Unit11: Proximal Upper Limb Flashcards
What are the key bones involved in attachment points in the upper arm?
Humerus
Scapula
What are the two groups of muscles in the upper arm?
Anterior/ventral
posterior/dorsal
What muscles are found in the anterior compartment of the arm?
Coracobrachialis
Brachialis
Biceps brachii
What muscles are found in the posterior compartment of the the upper arm?
Triceps brachii
Anconeus
What are the features of the biceps brachii?
Two heads - short medial and long lateral
Long head - originates from superglenoid tubercule of scapula
Short head - corcoid process of the scapula
Both heads merge distally into a single belly
Inserts onto radial tuberosity and the antebrachial fascia
What are the position features of the brachialis muscle?
Originates from distal lateral half of anterior humerus - particularly the medial an dlateral intermuscular septum
Inserts onto ulnar tuberosity and coronoid process
What is the anatomical location of the coracobrachialis muscle?
Originates from the coracoid process of the scapula
Inserts along anteromedial surface of humerus
What is the anatomical location of the triceps brachi muscle?
Three head
Long - infraglenoid tubercle of the scapula
Medial - posterior surface of humeris (distal to radial groove and medial intramuscular septum)
Lateral head -posterior surface of humerus (proximal to radial groove and latera intermuscular septum)
All tendons merge and insert via a common tendon onto the olecranon process of the ulna.
What is the anatomical location of the anoconeus muscle?
Originates from the lateral epicondyle of the humerus
Inserts on the proximal end of the ulnar.
What is the anatomical location of the deltoid muscle?
Most superficial in the shoulder
Three subdivisions:
Clavicualr part from lateral third of clavicle
Acromial part - from acromium of scapula
Scapula spine part - orginates from spine of scapula
What muscles are found deep to the deltoid?
Rotator cuff muscles (4)
- subscapularis
- infraspinatus
- teres minor
- supraspinatous
Teres major
What are the shared features of the rotator cuff muscles?
All have a shared insertion of the proximal end of the humerus
Maintain stability of the shoulder joint by keeping the head of the humerus within the glenoid cavity
What is the anatomical location of the subscapularis muscle?
Origin: anterior surface of scapula = the subscapular fossa
Inserts onto the lesser tubercle of the humerus
What is the anatomical location of the infraspinatus muscle?
Originates from the infraspinous fossa of the scapula (posterior surface)
Inserts onto the greater tubercule of the humerus
What is the anatomical location of the teres minor?
Originates from the infraspinous fossa and lateral border of the scapula
Inserts on the greater tubercle of the humerus
What is the anatomical location of the supraspinatous muscle?
Originates from the supraspinous fossa of the scapula
Inserts onto the greater tubercle of the humerus.
What are the four cuff rotator muscles?
- Subscapularis
- Infraspinatus
- Teres minor
- Supraspinatus
(SITS)
What is the anatomical location of the teres major muscle?
Origin of the inferior angle of the scapula
Inserts onto the crest of the lesser tubercule.
What are the three types of rotator cuff injury?
Tendinitis - overuse must common in tennis and patients
Bursitis - inflammation of bursae
Strains and tears - from overuse or acute trauma
How can we prevent rotator cuff injury?
Shoulder stretches - increase flexibility
Strengthen shoulder blade and posterior shoulder to ensure muscle balance.
What are the two main superficial veins in the arm?
The basilic vein
The cephalic vein
Describe the course of the basilic vein.
Continuation of the medial side of the dorsal venous arch on the dorsum of the hand
Continues up the medial surface of the posterior forearm until halfway up the forearm, then loops to the anterior surface (medial edge) of the forearm, passes medial through the cubital fossa, continues up the arm.
Pierces the deep fascia and merges with the brachial vein just inferior to teres major then continues as the axillary vein.
Describe the passage of the cephalic vein.
Continuous from the lateral end of the dorsal venous arch on the dorsum of the hand
Arches around the radial aspect to ascends up the anterolateral aspect of the forearm, passes over the cubital fossa laterally and ascends laterally to the biceps brachii muscle then travels in the deltopectoral groove, peircing the clavicopectoral fascia to drain into the axillary vein.
What is the median cubitubal vein?
Begins a few centimers inferior to the bend of the elbow in the cephalic vein
Travels in a superiomedial direction to act as a venous connection between the cephalic and basilic veins.
What is the medial antebrachial vein?
Drain palmar plexus venous plexus
Rains medially up the dorsal surface of the arm. Connects the basilic and cephalic vein by two possible ways.
