Review of the Upper Limb Flashcards
What elements is the shoulder between
Between the thorax and the arm includes the pectoral girdle
what bones make up the shoulder
- clavicle
- scapula
- humerus
What are the three joints in the shoulder
- sternoclavicular
- acromoclavicular
- glenohumeral
what is the shoulder designed for
mobility and to have the greatest range of movement possible
What type of joint is the glenohumeral joint
- ball and socket synovial joint
What type of joint is the sternoclavicular joint
saddle synovial joint
What type of joint is the acromoclavicular joint
plane synovial joint
what joint is the only joint that attaches the arm to the axial skeleton
- sternoclavicular
describe the arterial blood supply to the arm
subclavian artery supplies the arm
- this turns into the axillary artery when it passes via the lateral border of the 1st rib to the inferior border of trees major
- the axially artery gives of the medial and lateral circumflex artery which supply the shoulder
- it turns into the brachial artery once it passes the inferior border of trees
- the brachial artery then splits into the radial and ulnar artery
describe the superifical venous supply to the arm
Superficial veins
- cephalic (more medial) and basilic (more lateral)
what is the nerve roots of the brachial plexus
C5-T1
name the branches of brachial plexus
- Musculotaneous
- median
- ulnar
- axially
- radial
describe the different cords of the brachial plexus
Anterior cord (lateral to medial)
- Musculocutaneous
- Median
- Ulnar
Posterior cord
- Axillary
- Radial
what does the musculotaneous nerve supply and the nerve roots
C5-C7
- brachialis, biceps brachii and coracobrachialis muscles.
What does the median nerve supply and the nerve roots
C5-T1
- most of the flexor in the forearm
- thenar muscles
sensory
- Gives off the palmar cutaneous branch, which innervates the lateral part of the palm, and the digital cutaneous branch, which innervates the lateral three and a half fingers on the anterior (palmar) surface of the hand.
What does the ulnar nerve supply and the nerve roots
C8 and T1
- flexor carpi ulnaris and medial half of flexor digitorum profundus.
- intrinsic muscles of the hand
sensory
- Innervates the anterior and posterior surfaces of the medial one and half fingers, and associated palm area.
What does the radial nerve supply and the nerve roots
C5 – T1
- the extensors of the forearm
What does the radial nerve supply and the nerve roots
C5 – T1
- the extensors of the forearm
sensory
- the posterior aspect of the arm and forearm, and the posterolateral aspect of the hand.
what two types of forces that can cause a clavicle break
- direct or indirect force
when is a clavicle break a medical emergency
- tingling or reduced peripheral pulses - medical emergency
What does a clavicle break look like and why
- looks like tenting
SCM - this causes the clavicle to move upwards
gravity causes the clavicles to move down
what causes a direct clavicle break
- something lands on the shoulder
What causes an indirect clavicle break
- this is when you land with your hands stretched out and the end point of the upper limb is the clavicle and this is where the force is applied
where about is the fracture usually in the clavicle
2/3 of the way in the clavicle
what percentage of adult fractures are clavicle breaks
2-5%
what type of shoulder dissociation is most common
- anterior = due to lack of rotatory cuff muscles present
what nerve is at risk of injury in an anterior dislocation of the shoulder
- axillary
what does a shoulder dislocation look like
- loss of the round profile
- may end up with sensory loss of the regimental patch due to damage to the axillary nerve
describe the prevalence of the anterior dislocation
- 1-7% of the population
- recurrence rate is 50-89%
what movement does the deltoid muscle do
abduction
what happens if you have deltoid paralysis
- weakness in abduction of the arm
- loss of loudness of the shoulder
- numbness over regimental badge
describe the muscles responsible for abduction in the arm
- Supraspinatus is responsible for the first 10 degrees
- then deltoid is responsible for the 10-180 degrees
How do you repair a deltoid muscle injury
- use muscle transfer
- therefore you get pec major and flip it over to replace deltoid and then you use the medial and lateral pectoral nerves to replace the axillary nerve
- use pec major as you can liver without it as there are other muscles that already do the same job
what are the 5 groups of the axillary lymph nodes
- Pectoral
- humeral
- central
- apical
- supraclavicualr
- sub scapular
where does the upper limb have its lymphatic drainage
- upper limb lymph mainly drains into humeral and central nodes
describe the lymphatic drainage of the breast
- Lateral breasts drain to the axillary nodes
