Upper Extremity Flashcards
_______ is a continuation of the spine of the scapula
Acromion (posterior)
______ connects the coracoid process to the clavicle.
Coraclavicular ligament
_____ connects the acromion to the clavicle
Acromioclavicular ligament
______ connects it to itself, Coracoid and Acromion. Helps to stabilize
Coracoacromial ligament- would need a fracture of the scapula in order to stress this ligament
Type I shoulder joint separation
Stretch and damage AC joint but nothing is ruptured
Type II
AC joint is ruptured and stress CC
Type III shoulder separation
AC and CC are both ruptured
In what type of shoulder separation is the clavicle raised up and lump in their neck?
Type III
______ articulates the humerus to the radius
Capitulum
______ is where the humerus and ulnar articulate
Trochlea
______ is a common place to fracture the humerus because it narrows and it is outside the joint capsule
Surgical neck of the humerus
_______ is significantly larger in people who work manual labor jobs. Why?
Deltoid tuberosity, because it is a site for muscle attachment.
Lateral epidcondyle and ridge is where Extensors or flexors attach?
Extensors
Medial epidcondyle and ridge is where Extensors or flexors attach?
Flexors
_______ is the point of the elbow. What bone is it on?
Olecranon process, Ulna
What is weird about the Ulna?
The “head” is distal (closer to the wrist)
What inserts at the Ulnar Tubersoity?
Brachiliasis muscle
What inserts at the Radial tuberosity?
Biceps Brachi
What three ligaments are responsible for the elbow?
Radial collateral, Ulnar collateral and annular
What ligament does Tommy John’s Sx repair?
Ulnar collateral
Nursemaid’s elbow is displacement of what ligament? What bone is displaced?
Annular ligament, radial head
____ is the boat shaped carpal bone
Scaphoid
_____ is stickying out of the carpal bones (palmar side)
Pisiform
______ (hand bone) is on the thumb side
Trapezium
Rank the joints in the hand from most moveable to least moveable.
- Radiocarpal joint (most “flexible”)
- Intercarpal joint (middle)
- Carpometacarpal joint (Least)
The _____ only has a proximal and distal phalanges
Thumb (digit 1)
Digits 2-5 has ____, ____ and _____.
Proximal, middle and distal phalanges
What are the 3 joints in the phalanges called?
MCP- Metacarpophalangeal joint
PIP- Proximal interphalangeal joint
DIP- distal interphalangeal joint
The flexor retinaculum connects what 3 carpal bones?
Pisiform, hamate and trapezium
______ is the top of the carpal tunnel
Flexor retinaculum
Hyperextension injury tears what ligament in the hand?
Palmar plates
_______ takes the most of the weight when you fall on your hand
Scaphoid bone
Colle fractures is a fracture of what bone?
fracture of the distal radius
_______ is responsible for holding the scapula to the body wall
Serratus Anterior
_____ starts abbduction of the arm
Supraspinatus
____ and ___ rotate the humerus
Infraspinatus and Teres Minor
_____ internally rotates the arm
Subscapularis
4 Rotator Cuff muscles
- Supraspinatus
- Infraspinatus
- Subscapularis
- Teres Minor
______ is testing the supraspinatus
Drop arm test
Scratch back from above (Externally rotate the arm)
Infraspinatus muscle
Scratch back from below (internally rotate the arm)
Subscapularis muscle
______ are lubricating sacs that help prevent friction
Bursae
Pectoralis major attaches to ____
Intertubulcar sulcus of the humerus
Anterior compartment of the arm is responsible for ____
Flexing the arm at the elbow
Deep to the biceps brachii is the ______
Brachialis
_______ shares most of its functions with the Pectoralis major
Coracobrachialis
_______ is responsible for flexion and supination of the forearm
Biceps Brachii
_______ is small, posterior arm muscles, mostly responsible for stablization. Some extension of the forearm
Anconeus
_____ on the anterior side
flexors
____ on the posterior side
extensors
_____ muscle move the wrist and entire hand
Carpi
____ muscles move the digits
Digitorum
_____ muscles move the thumb
Pollicis
____ muscles specifically move the index finger- 2nd digit
Indicis
_____ muscles specifically move the little finger- 5th digit
Digiti minimi
______ acts like a flexor even though it is on the posterior side
Brachioradialis
_____ and ____ both extend the 5th digit
Extensor Digitorum and Extensor Digiti Minimi
_____ wraps around the radius
Supinator
crank your thumb backwards
is extension
Flexion of the thumb in….
folding it in over your palm
_____ is important because it has a big, long tendon that can be used as an autograph for surgery
Palmaris longus
The _____ is responsible for the flexion of the DIP joint
Flexor Digitorum Profundus
What is tennis elbow?
