MSK Workbooks Upper Limb Flashcards

1
Q

The Anterior Muscles of Forearm have what action on wrist and digits

A

Flexors

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2
Q

Anterior Muscles of Forearm facilitate what movement of forearm at radio-ulnar joint

A

Pronation

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3
Q

What muscle is the common flexor origin for superficial and intermediate flexors

A

Medial Epicondyle

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4
Q

Anterior wall of axilla is formed by which two muscles

A

Pec Major and Pec Minor

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5
Q

The posterior wall of axilla is formed by

A

Scapularis, Teres Major and Lat Dorsi

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6
Q

Medial wall of axilla formed by

A

Thoracic Wall and Serratus Ant

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7
Q

Lateral Wall of Axilla formed by

A

Intertubercular Groove of Humerus

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8
Q

The axillary artery is continuation of which artery

A

subclavicular artery

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9
Q

At what anatomical point does axillary artery begin

A

lateral border 1st rib

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10
Q

the axillary artery continues beyond the axilla as which vessel

A

brachial artery

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11
Q

at what anatomical point does the name of brachial artery change

A

inf border teres major

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12
Q

Brachial nerve plexus is formed by ventral rami of

A

C5-T1

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13
Q

which nerve roots form upper trunk of brachial plexus

A

C8 and T1

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14
Q

Which root forms middle trunk of brachial plexus

A

C7

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15
Q

Which artery and vein are trunks of brachial plexus closely related to

A

Axillary Artery and Vein

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16
Q

The cords of brachial plexus are named for position in relation to which structure

