MSK Workbooks Upper Limb Flashcards
The Anterior Muscles of Forearm have what action on wrist and digits
Flexors
Anterior Muscles of Forearm facilitate what movement of forearm at radio-ulnar joint
Pronation
What muscle is the common flexor origin for superficial and intermediate flexors
Medial Epicondyle
Anterior wall of axilla is formed by which two muscles
Pec Major and Pec Minor
The posterior wall of axilla is formed by
Scapularis, Teres Major and Lat Dorsi
Medial wall of axilla formed by
Thoracic Wall and Serratus Ant
Lateral Wall of Axilla formed by
Intertubercular Groove of Humerus
The axillary artery is continuation of which artery
subclavicular artery
At what anatomical point does axillary artery begin
lateral border 1st rib
the axillary artery continues beyond the axilla as which vessel
brachial artery
at what anatomical point does the name of brachial artery change
inf border teres major
Brachial nerve plexus is formed by ventral rami of
C5-T1
which nerve roots form upper trunk of brachial plexus
C8 and T1
Which root forms middle trunk of brachial plexus
C7
Which artery and vein are trunks of brachial plexus closely related to
Axillary Artery and Vein
The cords of brachial plexus are named for position in relation to which structure
Axillary Artery
Injury to upper trunk causes what type of palsy
Erb
Waiter’s Tip is associated with what type of palsy
Erb
What does Erb’s palsy look like
medial rotation of arm with wrist flexion caused by hyper extension injury
Which group of muscles affected by Erb Palsy
C5-6
Injury to lower trunk causes what palsy
Klumpke
Klumpke’s palsy affects what
intrinsic muscles of hand, flexors of wrist and flexors of fingers
Klumpke’s palsy are most commonly caused by
shoulder dystocia at birth or trauma
5 Major Branches of Brachial Plexus
- Axillary Nerve from Pos Cord
- Radial Nerve from Pos Cord
- Musculotaneous Nerve from Lat Cord
- Ulnar Nerve from Medial Cord
- Median Nerve from Lat and Medial Cord
Which brachial plexus nerve comes from lateral and medial cord
Median Nerve
What venous arch is found at distal upper arm
Dorsal Venous Arch
Where do superficial veins of upper limb lie
Subcutaneous Tissue
The median cubital vein shunts blood form where to where
Cephalic to Basilic Vein
Where is the median cubital vein found
Ante Cubital Fossa
Most common site for venipuncture
Ante Cubital Fossa - Median Cubital Vein
The cephalic vein ascends arm where
Lateral aspect
The cephalic vein drains into
Axillary vein
The basiilic vein ascends arm where
medial arm
The basilic vein becomes which vein at lower border of teres minor
axillary vein
Where does basilica vein become axillary vein
Lower Border of Teres Minor
Following an injury to a spinal root a sensory loss (paraesthesia) will be mapped on skin according to
that dermatome
All lymphatic vessels from upper vein drain into
Axillary Nodes
Infection of little finger spreads to what lymph
Axillary
Boil in Scapula spreads to what lymph
Axillary
Medial part of breast infection spreads to what lymph
Int Mammary
Lateral part of breast infection spreads to what lymph
Axillary
infection around umbilicus spreads to what lymph
Axillary and Superficial Inguinal
What set of bones connects upper limb to axial skeleton on each side
Pectoral Girdle
The conoid tubercle attachment of conoid ligament is found where
inf aspect of lat clavicle
which part of clavicle is weakest and commonly breaks during fall
Lat/Med 1/3
What type of synovial joint is acromioclavicular joint
Plane
what type of synovial joint is sternoclavicular joint
saddle
The first 30 degrees of shoulder abduction is caused by muscles acting at which joint
glenohumeral joint
Beyond 30 degrees what do we need for shoulder abduction
Scapula Elevated
Lat Rotate Chest Wall
For every 3 degrees of shoulder abduction past initial 30 degrees 2 degrees occurs where
