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Musculoskeletal > Upper Limb > Flashcards

Upper Limb Flashcards

1
Q

Features of medial 2/3rd of clavicle

A
  • Convex anteriorly

- Circular in cross-section

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2
Q

Features of lateral 1/3rd of clavicle

A
  • Convex posteriorly

- Flattened cross-section

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3
Q

What attaches clavicle to 1st costal cartilage

A

Costoclavicular ligament

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4
Q

What attaches clavicle to coracoid process

A

Coracoclavicular ligament (conoid tubercle)

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5
Q

Significance of clavicle in embryology

A

First bone to ossify in the fetus

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6
Q

Where is the clavicle most likely to fracture

A

Junction between middle and outer thirds

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7
Q

What are the three attachments of the coracoclavicular ligament

A
  1. Coracoid
  2. Conoid tubercle of clavicle
  3. Trapezoid line of clavicle
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8
Q

What type of joint is the ACJ

A

Plane/Gliding synovial joint

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9
Q

What two ligaments make up the coracoclavicular ligament

A
  • Conoid ligament

- Trapezoid ligament

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10
Q

Which ribs does the scapula cover

A

2nd to 7th

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11
Q

Shape and orientation of humeral head

A
  • 1/3rd sphere

- Projects medially, upwards, and backwards

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12
Q

What separates the greater and lesser tubercles of the humerus

A

Bicipital (intertubercular) groove

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13
Q

Where is the surgical neck of humerus

A

At the junction between the shaft and head of humerus

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14
Q

What lies in close proximity to the surgical neck of the humerus

A
  • Axillary nerve

- Circumflex humeral vessels

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15
Q

Where is the deltoid tuberosity

A

Anterolateral aspect of midshaft

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16
Q

Where is the spiral groove of the humerus located

A

Posterior shaft

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17
Q

Significance of the spiral groove

A

Home to the radial nerve which winds around the humerus between medial and lateral heads of triceps

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18
Q

What part of the humerus articulates with the radial head

A

Capitulum

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19
Q

What part of the humerus articulates with the humerus

A

Trochlea (with trochlea notch of humerus)

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20
Q

Anterior landmarks of lower humerus

A

Coronoid fossa (accepts coronoid process of ulna)

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21
Q

Posterior landmarks of lower humerus

A

Olecranon fossa (accepts olecranon of ulna)

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22
Q

Where does the ulna nerve lie with respect of the medial condyle of humerus

A

Lies in groove on the posterior aspect

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23
Q

Significance of ulna tuberosity

A

Attachment site for brachialis

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24
Q

Direction of interosseous membrane fibres

A

Oblique course inferiorly from radius medially to ulna

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25
Q

List the proximal row of carpal bones from lateral to medial

A
  1. Scaphoid
  2. Lunate
  3. Tiquetral
  4. Pisiform
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26
Q

Proximal articulations of the Triquetral bone

A

Articular disc of the distal radio-ulnar joint

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27
Q

List the distal row of carpal bones from lateral to medial

A
  1. Trapezium
  2. Trapezoid
  3. Capitate
  4. Hamate
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28
Q

Describe the structure of the proximal ulna

A
  • Olecranon process (superior)
  • Trochlear notch
  • Coronoid process (contains radial notch)
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29
Q

List the articulations of the trapezium

A
  • Scaphoid
  • Lunate
  • 1st and 2nd metacarpal
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30
Q

List the articulations of the trapezoid

A
  • Scaphoid
  • Trapezium
  • Capitate
  • 2nd metacarpal
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31
Q

List the articulations of the capitate

A
  • Scaphoid
  • Lunate
  • Trapezoid
  • Hamate
  • 2nd metacarpal
  • 3rd metacarpal
  • 4th metacarpal
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32
Q

Articulations of the 2nd metacarpal

A
  • Trapezium
  • Trapezoid
  • Capitate
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33
Q

List the articulations of the hamate

A
  • Lunate
  • Capitate
  • Triquetrum
  • 4th metacarpal
  • 5th metacarpal
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34
Q

What deepens the glenohumeral joint

A

Glenoid labrum

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35
Q

Weakest part of the GH capsule

A

Inferior part

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36
Q

Describe the attachments of the GH capsule

A

Around the epiphyseal line of glenoid and humeral head

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37
Q

Medial margin of GH capsule

A

Margin of glenoid cavity

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38
Q

Lateral margin of GH capsule

A

Anatomical neck of humerus

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39
Q

What tendon passes through the GH joint

A

Long head of biceps tendon

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40
Q

List the 4 ligaments of the GH joint

A
  1. Glenohumeral
  2. Coracohumeral
  3. Transverse humeral
  4. Coraco-acromial
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41
Q

