Pectoral Girdle, Upper Limb And Chest

Question 1

Name the joints of the clavicle and state their position.

Answer 1

The sternoclavicular joint is at the medial clavicle at the sternal articular surface and the acromioclavicular head is at the lateral end at the acromial facet.

Question 2

Name the joints of the scapula and state their position.

Answer 2

The acromioclavicular joint is at the acromion and the glenohumeral joint is at the glenoid cavity.

Question 3

Name parts of the scapula from a to j.

Answer 3

(letter = posterior, anterior)
a = suprascapular notch, acromioclavicular joint
b = coracoid process, acromion
c = acromioclavicular joint, coracoid process
d = acromion, glenoid cavity
e = spinoglenoid notch, circumflex scapular groove
f = glenoid cavity, lateral border
g = circumflex scapular groove, inferior angle
h = infraspinous fossa, subscapular fossa
i = spine, medial border
j = supraspinous fossa, superior angle

Question 4

Name parts of the humerus from 1 to 17. (anterior, posterior)

Answer 4

1 = deltoid tuberosity
2 = greater tubercle
3 = intertubercular groove
4 = olecranon fossa
5 = surgical neck
6 = head(of humerus)
7 = deltoid tuberosity
8 = medial supracondylar ridge
9 = lateral epicondyle
10 = medial epicondyle
11 = anatomical neck
12 = lesser tubercle
13 = trochlea
14 = lateral supracondylar ridge
15 = capitulum
16 = radial fossa
17 = coronoid fossa

Question 5

Differentiate between the left and right clavicle.

Answer 5

When looking superiorly and the anterior is on the right hand side, the right clavicle has an s-shape. When looking superiorly and the anterior is on the left hand side, the left clavicle has a reverse s-shape.

Question 6

Name the parts of the left clavicle from left to right.
(excl. of 4 - 6)

Answer 6

1 = sternal head
2 = sternal facet
3 = impression for costoclavicular ligament
(4 = anterior
5 = posterior
6 = inferior surface)
7 = subclavian groove
8 = conoid tubercle
9 = trapezoid line
10 = acromial facet
11 = acromial head

Question 7

Name the origins, insertion, actions and nerve supply of the pectoralis major.

Answer 7

Origins: upper 6 costal cartilages and anterior sternum (sternocostal head), medial clavicle (clavicular head)
Insertion: lateral lip of intertubercular groove
Actions: flexion, medial rotation and adduction of humerus
Nerve supply: medial pectoral nerve (C8,T1) and lateral pectoral nerve (C5-7)

Question 8

Name the origins, insertion, actions and nerve supply of the pectoralis minor.

Answer 8

The pectoralis minor’s origin is from ribs 3 to 5.
Its insertion is the coracoid process.
Its actions are protraction and stabilization of the scapula.
Its nerve supply is the medial pectoral nerve (C8,T1)

Question 9

Name the origins, insertion, actions and nerve supply of the serratus anterior.

Answer 9

The origin of the serratus anterior is from ribs 1 to 8.
Its insertion is the medial border of the scapula.
Its actions are the protraction, rotation and stabilization of the scapula.
Its nerve supply is the long thoracic nerve.

Question 10

Name the origins, insertion, action and nerve supply of the subclavius.

Answer 10

The origin of the subclavius is the 1st rib and 1st costal cartilage.
Its insertion is the inferior surface of the clavicle.
It aids in the depressing lateral part of the clavicle.
Its nerve supply is the nerve to the subclavius (C5,6)

Question 11

How are limbs formed in a foetus?

Answer 11

Limbs are outgrowths of the ventral body wall that undergo distal growth, differentiation and rotation.

Question 12

What spinal segmental nerves end in the upper limb?

Answer 12

C3 to T2

Question 13

What spinal segmental nerves end in the lower limb?

Answer 13

L2 to S4.

Question 14

Draw a diagram of the upper limb’s nerve supply (the brachial plexus). 16 nerves total.

Answer 14

Question 15

Name the origins, insertion, actions and nerve supply of the trapezius.

Answer 15

Origins: superior nuchal line of the occipital bone, nuchal ligament and spinous processes of C7 to T12.
Insertions: lateral 3rd of the clavicle, acromion process, spine of scapula.
Actions: Elevation, retraction and depression the scapula. (Assist in scapula’s upward rotation.)
Nerve supply: cranial nerve XI and cervical nerve (C3,4).

Question 16

Name the origins, insertion, actions and nerve supply of the rhomboid major.

Answer 16

Origins: (Spinous processes of) T2-T5
Insertion: Medial border of the posterior scapula (from the spine to the inferior angle)
Actions: Retracts, elevates, and rotates the scapula
Nerve Supply: Dorsal scapular nerve (C4-C5)

Question 17

Name the origins, insertion, actions and nerve supply of the rhomboid minor.

Answer 17

Origins: spinous processes of C7 and T1, and the lower part of the nuchal ligament.
Insertion: Medial border of the scapula at the level of the spine.
Actions: Retracts, elevates, and rotates the scapula.
Nerve Supply: Dorsal scapular nerve (C4-C5).