glenohumeral joint and 1 degree due to scapula thoracic movement
Elevation of Scapula Muscles (3)
Trapezius
Levator Scapulae
Rhomboids
Depression of Scapula Muscles (5)
Trapezius Pec Minor Subclavius Serratus Ant Lat Dorsi
Protraction of Scapula Muscles (2)
Serratus Ant
Pec Major
Retraction of Scapula Muscles
- Trapezius Middle Fibre
2. Rhomboids
Which muscles elevate glenoid cavity
Trapezius and Serratus Ant
Which muscles depress glenoid cavity (medial rotate)
- Levator Scapulae
- Rhomboid Major and minor
- Pec Minor
The shoulder joint is what type of joint
Ball and Socket Synovial
Head of the Humerus is what in shoulder joint
Ball
Glenoid Cavity is what in shoulder joint
Socket
Rim of Cartilage surrounding glenoid cavity in shoulder is called
Glenoid Labrum
The coracohumeral ligament strengthens
upper aspect of joint capsule
The coraco-acromial arch is made up of
acromial and coracoid process of scapula and ligament
The coraco-acromial arch prevents
superior displace of humeral head
Which part of shoulder joint capsule is weakest
Inferior
What are the two bursa of shoulder called
- Subacromial (SUbdeltoid)
2. Subscapula
Which bursa communicates with joint cavity
Subscapular
What is the role of subacromial bursa
movement
Name the four rotator cuff muscles
- Subscapularis
- Supraspinatus
- Infraspinatus
- Teres minor
Proximal attachment of Subscapularis
medial 2/3 of costal scapula
Proximal attachment of supraspinatus
scapula
proximal attachment of infraspinatus
infraspinous fossa of scapula
proximal attachment of teres minor
upper 2/3 of lat border of scapula
distal attachment of subscapularis
lesser tuberosity
distal attachment of supraspinatus
greater tuberosity of humerus
distal attachment of infraspinatus
mid facet of greater tuberosity of humerus
distal attachment of teres minor
lesser tuberosity of humerus
Subscapularis movement at shoulder
adduct and med rotate
supraspinatus movement at shoulder
abduct
infraspinatus movement at shoulder
lat rotate
teres minor movement at shoulder
adduct and lat rotate
deltoid arises form
lateral spine of scapula
distal attachment of deltoid
deltoid tuberosity of humerus
Anterior fibres of deltoid do what at shoulder
Flex and Med Rotate
Middle fibres of deltoid do what at shoulder
Abduct
posterior fibres of deltoid do what at shoulder
Extend and Lat Rotate
nerve supply to deltoid
Axillary
common injury where axillary nerve damaged
shoulder dislocate
Distal attachment of pectorals major
intertuberuclar lip of bicipital groove of humerus
pectoralis major action on shoulder
adduct shoulder and medial rotate the humerus at glenohumeral joint
which muscle helps to stabilise scapula
serratus anterior
serratus anterior inserts where
into scapula
What action does superior fibres of trapezius have on scapula
Retraction and Rotate Scapula during Abduct
What action does middle fibres of trapezius have on scapula
Retract
what action of inferior fibres of trapezius have on scapula
pull scapula inferiorly
Trapezius innervation
Accessory
Which foramen of skull does Accessory nerve pass through
Jugular
Which three muscles contribute to flexion of shoulder (sagittal)
- Pec Major
- Ant Deltoid
- Coracobrachialis
Which three muscles contribute to extension of shoulder
- Pos Deltoid
- Lat Dorsi
- Teres Major
Which three muscles contribute to adduction of shoulder
- Pec Major
- Lat Dorsi
- Teres Major
Which 2 muscles contribute to shoulder joint abduction 0-90 degrees
- SUpraspinatus
2. Lat Dorsi
Which 2 muscles contribute to shoulder joint abduction 90-180 degrees
- Trapezius
2. Serratus Ant
Medial or Internal Rotation movements of shoulder. which muscles (3)
- Subscapularis
- Lat Dorsi
- Pec Major
- Teres major
Lat or External Rotation movement of shoulder. Which muscles
- Infraspinatus
2. Teres Minor
Which four structures in ant arm
