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MRCS Anatomy > Raftery Upper Limb > Flashcards

Raftery Upper Limb Flashcards

1
Q

What is the female breast made of?

A

Fat
Fibrous tissue
Glandular tissue (15-20 lobules)

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2
Q

What are the lobules of glandular tissue in the breast separated by?

A

By fibrous septa running from subcutaneous tissues to the fascia of the chest wall (i.e. ligaments of Astley Cooper)

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3
Q

What does each gland in the breast drain into?

A

Lactiferous duct, which converges towards the nipple. Each duct becomes dilated to form a lactiferous sinus beneath the areola.

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4
Q

What are glands of Montogomery in the breast?

A

Large modified sebaceous glands that lubricate the areola

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5
Q

Arterial supply of breast

A

Axillary artery via lateral thoracic and acromiothoracic branches
Internal mammary (thoracic) artery via its perforating branches
Intercostal arteries via perforating branches

(Venous drainage to corresponding veins)

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6
Q

Lymphatic drainage of breast

A

Axillary LNs along tributaries of axillary vein
Internal mammary chain along tributaries of internal mammary vessels
(free communication between lymphatic vessels between breast lobules, but lateral part tends to drain towards axilla and medial part towards internal mammary chain)

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7
Q

Anatomical classification of axillary nodes

A

Anterior (pectoral) - 3-5 nodes lie deep to pec major in medial wall of axilla along lower border of pectoralis major, related to lateral thoracic artery. Receive lymph mainly from anterior thoracic wall including most of breast.

Posterior (subscapular) - 6-7 nodes along posterior axillary fold and subscapular vessels. Lymph from posterior thoracic wall and scapular region.

Lateral (humeral) - 4-6 nodes posterior to axillary vein, most lymph drained from UL

Central - 3-4 large nodes near base of axilla (deep to pec minor, close to 2nd part of axillary artery) in axillary fat. Lymph from efferent vessels from pectoral, subscapular and humeral axillary LN groups

Apical - immediately behind clavicle at apex of axilla above pectoralis minor. Close to axillary vein (all other axillary nodes drain down this group and also from lymph vessels accompanying cephalic veins)

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8
Q

Surgical classification of axillary nodes

A

Level 1 nodes - below and lateral to inferolateral border of pec minor (lateral, anterior and posterior nodes)

Level 2 nodes - behind pec minor (central and some apical nodes)

Level 3 nodes - above upper border of pec minor (apical and infraclavicular nodes)

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9
Q

How may a male breast cancer spread when it has infiltrated the normal pathways of lymphatic drainage?

A

Lymphatics of opposite breast
Contralateral axillary nodes
Inguinal lymph nodes
Cervical lymph nodes

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10
Q

How are incisions in the breast made?

A

Radially, to avoid cutting across the line of the ducts

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11
Q

What is dimpling of the skin over a carcinoma of the breast?

A

It is the result of malignant infiltration and contraction of Cooper’s ligaments

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12
Q

What is the shape of the axilla?

A

Pyramidal, with a base, apex and 4 walls

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13
Q

Contents of the axilla

A

Axillary artery (3 parts) - medial, posterior and lateral to pectoralis minor (medial and posterior parts travel in axilla)

Axillary vein - lies in apex of axilla, continuation of basilic vein, becomes subclavian vein at outer border of 1st rib

Brachial plexus

Axillary lymph nodes - lymph from UL and pectoral region

Biceps brachii (short head) and coracobrachialis - attach to coracoid process of scapula

Long thoracic nerve (of Bell) - derived from C5-7, passes behind brachial plexus to enter axilla. Lies on medial chest wall, supplies serratus anterior. Damage during axillary surgery causes winging of scapula.

Thoracodorsal nerve and trunk - innervate and vascularise latissimus dorsi

Intercostobrachial nerves - traverse the axillary LNs, often divided during axillary surgery, provide cutaneous sensation to axillary skin

Fat

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14
Q

Borders of the axilla

A

Medial - thoracic wall, serratus anterior

Lateral - bicipital/intertubercular groove of humerus/humeral head

Anterior - lateral border of pec major, pec minor, subclavius muscles

Posterior - subscapularis, teres major, lat dorsi

Apex (axillary inlet) - lateral border of 1st rib, superior border of scapula, posterior border of clavicle

Fascia - clavipectoral fascia

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15
Q

Boundaries of antecubital fossa

A

Medial - lateral border of pronator teres
Lateral - medial border of brachioradialis
Superior - horizontal line between epicondyles of humerus
Floor - brachialis (proximally) and supinator (distally)
Roof - bicipital aponeurosis, fascia, subcutaneous fat, skin

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16
Q

Contents of antecubital fossa

A

(Lateral to medial)
Radial nerve - along lateral border of cubital fossa, divides into superficial and deep branches, motor and sensory function in posterior arm and hand

Biceps tendon - passes centrally through fossa, attaches the radial tuberosity (immediately distal to radial neck), gives rise to bicipital aponeurosis which contributes to roof of cubital fossa

Brachial artery - divides into radial and ulnar arteries at apex of fossa, brachial pulse can be felt by palpating medial to biceps tendon

Median nerve - travels medially through fossa, exiting by passing through 2 heads of pronator teres, motor and sensory function in anterior arm and hand

Roof of cubital fossa also contains a few superficial veins - median cubital vein connecting basilic and cephalic veins

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17
Q

Boundaries of carpal tunnel

A

Roof - flexor retinaculum

Floor and walls - concavity of carpal bones (medial to lateral: trapezium, trapezoid, capitate, hamate)

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18
Q

Contents of carpal tunnel

A

Median nerve
9 tendons surrounded by synovial sheaths: FDS (4), FDP (4), flexor pollicis longus

Former 2 surrounded by single synovial sheath, latter has its own sheath - sheaths allow free movement of tendons

Note: flexor carpi radialis is located within the flexor retinaculum and not within carpal tunnel itself

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19
Q

Why is there no sensory impairment on lateral side of the palm if the median nerve is compressed in the carpal tunnel?

A

The superficial palmar branch innervating the lateral palm is given off proximal to the flexor retinaculum

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20
Q

Borders of anatomical snuffbox (radial fossa)

A

Medial - EPL
Lateral - abductor pollicis longus, EPB
Proximal - styloid process of radius
Floor - trapezium, scaphoid

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21
Q

Contents of anatomical snuffbox (radial fossa)

A

Radial artery - crosses floor of anatomical snuffbox, then turns medially and travels between heads of adductor pollicis muscle

Superficial branch of radial nerve - innervates dorsal surface of lateral 3.5 digits

Cephalic vein

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22
Q

Which structure is close to the dorsal branch of the radial artery?

A

Cephalic vein - site for creating AV fistula for dialysis

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23
Q

Lymphatics of upper limb (broadly speaking)

A

Superficial - accompany veins, very few in UL mainly epitrochlear nodes
Efferents from epitrochlear nodes pierce the deep fascia and end in axillary nodes
Deep - accompany arteries

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24
Q

Which structures do the axillary nodes drain?

A 
Breast
Pectoral region
Upper abdominal wall down to umbilicus
Skin of back down to iliac crest
Upper limb
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25
Q

What emerges from the axillary nodes?

A

Subclavian lymph trunk

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26
Q

Overview of arteries of the upper limb

A 
Subclavian
Axillary
Brachial
Radial
Ulnar
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27
Q

Start and end points of axillary artery

A

Starts at lateral border of 1st rib (from subclavian artery)

Ends at lower border of teres major (as brachial artery)

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28
Q

Parts of axillary artery

A 
Divided into 3 parts by pec minor:
1st part (proximal) - superior thoracic artery

2nd part (posterior) - thoracoacromial and lateral thoracic artery

3rd part (distal) - subscapular, anterior and posterior circumflex arteries (latter form anastomotic network around surgical neck of humerus, can be damaged in fractures)

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29
Q

Relations of axillary artery

A

Brachial plexus cords (lateral, medial, posterior) surround the artery

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30
Q

Start and end points of brachial artery

A

Starts at lower border of teres major (from axillary artery)

Ends in cubital fossa at level of neck of radius (divides into radial and ulnar artery)

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31
Q

Where does the brachial artery lie in its course?

