Review of Anatomy of Upper Limb Flashcards
What is the upper limb divided into for descriptive purposes? (4)
Shoulder (between thorax and arm, includes pectoral girdle)
Arm (between shoulder and elbow)
Forearm (between elbow and wrist)
Hand (distal to wrists)
What bones make up the shoulder? (3)
Clavicle, scapula and humerus
What joints make up the shoulder? (3)
Sternoclavicular, acromoclavicular and glenohumeral
What is the blood supply to the shoulder? (3)
Subclavian
Axillary
Brachial
Where does the subclavian artery become the axillary artery?
When does it become brachial?
Lateral border 1st rib
Inferior border of teres major
What is the venous drainage of the shoulder? (3)
Parallels arterial, plus superficial veins
The shoulder is innervated by the brachial plexus.
What are the nerve roots of the brachial plexus?
C5-T1
What are the 5 terminal nerves of the brachial plexus?
Are they sensory or motor?
Anterior cord:
Musculocutaneous, median, ulnar
Posterior cord:
Axillary, radial
MIXED - sensory and motor axons in the same nerve.
What are the nerve roots of musculocutaneous nerve?
What is it’s motor function?
What is it’s sensory function?
C5-C7
Innervates muscles in anterior compartment of arm (coracobrachialis, biceps brachii and brachialis)
Innervates skin on the lateral surface of forearm (lateral cutaneous nerve of forearm).
What are the nerve roots of median nerve?
What is it’s motor function?
What is it’s sensory function?
What sign is associated with its palsy?
C6 – T1
Innervates the flexor muscles in the anterior compartment of the forearm. Also innervates the thenar muscles and lateral two lumbricals in the hand.
Innervates lateral part of palm and lateral three and a half fingers on anterior surface of hand.
HAND OF BENEDICTION
What are the nerve roots of ulnar nerve?
What is it’s motor function?
What is it’s sensory function?
What sign is associated with its palsy?
C8-T1
Innervates the muscles of the hand (apart from the thenar muscles and two lateral lumbricals), flexor carpi ulnaris and medial half of flexor digitorum profundus.
Innervates the anterior and posterior surfaces of the medial one and half fingers, and the associated palm area.
CLAW HAND
What are the nerve roots of axillary nerve?
What is it’s motor function?
What is it’s sensory function?
C5 and C6
Innervates teres minor and deltoid.
Innervates the skin over the lower deltoid ‘(‘regimental badge area’).
What are the nerve roots of radial nerve?
What is it’s motor function?
What is it’s sensory function?
What sign is associated with its palsy?
C5-T1
Innervates triceps brachii, and extensor muscles of forearm.
Innervates most of the skin of the posterior side of forearm, and the dorsal surface of the lateral side of the palm, and lateral three and a half digits.
WRIST DROP
What are the two main pathologies of the shoulder?
Fractured clavicle and dislocated shoulder (glenohumeral joint).
How might a clavicle fracture?
How many % of adult fractures does this account for?
When might it become a medical emergency?
Direct or indirect force
2-5%
If tingling or reduced peripheral pulses (blood supply and nerve supply compromised).
How might the shoulder appear in a fractured clavicle?
Shoulder drooping
Rounded profile of shoulder (deltoid) maintained
Loss of width of shoulder
How many % of population will suffer a dislocated shoulder? What is the recurrence rate?
Does it dislocate anteriorly or posterioly?
1.7%
50-89%
Anteriorly
How will a shoulder appear in an anterior dislocation?
What nerve is at risk of injury and what will this result in?
Loss of rounded profile (due to deltoid stretched by arm being pulled down by gravity)
Acromion is more prominent
Axillary (deltoid paralysis)
How will deltoid paralysis present? (5)
How can it be fixed?
Weakness in abduction of the arm Can move arm when standing Leaning to side Loss of roundness of the shoulder Numbness over regimental badge
Nerve repair, or muscle transfer of pect major.
Which nerve innervates deltoid?
What is the function of deltoid?
Axillary
Main abductor of arm
Where is the lymphatic drainage of the shoulder (shared with drainage of lateral breast)?
Many lymph nodes in axilla, with nodes arranged in 5 groups.
What are the five groups of axillary lymph nodes?
Humeral (lateral) Central Subscapular (posterior) Apical Pectoral (anterior)
Where does upper limb lymph mainly drain into?
Humeral and central nodes
Where does lymph of medial breast drain?