Lateral Epicondylitis
What is golfer’s elbow?
Medial Epicondylitis
The ______ usually communicate with the common flexor sheath versus the rest of the digits are independent tendon sheaths.
Synovial sheath of the 5th digit
_____ is not part of the thenar eminence
Adductor Pollicis
______ attach to the tendons in the hand and help extend the phalanges
Lumbricals
The Lumbricals are ____ until they reach the MCP and then they go _____
palmar, dorsal
_____ are found with the tendon sheath to help reduce friction
synovial fluid
What nerve roots are the major contributors to the upper limbs?
C5-T1
The more promixal the muscles, what nerves are it more likely to be innervated by?
Superior nerves
The more distal the muscle, what nerves are it more likely to be innervated by?
Inferior nerves
C5 Dermatome
Lateral shoulder
C6 Dermatome
First digit (Thumb)
C7 Dermatome
3rd Digit
C8 Dermatome
5th Digit- pinky
T1 Dermatome
Medial elbow
The “roots” in the brachial plexus are actually what?
Anterior Rami
C5 and C6 form to become what trunk?
Superior Trunk
C7 is what trunk of the brachial plexus?
Middle
C8 and T1 fuse to become what trunk?
Inferior Trunk
Superior and Middle anterior divisions form ____
Lateral cord
Inferior anterior forms what ?
Medial cord
The superior posterior, middle posterior and inferior posterior all fuse to become ____
Posterior cord- extensor muscles
Lateral cord innverates _____
Musculocutaneous nerve
Medial cords innverates _____
ulnar nerve
______ and _____ form the median nerve.
Lateral and Medial Cord
Posterior cord innervates all the _______. Name the 2 nerves
Extensors, Axillary and Radial nerve
______ innervates all the muscles of the anterior compartment of the arm.
Musculocutaneous nerve
_______ carries sensory information form the lateral forearm.
Musculocutaneous nerve
A _______ nerve lesion presents with weakness/inability to flex the forearm at the elbow and altered sensation over lateral forearm
Musculocutaneous
What nerve does this represent? WITH weakness/inabiilty to flex the forearm
Musculocutaneous
What happened here?
Biceps Tendon Rupture
Axillary nerve innervates ______
Deltoid (mainly the Deltoid) and teres minor
The _____ innervates all the muscles of the posterior compartment of the arm.
Radial nerve
In the forearm the radial nerves divides into: (Name and what kind?)
- Superficial Radial- Sensory
- Deep Radial- Motor
- Posterior Interosseous- Motor
The area in red represents what what nerve?
Radial nerve
The area in grey represents what nerve?
Axillary nerve
An ______ lesion will present with weakness/inability to flex/extend/abduct the arm at the shoulder and altered sensation over the shoulder.
Axillary Nerve
The ______ carries sensory information from the posterior arm and posterior forearm
radial nerve
A ______ nerve lesion presents with weakness or inability to extend the forearm at the elbow, extend the hand at the carpus and extend the fingers. Also altered sensation over the posterior arm, forearm and hand.
proximal radial
A______ nerve lesion presents with intact elbow movement but weakness/inability when extending the wrist and fingers. Also altered sensation over the posterior forearm and hand.
More distal radial
Axillary nerve damage can cause atrophy to what muscle?
Deltoid muscle
The _______ innervates nearly all of the muscles in the anterior forearm and a few of the muscles of the hand
Median Nerve
The ______ innervates 1 & ½ muscles in the forearm and nearly all of the muscles of the hand
ulnar nerve
What muscles in the hand does the Median Nerve Innervate?
-Abductor pollicis brevis
-Opponens pollicis
-Flexor pollicis brevis
-1st and 2nd lumbricals
Name the 2 branches of the median nerve
-Anterior interosseous nerve
-Recurrent branch of the median nerve (muscles of thenar eminence)
The ______ carries sensory info from the palmar aspect of digits 1-3 & the radial ½ of the 4th digit
median nerve
What nerve doest this correlate with? Sensory or Motor?
