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ACEM Primary Written > Musculoskeletal: Anatomy - Upper limb summary > Flashcards

Musculoskeletal: Anatomy - Upper limb summary Flashcards

1
Q

Boundaries and contents of clavipectoral triangle

A

Clavicle superiorly, pec major medially, deltoid laterally
Contents: medial and lateral pectoral nerves, cephalic vein

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2
Q

Boundaries and contents of quadrangular space

A

Teres minor superiorly, teres major inferiorly, neck of humerus laterally, long head of triceps medially, subscapularis anteriorly
Contents: axillary nerve, posterior circumflex humeral artery

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3
Q

Boundaries and contents of the triangular interval

A

Teres major superiorly, neck of humerus laterally, long head of triceps medially
Contents: radial nerve, profunda brachii artery

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4
Q

Borders and branches of the axillary artery

A

1 branch in 1st part, 2 branches in 2nd part, 3 branches in third part

First part: lateral 1st rib to medial pec minor, superior thoracic artery

Second part: posterior to pec minor, thoracoacromial and lateral thoracic arteries

Third part: lateral pec minor to inferior border teres major, subscapular and anterior and posterior circumflex humeral arteries

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5
Q

Mnemonic branches of the axillary artery

A

Send The Lord to Say A Prayer:
- Superior thoracic
- Thoracoacromial
- Lateral thoracic
- Subscapular
- Anterior circumflex humeral
- Posterior circumflex humeral

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6
Q

Musculocutaneous nerve

A

Roots: C5-7
Motor: anterior compartment of arm (flexors)
Sensory: lateral cutaneous nerve of forearm

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7
Q

Muscles in anterior compartment of arm

A

Biceps brachii
Brachialis
Coracobrachialis

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8
Q

Motor innervation of anterior compartment of arm

A

Musculocutaneous (C5-7)

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9
Q

Arterial supply of anterior compartment of arm

A

Muscular branches of brachial artery

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10
Q

Biceps tendon reflex nerve root

A

C6

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11
Q

Origin, insertion and actions of biceps brachii

A

Long head: supraglenoid tubercle of scapula
Short head: coracoid process of scapula
Insertion: radial tuberosity and fascia of forearm via bicipital aponeurosis
Action: prime supinator, flexes arm and forearm

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12
Q

Origin and insertion coracobrachialis

A

Origin: coracoid process of scapula
Insertion: medial humerus

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13
Q

Origin and insertion brachialis

A

Origin: shaft of humerus
Insertion: ulnar tuberosity

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14
Q

Motor innervation of posterior compartment of arm

A

Radial nerve (C5-8, T1)

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15
Q

Triceps tendon reflex nerve root

A

C7

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16
Q

Origin and insertion of triceps brachii

A

Long head: infraglenoid tubercle of scapula
Lateral head: humerus (superior to radial groove)
Medial head: humerus (inferior to radial groove)
Insertion: Olecranon

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17
Q

Borders and contents of the triangular SPACE

A

Teres minor superiorly, teres major inferiorly, long head of biceps laterally
Contents: circumflex scapular artery and vein

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18
Q

Course of the radial nerve

A

Continuation of posterior cord of brachial plexus
Lies on tendon of latissimus dorsi in posterior wall of axilla
Enters arm via triangular interval

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19
Q

What is the largest branch of the brachial plexus?

A

Radial nerve

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20
Q

Axillary nerve

A

Roots: C5-6
Motor: deltoid, teres minor, long head of triceps
Sensory: superior lateral cutaneous nerve of arm (“regimental badge” area)

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21
Q

Median nerve

A

Roots: C6-8, T1
Motor: flexors of forearm (except FCU and medial FDP), thenar muscles, lateral lumbricals
Sensory: palmar cutaneous branch and digital cutaneous branch (lateral palm and 3.5 fingers anteriorly)

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22
Q

Radial nerve

A

Roots: C5-8, T1
Motor: extensors of arm and forearm
Sensory: posterior arm and forearm, posterolateral aspect of hand (not including distal fingers)

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23
Q

Ulnar nerve

A

Roots: C8, T1
Motor: FCU, medial FDP, muscles of hand (except thenar muscles and lateral lumbricals)
Sensory: anterior and posterior medial 1.5 fingers, associated palmar area