Describe the glenohumeral ligaments

A
  • Three bands = superior, middle, inferior
  • Only evident on the internal aspect of the capsule
  • Blend with the fibrous capsule as it attaches to neck of humerus
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42
Q

Course of the coracohumeral ligament

A

Passes from coracoid process to anterior aspect of greater tubercle of humerus

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43
Q

Describe the tranverse humeral ligament

A
  • Broad band
  • Runs from greater to lesser tubercle
  • Creates canal that transmits the synovial sheath and tendon of biceps brachii
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44
Q

What forms the coraco-acromial arch

A
  • Acromion
  • Coracoid process
  • Coraco-acromial ligament
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45
Q

Function of the coraco-acromial ligament

A

Prevents superior displacement of the humerus

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46
Q

Blood supply of the GH joint

A

Anterior and posterior circumflex humeral arteries (branches of the suprascapular artery)

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47
Q

Innervation of the GH joint

A
  • Suprascapular
  • Axillary
  • Lateral pectoral
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48
Q

Which muscles cause flexion of the shoulder

A
  • Pec major

- Anterior fibres of deltoid

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49
Q

What muscle causes extension of the shoulder

A
  • Deltoid (spinal part)
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50
Q

Which muscle initiates abduction of the shoulder

A

Supraspinatus

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51
Q

Which muscles tense the articular capsule of the GH joint

A
  • Subscapularis

- Infraspinatus

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52
Q

Which muscle resists downward dislocation of the GH joint

A

Deltoid (also long head of triceps, coracobrachialis, short head of biceps brachii)

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53
Q

What type of joint is the sternoclavicular joint

A

Sadlle-type synovial

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54
Q

List the ligaments of the SC joint

A
  • Anterior and posterior sternoclavicular ligaments
  • Interclavicular ligament
  • Costo-clavicular ligament
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55
Q

Blood supply of SC joint

A
  • Internal thoracic

- Suprascapular

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56
Q

What are the articular surfaces of the elbow joint

A
  • Humeral = trochlea (medial) and caputulum (lateral)
  • Ulna = trochlear notch
  • Radius = superior aspect of head
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57
Q

Outline the ligaments of the elbow joint

A
  • Radial collateral ligament = lateral epicondyle of humerus to blend with anular ligament of radius
  • Medial collateral ligament (triangular) = medial epicondyle of humerus to coronoid process and olecranon of the ulna
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58
Q

Function of the Anular ligament

A

Joint proximal radius and ulna

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59
Q

Describe the joint capsule of the proximal radio-ulnar joint

A

Continuous with the elbow joint

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60
Q

Which muscle elicit supination of the forearm

A
  • Supinator

- Biceps brachii (when force required)

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61
Q

Blood supply of the proximal radio-ulnar joint

A

Radial portion of the peri-articular arterial anastomosis of the elbow

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62
Q

Describe the movement of the distal radio-ulnar joint

A

Radius moves around a relatively fixed ulna

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63
Q

Blood supply of distal radio-ulnar joint

A

Anterior and posterior interosseous

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64
Q

What type of joint is the radio-carpal joint

A

Condyloid synovial joint

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65
Q

Movements permitted by the radio-carpal joint

A
  • Flexion
  • Extension
  • Adduction
  • Abduction
  • Circumduction
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66
Q

Surface marker of radio-carpal joint line

A

PROXIMAL wrist crease

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67
Q

Distal articular surfaces of the radio-carpal joint

A
  • Scaphoid
  • Lunate
  • Truquetral
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68
Q

List the ligaments of the radio-carpal joint

A
  1. Palmar radiocarpal ligaments
  2. Dorsal radiocarpal ligaments
  3. Ulnar collateral ligament
  4. Radial collateral ligament
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69
Q

Course of ulnar collateral ligament

A

Ulnar styloid to triquetral

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70
Q

Course of radial collateral ligament

A

Radial styloid to scaphoid

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71
Q

What type of joint is the CMC joint of the thumb

A

Saddle-type synovial

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72
Q

What prevents the MCP joints of the fingers spreading during a tight drip

A

Deep transverse ligaments

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73
Q

Course of Pectoralis major

A
  1. Clavicular Head = anterior surface of medial 1/2 clavicle
  2. Sternocostal Head = anterior surface of sternum and superior 6 costal cartilages
  3. Lateral lip of intertubercular sulcus of humerus
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74
Q