Median nerve, sensory to the hand and motor to the thumb
______ is response for rolling the radius over? Innervation?
Pronator Teres, median nerve
_______ innervates the thenar eminence
Median nerve
Impingement at the carpal tunnel or damage to the ______ presents with:
-weakness in thumb motion
-diminished grip strength (thumb).
-altered sensation over the palmar hand
-altered sensation over palmar aspect of digits 1-3
- altered sensation over the lateral aspect of 4th digit
recurrent branch of the median nerve
______ presents with:
-weakness in thumb motion
-diminished grip strength (thumb).
-altered sensation over the palmar hand –altered sensation over palmar aspect of digits 1-3
- altered sensation over the lateral aspect of 4th digit
-weakness in motion of the 2nd digit
-Inability to make a circle with the thumb and index fingers
median nerve proximal to the carpal tunnel or damage to the anterior interosseous nerve
________ presents with:
-weakness in thumb motion
-diminished grip strength (thumb).
-altered sensation over the palmar hand –altered sensation over palmar aspect of digits 1-3
- altered sensation over the lateral aspect of 4th digit
-weakness in motion of the 2nd digit
-Inability to make a circle with the thumb and index fingers
-weakness in wrist flexion and in grip strength from the forearm muscles.
-When asked to make a fist “hand of benediction” is formed
proximal median nerve lesion
The ulnar nerve innervates two muscles of the anterior forearm:
Flexor carpi ulnaris
½ of Flexor digitorum profundus
The _______ innervates all muscles of the hand that are not innervated by the median nerve.
deep branch of the ulnar nerve
The ______ carries sensory information from the palmar and dorsal aspects of the 5th digit and the ulnar ½ of the 4th digit.
superficial branch of the ulnar nerve
What nerve?
Ulnar Nerve
_____ presents with:
-atrophy of intrinsic muscles of the hand (except thenar eminence)
-weakness in grip but particularly in abduction and adduction of the digits against resistance
-altered sensation of 5th digit
- altered sensation of the medial aspect of 4th digit
ulnar nerve lesion at the wrist
_____ presents with:
-atrophy of intrinsic muscles of the hand (except thenar eminence)
-weakness in grip but particularly in abduction and adduction of the digits against resistance
-altered sensation of 5th digit
- altered sensation of the medial aspect of 4th digit
-weakness in wrist flexion and in grip strength from the forearm muscles
-when asked to make a fist, patient will often be described as having a “claw hand”
proximal ulnar nerve lesion
What does this indicate? Name?
proximal ulnar nerve lesion, “Claw Hand”
On the palm, the _______ send sensory branches to the palmar aspect of each finger.
median and ulnar nerves
Common palmar digital nerves give off ______
proper palmar digital nerves
_______ innerves the thenar eminence
Recurrent branch of the median nerve
The Dorsal Scapular Nerve comes off of _____
C5
C5, C6 and C7 proximally give off what nerve?
Long thoracic nerve
The Superior branch has 2 proximal branches, named….
- Suprascapular nerve
- Nerve to subclavius
_______ is a proximal branch off the lateral cord
Lateral pectoral nerve
_______ is a proximal branch off the medial cord
Medial Pectoral nerve
the ____ and _____ nerve tend to form a loop
Lateral pectoral and medial pectoral nerves
Name the 3 proximal branches off the Posterior cord
- Subscapular Nerve
- Thoracodorsal Nerve
- Subscapular Nerve
The ______ from the radial nerve do not quite make it to the end of the fingers.
dorsal digital nerves
The ______ nerves also give off a dorsal branch to the fingertips and nail bed areas
proper palmar digital
Name 6 nerves that originate from cords:
1.Subscapular nerve
2. Thoracodorsal nerve
3. Lateral pectoral nerve
4. Medial pectoral nerve
5. Medial cutaneous nerve of arm
6. Medial cutaneous nerve of forearm
______ internal rotation of the arm
subscapularis muscle
_______ is responsible for arm adduction
Teres major muscle
A _______ presents with weakness/inability to internally rotate the arm. It may present with the arm persistently rotated externally.
