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MRCSA anatomy > Upper Limb > Flashcards

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
Q

What is the course of the median nerve relative to the brachial artery in the upper arm?

A

Relations of median nerve to the brachial artery:
Lateral -> Anterior -> Medial

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26
Q

What out of the contents of the axilla is most likely to be divided in axillary surgery?

A

intercostobrachial nerves (cutaneous sensations to axillary skin)

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27
Q

Muscles supplied by the radial nerve?

A

BEST
Brachioradialis
Extensors
Supinator
Triceps

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28
Q

How many extensor compartments are there?

A

6

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29
Q

What is the path of the radial artery in the wrist?

A

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.

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30
Q

what are the intrinsic muscles of the hand?

A

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

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31
Q

what are the branches of the axillary artery in order?

A

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

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32
Q

Where does the axillary artery go from and to?

A

outer border of the first rib to the lower border of teres major, where it becomes the brachial artery

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33
Q

what are the three zones of the axillary artery?

A

related to pec minor
1. lies above pectoralis minor
2. behind the muscle
3. inferior to it.

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34
Q

anterior wall of the carpal tunnel?

A

flexor retinaculum

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35
Q

posterior wall of carpal tunnel?

A

carpal arch formed by 6 carpal bones

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36
Q

contents of carpal tunnel?

A

Contents – 9 tendons, 1 nerve
4 FDS tendons
4 FDP tendons
Flexor pollicis longus tendon
Median nerve

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37
Q

what passes superiorly to the flexor retinaculum?

A

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*

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38
Q

What ligament links the metacarpals?

A

deep transverse metacarpal ligaments

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39
Q

what is pisiform suspended in?

A

sesamoid bone existing in tendon of FCU

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40
Q

what type of joint is radiocarpal joint?

A

Synovial joint between the distal end of radius, the scaphoid and lunate

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41
Q

which fibrous ligaments assisting radiocarpal joint?

A

Palmar and dorsal radio-carpal ligaments
Ulnar and Radial collateral ligaments (of the wrist)

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42
Q

List the joints of the hand

A

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

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43
Q

what sort of joint is the first metacarpal joint?

A

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)

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44
Q

What ligaments are MCP joints reinforced by?

A

Palmar ligament
Medial and lateral MCP collateral ligaments

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45
Q

What ligaments reinforce the IP joints?

A

Reinforced by medial and lateral collaterals

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46
Q

what is the palmar aponeurosis continuous with?

A

Proximally continuous with the flexor retinaculum
Distally continuous with the fibrous digital sheaths - this fascia further condenses into annular and cruciate ligaments

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47
Q

What are osseous-fibrous tunnels?

A

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

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48
Q

Describe the path of a flexor tendon?

A

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

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49
Q

Where are extensor hoods found?

A

The extensor tendons will expand over the proximal phalanges to form complex extensor hoods

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50
Q

What attaches to extensor hoods?

A

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

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51
Q

Name the superficial muscles of the forearm from lateral to medial?

A

Pronator teres [median]
Flexor carpi radialis [median]
Palmaris longus [median]
Flexor carpi ulnaris [ulnar]

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52
Q

distal insertion of pronator teres?

A

radius

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53
Q

distal insertion of flexor carpi radialis?

A

metacarpals (II & III)

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54
Q

distal insertion of palmaris longus?

A

Palmar aponeurosis of the hand

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55
Q

intermediate muscles of the forearm?

A

flexor digitorum superficialis [median]

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56
Q

proximal and distal attachments of flexor digitorum superficial?

A

Proximal: Radial and ulnar heads
Partial attachment to the humerus

Distal:Middle phalanx

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57
Q

functions of FDS?

A

Flexion at the proximal interphalangeal, MCP and wrist joints

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58
Q

Deep muscles of anterior forearm?

A

Flexor digitorum profundus [median except for FDP to ring and little fingers (ulnar nerve)]
Flexor pollicis longus [median]
Pronator quadrats [median]

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59
Q

proximal and distal attachments of FDP?

A

Proximal: Ulna and interosseous membrane*
Distal: Anterior aspect of distal phalanges

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60
Q

Function of FDP?