A

Immediately below the deep fascia in most of its course where it is readily accessible e.g. for brachial embolectomy.

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32
Q

What crosses the brachial artery superficially from lateral to medial side?

A

Median nerve at level of mid-humerus

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33
Q

Start and end points of radial artery

A

Starts at neck of radius lying on biceps tendon

Distal to the wrist, give off branches contributing to superficial palmar arch

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34
Q

Where does the radial artery lie in its course?

A

Overlapped by brachioradialis in its upper half
In distal forearm - lies between the brachioradialis and FCR (can palpate at wrist)
Closely related to radial nerve in middle of forearm
Passes deep to tendons of APL and EPB to enter anatomical snuffbox
Pierces first dorsal interosseous and adductor pollicis to contribute to deep palmar arch

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35
Q

Start and end points of ulnar artery

A

Starts at neck of radius in middle of antecubital fossa
Passes obliquely downward, reaching ulnar side of forearm midway between elbow and wrist
Crosses in front of flexor retinaculum to divide into superficial and deep volar arches, and form superficial palmar arch with superficial branch of radial artery

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36
Q

Where does the ulnar artery lie in its course?

A

Passes deep to muscles from common flexor origin
Lies on FDP, overlapped by FCU
Median nerve at medial side of artery for ~2.5cm, then crosses it superficially
In distal forearm - becomes superficial between tendons of FDP and FCU
Ulnar nerve lies at medial side in distal 2/3 of forearm and across the flexor retinaculum

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37
Q

What separates the median nerve from the ulnar artery?

A

Deep head of pronator teres

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38
Q

What are the veins in UL important for?

A

Cannulation

Creation of AV fistula for dialysis

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39
Q

Overview of veins of the upper limb

A

Superficial - cephalic, basilic (combine to form median cubital vein)

Deep (venae comitantes accompanying arteries)

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40
Q

Start and end points of superficial veins in upper limb

A

Starts as dorsal venous network on dorsum of hand

Dorsal venous network drains into lateral cephalic vein and dorsal basilic vein

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41
Q

Where does the cephalic vein lie in its course?

A

Lies subcutaneously just behind radial styloid
Runs up anterior aspect of forearm
Lies in along lateral border of biceps in upper arm
Passes to deltopectoral triangle (superficial until reaches here)

Pierces clavipectoral fascia to enter axillary vein

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42
Q

Path of basilic vein

A

Originates on medial side of dorsal venous network of the hand

Passes MEDIALLY up forearm and arm (most of its course is superficial), runs in groove along medial border of biceps

Joins cephalic vein near region anterior to cubital fossa

Passes deep under the muscles midway up the humerus

Anterior and posterior circumflex humeral veins feed into it at lower border of teres major

Often joined by medial brachial vein (venae comitantes of brachial artery) before draining into axillary vein

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43
Q

Which vein connects the cephalic and basilic vein?

A

Median cubital vein

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44
Q

What separates the median cubital vein at the elbow from the underlying brachial artery?

A

Tough bicipital aponeurosis

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45
Q

What are the components of the brachial plexus and their locations?

A

Roots - between scalenus anterior and scalenus medius
Trunks - posterior triangle of neck
Divisions - behind clavicle
Cords - in axilla

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46
Q

Roots of the brachial plexus

A

Anterior primary rami of C5-8 and T1

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47
Q

Trunks of the brachial plexus

A

Superior - C5-6
Middle - C7-8
Inferior - C8-T1

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48
Q

Divisions of the brachial plexus

A

Each trunk divides into anterior and posterior divisions

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49
Q

Cords of the brachial plexus

A

Lateral - fused anterior divisions of upper and middle trunks
Medial - anterior division of lower trunk
Posterior - fusion of all 3 posterior trunks

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50
Q

What are the nerves that arise from each cord?

A

Lateral cord - musculocutaneous nerve
Medial - ulnar nerve
Posterior - radial, axillary nerve
Cross-communication between lateral and medial cords - median nerve

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51
Q

What is the radius?

A

One of 2 long forearm bones extending from lateral side of elbow to thumb side of wrist. Has 2 expanded ends, distal end is larger.

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52
Q

Relations of radius at its upper end

A

Articular cartilage - covers medial > lateral side
Articulates with radial notch of ulna by annular ligament

Biceps brachii attaches to radial tuberosity

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53
Q

Muscle attachment at shaft of radius

A

Upper 1/3 of body - supinator, FDS, FPL

Middle 1/3 of body - pronator teres

Lower 1/4 of body - pronator quadratus, tendon of supinator longus

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54
Q

Relations of lower end of radius

A

Quadrilateral

Anterior surface - capsule of wrist joint

Medial surface - head of ulna

Lateral surface - ends in styloid process

Posterior surface - 3 grooves containing: tendons of extensor carpi radialis brevis and longus, EPL and extensor indicis

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55
Q

Which nerve forms the terminal branch of the posterior cord of the brachial plexus?

A

Axillary nerve (C5-6) - divides into anterior and posterior branches

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56
Q

What does the axillary nerve innervate?

A

Deltoid muscle, small patch of skin over deltoid

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57
Q

Course of axillary nerve

A

Descends posterior to axillary artery at lower border of subscapularis, then passes through quadrangular space with posterior circumflex humeral vessels

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58
Q

Relations of brachial artery

A

Posterior - long head of triceps, with radial nerve and profunda vessels intervening

Anterior - overlapped by medial border of biceps, crossed by median nerve in middle of arm

In cubital fossa it is separated from median cubital vein by bicipital aponeurosis

Basilic vein is in contact at most proximal aspect of cubital fossa and lies medially

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59
Q

Origin of trapezius muscle

A

Medial 1/3 of superior nuchal line of occiput
External occipital protruberance
Ligamentum nuchae
Spines of C7 and all thoracic vertebrae and all intervening interspinous ligaments

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60
Q

Insertion of trapezius muscle

A

Posterior border of lateral 1/3 of clavicle
Medial border of acromion
Upper border of crest of spine of scapula

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61
Q

Nerve supply of trapezius

A

Spinal portion of accessory nerve (CN XI)

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62
Q

Actions of trapezius muscle

A

Elevation of shoulder girdle

Lateral rotation of scapula

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63
Q

Relations of ulnar artery

A

Deep to - pronator teres, FCU, palmaris longus
Lies on - brachialis, FDP
Superficial to flexor retinaculum at wrist

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64
Q

Branch of ulnar artery

A

Anterior interosseous artery

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65
Q

Course of long thoracic nerve

A

Derived from ventral rami of C5-7, close to their emergence from intervertebral foramina

Runs downward and passes either anterior or posterior to middle scalene muscle

Reaches upper tip of serratus anterior muscle and descends on outer surface of this muscle, giving branches to it

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66
Q

When does winging of scapula occur?

A

Long thoracic nerve injury - commonest
Spinal accessory nerve injury - denervates trapezius
Dorsal scapular nerve injury

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67
Q

What is the anterior (volar) interosseous nerve a branch of?

A

Median nerve

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68
Q

What does the anterior interosseous nerve supply?

A

PURE MOTOR

Deep muscles in anterior compartment of forearm:

  1. FPL
  2. Pronator quadratus
  3. Radial half of FDP (lateral 2/4 tendons)
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69
Q

Course of anterior interosseous nerve

A

Accompanies anterior interosseous artery along anterior of interosseous membrane of forearm, in the interval between FPL and FDP
Ends below in pronator quadratus and wrist joint

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70
Q

Which joint does the axilla lie under?

