session 2: upper limb Flashcards
1
Q
which bones connect the upper extremity to the trunk?
A
clavicle and scapula
2
Q
at which joint does the humerus articulate with the scapula?
A
shoulder joint-glenohumeral joint
3
Q
where do the scapula and clavicle articulate with the thorax?
A
sternoclavicular joint
4
Q
which part of the clavicle articulates with the scapula and at which joint?
A
lateral clavicle with acromion on scapula
acromioclavicular joint
5
Q
how is the scapula held onto the body?
A
acromioclavicular joint and muscles
6
Q
what shape is the clavicle?
A
S-shaped-forward curve to medial half, large joint surface at medial end
7
Q
what is the trianglular flatish part of the scapular called?
A
blade
8
Q
where is the glenoid fossa?
A
on scapula, articular surface for shoulder joint
9
Q
where are the supraglenoid and infraglenoid tubercles?
A
above and below glenoid fossa
10
Q
what is the glenoid labrum and its function?
A
ring of fibrocartilge on glenoid fossa, makes joint socket wider and deeper
11
Q
where is the spine of the scapula?
A
prominent bony ridge arising from the dorsal surface
12
Q
what does the spine of the scapula divide it into?
A
supraspinous and infraspinous fossa
13
Q
where is the acromion?
A
lateral end tip of scapula
14
Q
describe the coracoid process.
A
on the scapula, looks like a bent finger
15
Q
what joins the coracoid process to the acromion?
A
coraco-acromial ligament
16
Q
describe the ligaments at the acromioclavicular joint
A
trapezoid in front and conoid behind
fix underside of clavicle to the coracoid process
17
Q
describe the range of movement at the acromioclavicular joint.
A
little movement
18
Q
edscribe the movements of the clavicle and scapula.
A
elevation and depression
protraction: forward movement of scapula around the trunk
retraction
upward rotation, downward rotation
scapula provides 1/3 of total range of motion of humerus relative to body
19
Q
where is the bicipital groove
A
aka intertubercular groove
where long head of biceps tendon runs
on anterior aspect of proximal humerus
20
Q
where is the deltoid tuberosity?
A
lateral aspect of humerus halfway down bone, rough spot
21
Q
why is the shoulder joint capsule weak?
A
allows movement
22
Q
describe the movements of theshoulder joint.
A
flexion, extension, abduction, adduciton, internal and lateral rotation
23
Q
which muscles go from the scapula to the humerus>
A
subscapularis, supraspinatous, infraspinatous and teres minor, teres major, coraco-brachialis
24
Q
which muscles form the rotator cuff?
A
supscapularis, suprspinatous, infraspinatous, teres minor
25
what is the rotator cuff?
continuous cuff of tendons around the shoulder joint supporting it
26
where does the subscapularis originate and insert?
anterior aspect of scapula-subscapular fossa
lesser tubercle
is on the front
27
what are the actions of subscapularis?
alone: internal rotation of humerus
| with other rotator cuff: holds humeral head and glenoid fossa together
28
where does the supraspinatus originate and insert?
supraspinous fossa, passes under acromion and inserts on greater tubercle of humerus
on back above scapula
29
what is the action of supraspinatous?
initiats abductiob of humerus
30
where does infraspinatous originate and insert?
infraspinous fossa
back of greater tubercle
on back below spine of scapula
31
what is the action on infraspinatus?
external rotation of humerus
32
where is the origin and insertion of teres minor>
```
infraspinus fossa (below infraspinatus)
back of greater tubercle below infraspinatus
```
33
what is the action of teres minor?
external rotation of humerus
34
where does teres major originate and insert
inferior angle and lowe 1/3 lateral border of scapula
| crest of lesser tubercle of humerus
35
what is the action of teres major?
poweful adductor of humerus
36
where does coraco-brachialis originate and insert?
coracoid process
medial surface of mid humeral shaft
on front deep to pec major and anterior deltoid
37
what is the action of coraco-brachialis?
helps flex shoulder joint
38
which muscles pass from the trunk to the scapula?
