Scenario 13: Sheila's Sore Shoulder Flashcards
1
Q
Where is the transverse humeral ligament?
A
Between the humeral tubercles in the bicipital groove acting as a reticulum for the long head of biceps brachii
2
Q
What runs in the spiral groove of the humerus?
A
The radial nerve and the profunda brachii artery
3
Q
What is the contents of the axilla?
A
Axillary vessels, brachial plexus, some branches of intercostal nerves and many lymph glands along with fat and loose areolar tissue
4
Q
Which cutaneous nerve supplies the medial strip in the arm?
A
Medial cutaneous nerve of arm and forearm
5
Q
What are the boundaries of the cubital fossa?
A
BASE: 2 epicondyles of humerus
LATERAL WALL: brachioradialis muscle and wrist extensors
MEDIAL WALL: pronator teres and flexor group
FLOOR: brachialis, supinator, anterior capsule of elbow joint
ROOF: bicipital aponeurosis and deep fascia of forearm
6
Q
What is ‘winged scapula’?
A
A condition caused by damage to the long thoracic nerve resulting in damage to serratus anterior, the scapula is hence pushed backwards so it looks like a wing.
7
Q
What is the joint between the humerus and the scapula called? Describe the movement at this joint.
A
Glenohumeral joint (head of humerus to glenoid cavity) Most of movement of shoulder occurs here.
8
Q
What are the supinators of the elbow joint?
A
Biceps brachii, supinator, adductor pollicus longus, extensor pollius longus and brachioradialis
9
Q
What are the deep posterior forearm muscles?
A
Supinator, abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, extensor indicis
10
Q
What bony features does the proximal humerus have?
A
A head, anatomical and surgical necks, a greater and a lesser tuberosity, the bicipital groove and spiral groove
11
Q
Where does the ulnar nerve supply and which branch of the brachial plexus does it come off?
A
Medial cord. Couple of muscles of anterior forearm and muscles of hand
12
Q
Where does brachialis arise from and insert onto?
A
Arises from lower shaft of the humerus and inserts onto the ulnar just inferior to the coronoid process.
13
Q
What is the function of flexor pollicus longus?
A
Flexes the thumb
14
Q
What are the superficial anterior forearm muscles?
A
Pronator teres, flexor carpi radialis, palmaris longus, flexor digitorum superficialis, flexor carpi ulnaris
15
Q
Which spinal roots control the extension of the elbow?
A
C7-8
16
Q
What is the joint between the clavicle and the sternum called? Describe the movement at this joint.
A
Sternoclavicular joint. Very mobile with superior-inferior and anterior-posterior movements.
17
Q
Where can we palpate the brachial pulse?
A
Pressing laterally against the humerus
18
Q
Describe the deep venous drainage of the arm.
A
Follows the pattern of the arteries but often as doublets on either side of the arteries
19
Q
Which spinal roots control the precise adduction and abduction of digits 2-5?
A
T1
20
Q
Where does trapezius arise from and insert onto?
A
Arises from the external occipital protruberance of the skull, the nuchial ligament and the spines of C7-T12. Inserts onto lateral 1/3 of clavicle, acromial process and spine of scapula laterally
21
Q
Where is the centre of the axis of movement in the elbow joint?
A
Around the centre of the capitulum
22
Q
Where does the radial nerve supply and which branch of the brachial plexus does it come off?
A
Posterior cord. Supplies extensors of arm and forearm
23
Q
What is the joint between the clavicle and the scapula called? Describe the movement at this joint.
A
Acromioclavicular joint. Small gliding and rotation movements
24
Q
What is Duypuytren’s contracture?
A
A thickening and shorting of palmar aponeurosis leading to a deformity where the fingers cannot straighten
25
Where does the axillary nerve supply and which branch of the brachial plexus does it come off?
Posterior cord. A short nerve of the axilla.
26
What ligaments support the acromioclavicular joint?
Coracoclavicular ligament, acromioclavicular ligament, trapezoid ligament and conoid ligaments form the capsule.
27
Where does extensor digitorum insert?
