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Limbs anatomy > The shoulder and arms > Flashcards

The shoulder and arms Flashcards

1
Q

what does the radial nerve innervate?

A

posterior arm muscles

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2
Q

what does the musculocutaneous nerve innervate?

A

anterior arm muscles

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3
Q

what does the axillary nerve innervate?

A

deltoid, teres minor

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4
Q

what does the thoracodorsal nerve innervate?

A

latissimus dorsi

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5
Q

what does the long thoracic nerve innervate?

A

serratus anterior

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6
Q

what do the lateral and medial pectoral nerves innervate

A

pectoralis major/minor

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7
Q

what do the suprascapualr and subscapular nerves innervate?

A

rotator cuff

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8
Q

what does the subclavian artery become?

A

subclavian –> axillary –> brachial artery

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9
Q

what are the branches of the brachial artery?

A
  • circumflexhumoral arteries

- deep branch (profunda brachii artery)

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10
Q

what are the 3 branches off the axillary artery?

A
  1. superior thoracic artery
  2. thoraco-acromial, lateral thoracic artery
  3. subscapular, anterior and posterior humoral circumflex arteries
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11
Q

what is the venae comitantes of the brachial artery?

A

these are a pair of veins that closely accompany an artery in such a way hat pulsations of the artery aid venous return

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12
Q

what is the delto-pectoral groove?

A

triangle:

  • clavicle superiorly
  • deltoid laterally
  • pectoralis major medially
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13
Q

what are the 3 articulations of the scapula?

A

glenohumoral joint
acromio-clavicular joint
scapulo-thoracic joint

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14
Q

describe the scapulo-thoracic joint

A

gliding phsiological joint with chest wall (via serratus anterior)

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15
Q

what are the spinal landmarks of the scapula?

A

superior angle - T2
medial end of scapula spine - T3
inferior angle - T7

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16
Q

describe the ossification of the clavicle

A
  • first long bone to ossify (5th week)

- intamembranous ossificiation not endochondral

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17
Q

describe the 2 ends of the clavicle

A

flat lateral end at acromion of scapula

circular sternal end at sternum/1st CC

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18
Q

what can be found on the distal end of the humerus?

A 
laterally = capitulum 
medially = trochlea
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19
Q

what can be found on the posterior aspect of the humerus?

A

olecranon

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20
Q

what are the points of articulations on the humerus?

A

glenoid cavity of scapula
capitulum (radius)
trochlea (ulnar)

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21
Q

describe the axillary nerve in relation to the humerus

A

winds around surgical neck of humerus

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22
Q

when can the axillary nerve be damaged?

A

in shoulder dislocation

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23
Q

describe the radial nerve in relation to humerus

A

runs in radial groove

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24
Q

what can damage the radial nerve?

A

humoral shaft fractures

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25
Q

describe the relation of the ulnar nerve to the humerus?

A

runs posterior to medial epicondyle

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26
Q

what can damage the ulnar nerve?

A

dislocations of elbow joint

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27
Q

describe the relation of the median nerve to the humerus

A

runs anterior to distal humerus

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28
Q

what can damage the median nerve?

A

supracondylar fractures of humerus

dislocations of elbow joint

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29
Q

what does the SCM do? Innervation?

A

turn head left/right against resistance

CN 11, C3, C4

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30
Q

what does the trapezius do? innervation?

A

raise both shoulders against resistance

CN 11, C3, C4

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31
Q

what does the pec major do? innervation?

A

adduct and abduct arm against resistance

lateral/medial pectoral nerve (C5-T1)

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32
Q

what does the serratus anterior do? innervation?

A

both arms outstretched with arms against wall and press firm

long thoracic nerve, C5, C6

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33
Q

what does the teres major do? innervation?

A

adduct arm against resistance

lower subscapular nerve, C5, C6

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34
Q

what does the latissimus dorsi do? innervation?

A

abduct arm to 90 degreees
adduct against resistance
thoraco-dorsal nerve, C6, C7, C8

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35
Q

what does the deltoid do? innervation?

A

abduct upper arm against resistance

axillary nerve, C5, C6

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36
Q

what movements does the scapulo-thoracic joint allow?

A
  • elevation
  • depression
  • protraction
  • retraction
  • rotation up
  • rotation down
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37
Q

which muscles are responsible for elevation at the scapulo-thoracic joint?

A
  • superior trapezius
  • levator scapulae
  • rhomboids
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38
Q

which muscles are responsible for depression at the scapulo-thoracic joint?

