Upper Limb 1 Flashcards
What is the name of the shoulder joint?
The glenohumeral joint
The middle portion of the clavicle is positioned anterior or posterior?
Being S-shaped it moves forward in an anterior aspect
The medial portion (Sternal end) of the clavicle is positioned anterior or posterior?
Posterior
The lateral portion (acromial end) of the clavicle is positioned anterior or posterior?
Anterior
What is the role of the conoid ligament?
It binds the conoid tubercle of the clavicle to the coracoid process of the scapula
Which part of the clavicle is weakest?
The middle 1/3rd
What is the Allman classification used for?
Specifying the type of clavicle fracture:
> Group I = Middle 1/3rd
> Group 2 = Lateral 1/3rd
> Group 3 = Middle 1/3rd
In terms of the scapula what aspect forms the shoulder joint?
The glenoid fossa
What does the spine of the scapula continue on to form?
The Acromian of the scapula
What is the name of the fossa superior to the spine of the scapula?
The supraspinous fossa
What is the name of the fossa inferior to the spine of the scapula?
The infraspinous fossa
What is found at the superior aspect of the glenoid fossa?
The supraglenoid tubercle
What is found at the inferior aspect of the glenoid fossa?
The infraglenoid tubercle
What is the projection of the scapula found on the anterior surface?
The coracoid process
What is the fossa of the scapula found on the anterior surface?
The sub scapular fossa
What are the joints of the clavicle?
1) The Sternoclavicular
2) The acromioclavicular
What type of joint is the sternoclavicular?
Synovial saddle joint
What is the fear aspect of the scapula known as?
The blade of the scapula
What type of joint is the acromioclavicular?
Synovial plane
How does the clavicle articulate with the scapula?
At the acromian forming the acromioclavicualr joint
What is the ring of fibrocartilage surrounding the glenoid fossa called?
The glenoid/acetabular labrum
What is the role of the glenoid labrum?
The ring of fibrocartilage surrounding the glenoid fossa allows a wider and deeper joint increasing its stability.
Which ligament is found between the acromian and the coracoid process?
The coraco-acromial ligament
Which ligament(s) fix the clavicle to the coracoid process?
1) Trapezoid (In front)
2) Conoid (Behind)
What is meant by the scapula-thoracic joint?
Although not a true joint it is the movement of the scapula on the thoracic wall allowing full abduction of the shoulder joint
What is the upwards movement of the scapula called?
Elevation
What is the downwards movement of the scapula called?
Depression
What is the forwards movement of the scapula called?
Protraction
What is the backwards movement of the scapula called?
Retraction
What is the upward rotation of the scapula called? (Elevating the glenoid cavity)
Lateral rotation
What is the downward rotation of the scapula called? (Depressing the glenoid cavity)
Medial rotation
The articular surface of the humerus is known as what?
The head of the humerus
What is the groove called the tendon of the long head of the biceps brachii passes through on the humerus?
The bicipital/intertubercular groove
Which tubercles are found either side of the bicipital/intertubercualr groove of the humerus?
1) Anterior = Lesser tubercle
2) Posterior = Greater tubercle
There is a rough aspect roughly 1/2 the way down on the humerus, what is the name of this?
The deltoid tuberosity
What is the name of the loose sleeve of tissue that encloses the shoulder joint?
The joint capsule
In terms of the movement at the shoulder joint, what is it called to move forwards and upwards?
Flexion
In terms of the movement at the shoulder joint, what is it called to movement downwards and backwards?
Extension
What type of joint is the glenohumeral joint?
Synovial ball and socket
In terms of the movement at the shoulder joint, what is it called to movement away from the body?
Abduction
In terms of the movement at the shoulder joint, what is it called to movement towards from the body?
Adduction
In terms of the movement at the shoulder joint, what is it called to rotate the arm forwards, towards the body?
Internal rotation
In terms of the movement at the shoulder joint, what is it called to rotate the arm backwards, away the body?
External rotation
What is the role of the coracohumeral ligament?
Strengthen the superior aspect of the joint capsule
What is the role of the glenohumeral ligaments?