- Biceps Brachii
- Corachobracialis
- Musuclocut Nerve
- Brachialis mMuscle
What is the most superficial muscle of anterior arm
Biceps Brachii
Biceps Brachii arises from where
Scapula
Tendon from biceps inserts onto
Radial Tuberosity
The short head of biceps muscle originates from
Coracoid process of scapula
The long head of biceps muscle originates from
Supraglenoid tubercle of scapula
The biceps action
Flexes shoulder and elbow
At the superior radio-ulnar joint where is the biceps involved in
supination
what is the action in which radius rotates over ulna
supination
The coracobrachialis muscle inserts into
medial aspect of humerus mid shaft
Coracobrachialis action
Flex Arm at Shoulder
Brachialis muscle arises from
Ant Distal shaft of Humerus
Brachialis muscle attachment
Ulner
Brachialis action
flex elbow
The musculocutaneous nerve arises as terminal branch where
lat cord of brachial plexus
What is the main nerve of ant compartment of arm
musculocutaneous nerve
How does musculocutaneous nerve enter arm
perforate coracobrachialis
What happens to musculocutaneous nerve after crossing elbow
supplies skin as lat cutaneous nerve
Segmental or Root value of musculocutaneous nerve
C5-C7
Where does musculocutaneous nerve supply
Sensory Lat Forearm
Motor: Biceps, Brachialis and Coracobrachialis
The brachial artery is a direct continuation of which artery
Axillary
Where does brachial artery begin
Lower border of teres major
where does brachial artery end
cubital fossa by dividing into radial and ulnar arteries
where is the cubital fossa close to
neck of radius
What is the deep artery of arm
Profunda Brachii
which artery passes deep to triceps
Profunda Brachii
How does the median nerve arise in arm
Two roots: one med and one lat cord of brachial plexus
how does median nerve descend in arm
Lat side of Axillary and upper Brachial artery
what happens to the median nerve in arm in middle part of arm
Crosses to med aspect of brachial artery and enters cubital fossa.
The ulnar artery arises from
Medial cord of brachial plexus
Ulnar artery descends along
Medial brachial artery and enters pos compartment of arm through medial intermuscular septum
where does ulnar artery lie behind eventually
along medial head of triceps and to lie behind epicondyle at elbow
Triceps arises by
long head of scapula and by lateral and medial heads from humerus
common tendon of triceps is inserted into
olecranon process of ulna
Which head of triceps attaches onto infra glenoid tubercle of scapula
long
main action of triceps on elbow
extend
Action of Triceps and Anconeus Muscle
Extend Forearm
Stabilise
Nerve supply to triceps and ancones
radial nerve
radial nerve is one of the terminal branches of which cord of brachial plexus
pos
The radial nerve supplies where
extensor arm and forearm including wrist
Radial nerve enters arm anterior to
long and medial head of tripeps
radial nerve runs with
radial artery
the radial artery is a branch of
brachial artery
the radial artery descends down around midshaft humerus in radial groove then does what
appears between humerus and triceps
Segmental root value of radial nerve
C5-8 and T1
Fracture to Surgical Neck associated with which nerve injury
Axillary Nerve
Fracture to Medial Epicondyle associated with which nerve injury
Ulnar Nerve
Fracture to Spiral groove associated with which nerve injury
Radial Nerve
Which vein lies anterior to roof of antecubital fossa
median cubital fossa
at what level does brachial artery bifurcate into radial and ulnar artery
neck of radius
The cephalic vein lies over where
Ant Lat Aspect
The basilica artery lies over
Medial Fossa
Which ligament holds ulnar in place
Ulnar Collateral Ligament
Which ligament holds head of radius in place
Radial Collat Ligament
Which muscles cause flexion of elbow
Brachialis
Brachioradialis
Biceps
which muscles cause elbow extension