trapezius, levator scapulae, rhomboids, subclavius, omohyoid , 1 in front (pec minor), 1 underneath (serratus anterior)
39
where is the origin and insertion of serratus anterior?
side and front of first 8 ribs
| runds down and back and inserts on medial border of scapula
40
what is the action of serratus anterior?
protrusion
upper fibres=downward rotation of scapula
lower=upward rotation scapula
41
where is the origin and insertion of trapezius?
large and superficial on top of levator scapulae and rhomboids
upper part origin=occiput, nuchal ligament, T1-3 in midline and inserts on upper edge of spine fo scapula, around acromion and alteral 1/3 clavicle
lower part is smaller and originates T4-12 in midline, inserts on lower edge of spine of scapula
42
what are the actions of trapezius?
whole trapezius contracts=retracts scapula
| upper part=elevates scapula
43
where does levator scapulae originate and insert
outer surface 1st 3 cervical vertebrae
| upper medial corner of scapula
44
what is the action of levator scapulae?
elevates scapula
45
where does rhomboid major originate and insert?
spinous processes T2-5,
| medial border of scapula between spine of scapula and inferior angle
46
where does rhomboid minor originate and insert?
spinous processes C7 to T1
| upper portion medial border of scapula
47
what are the actions of the rhomboids?
adduct, elevate abd retract scapula
48
where does pec minor originate, insert and its action?
2nd to 4th ribs
medial surface coracoid process
depression of scapula
49
where is the subcavious origin and insertion and action?
1st rib
clavicle
uncertain
50
what is the origin, insertion and action of omohyoid?
hyoid bone
upper edge spine of scapula
depress hyoid bone and larynx
51
describe the origin and insertion of pectoralis major.
medial 1/3 clavicle, front of sternum and 1st 6 costal cartilages
crest of greater tubercle of humerus
52
what is the action of pectoralis major?
powerful adductor of humerus, internal rotation
53
where is the origin and insertion latissimus dorsi?
T7 to sacrum and posterior iliac crest, lower 4 ribs
| floor of bicipital groove-tendon has to spiral around teres major
54
describe the action of latissimus dorsi.
adductor of humerus, depressor scapula
55
where is the origin and insertion of deltoid?
surrounds shoulder joint
spine of scapula, acromion, lateral 1/3 clavicle
deltoid tuberosity of humerus
56
what are the actions of deltoid
anterior=flexor
posterior part=extensor
lateral part=abductor
57
what is the superior thoracoid aperture?
opening at the top of the chest (between 1st 2 ribs)
58
where doe the subclavian artery and vein cross the first rib?
behins medial end of clavicle
59
what is T1 level with
1st rib
60
where do the rotts of the brachial plexus emereg?
between the 2 scalene muscles
61
which vein is in the groove between pec major and deltoid and what does it join
cephalic vein
| joins subclavian
62
describe the pathway of the subclavian vein
comes up from arm and under pec minor, emerges and passes over 1st rib and under subclavius muscle and clavicle, reaches medial border of 1st rib and joined by internal jugular to form brachiocehalic, passes medial to 1st rib and enters chest, L and R join R of midline to form SVC
63
how does the name of the arteries of the upper limb change?
subclavian to axilary to brachial
64
describe the pathway of the arteries from the subclavian to brachial.
subclavian: on R sude it arises with common carotid from braciocephalic trunk, on the L directly from arch of aorta
L passes over dome of pleura and gives off internal thoracic, thyrocervical trunk, vertebral, transverse cervical and suprascapular
called the axillar artery once crosses lateral border of 1st rib, gives off 2 branches behind pec minor: thoraco-acromial and lateral thoracic. 3 more branches in axilla: subscapular, anterior and posterior circumflex humeral
called brachial artery at level of inferior border teres major
65
what are the roots of the brachial plexus
C5-T1 ventral rami of spinal nerves
66
draw the brachial plexus
google
67
what are the trunks of the brachial plexus and how do they divide>
upper, middle and lower
anterior and posterior divisions
2 anterior unite, 1 anterior stays alone
3 posterior unite
68
what roots is the musculocutaneous nerve formed from?