Strengthen the anterior aspect of the joint capsule
What is the coraco-acromial arch made up of?
1) The acromian
2) The coracoid process
3) Coracoacromial ligament
What is the role coraco-acromial arch?
Strengthen the superior aspect of the joint capsule, reducing the risk of a superior dislocation
Which two ligaments form the coracoclavicular ligament?
1) Trapezoid (In front)
2) Conoid (Behind)
Which part of the shoulder is weakest and not protected by muscle of ligaments?
The inferior aspect - This is why inferior-anterior dislocations are the most common
What is the role of bursae?
They are important in providing cushioning around joints, via their fluid filled interiors
Which bursa communicates with the joint cavity of the shoulder?
Subscapular bursa
What is the role of the subacromial bursa?
Provide cushioning, thus facilitating the gliding of muscles/tendons without friction on bone
Which common sporting injury damages the subacromial bursa?
Rotator cuff injury
Which muscle is found on the anterior aspect of the scapula?
The Subscapularis
Which tendon arises from the infraglenoid tubercle?
The long head of the triceps brachii
Which tendon arises from the supraglenoid tubercle?
The long head of the biceps brachii
Which muscle is found on the posterior aspect of the scapula superior to the spine?
Supraspinatus
What is the action of the subscapularis acting alone?
Internal rotation at the gleno-humeral joint
Where does the supraspinatus originate and insert?
1) Originate = Supraspinatus fossa of the scapula
2) Insert = Greater tubercle of the humerus
What is the action of supraspinatus?
Initiates abduction of the humerus
Which muscle is found on the posterior aspect of the scapula inferior to the spine?
1) Superior = Infraspinatus
2) Inferior = Teres minor
Where does the infraspinatus originate and insert?
1) Originate at the superior aspect of the infraspinatus fossa
2) Insertion = Greater tubercle above the tendon of the teres minor
Where does the teres minor originate and insert?
1) Originate at the inferior aspect of the infraspinatus fossa
2) Insertion = Greater tubercle below the tendon of the infraspinatus
What is the action of the infraspinatus and trees minor?
1) External/lateral rotation of the humerus
2) Weakly adducts the humerus
Over than movement what is the role of the tendons of the rotator cuff and the long head of the triceps brachii?
Stability of the shoulder joint, stopping the humerus moving down and out of the glenoid fossa
Which muscle originate at the lower lateral border of the scapula?
The teres major
Which muscle inserts on the posterior lip of the bicipital groove?
The teres major
What is the action of teres major?
1) Powerful adductor of the humerus
2) Extension of the humerus
3) Medial rotation of the humerus
Which muscle arises from the coracoid process?
1) The coracobrachialis
2) Short head of the biceps brachii
What is the action of the The coraco-brachialis?
Aids in flexion and adduction of the shoulder joint
Which nerves supply the terms major? What are the nerve roots?
1) The lower subscapular nerve
2) C5, C6 and C7
Which muscle attaches to the mid-medial surface of the humerus?
Coracobrachialis
Which nerves supply the coracobrachialis? What are the nerve roots?
1) Musculocutaneous nerve
2) C5, C6, C7
What is the insertion of the subscapularis muscle?
The lesser tubercle of the humerus
Which nerves supply the subscapularis? What are the nerve roots?
1) Upper and lower subscapular nerves
2) C5, C6, C7
Which nerves supply the supraspinatus? What are the nerve roots?
1) Suprascapular nerve
2) C5 and C6
Which nerves supply the infraspinatus? What are the nerve roots?
1) Suprascapular nerve
2) C5 and C6
Which nerves supply the terms minor? What are the nerve roots?
1) Axillary nerve
2) C5 and C6
Where does the serratus anterior arise?
The front of the first 8 ribs
Where does the serratus anterior insert?
The medial border of the scapula
What is the action of the serious anterior?
1) Together = Protrusion (Abducts scapula)
2) Upper fibres alone = Lateral (Upwards) rotation
3) Lower fibres alone = Medial (Downwards) rotation
Which nerves supply the serratus anterior? What are the nerve roots?