subscapular nerve lesion
__________ innervates Latissimus dorsi muscle
thoracodorsal nerve
______ Adduct and extend arm at the shoulder
Latissimus dorsi muscle
A ______ will present with weakness/inability to “row” one’s arm back from a flexed or abducted position at the shoulder
thoracodorsal nerve lesion
______ innervates the Pectoralis major and minor
medial pectoral nerve
______ adduct and flex arm at shoulder
Pectoralis major
_____ stabilize scapula by pulling coracoid process inferiorly and anteriorly
Pectoralis minor
_____ innervates just the Pectoralis Major
lateral pectoral nerve
______ present with weakness/ inability to push away from a wall or move the shoulder from an abducted to flexed position
Pectoral nerve lesions
_______ Loss of radial and axillary nerve function.
Posterior cord damage
______ Loss of musculocutaneous and weakness of median nerve
Lateral cord damage
________ Loss of ulnar nerve and weakness of median nerve. Loss of sensation from medial arm and forearm
Medial cord damage
Nerves from the roots and trunks include what 4 nerves.
- Dorsal Scapular
- Long thoracic
- Nerve to the subclavius
- Suprascapular nerve
______ innervates Levator scapulae and Rhomboid major and major
dorsal scapular nerve
An _____ would present with weakness elevating and retracting the scapula, but a functional trapezius would mask the problem.
isolated dorsal scapular nerve lesion
______ innervates Serratus anterior muscle
long thoracic nerve
_______ protraction and rotation of scapula
Serratus anterior muscle
A _____will present with weakness/inability to protract the scapula. The scapula “wings” posteriorly when the person tries to push their body away from leaning against a wall or doing a push up.
long thoracic nerve lesion
nerve to subclavius innervates the ____
Subclavius muscle
______ innervates the Supraspinatus muscle and Infraspinatus muscle
suprascapular nerve
_______ initiate of arm abduction
Supraspinatus muscle
_____ lateral rotation of the arm
Infraspinatus muscle
A _______ will present with weakness/inability to initiate abduction of the arm at the shoulder and to externally rotate the arm at the shoulder
suprascapular nerve lesion
_______ caused by injury to the superior trunk or C5-C6 roots of the brachial plexus. It results in weak or nonfunctional: nerve to the subclavius, suprascapular, axillary and musculocutaneous nerves. The dorsal scapular, long thoracic nerves MAY be injured
Erb-Duchenne Palsy
The axillary region is bordered by what 4 structures?
Pectoral muscles- Anterior
Subscapularis muscle- Posterior
Humerus- Lateral
Serratus Anterior Muscle- Medial
Erb-Duchenne Palsy will results in weak or nonfunctional: (What 4 nerves). The dorsal scapular, long thoracic nerves MAY be injured
- nerve to the subclavius
- suprascapular
- axillary
- musculocutaneous nerves
______ caused by injury to the inferior trunk of the brachial plexus. Nonfunctional ulnar nerve and sensory loss from the medial cutaneous nerves of the arm and forearm. Median & radial nerves will be less severely affected.
Klumpke’s Paralysis
Klumpke’s Paralysis caused by injury to the ________. Nonfunctional _____ nerve and sensory loss from the _____ nerves of the arm and forearm. Median & radial nerves will be less severely affected.
inferior trunk of the brachial plexus, ulnar, medial cutaneous
In Klumpke’s Paralysis the claw hand appreance is due to what?
Proximal ulnar nerve damage
______ firmly attaches the scapula to the ribs
Serratus anterior
Persistent internally rotation of the arm. What is weak?
Weak infraspinous and supraspinous
Persistently extended elbows is during to damage to what nerve?
muslcocutaneous nerve
Describe the “Waiter’s Tip” sign and what Palsy does it indicate?
Elbows extended with wrist permanently flexed, Erb- Duchenne Palsy
Name 2 causes of Erb-Duchenne Palsy
Traction of the neck during childbirth and falling on your neck
The ____ allows passage of neurovascular structures to axilla from the neck
Apex
_____ is the parent artery to the entire upper limb
Subclavian artery
Once subclavian artery crosses the first rib, it becomes the _____
axillary artery
____ supplies levator scapulae and rhomboid muscles.
Dorsal scapular artery
_____ supplies supraspinatus and infraspinatus muscles
Suprascapular artery
The axillary artery is divided into 3 segments
Supreme thoracic artery-Segment 1
Lateral thoracic artery- Segment 2
Thoracoacromial trunk- Segment 3
_______ supplies the anterior
1st and 2nd intercostal spaces. Where is it in relation in the chest cavity?
