Upper extremity Flashcards

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1
Q

upper v. lower extremity function

A

lower extremity about balance and weight bearing, upper about mobility and fine motor control

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2
Q

Shoulder girdle:
1. clavicle
2. scapular landmarks

A
  1. anchored to sternum medially and to scapula at the acromion
  2. on med border sup and inf angle, sup lat border is glenoid fossa for humerus, supra and infra glenoid tubercules sup and inf to glenoid fossa, spine of scapula on post separates supraspinous fossa and infraspinous fossa, acromion process ext of spine of scapula, coracoid process on ant side point laterally, subscapular fossa on ant scapula
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3
Q

4 shoulder girdle actions

A
  1. elevation: move scapula and rotate clavicle superiorly
  2. depression: move scapula and rotate clavicle inferiorly
  3. protraction: clavicles rotate posteriorly to bring scapulas apart
  4. retraction: clavicles rotate anteriorly to bring scapulas closer together
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4
Q

sternoclavicular joint:
1. comp
2. articular disk
3. motion

A
  1. sternal end of clavicle meets manubrium of sternum
  2. fibrocartilage in capsule that prevents shear and compression
  3. facilitates shoulder girdle movements and sup/inf rotation of the scapula
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5
Q

4 + 1 scapular actions

A
  1. superior rotation: rotate superior angles closer to the spine, occurs during elevation
  2. inferior rotation: rotate inferior angles closer to the spine, occurs during depression
  3. anterior tilt: superior angle gets closer to the thorax
  4. posterior tilt: inferior angle gets closer to the thorax
  5. winging: scapula not anchored to rib cage, if held by suboptimal muscular control scapula lift away from rib cage
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6
Q

sternoclavicular joint ligaments:
1. anterior sternoclavicular ligament
2. posterior sternoclavicular ligament
3. costal-clavicular ligament

A
  1. connect sternum to clavicle on ant side, limits superior rotation, and retraction
  2. connect sternum to clavicle on post side; limits superior rotation and protraction
  3. connects costal cartilage of ribs 1 to the clavicle; limits elevation and sup translation of med clavicle
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7
Q

acromioclavicular joint:
1. comp
2. articular disk
3. motion
4. injury

A
  1. articulation of acromion process and lat end of clavicle
  2. fibrocartilage preventing shear and compression in acromioclavicular joint capsule
  3. no motion, holds clavicle to scapula for shoulder girdle movements
  4. separated shoulder from clavicle and scapula being pulled apart
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8
Q
  1. acromial clavicular ligament
  2. coracoclavicular ligaments
  3. coracoacromial ligament
A
  1. connect acromion to clavicle in place
  2. hold coracoid to clavicle, conoid on medial coracoid to conoid tubercle on inf clavicle, trapezoid on lat ant coracoid to trapezoid line on clavicle; limit sup translation of clavicle and depression
  3. does not cross joint, forms bridge b/w coracoid and acromion creates subacromial space over humerus, prevent sup translation of humerus
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9
Q

trapezius (origin, insertion, motion):
1. upper fibres
2. middle fibres
3. lower fibres

A
  1. desc fibres, originate as nuchal lig and insert at lat clavicle for elevation
  2. originate from spinous processes of T1-4 and insert at acromion and spine of scapula for retraction
  3. asc fibres, originate at spinous process of T4-12, insert on acromion and spine of scapula for superior rotation and post tilt of scapula and depression
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10
Q
  1. nuchal ligament
  2. supraspinus ligament
A
  1. nuchal lig is elastic broad lig from superior nuchal line extending lat from external occipital protuberance moving inf, touching each spine of cervical vertebrae before attaching to C7; limit flexion of the neck
  2. continuous with nuchal lig at C7 to sacrum; limit flexion of the spine
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11
Q
  1. levator scapulae
  2. rhomboid major
  3. rhomboid minor
A
  1. originate at transverse process of C1-4, insert on sup angle of scapula for inf rotation of scapula
  2. originate at spinous process of T2-T5, insert on med border of scapula; retraction, manage winging
  3. originate at spinous process of C7-T1, insert on root of spine of scapula; retraction, manage winging
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12
Q
  1. serratus anterior
  2. pectoralis minor
A
  1. originate on lat ribs 1-8 under scapula to med border of scapula; protraction by upper fibres and sup rotation of scapula by lower fibres, manage winging
  2. ant ribs 3-5 to med coracoid process, protraction, depression, and ant tilt of scapula, can contribute winging on inf angle > managed by lower fibres of traps
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13
Q