Innervation of Pectoralis major

A

Medial and lateral pectoral nerves

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75
Q

Course of Pectoralis minor

A
  1. 3rd-5th ribs near costal cartilage

2. Medial border and upper surface of coracoid process of scapula

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76
Q

Innervation of Pectoralis minor

A

Medial pectoral nerve

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77
Q

Action of Pectoralis minor

A

Assists serratus anterior in drawing scapula forwards and depresses the point of the shoulder

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78
Q

Course of subclavius

A
  1. Junction of 1st rib and costal cartilage

2. Inferior surface of middle 1/3rd of clavicle

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79
Q

Innervation of Subclavius

A

Nerve to subclavius (C5, C6)

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80
Q

Course of serratus anterior

A
  1. External surfaces of lateral part of ribs 1-8

2. Anterior surface of medial border of scapula

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81
Q

Innervation of serratus anterior

A

Long thoracic nerve (C5-7)

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82
Q

Course of trapezius

A
  1. Medial superior nuchal line/external occipital protuberance/nuchal ligament/spinous process C7-T12
  2. Lateral 1/3rd clavicle/acromion and spine of scapula
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83
Q

Innervation of trapezius

A

Spinal accessory nerve (CN 11)

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84
Q

Course of latissimus dorsi

A
  1. Spinous processes of inferior 6 thoracic vertebrae/thoracolumbar fascia/inferior 3/4 ribs
  2. Floor of intertubercular sulcus of humerus
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85
Q

Innervation of latissimus dorsi

A

Thoracodorsal nerve (C6-8)

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86
Q

Course of levator scapulae

A
  1. Posterior tubercles of transverse processes of C1-4

2. Medial border of scapula

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87
Q

Innervation of levator scapulae

A

Dorsal scapular and cervical nerves (C3/4)

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88
Q

Innervation of rhomboid major and minor

A

Dorsal scapular nerve

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89
Q

Course of Deltoid

A
  1. Lateral 1/3rd clavicle/acromion/spine of scapula

2. Deltoid tuberosity of humerus

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90
Q

Innervation of Deltoid

A

Axillary nerve (C5/6)

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91
Q

Course of supraspinatus

A
  1. Supraspinatus fossa of scapula

2. Superior facet of greater tubercle of humerus

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92
Q

Innervation of supraspinatus

A

Suprascapular nerve (C4-6)

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93
Q

Course of infraspinatus

A
  1. Infraspinatus fossa of scapula

2. Middle facet of greater tubercle of humerus

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94
Q

Innervation of infraspinatus

A

Suprascapular nerve (C5/6)

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95
Q

Course of teres minor

A
  1. Middle part of lateral border of scapula

2. Inferior facet of greater tubercle of humerus

96
Q

Innervation of teres minor

A

Axillary nerve (C5/6)

97
Q

Course of teres major

A
  1. Posterior surface of inferior angle of scapula

2. Medial lip of intertubercular sulcus of humerus

98
Q

Innervation of teres major

A

Lower subscapular nerve (C5/6)

99
Q

Course of subscapularis

A
  1. Subscapular fossa of anterior surface of scapula

2. Lesser tubercle of humerus

100
Q

Innervation of subscapularis

A

Upper and lower subscapular nerve (C5-7)

101
Q

Muscles involved in medial (IR) rotation of humerus

A
  1. Subscapularis
  2. Teres major
  3. Latissimus dorsi
  4. Pectoralis major
  5. Anterior part of Deltoid
102
Q

Muscles involved in lateral rotation (ER) of humerus

A
  1. Infraspinatus
  2. Teres minor
  3. Lateral part of Deltoid
103
Q

Course of Biceps brachii

A
  1. SH = tip of coracoid, LH = supraglenoid tubercle of scapula
  2. Tuberosity of radius and fascia of forearm via bicipital aponeurosis
104
Q

Innervation of biceps brachii

A

Musculocutaneous nerve (C5, C6, C7)

105
Q

Course of coracobrachialis

A
  1. Tip of coracoid

2. Medial 1/3rd of medial humeral surface

106
Q

Innervation of coracobrachialis

A

Musculocutaneous nerve (C5, C6, C7)

107
Q

Course of brachialis

A
  1. Distal 1/2 of humeral anterior surface

2. Coronoid process and tuberosity of ulna

108
Q

Innervation of brachialis

A

Musculocutaenous and radial nerve

109
Q

Function of biceps brachii

A
  • Supinates forearm
  • Flexes forearm when supine
  • Short head resists dislocation
110
Q