Dorsal expansion of fingers 2-5
28
Which part of the skin of the upper limb is not supplied by the brachial plexus?
Over the shoulder is supplied by the supraclavicular nerves of the cervical plexus
29
What is the function and supply of the rhomboids?
Assist holding of the scapula against the chest wall and retracting and medially rotating the scapula. Supplied by dorsal scapular nerve (C5)
30
Where does the median nerve nerve supply and which branch of the brachial plexus does it come off?
Lateral and medial cords. Supplies anterior forearm and muscles of thenar eminence.
31
What is the function and supply of infraspinatus ?
Lateral rotator of the humerus. Supplied by suprascapular nerve (C5,6)
32
What is the function of brachioradialis?
Flexes the elbow
33
Where is coracobrachialis?
Spanning the corocoid process and the mid arm.
34
What does the crest of the ulna receive?
The insertion of supinator muscle
35
What does the coronoid fossa of the humerus do?
Accommodates the coronoid of the ulna during flexion
36
Where can we palpate the axillary pulse?
Pressing deep into the axilla
37
Where does pectoralis minor arise from and insert onto?
Arises from ribs 3-5 or 2-4 and inserts onto coracoid process
38
What is the purpose of the fat pads in the elbow joint?
Fatty tissue lies between the synovial and fibrous membranes of the capsule to prevent excessive movement of the joint
39
Where is the subscapular bursa?
In front of the subscapularis muscle, between the glenohumeral ligaments
40
What are the boundaries of the anatomical snuffbox?
MEDIAL WALL: tendons of abductor pollicis longus
LATERAL WALL: tendons of extensor pollicis brevis
PROXIMAL BORDER: styloid process of radius
FLOOR: scaphoid and trapezius bones and the base of the first metacarpal
ROOF: skin and juicy
41
Which muscles make up the 'mobile wad' of lateral muscles of the forearm?
Brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis
42
What are the names of the fossa of the scapula inferior and superior to the spine of the scapula?
Inferior is the infraspinous fossa, superior is the supraspinous fossa
43
Which ligaments prevent sideways movement at the elbow?
The medial and lateral collateral ligaments
44
Where does abductor pollicus longus arise from and insert onto?
Arises from dorsal surface of the ulna, radius and interosseous membrane. Inserts onto base of 1st metacarpal bone.
45
What is supinator supplied by?
The radial nerve
46
What are the key bony features of the distal end of the ulna?
Head and styloid process
47
What is the humeroulnar joint between?
The trochela of the humerus and the trochelar notch of the ulna
48
Which muscles are involved in elevation at the shoulder?
Serratus anterior. To elevate above 90 degrees the arm must first be abducted.
49
Where does the corocoid process of the scapula arise?
On the superior margin projecting antero-laterally above the glenoid fossa
50
Describe the deltoid tuberosity of the humerus.
A prominent V shaped tuberosity on the shaft of the humerus which receives the tendon of the deltoid muscle.
51
What is the function of extensor indicis?
Extends index finger and dorsiflexes at wrist and midcarpal joints
52
Describe the shoulder girdle.
Formed of clavicle and scapula, acts as a brace for the upper limb attaching it to the trunk. Joins to humerus in the glenohumeral joint
53
What are the supinators of the arm?
Biceps brachii and supinator
54
Which anterior rami does the brachial plexus encompass?
C5-T1
55
What are the facets of the clavicle and what do they articulate with?
Large oval facet at medial end articulates with sternum, flattened lateral end with small postero-lateral facet which articulates with the acromion process of the scapula.
56
Where is the median nerve prone to injury?
Where it lies in the median side of the cubital fossa following a supracondylar fracture.
57
Name the supraclavicular branches of the brachial plexus.
Dorsal scapula nerve, suprascapular nerve, subclavian nerve, long thoracic nerve
58
Where do the two parts of pectoralis major arise from and insert onto?
The clavicular part arises from the medial 1/2 of the anterior surface of the clavicle. The sternocostal part arises from the sternum and cartilages of ribs 2-6. It inserts onto the lateral crest of the bicipital groove
59
What does the lateral epicondyle of the humerus give rise to?
