The Arm Flashcards
What are the upper limb reflexes and how can you test for them?
Biceps reflex (C5/C6) - inthe antecubital fossa, tap overlying the biceps tendon
Triceps reflex (C7) - place forearm rested at 90 degress flexion
Supinator reflex (C6) - located 4 inches proximal to the base of the thumb
What are the myotomes of the arm?
Elbow flexors/Biceps - C5
Wrist extensors - C6
Elbow extensors Triceps - C7
Long finger flexors - C8
Small finger abductors - T1
What would be the clinical findings in the C4 nerve root compression?
Sensory deficit
- lateral neck and shoulder
Muscle weakness
- scapula
Reflex changes
- none
What would be the clinical findings in a C5 nerve root compression>
Sensory deficit
- upper lateral arm and elbow
Muscle weakness
- Deltoid and biceps
Reflex changes
- bicepsWha
What would be the clinical findings in a C6 nerve root compression?>
Sensory deficit
- lateral forearm and thumb and index finger
Muscle weakness
- biceps and wrist extensors
Reflex changes
- brachioradialis
What would be the clinical features of a C7 nerve root compression>
Sensory deficit
- middle finger
muscle weakness
- triceps
- wrist flexors
- long finger extension
reflex changes
- triceps
What would be the clinical findings in a C8 nerve root compression?
Sensory deficit
- little and ring finger
- ulnar border of the palm
- medial forearm
Muscle weakness
- finger flexors
Reflex changes
- none
What would be the clinical features of T1 nerve root compression?
Sensory deficit
- medial arm
muscle weakness
- dorsal interossei
- abductor digiti minimi
Reflex changes
- none
Where is the intertubercular groove on the humerus and what runs in it?
The anterior aspect of the proximal end of the humerus
Long head of biceps tendon runs through it
Where do the humerus, radius and ulna articulate with each other?
- Capitulum of the humerus and radial head
- Trochlea of the humerus and the trochlear notch of the ulna
- Olecranon of the ulna and the olecranon fossa of the humerus
Which muscle flex the elbow joint?
Biceps
Brachialis
Brachioradialis
Pronator teres
Flexor carpi radialis
Which structure pass through the spiral groove?
Radial nerve
Profunda brachii vessels
What clinical picture would be the result of a radial nerve injury at the spiral groove?
Paralysis of the wrist extensors - wrist drop
Paralysis of finger extensors - finger drop
- Loss of sensation of the 1st web space
What injuries are associated with a supracondylar fracture of the humerus?
- Brachial artery injury
- Anterior interosseous nerve injury (unable to flex the interphalangeal joint of the thumb and DIP of index finger)
- Ulnar nerve injury (claw hand)
- Radial nerve injury (wrist drop and finger drop)
What is the origin of the coracobrachialis muscle?
Coracoid
Where is the insertion of the coracobrachialis muscle?
Mid-humerus (medial)WH
What is the action of the coracobrachialis muscle?
Flexion and adduction of the arm
What is the innervation of the coracobrachialis muscle?
Musculocutaneous
What is the origin of the biceps brachii?
Coracoid (short head)
Supraglenoid (long head)
Where does the biceps brachii insert?
Radial tuberosity
Relations of the bicipital tendon
- medial, the median nerve and brachial artery
- lateral, the radial nerve
What is the action of the biceps brachii?
Supination and flexion
What is the innervation of the biceps brachii?
Musculocutaneous
Where is the origin of the brachialis muscle?
Anterior humerus
Where does the brachialis muscle insert?
Ulnar tuberosity (anterior)Wh
What is the action of the brachialis muscle?
Flexing the forearm
What is the innervation of the brachialis muscle?
Musculocutaneous
Radial
What is the origin of the triceps brachii?
Infraglenoid (long head)
Posterior humerus (lateral head)
Posterior humerus (medial nerve)
Radial nerve and profunda brachii vessels lie between the medial and lateral heads
Where does the triceps brachii insert?
The olecranon
What is the action of the triceps brachii?
Extending the forearm (elbow extension)
The long head can adduct the humerus and extend it from a flexed position
What is the innervation of the triceps brachii?
Radial nerve
What is the blood supply of the triceps brachii?
Profunda brachii artery
What muscles make up the superficial flexors of the forearm?
Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris
Flexor digitorum superficialis
What is the origin, insertion, action and innervation of pronator teres?
Origin - medial epicondyle and coronoid
Insertion - mid-lateral radius
Action - pronating, flexing the forearm
Innervation - median nerve
What is the origin, insertion, action and innervation of flexor carpi radialis?
Origin - medial epicondyle
insertion - 2nd and 3rd MC bases
Action - flexing the wrist
Innervation - median nerve
What are the origin, insertion, action and innervation of palmaris longus|?
Origin - medial epicondyle
Insertion - palmar aponeurosis
Action - flexing the wrist
Innervation - median nerve
What are the origins, insertion, actions and innervation of flexor carpi ulnaris?
Origin - medial epicondyle and posterior ulna
Insertion - pisiform
Action 0 flexing wrist
Innervation - ulnar nerve
What are the origins, insertions, actions and innervation of flexor digitorum superficialis?
Origin - medial epicondyle, proximal anterior ulna and anterior radius
insertion - base of middle phalanges
Action - flexing PIP joints
Innervation - median nerve
What muscles make up the deep flexors of the forearm?
Flexor digitorum profundus
Flexor pollicis longus
Pronator quadratus
What are the origins, insertion, action and innervation of flexor digitorum profundus?
Origin - anterior and medial ulna
Insertion - base of the distal phalanges
Actions - flexing of the DIP joints
Innervation - median -anterior interosseous/ulnar nerves
What are the origins, insertions, actions and innervation of flexor pollicis longus?
Origin - anterior and lateral radius
Insertion - base of distal phalanges
action - flexing IP joint of the thumb
Innervation - median- anterior interosseous nerve
What are the origins, insertion action and innervations of pronator quadratus?
Origin - distal ulna
Insertion - volar radius
Action - pronating hand
Innervation - median-anterior interosseous nerve
What muscles make up the superficial extensors of the forearm?
Brachioradialis
Extensor carpi radialis longus
Extensor carpi radialis brevis
Anconeus
Extensor digitorum
Extensor digiti minimi
Extensor carpi ulnaris
What are the origins, insertion, actions and innervation of brachioradialis
Origin - lateral supracondylar humerus
Insertion - lateral distal radius
Action - flexing forearm
Innervation- radial nerve
What are the origins, insertion, actions and innervation of Extensor carpi radialis longus?
Origin - lateral supracondylar humerus
Insertion- second metacarpal base
Action- extending wrist
Innervation - Radial nerve
What are the origins, insertion, actions and innervation of extensor carpi radialis brevis?
Origin - lateral epicondyle of humerus
Insertion - third base of metacarpal
Action- extending wrist
Innervation - Radial nerve
What are the origins, insertion, actions and innervation of anconeus?
Origin - lateral epicondyle of humerus
Insertion - Proximal dorsal ulna
Action - extending forearm
Innervation - Radial nerve
What are the origins, insertion, actions and innervation of extensor digitorum?
Origin - Lateral epicondyle of the humerus
Insertion - Extensor aponeurosis
Action - extending the digits
Innervation - Radial-posterior interosseous nerve
What are the origins, insertion, actions and innervation of extensor digiti minimi
Origin - common extensor tendon
Insertion - Small finger extension expansion over P1
Action - Extending small finger
Innervation - Radial-posterior interosseous nerve
What are the origins, insertion, actions and innervation of extensor carpi ulnaris
Origin - lateral epicondyle of humerus
Insertion - Fifth metacarpal base
Action - extending/adducting hand
Innervation - Radial posterior interosseous nerve
What muscles make up the deep extensors of the forearm
Supinator
Abductor pollicis longus
Extensor pollicis brevis
Extensor pollicis longus
Extensor indicis proprius
What are the origins, insertion, actions and innervation of supinator
Origin - lateral epicondyle of humerus
Insertion - dorsolateral radius
Action - Supinating forearm
Innervation - Radial-posterior interosseous nerve
What are the origins, insertion, actions and innervation of Abductor pollicis longus
Origin - Dorsal ulna/radius
Insertion - First metacarpal base
Action - Aducting/extending the thumb
Innervation - Radial-posterior interosseous nerve
What are the origins, insertion, actions and innervation of extensor pollicis brevis
Origin - Dorsal radius
Insertion - Thumb proximal phalanx base
Action - Extending thumb MCP joint
Innervation - Radial-posterior interosseous nerve
What are the origins, insertion, actions and innervation of extensor pollicis longus
Origin - Dorsolateral ulna
Insertion - Thumb dorsal phalanx base
Action - extending thumb at IP joint
Innervation - Radial posterior interosseous nerve
What are the origins, insertion, actions and innervation of extensor indicis proprius
Origin - Dorsolateral ulna
Insertion - Index finger extensor apparatus (ulnarly)
Action - extending the index finger
Innervation - Radial posterior interosseous nerve
What are the boundaries of the cubital fossa?