Supreme thoracic artery, Proximal to the pectoralis minor
______ supplies serratus anterior muscle and breast tissues.
Lateral thoracic artery
The thoracoacromial trunk supplies what 4 things
Clavicular branch
Pectoral branch
Acromial branch
Deltoid branch
Segment 2 of the Axillary artery is called _____. Where is it in the chest cavity?
Lateral thoracic artery, covered by the pectoralis minor
______ innervates the serratus anterior
Long thoracic
Segment 3 of the axillary is named what? Where is it in the chest cavity?
Thoracoacromial trunk, distal to pectoralis minor
_____ supplies subscapularis and has two branches. Name them.
Subscapular artery
- Circumflex scapular artery
- Thoracodorsal artery
_____ supplies the infraspinatus muscle
Circumflex scapular artery
______ supplies latissimus dorsi muscle
Thoracodorsal artery
_____ and ______ supply the deltoid and anterior compartment of the arm
-Anterior humeral circumflex artery (tends to be smaller)
-Posterior humeral circumflex artery (tends to be larger)
As the axillary artery crosses the teres major muscle it becomes the _____
Brachial artery
What artery when compressed against the humerus can you feel a pulse on the medial arm?
Brachial artery
Name the 3 branches of the brachial artery. What parts of the arm do they supply?
- Deep brachial artery -supplies posterior compartment of arm
- Superior ulnar collateral artery branches medially near middle arm.
- Inferior ulnar collateral artery branches medially near elbow
In cubital fossa the brachial artery splits into _____ and ______.
radial and ulnar arteries
The radial artery gives off _____ near the elbow
Radial recurrent artery
the ______ has a very palpable pulse on anterior wrist near base of thenar eminence
Radial artery
The ______ has a pulse palpable just lateral to tendon of flexor carpi ulnaris muscle
ulnar artery
Name the 2 branches of the Ulnar artery
-Ulnar recurrent artery
-Common interosseous artery
The common interosseous artery splits into:
_____ which supplies deep structures of the anterior compartment of forearm.
and
______ which supplies structures of the posterior compartment of the forearm
and
_____
Anterior interosseous artery
Posterior interosseous artery
Small recurrent interosseous branch
_______ supply the deep muscles in the forearm
Anterior and posterior interosseous arteries
The ulnar artery forms MOST of the ______ arch along with a variable contribution from the ______
superficial palmar arch, radial artery
_____ gives off several common _______ that then split into:
_______ traveling on either side of the digit
Superficial palmar arch
palmar digital arteries
Proper palmar digital arteries
Most of the _____ passes posterior to wrist but dives anteriorly through the adductor pollicis muscle to form the ______ with some contribution from the _____
radial artery
deep palmar arch
ulnar artery
Deep palmar arch gives off:
_______ that join with common palmar digital arteries
Palmar metacarpal arteries
Red blood cells, white blood cells, and platelets are produced in the marrow of long bones and enter circulation via ______
nutrient veins
Fluids can be administered into the long bones’ ______.
medulla
Define Anastomosis
The blood vessels interconnect
The ____ artery is commonly used as an autograph in heart surgery. Why?
Radial Artery. Due to anastomosis in the hand the Ulnar artery will find a way to keep the hand supplied with blood.
Name the 2 veins with no corresponding artery
Cephalic and basilic vein
Where does the cephalic vein empty?
Drains into the subclavian vein at the deltopectoral triangle
____ drains radial hand, posterior forearm and arm
Cephalic vein
_____ drains the ulnar hand and anterior forearm
Basilic vein
______ drains to the brachial vein at the elbow
Basilic vein
______ connects the cephalic and basilic vein
Medial cubital vein
Give one example of a neurovascular bundle
axillary artery’s close connection to cords of the brachial plexus, where vessels and nerves run alongside each other
The quadrangular space is
bounded by:
long head of triceps
teres minor
teres major muscles
humerus
The ____ is vulnerable during shoulder dislocation and humeral neck fracture
quadrangular space
The triangular interval
bounded by: (3 things). When is it vulnerable?
long head of triceps
lateral head of triceps
teres major muscles
During mid-shaft humeral fractures
The ulnar nerve/vessel bundle is vulnerable when….
trauma/fracture near the medial aspect of the distal forearm and carpus.
The proper palmar digital nerves/vessel bundle is vulnerable when…
laceration on the lateral palmar aspect of all digits
Fracture of humeral shaft will often involve:
Radial nerve and Deep brachial artery and vein
_____ is the result of blocking the flow of lymph results in edema, or swelling.
Lymphedema