C5 and 6
69
what roots form the axillary nerve>
C5-6
70
what roots form the median nerve?
C5-T1
71
what roots form the radial nerve?
C5-T1
72
what roots form the ulnar nerve?
C8-T1
73
what does the lateral cord of the brachial plexus divide to form?
musculocutanrous nerve and 1/2 median nerve
74
what does the medial cord divide to form?
ulnar nerve and half of median nerve
75
what does the posterior cord divide to form?
axillary nerve and radial nerev
76
which artery do the cords of the brachial plexus surround?
axillary
77
where do the pectoral nerves arise and what do they supply?
medial from medial cord
lateral from lateral cord
pec major and minor
78
what does the musculocutaneous nerve supply?
corachobrachialis and 2 upper arm muscles
79
what does the axillar nerve supply/
deltoid and teres minor
80
where do the upper and lower subscapular nerves arise and supply?
posterior cord
| subscapularis and teres major
81
where does the throracodorsal nerve arise and supply?
posterior cord
| latissimus dorsi
82
where does the suprascapular nerve arise and supply/
from upper trunk, not brachial plexus
| supraspinatous and infraspinatous
83
where does the dorsal scapular nerve arise and supply?
C5 root, rhomboids
84
where does the long thoracic nerve arise and supply?
C5-7
| emerges through medial scalene and supplies serratus anterior
85
what muscles does the spinal accessory nerve supply?
trapezius
86
which roots supply levator scapulae
C3-5
87
where are the flexor and extensor aspects of forearm?
front
| back
88
where are the ulnar and radial sides of the forearm
elbow to little finger
| thumb to elbow
89
what s the arm?
shoulder to elbow
90
where is the forearm?
elbow to wrist
91
what are the articular surafces of the distal humerus?
trochlear articulates with ulnar
| rounded capitulum articulates with radius
92
what is the olecranon fossa?
hole on back oh humerus, accommodates olecranon of ulnar in extension
93
is the radius bigger proximally or distally?
distally
94
is the ulnar bigger proximally or distally?
proximally
95
do the radius and ulnar rotate?
only the radius
96
where is the trochlear notch?
large curved articualt surface on proximal ulnar
97
what is the olecranon?
on the proximal end of the ulnar, where triceps tendon attaches
98
where is the coronoid process?
projection on proximal ulnar
99
where is the ulnar tuberosity?
roufh area on proximal ulnar, insertion brachialis tendon
100
where is the radial notch?
on proximal ulnar, wherre head of radius articulates
101
what does the proximal radial head articualte with?
capitulum of humerus
102
what is the radial tuberosity?
on proximal radius, insertion of biceps tendon
103
which ligaments hold the radial side of the elbow in place?
radial collateral ligament, anular ligament (provides socket for head of radius to rotate in)
104
where does the anular ligament attach?
edges of radial notch of ulnar
| shaped like a cup
105
where does the radial collateral ligament originate?
lateral epicondyle, fans out an vecomes continuous with anular ligaent
106
where does the ulnar collateral ligament run?
origin=medial epicondyle and fans out in a triangle
| attached to ulnar along medial side trochlear notch
107
describe the capsule of the elbow joint
thin and loose in front and behind to allow movement
108
why is the elbow joint stable?
due to ligaments and shape of bones (deep joints)
109
what is the ulnar styloid?
pointed tip of distal ulnar
110
how many articular surfaces does the distal radius have?
