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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
Muscles in posterior compartment of arm
Triceps brachii Anconeus
26
Origin and insertion of anconeus
Origin: lateral epicondyle of humerus Insertion: lateral olecranon and superoposterior ulna
27
Muscles in anterior compartment of forearm
Superficial x4: FCU, FCR, palmaris longus, pronator teres Intermediate x1: FDS Deep x3: FPL, FDP, pronator quadratus
28
Innervation of anterior compartment of forearm
All except FCU and medial FDP by median nerve (with deep muscles by anterior interosseous branch of median nerve)
29
Arterial supply of anterior compartment of forearm
30
Common origin of superficial and intermediate muscles of anterior compartment of forearm
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
31
Actions of muscles of anterior compartment of forearm
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
32
Distal attachments of superficial anterior forearm compartment muscles
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
33
What two structures pass between the ulnar and radial heads of FDS?
Median nerve Ulnar artery
34
Proximal and distal attachments of FDP
Proximal: ulna and interosseous membrane Distal: base of distal 2nd-5th phalanges
35
Proximal and distal attachments of FPL
Proximal: radius and interosseous membrane Distal: base of distal 1st phalanx
36
Proximal and distal attachments of pronator quadratus
Proximal: distal ulna Distal: distal radius
37
Muscles of the posterior compartment of the forearm
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
Innervation of the posterior compartment of the forearm
Radial nerve
39
Which of the 6x superficial muscles of the posterior compartment of the forearm originate from the common extensor tendon?
Originating from common extensor tendon on lateral epicondyle of humerus: - ECU - ECRB - Extensor digitorum - Extensor digiti minimi
40
Attachments and action of brachioradialis
From lateral supracondylar humerus to distal radius Weak flexor, assists in supination
41
Attachments of ECRL and ECRB
ECRL from lateral supracondylar humerus, ECRB from common extensor tendon at lateral epicondyle of humerus Attach to base of 2nd and 3rd metacarpals
42
Which nerves of the posterior compartment of the forearm are supplied by the deep and posterior interosseous branches of the radius?
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
Where do the tendons of the extensor muscles for the digits insert?
Into the extensor hoods of each respective digit Some have more than one muscle insert (i.e. thumb, index finger, and little finger)
44
Distal attachment of ECU
Base of 5th metacarpal
45
What is tennis elbow vs golf elbow?
Tennis elbow: lateral epicondylitis (aim for "lateral" line of the court) Golf elbow: medial epicondylitis (aim for "middle" of the fairway)
46
The radial nerve passes between the two heads of which muscle?
Supinator
47
Proximal and distal attachment of supinator
Proximal: two heads, one from lateral epicondyle of humerus (common extensor origin) and one from posterior ulna Distal: posterior surface of proximal radius
48
Proximal and distal attachment of abductor pollicis longus
Proximal: interosseous membrane, adjacent radius and ulna (just distal to supinator) Distal: base of 1st metacarpal
49
Proximal and distal attachment of EPB
Proximal: posterior radius and interosseous membrane Distal: base of 1st proximal phalanx
50
Proximal and distal attachment of EPL
Proximal: posterior ulna and interosseous membrane Distal: base of 1st distal phalanx
51
Proximal attachment of extensor indicis
Posterior ulna and interosseous membrane
52
What does the recurrent branch of the median nerve innervate?
Thenar muscles
53
Which thenar muscles are innervated by the ulnar nerve?
Deep head of flexor pollicis brevis Adductor pollicis
54
Attachments of flexor pollicis brevis
Trapezium and flexor retinaculum to base of 1st proximal phalanx
55
Attachments of opponens pollicis
Trapezium and flexor retinaculum to lateral side of 1st metacarpal
56
Attachments of abductor pollicis brevis
From scaphoid, trapezium and flexor retinaculum To lateral side of 1st proximal phalanx
57
Attachments of flexor digiti minimi
Hook of hamate and flexor retinaculum to base of 5th proximal phalanx
58
Attachments of abductor digiti minimi
Pisiform and FCU tendon to base of proximal phalanx
59
Attachments of opponens digiti minimi
Hook of hamate and flexor retinaculum to medial aspect of 5th metacarpal
60
Which has two heads: dorsal or palmar interossei?
Dorsal
61
Attachments of adductor pollicis
One head from 3nd metacarpal, one from capitate and 2nd-3rd metacarpals Inserts into base of 1st proximal phalanx
62
What does the radial artery pass through to form the dorsal palmar arch?
Two heads of adductor pollicis
63
Boundaries and contents of the cubital fossa
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
Boundaries of the cubital tunnel
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
Extensor tendon compartments of the wrist and their contents
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
What is De Quervain's tenosynovitis?
Inflammation affecting tendons of extensor compartment 1 (EPB and abductor pollicis longus)
67
Borders of the carpal tunnel
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
Contents of the carpal tunnel
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
What tendon is contained within the flexor retinaculum itself?
FCR
70
Borders of the anatomical snuffbox
Ulnar border: EPL Radial border: EPB and abductor pollicis longus Proximal: radial styloid Floor: scaphoid, trapezium Roof: skin and subcutaneous tissue
70
Borders of the ulnar canal
Medial: pisiform, FCU tendon, abductor digiti minimi Lateral: hook of hamate Roof: palmar carpal ligament Floor: flexor retinaculum
71
Contents of the anatomical snuffbox
Radial artery Superficial branch of radial nerve (sensory) Cephalic vein
72
Inflammation of which bursa causes olecranon bursitis?
Subcutaneous olecranon bursa
73
What are the three bursae of the elbow joint?
Intratendinous: inside triceps brachii tendon Subtendinous: between triceps brachii tendon and olecranon Subcutaneous: between olecranon and overlying connective tissue
74
Which structures may be damaged with elbow dislocation?
Dislocation is typically posterior Ulnar collateral ligament may be torn Ulnar nerve may be damaged
75
Four ligaments of the wrist
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
What is the clinical presentation of a lunate dislocation?
Lunate compresses carpal tunnel -> paraesthesia in median nerve distribution and weakness of thenar muscles
77
Describe the course of the brachial artery
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
Describe the course and distribution of the radial artery
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
Describe the course and distribution of the ulnar artery
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
Divide the course of the anterior and posterior interosseous arteries
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
Which arch gives off the digital arteries?
Palmar (superficial)
82
Describe the course of the median nerve
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
Why does a fracture of the radial head not produce a wrist drop?
Innervation and function of ECRL still intact
84
Describe the course of the ulnar nerve
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
Describe the course of the basilic vein
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
Describe the course of the cephalic vein
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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