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Anatomy > Upper Limb > Flashcards

Upper Limb Flashcards

1
Q 
Origin
Insertion
Action
Nerve 
Special features
Pec Major
A

Clavicular head from medial 1/2 of clavicle. Sternocostal head from lateral manubrium and sternum, 6 upper costal cartilages and external oblique aponeurosis.

Lateral lip of bicipital groove of humerus and anterior lip of deltoid tuberosity

Clavicular: flexes and adducts arm
Sternal: adducts and medially rotates arm
Accessory muscle of respiration.

Medial pectoral nerve abd lateral pectoral nerve

Only muscle to be supplied by all 5 segments of brachial plexus. Folds on itself with clavicular fibres lowest and sternal fibres highest

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2
Q 
Origin
Insertion
Action
Nerve 
Special features
Pec Minor
A

Anterior aspect of 3,4, 5 ribs

Med and upper surface of coracoid process of scapula

Elevates ribs if scapula fixed, protraction of scapula

Medial pectoral nerve and lateral pectoral nerve (c6-8)

Pierced by medial pectoral nerve. Enclosed by clavipectoral fascia, landmark for axillary artery and cords of plexus

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3
Q 
Origin
Insertion
Action
Nerve 
Special features
Subclavius
A

Costochondral junction of first rib

Subclavian groove on middle 1/3 of clavicle

Depresses and steadies clavicle

Nerve to subclavius (C5,6, upper trunk)

Enclosed by clavipectoral fascia which forms costocoracoid ligament

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4
Q

Which four structures pierce the clavipectoral fascia?

A

Lymphatics
Cephalic vein
Lateral pectoral nerve
Thoracoacromial artery

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5
Q 
Origin
Insertion
Action
Nerve 
Special features
Trapezius
A

Med 1/3 sup nuchal line, ligamentum nuchae, spinous process and supraspinous ligs of all thoracic vertebrae

Upper fibres to lat 1/3 of post border of clavicle, med acromion and lat spine of scapula, lower fibres to med end of scapula spine as far as deltoid tub spine

Elevates and retracts scapula, rotates it during abduction of the arm. If scapula fixed extends and laterally flexes neck. Assists in raising arm above head

Spinal root of accessory nerve CNXI, proprioceptive C3 C4

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6
Q 
Origin
Insertion
Action
Nerve 
Special features
Latissimus dorsi
A

All thoracic spines and supraspinous ligs of lower 6 vertebrae, and L/S spines via lumbar fascia, post 1/3 iliac crest, lower 4 ribs (id w/ EOM)

Floor of bicipital groove of humerus after spiralling around teres major

Extends, adducts and medially rotates arm, costal also helps with deep inspiration

Thoracodorsal nerve from posterior cord C6-8

Glistening tendon
Highest fibres insert lowest into tendon
Only muscle of upper limb to have a pelvic attachment (via lumbar fascia)
Fibres from lowest 4 ribs interdigitate with external oblique

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7
Q 
Origin
Insertion
Action
Nerve 
Special features
Rhomboid major
A

Spines T2-T5 and supraspinous ligaments

Lower 1/2 of posteromedial border of scapula

Retracts scapula and rotates to rest position

Dorsal scapula nerve C5 from root

Test by pushing elbow back against resistance with hand on hip

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8
Q 
Origin
Insertion
Action
Nerve 
Special features
Rhomboid minor
A

Lower ligamentum nuchae, spines of C7/T1

Small area of posterior border of scapula at the level of the spine

Retracts scapula and rotates to rest position

Dorsal scapula nerve C5 from root

Test by pushing elbow back against resistance with hand on hip

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9
Q 
Origin
Insertion
Action
Nerve 
Special features
Levator scapulae
A

Post tubercle of transverse processes of C1-C4

Upper part of med border of scapula

Raises med border of scapula and laterally flex neck

Anterior rami of C3 and C4 and dorsal scapular nerves C5

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10
Q 
Origin
Insertion
Action
Nerve 
Special features
Serratus anterior
A

Upper 8 ribs, lowest 4 interdigitate with EOM

Inner med border of scapula; 1+2 upper angle, 3+4 costal margin, 5-8 inf angle

Laterally rotates upwards and protracts scapula, assists in raising arm above head

Long thoracic nerve from C5, C6, C7

Tested by pushing on a wall: winged scapula in paralysis
Nerve lies behind mid axillary line (usually protected in axillary operations)

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11
Q

What four ligaments make up the sternoclavicular joint?