2, smaller one for the ulnar
111
what is the radial styloid?
point on distal radius
112
what is the articular disk?
triangular fibrocartilage holds distal radio-ulnar joint together, attaches to radius and ulnar styloid
113
what are the carpal bones?
proximal row=scaphoid, lunate, triquetrum, pisiform
| distal row=trapezium, trapezoid, capitate, hamate
114
which bones articulate at the radiocarpal joint?
radius with scaphoid, lunate and part of triquetrum
115
which bone does the 1st metacarpal articulate with?
trapezium
116
where does the radial collateral ligament at the wrist run
radial styloid to scaphoid and trapezium
117
where does the ulnar collateral ligament at the wrist run?
ulnar styloid to triquetrum and pisoform
118
describe the joint capsule at the wrist joint
thick and strong, forms dorsal radio-carpal ligament o extensor aspect, on flexor aspect it forms palmar radiocarpal ligament
119
which muscles move the elbow?
brachialis, biceps brachii, brachioradialis, triceps, anconeus
120
what is origin, insertion and action of brachialis?
distal 1/2 anterior humerus
ulnar tuberosity and coronoid process
flexion at elbow
121
what is the origin and insertion of biceps brachii?
in front of brachia;is
2 heads: short originates with coracobrachiolais on coracoid process, long on supraglenoid tubercle of scapula
unite to form a signle belly which inserts as a 2 part tendon, mainly on the radial tuberoity but the lateral edge fans out to the bicipital aponeurosis whic becomes continuous with deep fascia surrounding the forearm, gives indirect attache ment to ulnar
122
what are the actions of biceps brachii?
flexion-more effeicient in pronation
| supination
123
where does brachioradialis originate, insert and action/
proximal 2/3 lateal supracondylar ridge of humerus
styloid process of ulnar
flexor
124
where does triceps originate, insert anda ction?
3 heads: long=infraglenoid tubercle of scapula, lateral=posterior surface of proximal half of humerus, medial/deep=posterior surface of distal half of humerus
converge to form a tendon which inserts on olecranon process of ulna
extension
125
which heads of triceps does the radial nerve run between
lateral and medial
126
what is the origin, insertion and action of anconeus
lateral epicondyle
lateral aspect proximal ulnar
minor extensor
127
what is the origina dn insertion of pronator teres?
medial epicondyle and deep head from proximal ulnar
| halfway down lateral surface of radius
128
where is the origina nd insertion pronator quadratus?
anteromedial aspect of ulna
| anterior surface of radius
129
where is the origin adn insertion of supinator?
lateral epicondyle, anular ligament, supinator crest on ulna
| radius just above pronator teres
130
which is more powerful, supination of pronation?
supination
131
what are the flexors and extensors of the wrist?
flexor carpi radialis, flexor carpi ulnaris, palmaris longus
| extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris
132
where does flexor carpi radialis originate and insert/
medial epicondyle-common flexor tendon
| passes throug ligamentous tunnel and inserts on base of 2nd and 3rd meacarpal
133
where does flexor carpi ulnaris originate and insert?
medial epicondyle-common flexor tendon, ulnar head from the ulnar
inserts on pisiform bone (and hook of hamate and 5th metacarpal) piso-hamate and piso-metacarpal ligaments transfer force of ulnar from pisiform
134
what other actions do flexor carpi radialis and ulnaris have?
radial and ulnar abduction
135
what is the origin and insertion palmaris longus?
medial epicondyle
between the other 2 flexors, can be absent
inserts into palmar aponeurosis
136
where does extensor carpi radialis longus originate, insert and other action?
supracondylar ridge on lateral side of humerus
base 2nd metacarpal
radial abduction
137
where does extensor carpi radialis brevis originate, insert and other action/
lateral epicondyle of humerus
base 3rd metacarpal
radial abduction
138
where does extensor carpi ulnaris originate, insert and other action?
lateral epicondyle and ulnar head from ulnar
base 5th metacarpal
ulnar abduction
139
describe the pathway of the superficial veins of the arm
converge below elbow to form basilic and cephalic veins
cephalic stays superficial over biceps, between deltpid and pec major
basilic runs up medial arm to join one of the bracial veins, 2 brachial veins joint o1 brachial vein, name changes to axillary
140
where is the antecubital vein?