Function of coracobrachialis

A
  • Helps flex and adduct arm

- Resists dislocation

111
Q

Function of brachialis

A

Flexes forearm in all positions

112
Q

Which nerve root does the biceps tendon reflex test

A

C6

113
Q

Course of triceps brachii

A
  1. LH = infraglenoid tubercle of scapula, Lateral H = posterior surface of humerus, Medial H = posterior surface of humerus
  2. Proximal end of olecranon of ulna and fascia of forearm
114
Q

Innervation of triceps brachii

A

Radial nerve (C6, C7, C8)

115
Q

Course of anconeus

A
  1. Lateral epicondyle of humerus

2. Lateral surface of olecranon and superior part of posterior surface of ulna

116
Q

Innervation of anconeus

A

Radial nerve (C7, C8, T1)

117
Q

List the muscles of the anterior compartment of the arm

A
  1. Biceps brachii
  2. Brachialis
  3. Coracobrachialis
118
Q

Function of the anterior compartment of the forearm

A

Flexors and pronators

119
Q

Function of the posterior compartment of the forearm

A

Extensors and supinator

120
Q

List the layers of the anterior compartment of the forearm

A
  1. Superficial layer - all originate from common flexor tendon on medial epicondyle of humerus
  2. Intermediate layer
  3. Deep layer - all do NOT cross the elbow joint
121
Q

List the muscles of the superficial compartment of the forearm

A
  1. Pronator teres
  2. Flexor carpi radialis
  3. Palmaris longus
  4. Flexor carpi ulnaris
122
Q

List the muscles of the intermediate compartment of the anterior forearm

A

Flexor digitorum superficialis

123
Q

List the muscles of the deep compartment of the anterior forearm

A
  1. Flexor digitorum profundus
  2. Flexor pollicis longus
  3. Pronator quadratus
124
Q

Describe the innervation of the anterior compartment of the forearm

A

All but FCU are supplied by the median nerve (Deep anterior compartment is anterior interosseous branch of median nerve)

125
Q

Course of pronator teres

A
  1. Ulnar head = coronoid, Humeral head = medial epicondyle

2. Middle convexity of lateral radial surface

126
Q

Course of Flexor carpi radialis

A
  1. Medial epicondyle

2. Base of 2nd metacarpal

127
Q

Course of Palmaris longus

A
  1. Medial epicondyle

2. Distal half of flexor retinaculum

128
Q

Course of Flexor carpi ulnaris

A
  1. Humeral head = medial epicondyle, Ulnar head = olecranon

2. Pisiform/hook of hamate/5th metacarpal

129
Q

Course of Flexor digitorum superficialis

A
  1. Humero-ulnar head = medial epicondyle, Radial head = superior half of anterior border
  2. Shafts of medial phalanges of the medial 4 digits
130
Q

Function of Flexor digitorum superficialis

A

Flexes middle phalanges at PIPs and MCPs

131
Q

Innervation of Flexor digitorum profundus

A
  • Medial part = ulnar nerve

- Lateral part = anterior interosseous nerve

132
Q

Course of Flexor digitorum profundus

A
  1. Proximal 3/4 of medial and anterior surface of ulna and interosseous membrane
  2. Bases of distal phalanges 2-5
133
Q

Course of Flexor pollicis longus

A
  1. Anterior surface of radius and interosseous membrane

2. Base of distal phalanx of thumb

134
Q

Course of Pronator quadratus

A
  1. Distal 1/4 of anterior surface of ulna

2. Distal 1/4 of anterior surface of radius

135
Q

Function of Flexor digitorum profundus

A

Flexes DIPs

136
Q

When do the extensor tendons of the forearm get provided with synovial sheaths

A

As the tendon passes over the dorsum of the wrist

137
Q

How can the muscles of the posterior compartment of the forearm be FUNCTIONALLY divided

A
  1. Muscles that extend and abduct/adduct the hand at the wrist
  2. Muscles that extend the medial 4 fingers
  3. Muscles that extend or abduct the thumb
138
Q