A

Anterior and posterior sternoclavicular ligaments
Interclavicular ligament
Costoclavicular ligament

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12
Q

What is the key ligament in the acromioclavicular joint?

A

Coracoclavicular ligament
Attaches corocoid to clavicle
In 2 parts: conoid and trapezoid
Movements are all passive

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13
Q 
Origin
Insertion
Action
Nerve 
Special features
Subscapularis
A

Medial 2/3 of subscapular fossa of ant scapula

Lesser tubercle of humerus

Med rotates arm and stabilises shoulder joint

Upper and lower subscapular nerves C5,C6 from posterior cord

Subscap bursa communicates with shoulder joint

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14
Q 
Origin
Insertion
Action
Nerve 
Special features
Supraspinatus
A

Med 3/4 of supraspinous fossa of scapula

Greater tubercle of humerus, blends with shoulder joint capsule

Abducts arm and stabilises shoulder joint

Suprascapular nerve C5, C6 from superior trunk

Subacromial bursa lies above its tendon which forms part of rotator cuff. Test is abduction against resistance

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15
Q 
Origin
Insertion
Action
Nerve 
Special features
Infraspinatus
A

Med 3/4 of infraspinatous fossa of posterior scapula and deep infraspinous fascia

Middle facet of greater tubercle of humerus and capsule of shoulder joint

Laterally rotates arm and stabilises shoulder joint

Suprascapular nerve C5, C6 from superior trunk

Tested by keeping elbow flex and into side, then externally rotated forearm to the side. Bursa lies under its tendon. Covered by infraspinous fascia

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16
Q 
Origin
Insertion
Action
Nerve 
Special features
Teres minor
A

Middle 3rd of lat border of posterior scapula

Inf facet of greater tubercle of humerus andcapsule of shoulder joint

Lat rotates arm and stabilises shoulder joint

Axillary nerve (C5, 6) from posterior cord

Tendon forms part of rotator cuff, covered by infraspinatous fascia

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17
Q 
Origin
Insertion
Action
Nerve 
Special features
Teres major
A

Lower 1/3 of lateral side of inf angle of scapula

Medial lip/intertubular sulcus of ant humerus

Medially rotates and adducts arm, stabilises shoulder joint

Lower subscap nerve C6,C7 from posterior cord

Test is adduct arm against resistance. Lies in front of triceps and behind lat dorsi

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18
Q 
Origin
Insertion
Action
Nerve 
Special features
Deltoid
A

Lateral 1/3 of clavicle, acromion and spine of scapula

Deltoid tuberosity

Abducts arm, ant fibres flex and medial rotate, post fibres extend and laterally rotate

Axillary nerve (C5 and 6) from posterior cord

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19
Q

What are the three main vessels of the scapular anastomosis and what are their origins?

A

Transverse cervical artery/subclavian -> dorsal scapular artery

1st part of subclavian->Thyrocervical trunk -> transverse cervical->suprascapular artery

Axillary-> subscapular-> circumflex scapular branch

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20
Q

Where does the transverse humeral ligament lie?

A

Between the greater and lesser tubercles of humerus

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21
Q

Which muscular tendon is intracapsular with the shoulder joint?

A

Biceps brachii tendon, long head

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22
Q

Where do the 3 cords of the brachial plexus enter the axilla?

A

Formed behind the clavicle and enter axilla above the axillary artery

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23
Q

How does the axillary artery enter the axilla?

A

Passes over serratus anterior at the outer border of the first rib, behind the midpoint of the clavicle

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24
Q

Where does the axillary artery become the brachial artery?

A

At the lower border of teres major. Divided into 3 according to position in relation to pec minor; above, behind and below. The part that sits behind the muscle is surrounded by the 3 cord of the brachial plexus

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25
Q

How does the axillary artery divide?