crosses front of elbow, joining cephalic and basilic veins
141
describe the pathway of the axillar artery down the arm
emerges from pec minor, in arm is the brachial artery
gives off deep brachial branch which passes backward deep to triceps with raidal nerve
brachial artery runs down medial side of arm with brachialis muscle
passes beneath bicipital aponeurosis
divides into radial and ulnar
radial stays superficial and runs down between pronator teres and brachioradialis
ulnar is deeper to pronator teres
142
what does the musculocutantous nerve supply and then become?
corachobrachialis, biceps, brachialis
| lateral cutaneous nerve
143
what does the median nerve supply in the forearm?
nothing above elbow
| pronator teres, flexor carpi radialis, palmaris longus, pronator quadratys
144
what does the ulnar nerve supply?
nothing above elbow
| flexor carpi ulnaris
145
what does the radial nerve divide to and supply?
divides at lateral epicondyle to deep motor branch and superficial sensory
triceps, anconeus, brachioradialis, wrist extensors, supinator
146
what are the palmar and dorsal aspects of the hand?
front
| back
147
how many metacarpals does each finger have?
thumb=proximal and distal
| others=proximal, middle, distal
148
what is the joints between the carpals and metacarpals callde?
carpo-metacarpal joint
149
what is the joint between the proximal phalanges and metacarpals called?
metacarpo-phalangeal
150
are the CMC joints mobile?
5th is the most mobile, 2nd and 3rd hardly move
151
what is the deep transverse meacarpal ligament?
stops heads of metacarpals spreading
| continuous with palmar plate at each joint, not connected ti first metacarpal
152
describe the joint capsulse at the MP joint?
capsule loose on back, thicker on front into fibrocartilage (palmar plate)
153
in which direction do the collateral ligaments of the MP joints run?
obliquely, prevent ulnar and radial deviation when flexed
154
what actions occur at IP joints
flexions and extension
155
describe the collateral ligaments at the IP joints
equally tight in flexion and extension
156
what are the movements at the first CMC and why can these occur?
abduction, adduction, flexion, extension, opposition (abduction, flexion, medial rotation)
shape of joint surfaces
157
where are the sesamoid joints in the thumb?
MP joint
158
what is the flexor retinaculum and where does it attach?
tough fibrous tissue, forms roof of carpal tunnel
| attached to scaphoid and trapezium on radial side and pisiform and hook of hamate on ulnar side
159
what runs through the carpal tunnel
median nerve, flexor tendonds
160
what structures go rhtough the branches of the carpal tunnel
branches form 2 separate tunnels
on radial side: flexor carpi radialis
ulnar side: ulnar artery and nerve
161
where is the extensor retinaculum and what passes under it?
runs obliquely from ridge on radius to ulnar styloid, triquetrum and hamate
deep extensions attached to radius
all extensors pass under
162
where is the flexor tendon sheath?
starts proximal to MP joint and extends to distal phalanx
attached to palmar plate at joint
thumb has flexor tendon sheath for 1 flexor tendon
163
what forms the extensor mechaism?
4 muscles-extensor tendon, interosseus, lumbircal
164
what is the extensor hood?
connects the extensor tendon to interosseus membrane
165
describe the path of the extensor tendons
divide into 3 slips; central crosses proximal IP joint and inserts on base of middle phalanx
on either side fuse with interosseus tendon to form lateral bands, join together on middle phalanx and insert on base distal phalanx
thumb has 2 extensor tendons
166
where is the palmar fascia?
triangular, covers middle part of palm
continuous with flexor retinaculum and tendon palmaris longus proximally,
distally it separates into slips which insert on the edges of the palmar plates of the MP joints
167
where does flexor digitorum profundus originate and insert?
deep
anterior and medial surface of ulna and inerosseus membrance
4 tendons enter carpal tunnel
insert on base distal phalanx
168
what are the action sof flexor digitorum profundus?
flex IPs and MP
169
where do the lumbicals arise from?
4 of them
| flexor digitorum profundus tendons
170
where does flexor digitorum superficialis originate?
on top of profuncus
2 heads of origin: radial=oblique line on radius
humero-ulnar=part of common flexor tendon from medial epicondyle
171
where does flexor digitorum superficialis insert?