1) Long thoracic nerve
2) C5, C6 and C7
What is the origin of the pectoralis major?
1) Clavicular head: medial half of the clavicle.
2) Sternal head: sternum, upper costal cartilages (1-6), and the aponeurosis of the external oblique.
What is the insertion of the pectoralis major?
1) Lateral lip of the intertubercular (bicipital) groove of the humerus.
2) Crest of the greater tubercle of the humerus.
What is the action of the pectoralis major?
1) Clavicular head = Flex the humerus at the shoulder joint
2) Sternal head = Extends the shoulder (glenohumeral) joint from a flexed position.
3) ** Together:
- Medially rotates the shoulder
- Adduction of the shoulder
Which nerves supply the pectoralis major? What are the nerve roots?
> Clavicular head
1) Lateral pectoral nerve
2) C5, C6 and C7
> Sternal head
1) Medial pectoral nerve
2) C8 and T1
What is the space below the clavicle, between deltoid and pectoralis major muscles known as?
The deltopectoral triangle
Which vein is found within the deltopectoral triangle? What is the clinical importance of this?
1) The subclavian vein
2) Site of placement of central lines
What defines the posterior and anterior aspect of the axilla?
1) Posterior = Latissimus dorsi
2) Anterior = Pectoralis major
What is the action of the anterior head of the deltoid muscle?
1) Flex the shoulder joint
2) Horizontal adduction
3) Medially rotates the humerus
What is the action of the middle head of the deltoid muscle?
Abduction of the shoulder joint
What is the action of the posterior head of the deltoid muscle?
1) Extension of the humerus
2) Horizontal abduction
3) Laterally rotates the humerus
Which nerves supply the deltoid? What are the nerve roots?
Axillary nerve (C5 and C6)
What common injury often leads to damage of the axillary nerve?
Dislocation at the glenohumeral joint
How can damage of the axillary nerve be determined?
1) Loss of motor action of the deltoid muscle and teres minor
2) Loss of sensation over the outer aspect of
- The arm = C5
- The forearm/thumb = C6
What clinical sign is seen if there is damage to the long thoracic nerve (C5, C6, C7)?
Scapular winging
What does Scapular winging indicate?
Either damage to the long thoracic nerve, its nerve roots (C5, C6, C7) Or the serratus anterior muscle itself
During which procedure can the long thoracic nerve be damaged? What will this lead to?
Radical mastectomy - This would lead to scapular winging
What is the origin of the biceps brachii?
1) Long head: supraglenoid tubercle of the scapula.
2) Short head: coracoid process of the scapula.
What is the insertion of the biceps brachii?
1) Radial tuberosity.
2) Bicipital aponeurosis to the fascia on the medial side of the forearm.
What is the action of the biceps brachii?
1) Flexion at the elbow
2) Supinates the forearm
3) Weak flexion at the shoulder
Which nerves supply the biceps brachii? What are the nerve roots?
1) Musculocutaneous nerve
2) C5, C6 and C7
Where does the latissimus dorsi insert?
The floor of the intertubercular (bicipital) groove of humerus.
What is the action of the latissimus dorsi?
1) Adducts the humerus
2) Medial rotation of the shoulder
3) Extends the humerus
Which nerves supply the latissimus dorsi? What are the nerve roots?
1) Thoracodorsal nerve
2) C6, C7 and C8
What is the origin and insertion of the lateral head of the triceps brachii?
1) Origin = Proximal portion of posterior humerus, superior to radial groove.
2) Insertion = Posterior olecranon process of ulna.
What is the origin and insertion of the medial head of the triceps brachii?
1) Origin = Inferior 2/3 of posterior humerus, inferior to the radial groove
2) Insertion = Posterior olecranon process of ulna.
What is the origin and insertion of the long head of the triceps brachii?
1) Origin = Infraglenoid tubercle of the scapula.
2) Insertion = Posterior olecranon process of ulna.1
Which nerves supply the triceps brachii? What are the nerve roots?
1) Radial nerve
2) C7 and C8
What is the action of the triceps brachii?