1. drains into median cubital vein
2. Branches directly into the cephalic or basilic vein.
In what situation may the medial cubital vein be absent?
When the median antebrachial vein runs up the forearm and splits into the median basilic vein and the medial cephalic vein to join the basilic and cephalic vein respsctivly rather than indirectly br draining into the medial cubital vein.
What are the key features of the deep veins of the arms?
Sutiated underneath the deep fascia
Are paired veins found on either side of the artery.
What does it mean if a vein is described as vena comitantes and why is this important?
Paired veins that exist on either side of the artery.
Pulses from the artery aid venous return.
What connects the deep and superficial veins of the upper limb?
Perforating veins
What are the deep veins of the arm?
The brachial vein
The radial vein
The ulnar vein
What is the action of the supraspinatous muscle?
Abduction of the humerus - up to 15 degrees
What is the action of the infraspinatous muscle?
Lateral rotation of the humerus
What is the function of teres minor?
Lateral rotation of the humerus
What is the function of the subscapularis muscle?
Medial rotation of the humerus
What is the innervation of tje supraspinatous and infraspinatous muscle?
Suprascapular nerve C5-C6
What is the innervation of teres minor?
Axillary nerve C5-C6
What is the innervation of subscapularis muscle?
Upper and lower subscapularis nerve C5-7.
What is the function of the different parts of the trapezius muscle?
Descending part - elevate the scapula
Transverse part - retract the scapula
Ascending part - depress the scapula
What muscles depress the scapula?
Pectoralis minor
Serratus anterior
Trapezius (ascending part)
What muscles elevate the scapula?
Levator scapulae
Trapezius
What is the function of serratus anterior?
Protraction of the scapula
What muscles aid in the retraction of the scapula?
Trapezius (transverse part)
Rhomboid major
Rhomboid minor
What innervates serratus anterior?
The long thoracic nerve C5-7
What innervates the trapezius muscle?
The accessory nerve
What innervates the rhomboid major and minor muscles?
The dorsal scapula nerve C4-5
What innervates levator scapulae?
Anterior rami of third and fourth cervical nerves, dorsal scapular nerve C5.
What innervates the pectoralis minor muscle?
The medial and lateral pectoral nerves (C5-T1)
What is a good reference point if the scapula is in a downward or upward rotation of the scapula?
The glenoid fossa - if looking upwards in in upward rotation
What muscles aid the upwards rotation of the scapula?
Trapezius (descending, transverse and ascending part)
Serratus anterior
What muscles aid in downwards rotation of the scapula?
Levator scapulae
Rhomboid major
Rhomboid minor
Pectoralis minor
What is the function of pectoralis major in relation to the shoulder joint?
Internal rotation of the humerus
Adduction of the humerus
What is the function of the deltoid muscle?
Flexion of the shoulder
Abduction of the humerus
Extension of the shoulder
(think of the three different fibre directions)
What is the function of teres major?
Internal rotation
Adduction of humerus
What is the function of the latissimus dorsi?
Internal rotation of the humerus
Adduction of humerus
Extension of shoulder
What innervates the deltoid muscle?
The axillary nerve
What innervates pectoralis major?
Medial and lateral pectoral nerves (C5-T1)
What innervates latissimus dorsi muscle?
Thoracodorsal nerve (C6-8)
What innervates teres major?
Lower subscapular nerve (C5-7)
What is the function of biceps brachii?
supinates forearm, flexes forearm at elbow
By both the short head and the long head
What innervates the biceps brachii muscle?
The musculocutaneous nerve (C5-6)
What is the action of coracobrachialis?
Adducts and flexes arm at glenohumerual joint
What nerve innervates coracobrachialis?
Musculcuntaneous nerve C5-6
What is the action of the brachialis muscle?
Flexes forearm at the elbow
What innervates the brachialis muscle?
Musculocutaneous nerve C5-6
Ulnar nerve C7
Describe the reasoning behind the functional difference of the biceps brachii and brachialis muscle as flexors at the elbow.
Brachialis - main flexor at the elbow, due to attachment on ulnar, ulnar does not rotate during supination or pronation so insertion is always in correct position to contract and cause flexion
Biceps brachii - only flex the arm greatly when in supination, because in pronation the insertion point on the radius is not in the correct position to flex the arm due to the radius rotating.
What is the innervation of triceps brachii?
Radial nerve
What is the function of the triceps brachii?
