Upper Extremity Flashcards
Connects the appendicular and axial skeletons
Pectoral girdle
What are the three joints of the shoulder?
Scapulothoracic joint
Acrominoclavicular joint
Glenohumeral joint
Bone that transmits forces from the upper limb to the axial skeleton
Clavicle
What are the two functions of the curvature of the clavicle?
- Bony protection for brachial plexus
- Curvature that increases the resilience of the clavicle allowing it to transmit shock from the upper limbs to the axial skeleton
First long bone to ossify
Clavicle
What nerve may be injured if someone fractures the distal ends of the humerus?
median nerve
Where do wrist flexors attach?
Medial epicondyle of humerus
Where do wrist extensors attach?
Lateral epicondyle of humerus
Where does the ulna articulate with the carpal bones?
It doesn’t
How many metacarpal bones are in one hand?
5
How many phalanges are in one hand?
3 for each finger, 2 for the thumb. so 14 altogether
Where are sesamoid bones often found in the hand?
Palmar side of metacarpal heads and also common on the thumb
Muscles of the shoulder joint capsule (rotator cuff)
Subscapularis anteriorly
Supraspinatous superiorly
Infraspinatous and teres minor posteriorly
What is the most frequently injured SITS muscle?
Supraspinatous. Due to how acromion impinges on it with overhead arm movement
Which glenohumeral ligament is most important for anterior stability?
Inferior
What structure bridges the gap between the greater and lesser tuberosities of the humerus? What runs through it?
Transverse Humeral Ligament.
Tendon of the long head of the biceps runs under it and is kept in place by it.
What is the nerve supply of the shoulder?
Axillary and suprascapular nerves
Muscles that produce shoulder flexion
Deltoid, pectoralis major, biceps, and coracobrachialis
“Cowboys bring pretty misses drinks”
Muscles that produce shoulder extension
Deltoid, latissimus dorsi, and teres major
“Don’t let dogs trot merrily”
Muscles that produce shoulder abduction
Deltoid, supraspinatus
“san diego will blow you away”
Muscles that produce adduction in shoulder
Pec major, latissimus dorsi, teres minor and teres major
“terry may never leave PA”
Teres minor and major, lats, pec major
Muscles of the shoulder that perform external rotation
Infraspinatous, teres minor, deltoid
Hitchhiking “Is Dumb for Minors”
Internal rotation shoulder muscles
Subscapularis, latissimus doris, teres major, deltoid
Thumbs down “Ladies don’t take major shits”
How do you test supraspinatous on PE?
Palpate above scapular spine as patient abducts against resistance
Where is the subacromial bursa located?
Between acrominon process and rotator cuff tendon. Extends distally between deltoid muscle and humerus.
What are the stabilizing features of the elbow?
Bony fit, capsule, collateral ligaments, and muscles attaching across the joint
How is the elbow innervated?
Median nerve and ulnar nerve.
What stabilizes the radio-ulnar joint?
Annular ligament
The distal radius and ulna are firmly attached by the ______ of the distal radioulnar joint.
Articular disc “Triangular ligament”
What is the pivot point for rotary movement of the radio-ulnar joint?
Ulnar styloid process attachment to radius
In full supination, the bones are ________.
Parallel
Which ligaments in the wrist joint strengthen the wrist?
Anterior and posterior ligaments
What does the medial ligament of the wrist do?
Connects styloid process of ulna to the triquetrum
What does the lateral ligament do?
Connects styloid process of raidus to the scaphoid
What is the nerve supply of the wrist?
Anterior interosseous nerve (from median nerve) and deep branches of radial and ulnar nerves
How is motion created in the radiocarpal joint?
No tendons or muscles are used: motion is determined purely by shape of the bones and ligaments.
What type of joint is a carpometacarpal joint?
Synovial gliding joint. Little motion
What ligaments prevent hyperextension in the metacarpophalangeal joints?
Palmar ligaments
When the MCP joint is in flexion, the collateral ligaments are _____ (taut, lax)
taut
What type of joint is an interphalangeal joint? (IP)
Synovial hinge joint
one in thumb, two in other digits
In surgery, what area is important to get to the shoulder joint?
Deltopectoral groove
What muscles cause flexion of the elbow?
Anterior compartment.
Biceps brachii, brachialis, brachioradialis
“Bring back big booty readheads’
What muscles cause extension of the elbow?
Posterior compartment
Triceps brachii muscle
What is the main innervation to the biceps?
Musculocutaneous nerve
What is the main innervation to the flexors of the forearm?
median nerve
What muscles cause pronation at the radioulnar joint?