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24
Q

Arterial supply of posterior compartment of arm

A

Profunda brachii

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25
Q

Muscles in posterior compartment of arm

A

Triceps brachii
Anconeus

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26
Q

Origin and insertion of anconeus

A

Origin: lateral epicondyle of humerus
Insertion: lateral olecranon and superoposterior ulna

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27
Q

Muscles in anterior compartment of forearm

A

Superficial x4: FCU, FCR, palmaris longus, pronator teres
Intermediate x1: FDS
Deep x3: FPL, FDP, pronator quadratus

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28
Q

Innervation of anterior compartment of forearm

A

All except FCU and medial FDP by median nerve (with deep muscles by anterior interosseous branch of median nerve)

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29
Q

Arterial supply of anterior compartment of forearm

A
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30
Q

Common origin of superficial and intermediate muscles of anterior compartment of forearm

A

Medial epicondyle of humerus via common shared tendon
From lateral to medial: pronator teres, FCR, palmaris longus, FCU

Additionally:
- Pronator teres: also arises from coronoid process
- FCU: also arises from olecranon process
- FDS: also arises from coronoid process and radial head

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31
Q

Actions of muscles of anterior compartment of forearm

A

Superficial: flexion of wrist (plus abd/adduction by FCR and FCU respectively, pronation by PT)
Intermediate: PIPJ and MCPJ flexion
Deep: pronation by pronator quadratus, digit flexion by FDP and FPL

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32
Q

Distal attachments of superficial anterior forearm compartment muscles

A

Pronator teres: mid-shaft of radius
FCR: base of 2nd metacarpal
Palmaris longus: flexor retinaculum and palmar aponeurosis
FCU: base of 5th metacarpal, pisiform and hook of hamate

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33
Q

What two structures pass between the ulnar and radial heads of FDS?

A

Median nerve
Ulnar artery

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34
Q

Proximal and distal attachments of FDP

A

Proximal: ulna and interosseous membrane
Distal: base of distal 2nd-5th phalanges

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35
Q

Proximal and distal attachments of FPL

A

Proximal: radius and interosseous membrane
Distal: base of distal 1st phalanx

36
Q

Proximal and distal attachments of pronator quadratus

A

Proximal: distal ulna
Distal: distal radius

37
Q

Muscles of the posterior compartment of the forearm

A

6x superficial:
- Brachioradialis
- ECU
- ECRL and ECRB
- Extensor digitorum
- Extensor digiti minimi

5x deep (from superficial to deep / proximal to distal):
- Supinator
- Abductor pollicis longus
- EPL and EPB
- Extensor indicis

38
Q

Innervation of the posterior compartment of the forearm

A

Radial nerve

39
Q

Which of the 6x superficial muscles of the posterior compartment of the forearm originate from the common extensor tendon?

A

Originating from common extensor tendon on lateral epicondyle of humerus:
- ECU
- ECRB
- Extensor digitorum
- Extensor digiti minimi

40
Q

Attachments and action of brachioradialis

A

From lateral supracondylar humerus to distal radius
Weak flexor, assists in supination

41
Q

Attachments of ECRL and ECRB

A

ECRL from lateral supracondylar humerus, ECRB from common extensor tendon at lateral epicondyle of humerus
Attach to base of 2nd and 3rd metacarpals

42
Q

Which nerves of the posterior compartment of the forearm are supplied by the deep and posterior interosseous branches of the radius?

A

Radial nerve:
- Brachioradialis
- ECRL and ECRB

Deep branch of radial nerve:
- Supinator
- ECU
- Extensor digitorum
- Extensor digiti minimi

Posterior interosseous branch of radial nerve:
- EPL and EPB
- Extensor indicis
- Abductor pollicis longus

43
Q

Where do the tendons of the extensor muscles for the digits insert?

A

Into the extensor hoods of each respective digit
Some have more than one muscle insert (i.e. thumb, index finger, and little finger)

44
Q

Distal attachment of ECU

A

Base of 5th metacarpal

45
Q

What is tennis elbow vs golf elbow?

A

Tennis elbow: lateral epicondylitis (aim for “lateral” line of the court)
Golf elbow: medial epicondylitis (aim for “middle” of the fairway)

46
Q

The radial nerve passes between the two heads of which muscle?

