Unit 2 - Upper limb Flashcards
What are the parts of the clavicle?
- shaft
- sternal end
- acromial end
- superior surface
- inferior surface with ligamentous attachment points
What ligaments attach to the clavicle?
- conoid ligament (medial part of coracoclavicular ligament)
- trapezoid ligament (lateral part of coracoclavicular ligament)
- costoclavicular ligament
Where does the conoid ligament attach on the clavicle?
-the conoid tubercle on the inferior side of the acromial end
Where does the trapezoid ligament attach on the clavicle?
-the trapezoid line on the inferior side of the acromial end
Where does the subclavius muscle attach on the clavicle?
subclavian groove in the middle of the inferior side of clavicle
What muscles attach to the clavicle?
- subclavius muscle (insertion)
- deltoid muscle (origin)
- trapezius muscle (insertion)
- pectoralis major muscle (origin)
- sternocleidomastoid muscle (origin)
- sternohyoid muscle (origin)
Where does the costoclavicular ligament attach on the clavicle?
- a rough, oval depression on the inferior sternal end
What are the parts of the scapula?
- spine
- body
- acromion
- supraspinous fossa
- infraspinous fossa
- glenoid fossa
- subscapular fossa
- coracoid process
What attaches to the spine of the clavicle?
- deltoid (origin)
- trapezius (insertion)
What bony projections surround the glenoid fossa?
- supraglenoid tubercle
- infraglenoid tubercle
What is the function of the glenoid fossa?
articulation with the humerus
AKA glenoid cavity
Where is the coracoid process located?
anterolateral portion of scapular body superior to the glenoid fossa
Where is the suprascapular notch?
the indentation on the superior border of scapular medial to the coracoid process
What is the spinoglenoid notch?
notch that connects supra and infraspinous fossae
What muscles insert on the medial border of the scapula?
Anteriorly -serratus anterior Posteriorly -rhomboid major -rhomboid minor -levator scapula
What muscle originate on the lateral border of the scapula?
- triceps brachii
- teres minor
- teres major
What muscle originates on the inferior angle of the scapula?
-lattisimus dorsi
What muscles attach to the coracoid process?
- pectoralis minor (insertion)
- coracobrachialis (origin)
- biceps brachii (origin)
What are the parts of the humerus?
- head
- anatomical neck
- greater (lateral) and lesser (anterior) tubercle separated by inter tubercular grooved
- surgical neck
- shaft
- medial and lateral epicondyle
- condyle
What are the landmarks on the shaft of the humerus?
Anterior:
-crests of greater and lesser tubercles, separated by inter tubercular sulcus
Lateral:
-deltoid tuberosity (in the middle of the shaft)
-lateral supracondylar ridge (distal part of shaft)
Posterior:
-radial groove
Medial:
-medial supracondylar ridge (distal part of shaft)
What are the parts of the Condyle of the humerus?
- capitulum (lateral)
- radial fossa (anteriolateral, just above capitulum)
- trochlea (medial)
- coronoid fossa (anteriomedial, just above trochlea)
- olecranon fossa (posterior)
What does the capitulum of the humerus articulate with?
head of radius
What does the trochlea of the humerus articulate with?
trochlear notch of the ulna
What does the coronoid fossa articulate with?
coronoid process of the ulna during flexion
What does the radial fossa articulate with?
head of the radius during flexion
What does the olecranon process articulate with?
olecranon of ulna during extension
Where is the ulna located in relation to the radius
medial
What are the parts of the Ulna?
- olecranon
- trochlear notch
- coronoid process
- radial notch
- tuberosity of ulna
- shaft
- head
- ulnar styloid process
What are the parts of the radius?
- head
- neck
- radial tuberosity
- shaft
- ulnar notch
- radial styloid process
- dorsal tubercle of radius
How many carpal bones are there and how are they arranged?
there are 8 carpal bones arranged in proximal and distal rows of four
What does the distal row of carpals articulate with?
the proximal row of carpals and metacarpals
What are the names of the proximal carpals, lateral to medial?