The origin of the extensor and supinator muscles of the forearm. Has lateral supracondylar ridge.
60
What is the function of flexor digitorum superficialis?
Flexor of the wrist and finger joint
61
Where does brachioradialis arise from and insert onto?
Arises from supracondylar ridge, inserts onto radial surface of styloid process
62
What is the main support of the superior radioulnar joint?
The anular ligament which attaches to the ulnar and encircles the radius
63
Where is the ulnar nerve prone to injury?
Where it passes posterior to the medial epicondyle
64
What separates the greater and lesser tuberosities of the proximal head of the humerus?
The bicipital groove
65
Where is the radial nerve prone to injury?
Where it passes in front of the lateral epicondye and in the spiral groove in the humeral shaft
66
What is the function and supply of deltoid?
The clavicular part flexes and medially rotates the arm, the acromial part abducts the arm, the spinal part extends and laterally rotates the arm. Supply is the axillary nerve
67
Which nerve supplies the deep posterior forearm muscles?
Radial nerve
68
What is tennis elbow?
Lateral epicondylitis, severe burning pain on the lateral side of the elbow that may radiate down forearm
69
What is the function and supply of sternocleidomastoid?
CN X (vagus), extend and turn head, flex neck, inspiration
70
Describe the superficial lymphatics of the arm
Follow the pattern of the superficial veins. Those related to the basilic vein may enter nodes at the elbow (supratrochlear nodes), those related to the cephalic vein may enter infraclavicular nodes or the deep apical nodes of the axilla
71
What muscles form the anterior compartment of the arm?
Brachilais, coracobrachialis and biceps brachii (flexors)
72
What is the course of the radial artery in the forearm?
Runs downwards and laterally on the medial border of brachioradialis. Above the wrist the artery turns laterally and posteriorly to the dorsum of the hand
73
Where does the joint capsule of the elbow attach?
Around the articular surfaces blending with the annular ligament. It covers the tip of the olecranon, the coronoid process and the radial fossa
74
What is pronator teres supplied by?
The median nerve
75
Which spinal roots control the flexion of the elbow?
C5-C6
76
Where does extensor digiti minimi insert?
5th tendon compartment of the dorsum of the wrist to the dorsal aponeurosis of the 5th digit
77
The fibres of which muscles radiate into the capsule of the elbow joint and for what purpose?
The fibres of brachialis and triceps brachii muscles act as articular muscles and radiate into the capsule in order to tense it.
78
What is the name of the medial condyle of the humerus and what does it articulate with?
Trochlea which articulates with the trochlear notch of the ulnar
79
Where does the musculocutaneous nerve supply and which branch of the brachial plexus does it come off?
The lateral cord. Supplies anterior arm.
80
What is the innervation and function of pectorialis minor?
Lowers, protracts and rotates the scapula. It is supplied by the median pectoral nerve
81
What are the two notches and two processes of the proximal ulna?
The olecranon and the coronoid process forming the semilunar and radial notches
82
Describe the course of the basilic vein
Runs along the anterior and medial surface of the forearm, passes along the medial border of the arm to join the brachial vein mid arm
83
What is the function of extensor digitorum?
Dorsiflexor of the wrist and mid-carpal joints, extends and spreads the fingers
84
Describe the deep fascia of the hand.
Condensed into palmar aponeurosis which are four longitudinal bands of fascia each with an intervening transverse band
85
What three joints form the elbow joint?
Superior radioulnar, humeroradial and humeroulnar
86
Where does extensor carpi ulnaris arise from and insert?
As well as the common origin, it arises from the ulnnar and runs through the 6th tendon compartment to the base of the 5th metacarpal
87
Which spinal roots control the pronation of the radioulnar joint?
C7-8
88
Describe the deep lymphatics of the arm
Follow the pattern of the deep veins before congregating in the axilla
89
What is the fascia at the front of the elbow?
Cubital fascia in the cubital fossa
90
What is the function and supply of trapezius?
Stabiliser of the scapula, upper part shrugs shoulders (elevate scapula and clavicle), rotate scapula laterally allowing elevation of arm above 90 degrees. Accessory nerves CN XI and C2-4 spinal
91
What is pronator quadratus supplied by?