Parasternal nodes
What muscles rotate the scapula? (2)
Trapezius and serratus anterior
How many degrees does the scapula rotate the shoulder? What moves it the other 120 degrees?
60
Glenohumeral joint
What muscle does the first 10 degrees of abduction?
What muscle does the rest?
Supraspinatus
Deltoid
What nerve innervates serratus anterior?
Long thoracic nerve
Injury to long thoracic nerve causes…?
Winging of scapula
What nerve innervates lat dorsi?
Thoracodorsal nerve
When might long thoracic nerve or thoracodorsal nerve be injured?
Axillary lymph node clearance for metastatic breast cancer
What nerve innervates trapezius?
Spinal accessory nerve
In what condition is the winging more prominent – spinal accessory damage or serratus anterior palsy?
Serratus anterior palsy
What might damage the spinal accessory nerve? (2)
Tumour around jugular foramen
Neck surgery
How might spinal accessory palsy present?
Weak abduction (stop at about 70 degrees)
Atrophy of trapezius
Shoulder droops
Scapula winging
What are the bones of the arm?
Humerus
What are the joints of the arm? (4)
What are for flexion and extension?* Which is for rotation?**
Glenohumeral
Elbow (humero-ulnar, humero-radial and proximal radio-ulnar**)
What nerve and what artery run in the spiral groove in posterior compartment of arm?
Radial nerve
Deep artery of arm
What nerves and artery are in the anterior compartment?
Median and musculocutaneous nerves
Brachial artery
What nerve is at risk of injury with a midshaft humeral fracture?
Radial nerve
What nerve is at risk of injury with a supracondylar fracture of the humerus?
Median nerve
What nerve is at risk of injury in a medial epicondyle fracture?
Ulnar nerve
What type of joint is the elbow?
Hinge joint (brings hand to body using humeroulnar and humeroradial) Pivot joint (turns hand over using proximal radio-ulnar)
What are the bones of the forearm? (2)
Radius
Ulna (main stabilising bone)
What are the joints of the forearm? (3)
Elbow, distal radioulnar joint and radiocarpal joint
What muscles groups are in the anterior compartment of the forearm?
What nerves? (2)
What arteries? (2)
Flexors and pronators
Median (main one) and ulnar nerves (for precision muscles)
Radial and ulnar arteries
What muscles groups are in the posterior compartment of the forearm?
What nerve?
What artery?
Extensors and supinators
Radial nerve
Posterior interosseus artery (comes off ulnar artery)
What is the blood supply to the forearm? What are they terminal branches of and where do they start?
Ulnar and radial arteries
Brachial artery
Opposite neck of radius in inferior cubital fossa
What are the bones of the hand? (3)
Carpals, metacarpals and phalanges
What are the joints of the hand? (3)
Distal radioulnar, radiocarpal, intercarpals, carpometacarpals, metacarpalphalangeals and interphalangeals (distal and proximal)
How many phalanges does the thumb have? What about the rest of the digits?
2
3
What carpals does the radius articulate with?
What about the ulna?
Scaphoid and lunate
Does not articulate with carpals
Where are the power muscles for the hand located?
In forearm (have long tendons that pass over wrist into hand)
What is a common presenting sign of rheumatoid arthritis?
Carpal tunnel-like syndrome
What is a Colles fracture?
What deformity does it result in?
Fracture of distal radius (within 2cm of distal end of radius).
Dorsal displacement of distal fragment of radius results in dinner fork deformity.
Fractures of distal radius and ulna make up what percentage of wrist injuries?
75%
Why are there fewer injuries to carpals?
How many % of injuries to the hand does this account for?
Fewer injuries to carpals as there are ligaments to hold them in place.
10%
In carpal tunnel syndrome, what nerve is compressed?
What muscle group has atrophied?
What protects the long flexor and extensor tendons from rubbing on the bones?
Median nerve
Phenar muscle group
Synovial tendon sheaths
What are the compartments of the hand? (3)
Superficial - long flexor tendons and their sheaths
Medial and lateral - hypothenar and thenar muscles
Deep - intrinsic muscles of the hand
How many % of population don’t have collateral circulation in hand?
30%
Radial and ulnar arteries anastomose in the…?
Superficial and deep palmar arches
What 3 nerves from the brachial plexus terminate in the hand?
Median
Radial
Ulnar
What % of hand movements does the thumb account for?
50%
