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Upper Limb Flashcards

1
Q

How many synovial tunnels in the extensor retinaculum that transmit extender tendons?

A

6

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2
Q

Attachments of the extensor retinaculum?

A

The pisiform and triquetral medially
The end of the radius laterally

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3
Q

Structures superficial to the extensor retinaculum?

A

Basilic vein
Dorsal cutaneous branch of the ulnar nerve
Cephalic vein
Superficial branch of the radial nerve

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4
Q

Structures deep to extensor retinaculum?

A

Extensor carpi ulnaris tendon
Extensor digiti minimi tendon
Extensor digitorum and extensor indicis tendon
Extensor pollicis longus tendon
Extensor carpi radialis longus tendon
Extensor carpi radialis brevis tendon
Abductor pollicis longus and extensor pollicis brevis tendons

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5
Q

Effects of ulnar nerve damage at the wrist?

A

Wasting and paralysis of intrinsic hand muscles (claw hand)
Wasting and paralysis of hypothenar muscles
Loss of sensation medial 1 and half fingers

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6
Q

Effects of ulnar nerve damage at the elbow?

A

Radial deviation of the wrist
Clawing less in 4th and 5th digits

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7
Q

What is innervated by the anterior interosseous nerve?

A

Flexor pollicis longus
Pronator quadratus
The radial half of flexor digitorum profundus (the lateral two out of the four tendons).

These muscles are in the deep level of the anterior compartment of the forearm.

NO SENSORY

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8
Q

How many bones of the hand?

A

8 Carpal bones
5 Metacarpals
14 phalanges

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9
Q

Which muscles make up the thenar eminence?

A

Abductor pollicis brevis
Opponens pollicis
Flexor pollicis brevis

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10
Q

Which muscles make up the hypothenar eminence?

A

Opponens digiti minimi
Flexor digiti minimi brevis
Abductor digiti minimi

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11
Q

What are the intrinsic muscles of the hand?

A

8 Interossei - Supplied by ulnar nerve
4 palmar-adduct fingers
4 dorsal- abduct fingers

Lumbricals
Flex MCPJ and extend the IPJ.
Origin deep flexor tendon and insertion dorsal extensor hood mechanism.
Innervation: 1st and 2nd- median nerve, 3rd and 4th- deep branch of the ulnar nerve.

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12
Q

What are the boundaries of the axilla?

A

Floor: subscapularis/teres major and latissimus dorsi
Anterior: Lateral border of Pectoralis major/pec minor
Lateral: Humeral head
Medial:Chest wall and Serratus anterior

Apex: lateral border of the first rib, superior border of scapula, and the posterior border of the clavicle.

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13
Q

Contents of the axilla?

A
  • Long thoracic nerve (of Bell)
  • Thoracodorsal nerve and thoracodorsal trunk
  • Intercostobrachial nerves
  • Axillary vein
  • Lymph nodes
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14
Q

What is the anterior interosseous nerve a branch of?

A

median nerve

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15
Q

What does the anterior interosseous nerve innervate?

A

The anterior interosseous nerve classically innervates 2.5 muscles:

Flexor pollicis longus
Pronator quadratus
The radial half of flexor digitorum profundus (the lateral two out of the four tendons).

Deep anterior forearm

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16
Q

What is tunica vaginalis derived from?

A

abdominal peritoneum

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17
Q

What structures cover the spermatic cord?

A

Internal spermatic fascia
Cremasteric fascia
External spermatic fascia

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18
Q

What are the contents of the spermatic cord?

A

vas deferens
testicular artery
artery of vas deferens
cremasteric artery
panpiniform plexus
sympathetic nerve fibres
genital branch of the genitofemoral nerve
lymphatic vessels

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19
Q

Which muscles are used in shoulder flexion?

A

Anterior part of deltoid
Pectoralis major
Biceps
Coracobrachialis

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20
Q

Which muscles are used in shoulder extension?

A

posterior deltoid
teres major
latissimus dorsi

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21
Q

Which muscles are used in shoulder adduction?

A

Pectoralis major
Latissimus dorsi
Teres major
Coracobrachialis

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22
Q

which muscles are used in shoulder abduction?

A

Mid deltoid
Supraspinatus

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23
Q

which muscles are used in shoulder medial rotation?

A

Subscapularis
Anterior deltoid
Teres major
Latissimus dorsi

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24
Q

which muscles are used in shoulder arm lateral rotation?