A
  • inferior trapezius
  • pectoralis minor
  • serratus anterior
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39
Q

which muscles are responsible for protraction at the scapulo-thoracic joint?

A
  • pec minor

- serratus anterior

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40
Q

which muscles are responsible for retraction at the scapulo-thoracic joint?

A
  • rhomboids
  • middle trapezius
  • latissimus dorsi
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41
Q

which muscles are responsible for rotation up at the scapulo-thoracic joint?

A
  • superior trapezius
  • inferior trapezius
  • serratus anterior
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42
Q

what movements does the shoulder joint allow?

A
  • flexion
  • extension
  • abduction
  • adduction
  • internal rotation
  • external rotation
43
Q

which muscles are responsible for flexion at the shoulder joint?

A
  • pec major

- deltoid

44
Q

which muscles are responsible for extension at the shoulder joint?

A

deltoid

45
Q

which muscles are responsible for abduction at the shoulder joint?

A

supraspinatus (inital 15 degrees)

deltoid after

46
Q

which muscles are responsible for adduction at the shoulder joint?

A

pec major

latissimus dorsi

47
Q

which muscles are responsible for internal rotation at the shoulder joint?

A

subscapularis

48
Q

which muscles are responsible for external rotation at the shoulder joint?

A

infraspinatus

49
Q

which movements does the elbow joint allow?

A
  • flexion

- extension

50
Q

which muscles are responsible for flexion at the elbow joint?

A
  • biceps
  • brachialis
  • brachioradialis
51
Q

which muscles are responsible for extension at the elbow joint?

A

triceps

52
Q

where can you palpate the trunks of the brachial plexus?

A

supraclavicular fossa

53
Q

where can you palpate the median nerve?

A

cubital fossa

medial to brachial artery

54
Q

where can you palpate the radial nerve?

A

cubital fossa

lateral to biceps tendon

55
Q

where can you palpate the ulnar nerve?

A

elbow

medial epicondyle

56
Q

where can you palpate the median nerve?

A

wrist

palmaris longus, FCR

57
Q

where can you palpate the ulnar nerve?

A

wrist

medial to ulnar pulse

58
Q

which nerves supply the anterior and posterior compartments of the arm?

A

radial nerve - post

median/ulnar - ant

59
Q

what nerve innervates the flexor-pronator compartment?

A

posterior interosseous nerve

60
Q

what nerves innervates the extensor-supinator compartment?

A
  • posterior interosseous nerve
  • radial artery
  • median nerve
  • ulnar nerve
61
Q

what is compartment syndrome?

A

inc. in pressure in facial compartment due to inflammatory response that can impinge vessels and nerves

62
Q

what is healing in compartment syndrome?

A

by fibrosis and contracture

63
Q

what are the signs and symptoms?

A

pain, pallor, cold, absent pulse and limited movement

64
Q

what is the treatment of compartment syndrome?

A

fasciotomy

65
Q

what is the cause of Erb’s palsy?

A

damage to C5, C6 during birth or motorcycle falls (abduction of head and neck)

66
Q

what are the muscles affected in Erb’s palsy?

A 
supra/infraspinatus
deltoid
biceps
brachialis
brachioradialis
supinator
wrist extensors
67
Q

what is the presentation of Erb’s palsy?

A

arm adducted, medially rotated, pronated forearm with flexed wrist
(Waiter’s tip position)

68
Q

what are the causes of Klumpke’s palsy?

A

damage to C8, t1 when arm pulled superior

birth trauma, breaking a fall by hanging on branch, violent abduction

69
Q

how do you locate the site of the lesion in Klumpke’s palsy?

A

test for elevation of scapula. if nerves to Levator scapulae and rhomboids are inracr, lesion is distal = GOOD prognosis
if pt has Horner’s syndrome (T1 symp damage), BAD. sympathetic component is proximal

70
Q

what are the muscles affected in Klumpke’s palsy?

A

FC ulnaris
FD profundus
lumbricals
all interossei

71
Q

what are the 3 types of Klumpke’s palsy?

A
  • ulnar claw hand
  • median nerve claw hand (Hand of Benediction)
  • true claw hand
72
Q

describe ulnar claw hand

A
  • clawing of 4th and 5th fingers at rest
  • thumb inability to adduct
  • difficulty in making a fist (MCP joints hyperextended, unopposed action of extensor digitorum)
  • sensory loss to ulnar side of forearm and hand
73
Q

describe median nerve claw hand

A

when trying to make a fist, 2nd and 3rd fingers fail to flex completely, thumb unable to oppose

74
Q

what muscles are involved in median nerve claw hand?