A

1st/ above pec minor: superior thoracic artery (pec muscles)
2nd/ behind pec minor: thoracoacromial (splits into 4) and lateral thoracic (pecs and boobs)

3rd/below pec minor: subscapular, and 2 circumflex humeral arteries (anterior and posterior)

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26
Q

Which branch of the axillary artery runs with the axillary nerve?

A

Axillary artery->3rd part-> posterior circumflex artery
Passes between subscapularis and teres major lateral to long head of triceps
Supplies the deltoid
Anastomses with anterior circumflex artery and profunda brachii artery

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27
Q

Describe the axillary vein

A

No sheath
Medial to artery and nerve
Becomes subclavian vein once over the first rib

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28
Q

What are the 5 nerve roots of the brachial plexus?

A 
C5 (phrenic, dorsal scapular, long thoracic)
C6 (long thoracic)
C7 (long thoracic)
C8
T1 (1st intercostal)
Lie behind scalenus medius
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29
Q

What are the 3 trunks of the brachial plexus?

A

Superior (suprascapular nerve)
Middle
Inferior
Cross the posterior triangle of the neck

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30
Q

Where are the divisions of the brachial plexus?

A

Behind the clavicle

All 3 trunks form an anterior and posterior division

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31
Q

How do the cords of the brachial plexus relate to the axillary artery?

A

They enter the axilla above the first part, then embrace the second part, and give off their branches around the third part

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32
Q

What are the 3 cords of the brachial plexus?

A

Lateral (lateral pectoral nerve)
Posterior (upper subscapular, thoracodorsal, lower subscapular)
Medial (medial pectoral nerve, medial cutaneous nerve of the arm, medial cutaneous nerve of the forearm)

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33
Q

What are the 5 terminal branches of the brachial plexus, which spinal nerves do they originate from and which cords do they come from?

A 
Musculocutaneous C5-7 Lateral cord
Axillary C5-6 Posterior cord
Radial C5-T1 Posterior cord
Median C5-T1 Lateral and medial cords
Ulnar C7-T1 Medial cord
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34
Q

Describe the course of the axillary nerve

A

Passes between subscapularis and teres major, lateral to the long head of triceps (through quandrangular space)
Lies in contact with surgical neck of humerus. Gives branches to shoulder joint and splits into anterior and posterior. Anterior supplies deltoid. Posterior supplies teres minor then becomes cutaneous as the upper lateral cutaneous nerve of the arm

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35
Q

Describe how the radial nerve gets to the arm

A

Crosses the lower border of posterior axillary wall, lies on top of glistening lat dorsi tendon, passes through triangular space- with profunda brachii (lower border of teres major, long head of triceps and humerus). Supplies long head of triceps and the extensor compartment of forearm
Largest nerve in whole plexus

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36
Q

What is the blood and nerve supply to the breast? Which nerves are at risk of damage during mastectomy?

A

Lateral thoracic artery
T4 to T6 intercostal nerve
Long thoracic and thoracodorsal nerves

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37
Q 
Origin
Insertion
Action
Nerve 
Special features
Triceps
A

Long head: infraglenoid tubercle of scapula
Lat head: Upper half post. humerus
Med head: lower half post. humerus

Posterior part of upper olecrenon process and posterior capsule

Extends elbow, stabilises shoulder and retracts capsule of elbow internally

Radial nerve C7-8 4 branches

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38
Q

What is the key stabilising factor of the shoulder joint?

A

The 4 rotator cuff muscles (supraspinatus, infraspinatus, subscapularis and teres minor) all fuse with the lateral part of the capsule

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39
Q 
Origin
Insertion
Action
Nerve 
Special features
Corocobrachialis
A

Corocoid process of scapula with biceps brachii

Middle 3rd of medial border of humerus

Flexes and weekly adducts arm
Mscn N C5,-7

Musculocutanous nerve pierces

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40
Q 
Origin
Insertion
Action
Nerve 
Special features
Biceps brachii
A

Long head from supraglenoid tubercle of scapula. Short head from coracoid process

Posterior border of bicipital tuberosity of radius and bicipital aponeurosis to deep fascia