A

Axillary Artery

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17
Q

Injury to upper trunk causes what type of palsy

A

Erb

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18
Q

Waiter’s Tip is associated with what type of palsy

A

Erb

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19
Q

What does Erb’s palsy look like

A

medial rotation of arm with wrist flexion caused by hyper extension injury

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20
Q

Which group of muscles affected by Erb Palsy

A

C5-6

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21
Q

Injury to lower trunk causes what palsy

A

Klumpke

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22
Q

Klumpke’s palsy affects what

A

intrinsic muscles of hand, flexors of wrist and flexors of fingers

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23
Q

Klumpke’s palsy are most commonly caused by

A

shoulder dystocia at birth or trauma

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24
Q

5 Major Branches of Brachial Plexus

A
  1. Axillary Nerve from Pos Cord
  2. Radial Nerve from Pos Cord
  3. Musculotaneous Nerve from Lat Cord
  4. Ulnar Nerve from Medial Cord
  5. Median Nerve from Lat and Medial Cord
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25
Which brachial plexus nerve comes from lateral and medial cord
Median Nerve
26
What venous arch is found at distal upper arm
Dorsal Venous Arch
27
Where do superficial veins of upper limb lie
Subcutaneous Tissue
28
The median cubital vein shunts blood form where to where
Cephalic to Basilic Vein
29
Where is the median cubital vein found
Ante Cubital Fossa
30
Most common site for venipuncture
Ante Cubital Fossa - Median Cubital Vein
31
The cephalic vein ascends arm where
Lateral aspect
32
The cephalic vein drains into
Axillary vein
33
The basiilic vein ascends arm where
medial arm
34
The basilic vein becomes which vein at lower border of teres minor
axillary vein
35
Where does basilica vein become axillary vein
Lower Border of Teres Minor
36
Following an injury to a spinal root a sensory loss (paraesthesia) will be mapped on skin according to
that dermatome
37
All lymphatic vessels from upper vein drain into
Axillary Nodes
38
Infection of little finger spreads to what lymph
Axillary
39
Boil in Scapula spreads to what lymph
Axillary
40
Medial part of breast infection spreads to what lymph
Int Mammary
41
Lateral part of breast infection spreads to what lymph
Axillary
42
infection around umbilicus spreads to what lymph
Axillary and Superficial Inguinal
43
What set of bones connects upper limb to axial skeleton on each side
Pectoral Girdle
44
The conoid tubercle attachment of conoid ligament is found where
inf aspect of lat clavicle
45
which part of clavicle is weakest and commonly breaks during fall
Lat/Med 1/3
46
What type of synovial joint is acromioclavicular joint
Plane
47
what type of synovial joint is sternoclavicular joint
saddle
48
The first 30 degrees of shoulder abduction is caused by muscles acting at which joint
glenohumeral joint
49
Beyond 30 degrees what do we need for shoulder abduction
Scapula Elevated | Lat Rotate Chest Wall
50
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
51
Elevation of Scapula Muscles (3)
Trapezius Levator Scapulae Rhomboids
52
Depression of Scapula Muscles (5)
``` Trapezius Pec Minor Subclavius Serratus Ant Lat Dorsi ```
53
Protraction of Scapula Muscles (2)
Serratus Ant | Pec Major
54
Retraction of Scapula Muscles
1. Trapezius Middle Fibre | 2. Rhomboids
55
Which muscles elevate glenoid cavity
Trapezius and Serratus Ant
56
Which muscles depress glenoid cavity (medial rotate)
1. Levator Scapulae 2. Rhomboid Major and minor 3. Pec Minor
57
The shoulder joint is what type of joint
Ball and Socket Synovial
58
Head of the Humerus is what in shoulder joint
Ball
59
Glenoid Cavity is what in shoulder joint
Socket
60
Rim of Cartilage surrounding glenoid cavity in shoulder is called
Glenoid Labrum
61
The coracohumeral ligament strengthens
upper aspect of joint capsule
62
The coraco-acromial arch is made up of
acromial and coracoid process of scapula and ligament
63
The coraco-acromial arch prevents
superior displace of humeral head
64
Which part of shoulder joint capsule is weakest
Inferior
65
What are the two bursa of shoulder called
1. Subacromial (SUbdeltoid) | 2. Subscapula
66
Which bursa communicates with joint cavity
Subscapular
67
What is the role of subacromial bursa
movement
68
Name the four rotator cuff muscles
1. Subscapularis 2. Supraspinatus 3. Infraspinatus 4. Teres minor
69
Proximal attachment of Subscapularis
medial 2/3 of costal scapula
70
Proximal attachment of supraspinatus
scapula
71