glenohumeral joint:
1. comp
2. motion
3. glenoid labrum

A
  1. head of humerus (ball) on shallow socket of (pear-shaped) glenoid fossa; low bony congruency for large mobility
  2. sagittal flex (bring fingers to ceiling), sagittal extend (bring fingers from full flexion back to anatomical pos and beyond post), cross-flex (swing arm across body in transverse plane), cross-extend (from cross-flex to anatomical and beyond post), abduction (increase angle b/w arm and midline in frontal plane), adduction (decrease angle b/w arm and midline in frontal plane), ext rot (greater tuberosity gets closer to acromion), int rot (greater tuberosity gets closer to clavicle)
  3. fibrocartilage ring holding humerus in fossa
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14
Q

11 humeral landmarks

A
  1. distal to head is anatomical neck
  2. greater tuberosity is protrusion post and lat to anatomical neck of humerus
  3. lesser tuberosity is protrusion ant to anatomical neck
  4. bicipital groove with lat and med lip b/w tuberosities
  5. surgical neck is narrow area of humeral neck before shaft, easily fractured
  6. deltoid tuberosity on lat humerus distal to greater tuberosity
  7. distal end capitulum lat rounded articular surface with radius
  8. distal end trochelea med rounded articular surface for ulna
  9. medial and lat epicondyles at base, med more prominent
  10. radial groove diagonal groove for radial nerve from post shaft towards capitulum
  11. supracondylar ridge, lat and med side
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15
Q
  1. superior glenohumeral lig
  2. middle glenohumeral lig
  3. inferior glenohumeral complex
  4. common way to dislocate humerus
A
  1. 1:00 pos on glenoid rim to sup lesser tuberosity, limit ext rot when <45° abduction and sup translation of humerus.
  2. 2:00 pos on glenoid rim to lesser tuberosity to anatomical neck, limit cross ext during 45-90° abduction, sup translation of humerus
  3. Ant and post bands w/axillary pouch b/w, 3:00-8:00 pos to anatomic neck, limit ext rotation at >= 90° abduction, sup translation of humerus
  4. Abduction and ext rotation
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16
Q

rotator cuff:
1. cuff idea
2. subscapularis
3. supraspinatus
4. infraspinatus
5. teres minor

A
  1. incomplete cuff due to rotator interval created by gh capsule, hold head of humerus in glenoid fossa for stability
  2. Originate at Subscapular fossa pass through GH capsule to insert at lesser tuberosity, int rot of humerus
  3. Originate at supraspinus fossa and insert on sup post greater tuberosity, ext rot and abduction
  4. Originate at infraspinatus fossa and insert on post greater tuberosity, ext rot
  5. Originate at lat border of scapula to post inf greater tuberosity, ext rot and adduction
17
Q

deltoids:
1. ant delt
2. middle delt
3. post delt
4. Deltopectoral space

A
  1. Clavicular head, originate at lat 1/3 clavicle to Acromioclavicular Joint and insert at deltoid tuberosity, abduction, flexion, int rot
  2. Acromial head, originate at lat Acromion, insert at deltoid tuberosity, abduction
  3. Spinal heads originate at spine of Scapula insert at deltoid tuberosity, abduction, extension, ext rot
  4. Triangle b/w post delt and Pectoralis major
18
Q