A

Flexion of interphalangeal joints and wrist

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61
Q

Flexor pollicis longus attachments?

A

Proximal: Radius*
Distal: Distal phalanx of thumb*

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62
Q

Function of flexor pollicis longus?

A

Function: Flexes interphalangeal joints of thumb

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63
Q

attachments of pronator quadratus?

A

Proximal: Distal ulna*
Distal: Distal radius*

64
Q

function of pronator quadrates?

A

pronation

65
Q

Extensor muscles of the wrist?

A

Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor carpi ulnaris

66
Q

Extensor muscles of the digits?

A

Extensor digitorum (all 4 digits)
Extensor indicis (index digit)
Extensor digiti minimi (little finger)

67
Q

innervation of posterior forearm?

A

Posterior interosseous nerve, which is a continuation of the deep motor branch of the radial nerve.

68
Q

Extensor muscles of thumb?

A

Extensor pollicis brevis
Extensor pollicis longus
Abductor pollicis longus
(Mostly thumb abduction)

69
Q

what are the borders of the anatomical snuffbox?

A

Anterior border: Extensor pollicis brevis tendon (and APL)
Posterior (dorsal) border: Extensor pollicis longus tendon
Floor:Scaphoid and trapezium

70
Q

what are the contents of the anatomical snuffbox?

A

Radial artery
Cephalic vein

71
Q

What muscles are in the anterior compartment of the intrinsic hand muscles?

A

Thenar + hypothenar eminences
Lumbricals (4)
Palmar interossei (3/4)
Adductor pollicis
Palmaris brevis

72
Q

Which muscles are in the posterior compartment of the hand?

A

Dorsal interossei (4)

73
Q

Which hand muscles are supplied by median nerve?

A

LOAF
Lateral 2 lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

74
Q

Which nerve supplies the majority of intrinsic hand muscles?

A

The deep branch* of the ulnar nerve

75
Q

What are the three hypothenar muscles?

A

abductor digiti minimi
flexor digiti minimi brevis
opponens digiti minimi

76
Q

What are the three thenar muscles?

A

flexor pollicis brevis
opponens pollicis
abductor pollicis brevis

77
Q

thenar and hypothenar muscles?

A

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
Q

Where do the thenar muscles originate from?

A

Tubercle of scaphoid, trapezium and adjacent flexor retinaculum

79
Q

Where do the hypothenar muscles originate from?

A

Hook of hamate, pisiform bone and adjacent flexor retinaculum

80
Q

Where do the thenar/hypothenar muscles insert?

A

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
Q

innervation of thenar muscles?

A

recurrent branch of median nerve

82
Q

innervation of hypothenar muscles?

A

deep branch of ulnar nerve

83
Q

origin of lumbricals?

A

Sides of FDP tendons

84
Q

insertion of lumbricals?

A

Lateral side of extensor hoods

85
Q

function of lumbricals?

A

Flexion of MCP and extension of IP joints

link flexor and extensor tendons and allow small intricate movements

86
Q

innervation of lumbricals?

A

Medial two: Ulnar Nerve (deep branch*)
Lateral two: Median Nerve

87
Q

origin and insertion of the palmar interossei?

A

Origin: Sides of metacarpals
Insertion: extensor hoods

88
Q

how many palmar interossei?

A

3/(4)

first palmar interossei is often considered rudimentary (part of adductor or flexor pollicis brevis)

89
Q

function and innervation of palmar interossei?

A

Function: Adduction at the MCP joint
Innervation:
Ulnar nerve

90
Q

How do you remember the functions of the interossei?

A

PAD + DAB
PAD: Palmar adduction
DAB: Dorsal abduction

91
Q

origin of adductor pollicis?

A

Origin:
Straight Head: 3rd MC
Oblique Head: Capitate, 2nd, 3rd MC

92
Q

Insertion of adductor pollicis?

A

Insertion:
Medial side of extensor hood of thumb

93
Q

origin of palmaris brevis?

A

Origin:
Palmar aponeurosis
Flexor retinaculum

94
Q

What does damage to the anterior interosseous nerve result in?