proximal attachment of infraspinatus
infraspinous fossa of scapula
72
proximal attachment of teres minor
upper 2/3 of lat border of scapula
73
distal attachment of subscapularis
lesser tuberosity
74
distal attachment of supraspinatus
greater tuberosity of humerus
75
distal attachment of infraspinatus
mid facet of greater tuberosity of humerus
76
distal attachment of teres minor
lesser tuberosity of humerus
77
Subscapularis movement at shoulder
adduct and med rotate
78
supraspinatus movement at shoulder
abduct
79
infraspinatus movement at shoulder
lat rotate
80
teres minor movement at shoulder
adduct and lat rotate
81
deltoid arises form
lateral spine of scapula
82
distal attachment of deltoid
deltoid tuberosity of humerus
83
Anterior fibres of deltoid do what at shoulder
Flex and Med Rotate
84
Middle fibres of deltoid do what at shoulder
Abduct
85
posterior fibres of deltoid do what at shoulder
Extend and Lat Rotate
86
nerve supply to deltoid
Axillary
87
common injury where axillary nerve damaged
shoulder dislocate
88
Distal attachment of pectorals major
intertuberuclar lip of bicipital groove of humerus
89
pectoralis major action on shoulder
adduct shoulder and medial rotate the humerus at glenohumeral joint
90
which muscle helps to stabilise scapula
serratus anterior
91
serratus anterior inserts where
into scapula
92
What action does superior fibres of trapezius have on scapula
Retraction and Rotate Scapula during Abduct
93
What action does middle fibres of trapezius have on scapula
Retract
94
what action of inferior fibres of trapezius have on scapula
pull scapula inferiorly
95
Trapezius innervation
Accessory
96
Which foramen of skull does Accessory nerve pass through
Jugular
97
Which three muscles contribute to flexion of shoulder (sagittal)
1. Pec Major 2. Ant Deltoid 3. Coracobrachialis
98
Which three muscles contribute to extension of shoulder
1. Pos Deltoid 2. Lat Dorsi 3. Teres Major
99
Which three muscles contribute to adduction of shoulder
1. Pec Major 2. Lat Dorsi 3. Teres Major
100
Which 2 muscles contribute to shoulder joint abduction 0-90 degrees
1. SUpraspinatus | 2. Lat Dorsi
101
Which 2 muscles contribute to shoulder joint abduction 90-180 degrees
1. Trapezius | 2. Serratus Ant
102
Medial or Internal Rotation movements of shoulder. which muscles (3)
1. Subscapularis 2. Lat Dorsi 3. Pec Major 4. Teres major
103
Lat or External Rotation movement of shoulder. Which muscles
1. Infraspinatus | 2. Teres Minor
104
Which four structures in ant arm
1. Biceps Brachii 2. Corachobracialis 3. Musuclocut Nerve 4. Brachialis mMuscle
105
What is the most superficial muscle of anterior arm
Biceps Brachii
106
Biceps Brachii arises from where
Scapula
107
Tendon from biceps inserts onto
Radial Tuberosity
108
The short head of biceps muscle originates from
Coracoid process of scapula
109
The long head of biceps muscle originates from
Supraglenoid tubercle of scapula
110
The biceps action
Flexes shoulder and elbow
111
At the superior radio-ulnar joint where is the biceps involved in
supination
112
what is the action in which radius rotates over ulna
supination
113
The coracobrachialis muscle inserts into
medial aspect of humerus mid shaft
114
Coracobrachialis action
Flex Arm at Shoulder
115
Brachialis muscle arises from
Ant Distal shaft of Humerus
116
Brachialis muscle attachment
Ulner
117
Brachialis action
flex elbow
118
The musculocutaneous nerve arises as terminal branch where
lat cord of brachial plexus
119
What is the main nerve of ant compartment of arm
musculocutaneous nerve
120
How does musculocutaneous nerve enter arm
perforate coracobrachialis
121
What happens to musculocutaneous nerve after crossing elbow
supplies skin as lat cutaneous nerve
122
Segmental or Root value of musculocutaneous nerve
C5-C7
123
Where does musculocutaneous nerve supply
Sensory Lat Forearm | Motor: Biceps, Brachialis and Coracobrachialis
124
The brachial artery is a direct continuation of which artery
Axillary
125
Where does brachial artery begin
Lower border of teres major
126
where does brachial artery end
cubital fossa by dividing into radial and ulnar arteries
127
where is the cubital fossa close to
neck of radius
128
What is the deep artery of arm
Profunda Brachii
129
which artery passes deep to triceps
Profunda Brachii
130
How does the median nerve arise in arm
Two roots: one med and one lat cord of brachial plexus
131
how does median nerve descend in arm
Lat side of Axillary and upper Brachial artery
132
what happens to the median nerve in arm in middle part of arm
Crosses to med aspect of brachial artery and enters cubital fossa.
133
The ulnar artery arises from
Medial cord of brachial plexus
134
Ulnar artery descends along
