median nerve
(4. ) Superficial veins (basilic v = medially, cephalic v = laterally)

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21
Q

What is the blood supply and innervation of the coracobrachialis, bicep brachii, brachialis?

A

(1. ) Brachial A

(2. ) Musculocutaneous N

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22
Q

What drains into the axillary lymph node

A

(1. ) Upper limb
(2. ) Thorax
(3. ) Abdominal wall above the umbilicus

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23
Q

What would you see if the there was damage to the upper trunk of the brachial plexus (C5 + C6)

A

(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’

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24
Q

What would you see if the there was damage to the lower trunk of the brachial plexus (T1 + C8)

A

(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,

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25
Q

What would you see if there was damage to T1?

A

(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.

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26
Q

Most commonly injured bones

A

(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

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27
Q

Course and distribution of major arteries in upper limb

A

(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

28
Q

Bicep brachii: origin, insertion, action, innervation, blood supply

A
  • 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
29
Q

What is the common origin for flexors of the forearm

A

Medial epicondyle

30
Q

Cutaneous (sensory) innervation of the hand

A

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

31
Q

What is the common origin for flexors of the forearm? What muscles do not fall in this?

A

(1. ) Medial epicondyle
(2. ) FDP and Pronator quadratus = ulna
(3. ) FPL = radius

32
Q

Cutaneous (sensory) innervation of the hand

A

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

33
Q

List the nerves that innervate the forearm

A

(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

34
Q

What muscles are found in the flexor compartment? (1.) superficial (2.) middle, (3) deep planes.

A

Superficial

  • Pronator teres
  • Flexor carpi radialis
  • Palmaris longus
  • Flexor carpi ulnaris

Middle
- Flexor digitorium superficialis

Deep

  • Flexor digitorium profundus
  • Flexor pollicis longus
  • Pronator quadratus
35
Q

What is carpal tunnel syndrome?

A

(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

36
Q

What is a ganglion cyst?

A
  • 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
37
Q

Pronator Quadratus: origin, insertion, action, innervation

A
  • origin = ulna
  • insert = radius
  • action = pronates forearm
  • innervation = median nerve
38
Q

Name the carpal bone of the left hand in order

A

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.

39
Q

What actions are produced from the interosseus? Innervation?

A

‘PAD DAB’

(1. ) Palmar interossues = adduct
(2. ) Dorsal interosseus = abduct
(3. ) Innervated by ulnar nerve

40
Q

Where may you find tendon sheaths in the hand?

A

Around tendons of FDS, FDP, FPL

41
Q

What muscles make up the thenar group? Innervation?

A

Thenar muscles innervated by medial nerve

(1. ) Abductor pollicis brevis
(2. ) Flexor pollicis brevis
(3. ) Opponens pollicis

(4.) Adductor pollicis - innervated by ulnar nerve

42
Q

What muscles make up the hypothenar group? Innervation?

A

Innervated by the ulnar nerves

(1. ) Abductor digiti minimi
(2. ) Flexor digiti minimi
(3. ) Opponens digits minimi

43
Q

Attachment of lumbricals? Innervation?

A

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

44
Q

What does the median nerve innervate?

A

(1. ) Flexor forearm compartment (except: FCU, 1/2 FDP)
(2. ) Hand: LLOAF
- lateral two lumbricals
- Opponenes pollicis
- Abductor pollicis brevis
- Flexor pollicis brevis

45
Q

What makes up the snuffle box? Whats found in it?

A

Made up of:

  • Abductor pollicis longus (lateral border)
  • Extensor pollicis brevis (lateral border)
  • Extensor pollicis longus (medial border)

Contains scaphoid and radial artery

46
Q

What is Dupuytren’s contracture?

A

(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

47
Q

What is trigger finger?

A

(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

48
Q

What is Gamekeeper (skier’s) thumb?

A

(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

49
Q

Why may you get avascular necrosis of the scaphoid?

A

(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

50
Q

What supplies the posterior compartment of the forearm?

A

Radial Nerve

51
Q

What 12 muscles make up the posterior compartment of the forearm?

A

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

52
Q

Where do the extensor carpi radialis longus and brevis and extensor carpi ulnaris insert into?

A

CARPI muscles insert into the metacarpals

53
Q

What muscles have origin at the lateral epicondyle? (7).

A

(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

54
Q

what forms the extensor expansion and what muscles insert into it?

A

(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

55
Q

What is tennis and golfer’s elbow?

A

(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.

56
Q

Rupture of extensor tendon on distal phalanx - what would you expect to see?

A

(1. ) This is a Mallet Finger (acute injury)

(2. ) Distal IP joint will be held in flexion

57
Q

How may a swan neck finger injury come about?

A

(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

58
Q

What is boutonneire deformity?

A

(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

59
Q

What muscles are responsible for pronation of forearm

A

Pronator teres and pronator quadratus

60
Q

What muscles are responsible for supination when the elbow is (1.)fully extended and (2.)flexed at 90 degrees?

A

(1. ) Supinator

(2. ) Bicep

61
Q

Describe the articulations at the elbow joint

A

(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.

62
Q

Describe articulation at the wrist joint

A

(1. ) Scaphoid and lunate articulates with distal radius

(2. ) Triangular fibrocartilage connects distal radius and ulna

63
Q

What carpal bone is at the base of the thumb?

A

trapeziUm

64
Q

What muscle contributes to the first 90 degrees of abduction of the shoulder joint?

A

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.

65
Q

Damage to which nerve can cause a winged scapula?

A

The long thoracic nerve innervates serratus anterior. Damage to it can result in a winged scapula.

66
Q

What four muscles attach to the medial border of the scapula

A

serratus anterior
levator scapulae
rhomboid minor
rhomboid major

67
Q

What nerve would be damaged in a mid shaft and neck fracture of the humerus? and damage to medial epicondyl?

A

(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

Anatomy (8 decks)

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