Supinates forearm, flexes elbow, weakly flexes shoulder

Mscn N

No attachments to humerus

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41
Q 
Origin
Insertion
Action
Nerve 
Special features
Brachialis
A

Ant lower 1/2 of humerus and med and lat IM septa

Coronoid process and tuberosity of ulba

Flexes elbow

Mscn N and cheeky small supply radial nerve

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42
Q

Describe the origin and course of the brachial artery

A

Continuation of axillary artery
Superficial, immediately deep to the deep fascia of the anteromedial aspect of the arm
Median nerve laterally above, medial side below
Ulnar nerve posterior above
Artery splits into radial and ulnar arteries

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43
Q

Branches of brachial artery

A 
Ulnar
Radial
Profunda brachii (supplies triceps and splits into radial collateral and medial collateral)
Superior ulnar collateral
Inferior ulnar collateral
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44
Q

Veins of the arm?

A

Cephalic (lateral) -lies in groove between deltoid and pec major
Basilic (medial)->axillary vein

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45
Q

Course of median nerve

A

Commences lateral to axillary artery

Lies in front and medial to brachial artery at elbow

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46
Q

Course of the musculocutaneous nerve

A

Pierces coracobrachialis and lies between biceps and brachialis
Supplies flexor compartment of the arm

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47
Q

Course of ulnar nerve

A

Gives no branches in the arm
Branch to elbow joint comes off as it lies on the groove behind medial epicondyle of humerus where it is palpable
Disappears into forearm between the heads of flexi carpi ulnaris

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48
Q

Course of medial cutaneous nerve of the forearm

A

Commences between axillary artery and vein
Divides into anterior and posterior branches
Anterior branch passes over the median cubital vein
Supplies skin to lower part of the arm and over medial forearm

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49
Q

What does the intercostobrachial nerve supply?

A

A branch of the second intercostal nerve

Supplies skin of axilla and medial upper arm and communicates with medial cutaneous nerve of the arm

50
Q

Describe the course of the radial artery within the arm

A

Enters through triangular space with profunda brachii
Runs between brachialis and brachioradialis
Supplies elbow joint
Gives lower lateral cutaneous nerve of the arm and posterior cutaneous nerve of the forearm.
Gives branches to brachioradialis, extensor carpi radialis longus and the lateral part of brachialis
Terminates into superficial branch and posterior interosseous nerve at lateral epicondyle

51
Q

Which parts of the ulna and radius articulate with the trochlea and capitulum of the humerus?

A

Ulna: olecrenon, trochlear notch, coronoid process
Radius: head

52
Q

What is the difference between the radial collateral ligament and the ulnar collateral ligament?

A

Both triangular
Ulnar collateral has 3 parts
Radial has 2 parts

53
Q

Where is the annular ligament attached?

A

The radial notch of the ulna

Nil attachment to the radius itself

54
Q

How does the valgus angle of the elbow differ between men and women?

A

Obliquity of the ulna is more pronounced in women

55
Q 
Origin
Insertion
Action
Nerve 
Special features
Pronator teres
A

Superficial head: medial epicondyle, med supracondylar ridge. Deep head: med border of coronoid process

Lateral convexity of radius

Pronates forearm and flexes elbow

Median N (C6,7)

Median nerve passes between two heads. Ulnar artery passes deep to deep head
Forms medial border of cubital fossa

56
Q 
Origin
Insertion
Action
Nerve 
Special features
Flexor carpi radialis
A

Common flexor origin

Bases of 2nd and 3rd MC via groove in trapezium

Flexes and abducts wrist

Median N (C6,7)

Own compartment in carpal tunnel
At level of the wrist-median nerve medial to tendon and radial artery lateral to it

57
Q 
Origin
Insertion
Action
Nerve 
Special features
Flexor digitorum superficialis
A

Humeral head:Common flexor origin
Ulnar head: Sublime tubercle and fibrous arch
Radial head: whole length of oblique line

Middle phalanges of medial 4 fingers

Flexes prox IP joints and MCP/wrist

Median N (C7, 8,T1)

Median nerve is applied to under surface of muscle. At wrist, tendons of middle and ring fingers lie superficial to index and little finger

58
Q 
Origin
Insertion
Action
Nerve 
Special features
Palmaris longus
A

Common flexor origin

Flexor retinaculum and palmar aponeurosis

Flexes wrist and anchors skin and fascia against shearing forces

Median N (C7,8)

Absent in 13% of people
Lies in front of median nerve at wrist.