Pronator teres, pronator quatratus
Anterior compartment
“pronate to pants quickly”
What muscles cause supination at the radioulnar joint?
Biceps brachii, supinator
Don’t question my “super biceps”
What are the superficial muscles of the anterior forearm?
Brachioradialis, flexor carpi radialis, palmaris longus, flxor carpi ulnaris.
Excessive use of extensors can cause what?
Tennis elbow (lateral epicondylitiis)
Excessive use of flexors can cause what?
Golfer’s elbow (medial epicondylitis)
Where does the flexor digitorum superficialis attach?
base of middle phalanx
Where does the flexor digitorum profundus attach?
Base of distal phalanx
What is the name given to the mass of muscles at the base of the thumb that help it perform various movements?
thenar compartment
What is the most common bone fractured in the wrist?
Scaphoid
What muscles act on the MP joints, aiding in flexion, extension, ad/abduction of the digits?
Interosseus and lumbrical muscles of the central compartment (intrinsic)
What is the name given to the mass of muscles at the base of the 5th digit that helps it perform various movements? What nerve damage can cause atrophy to this area?
Hypothenar compartment
Ulnar nerve damage
Where do the roots of the brachial plexus enter?
Base of the neck between the scalenes (anterior and medius)
Where are the roots of the brachial plexus located?
Scalene triangle of the neck
What nerve innvervates hte serratus anterior muscle?
Long thoracic nerve
The posterior cord of the brachial plexus gives you which nerves?
Radial and axillary
The lateral cord of the brachial plexus gives you which nerves?
musculocutaneous, contributes nerve fibers to median nerve
The medial cord of the brachial plexus gives you which nerves?
ulnar, medial antebrachial cutaneous nerve, contributes fibers to the median nerve
The cords of the brachial plexus become arranged around what?
The axillary artery
What nerve innervates the web space on dorsum between the thumb and the forefinger?
Radial
What nerve innervates the tip of the forefinger?
median
What nerve innervates the tip of the pinky?
ulnar
Which nerve divides into a superficial branch and a deep branch at the elbow? When the deep branch passes through the supinator muscle, what is its new name?
Radial nerve
Posterior interosseous nerve
Which nerve enters the deep surface of the deltoid?
Axillary
Which nerve branches in anterior compartment into each muscle and then changes its name to lateral cutaneous nerve of the forearm?
Musculocutaneous nerve
Which nerve starts at the front of the shoulder joint and then enters the hand superficially to the carpal tunnel, between pisiform and hamate bones, deep to Guyon’s canal and enters the hydrothenar compartment?
Ulnar nerve
Digital nerves include branches from what?
Median, radial, and ulnar nerves
What condition is characterized by partial occlusion of the subclavian artery so with decreased vascular resistance in the arm (vasodilation from exercise), blood is directed into the arm and away from the brain causing syncope?
Subclavian steal syndrome
Radial and ulnar collateral arteries branch from which artery?
Brachial artery
How are superficial veins drained in the arm?
Dorsal venous plexus (digital veins)
Cephalic vein (joins axillary vein)
Basilic vein (joints brachial plexus)
Median cubital vein (connects cephalic and basilic veins in cubital fossa)
How are deep veins drained in the arm?
They follow arteries. “Comcomittant veins”
Brachial vein is actually several veins that wind around brachial artery. Joined by basilic vein and enters axilla to become axillary vein, then joins cephalic vein at first rib and is subclavian vein.
Superficial lymph vessels follow the course of _______. Deep lymph vessels follow the course of ________.
Superficial veins
Arteries
Where do lymph nodes and vessels along the axillary and subclavian veins converge?
Base of the neck
Lymph vessels from the right upper limb drain where? Lymph vessels from the left upper limb drain where?
Right: veins on right side of neck
Left: thoracic duct
Specialized, thickened bands of deep investing fascia that guide and restrain tendons crossing the wrist
Retinacula
Tubular bursa that envelops a tendon, wherever a tendon is subject to friction. Subject to inflammation and swelling.
Tendon sheath
When you jam a finger, you get a hyper______ of a PIP joint.
flexion
Area between proximal palmar crease and insertion oft he flexor superficialis at the midpportion of the middle phalanx. Where both flexor tendons of the fingers run through a tight fibrous tunnel
No man’s land
Hyperflexion of the PIP joint and hyperextension of the DIP. Rupture of central slip. More common in rheumatoid arthritis
Boutinnere deformity
Evulsion of the distal extensor tendon off the distal phalanx
Mallet finger