Median nerve
92
Which spinal roots control the powerful flexion and extension of the digits?
C7-8
93
What kind of joints are the radioulnar joints?
Synovial pivot joints
94
Which cutaneous nerve supplies the lateral strip in the lower arm?
Radial (posterior cutaneous) nerve
95
Which spinal roots control the medial rotation and adduction of the shoulder?
C6-8
96
What are the pronators of the arm?
Pronator teres and pronator quadratus
97
What is the function and supply of serratus anterior?
Contraction of the whole of serratus anterior will thrust the upper limb forwards, keeps the scapula tightly placed against the rib cage by antagonising the rhomboids. When the lower part contracts it can rotate the scapula laterally elevating the glenoid fossa. Supplied by long thoracic nerve (C5-7)
98
What are the four main causes of frozen shoulder?
Idiopathic frozen shoulder, diabetic frozen shoulder, post-traumatic frozen shoulder, post-surgical frozen shoulder
99
Which spinal roots control the flexion and extension of the wrist?
C6-7
100
What is the function and supply of supraspinatus ?
Abducts the humerus. Supplied by suprascapular nerve (C5,6)
101
What are the dorsal scapular muscles?
Supraspinatus, infraspinatus and teres minor from the rotator cuff as well as teres major.
102
Why is the glenohumeral joint prone to dislocations and what is in place to prevent this?
The glenoid fossa is much smaller than the head of the humerus which gives great mobility but makes the joint prone to dislocation. The glenoid labrum, formed of hylaine cartilage, serves to deepen the socket
103
Describe the sternoclavicular joint and its articular cartilage
Synovial joint, functionally a ball and socket. Articular cartilage divides the joint cavity in two as well as deepening the shallow socket in the sternum by covering the articular surfaces to aid congruence.
104
Which ligaments and other structures support the glenohumeral joint?
A muscle-dependant joint, there are few strong ligaments. The tendon of biceps supports as do the three weak glenohumeral ligaments and the coracohumeral ligament
105
When do subclavian arteries become axillary?
When they cross the first rib
106
What does the tuberosity of the ulna receive?
The insertion of brachialis muscle
107
Where do supraspinatus and infraspinatus arise from and insert onto?
Arising from the supraspinous and infraspinous fossa of the scapula respectively, these muscles fuse in the hjoint stabilising the humeral head in it's socket
108
What is the lateral process of the spine of the scapula?
The acromion process
109
What is the common origin of the superior anterior forearm muscles?
Medial epicondyle of the humerus
110
Which of the principal nerves of the upper arm cross the elbow and are therefore at risk of damage here?
The median, radial and ulnar nerves
111
What is the function of flexor carpi radialis?
Weak flexor and pronator of the elbow joint and palmar flexion of the wrist, radial abduction
112
What does the radial fossa of the humerus do?
Accommodates the head of the radius during flexion
113
What does the olecranon fossa of the humerus do?
Accommodates the olecranon during flexion
114
Where does flexor digitorum profundus arise from and insert onto?
Arises from proximal 2/3 of the palmar surface of the ulnar interosseous membrane. Attaches to terminal phalanges 2-5 by tendons
115
Describe the ligaments of the sternoclavicular joint
Has a slack and thick capsule strengthened by anterior and posterior sternoclavicular ligaments. The clavicles are connected by the interclavicular ligament. The costoclavicular ligament extends between the first rib and clavicle.
116
How many muscles are there in the posterior compartment of the forearm and what is the function and nerve supply of these muscles?
3 superficial muscles, 3 lateral muscles (mobile wad) and 5 deep muscles which serve to extend the forearm and are supplied by the radial nerve
117
Where are the ulna and radius in relation to one another?
The radius is lateral to the ulna.
118
Describe the general organisation of the brachial plexus.
C5-T1 roots form superior, middle and inferior trunks, anterior and posterior divisions lead to lateral, posterior and medial cords which terminate as the different nerves.
119
Which cutaneous nerve supplies the lateral strip in the upper arm?