Medial brachial artery and enters pos compartment of arm through medial intermuscular septum
135
where does ulnar artery lie behind eventually
along medial head of triceps and to lie behind epicondyle at elbow
136
Triceps arises by
long head of scapula and by lateral and medial heads from humerus
137
common tendon of triceps is inserted into
olecranon process of ulna
138
Which head of triceps attaches onto infra glenoid tubercle of scapula
long
139
main action of triceps on elbow
extend
140
Action of Triceps and Anconeus Muscle
Extend Forearm | Stabilise
141
Nerve supply to triceps and ancones
radial nerve
142
radial nerve is one of the terminal branches of which cord of brachial plexus
pos
143
The radial nerve supplies where
extensor arm and forearm including wrist
144
Radial nerve enters arm anterior to
long and medial head of tripeps
145
radial nerve runs with
radial artery
146
the radial artery is a branch of
brachial artery
147
the radial artery descends down around midshaft humerus in radial groove then does what
appears between humerus and triceps
148
Segmental root value of radial nerve
C5-8 and T1
149
Fracture to Surgical Neck associated with which nerve injury
Axillary Nerve
150
Fracture to Medial Epicondyle associated with which nerve injury
Ulnar Nerve
151
Fracture to Spiral groove associated with which nerve injury
Radial Nerve
152
Which vein lies anterior to roof of antecubital fossa
median cubital fossa
153
at what level does brachial artery bifurcate into radial and ulnar artery
neck of radius
154
The cephalic vein lies over where
Ant Lat Aspect
155
The basilica artery lies over
Medial Fossa
156
Which ligament holds ulnar in place
Ulnar Collateral Ligament
157
Which ligament holds head of radius in place
Radial Collat Ligament
158
Which muscles cause flexion of elbow
Brachialis Brachioradialis Biceps
159
which muscles cause elbow extension
Triceps | Anconeus
160
Tennis elbow is related to inflammation of muscle tendons attached to
lat epicondyle of elbow
161
golfer elbow is related to inflammation of muscle tendons attached to
medial epicondyle of elbow
162
Radius and Ulnar are bones found where
forearm
163
Type of joint Radius and Ulna
Pivot Synovial allowing pronation and supination
164
The proximal radio-ulnar joint is supported by which ligament arising at elbow which keeps head of radius in place
Radial Annular Ligament
165
Supination and Pronation are movements of which joint
radio-ulnar
166
Muscles involved in Supination of radio ulnar joint
1. Pronator Quad | 2. Pronator Teres
167
Muscles involved in Pronation of radio ulnar joint
1. Supinate | 2. Biceps Brachii
168
Anterior compartment of arm muscles do what
Flex Wrist and Digits and help with Pronation at radioulnar joint
169
Medial epicondyle of humerus acts as
common flexor origin
170
Where is golfer's elbow reflected
medial epicondyle of humerus
171
Which muscle is missing in 20% of people in anterior forearm
Palmaris Longus
172
Which superficial flexor of arm is most medial
Flexor Carpi Ulnaris
173
which superficial flexor of arm is most lateral
Pronator Teres
174
Action of pronator teres
pronate arm
175
Apart from flexing the wrist, which superficial muscle is involved in adduction (ulnar deviation) of the wrist joint?
flexor carpi ulnaris
176
Apart from flexing the wrist, which superficial muscle is involved in abduction (radial deviation) of the wrist joint?
flexor carpi radialis
177
which superficial anterior arm is not supplied by median nerve
flexor digotirum lumbricals
178
the flexor digitorum lubricals is supplied by
ulnar nerve
179
Flexor Digitorum Superficialis is deep to
Superficial flexors in forearm
180
Which muscle is seen as only muscle on intermediate group on forearm
Flexor Digitorum Superficialis
181
To which fingers are the four tendons of FDS attached
2-5
182
On which phalanx are four tendons of FDS attached
Palmar
183
The Flexor Digitorum Superficialis actions
Flex wrist Flex Metacarpophalangeal Flex Prox Interphalangeal
184
Which nerve innervates Flexor Digitorum Superficialis
Medial
185
The brachioradialis acts on which joint
Flex Elbow
186
Which nerve innervates brachioradialis
Radial
187
Which muscle is an exception to the rule that all flexors lie in anterior compartment
Brachioradialis
188
The brachioradialis lies in which compartment
posterior
189
Injury to upper trunk causes what type of Palsy
Erb Palsy
190
How is Erb palsy features
Waiter Tip | Medial Rotation of Arm with wrist flex
191
How does Erb's Palsy happen
Hyperextend of Head from Shoulder
192
Which group of muscles affected in Erb Palsy
C5-6
193
Which muscles are involved in Erb Palsy
Biceps Brachii Brachalis Corticobronchialis Brachioradialis