A

Glenohumeral joint, at the junction between UL and thorax

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71
Q

Passageways exiting axilla

A

3 main routes:
1. Immediately inferiorly and laterally, into the UL (majority)

  1. Quadrangular space (gap in posterior wall of axilla, structures passing through include axillary nerve and posterior circumflex humeral artery - branch of axillary artery)
  2. Clavipectoral triangle (gap in anterior wall) - bounded by pec major, deltoid and clavicle. Cephalic vein enters axilla here, while the medial and lateral pectoral nerves leave
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72
Q

What happens when vessels and nerves become compressed between the bones (clavicle, 1st rib, scapula) in the apex of axilla?

A

Thoracic outlet syndrome

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73
Q

Common causes of thoracic outlet syndrome

A

Trauma e.g. fractured clavicle

Repetitive movements - commonly in jobs with arm lifting

Cervical rib - extra rib from C7 vertebra

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74
Q

What is a supracondylar fracture?

A

Fracture of the distal humerus - usually transverse or oblique

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75
Q

Commonest mechanism of injury in supracondylar fracture

A

FOOSH, commoner in children than adults

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76
Q

What can happen if damage to the brachial artery is not repaired?

A

Volkmann’s ischaemic contracture (uncontrolled hand flexion) as forearm flexors become fibrotic and short

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77
Q

Damage to which structures can occur in supracondylar fracture?

A

Brachial artery
Anterior interosseous nerve (branch of median nerve) - weakness of flexor pollicis longus
Ulnar nerve
Radial nerve

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78
Q

What is the ulnar (cubital) tunnel?

A

A fibro-osseous space located on the posteromedial aspect of elbow

Transmits the ulnar nerve from arm into forearm

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79
Q

Borders of cubital tunnel

A

Medial - medial epicondyle of humerus

Lateral - olecranon of ulna

Floor - elbow joint capsule and medial collateral ligament of elbow

Roof - ligament spanning between medial epicondyle and olecranon (cubital tunnel retinaculum aka arcuate ligament of Osborne - band of fascia running between ulnar and humeral heads of flexor carpi ulnaris)

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80
Q

Contents of cubital tunnel

A

Ulnar nerve

After the tunnel, nerve travels between the 2 heads of flexor carpi ulnaris and continues into forearm and hand

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81
Q

What is cubital tunnel syndrome?

A

Compression of the ulnar nerve within the ulnar tunnel.

2nd commonest peripheral neuropathy of UL

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82
Q

What is the ulnar (Guyon’s) canal?

A

A fibro-osseous tunnel located at the level of the palm. Transmits ulnar neurovascular bundle from forearm into hand

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83
Q

Length of ulnar canal

A

About 4cm long, extends from proximal aspect of pisiform bone to origin of hypothenar muscles at hook of hamate

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84
Q

Borders of ulnar canal

A

Medial - pisiform, pisohamate ligament, abductor digiti minimi
Lateral - hook of hamate
Roof - palmar carpal ligament
Floor - flexor retinaculum, hypothenar muscles

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85
Q

Contents of ulnar canal

A

Ulnar nerve - divides within canal into superficial (sensory) and deep (motor) branches

Ulnar artery - located on radial aspect of ulnar nerve, gives rise to deep palmar branch, continues laterally across palm as superficial palmar arch

Venae comitantes of ulnar artery

Lymphatic vessels

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86
Q

Commonest causes of ulnar canal syndrome

A

Ganglion cyst
Lipoma
Trauma

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87
Q

Layers of carpal tunnel

A

Deep carpal arch - forms concave surface, converted into tunnel by overlying flexor retinaculum (transverse carpal ligament)

Superficial flexor retinaculum

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88
Q

What is the carpal arch of carpal tunnel formed by?

A

Lateral - scaphoid, trapezium tubercles

Medial - hook of hamate, pisiform

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89
Q

Divisions of median nerve once it passes through carpal tunnel

A

2 branches:
Recurrent branch - supplies thenar muscles

Palmar digital nerve - sensory innervation to palmar skin and dorsal nail beds of lateral 3.5 digits, motor innervation to lateral 2 lumbricals

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90
Q

Origin of subclavian artery

A

Right - brachiocephalic trunk

Left - directly from aortic arch

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91
Q

Parts of subclavian artey

A

1st part - origin of subclavian artery to medial border of anterior scalene

2nd part - posterior to anterior scalene

3rd part - lateral border of anterior scalene to lateral border of 1st rib (becomes axillary artery)

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92
Q

Which structure can be compressed in axillary artery aneurysm?

A

Brachial plexus, causing paraesthesia and muscle weakness

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93
Q

Which artery does the brachial artery give rise to immediately distal to teres major?

A

Deep artery (profunda brachii) - supplies structures in posterior aspect of upper arm (e.g. triceps brachii)

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94
Q

What does the profunda brachii travel with in the radial groove of humerus?

A

Radial nerve

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95
Q

What does the radial artery supply?

A

Posterolateral aspect of forearm

Contributes to anastomotic networks surrounding elbow joint and carpal bones

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96
Q

What does the ulnar artery supply?

A

Anteromedial aspect of forearm

Contributes to anastomotic network surrounding elbow joint

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97
Q

What does the ulnar arteries divide into?

A

Anterior and posterior interosseous arteries - supply deeper structures in forearm

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98
Q

What is formed when the radial and ulnar arteries anatosmose in the hand?

A

Superficial and deep palmar arches

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99
Q

Where does the ulnar artery enter the hand?

A

Anterior to flexor retinaculum, lateral to ulnar nerve

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100
Q

Where does the radial artery enter the hand?

A

Dorsally, crossing the floor of the anatomical snuffbox. Then turns medially and travels between heads of adductor pollicis muscle

Radial artery supplies 1 branch to the thumb, index finger and the superficial palmar arch, then continues as deep palmar arch

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101
Q

Origins of basilic and cephalic vein

A

Dorsal venous network of the hand

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102
Q

Where does the basilic vein travel in the arm?

A

Ascends the medial aspect of upper limb, moves deep into arm at border of teres major

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103
Q

What happens to the basilic vein at the border of teres major?

A

Basilic vein moves deep into the arm i.e. combines with brachial veins from deep venous system to form axillary vein

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104
Q

Where does the cephalic vein travel in the arm?

A

Ascends the anterolateral aspect of upper limb, passing anteriorly at the elbow.

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105
Q

Where does the cephalic vein travel at the shoulder?

A

Between the deltoid and pectoralis major (deltopectoral groove)

Enters axilla region via clavipectoral triangle where it empties into axillary vein

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106
Q

What is the deep venous system of the upper limb formed by?

A

Paired veins that accompany and lie on either side of an artery (brachial, ulnar, radial) - vena comitantes

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107
Q

What connects the deep and superficial veins of the upper limb?

A

Perforating veins

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108
Q

What is formed from the efferent vessels from apical axillary nodes?

A

Efferent vessels from apical axillary nodes travel through the cervico-axillary canal and converge to form the subclavian lymphatic trunk

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109
Q

What structures do the right and left subclavian trunks drain into?

A

Right subclavian trunk - right lymphatic duct, enters right venous angle directly (junction of internal jugular and subclavian veins)

Left subclavian trunk - thoracic duct

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110
Q

Common causes of axillary lymphadenopathy

A

Infection of UL resulting in lymphangiitis - lateral (humeral) group usually affected first

Infections of pectoral region and breast
Metastases of breast cancers

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111
Q

What is at risk of damage during axillary lymph node dissection?

A

Long thoracic nerve (causing winged scapula)

Thoracodorsal nerve

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112
Q

Where do the superficial lymphatic vessels of the UL arise from?