All head extend the forearm ar the elbow joint
What bony features should you be able to identify on the scapulae?
The spine
The acromium
The glenoid fossa
The coracoid process
Infraglenoid tubercule
Supraglenoid tubercule
What is the bicipital aponeurosis?
Inserts on the radial bone
However forms an aponeurosis which attaches to the ulnar.
What are the key bony features of the clavicle?
The lateral surface - rounded for articular with the acromion
The medial surface - flat and wide for articulation with the manubrium of the sternum and first costal cartilage.
Conoid tubercule
What are the different borders of the scapula?
Superior border
Lateral border
Medial border
Linked by an inferior angle and a superior angle
Describe the bony attachments at the elbow with the humerus
The coronoid fossa - coronoid process of the ulnar
Radial fossa - with the radius bone
Olecranon fossa - olecranon of the ulnar bone, prevents over extension of the elbow.
What makes up the pectoral girdle?
The clavicle, scapula, humerus.
What is clinically important to remember about the glenohumeral joint and dislocation?
GHJ is extremely mobile but not very stable
Dislocation is relatively common
Anteroinferior dislocation is the most common
Once it has been dislocated once a repeated dislocation is more common
What are some consequences of anterior dislocation of the glenohumeral joint dislocation?
Can tear the glenoid labrum and lead to compression of the axillary nerve with the humeral head
Lengthening of humerus can also stretch the axillary nerve causing radial paralysis.
What treatment can be given to prevent a repeat anterior glenohumeral joint dislocation?
Capsule can be tightened and the labrum stabilised arthorscopically
Coracoid process is severed and transferred to the anterior inferior border of the glenoid
Name the muscle
Subscapularis
Name the muscle
Infraspinatous muscle
Name the muscle
Supraspinatous muscle
Name the muscle
Teres minor
Name the muscle
Transverse part of trapezius
Name the muscle
Descending part of trapezius
Name the muscle
Ascending part of trapezius
Name the muscle
Rhomboid major
Name the muscle
Rhomboid minor
Name the muscle
Levator scapulae
Name the muscle
Seratus anterior
Name the muscle
Pectoralis minor
Name the muscle
Pectoralis major
Name the muscle
Deltoid muscle
Name the muscle
Teres major
Name the muscle
Latissimus dorsi
Name the muscle
Short head of biceps brachii
Name the muscle
Long head of biceps brachii
Name the muscle
Coracobrachialis
Name the muscle
Brachialis
Name the muscle
Medial head of triceps brachii
Name the muscle
Long head of triceps brachii
Name the muscle
Lateral head of triceps brachii
What are the features of the clavicle
What are the features of the clavicle?
What makes up the borders of the scapula?
Green
What are the key bony features of the scapula? Purple
What are the yellow features of the scapula?
What are the green labels?
Superior border
Superior angle
Medial border
Inferior angle
Lateral border
What are the blue labels?
Infraglenoid tubercule
Glenoid cavity
Coracoid process
Acromion
Articular surface for clavicle
Subscapular fossa
Label the image
Spinous process
Acromion
Superior angle
Supraglenoid fossa
Coracoid process
Glenoid cavity
Infraglenoid tubercule
Lateral border
Inferior angle
What are the blue labels?
Head
Anatomical neck
Surgical neck
What are the red labels?
Lateral lip, floor and medial lip of inter tubercule sulcus
Deltoid tuberosity
Coracobrachialis
What are the yellow labels?
Superior facet on greater tubercule
Greater tubercule
Inter tubercular sulcus
Lesser tubercle
Inter tubercular sulcus
What are the blue labels?
Anatomical neck
Surgical neck
What are the green labels?
Greater tubercule
Superior, middle and inferior facet
What are the yellow labels.
Lateral supraepicondylar ridge
Lateral epicondyle
Medial epicondyle
Medial supraepicondylar ridge
What are the green labels?
Radial fossa
Condyle - capitulum and trochlea
Coronoid fossa
What are the labels?
Olecranon fossa
Trochlea
What ligament is this?
Acromoclavicular
What ligament is this?
Trapezoid ligament
What ligament is this?
Conoid ligament
What ligament is this?
Fibrous layer of joint capsule of glenohumeral joint
What ligament is this?
Coracohumeral ligament
What ligament is this?
Glenoid labrum
What ligaments play an important role in supporting the should joint?
Trapezoid
Conoid
Coracohumeral
Acromioclavicular
Glenoid labum
Joint capsule of Glenoid humeral joint