194
Injury to Lower Trunk causes
Klumpke Palsy
195
Klumpke Palsy mechanism
Shoulder Dystocia at birth | Trauma
196
The flexor digitorum profounda is in relation to which bone
Ulna
197
The flexor policis longus is in relation to which bone
Radius
198
The pronator quadrates is in relation to which bones
Ulna and Radius
199
Flexor Digitorum Profundus action on wrist and fingers
Flexion
200
Flexor Digitorum Profundus nerve supply
Ulnar and Median
201
Which part of Flexor Digitorum Profundus supplied by Ulnar nerve
Medial
202
Which part of Flexor Digitorum Profundus supplied by median nerve
Lateral
203
Flexor Pollics Longus is what type of muscle
Flexor of Thumb
204
Which nerve innervates Flexor Pollics Longus
Anterior interosseous C8-T1 of Median
205
Pronator Quadratus origin and insertion
Ulna to Radius
206
Innervation of Pronator Quadrates
Anterior Interosseous Nerve
207
The median nerve enters forearm where
Ant to Brachial Artery
208
The median nerve goes under which muscle
pronator teres
209
After the median nerve enters the carpal tunnel where does it travel below
Flexor retinaculum
210
which muscle does median nerve not supply in anterior forearm
Flexor Carpi Ulnaris and Medial half of Flexor digitorum profundus
211
The ulnar nerve passes posterior to which epicondyle of humerus
Medial
212
The ulnar nerve enters forearm how
Pass between heads of Flexor Carpi Ulnaris Muscle
213
The ulnar nerve lies
medial to ulnar artery at wrist
214
The brachial artery exits where
ante cubital fossa
215
Where does brachial artery divide and into what
Ante Cubital Fossa into Radial and Ulnar arteries
216
where is the antecubital fossa
neck of radius
217
The ulnar artery lies between which muscles
Flexor Carpi Ulnaris and Flexor DIgitorum Profundus
218
which artery forms the superficial palmar arch
ulnar
219
The radial artery starts under which muscle
brachioradialis
220
how does radial artery enter hand
forming deep palmar arch
221
which arterial pulse can you feel under distal third of forearm medial to tendon of flexor carpi radials
ulnar
222
How to determine patency of arteries in distal forearm
Allen's Test
223
The carpal tunnel passes deep to
Flexor Retinaculum
224
Which muscle stabilises the carpal bones
Flexor Retinaculum
225
The flexor retinaculum is anchored to which carpal bones on lateral side
Scaphoid and Trapezium
226
The flexor retinaculum is anchored to which carpal bones on medial side
Pisiform and Hamate
227
Contents of carpal tunnel
4 tendons of flexor digitorum profundus 4 tendons of flexor digitorum superficialis 1 tendon of flexor policis longus median nerve
228
which muscle is dissected in carpal tunnel syndrome
flexor retinaculum
229
which muscle of forearm is continuous with fascia of palm
palmaris longus
230
How many compartments of muscles of hand
5
231
What is the first compartment of muscles of hand
Thenar
232
What is the second compartment of muscles of hand
Hypothenar
233
what is the third compartment of muscles of hand
Lumbricals and Long Flexor Tendons
234
what is the fourth compartment of muscles of hand
Adductor
235
what is the fifth compartment of muscles of hand
Interosseous
236
Thenar muscles are found
Lateral Palm
237
How many thenar muscles
3
238
What are the three thenar muscles
Flexor Pollicis Brevis Opponens Pollicis Abductor Pollicis Brevis
239
Nerve supply for thenar eminence
Median Nerve except FPB
240
Deep belly of Flexor Pollicis brevis innervation
Ulnar nerve
241
Which nerve segment from brachial plexus serves to provide majority of innervation to thenar muscles
Median C6-T1
242
Hypothenar Muscles
Abductor Digit Minimis Flexor Digiti Minimi Opponens Digiti Minimi
243
Which nerve innervates hypothenar muscles
Ulnar
244
Which nerve root from brachial plexus serves to provide majority of innervation to Hypothenar Muscles
C8-T1
245
Opposition is movement of fingers
towards each other
246
Where is central compartment in hand found
Deep to thenar and hypothenar eminence
247
The central compartment of hand contains
flexor tendons
248
Flexor tendons of hand
Flexor Digitorum Profundus Flexor Digitorum Superficialis Flexor Pollicis longus
249
Where do the lumbricals originate
Central Compartment of Hand
250
Where do the lumbricals arise from
medial and lateral FDP Tendon between 1st-5th metacarpals
251
The lumbricals do what at fingers
Flex fingers
252
The lumbricals flex fingers where
Metacarpophalngeal Joint
253
The lumbricals extend what joint
Interphalangeal joint of 2nd-5th digits
254
The medial two lumbricals are innervated by
Ulnar nerve
255
lateral two lumbricals innervated by
Median Nerve
256
How many heads does Adductor pollicis have
two
257