- scaphoid
- lunate
- triquetrum
- pisiform
What are the names of the distal carpals, lateral to medial?
- trapezium
- trapezoid
- capitate
- hamate
What are the parts of the metacarpal bones?
- head (distal)
- shaft
- base (proximal)
How are the metacarpals and phalanges named?
they are numbered 1-5 from lateral to medial
Which metacarpal is the thumb?
1st metacarpal
How any phalanges are in each digit?
3 (proximal, middle, distal), except the thumb has 2 (proximal and distal)
physiological joint between scapula and ribs?
scapular thoracic joint
The only joint between axial skeleton and upper limb?
sternoclavicular joint, AKA SC joint
Ligament that anchors inferior surface of sternal end of clavicle to the costal cartilage of 1st rib?
costoclavicular ligament
What ligaments reinforce the SC joint capsule?
- Anterior sternoclavicular ligament
- posterior sternoclavicular ligament
- interclavicular ligament (strengthens superiorly)
What kind of joint is the sternoclavicular joint?
synovial, ball and socket
What kind of joint is the acromioclavicular joint?
synovial, plane
Describe the joint capsule of the AC joint
separated by wedge-shaped articular disc to form a plane joint
Describe the joint capsule of the SC joint
Divided into two compartments by fibrocartilage articular disc which connects to anterior and posterior sternoclavicular ligaments and interclavicular ligaments that surround and reinforce the capsule. This makes this joint very strong
What ligaments reinforce the AC joint?
acromioclavicular ligament is the only one that reinforces it directly and does so superiorly. The AC joint is also reinforced by extrinsic ligaments.
What are the costocalvicular ligaments and their location?
-Trapezoid, more lateral
-Conoid, more medial
Both connect inferior surface of clavicle to coracoid process
What are the scapulohumeral/intrinsic shoulder muscles?
Muscles that attach scapula to humerus and act on the glenohumeral joint
- deltoid
- teres Major
- teres minor
- supraspinatus
- infraspinatus
- teres minor
- subscapularis
What are the rotator cuff muscles?
The SITS muscles that hold humerus in glenoid fossa by their tonicity
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis
What kind of joint is the glenohumeral joint?
synovial, ball and socket
The ring that surrounds the glenoid fossa, slightly deepening it?
glenoid labrum
What ligaments reinforce the glenohumeral joint?
- superior, middle and inferior glenohumeral ligaments (anteriorly and intrinsically)
- coracohumeral ligament (superiorly and intrinsically)
- coracoacromial ligament (superiorly and instrinsically)
- transverse humeral ligament (connects greater and lesser tubercle)
What tendons reinforce the glenohumeral joint?
- Supraspinatus tendon
- Infraspinatus tendon
- Teres minor tendon
- Subscapularis tendon
What is the function of the transverse humeral ligament?
connects greater and lesser tubercle over the humeral groove to hold synovial sheath and tendon of long head of biceps brachii m. in place
What fascia is continuous with deltoid fascia?
anteriorly, pectoral fascia and posteriorly, supraspinous fascia
What are the divisions of the deltoid?
unipennate (posterior and anterior)
multipennate (middle part)
What is the origin of the deltoid?
lateral 1/3 of clavicle, acromion and spine of scapula
What is the insertion of the deltoid?
deltoid tuberosity of the humerus
What innervates the deltoid muscles?
axillary nerve
What supplies blood to the deltoid muscles?
- anterior and posterior humeral circumflex arteries
- acromial and deltoid branches of thoracoacromial trunk of axillary artery
What is the origin of teres major muscles?
posterior surface of inferior angle of scapula
What is the insertion of teres major muscles?
medial lip of the inter tubercular groove of humerus
What innervates teres major muscles?
lower sub scapular nerve
What supples blood to teres major and teres minor muscles?
circumflex scapular artery
What is the origin of supraspinatus muscles?
supraspinous fossa of scapula
What is unique about supraspinatus among the SITS muscles?
it is the only one that does not rotate the humerus
What is the insertion of supraspinatus muscles?
superior facet of greater tubercle of humerus
What innervates supraspinatus and infraspinatus muscles?
