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Anatomy > Upper Limb > Flashcards

Upper Limb Flashcards

1
Q

What muscles make up the rotator cuff?

A
  1. Subscapularis
  2. Infraspinatus
  3. Supraspinatus
  4. Teres Minor
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2
Q

What are the origin and insertion points of the pectoralis major?

A

Origin:

  • Clavicular head - anteromedial clavicle
  • Sternocostal head - anterolateral surface of manubrium and body of sternum, 6 upper costal cartilages and external oblique aponeurosis

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

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3
Q

What is the action and nerve supply of the pec major?

A

Action:

  • Clavicular head: Flex and adduct arm
  • Sternal Head: Adduct and medially rotate arm

Nerve: (Branches from brachial plexus)

  • Medial pectoral nerve
  • Lateral pectoral nerve
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4
Q

Pectoralis major: T/F

1) Arises from eight upper ribs
2) Is inserted into the medial lip of bicipital groove
3) Is a powerful flexor of the glenohumeral joint
4) Is supplied by all 5 segments of the brachial plexus

A

1) F - Arises from med clav + sternum + 6 upper costal cartilages
2) F - Inserts into the lateral lip of bicipital groove
3) F - Not a powerful flexor - primarily an adductor
4) T - medial and lateral cords - C5-T1

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5
Q

Pectoralis Minor: T/F

1) Is supplied by fibres of the C5 root
2) Arises from the 2nd, 3rd and 4th costal cartilages
3) Is an adductor of the shoulder joint
4) Inserts into the medial border of the upper surface of the coracoid process of the scapula.

A

1) F - Supplied by C8/T1 - medial cord
2) F - From 2nd, 3rd and 4th ribs
3) F - Elevates ribs and protracts scapula
4) T

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6
Q

The clavi-pectoral fascia is pierced by: T/F

1) Cephalic vein
2) Medial pectoral nerve
3) Lymphatics passing from infraclavicluiar nodes to the apical nodes of the axilla
4) Superior thoracic artery

A

1) T - Cephalic vein passess betwen deltoid and the pectoralis major
2) F - Lateral cord, not medial cord
3) T
4) F
Deep fascia beteen subclavius and pec minor. Also pierced by thoracoacromial artery + vein + lateral pectoral nerve

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7
Q

Axillary Artery: T/F

1) Terminates at the inferior border of the teres major.
2) Lies posterior to the medial pectoral nerve.
3) Has a corresponding vein on medial side.
4) Begins at the medial border of the pectoralis minor.

A

1) T - Continues as brachial artery past the inferior border of the teres major.
2) F - Medial pectoral nerve arises posterior to the axillary artery
3) T
4) F - Begins above pec minor

3 divisions in relation to pec minor

1) Superior to pec minor - Superior thoracic Artery comes off
2) Posterior to pec minor - Thoraco-acromial and lateral thoracic branch
3) Inferior to pec minor - Subsap artery + Ant\Post Humeral CFlex artery branches

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8
Q

In the axilla: T/F

1) The long thoracic nerve runs on the medial wall deep the fascia over the serratus anterior muscle.
2) The axilllary nerve leaves the axilla by passing through a space bounded by humerus long head of tricpes, subscap and teres major.
3) The Thoraco-dorsal nerve runs on the posterior wall
4) The musculocutaneous nerves pierces the coraco-brachialis muscle.

A

1) T
2) T
3) T
4) T

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9
Q

What 4 structures pierce the clavipectoral fascia?

A

“CALL”

1) Cephalic vein
2) artery - Thoracoacromial artery
3) Lymphatics
4) Lateral Pectoral nerve

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10
Q

Describe where the clavipectoral fascia lies

A

Deep to the clavicular head of the pectoralis major - Fills space between clavicle and pec minor. It encloses the pec minor and the subclavius.

Superior: Clavicle
Inferior: Continuous with fascia of abdominal wall
Superolaterally: Enters deltopectoral grooce and continue with fascia over deltoid muscle.
Inferolaterally: Curves around pec major and beocmes continuous with axillary fascia

Medially - Connected to first rib and costoclavicular ligament and blends with membrane of upper 2 intercostal membranes.