The axillary nerve
120
Where does extensor pollicus longus arise from and insert onto?
Arises from the dorsal surface of the ulnar and inserts onto the base of the distal phalanx of the thumb
121
Where does omohyoid arise from and insert onto and what is it's function?
Arises from scapula inserts onto hyoid bone. Depresses hyoid.
122
Where can we palpate the subclavian pulse?
Between medial end of clavicle and sternocleidomastoid muscle
123
Which spinal roots control the precise adduction and abduction of the saddle joint of the thumb?
C8
124
Where does teres major arise from and insert onto?
Arises from the inferior angle of the scapula and inserts onto the medial lip of the bicipital groove
125
What is the function and supply of latissimus dorsi?
Pulls up the trunk when the arms are fixed, adducts, extends and medially rotates the humerus. Supplied by thoracodorsal nerve C6-8
126
Describe the superficial venous drainage of the arm.
Arise on the dorsum of the hands and separates into a lateral channel: the cephalic vein and a medial channel: the basilic vein
127
Where does subscapularis arise from and insert onto?
Arises from subscapula fossa inserts onto the lesser tubercle of the humerus
128
When does the axillary artery become the brachial artery?
When it crosses the posterior border of teres major which is the lower posterior boundary of the axilla
129
What is the function of palmaris longus?
Flexes hand toward palm and tenses palmar aponeurosis
130
Where does levator scapulae arise from and insert onto?
Arises from spinous processes C1-4, inserts onto superior process of the scapula
131
Where does extensor carpi radialis brevis arise from and insert onto?
Arises from common head of lateral epicondyle of humerus and inserts onto base of 3rd metacarpal
132
What is the fascia of the arm called?
Brachial fascia
133
What does the medial epicondyle of the humerus give rise to?
Attachment of the common flexor origin with a prominent groove for the ulnar nerve. Has medial supracondylar ridge.
134
Which cutaneous nerve supplies the posterior strip in the arm?
Posterior cutaneous branches of radial nerve
135
Which muscles are involved in extension at the shoulder?
Teres major, latissimus dorsi, long head of triceps brachii, spinal and some acromial fibres of deltoid
136
Which muscles are involved in medial rotation at the shoulder?
Subscapularis, pectoralis major, long head of biceps brachii, clavicular fibres of deltoid, teres major and latissimus dorsi
137
Where does the ulnar collateral ligament arise from and run to?
Arises from the medial epicondyle and runs to the anteriorly to the coronoid process and posteriorly to the medial margin of the olecranon as well as the oblique fibres which from the olecranon process to the coronoid process of the ulnar.
138
What movement do the radioulnar joints permit?
Pronation and supination
139
What is the contents of the anatomical snuffbox?
The radial artery runs on the floor of the anatomical snuffbox. The carpal bones, scaphoid and trapezium can be palpated as can the styloid process of the radius.
140
Where do the two heads of biceps brachii arise from and where do the two tendons insert onto?
The long head arises from the supraglenoid tubercle, the short head from the corocoid process of the scapula. The main rounded tendon inserts onto the radial tuberosity, the other tendon blends into the fasica of the medial foreman.
141
Which tendon is inside the capsule of the glenohumeral joint?
That of the long head of biceps brachii (intra-capsular but extra-synovial)
142
What does the anconeus muscle do?
Abducts ulna during pronation and extends the elbow
143
What are the pronators of the elbow joint?
Pronator teres, flexor carpi radialis, extensor carpi radialis longus and with a flexed forearm then pronator quadratus, brachioradialis and palmaris longus
144
Where is the glenohumeral joint weakest and why?
Inferiorly as the top of joint is protected by the coracoacromial arch and ligament and by the tendon of biceps brachii
145
Where do the two heads of supinator arise and where does it insert?
The humeral head arises from the posterior aspect of the lateral epicondyle, the ulnar head arises from the supinator crest on the lateral side of the ulna. It inserts onto the lateral aspect of the shaft of the proximal radius
146
What joints and bones form the pectoral girdle?
Anterior clavicle and posterior scapula form the acromiclavicular joint. The sternoclavicular joint and scapulo-thoracic 'joint' also.