59
Q 
Origin
Insertion
Action
Nerve 
Special features
Flexor carpi ulnaris
A

Humeral head: CFO
Ulnar head: aponeurosis from med olecrenon and upper 2/3 ulna

Pisiform, hook of hamate, base of 5th MC via pisometacarpal and pisohamate ligs

Flexes and adducts wrist. Fixes pisiform during action of hypothenar muscles

Ulnar nerve C7,C8

Ulnar nerve passes between the two heads

60
Q 
Origin
Insertion
Action
Nerve 
Special features
Flexor digitorum profundus
A

Upper 3/4 anterior and medial surfaces of the ulna including subcutaneous border and IO membrane

Distal phalanges of medial 4 fingers

Flexes distal IP joints then then rolls the fingers and wrist into flexion

Anterior interosseous branch of median nerve and ulnar nerve (C8, T1). 2:2 (60%), 3:1, 1:3. Each lumbrical supplied by the same nerve which innervates the belly of parent tendon

Tendon for index finger separates in forearm, other 3 don’t detach until palm

61
Q

Borders of cubital fossa

A

Pronator teres
Brachioradialis
Line between humeral epicondyles

62
Q

Contents of cubital fossa

A

Median nerve
Brachial artery
Tendon of biceps
Radial nerve and posterior interosseous branch

63
Q 
Origin
Insertion
Action
Nerve 
Special features
Flexor pollicis longus
A

Ant surface of radius below ant oblique line and adjacent IO membrane

Base of distal phalynx and thumb

Flexes distal phLnx of thumb

Ant IO (C7-C8) branch of median nerve

Unipennate fleshy fibres on radial side. Deep to FCR in carpal tunnel. Only flexor of thumb

64
Q 
Origin
Insertion
Action
Nerve 
Special features
Pronator quadratus
A

Antmed distal ulna

Ant surface of lower 1/4 radius

Pronates forearm and holds radius and ulna together

Ant IO (C7-8)

65
Q

Three nerves which supply forearm and the muscle who’s two heads they pass through

A

Median- pronator teres
Ulnar- flexi carpi ulnaris
Posterior interosseus branch of radial- supinator

66
Q

In which plane of the forearm does the radial artery lie?

A

over supinator and pronator teres but underneath brahcioradialis

67
Q

What are the branches of the ulnar artery in the forearm?

A

Common interosseous-> anterior +posterior interosseous

68
Q

Describe the cutaneous distribution of the radial nerve

A

Posterior arm with a strip down dorsal forearm to the wrist plus dorsal side of lateral 2 fingers excluding finger tips

69
Q

Describe the cutaneous distribution of the median nerve

A

Palmer surface of lateral 3 and a half fingers plus finger tips on dorsal side of the same fingers

70
Q

Which nerve supplies the elbow?

A

The median nerve

71
Q

Describe the course of the ulnar nerve in the forearm

A

Enters by passing humeral and ulnar heads of flexor carpi ulnaris
Lies under aponeurosis of flexor carpi ulnaris, with the ulnar artery lying just laterally to it along the distal 2/3 of the forearm

72
Q 
Origin
Insertion
Action
Nerve 
Special features
Brachioradialis
A

Upper 2/3 lateral supracondylar ridge of humerus

Base of styloid process of radius

Flexes elbow joint- strongest when semipronated

Radial nerve

Lies beneath abductor pollicis longus and extensor pollicis brevis
Lies on top of radial nerve and artery

73
Q 
Origin
Insertion
Action
Nerve 
Special features
Extensor carpi radialis longus
A

Lower 2/3 lateral sypracondylar ridge of humerus

Base of second metacarpal

Extends and abducts the wrist

Radial nerve (C6,7)

Making a fist. Runs with brachioradialis

74
Q 
Origin
Insertion
Action
Nerve 
Special features
Extensor carpi radialis brevis
A

CEO

Posterior base of 3rd MC

Extends and abducts the hand at the wrist

posterior interosseous nerve

Lies under ECRL

75
Q

Where is the common extensor origin?

