Upper limb Flashcards
What classification of joint is the sternoclavicular joint?
Saddle
What classification of joint is the acromioclavicular joint?
Plane
What are the carpals?
Capitate
Hamate
Lunate
Pisiform
Scaphoid
Trapezoid
Triquetrum
Trapezium
What are the common ways for a clavicle fracture to occur?
Force through outstretched hand from a fall
Fall directly on shoulder
What does the medial fragment of clavicle elevate after fracture?
It is elevated by the sternocleidomastoid
What can be damaged by a fracture of the surgical neck of the humerus?
Axillary nerve
Posterior circumflex artery
What can be damaged by a fracture of the shaft of the humerus?
Radial nerve
Profunda brachii artery
What can be damaged by a fracture of the supracondylar of the humerus?
Median nerve
Brachial artery
What can be damaged by a fracture of the medial epicondyle of the humerus?
Ulnar nerve
Ulnar collateral artery
What can occur with a lunate dislocation?
Compression of median nerve leading to CTS
What is a Boxer’s fracture?
Fracture at the head of the 5th metacarpal
What can occur with a hook of hamate fracture?
Damage to deep branch of ulnar nerve, in the Guyan’s canal
What can occur from a scaphoid fracture?
Avascular necrosis of proximal fragment and lead to DJD of wrist
What are the superficial veins of the upper limb?
Cephalic vein
Basilic vein
Median cubital vein
What are the deep veins of the upper limb?
Axillary vein into subclavian vein
What is the innervation of pectoralis major?
Lateral pectoral (C5-C7) and medial pectoral (C8-T1)
What are the actions of pectoralis major?
Flexion, adduction, and medial rotation of arm at shoulder
What is the innervation of pectoralis minor?
Medial pectoral (C8-T1)
What are the actions of pectoralis minor?
Stabilizes scapula by drawing inferiorly and anteriorly against the thoracic wall
What is the innervation of serratus anterior?
Long thoracic (C5-C7)
What are the actions of serratus anterior?
Protracts scapula and holds against thoracic wall
Rotates scapula
What is the innervation of subclavius?
Nerve to subclavius (C5-C6)
What are the actions of subclavius?
Depresses and anchors clavicle
What causes winged scapula?
Paralysis of serratus anterior - injury to long thoracic nerve (C5-C7)
What is the innervation of the trapezius?
Spinal accessory nerve (CNXI motor)
C3-C4 sensory nerves
What are the actions of the trapezius?
Elevation, depression, and retraction of scapula
Rotate glenoid cavity supperiorly
What is the innervation of latissimus dorsi?
Thoracodorsal nerve (C6-C8)
What are the action of latissimus dorsi?
Extension, adductions, and medial rotation of shoulder joint
Raises body towards arms when climbing
What is the innervation of levator scapulae?
Dorsal scapular (C5)
C3 and C4 spinal nerves
What are the actions of levator scapulae?
Elevation of scapula and rotates glenoid cavity inferiorly
What is the innervation of rhomboid major and rhomboid minor?
Dorsal scapular (C4-C5)
What are the actions of rhomboid major and rhomboid minor?
Retraction of scapula and inferior rotation of glenoid cavity
Attaches scapula to thoracic wall
What is the innervation of deltoid?
Axillary nerve (C5-C6)
What are the actions of deltoid?
Flexion, medial rotation, abduction, extension, and lateral rotation of arm
What are the rotator cuff muscles?
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
What is the innervation of supraspinatus?
Suprascapular nerve (C5-C6)
What is the action of supraspinatus?
Initiate abduction
What is the innervation of infraspinatus?
Suprascapular nerve (C5-C6)
What are the actions of infraspinatus?
Lateral rotation of arm at shoulder
Hold humeral head in glenoid cavity
What is the innervation of teres minor?
Axillary nerve (C5-C6)
What are the actions of teres minor?
Lateral rotation of arm at shoulder
Hold humeral head in glenoid cavity
What is the innervation of subscapularis?
Upper and lower subscapular nerves (C5-C6)
What are the actions of subscapularis?
Medial rotation and adduction of arm
Holds humeral head in glenoid cavity
What is the innervation of teres major?
Lower subscapular nerve (C5-C6)
What are the actions of teres major?
Adduction and medial rotation of arm
What are the muscles and innervation of the anterior compartment of arm?
Biceps brachii
Brachialis
Coracobrachialis
Musculocutaneous nerve
What are the muscle and innervation of the posterior compartment of arm?
Triceps brachii
Anconeous
Radial nerve
What are the actions of biceps?
Supination and flexion of forearm
Flexion at should joint
Resistance of shoulder dislocation
What are the actions of coracobrachialis?
Flexion and adduction at shoulder, resists dislocation
What are the actions of brachialis?
Flexion of elbow
What are the actions of triceps?
Extension of elbow
Extension of shoulder and resists dislocation
What are the actions of anconeus?
Extension of elbow
Stabilizes elbow
Pronation
What are the bursae of the shoulder?
Subacromial
Subdeltoid
Subscapular
What is the typical presentation of shoulder dislocation?