What are the heads of Adductor Pollicis
Adductor Pollicis Oblique and Adductor Pollcis Transverse
258
Contraction of Adductor Pollicis action
Adducts Thumb
259
Which nerve innervates adductor pollicis
Ulnar
260
Which muscles are deepest in hand
Interossi
261
Where do the interossei lie
Between fingers
262
Dorsal Interossei action
abduct fingers
263
Palmar interossei action
Adduct fingers
264
which nerve innervates dorsal and palmar interossei
ulnar
265
which spinal segment contributes the most to innervation of interossei
C8-T1
266
which arteries supply blood to hand
radial and ulnar
267
once the radial and ulnar arteries reach palm they form
superficial and deep palmar arch
268
which artery contributes to superficial palmar arch
Ulnar
269
which artery contributes to deep palmar arch
Radial
270
Which nerves supply hand
Median and ulnar
271
The median nerve enters hand through
cubital fossa
272
which muscles does median nerve not supply in hand
Deep Belly FPB and 1st and 2nd Metacarpal
273
Which nerves innervates Deep Belly FDP and 1st and 2nd
Ulnar
274
Ulnar and median nerves carry which fibres
C6-T1
275
The ulnar nerve is a branch of
medial inferior brachial plexus
276
How to test Axillary Nerve
Abduct shoulders (Deltoid) and Outer Shoulder
277
How to test Musculocutaenous Nerve
Flex elbow
278
How to test Radial Nerve
Extend Wrist
279
How to test Ulnar nerve
Spread fingers
280
How to test median nerve
Move thumb towards nose (abductor pollicis brevis)
281
What sits between ulna and carpal bones
Radiocarpal Joint and Articular Hyaline Cartilage
282
the radius articulates with which carpal bones
Scaphoid and Lunate
283
what type of fluid found between forearm and carpal bones
Synovial
284
flexion of wrist caused by
contraction of anterior compartment muscles
285
extension of wrist caused by
contraction of posterior compartment muscles
286
the combined action of flexion and extension carpi ulnas cause
radial deviation or extension of wrist
287
which muscles are responsible for radial deviation/abduction of wrist
abductor pollicis and flexor carpi radialis
288
circumduction of joint is what movement of wrist
rotation
289
Which bones sit between carpal bones and phalanges
Metacarpals
290
How many metacarpals
5
291
Where do metacarpals articulate proximally and distal
Proximal - Carpo-Meto Carpal Joint | Distal: Metacapophalngeal Joint
292
Phalanges are the
distal bones in hand
293
In fingers 2-5 what phalanges are there
Prox, Mid and distal
294
in thumb what phalanges are there
prox and distal
295
Muscles that extend and abduct or adduct hand at wrist
Extensor Carpi Radialis longus Extensor carpi radialis brevis extensor carpi ulnas
296
Action of extensor carpi radialis longus and brevis on wrist
extend and abduct wrist
297
what action is extensor carpi radialis longus and brevis with help of flexor carpi radialis
radial deviation of wrist
298
Muscles that extend medial four digits
Extensor digitorum Extensor indicis extensor digiti minimi
299
Extensor Digitorum origin
Lateral Epicondyle of Humerus
300
Muscles that extend or abduct thumb
Abductor Pollicis Longus Extensor Pollics Brevis Extensor Pollicis Longus
301
Where is supinator found
Proximal extensor compartment
302
Action of supinator
supinate forearm
303
Which nerve innervates ``` Extensor Digitorum Extensor Carpi Radialis Longus Extensor Carpi Radialis Brevis Brachioradialis Extensor Carpi Ulnaris Supinator Extensor Digiti Minimi ```
Radial
304
What is the deep branch of radial nerve in posterior forearm known as
Posterior | Interosseous Nerve
305
Main motor nerve of extensors of forearm
Posterior | Interosseous Nerve
306
Where does superficial radial nerve enter hand
over anatomical snuffbox
307
Posterior interosseous artery arises from
Ulnar artery
308
recurrent interosseous artery is a branch of
Ulnar artery
309
What provides stability proximally on dorsum of hand
extensor retinaculum
310
The cephalic vein lies at
lat continuation of dorsal venous arch proximally
311
the basilica vein lies as
medial continuation of dorsal venous arch
312
Which nerve innervates Extensor pollicis longus extensor pollicis brevis adductor pollicis longus
Posterior Interosseous nerve
313
Colles fracture is a common fracture of
distal radius with anterior displacement
314
Dinner fork fracture deformity associated with
colles fracture/distal radius/fall onto extended wrist
315
Smith's fracture is associated with
posterior displacement of radius | Fall onto flexed wrist
316
Most fractured carpal bone
Scaphoid Fracture | Pain felt in anatomical snuff box
317
Which muscles attach onto extensor expansion in dorsal digital of hand
Lumbrical Dorsal Interossei Palmar Interossei Extensor indiasis