Triceps
Anconeus
Tennis elbow is related to inflammation of muscle tendons attached to
lat epicondyle of elbow
golfer elbow is related to inflammation of muscle tendons attached to
medial epicondyle of elbow
Radius and Ulnar are bones found where
forearm
Type of joint Radius and Ulna
Pivot Synovial allowing pronation and supination
The proximal radio-ulnar joint is supported by which ligament arising at elbow which keeps head of radius in place
Radial Annular Ligament
Supination and Pronation are movements of which joint
radio-ulnar
Muscles involved in Supination of radio ulnar joint
- Pronator Quad
2. Pronator Teres
Muscles involved in Pronation of radio ulnar joint
- Supinate
2. Biceps Brachii
Anterior compartment of arm muscles do what
Flex Wrist and Digits and help with Pronation at radioulnar joint
Medial epicondyle of humerus acts as
common flexor origin
Where is golfer’s elbow reflected
medial epicondyle of humerus
Which muscle is missing in 20% of people in anterior forearm
Palmaris Longus
Which superficial flexor of arm is most medial
Flexor Carpi Ulnaris
which superficial flexor of arm is most lateral
Pronator Teres
Action of pronator teres
pronate arm
Apart from flexing the wrist, which superficial muscle is involved in adduction (ulnar deviation) of the wrist joint?
flexor carpi ulnaris
Apart from flexing the wrist, which superficial muscle is involved in abduction (radial deviation) of the wrist joint?
flexor carpi radialis
which superficial anterior arm is not supplied by median nerve
flexor digotirum lumbricals
the flexor digitorum lubricals is supplied by
ulnar nerve
Flexor Digitorum Superficialis is deep to
Superficial flexors in forearm
Which muscle is seen as only muscle on intermediate group on forearm
Flexor Digitorum Superficialis
To which fingers are the four tendons of FDS attached
2-5
On which phalanx are four tendons of FDS attached
Palmar
The Flexor Digitorum Superficialis actions
Flex wrist
Flex Metacarpophalangeal
Flex Prox Interphalangeal
Which nerve innervates Flexor Digitorum Superficialis
Medial
The brachioradialis acts on which joint
Flex Elbow
Which nerve innervates brachioradialis
Radial
Which muscle is an exception to the rule that all flexors lie in anterior compartment
Brachioradialis
The brachioradialis lies in which compartment
posterior
Injury to upper trunk causes what type of Palsy
Erb Palsy
How is Erb palsy features
Waiter Tip
Medial Rotation of Arm with wrist flex
How does Erb’s Palsy happen
Hyperextend of Head from Shoulder
Which group of muscles affected in Erb Palsy
C5-6
Which muscles are involved in Erb Palsy
Biceps Brachii
Brachalis
Corticobronchialis
Brachioradialis
Injury to Lower Trunk causes
Klumpke Palsy
Klumpke Palsy mechanism
Shoulder Dystocia at birth
Trauma
The flexor digitorum profounda is in relation to which bone
Ulna
The flexor policis longus is in relation to which bone
Radius
The pronator quadrates is in relation to which bones
Ulna and Radius
Flexor Digitorum Profundus action on wrist and fingers
Flexion
Flexor Digitorum Profundus nerve supply
Ulnar and Median
Which part of Flexor Digitorum Profundus supplied by Ulnar nerve
Medial
Which part of Flexor Digitorum Profundus supplied by median nerve
Lateral
Flexor Pollics Longus is what type of muscle
Flexor of Thumb
Which nerve innervates Flexor Pollics Longus
Anterior interosseous C8-T1 of Median
Pronator Quadratus origin and insertion
Ulna to Radius
Innervation of Pronator Quadrates
Anterior Interosseous Nerve
The median nerve enters forearm where
Ant to Brachial Artery
The median nerve goes under which muscle
pronator teres
After the median nerve enters the carpal tunnel where does it travel below
Flexor retinaculum
which muscle does median nerve not supply in anterior forearm
Flexor Carpi Ulnaris and Medial half of Flexor digitorum profundus