Course of brachioradialis

A
  1. Supra-condylar ridge of humerus

2. Lateral surface of distal radius

139
Q

Function of brachioradialis

A

Weak flexion of forearm, maximal when mid-pronated

140
Q

Course of extensor carpi radialis longus

A
  1. Lateral supracondylar ridge of humerus

2. Dorsal aspect of base of 2nd metacarpal

141
Q

Course of extensor carpi radialis brevis

A
  1. Lateral epicondyle

2. Dorsal aspect of base of 3rd metacarpal

142
Q

Course of extensor digitorum

A
  1. Lateral epicondyle

2. Extensor expansion of medial 4 digits

143
Q

Course of extensor digiti minimi

A
  1. Lateral epicondyle

2. Extensor expansion of 5th digit

144
Q

Course of extensor carpi ulnaris

A
  1. Lateral epicondyle and posterior border of ulna

1. Dorsal aspect of base of 5th metacarpal

145
Q

List the muscles of the superficial layer of the posterior compartment of the forearm

A
  1. Brachoradialis
  2. Extensor carpi radialis longus
  3. Extensor carpi radialis brevis
  4. Extensor digitorum
  5. Extensor digiti minimi
  6. Extensor carpi ulnaris
146
Q

Course of supinator

A
  1. Lateral epicondyle/radial collateral ligaments/supinator fossa/crest of ulna
  2. Proximal 1/3rd of radius laterally
147
Q

Course of extensor indices

A
  1. Posterior surface of distal 1/3rd ulna/interosseous membrane
  2. Extensor expansion of 2nd digit (index finger)
148
Q

Course of Abductor pollicis longus

A
  1. Posterior surface of proximal half or radius and ulna/interosseous membrane
  2. Base of 1st metacarpal
149
Q

Course of extensor pollicis longus

A
  1. Posterior surface of proximal half or radius and ulna/interosseous membrane
  2. Dorsal aspect of base of distal phalanx of thumb
150
Q

Course of extensor pollicis brevis

A
  1. Posterior surface of distal 1/3rd radius/interoessous membrane
  2. Dorsal aspect of base of proximal phalanx of thumb
151
Q

Muscles of forearm innervated by radial nerve

A
  • Brachioradialis

- Extensor carpi radialis longus

152
Q

Muscles of forearm innervated by Deep branch of radial nerve (C7, C8)

A
  • Extensor carpi radialis brevis
  • Extensor digitorum
  • Extensor digit minimi
  • Extensor carpi ulnaris
  • Supinator
153
Q

Muscles of forearm innervated by posterior interosseous nerve (continuation of deep branch of radial nerve)

A
  • Extensor indices
  • Abductor pollicis longus
  • Extensor pollicis longus
  • Extensor pollicis brevis
154
Q

Anterior border of anatomical snuffbox

A

Tendons of extensor pollicis brevis and abductor pollicis longus

155
Q

Posterior border of anatomical snuffbox

A

Tendon of extensor pollicis longus

156
Q

Proximal border of anatomical snuffbox

A

Styloid process of radius

157
Q

Floor of anatomical snuffbox

A
  • Trapeziuim

- Scaphoid

158
Q

Contents of the anatomical snuffbox

A

Radial artery

159
Q

Contents of the thenar eminence

A
  • Abductor pollicis brevis
  • Opponens pollicis
  • Flexor pollicis brevis
160
Q

Contents of the hypothenar eminence (Muscles of the little finger)

A
  • Opponens digiti minimi
  • Flexor digiti minimi brevis
  • Abductor digiti minimi
161
Q

Describe the interossei

A
  • 4 palmar = adduct fingers and flex MCPs

- 4 dorsal = abducts fingers and extend IPJs

162
Q

Innervation of the interossei

A

Deep ulnar branch of the ulnar nerve

163
Q

Describe the lumbricals

A
  • Origin = deep flexor tendon
  • Insertion = dorsal extensor hood
  • Innervation: 1st and 2nd = median, 3rd and 4th = deep branch of ulnar
  • Function = flex MCPs and extend ICPs
164
Q

Muscle of the hand innervated by median nerve

A 
L = lumbricals 1 and 2 
O = opponens pollicis 
A = Abductor pollicis brevis 
F = flexor pollicis brevis
165
Q

How many bones make up the hand

A
  • 8 carpal
  • 5 metacarpal
  • 14 phalanges
166
Q

Which finger is not attached to the interossei muscles

A

Middle finger

167
Q

Describe the course of the axillary artery

A
  1. Begins at the lateral border of 1st rib as continuation of subclavian artery
  2. Passes posterior to pectorlais minor
  3. Ends at the inferior border of teres major by becoming brachial artery
168
Q

What structure divides the axillary artery into 3 parts

A

Pectoralis minor

169
Q

Describe the 1st part of the axillary artery and its branches

A
  • Between lateral border of 1st rib and medial border of pec minor
  • Enclosed by axillary sheath with axillary vein which is surrounded by cords of brachial plexus
  • 1 branch = superior thoracic artery
170
Q