Superolateral - brachioradialis muscle
Medially - pronator teres
Floor - brachialis
What are the contents of the cubital fossa?
Medial to lateral
- Median nerve
- Brachial artery
- Biceps tendon
What sensory distribution of the median nerve?
Lateral 2/3 of the palm of the head
Lateral 3 1/2 digits on the palmar side
Dorsum of the tips of the index, middle and thumb
What is the median nerve motor distribution in the hand?
LOAF
Lateral 2 lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
What is the clinical picture of a medial nerve injury at the elbow?
Ape like hand
- hyperextended thumb (paralysis of FPB)
- Adducted thumb (paralysis of abductor pollicis brevis)
- Flat thenar eminence
- Loss of sensation from - lateral 2/3 of palm of hand
lateral 3 1/2 digits (palmar and distal dorsal aspect)
What is the clinical picture of an ulnar nerve injury at the wrist
Complete claw hand
- Clawing of the 4th and 5th digits (paralysis of the medial lumbricals and interossei)
- loss of sensation of the medial 1/3 of palmar and dorsal aspects of hand and fingers
What is the cause of the ulnar paradox?
In proximal ulnar nerve injuries, there will be paralysis of the medial 1/2 of the FDP which will decrease flexion of the IP joints
How is the superficial palmar arch formed?
Formed mainly by the arch of the superficial division of the ulnar artery and is completed by the superficial palmar branch of the radial artery
Name the carpal bones
Scaphoid
Lunate
Triquetrum
Pisiform
Trapezium
Trapezoid
Capitate
Hamate
Scared Lovers Try Positions That They Cant Handle
What is the blood supply of the scaphoid bone?
Receives its blood supply primarily from lateral and distal branches of the radial artery, via palmar and dorsal branches. These provide an abundant supply to the middle and distal bone, but neglects the proximal portion, which relies on retrograde flow
How do you test the ulnar artery supply
Allen’s test
What is the clinical application of Lister’s tubercle
Tubercle on the dorsal radius
Lighthouse of the wrist - EPL tendon runs around it.
It serves as a pulley for the tendon of the EPL which wraps around the medial side and take a 45 degree turn
What are the attachments for the flexor retinaculum
Proximal
- pisiform
- tubercle of scaphoid
Distal
- hook of hamate
- trapezium
What structures pass through the carpal tunnel?
4 tendons of flexor digitorum superficialis
4 tendons of flexor digitorum profundus
1 tendon of flexor pollicis longus
1 tendon of flexor carpi radialis
median nerve
How do you test Flexor digitorum superficialis?
Hold adjacent digits in extension, in order to eliminate FDP motion in adjacent fingers, which otherwise might give the impression of FDS motion in the examined finger
Where do they FDS and FDP tendons insert?
FDS - split tendon on both sides of the middle phalanx
FDP: Passes through the split tendon of FDS to be inserted into the terminal phalanx
Which tendon attaches to the pisiform?
Flexor carpi ulnaris
What attaches the extensor tendons to the phalanges?
Extensor expansion
What is the function of the intertendinous connections?
Create space between extensor tendons
Redistributes force between tendons
Coordinates extension of fingers
Stabilise MCP joints
What are the origins, insertion, actions and innervation of first interosseous
Origin - from the first metacarpal
Insertion - into the lateral side of extensor expansion of the index finger
Actin - abduction of index finger
Innervation - deep branch of ulnar nerve
What are the boundaries of the anatomical snuff box?
Posterior border - extensor pollicis longus tendon
Anterir border - Extensor pollicis brevis tendon
Abductor pollicis longus tendn
Proximal border - styloid process of the radius
Distal border - Apex of the snuffbox triangle
Floor - Trapezium and scaphoid
Content - radial artery