A

Anterior lateral epicondyle of the humerus

76
Q 
Origin
Insertion
Action
Nerve 
Special features
Extensor digitorum
A

CEO

Extensor expansion of all 4 fingers, with 3rd and 4th fused, little finger gets a tendon via tendinous band

Extends all joints of fingers and wrist

Posterior interosseous nerve

Separated from above 3 muscles by emergence of thumb muscles

77
Q 
Origin
Insertion
Action
Nerve 
Special features
Extensor digiti minimi
A

CEO

Extensor expansion of little finger, usually 2 tendons joined by extensor digitorum

Extends little finger and wrist

Posterior interosseous nerve (C7,8)

78
Q 
Origin
Insertion
Action
Nerve 
Special features
Extensor carpi ulnaris
A

CEO and aponeurotic sheath (ulnar origin)

Base of 5th MC via groove by ulnar styloid

Extends and adducts the hand at the wrist

PIN

Making a fist
Ulnar common origin

79
Q 
Origin
Insertion
Action
Nerve 
Special features
Anconeus
A

Smooth surface at lower extremity of posterior aspect of lateral epicondyle of humerus

Lateral olecranon

Small amount of posterolateral movement during pronation

Radial (C7,8)

80
Q 
Origin
Insertion
Action
Nerve 
Special features
Supinator
A

Deep part from the supinator crest and fossa of the ulna
Superficial part from the lateral epicondyle and lateral ligament of the elbow and annular ligament

Neck and shaft of radius

Fixes the forearm in supination. Only acts alone when elbow is extended

PIN

PIN passes between its 2 heads, prime supinator when elbow extended

81
Q 
Origin
Insertion
Action
Nerve 
Special features
Abductor pollicis longus
A

Posterior ulnar and radius and interosseous membrane

Inserts over radial extensor tendons and brachioradialis to base of 1st MC and trapezium

Extends thumb at CMC joint and abducts wrist

PIN

Forms radial side of the snuff box. Crosses BR and ECRL superficially

82
Q 
Origin
Insertion
Action
Nerve 
Special features
Extensor pollicis brevis
A

Lower 1/3 of posterior radius and IOM

Over tendons of radial extensors and BR to base of proximal phalanx

Extends thumb and prevents flexion of MCP joint when thumb and index finger pinched

PIN

Forms radial side of the snuff box. Crosses BR and ECRL superficially

83
Q 
Origin
Insertion
Action
Nerve 
Special features
Extensor pollicis longus
A

Middle 1/3 of posterior ulnar and ION

Base of distal phalanx and thumb

Extends IP and MCP joints of the thumb

PIN

Forms ulnar side of snuffbox
Crosses dorsal tubercle of radius

84
Q

What is hammer thumb?

A

Colles fracture causes occlusion of branches of anterior interosseous artery surrounding radius

These becomes necrosed and EPL tendon ruptures

This produces a flexion deformity of the distal phalanx

85
Q 
Origin
Insertion
Action
Nerve 
Special features
Extensor indicis
A

Lower posterior shaft of ulna and IOM

Extensor expansion of index finger

Extends index finger

PIN

Covered by tendons of extensor digitorum

86
Q 
Origin
Insertion
Action
Nerve 
Special features
Abductor pollicis brevis
A

Flexor retinaculum and scaphoid tubercle

Radial side of proximal phalanx and EPL tendon

Abducts thumb – moving in plane at right angles to palm, assist in extension

Muscular branch of medial (C8, T1)

87
Q

What are the borders of the anatomical snuff box?

A

Extensor pollicis longus tendon (ulnar side)
Extensor pollicis brevis and abductor pollicis brevis on the radial side
Cephalic vein begins at the roof of the snuffbox
Radial artery (deep to all 3 tendons) lies on the floor

88
Q

What are the attachments of the extensor retinaculum?