suprascapular nerve
What supplies blood to the supraspinatus, infraspinatus and subscapularis muscles?
suprascapular artery
What muscles abduct the humerus?
supraspinatus does the first 15 degrees
deltoids do the 15-90 degrees
What is the origin of infraspinatus muscles?
infraspinous fossa of scapula
What is the insertion of the infraspinatus muscles?
middle facet of greater tubercle of humerus
What innervates teres minor muscles?
axillary nerve
What is the origin of teres minor muscles?
lateral border of the middle part of scapula
What is the insertion of teres minor muscles?
inferior facet of greater tubercle of humerus
What is the origin of subscapularis muscles?
subscapular fossa
What is the insertion of subscapularis muscles?
lesser tubercle of the humerus
What innervates subscapularis muscles?
upper and lower subscapular nerves
Where is the sub scapular artery located and what are its terminal branches?
in the third part of axillary artery, descending along lateral border of subscapularis muscle. It terminates as thoracodorsal artery and circumflex scapular artery
Where is the thoracoacromial trunk located and what are it’s branches?
on the 2nd part of the axillary artery, ascending to give off pectoral branch, acromial branch, clavicular branch and deltoid branch
Where is the suprascapular artery located and where does it go?
it branches superiorly from the thyrocervical trunk off the subclavian artery, passes superior to transverse scapular ligament to supraspinous fossa and through spinoglenoid notch to infraspinous fossa to join scapular anastomoses
Where is the dorsal scapular artery located and where does it go?
it branches superiorly from the subclavian artery (usually) and passes through the trunks of the brachial plexus to run along medial border of the scapula and join scapular anastomoses
Where is the circumflex scapular artery and where does it go?
it is one of the terminal branches of the sub scapular artery off of the 3rd part of the axillary artery. It curves around lateral border of scapula, through triangular space to join scapular anastomoses
Where is the anterior humeral circumflex artery and where does it go?
it branches superiorly from the 3rd part of the axillary artery and encircles surgical head of humerus anteriorly to anastomose with posterior humeral circumflex
-often shares trunk with posterior humeral circumflex and is the smaller of the two
Where is the posterior humeral circumflex artery and where does it go?
it branches superiorly from the 3rd part of the axillary artery and encircles surgical head of humerus posteriorly, through quadrangular space, to anastomose with anterior humeral circumflex
-often shares trunk with anterior humeral circumflex and is the larger of the two
Where does the superior thoracic artery come from?
it branches from the 1st part of the axillary artery, inferior to subclavius
What are the branches of the 2nd part of the axillary artery?
- thoracoacromial trunk with it’s 4 branches
- lateral thoracic artery
What are the branches of the 3rd part of the axillary artery?
- anterior humeral circumflex artery
- posterior humeral circumflex artery
- subscapular artery that branches to circumflex scapular artery and thoracodorsal artery
What arteries are involved in the scapular anastomoses
- Dorsal scapular
- Circumflex scapular
- Supra scapular
What are the distal branches that become the axillary vein and where does the transition occur?
brachial veins (venae comitantes) and basilic vein merge at the inferior border of teres major muscle
Where does the axillary vein end and what does it then become?
the lateral border of the 1st rib is where it becomes the subclavian vein
What are the branches of the lateral cord of the brachial plexus?
- lateral pectoral nerve
- musculocutaneous nerve
- lateral root of median nerve
What are the branches of the posterior cord of the brachial plexus?
- upper subscapular nerve
- lower subscapular nerve
- thoracodorsal nerve
- axillary nerve
- radial nerve
What are the branches of the medial cord of the brachial plexus?
- medial pectoral nerve
- medial brachial cutaneous nerve
- medial anti brachial cutaneous nerve
- medial root of median nerve
- ulnar nerve
What are the branches of the superior trunk of the brachial plexus?
- nerve to subclavius
- suprascapular nerve
What branches from the C5 root of the brachial plexus?
dorsal scapular nerve
What branches from C5-C7 root of the brachial plexus?
lateral thoracic
What type of joint is the humeroulnar joint?
synovial, hinge
What type of joint is the humeroradial joint?
synovial, ball and socket
What is articulating in the humeroulnar joint?
