Surface anatomy of the upper limbs

Question 1

Describe the clavicle

Answer 1

• Medial 1/3 convex
• Middle 1/3 begins to curve backwards
  
  • Trunks of the brachial plexus lie in the supraclavicular notch posterior to this part.
• Lateral 1/3 is flattened with a concave anterior border

Question 2

What is below the anterior border of the lateral 1/3 of the clavicle?

Answer 2

The infraclavicular fossa and coracoid process of the scapula

Question 3

Where in terms of surface anatomy is the coracoid process of the scapula?

Answer 3

3cm below the juction of the middle and lateral thirds of the clavicle

Question 4

What ends the clavicle at the lateral part?

Answer 4

Acromioclavicular joint

Question 5

What happens to the clavicle when raising the upper limb?

Answer 5

• The lateral end of the clavicle elevates
• As the upper limb is fully raised the whole clavicle rotates backwards so that the normal anterior surface of the clavicle faces more superiorly.

Question 6

Where is the medial border of the scapule?

Answer 6

Approximately 5cm lateral to the spines of T2-T8 vertebrae

(It is hard to palpate the actual border due to attachment of rhomboids etc.)

Question 7

Where is the inferior angle of the scapula?

Answer 7

Normally overlies the posterolateral parts of the 7th/8th ribs - can be easily palpated.

Question 8

Why can’t the superior angle of the scapula not be easily palpated?

Answer 8

Because of the muscle mass of the superficial muscle layer of the back

Question 9

Why can’t the lateral border of the scapula not be easily palpated?

Answer 9

Because it is usually hidden under muscles, for example, teres major

Question 10

What happens to the inferior angle of the scapula with raising of the upper limb? Why?

Answer 10

• It elevates
• Without this movement, the head of the humerus comes into contact with the acromion process of the scapula as the limb raises, making it impossible to bring the limb above shoulder height.

Question 11

When reaching the upper limb out in front, what happens to the medial border of the scapula?

Answer 11

The medial border moves forwards - this is protraction.

Question 12

Why is the greater tubercle of the humerus difficult to palpate?

Answer 12

Because it is usually covered by deltoid

Question 13

Which muscle group originates from the lateral epicondyle of the humerus?

Answer 13

The extensor muscles

Question 14

Which muscle inserts onto the olecranon process?

Answer 14

Triceps brachii

Question 15

Which structure lies in the intertubercular groove of the humerus?

Answer 15

The tendon of the long head of the biceps

Question 16

Where is the medial epicondyle of the humerus?

Answer 16

Lies approximately 2cm above the elbow joint and 1cm below the level of the lateral epicondyle

Question 17

Which muscle group originates from the medial epicondyle of the humerus?

Answer 17

The Forearm flexor mucles

Question 18

There is a deep, bony groove on the posterior surface of the medial epicondyle of the humerus, carrying a cord-like structure. Which structure is this?

Answer 18

Ulnar nerve

Question 19

Where is the coronoid process of the ulna?

Answer 19

Anteromedial to the medial epicondyle

Question 20

How do you palpate the hook of the hammate?

Answer 20

• Place your fingers on either side of the pissiform bone
• Then move your fingers 1cm distal and slightly lateral to the pissiform and apply some moderate pressure.
• 2 small branches of the ulnar nerve pass close to this bony landmark.

Question 21

Where is the radial styloid process located?

What else is located here?

Answer 21

Within the anatomical snuff box

Scaphoid and trapezium

The first metacarpal may also be palpated in the floor of the anatomical snuff box

Question 22

Where can the proximal end of the thenar eminence be palpated?

Answer 22

1cm medial to the tip of the radial styloid process

Question 23

What can be palpated 1cm distal to the tubercle of the scaphoid bone?

Answer 23

The trapezium

Question 24

What type of joint is the first carpo-metacarpal joint?

Answer 24

Synovial saddle joint

Question 25

Where does the dorsal tubercle of the radius lie?

Answer 25

Just above the level of the styloid process

Question 26

Where does the trapezoid lie?

Answer 26

At the base of the 2nd metacarpal

Question 27

Where does the capitate lie?

Answer 27

At the base of the 3rd metacarpal

Question 28

Where does the hammate lie?

Answer 28

At the base of the 4th and 5th metacarpals

Question 29

Where, if you have the palmaris longus muscle, would its tendon appear upon clenching of fist and flexion of wrist?

Answer 29

Just medial to the tendon of flexor carpi radialis

Question 30

Which structures form the boundaries of the anatomical snuff box?

Answer 30

Tendons of abductor pollicis longus, extensor pollicis brevis (lateral) and extensor pollicis longus (medial).

Question 31

Why would you not palpate a pulse point with the thumb?

Answer 31

Due to the presence of princeps pollicis pulse point so you feel your own pulse, not the one you wish to locate

Question 32

How do you palpate the axillary artery pulse?

Answer 32

Press upward and laterally to compress the axillary artery on the lateral wall of the axilla. You may also compress some of the cords of the brachial plexus as you do this

Question 33

How do you palpate the brachial artery?

Answer 33

Compress the brachial artery against the humerus on the medial side of the biceps tendon. The brachial artery is also palpable just prior to the bicipital aponeurosis on the cubital fossa. You may be able to feel the ulnar nerve (superior) and the median nerve (inferior) to the brachial artery when feeling a pulse in the arm.

Question 34

How do you palpate the radial artery?

Answer 34

Easy to palpate at the wrist. Place your fingertips on the lower border of the radius and the radial styloid process, and then move them 0.5cm medially. The radial pulse can be felt between the anterior border of the radius and the tendon of flexor carpi radialis. The radial artery can also be palpated against the lateral side of the scaphoid in the anatomical snuffbox, between the tendons of extensor pollicis longus (medial), extensor pollicis brevis and abductor pollicis longus (lateral).

Question 35

How do you palpate the ulnar artery?

Answer 35

It is not easy, but may be felt at the wrist, just lateral to the pisiform bone.

Question 36

Where do you palpate the princeps pollicis artery?

Answer 36

May be palpated in the cleft between the thumb and the index finger, on the anteromedial side of of the thumb.

Question 37

How do you palpate the trunks of the brachial plexus?

Answer 37

Can be felt above the medial part of the clavicle, close to the lateral border of sternocleidomastoid. This requires deep pressure to be applied. The median and ulnar nerves may be palpable in the lateral wall of the axilla when compressing the axillary artery.

Question 38

How do you palpate the radial nerve?

Answer 38

Can be rolled against the surface of the humerus halfway down the lateral side of the arm (below the insertion of deltoid and anterior to the lateral head of triceps brachii). The superficial branch of the radial nerve can also be palpated on the distal half of the lateral surface of the radius as it passes under brachioradialis and onto the dorsum of the hand.

Question 39

How do you palpate the ulnar nerve?

Answer 39

Passes behind the medial epicondyle of the humerus as it crosses over the medial collateral ligament of the elbow. It will then disappear under the firbous arch of flexor carpi ulnaris.

Question 40

Where does the ulnar nerve become superficial?

Answer 40

7cm above the wrist lateral to flexor carpi ulnaris, but it is not easy to palpate in this region.

Question 41

How do you palpate the median nerve?

Answer 41

Can be palpated between the tendons of flexor carpi radialis and flexor digitorum superficialis on the anterolateral aspect of the wrist. The median nerve may be covered by the palmaris longus tendon in some individuals.