A

Posterior deltoid
Infraspinatus
Teres minor

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25
What is the course of the median nerve relative to the brachial artery in the upper arm?
Relations of median nerve to the brachial artery: Lateral -> Anterior -> Medial
26
What out of the contents of the axilla is most likely to be divided in axillary surgery?
intercostobrachial nerves (cutaneous sensations to axillary skin)
27
Muscles supplied by the radial nerve?
BEST Brachioradialis Extensors Supinator Triceps
28
How many extensor compartments are there?
6
29
What is the path of the radial artery in the wrist?
The radial artery passes between the lateral collateral ligament of the wrist joint and the tendons of the abductor pollicis longus and extensor pollicis brevis.
30
what are the intrinsic muscles of the hand?
Mnemonic for intrinsic hand muscles 'A OF A OF A' A bductor pollicis brevis O pponens pollicis F lexor pollicis brevis A dductor pollicis (thenar muscles) O pponens digiti minimi F lexor digiti minimi brevis A bductor digiti minimi (hypothenar muscles
31
what are the branches of the axillary artery in order?
Mnemonic for axillary artery branches Screw The Lawyer Save A patient Superior thoracic artery Thoracoacromial artery Lateral thoracic artery Subscapular artery Anterior humeral circumflex artery Posterior humeral circumflex artery
32
Where does the axillary artery go from and to?
outer border of the first rib to the lower border of teres major, where it becomes the brachial artery
33
what are the three zones of the axillary artery?
related to pec minor 1. lies above pectoralis minor 2. behind the muscle 3. inferior to it.
34
anterior wall of the carpal tunnel?
flexor retinaculum
35
posterior wall of carpal tunnel?
carpal arch formed by 6 carpal bones
36
contents of carpal tunnel?
Contents – 9 tendons, 1 nerve 4 FDS tendons 4 FDP tendons Flexor pollicis longus tendon Median nerve
37
what passes superiorly to the flexor retinaculum?
Palmaris longus, ulnar nerve and ulnar artery pass superficially to flexor retinaculum Ulnar nerve is medial to ulnar artery They both pass through Guyon’s canal*
38
What ligament links the metacarpals?
deep transverse metacarpal ligaments
39
what is pisiform suspended in?
sesamoid bone existing in tendon of FCU
40
what type of joint is radiocarpal joint?
Synovial joint between the distal end of radius, the scaphoid and lunate
41
which fibrous ligaments assisting radiocarpal joint?
Palmar and dorsal radio-carpal ligaments Ulnar and Radial collateral ligaments (of the wrist)
42
List the joints of the hand
Distal radio-ulnar joint Wrist joint – radiocarpal joint Intercarpal joint Between individual carpal bones Between proximal and distal row bones – midcarpal joint Carpo-metacarpal joints Intermetacarpal joints Metacarpophalangeal joints Proximal and distal interphalangeal joints
43
what sort of joint is the first metacarpal joint?
The joint between the metacarpal I and the trapezium It is a saddle joint which permits all movements of the thumb Often becomes osteoarthritic (most mobile)
44
What ligaments are MCP joints reinforced by?
Palmar ligament Medial and lateral MCP collateral ligaments
45
What ligaments reinforce the IP joints?
Reinforced by medial and lateral collaterals
46
what is the palmar aponeurosis continuous with?
Proximally continuous with the flexor retinaculum Distally continuous with the fibrous digital sheaths - this fascia further condenses into annular and cruciate ligaments
47
What are osseous-fibrous tunnels?
The osseo-fibrous tunnels are present on the palmar aspect of the hand They are tunnels which are formed by the fibrous digital sheaths and the underlying bone
48
Describe the path of a flexor tendon?
Pass into the hand under the flexor retinaculum And enters a common synovial sheath… Passes through an osseo-fibrous tunnel Within a digital synovial sheath The FDS splits around the FDP The FDS attaches to the middle phalanx and FDP attaches to the distal phalanx
49
Where are extensor hoods found?
The extensor tendons will expand over the proximal phalanges to form complex extensor hoods
50
What attaches to extensor hoods?
The interosseous muscles attach to the extensor hoods The distal attachment of the lumbricals is the extensor hood. This is why they cause MCP flexion and IP extension
51