- in flexion, coronoid process of ulna and coronoid fossa of humerus
- in extension, olecranon of ulna and olecranon fossa of humerus
What ligaments reinforce the humeroulnar joint?
-ulnar collateral ligament (has 3 bands)
What are the 3 bands of the ulnar collateral ligament?
- anterior band from medial epicondyle to tubercle of coronoid process of ulna
- posterior band from medial epicondyle to trochlear notch
- inferior band which spans the medial trochlear notch
What is articulating in the humeroradial joint?
capitulum of humerus to head of radius
What ligaments reinforce the humeroradial joint?
- radial collateral ligament
- anular ligament
Where is the anular ligament?
encircling the radial head
Where is the radial collateral ligament?
fanning from lateral epicondyle to anular ligament
What are the bursa around the elbow joint?
subtendinous olecranon bursa
intratendinous olecranon bursa
subcutaneous olecranon bursa
Where is the subtendinous olecranon bursa?
between olecranon and triceps tendon
Where is the intratendinous olecranon bursa?
in triceps tendon, sometimes
Where is the subcutaneous olecranon bursa?
in subcutaneous tissue above olacrenon
Describe the brachial fascia
- continuous with deltoid, pectoral, axillary and infraspinous fascia superiorly and also continuous with ante brachial fascia inferiorly
- has medial and lateral inter muscular septa
- divides arm into anterior and posterior compartments
What are the muscles of the anterior compartment of the arm?
- biceps brachii
- brachialis
- coracobrachialis
What innervates all the muscles of the anterior compartment of the arm?
musculocutaneous nerve
What supplies blood to biceps brachii muscle and brachialis muscles?
brachial artery
What supplies blood to the coracobrachialis muscles
axillary and brachial arteries
What is the origin of the long head of biceps brachii muscle?
supraglenoid tubercle and glenoid labrum
What is the origin of the short head of biceps brachii muscle?
tip of coracoid process
What is the insertion fo biceps brachii muscle?
tuberosity of the radius and fascia of the forearm via bicipital aponeurosis
What is the actions for the biceps brachii?
flexion and supination of forearm
What is the origin of brachialis muscle?
distal 1/2 of anterior surface of humerus
What is the insertion of brachialis muscle?
coronoid process and tuberosity of ulna
What is the action of brachialis muscle?
flexion of forearm in all postions
Where is brachialis muscle located?
Deep to biceps brachii muscle
Where is coracobrachialis muscle located?
superomedially
What is the origin of coracobrachialis muscle?
tip of coracoid process
What is the insertion of the coracobrachialis muscle?
middle 1/3 of medial surface of humerus
What is the action of the coracobrachialis muscle?
flexion and adduction of the arm
What are the muscles of the posterior compartment of the arm?
-triceps brachii
What is the origin of the long head of triceps brachii muscle?
infraglenoid tubercle
What is the origin of the lateral head of triceps brachii muscle?
posterior surface of humerus superior to radial groove
What is the origin of the medial head of triceps brachii muscle?
posterior surface of humerus inferior to radial groove
What is the insertion of triceps brachii muscle?
proximal end of olacrenon and fascia or forearm
What are the actions of the triceps brachii muscle
forearm extension
long head also assist in adduction and extension of humerus
What supplies blood to triceps brachii muscle?
profunda brachii artery
What innervates the triceps brachii muscle?
radial nerve
Where is the anconeus muscle?
posterolateral aspect of elbow
What is the origin of anconeus muscle?
lateral epicondyle of humerus
What is the insertion of anconeus muscle?
lateral surface of olecranon and superior part of posterior surface of ulna
What is the action of anconeus muscle?
forearm extension
What innervates anconeus muscle?
radial nerve
Describe the scapulothoracic joint
it is a physiological joint representing movement between the anterior scapula and the posterior the thoracic wall. There is a bursa in this space. The movement is controlled by the actions of serratus anterior, trapezius, rhomboid major, rhomboid minor and levator scapula