Laterally: Connected to corocoid process and blends with coracoclavicular ligament.

Costocorocoid Ligament - Thick part of this fascia running between first rib to coracoid process.

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10
Q

Describe where the clavipectoral fascia lies

A

Deep to the clavicular head of the pectoralis major - Fills space between clavicle and pec minor. It encloses the pec minor and the subclavius.

Superior: Clavicle
Inferior: Continuous with fascia of abdominal wall
Superolaterally: Enters deltopectoral grooce and continue with fascia over deltoid muscle.
Inferlaterally: Curves around pec major and beocmes continuous with axillary fascia

Medially - Connected to first rib and costoclavicular ligament and blends with membrane of upper 2 intercostal membranes.

Laterally: Connected to corocoid process and blends with coracoclavicular ligament.

Costocorocoid Ligament - Thick part of this fascia running between first rib to coracoid process.

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11
Q

T/F the sternoclavicular joint is a synovial joint

A

T

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12
Q

T/F the coracoclavicular ligament stabilises the sternoclavicular joint

A

F - The coracoclavicular ligament stabilises teh AC joint. The costoclavicular ligament is the primary ligament with stabilises the SC joint.

The coracoclavicular ligament attaches corocoid to clavicle and made up of two ligaments - Trapezoid ligament and conoid ligament!

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13
Q

Describe the boundaries of the axillae:

A

Floor - Axillary fascia (extends ffrom serratus anterior fascia to deep fascia of arm and supported by the suspensory ligament).

Anterior Wall - Pec Major, Pec Minor, Subclavius, and clavipectoral fascia

Posterior Wall - Subscapularis and teres major, wit tendone ot lat dorsi wrapping around the teres major

Medial Wall - Upper part (serratus anterior)

  • Lower limit of axilla defined as being the level of fourth rib
  • Apex is bounded by clavicle, scapula and outer border of the first rib
  • Anterior and posterior walls converge laterally to the lips of intertubercular groove of humerus.
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14
Q

What are the origin and insertion of the latissimus dorsi:

A

O: Spine T7, Spinous processes and supraspinous ligaments of all lower thoracis, lumbar and sacral vertebra, lumbar fascia, posterior third of ilac crest, last four ribs, and inferior ankle of scapula.
I: Floor of bicipital groove of humerus (after spiralling around teres major).
N: Thoracodorsal nerve (C6/7/8 from posterior cord).
A: Extends, adducts, and medially rotates arm

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15
Q

Serratus Anterior - Origin, insertion, nerve supply and action

A

O: Upper eight ribs and anterior intercostal membranes from midclavicular line - Lower four interdigitating with external oblique

I: Inner medial border of scapula (1-2 - upper angle, 3-4 - Costal surface, 5-8 - inferior angle).

A: Laterally rotates and protracts scapula

N: Long thoracic nerve (C5/6/7 - from brachioal plexus roots)

*Injury to LTN results in medial scapula winging as serratus anterior can’t stabilise the scapula to the chest wall.

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16
Q

Describe the pathway of long thoracic nerve

A
  • Originates from C5/6/7 roots of brachial plexus
  • Runs downwards and passes anterior to scalenus posterior muscle
  • Courses distal and laterally deep to clavicle and superfical to first and second rib
  • Runds inferiorly along chest wall in mid axillary ling on outer surface of serratus anterior 22-24cm
  • Terminates in branches that penetrate the serratus anterior
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17
Q

Subscapularis - Origin, insertion, nerve supply and action

A

O: Medial two thirds of subscapular fossa

I: Lesser tuberosity of humerus, upper medial lip of bicipital groove and capsule of the shoulder

N: Upper and lower subscapular nerve (C5,6 - Posterior cord of brachial plexus)

A: Medially rotates arm + Stabilises shoulder

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18
Q

What are the borders of and contents of the quadrangular space:

A

Lateral - Shaft of humerus
Medial - Long head of triceps
Superior - Teres minor
Inferior - Teres major

Contents - Axillary nerve + Posterior circumflex artery

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19
Q

What are the borders and contents of the Triangular space

A

Lateral - triceps long head
Superior - Teres Minor
Inferior - Teres Major

Contents - scapular circumflex artery

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20
Q

Borders and contents of triangular interval (lower)

A

Superior - Teres major
Lateral - Lateral head of triceps or the humerus
Medial - Long head of triceps

Contents - Radial nerve + Profunda brachii artery

21
Q

Which muscles insert into the bicipital groove?

A 
Medial Lip (LT Crest) - Teres Major 
Lateral Lip (GT Crest) - Pectoralis Major 
Floor - Latissimus Dorsi 
Groove - long head of biceps
22
Q

What is the nerve supply of the teres major

A

Lower subscapular nerve

23
Q

Describe the pathway of the axillary artery:

A

Axillary Artery: Continuation of 3rd part of subclavian artery - begins at outer border of 1st rib - passes over 1st digitation of serratus and into axilla - At the lower end of the Teres major it becomes the brachial artery.
- Divided in parts by relation to pec minor - above/behind/below.

24
Q

Describe the branches of the axillary artery:

A

1st Part - Superior thoracic
2nd Part - Thoracoacromial + Lateral Thoracic
3rd Part - Subscapular + Anterior Circumflex Humeral + Posterior Circumflex Humeral

25
Q

Between what muscles in the upper arm does the Cephalic vein run?

A

Groove between deltoid + pectorals major

- It then pierces the clavipectoral fascia to enter the axilla

26
Q

How many branches come from each of the brachial plexus constituent parts? (Roots, Trunks, Divisions, Cords)

A

Roots (3) - Dorsal Scap, Subclavius, Long Thoracic
Trunks (1) - Suprascapular (from upper trunk)
Divisions (0)
Cords (3-5-5)
Lateral Cord (3) - Lat pectoral, musculocutaneous, lat root of median
Medial Cord (5) - Med pectoral, medial root of median, medial cut nerve of arm, Medial cut of forearm, ulnar nerve
Posterior Cord (5) - Upper subscapular, lower subscapular, thoracodorsal, axillary, radial

27
Q

What nerve supplies the latissimus dorsi?

A

Thoracodorsal - Branch off the posterior cord of brachial plexus

28
Q

What is the function of the lateral pectoral nerve?

A

Branch of the lateral cord - pierces clavipectoral fascia
Communicates with axillary artery and medial pectoral nerve

Supplies pec major and pec minor - No cutaneous branch

29
Q

Describe the musculocutaneous nerve

A

Branch of lateral cord - runs obliquely downwards and sinks into coracobrachialis

Supplies biceps and brachialis
Becomes lateral cutaneous nerve of forearm

30
Q

Describe the median nerve

A
  • Formed by lateral root from lateral cord (C5/6/7) and medial root from medial cord (C8/T1)
  • Descends down arm with brachial artery and enters anterior compartment of forearm in cubital fossa.
  • In the forearm, the nerve travels between the flexor digitorum profundus and flexor digitorum superficialis muscles

Forearm Branches:

  • Anterior Interosseous -supplies the deep muscles in the anterior forearm.
  • Palmar Cutaneous - innervates the skin of the lateral palm.

Hand Branches:

  • Recurrent Branch - Thenar Muscles
  • Palmar Digital Branch - innervates the palmar surface and fingertips of the lateral three and half digits. Also innervates the lateral two lumbrical muscles.
31
Q

What muscles insert on the greater tuberosity of the humerus?

A

Supraspinatus,infraspinatus and teres minor

32
Q

What muscle/s insert onto the lesser tuberosity?

A

Subscapularis

33
Q

What ligaments are ruptured in AC Joint dislocation? Describe their position.

