Osteology and circulation of the upper limb Flashcards
Name and point to all of the different bones in the upper limb?
Clavicle, Scapula, Humerus, Radius, Ulna, Carpus, Metacarpus, Phalanges
What is significant about the clavicles surfaces?
Its superior side is smooth and the inferior is rough due to tendons and muscles attaching there
How can the Medial and Lateral ends of the clavicle be described?
Medial - round
Lateral - flat
What are the names of the proximal/medial and distal/lateral ends of the clavicles?
Medial - Sternal end
Lateral - Acromial end
What is the name of the bump on the inferior surface near the lateral end of the clavicle?
Conoid tubercle
What is the facet on the lateral end of the clavicle called?
Acromial facet
What is the name of the line on the clavicle found between the conoid tubercle and the acromial facet?
The trapezoid line
What is the groove that runs inferiorly in the middle of the clavicle called?
The subclavian groove
What is the facet on the medial end of the clavicle called?
Sternal facet
What does the impression inferior close to the medial end of the clavicle hold?
The costoclavicular ligament
What is the only boney connection from the upper limbs to the axial skeleton?
Clavicle
If I fell with my arms straight out what bone am I likely to break?
Clavicle as force is transmitted through arm to clavicle
What are the 3 features of the sternoclavicular joint?
Very strong ligaments
Fibrocartilage lined joint
Articular disc
What are the 3 angles of the Scapula?
Superior
Inferior
Lateral
What are the 3 Fossae of the Scapula?
Supraspinous
Infraspinous
Subscapular
What are the 3 borders of the Scapula ?
Medial
Lateral
Superior
What ligament attaches above the suprascapular notch and what does this form ?
Upper transverse Scapular ligament which forms the Suprascapular foramen
What runs through the Suprascapular foramen?
Neurovascular bundles
How many tubercles does the humerus have and what are their names?
2: Greater and lesser tubercle
What are the 2 necks found on a humerus ?
Anatomical neck
Surgical neck
What are the lumps, bumps and lines for in the humerus ?
Muscle attachment
What do the ligaments in the Glenohumeral joint do?
Thicken the joint capsule
What are the 6 ligaments involved in stabilising the glenohumeral joint?
Superior glenohumeral ligament
Middle glenohumeral ligament
Inferior glenohumeral ligament
Coraco-acromial ligament
Coraco-humeral ligament
Transverse humeral ligament
What is the muscle that supports the glenohumeral joint? (other than rotator cuff muscles)
The long head of biceps brachii passes up into the joint capsule and attaches over the top of the humeral head, which helps to prevent humeral dislocation
What muscles are found in the Glenohumeral joint?
Rotator cuff muscles:
Supraspinatus
Infraspinatus
Subscapularis
Teres minor
What is the function of the rotator cuff?
Stabilises the Glenohumeral joint - This is why muscle tone of this is important in preventing dislocation
What are the 4 Bursae in the Glenohumeral joint?
Subacromial (Subdeltoid - SASD)
Subscapular
Subcoracoid
Coracobrachial
What are the 2 tubercles found in the Humerus? And what is in between?
Lesser and greater tubercle
Intertubercular groove
What are the 3 different types of Humeral fractures, where are they found and what nerves are affected?
Mid shaft - Spiral groove in humerus (starts superiorly) - Radial Nerve
Surgical neck - Middle of Humerus - Auxillary nerve
Supracodylar - Above elbow joint - Median nerves
What Humeral fracture is most common and what is this caused by?
Surgical fracture due to people falling on arm
What attaches to the supinator crest?
Supinator muscle
What keeps the elbow capsule lax both anteriorly and posteriorly?
The collateral ligaments
What ligament is affected if someone has “pulled elbow” or “Nurse maid” elbow?
The annular ligament
What movement does the annular ligament of the radius allow for?
Allows the radius to do supination and pronation
What is the special relationship between bursae and muscles?
Bursae are named after the muscles they are related to
What is a Colles fracture?
Fracture of distal radius - common in old ladies with hands stretched out when falling
What kind of deformity appears in those with a Colles fracture?
Dinner fork deformity
What type of joint is the Middle Radio-Ulnar joint?
Syndesmosis - fibrous joint
What prevents the radius and ulnar from separating ?
The interosseous membrane
What bone in the forearm does all of the movement?
Radius - it moves around Ulnar
What are the 3 features of the distal radio-ulnar joint?
1) . Has a fibrous disc
2) . Has anterior and posterior radio-ulnar ligaments (weak)
3) . Synovial membrane
What does the Sacciform Recess do ?
Aid movement
The sacciform recess is a thin extension of the articular capsule of the
How many hand bones is there?
27
How many Phalanges is there?
14 - long bones (3 in each digit and 2 in thumb)
How many metacarpals is there?
5 - long bones (1 for each digit and thumb)
How many Carpal bones is there?