4 tendons enter carpal tunnel
| splits in 2 halves over proximal phalanx, pass around profundus tnedon and unite and insert on middle phalanx
172
what are the actions of flexor digitorum superficialis?
flex proximal IPs and MP
173
where does extensor digitorum originate and insert?
common extensor tendon (lateral epicondyle of humerus)
| divides into 4 slips which go under extensor retinaculum and insert on middle and distal phalanges of digits 2-5
174
where does extensor digiti minimi originate and insert?
ulnar side extensor digitorum
passes under retinaculum alone
joins extensor digitorum tendon
175
where does extensor indices originate and insert?
deep to digitorum
ulna and interosseus membrance
tendon pass under retinaculum with extensor digitorum
joins extensor digitosum at MP
176
where does flexor pollicis longus originate and insert?
anterior surface of radius and interosseus membrane
tendon passes through carpal tunnel
enters flexor sheath and inserts on base distal phalanc
177
what is the action of flexor pollicis longus?
flex MP and IP of thumb
178
where does abductor pollicis longus originate and insert?
posterior surface of radius and ulnar, interosseus membrance
tendon passes beneath extensor retinaculum alone
base of 1st metacarpal
179
what are the actions on abductor pollicis longus?
abduction and extension CMC joint
180
where does extensor pollicis longus originate and insert?
posterior surface of ulna and interosseus membrance
tenson passes beneath extensor retinaculum
base of distal phalanx
181
what is the action of extensor pollicis longus?
extends MP and IP of thumb
182
where is the origina and insertion extensor pollicis brevis?
posterior surface of radius and interosseus membrance
tendon passes beneath extensor retinaculum
base of proximal phalanx
183
what is the action of extensor pollicis brevis?
extends MP joint thumb
184
how many interosseus mucles are there/
7
1 for each side of middle, index and ring fingers
1 for radial side of little finger
4 dorsal and 3 palmar
185
where do the interosseus muscles originate and insert?
shaft metacarpal
pass deep to transverse metacarpal ligament
either side MP narrows to a double tendon, short inserts on base of proximal phalanx, long joins extensor mechanism
186
what are the actions of the interosseus muscles?
when contract together: flex MP joint and extend IP joints
just 1: ulnar or radial deviation MP joint
first dorsal interosseus: powerful radial deviation index finger, key pinch muscle
187
what is special about the interosseus on the radial side of the index finger?
large=first dorsal interosseus
| 2 heads origin: 1st and 2nd metacarpals
188
how many lumbricals are ther?
4, 1 for each finger
189
where doe the lumbricals originate and insert?
side of flexor digitorum profundus
pass in front of deep transverse metacapral ligament
radial side extensor mechanism
190
what are the actions of the lumbircals?
re inforces interossei extending IP, also radial deviation MP
191
what is the origina and insertion and action of adductor pollicis/
transverse=3rd metacarpal, oblique=capitate and 2nd metacarpal
ulnar sesamoid bone and proximal phalanx
key pinch muscle
192
what is the thenar eminance?
thenar muscles: flexor pollicis brevis, abductor pollicis brevis, opponens pollicis
193
where is the origina and insertion of flexor pollicis brevis?
flexor retinaculum and trapezoid
| base proximal phalanx of thumb on radial side
194
where is the origina and insertion of abductor pollicis brevis
trapezium, scaphoid tubercles and flexor retinaculum
| base of proximal phalanx of thumb on radial side
195
where is the origina and insertion of opponens pollicis?
deep
trapezium and flexor retinaculum
radial side 1st metacarpal
196
what is the hypothenar eminence?
hypothenar muscles: abductor digiti minimi, flexor digiti minimi, opponens digiti minimi
197
what is the origina nd insertion of abductor digiti minimi?
pisiform
| base and extensor mechanism
198
where is the origina and insertion of flexor digiti minimi?
hamate and flexor retinaculum
| proximal phalanx
199
where is the origin and insertion of opponens digiti minimi?