A

Lymphatic plexuses in the skin of hand (networks of lymphatic capillaries beginning in extracellular spaces)

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113
Q

Where do the superficial lymphatic vessels of the UL travel?

A

They travel up the arm in close proximity to major superficial veins

Basilic vein - enter cubital lymph nodes found medial to vein and proximal to medial epicondyle of humerus. They continue up the arm, ending in lateral (humeral) axillary lymph nodes

Cephalic vein - cross proximal part of arm to enter apical axillary lymph nodes, but some enter the more superficial deltopectoral lymph nodes

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114
Q

Where do the deep lymphatic vessels of the UL terminate?

A

Lateral (humeral) axillary lymph nodes

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115
Q

From which structures is lymph drained from by the deep lymphatic vessels of the UL?

A

Joint capsules
Periosteum
Tendons
Muscles

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116
Q

Which muscle originates from the subscapular fossa (anterior surface)

A

Subscapularis

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117
Q

Which muscles attach to the coracoid process of the scapula?

A

Pectoralis minor
Coracobrachialis
Short head of biceps brachii

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118
Q

Bony landmarks of scapula and their muscle attachments

A

Glenoid fossa - articulates with head of humerus to form glenohumeral joint

Supraglenoid tubercle - long head of biceps brachii

Infraglenoid tubercle - long head of triceps brachii

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119
Q

Landmarks of posterior surface of scapula and muscle attachments (if any)

A

Spine - most prominent feature, runs transverse across scapula, dividing it into supraclavicular and infraclavicular fossae

Acromion - projection of spine arching over glenohumeral joint and articulates with clavicle at acromioclavicular joint

Infraspinous fossa - origin of infraspinatus

Supraspinous fossa - origin of supraspinatus

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120
Q

Where does serratus anterior originate from and attach to?

A

Ribs 1-8, attaches to costal surface of scapula

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121
Q

Functions of clavicle

A

Long bone, attaches UL to trunk as part of ‘shoulder girdle’

Protects underlying NV structures supplying UL

Transmits force from UL to axial skeleton

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122
Q

Parts of clavicle

A

Sternal (medial) end
Shaft
Acromial end

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123
Q

Commonest mechanism of injury for fracture of clavicle

A

FOOSH or onto the shoulder

Commonest fracture in middle third (80%), followed by lateral and medial

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124
Q

What happens to orientation of arm after a clavicle fracture?

A

Lateral end displaced inferiorly by weight of arm

Displaced medially by pec major

Medial end pulled superiorly by sternocleidomastoid

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125
Q

Where does the costoclavicular ligament attach to?

A

Inferior surface of sternal end of clavicle

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126
Q

Which muscles attach to the shaft of clavicle?

A 
Trapezius
Deltoid
Subclavius
Pec major
Sternocleidomastoid
Sternohyoid
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127
Q

Which ligaments attach to the acromial end of clavicle?

A

Conoid ligament (medial part of coracoclavicular ligament, extrinsic) - attached to conoid tubercle

Trapezoid ligament (lateral part of coracoclavicular ligament, extrinsic) - attached to trapezoid line

Acromioclavicular ligament (intrinsic) - horizontally from acromion to lateral clavicle, covers joint capsule, reinforcing its superior aspect

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128
Q

What does the pectoral girdle consist of?

A

Scapula

Clavicle

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129
Q

Origin of scapula

A

Extends from 2nd to 7th rib

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130
Q

Attachment of clavicle

A

Attached to 1st rib by costoclavicular ligament

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131
Q

Which bone is the first bone to ossify in a fetus?

A

Clavicle

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132
Q

Which is the only long bone to develop in membrane?

A

Clavicle

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133
Q

Which nerves may pierce the clavicle?

A

Supraclavicular nerves

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134
Q

Proximal landmarks of humerus

A

Head - faces medially, upwards and backwards

Anatomical neck - separates head from greater and lesser tubercles

Surgical neck - runs from just distal to tubercles to shaft of humerus

Greater tubercle
Lesser tubercle

Intertubercular sulcus/bicipital groove - separates the 2 tubercles (edges are called lips)

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135
Q

Which muscles attach to the greater tubercle of the humerus?

A

Supraspinatus
Infraspinatus
Teres minor

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136
Q

What muscle attaches to the lesser tubercle of the humerus?

A

Subscapularis

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137
Q

Which muscles insert into the lips of the intertubercular sulcus?

A

Pec major
Teres major
Lat dorsi

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138
Q

Which tendon runs through the intertubercular sulcus?

A

Long head of biceps brachii

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139
Q

Which structures lie against the surgical neck of the humerus?

A

Axillary nerve - paralysis of deltoid and teres minor

Posterior circumflex artery

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140
Q

What attaches to the lateral side of the humeral shaft (deltoid tuberosity)?

A

Deltoid muscle

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141
Q

What is the radial (spiral) groove?

A

A shallow depression that runs diagonally down the posterior surface of the humerus, parallel to the deltoid tuberosity

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142
Q

Which structures lie in the radial groove on the posterior surface of the humerus?

A

Radial nerve
Pronfunda brachii

(Risk of damage from midshaft humeral fractures)

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143
Q

What muscles attach to the anterior surface of humeral shaft?

A

Deltoid
Brachialis
Brachioradialis
Coracobrachialis

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144
Q

What muscles attach to the posterior surface of humeral shaft?

A

Medial and lateral head of the triceps (spiral groove demarcates their origins)

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145
Q

What are the articulations at the elbow joint (distal humerus)?

A

Capitulum of humerus articulates with head of radius

Trochlea of humerus articulates with trochlear notch of ulna

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146
Q

What do the lateral and medial borders of the distal humerus form?

A

Lateral and medial supracondylar ridges (lateral more roughened, site of common origin of forearm extensors)

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147
Q

What passes in a groove on the posterior aspect of the medial epicondyle (distal humerus)?

A

Ulnar nerve

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148
Q

What are the depressions located on the distal humerus?

A

Coronoid
Radial
Olecranon fossae

Accommodate forearm bones during flexion/extension of elbow

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149
Q

Parts of radius

A

Head
Neck
Radial tuberosity
Shaft

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150
Q

What attaches to the radial tuberosity?

A

Biceps brachii muscle

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151
Q

What attaches to the middle of the lateral surface of radial shaft where there is a small roughening?

A

Pronator teres

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152
Q

What parts are found at the distal end of radius?

A

Styloid process
Ulnar notch - articulates with head of ulna, forming distal radioulnar joint

2 facets for articulation with scaphoid and lunate carpal bones (make up wrist joint)

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153
Q

What attaches the radius and ulna together?

A

Interosseous membrane

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154
Q

What is a Monteggia fracture?

A

Fracture of proximal shaft of ulna + anterior dislocation of head of radius at elbow

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155
Q

What is a Galeazzi fracture?

A

Fracture to the distal radius + dislocation of ulna head at distal radio-ulnar joint

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156
Q

Important landmarks of proximal ulna

A 
Olecranon
Coronoid process
Trochlear notch
Radial notch
Ulnar tuberosity
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157
Q

Surfaces of ulnar shaft and their muscle attachments

A

Anterior - pronator quadratus (distally)

Posterior - many

Medial - unremarkable

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158
Q

3 borders of ulnar shaft

A

Anterior - unremarkable

Interosseous - attachment of interosseous membrane

Posterior - palpable along entire length of forearm posteriorly

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159
Q

What muscle attaches to the olecranon of ulna?

A

Triceps brachii

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160
Q

What muscle attaches to the ulnar tuberosity?

A

Brachialis

161
Q

Carpal bones in order (lateral to medial)

A

Scaphoid
Lunate
Triquetrum
Pisiform (sesamoid bone, formed within tendon of flexor carpi ulnaris)

Trapezium
Trapezoid
Capitate
Hamate

162
Q

What bones does the radio-carpal joint consist of?