A
  • Acromioclavicular ligament
  • Coracoacromial ligament
  • Coracoclavicular ligament - made up of 2 ligaments
    - Trapezoid ligament laterally
    - Conoid ligament medially
34
Q

Supraspinatus - Origin, insertion, nerve supply and action

A

Origin - Medial 3/4 of supraspinous fossa + Upper scapular spine
Bursa separates it from lateral 1/4
Tendon crosses superior aspect of capsule

Insertion - Upper part of greater tuberosity

Nerve - Suprascapular nerve - C5/6 from upper trunk of brachial plexus

Action - Structural support of humerus in glenoid
+ assists deltoid in abduction

35
Q

Infraspinatus - Origin, insertion, nerve supply and action

A

Origin: Medial 3/4 of infraspinous fossa
Tendon blends with capsule of the joint

Insertion: Central facet of greater tuberosity (between supraspinatus and teres minor)
*Note insertion is much larger than supraspinatus - therefore less tears!

Nerve Supply: Suprascapular nerve - C5/6 from upper trunk of brachial plexus - after giving branches to the supraspinatus, it passes around lateral border of scapular spine and enters infraspinous fossa.

Action: Stabilise joint (braces humeral head to glenoid cavity) + Lateral/External rotator

36
Q

Teres Minor - Origin, insertion, nerve supply and action

A

Origin: Oval area on axiallary border of the scapula
Passes upwards laterally, edge-to-edge with the infraspinatus - over joint
Passes BEHIND the origin on the long head of triceps.
Lower border edge-to-edge with teres major - but terest major pass IN FRONT of the long head of triceps

Insertion: Lowest facet on the greater tuberosity + just below

Nerve Supply: Posterior branch of axillary nerve (C5/6) from posterior cord of plexus

Action: Joint Stabilisation + Lateral rotator + Weak adductor of humerus
Works with teres major to hold head of humerus aghainst upward pull of deltoid with abduction

37
Q

What is the clinical importance of the infraspinatous fascia

A

Tough sheet of connective tissue that forms roof over infraspinatus fossa containing infraspinatus and teres minor (but not major). Has a septum which separates the two muscles.
Strong attachment to the medial border of scapula.
Lateral aspect serve as attachment site for posterior deltoid.
Medial aspect deep to trapezius, lateral aspect covered by posterior belly of deltoid muscle, inferior aspect deep to latissimus dorsi.

  • Landmark for surgical exposures -
  • Fracture of blade of scapula may result in round haematoma beneath fascia that is limited to margins of bone - diagnostic of fracture
  • Compartment syndrome involved infraspinatous and teres minor
38
Q

Deltoid - Origin, insertion, nerve supply and action

A

O: Anterior and upper border of clavicle, lateral acromion, inferior lip of scapular spine
Intermediate fibres are multipennate (Decreased ROM, but increased Force), whereas anterior and posterior not multipennate.

I: Deltoid tuberosity - U-shaped tuberosity with a central verticle ridge

N: Axillary Nerve (C5/6 - posterior cord of brachial plexus)

A: Abduction (works with supraspinatus) - Most abduction from multipennate intermediate fibres from acromion. Anterior fibres alone work with pec major to flex and medially rotate, where posterior assist lats with extending the arm and lateral rotation.

39
Q

Describe the muscles involved movements of the shoulder

- Abduction, Adduction, Flexion, Extension, Rotation

A

Abduction - Deltoid and Supraspinatus (Supraspinatus starts and pulls head of humerus down slightly.

Adduction - Tere major, Coracobrachialis, Pec major, Lat dorsi.

Flexion - Clavicular head of pec major and anterior deltoid + Coracobrachialis and biceps assistance.