147
What separates the inferior radioulnar joint from the wrist joint?
The triangular disc
148
Where does extensor indicis arise from and insert onto?
Arises from dorsal ulna and inserts onto index finger
149
What is the function of extensor pollicus brevis?
Extends the thumb
150
Describe the course of the cephalic vein
Found on the anterior surface of the forearm, ascends into a groove between deltoid and pectoralis major before terminating into the axillary vein
151
Where does flexor carpi ulnaris insert?
Pistiform bone and extends via pisohamate ligament to the hamate
152
What is the function of abductor pollicus longus?
Extends the thumb
153
Where do the major and minor rhomboids arise from and insert onto?
Arise from spinous processes of lower cervical vertbrae (C6-7) and upper thoracic (T1-T4/5) and inserts onto the medial border of the scapula.
154
What are the three supraclavicular muscles?
Omohyoid, trapezius, sternocleidomastoid
155
What is the function of extensor carpi ulnaris?
Dorsiflexion of the radiocarpal joint and palmar flexion in the midcarpal joint
156
Where does pronator teres insert?
Lateral surface of the radium
157
Where do the three parts of deltoid arise from and insert onto?
The clavicular part arises from the lateral 1/3 of the clavicle, the acromial part arises from the acromion, the spinal part arises from the lower border of the spine of the scapula. Attaches to the deltoid tuberosity of the humerus.
158
What are the attachments of the capsule of the glenohumeral joint?
Glenoid labrum, anatomical neck of the humerus
159
Where does sternocleidomastoid arise from and insert onto?
Sternum, medial end of the clavicle and the mastoid process of the skull.
160
Which muscles are involved in lateral rotation at the shoulder?
Infraspinatus, teres minor, spinal fibres of deltoid
161
What is the joint between the scapula and the ribcage called? Describe the movement at this joint.
Scapulothoracic joint. Allow limb to be moved around the joint
162
Where does extensor pollicus brevis arise from and insert onto?
Arises from radius distal to abductor pollicus longus and extends to base of proximal phalange of the thumn
163
Where do the two heads of pronator teres arise and where does it insert?
The humeral head is from the medial epicondyle of the humerus and the ulnar head is from the medial side of the corocoid process of the ulnar. It inserts onto the lateral aspect of the radius.
164
What is the cutaneous nerve supply of the palmar surface of the hand?
The median nerve for the lateral 3.5 digits, the ulnar nerve for the medial 1.5 digits, the radial nerve for the thenar eminence at the base of the thumb
165
Which fossa runs on the anterior border of the scapula?
The broad, concave subscapular fossa
166
What is the nerve supply of triceps brachii?
Radial nerve C7-8 and the long head gets supply from the axillary nerve
167
What is the fascia of the forearm called?
Antebrachial fascia
168
Which spinal roots control the supination of the radioulnar joint?
C6
169
Where can we palpate the radial pulse?
Lateral to the tendon of flexor carpi radialis at the wrist and also in the anatomcial snuff box
170
What are the deep anterior forearm muscles?
Flexor pollicis longus, flexor digitorum profundus and pronator quadratus
171
What is the name of the lateral condyle of the humerus and what does it articulate with?
Capitulum which articulates with the radial head
172
What is the course of the ulnar artery in the forearm? What is it's main branch?
Directed downwards and medially under the flexor carpi ulnaris. Near the wrist it passes in front of the flexor reticulum lateral to the pistiform bone. The main branch is the common interosseous artery which divides into anterior and posterior
173
Describe the course of the brachial artery.
Begins when the axillary artery crosses teres major, lies on the medial side of the arm and enters the cubital fossa deep to the aponeurosis of the biceps. Crossed by the median nerve superficially. Divides into ulnar and radial arteries in the cubital fossa.
174
What is the nerve supply of superficial posterior forearm muscles?
Posterior interosseous nerve, a branch of the radial nerve
175
What ligaments support the inferior radioulnar joint?
Anterior and posterior radioulnar ligaments
176
Which bone is the axillary nerve closely associated to?