A

Radius
Scaphoid
Lunate

163
Q

What is a Boxer’s fracture?

A

Fracture of the 5th metacarpal neck, usually caused by clenched fist striking a hard object. Distal part of fracture is displaced anteriorly, producing shortening of affected finger

164
Q

What is a Bennett’s fracture?

A

Fracture of the 1st metacarpal base, caused by forced hyperabduction of the thumb. Fracture extends into 1st MCP joint leading to instability and subluxation of joint.

Hence, often needs surgical repair.

165
Q

Arterial supply to acromioclavicular joint

A

Suprascapular - from subclavian artery at thyrocervical trunk

Thoracoacromial - from axillary artery

166
Q

Nerve supply of acromioclavicular joint

A

Articular branches of suprascapular and lateral pectoral nerves - both arise directly from brachial plexus

167
Q

Ligaments of sternoclavicular joint

A

Sternoclavicular ligaments (anterior and posterior)

Interclavicular ligament - spans gap between sternal ends of each clavicle and reinforces joint capsule superiorly

Costoclavicular ligament - bind at 1st rib and cartilage inferiorly, and to the anterior and posterior borders of clavicle superiorly

168
Q

Arterial supply to sternoclavicular joint

A

Internal thoracic artery

Suprascapular artery

169
Q

Nerve supply of sternoclavicular joint

A

Medial supraclavicular nerve (C3-4)

Nerve to subclavius (C5-6)

170
Q

Which ligament acts as a pivot for movements of the clavicle?

A

Coracoclavicular ligament

171
Q

Bursae at glenohumeral (shoulder) joint

A

Subacromial - located deep to deltoid and acromion, superficial to supraspinatus tendon and joint capsule. Reduces friction beneath deltoid, promoting free motion of rotator cuff tendons.

Subscapular - between subscapularis tendon and scapula, reduces wear and tear at joint

172
Q

Ligaments at shoulder joint

A

Glenohumeral (superior, middle, inferior)

173
Q

What type of joint is the shoulder (glenohumeral) joint?

A

Ball and socket - inherently unstable, capable of wide ROM

174
Q

What stabilises the shoulder joint?

A

Muscles of rotator cuff that pass from scapula to insert into greater tuberosity of humerus (except subscapularis - inserts into lesser tuberosity)

175
Q

What is the glenoid labrum?

A

A fibrocartilaginous rim attached to the free edge of the glenoid cavity

176
Q

What arises from within the joint from the supraglenoid tubercle?

A

Tendon of long head of biceps

177
Q

What muscle attaches to the infraglenoid tubercle?

A

Long head of triceps

178
Q

Attachments of fibrous capsule of shoulder joint

A

Scapula external to glenoid labrum and to labrum itself (postero-superiorly)

Humerus at level of anatomical neck superiorly and surgical neck inferiorly

179
Q

Relations of fibrous capsule of shoulder joint

A

Anterior - subscapularis tendon

Superior - supraspinatus tendon

Posterior - infraspinatus and teres minor tendons

180
Q

How many defects are there in the fibrous capsule of shoulder joint

A

2 defects - superiorly for tendon of biceps, anteriorly defect beneath subscapularis tendon

181
Q

What is the inferior extension of the fibrous capsule of shoulder joint closely related to?

A

Axillary nerve at surgical neck of humerus, at risk of damage in anteroinferior dislocations

182
Q

Shoulder joint FLEXORS

A

Anterior deltoid
Pec major
Coracobrachialis
(Biceps)

183
Q

Shoulder joint EXTENSORS

A

Posterior deltoid
Teres major
Lat dorsi

184
Q

Shoulder joint ADDUCTORS

A

Pec major
Lat dorsi
(Teres major, coracobrachialis)

185
Q

Shoulder joint ABDUCTORS

A

Supraspinatus (first 15deg)

Mid deltoid

186
Q

Shoulder joint MEDIAL ROTATION

A 
Subscapularis
Anterior deltoid
Pec major
Teres major
Lat dorsi
187
Q

Shoulder joint LATERAL ROTATION

A

Posterior deltoid
Infraspinatus
Teres minor

188
Q

Important anatomical relations of shoulder joint

A

Anterior - brachial plexus, axillary artery and vein

Posterior - suprascapular nerve and vessels

Inferior - axillary nerve, circumflex humeral vessels

189
Q

Elbow joint FLEXORS

A

Biceps
Brachialis
Brachioradialis
(Pronator teres)

190
Q

Elbow joint EXTENSORS

A

Triceps

Anconeus

191
Q

Elbow joint PRONATORS

A

Pronator teres

Pronator quadratus

192
Q

Elbow joint SUPINATORS

A

Biceps

Supinator

193
Q

Root values of ulnar nerve

A

C8-T1

194
Q

Muscles supplied by ulnar nerve

A

(No muscles in upper arm)

Flexor carpi ulnaris
Flexor digitorum profundus (medial half)
Flexor digiti minimi
Abductor digiti minimi
Opponens digiti minimi
Adductor pollicis
Interossei muscles
3rd and 4th lumbricals
Palmaris brevis
195
Q

Path of ulnar nerve

A

Posteromedial aspect of upper arm to flexor compartment of forearm, then along ulnar

Passes below FCU

Passes superficial to flexor retinaculum into palm

196
Q

Branches of ulnar nerve

A 
Muscular branch
Palmar cutaneous branch (arises near middle of forearm)
Dorsal cutaneous branch
Superficial branch
Deep branch
197
Q

Areas supplied by branches of ulnar nerve

A

Muscular - FCU, medial half of FDP

Palmar cutaneous - skin on medial part of palm

Dorsal cutaneous - dorsal surface of medial part of hand

Superficial - cutaneous fibres to anterior surfaces of medial 1.5 digits

Deep - hypothenar muscles, all interossei, 3rd and 4th lumbricals, adductor pollicis, medial head of flexor pollicis brevis

198
Q

Effects of injury to ulnar nerve at wrist

A

Wasting and paralysis of hypothenar and intrinsic hand muscles (claw hand)

Loss of sensation of medial 1.5 fingers

199
Q

Effects of injury to ulnar nerve at elbow

A

Radial deviation of wrist

LESS clawing in 4th-5th fingers (as flexor digitorum profundus affected)

200
Q

Branches of thoracoacromial artery

A

Pectoral
Clavicular
Acromial
Deltoid

201
Q

Path of thoracoacromial artery

A

Projects forward to upper border of pec minor and pierces coracoclavicular fascia before dividing into its 4 branches

202
Q

Description of pectoral branch of thoracoacromial artery

A

Descends between 2 pectoral muscles
Distributed to the pectoral muscles and breast
Anastomose with intercostal branches of internal thoracic artery and with lateral thoracic

203
Q

Description of clavicular branch of thoracoacromial artery

A

Runs upwards and medially to the sternoclavicular joint

Supplies sternoclavicular joint and subclavius

204
Q

Description of acromial branch of thoracoacromial artery

A

Runs laterally over coracoid process and under the deltoid (to which it gives branches)

Pierces deltoid

Ends on acromion in an arterial network formed by branches from: suprascapular, thoracoacromial, posteriorr circumflex humeral arteries

205
Q

Description of deltoid branch of thoracoacromial artery

A

Arises with acromial branch

Crosses over pec minor

Passes in same groove as cephalic vein, between pec major and deltoid (giving branches to both muscles)

206
Q

What is the anterior interosseous nerve a branch of?

A

Median nerve

207
Q

What does the anterior interosseous nerve innervate?