hook of hamate
| ulnar sude 5th metacarpal
200
what do the small veins on the dorsal aspect of the hand form?
dorsal veins, all unite to cephalic
201
what do the veins on the flexor aspect of the hand and arm unite to form
basilic vein
202
describe the path of the radial artery from the wrist?
at wrist givs of superficial branch then spirals laterall, passes between 2 heads of first dorsal interosseus to give off branches to thumb, enters palm
203
what is the deep palmar arch?
radial artery anastomoses with branches of ulnar
204
describe the path of the ulnar artery?
deeper. gives off common interosseus artery beneath pronator teres, passes through tunnel in side of flexor retinaculum to reach hand
divides into a large superficial and smaller deep branch
ends by anastomising with superficial radial artery forming superficial palmar arch which gives off common digital arteries which each divide in 2 to run along either side of finger with digital nerve and rejoin at tip to form terminal anastomosis
205
what does the superficial radial nerve branch supply?
sensory-radial half of back of hand, back of thumb and 1st 2 fingers
206
what is the deep branch of the radial nerve and what does it supply/
posterior interosseus nerve
extensor carpi ulnaris, extensor digitorum and other 2 extensors, abductor pollicis longus, extensor pollicis longus and brevis
207
what does the median nerve supple?
passes through carpal tunne
small motor branch: thenar muscles, common digital nerves
sensation: medial half of palm, flexor aspect of thumb, index and middle fingers, radial side ring finger
flexor digitorum superficialis, flexor pollicis longus, raidal half flexor digitorum profundus, thenar muscle,s medial 2 lumbricals
208
what does the ulnar nerve supply in the hand?
dorsal sensory branch to back of hand
superficial: palmar digital for little finger and ulnar side ring finger
deep branch: sensation=ulnar half of back and fron tof hands, little finger, ulnar half of ring finger. half of flexor digitorum profundus, hypothenar muscles, interossei, adductor pollicis, ulnar ulbricals
209
how can you palpate the greater tubercle of the humerus?
internally adn externally rotate arm, place fingers in groove inferolateral below arch of acromion
210
where is the lesser tuberosity of the humerus?
more proximal, medial and inferior to greater tubercle, lateral to coracoid process
211
where is the coracoid process palpated?
need to be firm, 1cm below clavicle
212
which epicondyle of the humerus id more prominent?
medial
213
where is the olecranon process of the ulna palpated?
bony eminence on elbow
214
where can the styloid process of the ulna be palpated?
medial above crease line
215
where can the head of the radius be palpated?
pinch lateral forearm and supinate and pronate
216
how can extensor carpi radialis longus and brevis be palpated?
lateral and posterior to brachioradialis
| abduct wrist to engage
217
where can extensor carpi ulnaris be palpted?
along ulna shaft, ask to adduct wrist
218
where can extensor digitorum be palpated?
between radialus and ulnaris, ask to mime typing
219
where do the wrist and finger extensors lie?
between shaft of ulna and brachioradialis
220
what are the layers of wrist anf finger flexors?
superficial=flexor carpi radialis and ulnaris, palmaris longus
middle=flexor digitorum superficialis
deep=flexor digitorum profundus
221
what is the tendon in the middle of the wrist when you flex like you are holding a ball?
palmaris longus
222
how can the tendons of flexor carpi radialis and ulnaris be seen?
radialis: abduct wrist, close to palmaris
ulnaris: adduct wrist, right on ulnar side
223
how can you feel the deep wrist flexors?
ask to mime typing slowly
224
how do your palpate subscapularis?
flex shoulders whilst supine, find lateral border of scapula, press on subscapular fossa
225
how can infraspinatous be palpated?
lie on front, fins spine of scapular and move inferior and palpate the greater tubercle
find medial border of scapula and palpate up to greater tubercle and lateral border and palpate up to greater tubercle
ask to pusch arm up against resistance
226
how can teres minor be palpated
find lateral border of scapula and move to upper half
externally rotate (move hand to head) to contract
move up and across to greater tubercle of humerus
227
how can supraspinatus be palpated?
