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Anatomy > MSK1 - Upper Limb > Flashcards

MSK1 - Upper Limb Flashcards

1
Q

What forms the walls of the axilla?

A

Anterior: pec major and minor
Posterior: subscapularis
Medial: thoracic wall and serratus anterior
Lateral: intertubercular sulcus of humerus
Inferior: teres major and latissimus dorsi

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2
Q

The axillary artery is a continuation of which vessel? Which vessel does it become? And what are the anatomical borders for these?

A

Continuation of subclavian from lateral border of first rib

Becomes brachial at inferior border of teres major

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3
Q

What forms the brachial plexus? Which roots form each trunk?

A

Ventral rami of C5-T1

Upper/superior trunk: C5-6
Middle trunk: C7
Lower/inferior trunk: C8-T1

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4
Q

Damaging one of the trunks would result in what palsies? How do they appear on examination?

A

Upper: Erb’s palsy - medially rotated arm with flexed wrist

Lower: Klumpke’s palsy - claw hand

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5
Q

What are common reasons for damage to each trunk?

A

Upper: Hyperextension of head from shoulder e.g. fall, birth injury

Lower: undue abduction of the arm

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6
Q

Which nerves come from each CORD of the brachial plexus?

A

Lateral: lateral pectoral, lateral root of median, musculocutaneous
Posterior: thoracodorsal, axillary, radial, upper and lower subscapular nerve
Medial: medial pectoral, medial root of median, ulnar, medial cutaneous nerve of arm, and medial cutaneous of forearm

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7
Q

Describe the venous drainage of the upper limb?

A

Dorsal venous network in hand goes into cephalic (lateral) and basilic (medial) veins.

These veins communicate (cephalic to basilic) via the median cubital vein.

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8
Q

Describe the dermatome distribution of the upper limb

A

C6: thumb and lateral border of arm
C7: lateral palm and 2nd/3rd fingers
C8: 4th/5th fingers, medial palm and medial border of arm

C5/T1 down centre of anterior arm

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9
Q

Describe the lymphatic drainage of the upper limb

A

Axillary nodes

  • anterior/pectoral group
  • posterior/subscapular group
  • apical group
  • central group
  • lateral group
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10
Q

Label the scapula

A

Acromion
Coracoid Process
Glenoid cavity
Spine
Supraspinous and infraspinous fossa
Subscapular fossa
Medial and lateral border
Inferior and superior angle
Supra and infraglenoid tubercles

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11
Q

What type of joints are the AC and SC joints?

A

AC: plane synovial
SC: saddle synovial

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12
Q

What is the scapulo-humeral rhythm?

A

Beyond the first 30 degrees of arm abduction, every further 3 degrees of movement is from 2 at the glenohumeral and 1 at the scapulo-thoracic

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13
Q

What muscles are responsible for each movement of the scapula?

A

Elevation: upper trapezius, rhomboids, levator scapulae
Depression: lower trapezius, pec minor, lower serratus anterior

Protraction: serratus anterior
Retraction: middle trapezius and rhomboids

Lateral rotation (elevates glenoid cavity): upper trapezius
Medial rotation (depresses glenoid): gravity, levator scapulae, rhomboids and pec minor
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14
Q

What name is given to the cartilage surrounding the glenoid cavity and what purpose does it serve?

A

Glenoid labrum - deepens the socket for stability

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15
Q

Which ligaments surround the glenohumeral joint?

A

Coracohumeral
Coracoacromial
Glenohumeral ligaments

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16
Q

Which part of the shoulder joint is weakest and why?

A

Inferior - no muscle or ligaments

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17
Q

What are the two important bursae around the glenohumeral joint? Which communicates with the joint cavit?

A

The subacromial and subscapular bursae
- subscapular communicates

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18
Q

What are the muscles of the rotator cuff?

A

Subscapularis
Supraspinatus
Infraspinatus
Teres minor

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19
Q

What is the most important function of the rotator cuff?

A

Stability of the joint

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20
Q

What is the nerve supply to the deltoids? What injury may damage it?

A

Axillary nerve
- surgical neck of humerus fracture can damage

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21
Q

Where would you test for loss of sensation to see if axillary nerve injury had occurred?

A

Lateral shoulder

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22
Q

What is the action of the pec major?