Extension - Lat Dorsi, posterior deltoid

Lateral Rotation - Infraspinatus and teres minor

Medial Rotation - Subscapularis and teres major

40
Q

Describe the anterior approach to exposing the shoulder joint

A

Anterior - Deltopectoral Approach

Incision:
- Incision following line of deltopectoral groove (10-15cm)

Superficial Dissection:

  • Cephalic vein lies in deltopectoral groove - mobilised either medially or laterally.
  • Fibres of deltoid retracted laterally
  • Fibres of pectoralis major retracted medially

Deep Dissection:
- Short head of biceps and coracobrachialis arise from corocoid process and are retracted medially. **Note msc nerve neters biceps 5-8cm distal to corocoid - retraction of conjoint tendon must be done with care
- Fascia on lateral conjoint tendon incised to reveal subscapularis
- Subscap stretched with external rotation and released from insertion on lesser tuberosity.
Capsule incised as needed to enter joint.

Dangers:

  • Musculocutaneous nerve - vigorous retraction of biceps can damage
  • Cephalic vein - Preserved where possible
  • Axillary Nerve - Risk with release of subscap - runs distal/medial to
  • Anterior Circumflex Humeral artery - Runs anteriorly around proximal humerus to pectoralis major tendon.
41
Q

Which nerve supplies the muscles in the flexor compartment of the upper arm?

A

Musculocutaneous Nerve - C5/6

42
Q

What is the equivalent muscle of the adductors in the lower limb with the upper limb?
What are this muscles origin, insertion, function and nerve supply?

A

Coracobrachialis
O: Coracoid process
Fuses with the medial side of the short head of biceps
I: Medial border of the humerus -midpoint between origins of triceps and brachialis
A: Adduction + Flexion of glenohumeral joint
(Weak - main adductors are the pec major and lat dorsi)
N: Musculocutaneous C5/6/7

43
Q

Long head of biceps - Origin, insertion, nerve supply and action

A

O: Supraglenoid tubercle + glenoid labrum of scapula
Passes through the synovial cavity and emerges beneath transverse ligament at upper inter tubercular groove and goes through groove.
Merges with short head and passes through cubital fossa
I: Posterior border of radial tuberosity
N: Musculocutaneous nerve - C5/6
A: Elbow Flexion, Forearm supinator, shoulder flexion
Stabilises shoulder with tendon running over the top of the head of humerus

44
Q

Deltoid - Origin, insertion, nerve supply and action

A

O: Lateral third of clavicle, spine of scapula to deltoid tubercle
I: Middle of lateral surface of humerus - deltoid tuberosity
A: Abducts arm, anterior fibres flex and medially rotate, posterior fibres extend and laterally rotate.
N: Axillary Nerve - C5/6 - from posterior cord

45
Q

Describe the anastomosis of the arteries of scapular

A

Subclavian becomes the axillary artery

  • Thyrocervical trunk branches off subclavian -> Suprascapular and transverse cervical branch off thyrocervical trunk
  • Subscapular branches off axillary
  • > Circumfelx scpular and thoracodorsal branch off subscapular

Scapular Supply:

  • Medial border: Transverse cervical branch (Dorsal scapular (from thyrocervical trunk)
  • Lateral Border - Suprascapular from thyrocervical trunk (superiorly), and Thoracodorsal from subscapular
  • Posteriorly - Circumflex scapular artery from subscapular artery.
46
Q

What is the transverse humeral ligament

A

AKA Brodie Ligament

Small broad ligament that extends between the lesser and greater tubercles of the humerus superior to epiphyseal line.
Almost an extension from the insertion of th tendinous fibres after they insert onto the lesser tubercle and continue over the intertubercular groove.

Functions to hold the long head of biceps in the groove

47
Q

Describe the ligaments over the shoulder joint

A

Coracohumeral ligament
Glenogumeral Ligament
Trasnverse Humeral ligament

48
Q

Describe muscle/s involved in shoulder abduction

A

Supraspinatus - Initiates
Deltoid - Acromial fibres create the force

Stabilised by subscap, teres major/minor and infraspinatus - which prevent upward pull.

49
Q

Describe muscle/s involved in shoulder adduction

A

Short scapular muscles while deltoid relaxes
Strengthened by great muscles of axillary wall

Teres Major, coracobrachialis
Pectoralis major, lattisimus Dorsi

Anatomy (6 decks)

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