Extension at the elbow joint
The olecranon process and coronoid process are parts of which bone?
The ulna bone of the forearm
Which muscles originate form the coracoid process of the scapular?
1) The short head of the biceps brachii
2) The coracobrachialis
From which cord of the brachial plexus does the musculocutaneous nerve arise?
The lateral cord
What is the origin and attachment of the brachioradialis muscle?
1) Origin = Lateral supracondylar ridge of humerus.
2) Insertion = Styloid process of radius.
What is the action of the brachioradialis?
Flexes at the elbow joint
Which nerves supply the brachioradilais? What are the nerve roots?
1) Radial nerve
2) C5 and C6
What is the origin and insertion of the brachialis muscle?
1) Origin = Anterior, distal half of humerus
2) Insertion = Coronoid process and tuberosity of ulna
What is the action of the brachialis muscle?
Flexion at the elbow joint
Which nerves supply the brachialis? What are the nerve roots?
1) Musculocutaneous
2) C5 and C6
What is the origin of the trapezius muscle?
Medial superior nuchal line and external protuberance of occipital bone, ligamentum nuchae and spinous process of C7-T12.
What is the insertion of the trapezius muscle?
Lateral clavicle, acromion and spine of scapula.
What is the action of the upper fibres of the trapezius?
1) Elevate the scapula
2) Upwardly rotate the scapula
3) Extends the neck
What is the action of the middle fibres of the trapezius?
Retraction of the scapula
What is the action of the inferior fibres of the trapezius?
Depression of the scapula
What is the innervation of the trapezius muscles?
1) Cranial nerve XI, the accessory nerve
2) Roots C3 and C4
What is the origin and insertion of the levator scapulae muscle?
1) Origin = Transverse processes of the C1-C4.
2) Insertion = Medial border of the scapula between spine and superior angle.
What is the action of the levator scapulae muscle?
1) Elevates medial border of the scapula while downwardly rotating lateral angle
2) Helps trapezius and rhomboid muscles pull scapula upward and medially
3) Bends neck laterally
What is the innervation of the levator scapulae muscle?
1) Dorsal scapular nerve (C5)
2) Ventral primary rami of C3 and C4
What is the origin and insertion of the rhomboid major muscle?
1) Origin = Spinous process of T2-T5 vertabrae.
2) Insertion = Medial border of scapula inferior to spine.
What is the origin and insertion of the rhomboid minor muscle?
1) Origin = Spinous process of C7-T1 vertebrae.
2) Insertion = Medial border of scapula superior to spine.
What is the action of the Rhomboids muscles?
1) Retracts the medial border of scapula while it downwardly rotates the lateral angle.
2) Elevates the medial border of scapula while it downwardly rotates the lateral angle.
What is the innervation of the Rhomboids muscles?
Dorsal scapular nerve (C5)
If there has been a posterior shoulder dislocation what should be considered?
Whether the individual was electrocuted or had a seizure
Why are people <20 years old at higher risk of shoulder dislocation?
Increased instability of the joint and an increased risk of a Bankart tear (Labrum tear)
Which view is the best for arthritis of the shoulder joint?
Axillary view radiograph
Which head of the biceps arises from the coracoid process along with the coracobrachialis?
Short head of the bicep
Which head of the biceps arises from the supraglenoid tubercle?
Long head of the biceps
Which head of the biceps runs through the bicipital groove of the humerus?
The long head of the biceps
To which bony process does the biceps attach to distally?
The radial tuberosity of the radius
What is the action of the biceps?
1) Flexion of the elbow joint
2) Flexion at the shoulder joint
3) Supination of the radio-ulnar joint
What is the nerve supply to the biceps brachii?
Musculocutaneous nerve (C5, C6)
Which segmental fibres (Cervical segments) mainly innervate the biceps brachhii?
C5, C6 (Musculocutaneous nerve)
From which cord of the brachial plexus does the musculocutaneous nerve arise?
Lateral cord
Where does the coracobrachialis muscle arise?
The coracoid process of the scapula along which the short head of the biceps brachii
Where does the coracobrachialis muscle attach?