The ulnar nerve passes posterior to which epicondyle of humerus
Medial
The ulnar nerve enters forearm how
Pass between heads of Flexor Carpi Ulnaris Muscle
The ulnar nerve lies
medial to ulnar artery at wrist
The brachial artery exits where
ante cubital fossa
Where does brachial artery divide and into what
Ante Cubital Fossa into Radial and Ulnar arteries
where is the antecubital fossa
neck of radius
The ulnar artery lies between which muscles
Flexor Carpi Ulnaris and Flexor DIgitorum Profundus
which artery forms the superficial palmar arch
ulnar
The radial artery starts under which muscle
brachioradialis
how does radial artery enter hand
forming deep palmar arch
which arterial pulse can you feel under distal third of forearm medial to tendon of flexor carpi radials
ulnar
How to determine patency of arteries in distal forearm
Allen’s Test
The carpal tunnel passes deep to
Flexor Retinaculum
Which muscle stabilises the carpal bones
Flexor Retinaculum
The flexor retinaculum is anchored to which carpal bones on lateral side
Scaphoid and Trapezium
The flexor retinaculum is anchored to which carpal bones on medial side
Pisiform and Hamate
Contents of carpal tunnel
4 tendons of flexor digitorum profundus
4 tendons of flexor digitorum superficialis
1 tendon of flexor policis longus
median nerve
which muscle is dissected in carpal tunnel syndrome
flexor retinaculum
which muscle of forearm is continuous with fascia of palm
palmaris longus
How many compartments of muscles of hand
5
What is the first compartment of muscles of hand
Thenar
What is the second compartment of muscles of hand
Hypothenar
what is the third compartment of muscles of hand
Lumbricals and Long Flexor Tendons
what is the fourth compartment of muscles of hand
Adductor
what is the fifth compartment of muscles of hand
Interosseous
Thenar muscles are found
Lateral Palm
How many thenar muscles
3
What are the three thenar muscles
Flexor Pollicis Brevis
Opponens Pollicis
Abductor Pollicis Brevis
Nerve supply for thenar eminence
Median Nerve except FPB
Deep belly of Flexor Pollicis brevis innervation
Ulnar nerve
Which nerve segment from brachial plexus serves to provide majority of innervation to thenar muscles
Median C6-T1
Hypothenar Muscles
Abductor Digit Minimis
Flexor Digiti Minimi
Opponens Digiti Minimi
Which nerve innervates hypothenar muscles
Ulnar
Which nerve root from brachial plexus serves to provide majority of innervation to Hypothenar Muscles
C8-T1
Opposition is movement of fingers
towards each other
Where is central compartment in hand found
Deep to thenar and hypothenar eminence
The central compartment of hand contains
flexor tendons
Flexor tendons of hand
Flexor Digitorum Profundus
Flexor Digitorum Superficialis
Flexor Pollicis longus
Where do the lumbricals originate
Central Compartment of Hand
Where do the lumbricals arise from
medial and lateral FDP Tendon between 1st-5th metacarpals
The lumbricals do what at fingers
Flex fingers
The lumbricals flex fingers where
Metacarpophalngeal Joint
The lumbricals extend what joint
Interphalangeal joint of 2nd-5th digits
The medial two lumbricals are innervated by
Ulnar nerve
lateral two lumbricals innervated by
Median Nerve
How many heads does Adductor pollicis have
two
What are the heads of Adductor Pollicis
Adductor Pollicis Oblique and Adductor Pollcis Transverse
Contraction of Adductor Pollicis action
Adducts Thumb
Which nerve innervates adductor pollicis
Ulnar
Which muscles are deepest in hand
Interossi
Where do the interossei lie
Between fingers
Dorsal Interossei action
abduct fingers
Palmar interossei action
Adduct fingers
which nerve innervates dorsal and palmar interossei
ulnar
which spinal segment contributes the most to innervation of interossei
C8-T1
which arteries supply blood to hand
radial and ulnar
once the radial and ulnar arteries reach palm they form