A

Adducts and medially rotates humerus

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23
Q

Which vein is located in the deltopectoral triangle, and what is its clinical significance?

A

Subclavian vein
- used for central lines

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24
Q

What is the nerve supply of the serratus anterior? What clinical sign is seen when it is injured?

A

Long thoracic - C5-7
- winged scapula if damaged

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25
Q

What procedure commonly causes damage to the long thoracic nerve?

A

Mastectomy

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26
Q

Which nerve innervates the trapezius?

A

Accessory (CNXI)

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27
Q

What are the actions of teres major?

A

Adducts and medially rotates the arm

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28
Q

What are the actions of latissimus dorsi?

A

Extends, adducts, and medially rotates

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29
Q

Which shoulder muscles are responsible for each shoulder movement?

  • flexion/extension
  • adduction/abduction
  • medial/lateral rotation?
A

Flex: Pec Major, Anterior Deltoid, Coracobrachialis
Extend: Posterior Deltoid, Latissimus Dorsi, Teres Major

Adduct: Pec Major, Latissimus Dorsi, Teres Major
Abduct: Middle Deltoid, Supraspinatus

Medial rotation: Subscapularis, Latissimus Dorsi, Pec Major, Teres Major
Lateral rotation: Teres Minor, Infraspinatus

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30
Q

Label the humerus

A

Head
Greater Tubercle
Lesser Tubercle
Intertubercular Sulcus
Body
Deltoid Tuberosity
Lateral and Medial Epicondyles
Radial Fossa
Coronoid Fossa
Capitulum
Trochlea

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31
Q

What are the origins and insertions of the muscles of the anterior arm?

A

Biceps brachii - Long head from supraglenoid tubercle, short head from coracoid process.
- Both insert into the radial tuberosity and the fascia of the forearm via the bicipital aponeurosis.

Coracobrachialis - Originates from coracoid, passes through the axilla and attaches to medial humerus shaft, at the level of the deltoid tubercle

Brachialis- Originates from medial and lateral surfaces of humeral shaft and inserts into ulna tuberosity, just distal to the elbow joint

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32
Q

Which biceps head runs in the bicipital groove?

A

Long head

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33
Q

What are the actions of the biceps? What nerve supplies it (and segmental fibres)?

A

Elbow flexion
Shoulder flexion
Supinator (radio-ulnar joint)

Musculocutaneous nerve supply (C6) (+5 and 7?)

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34
Q

What is the action of the coracobrachialis? Which nerve supplies?

A

Shoulder flexion and (weak) adduction

Musculocutaneous supply

35
Q

What is the action of brachialis? Which nerve supplies?

A

Elbow flexion

Musculocutaneous supply

36
Q

What is the continuation of the musculocutaneous nerve?

A

Lateral cutaneous nerve

37
Q

Where does the brachial artery begin and end? What are the branches given off by it?

A

Begins at lower border of teres major (from axillary)
Ends in cubital fossa close to neck of radius
- divides into radial and ulnar
- gives off profunda brachii/deep artery of the arm

38
Q

Describe the path of the median nerve

What muscles does it supply?

What areas does it carry sensory information for?

A

Arises in axilla from medial and lateral cords
Descends along lateral side of axillary artery and upper part of brachial artery
In middle arm the nerve crosses to th emedial side of brachial artery and enters the cubital fossa
It gives no branches in either the exilla or upper arm

Supplies anterior forearm except FCU and part of FDP
- also supplies thenar muscles and lateral two lumbricals

Sensory for lateral aspect of the palm, and lateral three and a half fingers on the anterior (palmar) surface of the hand.

39
Q

Describe the path of the ulnar nerve?

What muscles does it supply and where does it carry sensory fibres from?

A

Arises from medial cord
Descends along medial side of brachial artery then enters the posterior compartment through the medial intermuscular septum
Runs along medial head of triceps and to the back of the medial epicondyle

Motor for Flexor Carpi Ulnaris and ulnar half of FDP
Also motor for majority of hand muscles (deep branch)
- hypothenar muscles, medial two lumbricals, adductor pollicis, palmar and dorsal interossei, palmaris brevis

Sensory for medial half of the palm/dorsum and the associated one and a half fingers

40
Q

What are the three common sites of the humerus where nerves may be damaged due to fracture?