Describe the 2nd part of the axillary artery and its branches

A
  • Lies posterior to pectoralis minor
  • 2 branches:
    A) Thoracoacromial artery
    B) Lateral thoracic arteries
171
Q

Describe the 3rd part of the axillary artery and its branches

A
  • Extends from lateral border of pec minor to inferior border of teres major
  • 3 branches:
    A) Subscapular artery
    B) Anterior circumflex humoral artery
    C) Posterior circumflex humoral artery
172
Q

Distribution of superior thoracic artery

A
  • Serratus anterior

- 1st/2nd intercostal spaces

173
Q

Distribution of lateral thoracic artery

A

Lateral aspect of the breast

174
Q

Describe the course and distribution of profunda brachii artery

A
  • Branch of brachial artery
  • Accompanies radial nerve along radial groove of humerus
  • Supplies posterior compartment of arm
175
Q

Describe the anatomical relations of the axillary sheath (1st part of axillary artery)

A
  • Within the sheath = medial cord of brachial plexus lies behind artery
  • Anteriorly = clavipectoral fascia
  • Superolaterally = lateral and posterior cords of brachial plexus
  • Inferomedially = axillary vein
176
Q

Describe the anatomical relations of the second part of the axillary artery

A
  • Posterior = posterior cord of brachial plexus and subscapularis
  • Anteriorly = pectoralis minor and major
  • Laterally = lateral cord of brachial plexus
  • Medially = medial cord of brachial plexus separates it from brachial vein
177
Q

Describe the anatomical relations of the third part of the axillary artery

A
  • Posterior = subscapularis, latissimus dorsi, teres major
  • Axillary and radial nerve lies between it and subscapularis
  • Anterior = medial root of median nerve
  • Laterally = median and musculocutaneous nerves and corcacobrachialis
  • Medially = axillary vein
178
Q

Where is the quadrangular space

A

Gap in the posterior wall of the axilla, allowing access to the posterior arm and shoulder area

179
Q

Contents passing through the quadragular space

A

Axillary nerve and posterior circumflex humeral artery (branch of the 3rd part of axillary artery)

180
Q

Location and function of the clavipectoral fascia

A
  • Under pec major

- Protects axillary vessels

181
Q

Bounds of the clavipectoral triangle

A
  • Pec major
  • Deltoid
  • Clavicle
182
Q

Contents of the clavipectoral triangle

A
  • Cephalic vein enters axilla

- Medial and lateral pectoral nerves leave

183
Q

Course of the brachial artery

A
  • Begins at lower border of teres major
  • Terminates in the cubital fossa at the level of the neck of the radius
  • Divides into radial and ulnar arteries
184
Q

What separates the brachial artery from the median cubital vein in the cubital fossa

A

Bicipital aponeurosis

185
Q

Where is the brachial artery crossed by the median nerve

A

Middle of the arm

186
Q

List the branches of the brachial artery

A
  • Profunda brachii

- Superior and inferior ulnar collateral arteries

187
Q

Course of the Basilic vein

A
  1. Originates on the medial side of the dorsal venous network of the hand
  2. Passes up the forearm and arm, mostly superficial
  3. Midway up humerus (border of teres major) it passes deep under the muscles
  4. Anterior and posterior circumflex humeral veins drain into it at the lower border of teres major
  5. Joined by medial brachial vein before draining into axillary vein
188
Q

Course of the Cephalic vein

A
  1. Originates from lateral side of dorsal venous arch of the hand
  2. Crosses the anatomical snuffbox and travels laterally up the arm
  3. Pierces deep fascia of deltopectoral groove to join axillary vein
189
Q

What forms the axillary vein

A
  1. Basilic vein

2. Brachial vein

190
Q

What accompanies the basilic vein on its course

A

Medial cutaneous nerve

191
Q

Course of the ulnar artery

A
  1. Begins at the middle of the antecubital fossa
  2. Passes obliquely downwards
  3. Follows ulnar border to the wrist
  4. Crosses over flexor retinaculum
  5. Divides into superficial and deep volar arches
192
Q

Anatomical relations of the ulnar artery

A
  • Anterior = pronator teres, FCU, palmaris longus
  • Lies on = brachialis, FDP
  • Median nerve crosses artery after 2.5cm
  • Ulnar nerve lies medial to the lower 2/3rd of the artery
193
Q