A

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
Q

what are the three important ligaments of the acromioclavicular joint?

A

1.Acromioclavicular
2.Coracoclavicular
(Composed of the conoid and trapezoid ligaments)
3.Coracoacromial

96
Q

Which ligaments of the shoulder girdle can commonly be caused by FOOSH?

A

Minor: Acromio-clavicular ligament tear
Major: Coraco-clavicular ligament tear

97
Q

Which tendon passes through the glenohumeral joint?

A

tendon of long head of biceps

98
Q

What is the most common site of shoulder impingement and which tendon is usually involved?

A

The acromion, coracoid and acromio-coracoid ligament form an arch above the joint

Supraspinatous tendon when raising the arm

99
Q

Which ligaments make up the capsule that surrounds the glenohumeral joint?

A

Gleno-humeral (x3)(superior, middle,inferior)
Coraco-humeral
Transverse-humeral

100
Q

What does inflammation of the glenohumeral joint result in ?

A

frozen shoulder

101
Q

What might anterior dislocation of the shoulder result in?

A

Tearing of the glenoid labrum

Compression of the axillary nerve-
Limited abduction due to reduced function of the deltoid muscle

102
Q

Muscles of the anterior pectoral compartment?

A

Pectoralis major
Pectoralis minor
Subclavius
Serratus anterior

103
Q

Attachment and insertion of pec major?

A

Proximal (attachment):
Medial 1/3 clavicle
Sternum
Costal cartilages I – VII

Distal (attachment):
Lateral lip of the intertubercular groove

104
Q

Innervation of pec major?

A

Lateral and medial pectoral nerves

105
Q

Attachments of pec minor?

A

Proximal*
Ribs III – V

Distal*
Coracoid process of the scapula

106
Q

Functions of pec minor?

A

Protraction of scapulothoracic joint

107
Q

Innervation of pec minor?

A

Medial pectoral nerve

108
Q

Functions of subclavius?

A

Anchors the clavicle
Stabilises the sternoclavicular joint

109
Q

Serratus anterior attachments?

A

Origin
Lateral surface of ribs I - VIII
Insertion
Medial border to the scapula

110
Q

Functios of serratus anterior?

A

Protraction at STJ
Rotation: Can elevate the glenoid fossa

111
Q

Which muscles are in the posterior pectoral compartment?

A

Trapezius
Latissimus dorsi
Levator scapulae
Rhomboids

112
Q

Attachments of latissimus dorsi?

A

Proximal
Vertebral column from T7 to ileum

Distal
Floor of intertubercular groove

113
Q

Functions of latissimus dorsi?

A

Adduction (same as pec major)
Medial rotation (same as pec major)
Extension (opposite to pec major)

114
Q

Attachments of teres major?
Innervation?

A

Proximal:
Inferior angle of the scapula

Distal:
Medial lip of intertubercular groove

Innervation: Inferior subscapular

115
Q

What is the triangular space made up of?

A

Teres major
Teres minor
Long head of triceps brachii

116
Q

What travels through the triangular space?

A

Circumflex scapular artery

117
Q

Borders of the triangular interval?

A

teres major
triceps brachii
lateral head of triceps/humerus

118
Q

What travels through the triangular interval?

A

Radial nerve
profunda brachii

119
Q

Which muscles does the radial nerve descend between in the upper arm?

A

between the medial and lateral heads of the triceps brachii*

120
Q

What does the radial nerve divide into above the the elbow?

A

Superficial radial nerve
Posterior interosseous nerve

121
Q

When does the axillary artery become the brachial?

A

inferior part of teres major

122
Q

How many parts does the axillary artery divide into and with respect to which muscle?

A

3/ pec minor

123
Q

three parts and branches of the axillary artery?

A

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
Q

Which carpal bones does the radius articulate with?

A

scaphoid and lunate

125
Q

Which ligaments stabilise the elbow joint?

A

1.Radial collateral ligament (lateral)
2.Ulnar collateral ligament (medial)
3.Annular ligament
(Strictly part of the proximal radio-ulnar joint)

126
Q

what are the 3 parts of the ulna collateral ligament?