Head of humerus moved anteriorly and inferiorly
May injure axillary and radial nerve
What is the presentation of AC joint dislocation?
Shoulder drops inferiorly with arm held close to body
What is the sign of adhesive capsulitis?
Limited ROM to 45 degrees elevation and rotation
What forms the base of the axilla?
Axillary fascia and skin
What forms the apex/inlet of the axilla?
Passageway for structures - bound by first rib, clavicle, and superior part of scapula
What forms the anterior wall of the axilla?
Pec major and minor, and clavipectoral fascia
What forms the posterior wall of the axilla?
Subscapularis, teres major, latissimus dorsi, and long head of triceps
What forms the medial wall of the axilla?
Upper rib cage, intercostal muscles, and serratus anterior muscles
What forms the lateral wall of the axilla?
Humerus
What is in the axilla?
Axillary veins
Axillary artery
Axillary lymph nodes
Brachial plexus
Axillary tail in females
Biceps and coracobrachialis
What are the axillary fasciae?
Pectoral fascia
Clavipectoral fascia
Axillary fascia
Axillary sheath
What are the 5 groups of axillary lymph nodes?
Central
Lateral/brachial/humeral
Posterior/subscapular
Anterior/pectoral
Apical/subclavian
What drainage do lateral lymph nodes receive?
Most of upper limb
What drainage do posterior lymph nodes receive?
Upper back, neck, and shoulder
What drainage do anterior lymph nodes receive?
Breast and anterior trunk
What drainage do apical lymph nodes receive?
Connect with infraclavicular nodes
What drainage do central lymph nodes receive?
Lymph from other node groups
How can you compress the axillary artery?
Apply downward pressure at angle between clavicle and attachment of sternocleidomastoid
What nerves branch from the roots of the brachial plexus?
Long thoracic
Dorsal scapular
What nerves branch from the upper trunk of the brachial plexus?
Nerve to subclavius
Suprascapular
What nerves branch from the medial cord of the brachial plexus?
Medial pectoral
Medial root of median nerve
Medial cutaneous of arm
Ulnar nerve
Medial cutaneous of forearm
What nerves branch form the lateral cord of the brachial plexus?
Lateral pectoral
Lateral root of median nerve
Musculocutaneous
What nerves branch from the posterior cord?
Upper subscapular
Lower subscapular
Thoracodorsal
Radial
Axillary
What is innervated by the musculocutaneous nerve?
Anterior arm
What is innervated by the axillary nerve?
Shoulder
What is innervated by the radial nerve?
Posterior arm and forearm
What is innervated by the median nerve?
Anterior forearm and lateral hand
What is innervated by the ulnar nerve?
Anterior forearm and medial hand
What nerves are damaged if arm is medially rotated and adducted?
Axillary and suprascapular
What nerve is damaged if forearm is extended and pronated?
Musculocutaneous
What is damaged if limb hands by side and is tightly adducted at shoulder?
Rotator cuff muscles or their innervation
What occurs with a lower brachial plexus lesion?
Damage to ulnar and median nerves
What are the intermuscular spaces of the shoulder?
Quadrangular
Upper triangular
Lower triangular
What is contained in the quadrangular space?
Axillary nerve
Posterior circumflex humeral artery
What is contained in the upper triangular space of the arm?
Circumflex scapular artery
What is contained in the lower triangular space?
Radial nerve
Deep brachial artery
What can damage the axillary nerve?
Fracture of cervical neck of humerus
Inferior dislocation of shoulder
What nerve innervates the sensation of the shoulder?
Axillary
What are signs of a damaged axillary nerve?
Loss of abduction at shoulder
Weak lateral rotation
Sensory loss of shoulder and lateral arm
What nerve innervates sensation of lateral forearm?
Musculocutaneous
What can damage the musculocutaneous nerve?
Compression at coracobrachialis
Trauma to axilla
What are the clinical signs of a damaged musculocutaneous nerve?
Weakness of elbow flexion
Reduced/absent biceps reflex
Weakness of supination
Sensory loss of lateral forearm
What nerve is damaged with a midshaft fracture of the humerus?
Radial nerve
What nerve runs through the medial epicondyle of the humerus?
Ulnar
What artery branches off the first part of the axillary artery?
Superior thoracic
What arteries branch off the second part of the axillary artery?
Thoraco-acromial
Lateral thoracic
What arteries branch off the third part of the axillary artery?
Circumflex humeral arteries
Subscapular
What arteries branch off subscapular artery?
Circumflex scapular
Thoracodorsal
Axillary
What does the axillary artery become?
Brachial artery
What arterial anastomoses can occur around the scapula?
Dorsal scapular, suprascapular, and subscapular
What are the bursae of the elbow?
Intratendinous olecranon bursa
Subtendinous olecranon bursa
Subcutaneous olecranon bursa
What are 4 main arteries that flow through the elbow joint?
Radial artery
Posterior interosseous artery
Ulnar artery
Common interosseous artery
What can be damaged by an evulsion fracture of the medial epicondyle of the humerus?