A
  1. 5 muscles (in deep level of anterior compartment of forearm):
    - Flexor pollicis longus
    - Pronator quadratus
    - Radial half of flexor digitorum profundus (lateral 2/4 tendons)
208
Q

Root values of axillary nerve

A

C5-6

Terminal branch of posterior cord of brachial plexus

209
Q

Path of axillary nerve

A

Descends posterior to axillary artery at lower border of subscapularis

Passes through quadrangular space with posterior circumflex humeral vessels

Divides into anterior and posterior branches

210
Q

Actions of interossei muscles

A

Palmar interossei - adduction of fingers

Dorsal interossei - abduction of fingers

PAD DAB

Flexion of MCP joint, extension of PIP and DIP joints (together with lumbricals) - claw hand seen if paralysed (digits pulled into hyperextension)

211
Q

How many interossei muscles are there in total?

A

4 palmar
4 dorsal
They occupy the spaces between the metacarpal bones

212
Q

Origins and insertions of interossei muscles

A

Palmar - originates from metacarpal of digit on which it acts

Dorsal - originates from surface of adjacent metacarpal on which it acts (hence 2x the size of palmar)

Interossei tendons (except 1st palmar) pass to one or other side of MCP joint posterior to deep transverse metacarpal ligament. They insert into the base of the proximal phalanx and partly into the extensor hood.

213
Q

Origins of triceps

A

Long head - infraglenoid tubercle of scapula

Lateral head - dorsal surface of humerus, lateral and proximal to groove of radial nerve

Medial head - posterior surface of humerus on inferomedial side of radial groove and both of the intermuscular septae

214
Q

Insertion of triceps

A

Olecranon process of ulna

Some fibres insert into deep fascia of forearm, posterior capsule of elbow

215
Q

Nerve supply of triceps

A

Radial nerve

216
Q

Blood supply of triceps

A

Profunda brachii

217
Q

Action of triceps

A

Elbow extension

Note: long head can adduct the humerus and extend it from a flexed position

218
Q

Relations of triceps

A

Radial nerve and profunda brachii lie between lateral and medial heads

219
Q

Nerve supplies of rotator cuff muscles

A

Supraspinatus, infraspinatus - suprascapular nerve

Teres minor - axillary nerve

Subscapularis - superior and inferior subscapular nerves

220
Q

Where is the pectoral region located?

A

Anterior chest wall

221
Q

Muscles of the pectoral region

A

Pectoralis major
Pectoralis minor
Serratus anterior
Subclavius

222
Q

Parts of pectoralis major

A

Sternal head

Clavicular head

223
Q

Attachments of heads of pectoralis major

A

Clavicular - from anterior surface of medial clavicle

Sternal - from anterior surface of sternum, superior 6 costal cartilages and aponeurosis of external oblique muscle

Both to intertubercular sulcus of humerus

224
Q

Function of pectoralis major

A

Adduction and medial rotation of UL
Draw scapula anteroinferiorly

Clavicular head acts individually to flex UL

225
Q

Nerve supply of pectoralis major

A

Lateral and medial pectoral nerves

226
Q

Where does the pectoralis minor lie?

A

Underneath its larger counterpart, pectoralis major

Both form part of anterior wall of axilla

227
Q

Attachments of pectoralis minor

A

From ribs 3-5 to coracoid process of scapula

228
Q

Function of pectoralis minor

A

Stabilise the scapula by drawing it anteroinferiorly against the thoracic wall

229
Q

Nerve supply of pectoralis minor

A

Medial pectoral nerve

230
Q

Where does the serratus anterior lie?

A

More laterally in the chest wall

Forms medial border of axilla region

231
Q

Attachments of serratus anterior

A

Several strips, originate from lateral aspects of ribs 1-8, to costal surface of medial border of scapula

232
Q

Function of serratus anterior

A

Rotate scapula, allowing arm to be raised >90 degrees

Hold scapula against ribcage

233
Q

Nerve supply of serratus anterior

A

Long thoracic nerve

234
Q

Where does the subclavius lie?

A

Directly underneath the clavicle, running horizontally

235
Q

Attachments of subclavius

A

From junction of 1st rib and its costal cartilage, to inferior surface of middle 3rd of clavicle

236
Q

Function of subclavius

A

Anchors and depresses the clavicle

237
Q

Nerve supply of subclavius

A

Nerve to subclavius

238
Q

Groups of muscles of the shoulder

A

Extrinsic (aka superficial back muscles) - originate from trunk and insert into bnoes of shoulder (clavicle, scapula, humerus)

Intrinsic - originate from scapula/clavicle and attach to humerus

239
Q

Layers of extrinsic muscles of shoulder

A

Superficial layer

Deep layer

240
Q

What are the superficial extrinsic muscles of shoulder?

A

Trapezius (most superficial of all back muscles)

Latissimus dorsi

241
Q

Attachments of trapezius

A

Originate from skull, nuchal ligament and spinous processes of C7-12

Attach to clavicle, acromion and scapula spine

242
Q

Innervation of trapezius

A

Motor - accessory nerve

Sensory (proprioception) - C3-4 spinal nerves

243
Q

Actions of trapezius

A

Upper fibres - elevate scapula and rotate it during abduction of arm

Middle fibres - retract scapula

Lower fibres - pull scapula inferiorly

244
Q

What is the commonest cause of accessory nerve damage?

A

Iatrogenic e.g. cervical LN biopsy, cannulation of internal jugular vein

245
Q

Signs of accessory nerve damage

A

Inability to shrug shoulders
Muscle wasting
Partial paralysis of SCM
Asymmetrical neckline

246
Q

Attachments of latissimus dorsi

A

Originate from spinous processes of T7-12, iliac crest, thoracolumbar fascia and inferior 3 ribs

Converge into a tendon that inserts into intertubercular sulcus of humerus

247
Q

Innervation of latissimus dorsi

A

Thoracodorsal nerve

248
Q

Actions of latissimus dorsi

A

Extension, adduction, medial rotation of UL

249
Q

What are the deep extrinsic muscles of shoulder?

A

Levator scapulae
Rhomboid major
Rhomboid minor

250
Q

Attachments of levator scapulae

A

Originate from transverse processes of C1-4 vertebrae

Attach to medial border of scapila

251
Q

Innervation of levator scapulae

A

Dorsal scapular nerve

252
Q

Action of levator scapulae

A

Elevation of scapula

253
Q

Where is the rhomboid minor located in relation to the other deep extrinsic shoulder muscles?

A

Above rhomboid major, below levator scapulae

254
Q

Attachments of rhomboid major

A

Originate from spinous processes of T2-5 vertebrae

Attach to medial border of scapula, between scapula spine and inferior angle

255
Q

Innervation of rhomboid major

A

Dorsal scapular nerve

256
Q

Action of rhomboid major

A

Retraction and rotation of scapula

257
Q

Attachments of rhomboid minor

A

Originate from spinous processes of C7-T1 vertebrae

Attach to medial border of scapula, at level of spine of scapula

258
Q

Innervation of rhomboid minor

A

Dorsal scapular nerve

259
Q

Action of rhomboid minor

A

Retraction and rotation of scapula

260
Q

What are the intrinsic shoulder muscles also known as?

A

Scapulohumeral group

261
Q

What are the intrinsic muscles of shoulder?