Name the superficial muscles of the forearm from lateral to medial?
Pronator teres [median] Flexor carpi radialis [median] Palmaris longus [median] Flexor carpi ulnaris [ulnar]
52
distal insertion of pronator teres?
radius
53
distal insertion of flexor carpi radialis?
metacarpals (II & III)
54
distal insertion of palmaris longus?
Palmar aponeurosis of the hand
55
intermediate muscles of the forearm?
flexor digitorum superficialis [median]
56
proximal and distal attachments of flexor digitorum superficial?
Proximal: Radial and ulnar heads Partial attachment to the humerus Distal:Middle phalanx
57
functions of FDS?
Flexion at the proximal interphalangeal, MCP and wrist joints
58
Deep muscles of anterior forearm?
Flexor digitorum profundus [median except for FDP to ring and little fingers (ulnar nerve)] Flexor pollicis longus [median] Pronator quadrats [median]
59
proximal and distal attachments of FDP?
Proximal: Ulna and interosseous membrane* Distal: Anterior aspect of distal phalanges
60
Function of FDP?
Flexion of interphalangeal joints and wrist
61
Flexor pollicis longus attachments?
Proximal: Radius* Distal: Distal phalanx of thumb*
62
Function of flexor pollicis longus?
Function: Flexes interphalangeal joints of thumb
63
attachments of pronator quadratus?
Proximal: Distal ulna* Distal: Distal radius*
64
function of pronator quadrates?
pronation
65
Extensor muscles of the wrist?
Extensor carpi radialis longus Extensor carpi radialis brevis Extensor carpi ulnaris
66
Extensor muscles of the digits?
Extensor digitorum (all 4 digits) Extensor indicis (index digit) Extensor digiti minimi (little finger)
67
innervation of posterior forearm?
Posterior interosseous nerve, which is a continuation of the deep motor branch of the radial nerve.
68
Extensor muscles of thumb?
Extensor pollicis brevis Extensor pollicis longus Abductor pollicis longus (Mostly thumb abduction)
69
what are the borders of the anatomical snuffbox?
Anterior border: Extensor pollicis brevis tendon (and APL) Posterior (dorsal) border: Extensor pollicis longus tendon Floor:Scaphoid and trapezium
70
what are the contents of the anatomical snuffbox?
Radial artery Cephalic vein
71
What muscles are in the anterior compartment of the intrinsic hand muscles?
Thenar + hypothenar eminences Lumbricals (4) Palmar interossei (3/4) Adductor pollicis Palmaris brevis
72
Which muscles are in the posterior compartment of the hand?
Dorsal interossei (4)
73
Which hand muscles are supplied by median nerve?
LOAF Lateral 2 lumbricals Opponens pollicis Abductor pollicis brevis Flexor pollicis brevis
74
Which nerve supplies the majority of intrinsic hand muscles?
The deep branch* of the ulnar nerve
75
What are the three hypothenar muscles?
abductor digiti minimi flexor digiti minimi brevis opponens digiti minimi
76
What are the three thenar muscles?
flexor pollicis brevis opponens pollicis abductor pollicis brevis
77
thenar and hypothenar muscles?
All for one and one for all Thenar compartment: Abductor pollicis brevis Flexor pollicis brevis Opponens pollicis Hypothenar compartment: Opponens digiti minimi Flexor digiti minimi Abductor digiti minimi
78
Where do the thenar muscles originate from?
Tubercle of scaphoid, trapezium and adjacent flexor retinaculum
79
Where do the hypothenar muscles originate from?
Hook of hamate, pisiform bone and adjacent flexor retinaculum
80
Where do the thenar/hypothenar muscles insert?
The abductor and the flexor insert on the outside of the extensor hood and base of proximal phalanx respectively The opponens insert on the outside of the respective metacarpal.
81
innervation of thenar muscles?
recurrent branch of median nerve
82
innervation of hypothenar muscles?
deep branch of ulnar nerve
83
origin of lumbricals?
Sides of FDP tendons
84
insertion of lumbricals?
Lateral side of extensor hoods
85
function of lumbricals?
Flexion of MCP and extension of IP joints link flexor and extensor tendons and allow small intricate movements
86
innervation of lumbricals?
Medial two: Ulnar Nerve (deep branch*) Lateral two: Median Nerve
87
origin and insertion of the palmar interossei?
Origin: Sides of metacarpals Insertion: extensor hoods
88
how many palmar interossei?
3/(4) first palmar interossei is often considered rudimentary (part of adductor or flexor pollicis brevis)
89
function and innervation of palmar interossei?
Function: Adduction at the MCP joint Innervation: Ulnar nerve