anterior axilla:
1. pectoralis major
2. coracobrachialis

A
  1. Clavicular fibres originate at med 1/2 clavicle,horizontal fiber originate at sternum and costal cartilages of ribs 1-6, abdominal fibres originate on abdominal CT, insert at lat lip of bicipital groove, adduct, and cross-flex, int rot
  2. Coracold tip to 1/2 med humerus, adduct, cross-flex, flex, int rot
19
Q

posterior axilla:
1. latissimus dorsi
2. teres major

A
  1. Originate at T6- L5, iliac crest, ribs 10-12 and insert into bicipital groove, ext, cross-extend, int rot, adduction
  2. Originate at lat border of scapula inf to teres minor,insert at med lip of bicipital groove, ext, cross-extend, int rot, adduction
20
Q
  1. axilla muscles
  2. glenohumeral joint motions in sport
A
  1. Close armpit through adduction
  2. Overhead throwing req strong int rot, swinging req crossflexion, swimming req extension
21
Q

humeroradial joint:
1. comp
2. motion
3. ligament

A
  1. flat head of the radius articulates with the rounded capitulum of lat side humerus
  2. flexion, extension, supination, pronation, varus
  3. radial collateral ligament attaches to the lat epicondyle of humerus and splits into 2 bands, ant band attach to ant annular lig, post band merge with post annular lig into supinator crest on lat ulna; limits varus of elbow
22
Q

2 characteristics of elbow joint

A
  1. high bony congruency, v. stable, hard to dislocate, req loose elbows and high F to dislocate
  2. full extension has natural valgus
23
Q

sup radioulnar joint:
1. comp
2. motion
3. ligament

A
  1. med side radial tuberosity of radius meets radial notch at base of ulna
  2. supination and pronation
  3. annular ligament attaches to post and ant margin of radial notch to hold radius loosely to ulna
24
Q

6 ulnar landmarks

A
  1. radial notch is concave area on med prox ulna articulating with radius
  2. ant prox conoid process
  3. post prox olecranon process fits into olecranon fossa of humerus
  4. ulnar tuberosity is roughened area distal to coronoid process
  5. supinator crest is line on lat side ulna
  6. trochlear notch is concave area b/w coronoid and olecranon articulating with the trochlea of the humerus
25
Q

humeroulnar joint:
1. comp
2. motion
3. ligament

A
  1. trochlea on med side humerus meets trochlear notch on ulna
  2. flexion, extension, and valgus
  3. ulnar collateral lig comp 3 well dev bands: 2 bands originate on prominent med epicondyle of trochlea, ant attach to coronoid, post attach to olecranon, transverse band attach ant at coronoid to post at olecranon; limits valgus
26
Q

muscles of the arm:
1. biceps brachii
2. brachialis
3. triceps brachii

A
  1. short head originate at coracoid process, long head originate at supraglenoid tubercle passing through bicipital groove, merge with short head near axilla to attach at radial tuberosity and bicipital aponeurosis; flex and supinate elbow, flex GH (long head)
  2. broad and flat deep to biceps brachii, origin at distal 1/2 of humerus to ulnar tuberosity; flex elbow
  3. long head at lat border of scapula (ext shoulder and adduction), med deep to lat, lat and med originate from post shaft of humerus, pass through radial groove and merge with long head into olecranon; extend elbow
27
Q

carpals

A

prox row:
1. scaphoid (articulates with radius)
2. lunate (articulates with radius)
3. triquetrum (articulates with lunate)
4. pisiform (embedded in flexor carpi ulnaris tendon)
distal row:
5. trapezium (articulates with mtc1)
6. trapezoid (articulates with mtc2)
7. capitate (articulates with mtc3)
8. hamate (articulates with mtc4 and 5, hook of hamate on palmar side)