A

Radial nerve from radial groove

Ulnar nerve from medial epicondyle

Axillary nerve from surgical neck

41
Q

What are the borders of the cubital fossa?

What are the contents?

A

Base - between the two epicondyles
Medial border - pronator teres
Lateral border - brachioradialis

Contents:

  • radial nerve
  • biceps tendon
  • brachial artery
  • median nerve
42
Q

What are the origins and insertion of the triceps?

A

Long head originates from the infraglenoid tubercle.

Lateral originates from the humerus, superior to the radial groove.

Medial head originates from the humerus, inferior to the radial groove.

The heads converge and insert into the olecranon of the ulna.

43
Q

What is the action of the anconeus? What is the nerve supply?

A

Situated in the extensor compartment of the forearm. It is blended with the fibres of the triceps brachii, and the two muscles can be indistinguishable.

Extends and stablises the elbow joint. Abducts the ulna during pronation of the forearm.

Radial nerve

44
Q

What are the segmental values for the radial nerve? Which vessel accompanies it in the radial groove?

A

C5-T1

Next to profunda brachii artery

45
Q

What is the characteristic clinical sign of radial nerve injury?

A

Wrist drop

46
Q

Which ligament holds the head of the radius?

A

Annular ligament

47
Q

What are the flexors and extensors of the elbow joint?

A

Flexors: biceps, brachialis, bracioradialis, pronator teres assists

Extensors: triceps, anconeus

48
Q

What type of joint are the proximal and distal radio-ulnar joints?

A

Synovial Pivot joints

49
Q

Which muscles are mainly responsible for supination and pronation? Which is most powerful for each?

A

Supination: Supinator and Biceps (stronger)

Pronation: Pronator teres (stronger) and Pronator Quadratus

50
Q

Which muscles are in the anterior forearm?

A

Superficial: pronator teres, FCR, palmaris longus, FCU

Intermediate: Flexor Digitorum Superficialis

Deep: FDP, FPL, Pronator Quadratus

51
Q

What is the common flexor origin of the superficial muscles of the anterior forearm?

A

Attached by common flexor tendon to the medial epicondyle

52
Q

What is the innervation of the superficial anterior forearm?

A

Median nerve except FCU and medial of FDP (ulnar)

53
Q

Why is brachioradialis strange?

A

It is a posterior muscle but flexes the elbow
- supplied by radial nerve

54
Q

Where does Flexor Digitorum Superficialis originate and insert? What is its innervation?

A

Origin medial epicondyle of the humerus, and radius

Inserts on middle phalanx of 4 fingers (no thumb) via carpal tunnel

Median nerve innervates

55
Q

Where does FDP originate and insert? How is it unique? What is its innervation?

A

Originates from ulna and associated interosseous membrane. Splits into four tendons that pass through the carpal tunnel and attaches to distal phalanges of the four fingers
- only muscle that can flex the distal IPJ

Medial FDP ulnar innervated (4th and 5th fingers)
Lateral FDP median innervated (2nd and 3rd fingers)

56
Q

What is the relationship of brachial artery to the median nerve in the cubital fossa?

A

The neve is medial to the artery

57
Q

What is the median nerve’s relationship to the flexor retinaculum

A

Median nerve passes deep to flexor retinaculum

58
Q

What is the ulnar nerve’s relationship to the ulnar artery?

A

Ulnar nerve is medial to the artery

59
Q

What are the contents of the carpal tunnel?

A

Median nerve
4 tendons of FDS
4 tendons of FDP
1 tendon of FPL

60
Q

What forms the walls of the carpal tunnel?

A

Flexor retinaculum is roof
Carpal bones form floor/sides
Between scaphoid/trapezium on lateral side and hamate/pisiform on medial

61
Q

What are the five compartments of the intrinsic hand muscles?

A

Thenar compartment
Hypothenar compartment
Adductor compartment
Lumbricals and long flexor tendons - central compartment
Interosseus compartment

62
Q

What are the thenar muscles and what is their function?

What is their innervation?

A

Abductor pollicis brevis
Flexor pollicis brevis
Opponens pollicis

Responsible mainly for apposition/fine thumb movements

Median nerve innervates

63
Q

What are the hypothenar muscles? What are their functions? What innervates (including segmental values)?

A

Abductor Digiti Minimi
Flexor Digiti Minimi
Opponens Digiti Minimi

Ulnar nerve innervates (deep branch) - C8,T1

64
Q

What innervates adductor pollicis? What are the two heads?