What separates the ulnar artery from the median nerve

A

Ulnar head of pronator teres

194
Q

Borders of Guyon’s (Ulnar) Canal

A
  • Medial (ulnar) = pisiform, abductor digiti minimi
  • Lateral = hook of hamate
  • Roof = palmar carpal ligament
  • Floor = flexor retinaculum and hypothenar muscles
195
Q

Contents of Guyon’s canal

A
  • Ulnar nerve bifurcates in canal to superficial (sensory) and deep (motor) branches
  • Ulnar artery (located on radial aspect of the ulnar nerve)
  • Venae comitantes of ulnar artery
  • Lymphatic vessels
196
Q

Course of the radial artery

A
  1. Commences at level of radial neck lying on biceps tendon
  2. Overlapped by brachioradialis
  3. Lies between brachioradialis and FCR in distal forearm
  4. Passes deep to APL and EPB tendons to enter snuffbox
197
Q

What forms the brachial plexus

A

Anterior rami of C5-T1 form the roots of the plexus

198
Q

Describe the course of the brachial plexus from neck to axilla

A
  1. Roots pass in gap between anterior and middle scalene
  2. As they enter the posterior triangle the trunks are formed
  3. Passes deep to clavicle and suprascapular vessels
  4. Enters axilla where the cords are formed
199
Q

How is the brachial plexus divided

A
  • Roots
  • Trunks
  • Divisions
  • Cords
  • Branches
    (Real Teenagers Drink Cold Beer)
200
Q

Where are the roots of the brachial plexus located

A
  • In posterior triangle

- Pass between anterior and middle scalene

201
Q

Where are the trunks of the brachial plexus located

A
  • Posterior to middle 1/3rd of clavicle
  • Upper and middle trunks related superiorly to subclavian artery
  • Lower trunk passes over 1st rib posterior to subclavian artery
202
Q

Where are the divisions of the brachial plexus

A

Apex of the axilla

203
Q

What forms the basis of the names of the cords of the brachial plexus

A

By their relation to the axillary artery

204
Q

Outline which roots become which trunks of the brachial plexus

A
  1. Superior trunk = C5 and C6
  2. Middle trunk = C7
  3. Inferior trunk = C8 and T1
205
Q

Describe how trunks become divisions of the brachial plexus

A

All trunks divide into anterior and posterior divisions

206
Q

Describe how the divisions form the cords of the brachial plexus

A
  • Posterior divisions all unite to form Posterior cord (C5-8)
  • Anterior divisions of superior and middle trunks form Lateral cord (C5-7)
  • Anterior division of the inferior trunk continues as the Medial cord (C8, T1)
207
Q

Where do the branches of the brachial plexus form

A

Beginning of the 3rd part of the axillary artery

208
Q

What nerves arise from the lateral cord

A
  • Musculocutaneous
  • Median (in tandem with medial cord)
  • Lateral pectoral nerve
209
Q

What nerves arise from the posterior cord

A
  • Axillary
  • Radial
  • Upper and lower subscapular nerves
  • Thoracodorsal nerve
210
Q

What nerves arise from the medial cord

A
  • Ulnar
  • Median (in tandem with lateral cord)
  • Medial brachial cutaneous nerve
  • Medial antebrachial cutaneous nerve
211
Q

Course of musculocutaneous nerve

A
  1. Branch of lateral cord
  2. Penetrates coracobrachialis
  3. Passes obliquely between biceps brachii and brachialis to lateral side of arm
  4. Pierces deep fascia lateral to tendon of biceps brachii above the elbow
  5. Continues in the forearm as the lateral cutaneous nerve
212
Q

What is innervated by the musculocutaneous nerve

A
  • Coracobrachialis
  • Biceps brachii
  • Brachialis
213
Q

Course of the median nerve

A
  1. Arises from medial and lateral cord of the plexus
  2. Initially anterior to 3rd part of axillary artery
  3. Descends lateral to brachial arteries before crossing over artery to medial side
  4. Passes deep to bicipital aponeurosis and median cubital vein at the elbow
  5. Passes between the heads of pronator teres and runs on the deep surface of FDS
  6. Becomes superficial at the wrist between tendons of FDS and FCR but deep to palmaris longus
  7. Passes deep to flexor retinaculum but anterior to long flexor tendons in the tunnel
214
Q

Branches of the median nerve in the forearm

A
  • Pronator teres
  • Pronator quadratus
  • FCR
  • Palmaris longus
  • FDS
  • FPL
  • FDP (radial half)
215
Q