8 - short bones
What are sesamoid bones?
a Sesamoid bone is a bone embedded in a tendon
What are the 4 proximal carpal bones from medial to lateral (in anatomical position!) ?
Scaphoid
Lunate
Triquetrum
Pisform
What are the 4 distal carpal bones from medial to lateral (in anatomical position!) ?
Trapezium
Trapezoid
Capitate
Hammate
What is the acronym for remembering Carpal bones?
Some
Lovers
Try
Positions
That
They
Cant
Handle
What isn’t involved in the wrist joint and why
The ulna - as it is separated from the wrist by a fibrocartilage disc
What are the 2 radio-carpal ligaments?
Palmar and dorsal radio-carpal ligaments
Where is the ulno-carpal ligament?
The palmer ulno-carpal ligament
What is significant about the radial and ulnar ligaments?
They run co-laterally
What kind of joints are inter carpal joints?
plane joints - sliding movement
Where are mid carpal joints and what are their function?
Between rows - abduction/extension
What name of joint is between the pisoform and triquetrum?
Pisoiotriquetral joint
What kind of joints occur between the 5 carpometacarpal joints?
1st carpometacarpal joint - saddle joint
2nd- 5th carpometacarpal joint - condyloid joints (allows movement in 2
What is the carpal joint capsule continuous with and what can this cause?
Continuous with Carpal-metacarpal - spread of infection
What is the carpal tunnel formed by ?
Carpal bones form a carpal arch
(Medially - Hook of Hamate and Pisoform)
(Laterally - Tubercle of Trapezium and Scaphoid)
Flexor retinaculum forms a roof
What ligament runs in the Metacarpal phalangeal joint?
Collateral and palmar ligaments
What ligament runs in the interphalangeal joints?
Collateral and palmar ligaments
What kind of joints are interphalangeal joints?
Hinge joints
What kind of movements can interphalangeal joints do?
Flexion and extension
What kind of movements can metacarpal-phalangeal joints do?
Flexion, Extension, Adduction, Abduction
(Middle finger can only abduct and flex, no adduction as middle finger is set reference point for other fingers to adduct to)
Where do the Subclavian arteries begin?
Right subclavian begins at the brachiocephalic trunk which extends out from the arch of aorta
Left subclavian begins at the arch of aorta
Where do the subclavian arteries end and what do they become next?
Subclavian arteries end at the lateral border of the 1st rib then becomes the axillary artery
What 2 other arteries does the subclavian artery branch of into?
The dorsal scapular and suprascapular arteries
What route does the subclavian arteries take?
Pass behind the clavicle over the top of the rib
Where does the axillary artery run from and to?
The lateral border of the 1st rib, crossing posteriorly to pectoralis minor to the inferior border of Teres major
What does the axillary artery become after?
The brachial artery
What is used as a landmark to split the axillary into the sections and where are these 3 sections found and what do they have?
Pectoralis minor
First Part (Proximal to Pectoralis Minor): This part gives off one branch, which is the superior thoracic artery.
Second Part (Behind Pectoralis Minor): This part usually gives off two branches, which are the thoracoacromial artery and the lateral thoracic artery.
Third Part (Distal to Pectoralis Minor): This part typically gives off three branches, which are the subscapular artery, anterior circumflex humeral artery, and posterior circumflex humeral artery.
What does the Scapular anastomosis do?
Connects the subclavian to the axillary artery
Where does the brachial artery start and end?
Starts at the lower border or Teres major and ends at its bifurcation anterior to the elbow before splitting into the ulnar and radial arteries
What are the 3 different branches of the Brachial artery ?
Profunda barachii (runs laterally down back)
Superior Ulnar collateral
Inferior Ulnar collateral
What are 3 features of radial and ulnar arteries?
Variable bifurcation
Ulnar is larger and deeper than radial
Both have recurrent branches -> Elbow anastomosis
What is the journey of the radial artery in the arm?
The radial artery lies anterior in the forearm then dorsally at the wrist before forming the anatomical snuffbox
What is the journey of the ulnar artery in the arm?
The ulnar artery remains anterior into the hand
What does the Ulnar artery quickly branch off into?
Common interosseous arteries then Anterior and posterior interosseous arteries
What arteries are palatable at the wrist?
The radial (stronger) and ulnar (weaker) arteries
What happens to the radial and ulnar arteries at the wrist?
Neither enter the carpal tunnel
Radial passes posteriorly to carpal bones
Ulnar passes anteriorly (superficially) to the flexor retinaculum
What is inside Guyons canal?
Ulnar nerve and artery
What is Allens test?
Patients clench both fists for 1 min
Pressure is applied to the Ulnar and radial arteries
Still elevated the hand should appear blanched
Ulnar is released and colour should return in 5-15 seconds
Should be repeated with Radial artery after
Shows a good collateral blood supply to wrist
What branches does the radius and ulnar arteries have at the wrist?
Palmar and dorsal carpal branches and dorsal and palmar carpal arches
What can a Scaphoid fracture cause?