Question 18

Name the origins, insertion, actions and nerve supply of the levator scapulae.

Answer 18

Origins: Transverse processes of C1-C4 vertebrae.
Insertion: Superior part of the medial border of the scapula.
Actions: Elevation and downward rotation of scapula, lateral flexion and extension of neck.
Nerve Supply: Dorsal scapular nerve (C4-C5) and cervical nerves (C3-C4).

Question 19

Name the origins, insertion, actions and nerve supply of the deltoid.

Answer 19

Origin: Lateral third of the clavicle, acromion, and spine of the scapula.
Insertion: Deltoid tuberosity.
Actions: Abducts, flexes, and extends the arm.
Nerve Supply: Axillary Nerve (C5-C6)

Question 20

What are the 4 rotator cuff muscles?

Answer 20

Supraspinatus, infraspinatus, teres minor and subscapularis

Question 21

Name the origins, insertion, actions and nerve supply of the supraspinatus.

Answer 21

Origin: Supraspinous fossa.
Insertion: Greater tubercle.
Action: Abducts the arm (initial 15 degrees).
Nerve Supply: Suprascapular Nerve (C5-C6)

Question 22

Name the origins, insertion, actions and nerve supply of the infraspinatus.

Answer 22

Origin: Infraspinous fossa.
Insertion: Greater tubercle.
Action: Lateral rotation of the arm.
Nerve Supply: Suprascapular Nerve (C5-C6)

Question 23

Name the origins, insertion, actions and nerve supply of the teres minor.

Answer 23

Origin: Lateral border of the posterior scapula.
Insertion: Greater tubercle.
Action: Lateral rotation of the arm.
Nerve Supply: Axillary Nerve (C5-C6)

Question 24

Name the origins, insertion, actions and nerve supply of the teres major.

Answer 24

Origin: Inferior angle of the posterior scapula.
Insertion: Medial lip of the intertubercular groove.
Action: Medial rotation, adduction, and extension of arm.
Nerve Supply: Lower Subscapular Nerve (C5,C6)

Question 25

Name the origins, insertion, actions and nerve supply of the subscapularis.

Answer 25

Origin: Subscapular fossa. Insertion: Lesser tubercle. Action: Medial rotation of the arm. Nerve Supply: Upper and Lower Subscapular Nerves (C5-C6)

Question 26

What nerve pierces the clavipectoral fascia?

Answer 26

The lateral pectoral nerve.

Question 27

What is the classification of the joint between the 1st rib and sternum?

Answer 27

Synchondrosis

Question 28

Name the origins, insertion, actions and nerve supply of the long head of the biceps.

Answer 28

Origin: supraglenoid tubercle Insertions: radial tuberosity and bicipital aponeurosis Actions: flexion of the elbow and supination of the forearm. Stabilization and flexion of the shoulder. Nerve supply: musculocutaneous nerve (C5,C6)

Question 29

Name the origins, insertion, actions and nerve supply of the short head of the biceps.

Answer 29

Origin: coracoid process Insertions: radial tuberosity and bicipital aponeurosis Actions: flexion of the elbow and supination of the forearm. Stabilization and flexion of the shoulder. Nerve supply: musculocutaneous nerve (C5,C6)

Question 30

Name the origins, insertion, actions and nerve supply of the long head of the triceps.

Answer 30

Origin: infraglenoid tubercle Insertion: olecranon fossa Actions: extension of elbow, adduction of arm, stabilization and extension of shoulder. Nerve supply: radial nerve (C6, C7, C8)

Question 31

Name the origins, insertion, actions and nerve supply of the lateral head of the triceps.

Answer 31

Origin: posterior humerus, above the radial groove Insertion: olecranon fossa Action: extension of elbow Nerve supply: radial nerve (C6, C7, C8)

Question 32

Name the origins, insertion, actions and nerve supply of the medial head of the triceps.

Answer 32

Origin: posterior humerus, below the radial groove Insertion: olecranon fossa Action: extension of elbow Nerve supply: radial nerve (C6, C7, C8)

Question 33

Name the origins, insertion, actions and nerve supply of the latissimus dorsi.

Answer 33

Origins: spinous processes of T7 - T12, thoracolumbar fascia, iliac crest, ribs 9 - 12, inferior angle of the scapula. Insertion: Intertubercular groove Actions: Extension, adduction and medial rotation of the shoulder, compresses the ribcage. Nerve supply: thoracodorsal nerve (C6, C7, C8)

Question 34

Which artery pierces the clavipectoral fascia?

Answer 34

The thoracoacromial artery.

Question 35

What spinal level is the inferior angle of the scapula?

Answer 35

Spinous process of T7

Question 36

Which arteries are linked by the scapular anastomosis?

Answer 36

3rd part of the axillary (circumflex scapular) and 1st part of the subclavian artery (suprascapular).

Question 37

Name the origins, insertion, actions and nerve supply of the coracobrachialis.

Answer 37

Origin: coracoid process Insertion: middle third of the medial humerus. Actions: flexion, adduction and stabilization of shoulder. Nerve supply: musculocutaneous nerve (C5, C6, C7)

Question 38

What is the axilla?