A

Proximally to the anterolateral border of the radius and distally to the pisiform and triquetral bones

89
Q

What are the three most proximal bones of the hand?

A

Scaphoid, lunate and triquetral

90
Q

Which vessels form the dorsal carpal arch?

A

Radial, ulnar and anterior interosseous arteries

91
Q

Describe the palmar aponeurosis

A

Made up of longitudinal and deeper transverse fibres

Localised thickening of palmar aponeurosis occurs in Dupuytren’s contracture

92
Q

Where does the flexor retinaculum run?

A

Hamate and pisiform medially
Scaphoid and trapezium laterally
Between it and the bones of the wrist is the carpal tunnel

93
Q

What lies in the carpal tunnel?

A

The four tendons of flexor digitorum superficialis (superfically)
Median nerve
Flexor pollicis longus tendon (radial side)-has its own sheath
Four tendons of flexor digitorum profundus (deep)-only index finger tendon separate

94
Q

What are the three muscles of the thenar eminence?

A

Abductor pollicis brevis
Flexor pollicis brevis
Opponens pollicis

95
Q 
Origin
Insertion
Action
Nerve 
Special features
Flexor pollicis brevis
A

Superficial head: flexor retinaculum and trapezium. Deep: trapezoid and capitate

Radial sesamoid of thumb and radial side base of proximal phalanx

Draws thumb across the palm

Muscular branch of medial (T1 +C8)- muscle with most variable nerve supply in the body

96
Q 
Origin
Insertion
Action
Nerve 
Special features
Opponens pollicis
A

Flexor retinaculum and trapezium

Radial border of thumb MC

Opposition of thumb

Muscular branch of medial T1 and C8

Deepest thenar muscle

97
Q

Which muscles make up the hypothenar eminence?

A

Abductor digiti minimi
Flexor digiti minimi brevis
Opponens digiti minimi

98
Q 
Origin
Insertion
Action
Nerve 
Special features
Abductor digiti minimi
A

Pisiform, tendon of FCU

Base of proximal phalanx and extensor expansion

Cup the palm and grip large objects

Deep branch ulnar nerve C8,T1

Most medial of thenar muscles. Sesamoid bone common in tendon

99
Q 
Origin
Insertion
Action
Nerve 
Special features
Flexor digiti minimi brevis
A

FR, hook of hamate

Ulnar side of base of proximal phalanx

Cup the palm and grip large objects

Deep branch ulnar nerve C8,T1

100
Q 
Origin
Insertion
Action
Nerve 
Special features
Opponens digiti minimi
A

FR, hook of hamate

Ulnar side of base of proximal phalanx

Cup the palm and grip large objects

Deep branch ulnar nerve C8,T1

Deepest hypothenar muscle

101
Q 
Origin
Insertion
Action
Nerve 
Special features
Palmaris brevis
A

Over hypothenar side of the hand attached to palmar aponeurosis

Ulnar nerve (superficial)- only muscle supplied by this nerve

102
Q 
Origin
Insertion
Action
Nerve 
Special features
Lumbricals
A

FDP tendons

Extensor expansions of dorsum of proximal phalanges

Extension of both interpharangeal joints- required for pinching

2 ulnar lumbricals by ulnar n, 2 radial lumbricals by median n
U/M distribution follows that of parent bellies of tendons in forearm
Ulnar supplied – bicipital, from adjacent profundus tendons
Median supplied – unicipital, arise from one tendon only (muscle arises from radial side of tendon)

103
Q 
Origin
Insertion
Action
Nerve 
Special features
Adductor pollicis
A

Transverse head: palmar border of 3rd MC. Oblique head: base of 2nd and 3rd MC

Ulnar sesamoid of thumb

Approximate thumb to index finger

Deep branch of ulnar nerve (C8, T1)

Radial artery passes between 2 heads to form deep palmar arch

104
Q 
Origin
Insertion
Action
Nerve 
Special features
Palmar interosseous
A

Ulnar side of MC 2, radial side of MC 4 and 5

Extensor expansion, on side of the finger towards the middle finger. Middle finger has no PI

Adduct fingers relative to the 3rd MC. Assist dorsal interossei with flexion and MCPJ and extension and PIPJ

Deep branch of ulnar nerve (c8, T1)- claw hand in paralysis
Small- only visible from palmar side

105
Q 
Origin
Insertion
Action
Nerve 
Special features
Dorsal interosseous
A

Both adjacent MC (2 heads)

Extensor expansion on the side of the finger away from the middle finger. Middle finger has DI on both sides.