A

Ulnar (deep branch)

Transverse and oblique head

65
Q

From which long flexor tendons do the lumbricals originate? What are their actions and innervation?

A

Tendon of FDP

Flex MCP Joint
Extend at IP Joints

Medial two innervated by ulnar
Lateral two by median

66
Q

How many interossei are there and what are their actions? How are they innervated (including segmental values)

A

4 dorsal and 3 palmar

Dorsal Abduct
Palmar Adduct

Ulnar (deep branch) - C8,T1

67
Q

Describe the anatomy of the superficial and deep palmar arches

A

Both formed by combination of radial and ulnar arteries

Superficial is primarily ulnar
Deep is primarily radial

68
Q

What areas of the hand does the radial nerve supply?

A

No muscles, but sensory for dorsal aspect

69
Q

Which nerve supplies the hand muscles, with what exceptions?

A

Ulnar

  • except thenar muscles (median)
  • except first and second lumbricals (median)
70
Q

What is the dermatomal distribution of each nerve in the hand?

A

Palmar

  • median: thumb, two fingers, lateral aspect of 4th finger, thenar area
  • ulnar: medial aspect of 4th finger, 5th finger, hypothenar area

Dorsal

  • median: thumb, next two finger from PIPJ, half of 4th finger from PIPJ
  • ulnar: dorsum of above
  • radial: rest of dorsum of hand
71
Q

Name the carpal bones?

A

Proximal lateral to medial:

  • scaphoid
  • lunate
  • triquetrum
  • pisiform

Distal lateral to medial

  • trapezium
  • trapezoid
  • capitate
  • hamate
72
Q

What type of joint is the wrist joint?

What bones form it?

A

Synovial condyloid/ellipsoid

Radius proximally
Scaphoid, Lunate, Triqeutrum distally

73
Q

Which muscles are responsible for what movements at the wrist?

A

Flexion: anterior forearm (FCU, FCR, FDS assists)
Extension: posterior forearm (ECR (L+b), ECU, Extensor Digitorum assists)

Adduction: ECU and FCU
Abduction: ECR (L+b), FCR, Abductor Pollicis

74
Q

What muscles are involved in clenching of the fist?

A

ECR and ECU with FCR

75
Q

Where does extensor digitorum arise and insert?

A

Arises from common extensor origin from lateral epicondyle

Ends in a tendon which passes under extensor retinaculum and divides into four tendons for the fingers (extensor hood)

76
Q

Which muscles extend or abduct the thumb?

A

Abductor pollicis longus
Extensor pollicis brevis
Extensor pollicis longus

77
Q

Just to be sure, name all the muscles in the posterior forearm

A

Superficial:

  • brachioradialis
  • ECR (L+b)
  • Extensor Digitorum
  • Extensor Digiti Minimi
  • ECU
  • Anconeus

Deep:

  • Supinator
  • Abductor Pollicis Longus
  • Extensor Pollicis Longus and Brevis
  • Extensor Indicis Proprius
78
Q

What are the divisions of the radial nerve? What do they innervate?

A

Divides into superficial and deep branches in the cubital fossa

  • deep also called Posterior Interosseus - everything except ECR Longus and Brachioradialis (Radial nerve itself)
  • superficial is sensory: dorsum of hand
79
Q

What term is given for a common fracture of the distal radius?

A

Colles fracture - ‘dinner fork deformity’

80
Q

What forms the anatomical snuffbox?

A

Tendon of APL and EPB laterally
Tendon of EPL medially

Scaphoid and Trapezium

81
Q

How do the functions of EPL and EPB differ? Where do they arise and attach?

A

EPL from posterior surface of the ulna/interosseous membrane. Attaches and extends distal phalanx

EPB from posterior surface of the radius/interosseous membrane. Attaches and extends from proximal phalanx base

82
Q

Where does Abductor Pollicis Longus arise/attach?

A

Originates from interosseous membrane and adjacent posterior surfaces of radius/ulna
Attaches to the lateral side of the base of metacarpal I

83
Q

Name the tendons/muscles attaching to the extensor hood

A

Extensor digitorum
Lumbricals
Interossei

[Extensor digiti minimi/extensor indicis]

Anatomy (11 decks)

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