The middle 1/3rd medial margin of the humerus
What is the action of the coracobrachialis on the shoulder joint?
Abduction + Flexion
What is the nerve supply of the coracobrachialis?
Musculocutaneous nerve (C5-C7)
Where does the brachialis muscle arise from?
From the anterior aspect of the distal half of shaft of the humerus.
Where does the brachialis muscle attach?
Inserts into the coronoid process of the ulna
Which muscle overlies the brachialis?
The biceps brachii
What is the main action of the brachialis on the elbow joint ?
The brachialis is a strong flexor of the elbow joint
Which nerve supplies the brachialis?
The musculocutaneous nerve (C5, C6) and the radial nerve (C7)
Which cord of the brachial plexus does the musculocutaneous nerve arise from?
The lateral cord
Which muscle does the musculocutaneous nerve perforate to enter the arm?
The coraco-brachialis
Which muscles does the musculocutaneous nerve pass between as it descends the arm?
Between the biceps and the brachialis
After supplying the muscles of the arm what does the musculocutaneous nerve continue on to become?
Continues as the lateral cutaneous nerve of the forearm
Which nerve may be damaged when there is a fracture to the medial epicondyle?
Ulnar nerve
Which nerve may be damaged when there is a fracture to the humerus mid shaft?
Radial nerve
Which nerve may be damaged when there is a fracture to the surgical neck of the humerus?
Axillary nerve
What is the segmental or root value of the musculocutaneous nerve?
C5, C6, C7
Which muscle of the arm does the musculocutaneous nerve supply?
1) Coraco-brachialis
2) Biceps brachii
3) Brachialis
Which part of the forearm foes the msuculocutaneous nerve carry cutaneous sensation. What is the nerve referred to at this site?
The lateral aspect of the forearm, it is for this reason it is named the lateral cutaneous nerve of the forearm
Does the musculocutaneous nerve supply any muscle in the forearm or hand?
No
If there was damage to the musculocutanous nerve how would someone present?
1) Loss of sensation to the lateral forearm
2) Paralysis of the elbow flexors, however the brachioradialis still functions due to innervation by the radial nerve
What is the brachial artery a continuation of?
The axillary artery
At which point does the axillary artery become the brachial artery?
Begins at the lower border of the terms major muscle
At which point does the brachial artery end?
Within the cubital for close to the neck of the radius where it branches into the radial and ulnar arteries
Which artery runs around the distal end of the humerus?
The humeral circumflex artery
Which artery arises from the brachial artery and passes lateral to the humerus?
The profunda brachial artery which further branches into anterior and posterior branches
Which artery passes between the radius and ulnar?
The common interosseous artery
Which cords does the median nerve arise from?
Both the medial and lateral cord of the brachial plexus
As the median nerve descends the arm what lies in relation to it?
As the medium nerve descends it lies lateral to the axillary artery and the upper part of the brachial artery.
In the muddle part of the arm the nerve crosses to the medial side of the brachial artery and enters the cubital fossa
What are the nerve roots of the median nerve?
C5, C6, C7, C8 and T1
What muscles does the median nerve supply?
The flexor muscles of the forearm (Except the flexor carpi and the ulnar head of flexor digitorum fundus)
Muscles of the thenar eminence
Radial two lumbricals
What cord of the brachial plexus does the ulnar nerve arise from?
The medial cord of the brachial plexus
As the ulnar nerve descends the arm what lies in relation to it?
As the ulnar nerve descends it lies medial to the brachial artery.
Enters the posterior compartment through the medial intermuscular septum.
It runs along the medial head of the triceps and to the back of the medial epicondyle
How does the ulnar nerve enter the posterior compartment of the arm?
Through the medial intermuscular septum.
Which nerve passes on the back of the media epicondyle?
The ulnar nerve
When you hit your “funny bone” which nerve is in fact being hit?
The ulnar nerve
Which muscles of the arm does the ulnar nerve supply?
Deep terminal branches = Intrinsic muscles of the hand:
- Interossei
- Medial two lumbricals
- Adductor pollicis