The surgical neck of the humerus
177
What sits in the bicipital groove of the proximal head of the humerus?
The tendon of the long head of biceps brachii
178
Where does the brachial artery divide into radial and ulnar arteries?
At the elbow
179
What is the common origin of superficial posterior forearm muscles?
Lateral epicondyle of the humerus
180
Which ligaments protect the superior radioulnar joint?
Annular and quadrate ligaments
181
How many muscles are there in the anterior compartment of the forearm and what is the function and nerve supply of these muscles?
5 superficial muscles and 3 deep muscles which serve to flex the forearm and are supplied by the median or ulnar nerve
182
Which muscles are involved in adduction at the shoulder?
Pectoralis major, long head of triceps brachii, teres major, latissimus dorsi, short head of biceps brachii, clavicular and spinal parts of deltoid
183
What is the function of flexor digitorum profundus?
Flexes fingers
184
What is prone to inflammation in the glenohumeral joint?
The subscapular bursa and the sheath around the biceps tendon
185
What is the function and supply of teres major?
Adducts and medially rotates the humerus. Supplied by lower subscapular nerve.
186
What is the function and supply of the levator scapulae?
Elevation of the scapula with trapezius muscle. Supply is the dorsal scapular nerve and C3-4
187
Where can we palpate the ulnar pulse?
Pressing it against the pistiform bone
188
Where does flexor pollicus longus arise from and insert onto?
Arises from anterior surface of the radius, distal to radial tuberosity and from interosseous membrane. Attaches to the terminal phalange the thumb
189
What is the function of extensor digiti minimi?
Aids dorsiflexion and ulnar adduction of the hand
190
What is the function of brachialis?
A flexor at the elbow joint
191
What is the principal branch of the brachial artery?
The profunda brachii artery
192
Where does flexor carpi radialis insert?
In the carpal tunnel in a groove in the trapezium
193
What is the cutaneous nerve supply of the dorsum of the hand?
Superficial branch of the radial nerve laterally and dorsal branch of the ulnar nerve medially
194
Where does latissimus dorsi arise from and insert onto?
Arises T7-12 spines of vertebrae, thoracolumnar fascia and posterior part of iliac crest. Inserts onto bicipital groove of humerus.
195
What are the extensors of the elbow joint?
Triceps brachii, mostly medial and lateral heads
196
Where does the radial collateral ligament arise from and run to?
Extends from lateral epicondyle of humerus to anular radial ligament, radiating into the ulnar before fusing with superficial extensors.
197
Where does extensor carpi radialis longus arise from and insert onto?
Arises from supracondylar ridge of humerus inserts onto the base of the 2nd metacarpal
198
In which direction is the shoulder most likely to be dislocated?
Anterior-inferior direction
199
What is the function of triceps brachii?
Antagonist to biceps brachii, the three heads together act as an extensor of the elbow. The long head has the addition function of extending and adducting the arm at the glenohumeral joint.
200
What does the interosseous membrane of radius and ulna do?
Stretches between radius and ulna preventing displacement of the radius and ulna in a parallel direction
201
What nerve are brachilais, coracobrachialis and biceps brachii supplied by?
Musculocutaneous nerve via the C5-6 myotomes
202
Where do the three heads of triceps brachii arise from and where does the muscle insert?
The long head arises from the infraglenoid tubercle of the scapula, the medial and lateral heads lies either side of the spiral groove of the humerus. The three heads merge to form a single tendon which inserts onto the olecranon process of the ulna
203
What are the rotator cuff muscles?
A complex of four muscles which arise from the scapula and whose tendons blend in with the capsule as they attach to the humerus. Subscapularis, supraspinatus, infraspinatus, teres minor
204
What is the humeroradial joint between?
The capitulum of the humerus and the head of the radius
205
Where does teres minor arise from and insert onto?
Arises from the lateral border of the scapula and inserts onto the inferior facet of the greater tubercle of the humerus, blending into the joint capsule.
206
What is the function of biceps brachii?
The long head abducts the arm, the short head adducts the arm. Both heads together flex the humerus. At the elbow joint biceps is a flexor, at the radioulnar joint it is a supinator.