Avascular necrosis
What is the journey of the superficial arteries of the hand?
- The ulnar artery enters the hand and gives off a deep branch
- This continues as a superficial ulnar branch, creating the superficial palmar arch
- This then meets the superficial palmar arch of the radial artery branch
- This arch gives of 3 common palmar digital arteries
- Each of the 3 common palmar digital arteries split off into 2 proper palmar digital arteries which pass up either side of each finger
What is the journey of the deep arteries of the hand?
- The radial artery passes posteriorly on the scaphoid and trapezium
- The radial artery then re-enters the palmar surface through the 1st dorsal interosseous muscles to the princeps policis artery
- This then forms deep palmar arch (anastomosing with deep branches of ulnar artery)
- The deep palmar arch gives off palmar metacarpal arteries which anastomose with common palmar arteries
What does hand Anastomoses do?
Provide a good collateral supply around highly moveable joints
Hand arterioles are very important for thermoregulation
What do most veins follow and what are these specific veins called?
Most veins follow arterial supply - Known as Venae comitantes
What do brachial veins come together to form?
Axillary Veins
What else attaches onto the Axillary veins and where can this be found?
Basilic vein at the lower border of Teres Major
What is the network of veins on the back of the hand called and what does this give rise to?
Dorsal venus network (Arch) - gives Cephalic and Basilic veins
What do the veins in the axilla often do?
Anastomose
What else joins onto the Axillary vein?
Body wall veins from lower abdomen
What are the 5 Axillary lymph nodes?
Humeral, central, apical, subscapular and pectoral
What makes up the pectoral girdle ?
The pectoral girdle is outlined by the upper border of one scapula, the clavicle, upper border of the sternum, the collateral clavicle and scapula
What does the sternoclavicular joint attach?
There sternoclavicular joint attaches the superior appendicular skeleton to the axial skeleton
Where does the medial articular facet of the clavicle articulate with?
The manubrium of the sternum
Where does the lateral articular facet of the clavicle articulate with?
The Acromion of the Scapula
What attaches to the subclavian groove?
The subclavius muscle and clavipectroal fascia
What attaches to the trapezoid line?
The trapezoid ligament
What is the joint where the clavicle articulates with the acromion of the scapula called?
The acromioclavicular joint
What does the Conoid ligament and Trapezoid ligament form together?
The coracoclavicular ligament
Where are forces from the upper limb transmitted to?
Forces from the upper limb are transmitted bu the trapezius to the cervical spine and by the clavicle to the axial skeleton by the coracoclavicular and costoclavicular ligaments
What attaches to the lateral border of the Scapula?
Heres major and minor
What attaches to the medial border of the Scapula ?
Rhomboid muscles
What ribs are the superior and inferior angles at the level of?
Superior angle - At level of 2nd rib
Inferior angle - At level of 7th rib
What muscles attach to the Acromion ?
The posterior fibres of the deltoid muscle and middle fibres of the trapezius
What muscles attach to the Corcoid process?
The short head of biceps, coracobrachialis and pectorals minor muscles
What attaches to the supraglenoid process?
The origin of the tendon of the long head of biceps muscle
What attaches to the infraglenoid process?
The origin of the tendon of the long head of triceps
What muscle attaches to the lesser tubercle of the humerus?
The subscapularis muscle
What muscles attach to the greater tubercle of the humerus?
Upper part of tubercle - supraspinatus, infraspinatus and teres minor muscle
What tendon is found in the intertubecular sulcus (bicipital groove) ?
The long tendon of the biceps muscle
What muscles attach to the medial and lateral lips ?
Medial lip - Teres major
Lateral lip - Pectoralis major
What muscle attaches in the groove between the 2 lips on the humerus ?
The latissimus dorsi
What muscle attaches to the deltoid tuberosity ?
The deltoid
What bone articulates with the Capitulum?
The radius
What bone articulates with the Trochlea?
The ulnar
What is held in the groove that runs inferior and posterior to the medial epicondyle ?
The groove for the ulnar nerve
What is the surface of the radius which articulates with the ulnar called?
The Circumferential surface
What tendon attaches to the radial tuberosity ?
The distal tendon of the biceps muscle
What is the name of the roughened area near the midpoint of the midpoint of the lateral surface of the radial shaft?
The pronator tuberosity
What tendons attach to the several grooves in the dorsal tubercle ?
Tendons of forearm muscles
What muscle attaches to the Olecranon ?
The distal attachment of the triceps muscle
What muscle attaches to the coronoid process in the ulnar ?
The brachialis
What articulates at the radial notch?
The head of the radius and the ulna
What muscle attaches attaches at the supinator crest and fossa?
The supinator muscle
What is located just inferior to the radial notch on the ulnar?
The supinator crest
What is the distal end of the ulna called?
The head of the ulna
What tendon passes in the groove that runs between the styloid process and the ulnar head ?
A tendon of the extensor muscle of the forearm