A
  1. anterior cord like band
  2. posterior fan like band
  3. oblique band
127
Q

Attachments and innervation of coracobrachialis?

A

coracoid process
humeral shaft

musclocutaneous

128
Q

Proximal and distal attachments of biceps brachii?

A

Long head: supraglenoid tubercle
Short head; coracoid process

Distal:Radial tuberosity
Bicipital aponeurosis

129
Q

Brachialis attachments?

A

anterior humeral shaft
ulnar tuberosity

130
Q

Triceps attachments:

A

Long head: infraglenoid tubercle
Medial and lateral heads: posterior humeral shaft
Distal: Olecranon

131
Q

Borders of the cubital fossa?

A

Line between the medial epicondyles
Brachioradialis
Pronator teres

132
Q

Roof of the cubital fossa?

A

Aponeurosis of the biceps brachii and deep fascia of the forearm

133
Q

Contents of the cubital fossa?

A

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
Q

What important structure does not go through the cubital fossa?

A

Ulnar nerve, passes posteriorly to medial epicondyle

135
Q

Responsible muscles for supination and pronation?

A

Pronation: Pronator teres, pronator quadratus
Supination: Supinator, biceps brachii (in pronated position)

136
Q

What are the anterior and posterior compartments of the forearm separated by?

A

interosseous membrane (has two apertures)

137
Q

Attachements of supinator?

A

Proximal: Lateral epicondyle of humerus*
Distal: Proximal 1/3 of radius*

Function:
Wrist supination

138
Q

Attachements of supinator?

A

Proximal: Lateral epicondyle of humerus*
Distal: Proximal 1/3 of radius*

Function:
Wrist supination

139
Q

Attachments of brachioradialis?

A

Proximal: Distal humerus*
Distal: Lateral distal radius*

140
Q

Main artery branch off the ulnar artery?

A

common interosseous artery
splits into anterior and posterior interosseous artery which supply anterior and posterior part of the arm respectively

141
Q

Which muscle head does the median nerve enter the forearm below?

A

head of pronator heres

142
Q

Which muscle head does the ulnar nerve enter the forearm below?

A

below head of flexor carpi ulnaris

143
Q

relative position of ulnar nerve at the wrist?

A

medial to FCU and lateral to ulnar artery

144
Q

Where does the radial nerve divide and what into?

A

Anterior to the lateral epicondyle it divides into

Sensory: Superficial radial nerve
Motor: Posterior interosseous nerve (deep branch)

145
Q

What is a gantzer muscle?

A

an aberrant accessory of the flexor pollicis longus and is a risk factor for anterior interosseous nerve compression

146
Q

signs of anterior interosseous nerve compression?

A

loss of pincer grip and normal sensation

147
Q

Branches of the axillary artery?

A

Highest thoracic artery
Thoraco-acromial artery
Lateral thoracic artery
Subscapular artery
Posterior circumflex humeral artery
Anterior circumflex humeral artery

148
Q

Structures in the carpal tunnel?

A

4 FDS tendons
4 FDP tendons
Flexor pollicis longus tendon
Median nerve

149
Q

Structures superficial to the carpal tunnel?

A

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
Q

Ligaments of the radiocarpal joint?

A

Palmar and dorsal radio-carpal ligaments
Ulnar and Radial collateral ligaments (of the wrist)

151
Q

Which tendons run through extensor compartment 1?

A

Abductor pollicis longus
Extensor pollicis brevis

152
Q

Which tendons run through extensor compartment 2?

A

Extensor carpi radialis longus
Extensor carpi radialis brevis

153
Q

Which tendons run through extensor compartment 3?

A

Extensor pollicis longus

154
Q

Which tendons run through extensor compartment 4?

A

Tendon sheath for extensor digitorum and extensor indicis

155
Q

Which tendons run through extensor compartment 5?

A

Extensor digiti minimi

156
Q

which tendons run through extensor compartment 6?

A

Extensor carpi ulnaris

157
Q

Mneumonic for branches of the subclavian artery?

A

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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