Answer 38

The axilla is a 4-sided, truncated pyramidal space at the junction of the arm and the trunk.

Question 39

State the boundaries of the axilla at the apex, anterior wall and posterior wall.

Answer 39

APEX: clavicle, scapula and lateral border of the 1st rib ANTERIOR WALL: skin, superficial fascia, pectoralis major, pectoralis minor and clavipectoral fascia POSTERIOR WALL: skin, superficial fascia, teres major, latissimus dorsi, subscapularis

Question 40

State the boundaries of the axilla at the medial wall, lateral wall and floor.

Answer 40

MEDIAL WALL: 1st to 4th ribs, serratus anterior LATERAL WALL: intertubercular groove FLOOR: skin, superficial fascia, axillary fascia

Question 41

What blood vessels and nerves run through the axilla?

Answer 41

The axillary artery and its branches and the axillary vein and its tributaries run through the axilla. The cords and branches of the brachial plexus and the lateral collateral branches of intercostal nerves run through the axilla.

Question 42

What muscles and tendons run through the axilla?

Answer 42

The long and short heads of the biceps brachii and the coracobrachialis.

Question 43

Describe the beginning and end of the axillary artery.

Answer 43

It starts from the 1st rib as a continuation of the subclavian artery. It ends at the inferior end of teres major, continuing as the brachial artery.

Question 44

State the position and branch of the 1st part of the axillary artery.

Answer 44

The 1st part of the axillary artery is above pec minor and has the superior thoracic artery as its sole branch.

Question 45

State the position and branches of the 2nd part of the axillary artery.

Answer 45

The 2nd part is behind pec minor and has the thoracoacromial artery and the lateral thoracic artery as its 2 branches.

Question 46

State the position and branches of the 3rd part of the axillary artery.

Answer 46

The 3rd part is below pec minor and has the anterior circumflex humeral artery, the posterior circumflex humeral artery and the subscapular artery (thoracodorsal and circumflex scapular) as its 3 branches.

Question 47

What is the largest branch of the axillary artery?

Answer 47

Subscapular artery

Question 48

How many axillary lymph nodes are there and where do they drain to?

Answer 48

There are 5: anterior, posterior, lateral, medial and apical. All nodes drain upwards to the apical node.

Question 49

State the myotomes for nerve root levels C1 to T1.

Answer 49

C1-2: cervical flexion C3: cervical lateral flexion C4: scapular elevation C5: shoulder abduction C6: elbow flexion, wrist extension C7: elbow extension, wrist flexion C8: finger flexion, thumb extension T1: finger abduction Mnemonic device: Certain foxes like finding strange events. Some also enjoy finding exciting events; feasting fun for all.

Question 50

State the myotomes for nerve root levels L1 to S2.

Answer 50

L1-2: hip flexion L3: knee extension L4: dorsiflexion L5: great toe extension S1: plantar flexion S2: knee flexion Hungry frogs keep eating delicious food. Great elephants playfully fly kites fast.

Question 51

What do upper and lower brachial plexus injuries lead to?

Answer 51

Upper brachial plexus (C5,C6) injury leads to Erb's palsy, paralysis of the arm. Lower brachial plexus (C8,T1) injury leads to Klumke's palsy, atrophy and pain of the arm.

Question 52

Name the origins, insertions, actions and nerve supply of the brachialis.

Answer 52

Origin: distal half of the anterior humerus Insertions: coronoid process and ulnar tuberosity Actions: elbow flexion Nerve supply: musculocutaneous nerve (C5,6) (and radial nerve)

Question 53

State the ligaments connecting the clavicle and scapula, include their attachments.

Answer 53

Coracoclavicular ligament consisting of the trapezoid ligament (lateral) and the conoid ligament (medial). This runs from the coracoid process to the clavicle. Acromioclavicular ligament connecting the acromion to the clavicle. Coracoacromial ligament.

Question 54

Which arm muscle has an attachment to the antebrachial deep fascia?

Answer 54

The biceps brachii muscle has an attachment to the antebrachial deep fascia, particularly the bicipital aponeurosis.

Question 55

Reduced blood supply to the anterior forearm is an important consideration in what type of fracture?

Answer 55

Supracondylar fractures of the humerus. Such fractures can cause damage to the brachial artery, leading to ischemia and may cause Volkmann's ischemic contracture which leads to permanent deformity of hand and forearm flexion.

Question 56

Where in the upper limb is the most common site of ulnar nerve injury?

Answer 56

The cubital tunnel (space on the medial elbow bordered by the olecranon and the medial epicondyle). The ulnar nerve passes through the cubital tunnel. It is caused by prolonged elbow flexion, stretching or trauma to the nerve. This is also seen in the Guyon's canal in the wrist. This is called cubital tunnel syndrome and is seen often in bowlers.

Question 57

State the boundaries and contents of the quadrangular space.

Answer 57

Superior=teres minor Inferior=teres major Lateral=long head of triceps brachii Contents: axillary nerve and posterior circumflex humeral artery

Question 58

What neurovascular structures are affected by a mid-humeral fracture?

Answer 58

Deep brachial artery and radial nerve