A

Deltoid
Teres major
4 rotator cuff muscles

262
Q

Parts of deltoid muscle

A

Anterior
Middle
Posterior

263
Q

Attachments of deltoid

A

Originate from lateral 3rd of clavicle, acromion and spine of scapula

Attach to deltoid tuberosity on lateral aspect of humerus

264
Q

Innervation of deltoid

A

Axillary nerve

265
Q

Actions of deltoid

A

Anterior fibres - flexion, medial rotation

Posterior fibres - extension, lateral rotation

Middle fibres - abduction

266
Q

Attachments of teres major

A

Originate from posterior surface of inferior angle of scapula

Attach to medial lip of intertubercular groove of humerus

267
Q

Innervation of teres major

A

Lower subscapular nerve

268
Q

Actions of teres major

A

Adduction and extension at shoulder

Medial rotation of arm

269
Q

Attachments of supraspinatus

A

Originate from supraspinous fossa of scapula

Attach to greater tubercle of humerus

270
Q

Innervation of supraspinatus

A

Suprascapular nerve

271
Q

Action of supraspinatus

A

Abduction of arm (1st 15 degree)

272
Q

Attachments of infraspinatus

A

Originate from infraspinous fossa of scapula

Attach to greater tubercle of humerus

273
Q

Innervation of infraspinatus

A

Suprascapular nerve

274
Q

Action of infraspinatus

A

Lateral rotation of arm

275
Q

Attachments of subscapularis

A

Originate from subscapular fossa, on costal surface of scapula

Attach to lesser tubercle of humerus

276
Q

Innervation of subscapularis

A

Upper and lower subscapular nerves

277
Q

Action of subscapularis

A

Medial rotation of arm

278
Q

Attachments of teres minor

A

Originate from posterior surface of scapula, adjacent to its lateral border

Attach to greater tubercle of humerus

279
Q

Innervation of teres minor

A

Axillary nerve

280
Q

Action of teres minor

A

Lateral rotation of arm

281
Q

What is the muscle most commonly affected in rotator cuff tendonitis?

A

Supraspinatus

During abduction, it ‘rubs’ against the coracoacromial arch - over time, causes inflammation and degenerative changes in tendon itself

282
Q

Muscles in upper arm

A

Anterior compartment - biceps brachii, brachialis, coracobrachialis

Posterior compartment - triceps brachii

283
Q

Innervation of muscles in anterior compartment of upper arm

A

Musculocutaneous nerve

284
Q

Arterial supply to anterior compartment of upper arm

A

Muscular branches of brachial artery

285
Q

Does the biceps brachii attach to humerus?

A

No. Although majority of the biceps muscle is located in front of the humerus, it has no attachment to the bone itself

286
Q

What forms the bicipital aponeurosis?

A

It is a connective tissue sheet that is given off when the tendon of biceps brachii enters the forearm

287
Q

What does the bicipital aponeurosis demarcate?

A

It forms the roof of the cubital fossa

Blends with deep fascia of anterior forearm

288
Q

Attachments of biceps brachii

A

Long head originate from supraglenoid tubercle of scapula

Short head originate from coracoid process of scapula

Both heads insert distally into radial tuberosity and fascia of forearm via bicipital aponeurosis

289
Q

Action of biceps brachii

A

Supination of forearm

Flexion of arm at elbow and shoulder

290
Q

Innervation of biceps brachii

A

Musculocutaneous nerve

291
Q

What spinal cord segment is the biceps tendon reflex?

A

C6

292
Q

Where does the coracobrachialis lie in relation to biceps brachii?

A

Deep to biceps brachii in arm

293
Q

Attachments of coracobrachialis

A

Originate from coracoid process of scapula

Pass through axilla

Attaches to medial side of humeral shaft at level of deltoid tubercle

294
Q

Action of coracobrachialis

A

Flexion of arm at shoulder

Weak adduction

295
Q

Innervation of coracobrachialis

A

Musculocutaneous nerve

296
Q

Where does the brachialis lie in relation to biceps brachii?

A

Deep to biceps brachii

Found more distally than other arm muscles

Forms floor of cubital fossa

297
Q

Attachments of brachialis

A

Flexion at elbow

298
Q

Innervation of brachialis

A

Musculocutaneous nerve

Contributions from radial nerve

299
Q

What sign can you see with rupture of the long head of biceps brachii?

A

Sign on flexing elbow - bulge where muscle belly is (Popeye sign)

300
Q

Arterial supply to posterior compartment of arm

A

Profunda brachii

301
Q

Attachments of triceps brachii

A

Long head - originate from inglenoid tubercle

Lateral head - from humerus, above radial groove

Medial head - from humerus, below radial groove

All converge into 1 tendon distally and insert into olecranon of ulna

302
Q

Function of triceps brachii

A

Extension of arm at elbow

303
Q

Innervation of triceps brachii

A

Radial nerve

Note: in some people, long head of triceps tendon is innervated by axillary nerve

304
Q

What spinal cord segment is the triceps tendon reflex?

A

C7

305
Q

Categories of muscles in anterior compartment of forearm

A

Superficial
Intermediate
Deep

306
Q

Superficial muscles in anterior compartment of forearm

A 
(Medial to lateral)
Flexor carpi ulnaris
Palmaris longus
Flexor carpi radialis
Pronator teres

All originate from common tendon arising from medial epicondyle of humerus

307
Q

Attachments of FCU

A

Originate from medial epicondyle of humerus

Another long origin from ulna

Pass into wrist

Attach to pisiform

308
Q

Action of FCU

A

Flexion and adduction at wrist

309
Q

Innervation of FCU

A

Ulnar nerve

310
Q

Attachments of palmaris longus

A

Originate from medial epicondyle of humerus

Attach to flexor retinaculum

311
Q

Action of palmaris longus

A

Flexion at wrist

312
Q

Innervation of palmaris longus

A

Median nerve

313
Q

Attachments of FCR

A

Originate from medial epicondyle

Attach to base of metacarpals 2 and 3

314
Q

Action of FCR

A

Flexion and abduction at wrist

315
Q

Innervation of FCR

A

Median nerve

316
Q

What is the pronator teres a landmark of?

A

Its lateral border forms the medial border of the cubital fossa

317
Q

Attachments of pronator teres

A

2 origins: from medial epicondyle and coronoid process of ulna

Attach laterally to midshaft of radius

318
Q

Action of pronator teres

A

Pronation of arm

319
Q

Innervation of pronator teres

A

Median nerve

320
Q

Muscles in anterior intermediate compartment of forearm

A

Flexor digitorum superficialis

can sometimes be classed as superficial, but lie between deep and superficial layers in most

321
Q

Why is the flexor digitorum superficialis a good anatomical landmark in the forearm?

A

Median nerve and ulnar artery pass between its 2 heads, then travel posteriorly

322
Q

Attachments of FDS

A

2 heads - one from medial epicondyle of humerus, and other from radius

Split into 4 tendons at wrist

Travel through carpal tunnel

Attach to middle phalanges of 4 fingers

323
Q

Action of FDS

A

Flexion of MCP and PIP joints at 4 fingers

Flexion at wrist

324
Q

Innervation of FDS

A

Median nerve

325
Q

Muscles in deep anterior compartment of forearm

A

Flexor digitorum profundus
Flexor pollicis longus
Pronator quadratus

326
Q

Attachments of FDP

A

Originate from ulna and associated interosseous membrane

Split into 4 tendons at wrist

Travel through carpal tunnel

Attach to distal phalanges of 4 fingers

327
Q

Action of FDP

A

Only muscle that can flex DIP joints of fingers

Flexion of MCP joints and wrist

328
Q

Innervation of FDP

A

Medial half by ulnar nerve

Lateral half by anterior interosseous branch of median nerve

329
Q

Where is the flexor pollicis longus in relation to the FDP?

A

Lateral to FDP

330
Q

Attachments of FPL

A

Originate from anterior surface of radius and surrounding interosseous membrane

Attach to base of distal phalanx of thumb

331
Q

Action of FPL

A

Flexion of MCP and IP joints of thumb

332
Q

Innervation of FPL

A

Anterior interosseous branch of median nerve

333
Q

Where is the pronator quadratus in relation to the FDP and FPL?