90
How do you remember the functions of the interossei?
PAD + DAB PAD: Palmar adduction DAB: Dorsal abduction
91
origin of adductor pollicis?
Origin: Straight Head: 3rd MC Oblique Head: Capitate, 2nd, 3rd MC
92
Insertion of adductor pollicis?
Insertion: Medial side of extensor hood of thumb
93
origin of palmaris brevis?
Origin: Palmar aponeurosis Flexor retinaculum
94
What does damage to the anterior interosseous nerve result in?
Pain in the forearm Loss of pincer movement of the thumb and index finger (innervates the long flexor muscles of flexor pollicis longus & flexor digitorum profundus of the index and middle finger) Minimal loss of sensation due to lack of a cutaneous branch
95
what are the three important ligaments of the acromioclavicular joint?
1.Acromioclavicular 2.Coracoclavicular (Composed of the conoid and trapezoid ligaments) 3.Coracoacromial
96
Which ligaments of the shoulder girdle can commonly be caused by FOOSH?
Minor: Acromio-clavicular ligament tear Major: Coraco-clavicular ligament tear
97
Which tendon passes through the glenohumeral joint?
tendon of long head of biceps
98
What is the most common site of shoulder impingement and which tendon is usually involved?
The acromion, coracoid and acromio-coracoid ligament form an arch above the joint Supraspinatous tendon when raising the arm
99
Which ligaments make up the capsule that surrounds the glenohumeral joint?
Gleno-humeral (x3)(superior, middle,inferior) Coraco-humeral Transverse-humeral
100
What does inflammation of the glenohumeral joint result in ?
frozen shoulder
101
What might anterior dislocation of the shoulder result in?
Tearing of the glenoid labrum Compression of the axillary nerve- Limited abduction due to reduced function of the deltoid muscle
102
Muscles of the anterior pectoral compartment?
Pectoralis major Pectoralis minor Subclavius Serratus anterior
103
Attachment and insertion of pec major?
Proximal (attachment): Medial 1/3 clavicle Sternum Costal cartilages I – VII Distal (attachment): Lateral lip of the intertubercular groove
104
Innervation of pec major?
Lateral and medial pectoral nerves
105
Attachments of pec minor?
Proximal* Ribs III – V Distal* Coracoid process of the scapula
106
Functions of pec minor?
Protraction of scapulothoracic joint
107
Innervation of pec minor?
Medial pectoral nerve
108
Functions of subclavius?
Anchors the clavicle Stabilises the sternoclavicular joint
109
Serratus anterior attachments?
Origin Lateral surface of ribs I - VIII Insertion Medial border to the scapula
110
Functios of serratus anterior?
Protraction at STJ Rotation: Can elevate the glenoid fossa
111
Which muscles are in the posterior pectoral compartment?
Trapezius Latissimus dorsi Levator scapulae Rhomboids
112
Attachments of latissimus dorsi?
Proximal Vertebral column from T7 to ileum Distal Floor of intertubercular groove
113
Functions of latissimus dorsi?
Adduction (same as pec major) Medial rotation (same as pec major) Extension (opposite to pec major)
114
Attachments of teres major? Innervation?
Proximal: Inferior angle of the scapula Distal: Medial lip of intertubercular groove Innervation: Inferior subscapular
115
What is the triangular space made up of?
Teres major Teres minor Long head of triceps brachii
116
What travels through the triangular space?
Circumflex scapular artery
117
Borders of the triangular interval?
teres major triceps brachii lateral head of triceps/humerus
118
What travels through the triangular interval?
Radial nerve profunda brachii
119
Which muscles does the radial nerve descend between in the upper arm?
between the medial and lateral heads of the triceps brachii*
120
What does the radial nerve divide into above the the elbow?
Superficial radial nerve Posterior interosseous nerve
121
When does the axillary artery become the brachial?
inferior part of teres major
122
How many parts does the axillary artery divide into and with respect to which muscle?
3/ pec minor
123
three parts and branches of the axillary artery?
1st part: Superior thoracic 2nd part: Thoracoacromial trunk - Clavicular -Humeral -Acromial -Pectoral Lateral thoracic 3RD part: Subscapular -Circumflex scapular -Thoracodorsal Anterior and posterior circumflex humeral
124
Which carpal bones does the radius articulate with?
scaphoid and lunate
125
Which ligaments stabilise the elbow joint?