A

Supinator

47
Q

Proximal and distal attachment of supinator

A

Proximal: two heads, one from lateral epicondyle of humerus (common extensor origin) and one from posterior ulna
Distal: posterior surface of proximal radius

48
Q

Proximal and distal attachment of abductor pollicis longus

A

Proximal: interosseous membrane, adjacent radius and ulna (just distal to supinator)
Distal: base of 1st metacarpal

49
Q

Proximal and distal attachment of EPB

A

Proximal: posterior radius and interosseous membrane
Distal: base of 1st proximal phalanx

50
Q

Proximal and distal attachment of EPL

A

Proximal: posterior ulna and interosseous membrane
Distal: base of 1st distal phalanx

51
Q

Proximal attachment of extensor indicis

A

Posterior ulna and interosseous membrane

52
Q

What does the recurrent branch of the median nerve innervate?

A

Thenar muscles

53
Q

Which thenar muscles are innervated by the ulnar nerve?

A

Deep head of flexor pollicis brevis
Adductor pollicis

54
Q

Attachments of flexor pollicis brevis

A

Trapezium and flexor retinaculum to base of 1st proximal phalanx

55
Q

Attachments of opponens pollicis

A

Trapezium and flexor retinaculum to lateral side of 1st metacarpal

56
Q

Attachments of abductor pollicis brevis

A

From scaphoid, trapezium and flexor retinaculum
To lateral side of 1st proximal phalanx

57
Q

Attachments of flexor digiti minimi

A

Hook of hamate and flexor retinaculum to base of 5th proximal phalanx

58
Q

Attachments of abductor digiti minimi

A

Pisiform and FCU tendon to base of proximal phalanx

59
Q

Attachments of opponens digiti minimi

A

Hook of hamate and flexor retinaculum to medial aspect of 5th metacarpal

60
Q

Which has two heads: dorsal or palmar interossei?

A

Dorsal

61
Q

Attachments of adductor pollicis

A

One head from 3nd metacarpal, one from capitate and 2nd-3rd metacarpals
Inserts into base of 1st proximal phalanx

62
Q

What does the radial artery pass through to form the dorsal palmar arch?

A

Two heads of adductor pollicis

63
Q

Boundaries and contents of the cubital fossa

A

Superior border: line between medial and lateral epicondyles of humerus
Medial border: pronator teres
Lateral border: brachioradialis
Roof: bicipital aponeurosis (also contains median cubital vein connecting basilic and cephalic veins)
Floor: brachialis proximally, supinator distally

Contents from lateral to medial (Really Need Beer to Be At My Nicest):
- Radial nerve
- Biceps tendon
- Brachial artery
- Median nerve

64
Q

Boundaries of the cubital tunnel

A

Medial: medial epicondyle of humerus
Lateral: olecranon
Floor: elbow joint capsule, medial collateral ligament of elbow
Roof: ligament spanning medial epicondyle of humerus and olecranon

65
Q

Extensor tendon compartments of the wrist and their contents

A

From lateral to medial

Compartment 1:
- EPB
- Abductor pollicis longus

Compartment 2:
- ECRL
- ECRB

Lister’s tubercle separates

Compartment 3:
- EPL

Compartment 4:
- Extensor digitorum
- Extensor digiti minimi

Compartment 5:
- Extensor digiti minimi

Compartment 6:
- ECU

66
Q

What is De Quervain’s tenosynovitis?

A

Inflammation affecting tendons of extensor compartment 1 (EPB and abductor pollicis longus)

67
Q

Borders of the carpal tunnel

A

Carpal arch forms concave base and sides
Formed laterally by scaphoid and trapezium tubercles
Formed medially by hook of hamate and pisiform

Roof formed by flexor retinaculum

68
Q

Contents of the carpal tunnel

A

9 tendons: FPL (in its own sheath), 4x FDP and 4x FDS (all in the same sheath)
Median nerve (AFTER giving off palmar cutaneous branch)

69
Q

What tendon is contained within the flexor retinaculum itself?

A

FCR

70
Q

Borders of the anatomical snuffbox

A

Ulnar border: EPL
Radial border: EPB and abductor pollicis longus
Proximal: radial styloid
Floor: scaphoid, trapezium
Roof: skin and subcutaneous tissue

70
Q

Borders of the ulnar canal

A

Medial: pisiform, FCU tendon, abductor digiti minimi
Lateral: hook of hamate
Roof: palmar carpal ligament
Floor: flexor retinaculum

71
Q

Contents of the anatomical snuffbox

A

Radial artery
Superficial branch of radial nerve (sensory)
Cephalic vein

72
Q

Inflammation of which bursa causes olecranon bursitis?