Abduct fingers relative to the axis (middle) of palm. Assists palmar in the flexion at mCPJ and extension at PIPJ

Deep branch of ulnar nerve (c8, T1)- claw hand in paralysis

Large muscles, can be seen from dorsal and palmar sides

106
Q

Which nerves supply the fingers?

A

Common palmar digital nerves-> proper palmar digital nerves

In the palm the arteries are superficial to the nerves but in the fingers the nerves are are superior to the arteries

107
Q

How does the median nerve supply the palm?

A

Enters beneath flexor retinaculum
Splits into 3, medial, lateral and muscular (recurrent)

Muscular recurrent supplies thenar muscles by passing over tenson of flexor pollicis longus- at risk during incision

108
Q

Why is their no anaesthesia over the thenar eminence in carpal tunnel syndrome?

A

Skin is supplied by palmar branch of median nerve which travels superficially to the FR, so escapes compression
If median nerve damaged at a higher level, will be weakness of thumb flexion and palmar cutaneous loss

109
Q

Which arteries make up the deep palmar arch?

A

Deep ulnar artery and radial artery

110
Q

What is a vincula?

A

A vascular synovial fold
Each tendon has two
Flexor digitorum profundus tendon long vincula passes from the tendon between the two halves of the superficialis tendon

111
Q

What are the branches of the lateral cord of the brachial plexus?

A

Lateral pectoral
Musculocutaneous (lateral cutaneous nerve of forearm)
Lateral root of median nerve

112
Q

What are the branches of the medial cord?

A 
Medial pectoral
Medial root of the medial nerve
Medial cutaneous nerve of arm
Medial cutaneous nerve of the forearm
Ulnar
113
Q

What are the branches of the posterior cord?

A 
Upper subscapular
Thoracodorsal
Lower subscapular
Axillary 
Radial
114
Q

What is the most common traction injury to the brachial plexus?

A

Erb’s paralysis, damage to C5 and C6 nerve roots
Arm hangs by side, medially rotated, extended at the elbow and pronated with loss of sensation of the lateral arm and forearm

115
Q

Which muscle is the only one supplied by all five nerve roots of the brachial plexus?

A

Pectoralis major

116
Q

How is the axillary nerve damaged?

A

In 5% of shoulder dislocations

Shoulder abduction is weak and there is a small area with loss of sensation over the deltoid

117
Q

How do you test if musculocutaneous nerve is intact?

A

Nerve is rarely injured

Flex biceps and palpate tendon

118
Q

How do you differentiate humeral fracture from Saturday night palsy?

A

Fractures of the humeral shaft damage radial nerve
Results in wrist drop
Saturday night palsy is a higher up compression of the nerve so also results in loss of elbow extension

119
Q

How to test for ulnar nerve injury?

A

Claw hand

Abduction of index finger

120
Q

What position is a hand with a medial nerve injury in?

A

Pointing index finger position

121
Q

What is the order of ossification of upper limb bones?

A
  1. Clavicle-starts week 5 as a fetus, completely fused by late teens
  2. Scapula- week 8 as a fetus, finished age 20
  3. Humerus- week 8 as a fetus (primary centre), 3 secondary centres (toddler), lateral epicondyle fuses age 15, medial epicondyle fuses age 20
  4. Radius- week 8 as a fetus, upper epiphyses fuses at 15, lower at 20
  5. Ulnar- week 8 as a fetus, olecrenon fuses at 16, head fuses at 18
  6. Carpal bones ossify in sequence from largest( capitate) to smallest (pisiform)
122
Q

List the bones of the hand distal to proximal and radial to ulnar

A

Scaphoid, lunate, triquestral, pisiform,

trapezium, trapezoid, capitate, hamate

Anatomy (6 decks)

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