28
Q
  1. metacarpals
  2. phalanges
A

digits of fingers: pollux/thumb = 1, pinky = 5
1. metacarpals 1-5
2. phalanges 1-5, pollux has prox and distal forming IP and MCP joint; 2-5 has prox, middle, and distal forming PIP, DIP, and MCP

29
Q

6 motions of wrist

A
  1. flexion decrease angle b/w palm and ant forearm
  2. extension increase angle b/w palm and ant forearm
  3. ulnar deviation move hand closer to ulna
  4. radial deviation move hand closer to radius
  5. supination anatomical pos with palms facing ant
  6. pronation anatomical pos with palms facing post
30
Q

6 motions of the hands

A
  1. flexion curl fingers
  2. extension straighten fingers
  3. abduction separate fingers
  4. adduction bring fingers together
  5. opposition bring pollux and pinky together
  6. reoposition return to anatomical pos after oppositon
31
Q

ant superficial forearm:
1. pronator teres
2. flexor carpi ulnaris
3. flexor carpi radialis
4. palmaris longus

A
  1. originate at medial epicondyle, wrap anteriorly, insert prox 1/3 radius; pronation
  2. originate at medial epicondyle, insert at pisiform, hamate, and mtc5; ulnar dev and flexion of wrist
  3. originate at medial epicondyle, insert at mtc3 and 4 base; rad dev and flexion of wrist
  4. originate at medial epicondyle, insert at palmar aponeurosis; prominent tendon, weak flexion, maintain arch of hand
32
Q

ant deep forearm:
1. flexor digitorum superficialis
2. flexor digitorum profundus

A
  1. originate at med epicondyle, med ulna, and shaft of radius, inserts as 4 tendons crossing under flexor retinaculum (carpal tunnel) to middle phalanges of 2-5; flex PIP, and MCP joints
  2. deep to superficialis, originate at ulna, 4 tendons cross flexor retinaculum and split into lat and med sides to attach to distal phalanges; flex PIP, DIP and MCP joints
33
Q

lat comp of forearm:
1. brachioradialis
2. extensor carpi radialis lonugs
3. extensor carpi radialis brevis

A
  1. originate at lat supracondylar ridge of humerus, insert distal end of radius; flex elbow
  2. originate at lat supracondylar ridge of humerus, insert on dorsal side mtc2 base; flex elbow, ext wrists, rad dev
  3. originate at lat epicondyle, insert on dorsal mtc3 base; flex elbow, ext wrists, rad dev
34
Q

post comp of forearm:
1. extensor carpi ulnaris
2. extensor digitorum
3. extensor digiti minimi
4. supinator

A
  1. originate from humerus lat epicondyle, insert dorsal mtc5 base; ulnar dev, weak ext
  2. lat epicondyle to distal and middle phalanges 2-5; extend wrist and fingers
  3. lat epicondyle to distal phalange 5; extend wrist and digit 5
  4. originate at lat epicondyle and supinator crest, wrap around post to prox 1/3 radius; supination
35
Q

intrinsic muscles of the hand

A
  1. thenar eminence of thumb and hypothenar eminence of digit 5 allow for grip
  2. interosseous muscles b/w mtc adduct/abduct fingers
36
Q
  1. prehensile gripping
  2. power gripping
  3. wrist stability
A
  1. fine control over small items using tips to pads of fingers
  2. decrease precision, increase F, using other joints than fingers to help grip
  3. many finger flexors also flex wrist, activation of wrist flexors to maintain neutral wrist during grip
37
Q
  1. cylinder grip
  2. spherical grip
  3. hook grip
  4. fist grip
  5. tip to tip pinch
  6. lateral pinch
  7. pad pinch
A
  1. fingers and thumb wrap around the cylinder, but they don’t overlap
  2. grasping a spherical object in the palm
  3. just fingers flexed, no thumb
  4. like hook or cylinder, but thumb wraps over fingers
  5. hold the object with the tips of your thumb and index finger
  6. thumb presses the object against the side of your finger
  7. hold the object between the pads of your thumb and a finger