find spine of scapula and move superior to supraspinous fossa, palpate an dmove across to acromion and greater tubercle of humerus
abduct against resistance
228
how can deltoid be palpated?
have seated
to engage: abduct against resistance, flexion engages anterior fibres, extension engages posterior
fins spine of scapula dna acromion and lateral 1/3 clavicle (origins)
deltoid tuberosity (halfway between shoulder and elbow)
deltopectoral groove@ between deltoid and pec major
229
how can brachioradialis be palpated?
superficial on lateral side of forearm, divides dlexor and extensors of wrist and hand
to engage: make fist and flexion of elbow against resistance
230
how can brachialis be palpated?
deep to biceps, lateral edge is palpable
| to engage: pronate and flex
231
how can biceps brachii be palpated?
superficial on anterior arm
seated or supine
engage by flexing against resistance or with a weight
232
how can pec major be palpated?
superficial
clavicular, sternal and costal fibres
adduct shoulder to engage
bony landmarks: medial clavicle, sternum. follow laterally to crest of greater tubercle of humerus
thinner as move medially
if breast tissue may have to ask to move out the way
233
how can pec minor be palpated?
palpate lateral clavicle and move down to coracoid process, from here there are 3 slips going under each of the ribs
is under pec major]
to engage: downward rotation of scapula (hand on back, lift posteriorly away from body)
234
how can trapezius be palpated?
superficial on upper back and neck
have lying on front
bony landmarks: superior nuchal line (in line with top of ears), spine of scapula, lateral 1/3 clavicle. C7-T12 (C7 at base of neck and prominent)
extend neck to feel upper fibres
raise elbow off table (horizontally abduct)=middle fibres
bring arm straigh in front (superman)=lower fibres
to shorten upper fibres elevate scapula, to shorten lower depress
235
how can levator scapulae be palpated?
inferior portion deep to trapezius, becomes superficial
belly 2 fingers wide
to engage:elevate scapula
bony landmarks: superior angle of scapula
236
how can latissimus dorsi be palpated?
broad ans superficial,
scoop lateral edge
medially rotate shoulder
in supine: hold arm up straight
237
how can teres major be palpated?
small and superficial, find lateral border of scapula
medially rotate shoulder when lying on front
in supine@ hold arm up straight
238
how can rhomboid major an dminor be palpated?
between scapula and vertebral column
deep to reapezius, superficial to erector spinae
major is bigger
bony landmarks: medial border of scapula, C7 to T5
to engage: place hand in small of back and lift elbow (adduct scapula)
239
how can serratus anterior be palpated?
posterior and lateral ribcage
not fully accessible
oblique fibres
portion below armpit accessible (mostly deep to scapula, latissimus dorsi, pec major)
to engage: lift arm and press hand toward ceiling against resistance
240
how do you palpate all the carpal bones?
trapezium: at base of thumb
scaphoid: proximal from trapezium
capitate: on dorsal hand go down from middle finger to dip=capitate
lunate: proximal from capitate, move from capitate to lump after the dip=lunate
trapezoid: "trapped" between capitatr and trapezium
hamate: hook in hypothenar eminence (press hard)
triquitrium: base of little finger
pisiform: on top of triquitrium (so on other side of hand)
241
where is the cubital fossa?
anterior elbow
242
what borders the cubital fossa?
superior border: horizontal line between epicondyles of humerus
lateral border: medial border brachioradialis
medial border: lateral border pronator teres
roof: bicipital aponeurosis, fascia, subcut fat and skin
floor: brachialis (proximal), supinator (distal)
243
what are the contents of the cubital fossa?
roof: superficial veins-median cubital vein
lateral->medial
radial nerve: along lateral border, divides into superficial and deep
biceps tendon: passes through centrally and attaches to radial tuberosity
brachial artery: bifurcates into radial and ulnar at apex
median nerve: exits by passing through 2 heads of pronator teres