1.Radial collateral ligament (lateral) 2.Ulnar collateral ligament (medial) 3.Annular ligament (Strictly part of the proximal radio-ulnar joint)
126
what are the 3 parts of the ulna collateral ligament?
1. anterior cord like band 2. posterior fan like band 3. oblique band
127
Attachments and innervation of coracobrachialis?
coracoid process humeral shaft musclocutaneous
128
Proximal and distal attachments of biceps brachii?
Long head: supraglenoid tubercle Short head; coracoid process Distal:Radial tuberosity Bicipital aponeurosis
129
Brachialis attachments?
anterior humeral shaft ulnar tuberosity
130
Triceps attachments:
Long head: infraglenoid tubercle Medial and lateral heads: posterior humeral shaft Distal: Olecranon
131
Borders of the cubital fossa?
Line between the medial epicondyles Brachioradialis Pronator teres
132
Roof of the cubital fossa?
Aponeurosis of the biceps brachii and deep fascia of the forearm
133
Contents of the cubital fossa?
Median cubital vein Medial and lateral cutaneous nerves of the forearm Median nerve Radial nerve -Passes anterior to lateral epicondyle* Brachial artery (divides in the cubital fossa) Biceps tendon
134
What important structure does not go through the cubital fossa?
Ulnar nerve, passes posteriorly to medial epicondyle
135
Responsible muscles for supination and pronation?
Pronation: Pronator teres, pronator quadratus Supination: Supinator, biceps brachii (in pronated position)
136
What are the anterior and posterior compartments of the forearm separated by?
interosseous membrane (has two apertures)
137
Attachements of supinator?
Proximal: Lateral epicondyle of humerus* Distal: Proximal 1/3 of radius* Function: Wrist supination
138
Attachements of supinator?
Proximal: Lateral epicondyle of humerus* Distal: Proximal 1/3 of radius* Function: Wrist supination
139
Attachments of brachioradialis?
Proximal: Distal humerus* Distal: Lateral distal radius*
140
Main artery branch off the ulnar artery?
common interosseous artery splits into anterior and posterior interosseous artery which supply anterior and posterior part of the arm respectively
141
Which muscle head does the median nerve enter the forearm below?
head of pronator heres
142
Which muscle head does the ulnar nerve enter the forearm below?
below head of flexor carpi ulnaris
143
relative position of ulnar nerve at the wrist?
medial to FCU and lateral to ulnar artery
144
Where does the radial nerve divide and what into?
Anterior to the lateral epicondyle it divides into Sensory: Superficial radial nerve Motor: Posterior interosseous nerve (deep branch)
145
What is a gantzer muscle?
an aberrant accessory of the flexor pollicis longus and is a risk factor for anterior interosseous nerve compression
146
signs of anterior interosseous nerve compression?
loss of pincer grip and normal sensation
147
Branches of the axillary artery?
Highest thoracic artery Thoraco-acromial artery Lateral thoracic artery Subscapular artery Posterior circumflex humeral artery Anterior circumflex humeral artery
148
Structures in the carpal tunnel?
4 FDS tendons 4 FDP tendons Flexor pollicis longus tendon Median nerve
149
Structures superficial to the carpal tunnel?
Palmaris longus, ulnar nerve and ulnar artery pass superficially to flexor retinaculum Ulnar nerve is medial to ulnar artery* They both pass through Guyon’s canal* [radial artery enters posterolaterally]
150
Ligaments of the radiocarpal joint?
Palmar and dorsal radio-carpal ligaments Ulnar and Radial collateral ligaments (of the wrist)
151
Which tendons run through extensor compartment 1?
Abductor pollicis longus Extensor pollicis brevis
152
Which tendons run through extensor compartment 2?
Extensor carpi radialis longus Extensor carpi radialis brevis
153
Which tendons run through extensor compartment 3?
Extensor pollicis longus
154
Which tendons run through extensor compartment 4?
Tendon sheath for extensor digitorum and extensor indicis
155
Which tendons run through extensor compartment 5?
Extensor digiti minimi
156
which tendons run through extensor compartment 6?
Extensor carpi ulnaris
157
Mneumonic for branches of the subclavian artery?
Mnemonic for the branches of the subclavian artery: VIT C & D V ertebral artery I nternal thoracic T hyrocervical trunk C ostalcervical trunk D orsal scapular

MRCSA anatomy (7 decks)

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