Ulnar nerve
What may be damaged by a posterior elbow dislocation?
Ulnar nerve or median nerve
What are the movements of the wrist?
Flexion, extension, abduction, and adduction
What is contained in the cubital fossa?
Biceps tendon
Median nerve
Superficial and deep radial nerves
Brachial artery and branches
Deep veins
What forms the roof of the cubital fossa?
Fascia
Bicipital aponeurosis
Median cubital vein
Medial and lateral cutaneous nerves of forearm
What are the superficial muscles of the anterior forearm?
Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris
flexor digitorum superficialis
What muscles are innervated by the median nerve in the anterior forearm?
Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor digitorum superficialis
Lateral flexor digitorum profundus
Flexor pollicis longus
Pronator quadratus
What are the deep muscles of the anterior forearm?
Flexor digitorum profundus
Flexor pollicis longus
Pronator quadratus
What muscles are innervated by the ulnar nerve in the anterior forearm?
Flexor carpi ulnaris
Medial flexor digitorum profundus
What are the muscles of the posterior forearm?
Brachioradialis
Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor digitorum
Extensor carpi ulnaris
Supinator
Abductor pollicis longus
Extensor pollicis brevis
Extensor pollicis longus
Extensor indicis
What nerve innervates the posterior forearm?
Radial
What are the 3 deep fasciae of the hand?
Flexor retinaculum
Palmar aponeurosis
Fibrous flexor sheath of digits
What muscles are in the palm of the hands?
Dorsal interosseous
Palmar interosseous
Lumbrical
What muscles are in the thenar prominence?
Abductor pollicis brevis
Flexor pollicis brevis
Opponens pollicis
Adductor pollicis
What muscles are in the hypothenar prominence?
Abductor digiti minimi
Flexor digiti minimi brevis
Opponens digiti minimi
What muscles of the hand are innervated by the median nerve?
Abductor pollicis brevis
Flexor pollicis brevis
Opponens pollicis
Lumbricals 1 and 2
What muscles of the hand are innervated by the ulnar nerve?
Adductor pollicis
Abductor digiti minimi
Flexor digiti minimi brevis
Opponens digiti minimi
Lumbricals 3 and 4
Dorsal interossei
Palmar interossei
What is affected in Dupuytren contracture?
Palmar fascia
What structures pass superficially through the carpal tunnel?
Palmaris longus tendon
Palmar cutaneous branch of median and ulnar nerves
Superficial branch of radial and ulnar arteries
Ulnar nerve
What structures pass deep through the carpal tunnel?
Median nerve
Four tendons of FDS
Four tendons of FDP
Flexor pollicis longus tendon
Flexor carpi radialis tendon
What nerve is typically compressed in CTS?
Median nerve
What are the common lesion sites of the median nerve?
Proximal to elbow
Distal at wrist
What is affected by a median nerve lesion at the elbow?
Loss of motor and sensory function of median nerve in forearm and hand resulting in ape hand and benedict hand
What can cause a median nerve lesion at the elbow?
Fracture of distal humerus
Nerve compression in cubital fossa
What would atrophy of thenar eminence indicate?
Damage to median nerve at wrist
What are common lesion sites of the ulnar nerve?
Axilla
Medial epicondyle trauma at elbow
Ventral wrist laceration
Guyon canal compression
Fracture of hook of hamate
What is the sign of ulnar nerve injury?
Claw hand - weak extension of digits
Abducted thumb
What structures run along the shaft of the humerus?
Radial nerve
Profunda brachii artery
What sensation is innervated by the radial nerve?
Dorsal surfaces of arm, forearm, and radial side of hand
What can cause a radial nerve injury in the axilla?
Long-term compression
Saturday night palsy
What nerve is damaged in wrist drop?
Radial nerve
What can cause radial nerve injury in the arm and forearm?
Fracture in midshaft of humerus
Trauma of lateral epicondyle of elbow
Dislocation of head of radius
Compression by supinator
What innervates the sensation of the shoulder?
Supraclavicular nerve
What innervates the sensation of the lateral upper arm?
Superior lateral cutaneous nerve of arm
What innervates the sensation of the axilla and posterior arm?
Intercostobrachial nerve
What innervates the sensation of the medial arm?
Medial cutaneous nerve of arm
What innervates the sensation of the medial forearm?
Medial cutaneous nerve of forearm
What innervates the sensation of the lateral forearm?
Lateral cutaneous nerve of forearm
What innervates the sensation of the lateral dorsal hand?
Radial nerve
What innervates the sensation of the medial hand?
Ulnar nerve
What innervates the sensation of the lateral palmar hand and lateral fingertips?
Median nerve
What are the main branches of the brachial artery?
Profunda brachii artery
Superior ulnar collateral
Inferior ulnar collateral
Radial
Ulnar
What are the main branches of the radial artery?
Radial recurrent branch
Palmar carpal branch
Superficial palmar branch
Princeps pollicis
Radialis indicis
Deep palmar arch
What are the main branches of the ulnar artery?
Anterior ulnar recurrent
Posterior ulnar recurrent
Common interosseous
Palmar carpal branch