A

Square-shaped muscle deep to tendons of FDP and FPL

334
Q

Attachments of pronator quadratus

A

Originate from anterior surface of ulna

Attach to anterior surface of radius

335
Q

Action of pronator quadratus

A

Pronation of forearm

336
Q

Innervation of pronator quadratus

A

Anterior interosseous branch of median nerve

337
Q

Layers of posterior compartment of forearm

A

Superficial
Deep

Both layers separated by a layer of fascia

338
Q

Superficial muscles in posterior compartment of forearm

A 
Brachioradialis
Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor digitorum communis
Extensor digiti minimi
Extensor carpi ulnaris
Anconeus

Radialis brevis, ulnaris, digitorum communis and digiti mini share a common tendinous origin at lateral epicondyle of humerus

339
Q

Why is the brachioradialis a paradoxical muscle?

A

Its origin and innervation are characteristic of an extensor muscle

It’s actually a flexor at the elbow

340
Q

When is the brachioradialis muscle most visible?

A

When forearm is half-pronated, and flexing at elbow against resistance

341
Q

Attachments of brachioradialis

A

Originate from proximal aspect of lateral supracondylar ridge of humerus

Attach to distal end of radius, just before styloid process

342
Q

Action of brachioradialis

A

Flexion at elbow

343
Q

Innervation of brachioradialis

A

Radial nerve

344
Q

Attachments of extensor carpi radialis longus and brevis

A

ECRL originate from supracondylar ridge

ECRB originate from lateral epicondyle

Tendons attach to metacarpal bones 2 and 3

345
Q

Action of of extensor carpi radialis longus and brevis

A

Extension and abduction at wrist

346
Q

Innervation of extensor carpi radialis longus and brevis

A

Radial nerve

347
Q

Which muscle the main extensor of fingers?

A

Extensor digitorum communis

348
Q

Attachments of extensor digitorum communis

A

Originate from lateral epicondyle

Continue into distal part of forearm, where it splits into 4

Insert into extensor hood of each finger

349
Q

Action of extensor digitorum communis

A

Extension of fingers at MCP and IP joints

350
Q

Innervation of extensor digitorum communis

A

Deep branch of radial nerve

351
Q

Anatomically, where does the extensor digiti minimi lie?

A

Medial to extensor digitorum

352
Q

Attachments of extensor digiti minimi

A

Originate from lateral epicondyle of humerus

Attach into extensor hood of fingers with extensor digitorum tendon

353
Q

Action of extensor digiti minimi

A

Extension of little finger

Contribute to extension at wrist

354
Q

Innervation of extensor digiti minimi

A

Deep branch of radial nerve

355
Q

Attachments of ECU

A

Originate from lateral epicondyle of humerus

Attach to base of metacarpal 5

356
Q

Action of ECU

A

Extension and adduction of wrist

357
Q

Innervation of ECU

A

Deep branch of radial nerve

358
Q

Where is the anconeus located in the extensor compartment of forearm?

A

Superiorly and medially

Blended with fibres of triceps brachii (the 2 can be indistinguishable)

359
Q

Action of anconeus

A

Extension and stabilisation of elbow

Abduction of ulna during forearm pronation

360
Q

Innervation of anconeus

A

Radial nerve

361
Q

Muscles in deep compartment of posterior forearm

A 
Supinator
Abductor pollicis longus
Extensor pollicis brevis
Extensor pollicis longus
Extensor indicis
362
Q

Where does the supinator lie in the deep posterior compartment of forearm?

A

In the floor of cubital fossa

363
Q

How many heads does the supinator have and what passes in between them?

A

2 hears with deep branch of radial nerve passing in between

364
Q

Attachments of supinator

A

1 head from lateral epicondyle of humerus, other from posterior surface of ulna

Attach together to posterior surface of radius

365
Q

Action of supinator

A

Supination of forearm

366
Q

Innervation of supinator

A

Deep branch of radial nerve

367
Q

Where is the abductor pollicis longus located in relation to the supinator?

A

Immediately distal to supinator

368
Q

Attachments of APL

A

Originate from interosseous membrane and adjacent posterior surfaces of radius and ulna

Attaches to lateral side of base of metacarpal 1

369
Q

Action of APL

A

Abduction of thumb

370
Q

Innervation of APL

A

Posterior interosseous branch of radial nerve

371
Q

Where is the extensor pollicis brevis located in relation to the APL?

A

Medial and deep to the abductor pollicis longus

372
Q

Attachments of EPB

A

Originate from posterior surface of radius and interosseous membrane

Attach to base of proximal phalanx of thumb

373
Q

Innervation of EPB and EPL

A

Posterior interosseous branch of radial nerve

374
Q

Attachments of EPL

A

Originate from posterior surface of ulna and interosseous membrane

Attach to distal phalanx of thumb

375
Q

Action of EPB

A

Extension at MCP and CMC joints of thumb

376
Q

Action of EPL

A

Extension of all thumb joints: CMC, MCP, IP joints

377
Q

What makes the extensor indicis propius unique?

A

It allows the index finger to be independent of other fingers during extension

378
Q

Attachments of extensor indicis propius

A

Originate from posterior surface of ulna and interosseous membrane, distal to EPL

Attach to extensor hood of index finger

379
Q

Action of extensor indicis propius

A

Extension of index finger

380
Q

Innervation of extensor indicis propius

A

Posterior interosseous branch of radial nerve

381
Q

What is wrist drop a sign of?

A

Radial nerve injury proximal to elbow

382
Q

What are the 2 common characteristic sites of damage of radial nerve?

A

Axilla - injured via humeral dislocations or fractures of proximal humerus

Radial groove of humerus - injured via humeral shaft fracture

383
Q

Groups of muscles acting on the hand

A

Extrinsic - located in anterior and posterior compartments of forearm, control crude movements and produce forceful grip

Intrinsic - located within hand itself, for fine motor functions

384
Q

Nerve roots of axillary nerve

A

C5-6

385
Q

Sensory function of axillary nerve

A

Gives rise to upper lateral cutaneous nerve of arm

Innervate skin over lower deltoid (‘regimental badge area’)

386
Q

Motor function of axillary nerve

A

Deltoid

Teres minor

387
Q

Anatomical course of axillary nerve

A

Direct continuation of posterior cord of brachial plexus

In axilla - posterior to axillary artery and anterior to subscapularis

Exits axilla at inferior border of subscapularis via quadrangular space

Pass medial to surgical neck of humerus

388
Q

What happens to the axillary nerve at the surgical neck of humerus?

A

Divides into 3 branches:

  1. Posterior terminal branch
  2. Anterior terminal branch
  3. Articular branch
389
Q

Function of posterior terminal branch of axillary nerve

A

Motor innervation to posterior aspect of deltoid and teres minor

Sensory innervation to skin over inferior part of deltoid

390
Q

Function of anterior terminal branch of axillary nerve

A

Motor innervation to anterior part of deltoid

Terminates with cutaneous branches to anterior and anterolateral shoulder

391
Q

Function of articular branch of axillary nerve

A

Supplies glenohumeral joint

392
Q

What is the quadrangular space?

A

A gap in the muscles of the posterior scapular region

Pathway for NV structures to move from axilla anteriorly to posterior shoulder and arm

393
Q

Boundaries of quadrangular space

A

Superior - inferior border of teres minor
Inferior - superior border of teres major
Lateral - surgical neck of humerus
Medial - long head of triceps brachii
Anterior - subscapularis

394
Q

What happens after the posterior terminal branch of axillary artery has innervated the teres minor?

A

It continues as the upper lateral cutaneous nerve of arm

395
Q

What is Erb’s palsy?

A

A condition due to damage from C5-6 roots

Axillary nerve is affected, person unable to abduct or externally rotate shoulder joint

396
Q

Nerve roots of musculocutaneous nerve

A

C5-7

397
Q

Motor function of musculocutaneous nerve

A

Muscles in anterior compartment of upper arm (biceps, brachialis, coracobrachialis)

398
Q

Sensory function of musculocutaneous nerve

A

Gives rise to lateral cutaneous nerve of forearm which innervates lateral aspect of forearm

MRCS Anatomy (9 decks)

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