A 
FC profundus (radial)
lumbricals (radial)
75
Q

describe why people with median nerve claw hand struggle to make a fist

A

flexion of 2nd and 3rd digits incomplete at distal interphalangeal joints
MCP joints hyperextended due to unopposed action of extensor digitorum
thumb can’t oppose due to paralysis of opponens pollicis, FP brevis

76
Q

describe the fingers in the true claw hand

A

clawing present in all 4 fingers

thumb assuming abducted position

77
Q

what nerve damage is seen in true claw hand?

A

ulnar and median nerve damage

78
Q

what do the lumbrcials and interossei do?

A

cause flexion of MCP joints

79
Q

what do the extensor digitorum tendons cause?

A

extension of IP joints

80
Q

what would be seen with a radial nerve lesion?

A
  • UPPER ARM: triceps affected –> impaired extension
  • FOREARM: supinator and wrist extensors –> wrist drop
  • CUTANEOUS: dorsum of hand and lateral digits
81
Q

what would be seen with a musculocutaneous nerve lesion?

A
  • ELBOW JOINT: flexors affected

- CUTANEOUS: lateral side of forearm up to wrist

82
Q

what would be seen with a median nerve lesion?

A

FOREARM: wrist flexors –> wrist adducted
FOREARM: pronators affected –> forearm supine
DIGITS: flexion –> hand of benediction
THENAR muscles: paralysed
CUTANEOUS: sensory loss

83
Q

what would be seen with a ulnar nerve lesion?

A

FOREARM: carpi ulnaris, medial FD profundus paralysed
SMALL MUSCLES OF HAND: paralysed –> claw hand
CUTANEOUS: medial half palm and arm/forearm

84
Q

describe the generic pathway in reflex testing

A

tendon is tapped by hammer
muscle spindle stretches
stimulation to motor neuron
conveys impulse round and back to muscle to flex in response

85
Q

what nerve are you testing in the biceps reflex response?

A

musculocutaneous nerve (C5, C6)

86
Q

what nerve are you testing with the tricpes and brachioradialis supinator response?

A

radial nerve

87
Q

what is frozen shoulder? Cause?

A
  • pain and stiffness in shoulder, esp during external rotation
  • unknown cause, may be autoimmune
88
Q

what is the treatment of frozen shoulder?

A
  • pain (anti-inflammatories, systemic steroids)
  • stiffness (physiotherapy)
  • recovery (physiotherapy and arthroscopic surgery)
89
Q

what is shoulder impingement syndrome?

A

pain and weakness when abducting arm

90
Q

what are the causes of shoulder impingement syndrome?

A
  • bone spurs under acromion at top of sub-acromial space (catches tendon)
  • swelling or thickening of rotator cuff tendon
  • bursitis
  • Ca deposits in rotator cuff tendon
91
Q

what is tennis elbow?

A

injury to insertion of extensor tendons on lateral epicondyle of humerus

92
Q

what is the cause of tennis elbow?

A

sharp flexion of wrist whilst extensors are contracted

backhand of tennis ball

93
Q

what is the treatment of tennis elbow?

A

rest and steroids

94
Q

what is golfer’s elbow?

A

injury to insertion of flexor attachment on medial epicondyle of humerus

95
Q

what is the cause of golfer’s elbow?

A

sharp flexion of elbow

golfer hitting ground instead of ball

96
Q

what is the treatment of golfer’s elbow?

A

rest and steroids

97
Q

what is mallet finger?

A

avulsion of extensor digitorum longus tendon at base of distal phalanx

98
Q

what is Poacher’s thumb?

A

damage to medial collateral ligament of first MCP joint by violent abduction

99
Q

what causes trigger finger?

A

flexor profundus longus tendon causes friction to tendon sheath
gets swelling of tendon which irritates sheath and narrows sheath
when finger is flexed, it gets stuck in flexed position

100
Q

what causes Colle’s fracture?

A

falling on outstretched hand leading to fracture of distal radius and ulnar styloid

101
Q

what would you see with Colle’s fracture?

A

dorsal displacement and dorsal angulation on x-ray

proximal impaction and radial deviation

102
Q

what is osteoarthritis?

A

degenerative changes in cartilage affecting articular cartilage and periarticular bone

103
Q

what causes the pain, stiffness and discomfort?

A

narrowing of joint space in inter-phalangeal joint

104
Q

what is rheumatoid arthritis?

A

chronic inflammatory condition resulting in synovitis of peripheral joints

Limbs anatomy (7 decks)

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