A

Subcutaneous olecranon bursa

73
Q

What are the three bursae of the elbow joint?

A

Intratendinous: inside triceps brachii tendon
Subtendinous: between triceps brachii tendon and olecranon
Subcutaneous: between olecranon and overlying connective tissue

74
Q

Which structures may be damaged with elbow dislocation?

A

Dislocation is typically posterior
Ulnar collateral ligament may be torn
Ulnar nerve may be damaged

75
Q

Four ligaments of the wrist

A

Palmar radiocarpal: from radius to both rows of carpal bones on palmar surface
Dorsal radiocarpal: from radius to both rows of carpal bones on dorsal surface
Ulnar collateral: from ulnar styloid to triquetrum and pisiform
Radial collateral: radial styloid to scaphoid and trapezium

76
Q

What is the clinical presentation of a lunate dislocation?

A

Lunate compresses carpal tunnel -> paraesthesia in median nerve distribution and weakness of thenar muscles

77
Q

Describe the course of the brachial artery

A

Continuation of axillary artery at inferior border of teres major
Gives off profunda brachii immediately (which travels with radial nerve in radial groove)
Terminates at the cubital fossa, bifurcating into radial and ulnar arteries

78
Q

Describe the course and distribution of the radial artery

A

Runs under brachioradialis and lateral to FCR in distal forearm (can be palpated here)
Gives off palmar carpal branch near distal border of pronator quadratus (anastamoses with ulnar palmar carpal branch to form palmar arch)
Crosses floor of anatomical snuffbox and pierces 1st dorsal interossei
Gives off dorsal carpal branch (anastamoses with ulnar dorsal carpal branch to form dorsal arch)

Supplies posterolateral forearm

79
Q

Describe the course and distribution of the ulnar artery

A

Descends deep to superficial and intermediate layers of anterior forearm muscles
At cubital fossa gives off common interosseous artery which divides into anterior and posterior interosseous arteries
Gives off palmar carpal branch at distal forearm
Passes superficial to flexor retinaculum in ulnar canal to enter hand
Gives off dorsal carpal branch proximal to pisiform

Supplies anteromedial forearm

80
Q

Divide the course of the anterior and posterior interosseous arteries

A

From common interosseous artery (branch of ulnar artery) at cubital fossa

Anterior: runs on anterior interosseous membrane then pierces membrane proximal to pronator quadratus, joins dorsal carpal arch

Posterior: passes to posterior interosseous membrane and runs between superficial and deep extensors (supplies both), joins anterior interosseous artery at distal forearm after it pierces through interosseous membrane

81
Q

Which arch gives off the digital arteries?

A

Palmar (superficial)

82
Q

Describe the course of the median nerve

A

Descends initially lateral to brachial artery
Halfway down the arm, median nerve crosses brachial artery to enter cubital fossa at medial aspect
Exits cubital fossa and travels between two heads of pronator teres, then descends between FDP and FDS
Gives off anterior interosseous nerve to supply deep flexor muscles
Gives off palmar cutaneous nerve just proximal to wrist
Enters hand via carpal tunnel
Terminates by dividing into recurrent branch (supplies thenar muscles) and palmar digital nerves (sensation to lateral 3.5 digits, motor to lateral 2 lumbricals

83
Q

Why does a fracture of the radial head not produce a wrist drop?

A

Innervation and function of ECRL still intact

84
Q

Describe the course of the ulnar nerve

A

Descends in medial arm between axillary artery laterally and axillary vein medially
At midpoint of arm, pierces medial septum to enter posterior compartment of arm and passes through elbow in ulnar tunnel
In the forearm it pierces FCU and travels deep to it
Gives off muscular, palmar cutaneous and dorsal cutaneous branches
Travels superficial to flexor retinaculum of wrist in ulnar canal (lies medial to the ulnar artery)
Terminates in hand by giving rise to superficial and deep branches

85
Q

Describe the course of the basilic vein

A

Originates from medial dorsal venous network of hand
Ascends medial aspect of upper limb
Moves deep into the arm at the inferior border of teres major
Combines with brachial veins to form axillary vein

86
Q

Describe the course of the cephalic vein

A

Arises from lateral dorsal venous network of hand
Ascends anterolateral aspect of upper limb
Travels in deltopectoral groove at shoulder
Enters axilla via clavipectoral triangle
Within axilla, empties into axillary vein

ACEM Primary Written (150 decks)

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