Motor branches of the median nerve in the hand

A
  • L = Lateral 2 lumbricals
  • O = Opponens pollicis
  • A = ABductor pollicis brevis
  • F = Flexor pollicis brevis
216
Q

Course of the axillary nerve

A
  1. Terminal branch of posterior cord of plexus
  2. Descends posterior to axillary artery
  3. Passes through quadrangular space with posterior circumflex humeral vessels
  4. Divides into anterior and posterior branches
  5. Innervates deltoid muscle and patch of skin over deltoid
217
Q

Course of the radial nerve

A
  1. Continuation of posterior cord of plexus
  2. Lies posterior to axillary artery on subscapularis, latissimus dorsi and teres major
  3. Enters arm between brachial artery and long head of triceps medial to humerus
  4. Spirals around the posterior surface of humerus in its groove
  5. Pierces intermuscular septum at the distal 1/3rd of lateral border and descends in front of lateral epicondyle
  6. Lies deep between brachialis and brachioradialis where it divides into superficial and deep branches
  7. Deep branch crosses the supinator to become posterior interosseous branch
218
Q

Distribution of radial nerve

A
  • Triceps
  • Anconeus
  • Brachioradialis
  • Extensor carpi radialis
219
Q

Distribution of posterior interoesseous branch

A
  • Supinator
  • ECU
  • Extensor digitorum
  • Extensor indices
  • Extensor digiti minimi
  • EPL
  • EPB
  • APL
220
Q

Course of the ulnar nerve

A
  1. Continuation of medial cord of plexus
  2. Descends posteromedial aspect of upper arm to flexor compartment of forearm
  3. Passes beneath FCU and superficially over the flexor retinaculum of the hand
221
Q

Distribution of the muscular branch of the ulnar nerve

A
  • FCU

- Medial half of flexor digitorum profundus

222
Q

List the branches of the ulnar nerve

A
  • Muscular
  • Palmar cutaneous branch
  • Dorsal cutaneous branch
  • Superficial branch
  • Deep branch
223
Q

Distribution of the superficial branch of the ulnar nerve

A

Cutaneous fibres to the anterior surfaces of the medial 1.5 digits

224
Q

Distribution of the deep branch of the ulnar nerve

A
  • Hypothenar muscles
  • All interosseous muscles
  • 3rd and 4th lumbricals
  • Medial head of flexor pollicis brevis
225
Q

Effect of ulnar nerve damage at the wrist

A
  • Wasting and paralysis of intrinsic hand muscles (claw hand)
  • Wasting of hypothenar muscles
  • Loss of sensation of medial 1.5 digits
226
Q

Effect of ulnar nerve damage at the elbow

A
  • Radial deviation of wrist

- Less clawing of 4th and 5th digits

227
Q

What forms the base of the axilla

A

Skin and fascia of the armpit

228
Q

Describe the bounds of the axilla

A
  • Medial = rib cage/serratus anterior
  • Lateral = bicipital groove of humerus
  • Anterior = pec major and minor
  • Posterior = latissimus dorsi, teres major, subscapularis
229
Q

What forms the apex of the axilla

A

Clavicle, 1st rib, acromion, superior border of scapular

230
Q

Contents of the axilla

A
  • Brachial plexus
  • Axillary artery
  • Axillary vein
  • Lymph nodes
  • Fat
231
Q

Borders of the antecubital fossa

A
  • Medial = pronator teres
  • Lateral = brachioradialis
  • Floor = brachialis and supinator
  • Roof = skin, superficial fascia, deep fascia augmented by bicipital aponeurosis
232
Q

Contents of antecubital fossa from lateral to medial

A
  1. Radial nerve
  2. Biceps tendon
  3. Brachial artery
  4. Median nerve
233
Q

Describe the flexor retinaculum

A
  • Thick connective tissue forming roof of carpal tunnel

- Extends from hook of hamate and pisiform to scaphoid and trapezium

234
Q

Surface marker of entrance to carpal tunnel

A

Distal wrist crease

235
Q

Contents of the carpal tunnel

A
  • Tendon of Flexor pollicis longus (has its own sheath)
  • Four tendons of Flexor digitorum superficialis
  • Four tendons of Flexor digitorum profundus
  • Median nerve
236
Q

Divisions of the median nerve in the hand

A
  1. Recurrent branch = innervates palmar skin and dorsal nail beds of lateral 3.5 fingers, lateral 2 lumbricals
  2. Palmar digital branch = supplies thenar muscle group

Musculoskeletal (5 decks)

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