- medial breast drains to the parasternal nodes
Describe what causes the movement of the scapula allowing the shoulder to abduct 180 degrees
- 120 degrees from the glenohumeral joint
- 80 degrees from the scapula thoracic joint
- trapeziums and serratus anterior cause these muscles to rotate
what gives the scapula even more range
Physiological scapulothoracic joint
what muscles are important for abduction of the shoulder
- trapezius and serratus anterior cause these muscles to rotate
when there is removal of the axillary lymph nodes what can there be damage to
- injury to the throacodorsal nerve and thus the latissmus doors
- injury to the long thoracic nerve which innervates serrates anterior and thus can cause winging of the scapula
what moves do lastissimus dorsi and serrates anterior do
- adduction and extension
what happens If you remove the lymph nodes
lymphedema as the excess interstitial fluid struggles to be drained
when is the long thoracic nerve at risk
- axillary lymph node removal
- stab wound
- thoracic surgery
- chest tube insertion
- crushed between clavicle and 1st rib
what happens if the spinal accessory nerve is damaged
- weak shoulder abduction and not as prominent winging of scapula
- atrophy of trapezius
- shoulder falls
- cannot abduct beyond 70-90 degrees as you cannot rotate the scapula
what is the biggest bone in the upper limb
Humerus
what is damaged by a mid shaft fracture of the humerus
radial nerve
what is damaged by an anterior discloation of the elbow
brachial artery
what is damaged by a supracondylar fracture of the humerus
- Median nerve
in a medial epicondyle break what nerve is damaged
Ulnar nerve as the ulnar never goes under the medial epicondyle
what type of joint is the elbow joint
hinge joint - flexion and extension
pivot joint - pronation and supination
what is the role fo the elbow
- the elbow positions you hand so you can get the object towards you
what is medial the radius or ulna
ulna
what are the joints between the radius and ulna
- distal and proximal radioulnar joint
what carpals articulates with the radius
scaphoid (larger one) and lunate
what is present in the anterior compartment of the forearm
- Flexors
- Pronators
- Median nerve
- Ulnar nerve
- Radial artery
- Ulnar artery
what is in the posterior compartment of the forearm
- Extensors
- Supinators
- Posterior compartment supplied by radial nerve
- Posterior interosseus artery
what nerve supplies the posterior compartments of the arm and forearm
radial nerve
what artery supplies the posterior compartment of the forearm
- posterior interssoesus which branches of the ulnar artery supplies the posterior compartment
which artery is bigger the ulnar or radial artery
ulnar
where does the ulnar and radial artery start
- opposite the neck of the radius in the inferior cubital fossa
where do the radial and ulnar arteries anatomise
- they anatomise in the hand where they form the deep and superficial palmar arches
what are the bones in the hand
carpals
metacarpals
phalanges
what are the joints in the hand
Ditsal radioulnar
radiocarpal
intercarpals
carpometacarpals,
metacapalphalangeals
interphalangeals (distal and proximal)
does the ulnar articulate with carpals
- no instead fibrocartilage disc fills the gap
- allows adduction of the wrist
where are the power muscles of the hand located
in the forearm = they have long tendons that pass over the wrist into the hand
what are the tendons wrapped in in the hand
- tendon sheath which has synovial fluid in it, allows the tendons to move smoothly and allows them to hold them in place
what holds the tendons in place in the hand
- retinaculum - thick fascia that holds the tendons in place
what is a collet fracture (dinner fork deformity)
- this is a fracture to the distal radius and ulnar
describe a scaphoid fracture
- problem with the scaphoid is the blood supply becoming affected
- snuffbox - if you feel in this you might be able to feel the breakage
what nerve is compressed in carpal tunnel syndrome
- the median nerve = can eventually lead to atrophy of the thenar muscles
what are bursa
these are synovial fluid bumps where the synovial fluid cannot drain
what are the compartments of the hand
Superficial the long flexor tendons and their sheaths
Medial and lateral the hypothenar and thenar muscles
Deep the intrinsic muscles of the hand
describe the blood supply of the hand
- superficial and deep palmer arches which are supplied from the radius and ulnar and is where the radius and ulnar anatomise so there is collateral circulation
- Digital arteriais that are going into the fingers
what percentage of movement does the thumb account for
- 50% of movements = does opposition movements
what can you use to replace the thumb
the big toe or 2nd toe can be used so you can still to opposition movements