superficial and deep palmar arch
which artery contributes to superficial palmar arch
Ulnar
which artery contributes to deep palmar arch
Radial
Which nerves supply hand
Median and ulnar
The median nerve enters hand through
cubital fossa
which muscles does median nerve not supply in hand
Deep Belly FPB and 1st and 2nd Metacarpal
Which nerves innervates Deep Belly FDP and 1st and 2nd
Ulnar
Ulnar and median nerves carry which fibres
C6-T1
The ulnar nerve is a branch of
medial inferior brachial plexus
How to test Axillary Nerve
Abduct shoulders (Deltoid) and Outer Shoulder
How to test Musculocutaenous Nerve
Flex elbow
How to test Radial Nerve
Extend Wrist
How to test Ulnar nerve
Spread fingers
How to test median nerve
Move thumb towards nose (abductor pollicis brevis)
What sits between ulna and carpal bones
Radiocarpal Joint and Articular Hyaline Cartilage
the radius articulates with which carpal bones
Scaphoid and Lunate
what type of fluid found between forearm and carpal bones
Synovial
flexion of wrist caused by
contraction of anterior compartment muscles
extension of wrist caused by
contraction of posterior compartment muscles
the combined action of flexion and extension carpi ulnas cause
radial deviation or extension of wrist
which muscles are responsible for radial deviation/abduction of wrist
abductor pollicis and flexor carpi radialis
circumduction of joint is what movement of wrist
rotation
Which bones sit between carpal bones and phalanges
Metacarpals
How many metacarpals
5
Where do metacarpals articulate proximally and distal
Proximal - Carpo-Meto Carpal Joint
Distal: Metacapophalngeal Joint
Phalanges are the
distal bones in hand
In fingers 2-5 what phalanges are there
Prox, Mid and distal
in thumb what phalanges are there
prox and distal
Muscles that extend and abduct or adduct hand at wrist
Extensor Carpi Radialis longus
Extensor carpi radialis brevis
extensor carpi ulnas
Action of extensor carpi radialis longus and brevis on wrist
extend and abduct wrist
what action is extensor carpi radialis longus and brevis with help of flexor carpi radialis
radial deviation of wrist
Muscles that extend medial four digits
Extensor digitorum
Extensor indicis
extensor digiti minimi
Extensor Digitorum origin
Lateral Epicondyle of Humerus
Muscles that extend or abduct thumb
Abductor Pollicis Longus
Extensor Pollics Brevis
Extensor Pollicis Longus
Where is supinator found
Proximal extensor compartment
Action of supinator
supinate forearm
Which nerve innervates
Extensor Digitorum Extensor Carpi Radialis Longus Extensor Carpi Radialis Brevis Brachioradialis Extensor Carpi Ulnaris Supinator Extensor Digiti Minimi
Radial
What is the deep branch of radial nerve in posterior forearm known as
Posterior
Interosseous Nerve
Main motor nerve of extensors of forearm
Posterior
Interosseous Nerve
Where does superficial radial nerve enter hand
over anatomical snuffbox
Posterior interosseous artery arises from
Ulnar artery
recurrent interosseous artery is a branch of
Ulnar artery
What provides stability proximally on dorsum of hand
extensor retinaculum
The cephalic vein lies at
lat continuation of dorsal venous arch proximally
the basilica vein lies as
medial continuation of dorsal venous arch
Which nerve innervates
Extensor pollicis longus
extensor pollicis brevis
adductor pollicis longus
Posterior Interosseous nerve
Colles fracture is a common fracture of
distal radius with anterior displacement
Dinner fork fracture deformity associated with
colles fracture/distal radius/fall onto extended wrist
Smith’s fracture is associated with
posterior displacement of radius
Fall onto flexed wrist
Most fractured carpal bone
Scaphoid Fracture
Pain felt in anatomical snuff box
Which muscles attach onto extensor expansion in dorsal digital of hand
Lumbrical
Dorsal Interossei
Palmar Interossei
Extensor indiasis