207
What is the superior radioulnar joint between?
Head of the radius and the radial notch of the ulnar
208
Where does palmaris longus insert?
Radiates into the palmar aponeurosis
209
What is the function and supply of teres minor?
A lateral rotator of the humerus and glenohumeral joint stabiliser supplied by the axillary nerve
210
What are the flexors of the elbow joint?
Biceps brachii, brachialis, brachioradialis and some superficial muscles of the anterior forearm
211
What is the contents of the cubital fossa?
From medial to lateral: median nerve, brachial artery and vein, biceps tendon
212
What is the function of extensor pollicus longus?
Extends the thumb and at the wrist it dorsiflexes and abducts the hand radially
213
What is the function of extensor carpi radialis longus and brevis?
Weak flexor of elbow, dorsiflexion and radial abduction at radiocarapal and mid-carpal joints. Fist clenchers.
214
Name the infraclavicular branches of the brachial plexus.
Lateral pectoral nerve, median pectoral nerve, median cutaneous nerve of arm, median cutaneous nerve of forearm, upper subscapular nerve, lower subscapular nerve, thoracicodorsal nerve,
215
Which muscles are involved in abduction at the shoulder?
Deltoid, supraspinatus and long head of biceps brachii
216
What are the superficial posterior forearm muscles?
Extensor digitorum, extensor digiti minimi, extensor carpi ulnaris, (anconeus)
217
Which muscles are involved in flexion at the shoulder?
Clavicular and some acromial fibres of deltoid, biceps brachii, clavicular and sternocostal fibres of pectoralis major, costobrachialis and serratus anterior
218
What is the innervation and function of pectorialis major?
Raise and lower the arm, adduct the arm and rotate it medially as well acting as an accessory muscle of inspiration. Supplied by lateral and medial pectoral nerves (C6-8)
219
Where does flexor digitorum superficialis insert?
Tendons run into the carpal tunnel each inserting onto the middle phalanges of fingers 2-5
220
What is the purpose of the olecranon bursa and how is it injured?
It helps protect the skin from the olecranon process. It can be injured by repetitive trauma by constant leaning.
221
Which cutaneous nerves supply the forearm?
The lateral, medial and posterior cutaneous nerves of the forearm
222
What is the function of coracobrachialis?
Flexor and adductor at the glenohumeral joint
223
What is golf elbow?
Medial epicondylitis, severe burning pain on the medial side of the elbow that may radiate down forearm
224
What are the boundaries of the axilla?
APEX: outer border of first rib, superior border of scapula, posterior surface of clavicle
BASE: skin and fascia
ANTERIOR WALL: pectoralis major and minor
POSTERIOR WALL: subscapularis, teres major and latissimus dorsi
MEDIAL WALL: chest wall, serratus anterior
LATERAL WALL: bicipital wall of humerus
225
What type of joint is the acromioclavicular joint?
Synovial gliding joint
226
What are the bony features of the proximal end of the radius?
Head for articulation with capitulum of humerus and radial notch of ulna, neck and a medial tuberosity
227
What is the function and supply of subscapularis?
Stabilises the glenohumeral joint and medially rotates the humerus. Supplied by upper and lower subscapular nerves.
228
What are the key bony features of the distal end of the radius?
The styloid process laterally and tubercle posteriorly
229
What nerve supplies biceps brachii?
Musculocutaenous nerve
230
Which spinal root controls the lateral rotation and abduction of the shoulder?
C5
231
What is the axillary recess of the glenohumeral joint?
The slack part of the articular capsule which hangs down
232
Where are the two necks of the proximal end of the humerus?
The anatomical neck lies below the head, the surgical neck lies at the top of the shaft
233
Where does serratus anterior arise from and insert onto?
Arises from the upper 8 ribs and inserts onto the whole medial border of the scapula
234
Where does pronator quadratus arise and insert?
Crosses between radius and ulnar in distal forearm
235
Where is the median cubital vein and what is it used for clinically?
Links the basilic and cephalic veins in the cubital fossa, used to take a venous blood sample or insert an IV
