Upper limb Flashcards
What are the proximal carpals ( lateral to medial, palmar aspect)
Scaphoid
Lunate
Triquetrum
Pisiform
Which of the carpals in considered a sesamoid bone and in which tendon does it lie
Pisiform
Lies within the tendon of flexor carpi ulnaris
What are the distal carpals (lateral to medial palmar aspect)
Trapezium
Trapezoid
Capitate
Hamate
What is a boxers #
of the 5th metacarpal
Distal section displaced anteriorly leading to the displacement of the finger
What is a Bennetts #
of the first metacarpal base
Due to forced abduction of the thumb
Why do Bennetts # often need surgical fixation
They extend into the first metacarpal joint, leading to instability and subluxation of the joint
Which muscles attaches on to the radial tuberosity
Biceps brachii
where does pronator teres attach to the radius
The middle lateral surface
Which 2 metacarpals does the radius articulate with
Scaphoid and Lunate
Describe a Colles #
Radial # with the distal aspect of the fracture being dorsally displaced (posterior)
Which # produces a dinner fork deformity
Colles #
Describe a Smiths #
Radial #- distal aspect of fracture with volar displacement (anterior)
Describe a Monteggia #
dislocation
# of the proximal ulna and dislocation of the radial head at the proximal radioulnar joint
Describe Galeazzi #
to the distal radius with ulna head dislocating at the distal radioulnar joint
Which parts of the ulna articulate with the humerus
Trochlear notch and coronoid process
Where does pronator quadratus attach to
The anterior surface of the shaft of the ulna
What attaches to the tuberosity of the ulna and where is it found
Brachialis attaches
Tuberosity of ulna - roughened area immediately distal to the coronoid process
Where does triceps brachii attach to
The superior surface of the olecranon
What separates the humeral head from the greater and lesser tuberosities
The anatomical neck of humerus
What is the greater tuberosity the attachment site for
3/4 Rotator cuff muscles
Supraspinatus
Infraspinatus
Teres Minor
Which muscle attaches to the middle facet of the greater tuberosity of the humerus
Infraspinatus
Which muscle attaches to the inferior facet of the greater tuberosity of the humerus
Teres Minor
Where is the lesser tuberosity of the humerus located
Medially
Which rotator cuff muscle attaches to the lesser tuberosity of the humerus
Subscapularis
Which muscle runs through the inter tubercular groove of the humerus
Long head of biceps brachii
Which muscles attach to the lips of the inter tubercular groove
Teres Major - medial lip
Latissmis dorsi
Pectoralis Major - lateral lip
Which nerve is at risk in a # of the surgical neck of humerus
Axillary nerve
What attaches to the conoid process of the clavicle
The conoid ligament - the medial part of the coracoclavicular ligament
What attaches to the trapezoid line of the clavicle
The trapezoid ligament - the lateral part of the coracoclavicular ligament
What are the 2 parts of the coracoclavicular ligament
The conoid ligament (medially) and the trapezoid ligament (laterally)
Which muscles attach to the shaft of the clavicle
Deltoid
Trapezius
Subclavius
Pectoralis major
Sternocleidomastoid
Sternohyoid
Describe the displacement of the lateral and medial aspects of a clavicle fracture
Lateral aspect - displaced inferiorly by the weight of the arm, and medially by pectoralis major
Medial aspect - pulled superiorly by sternocleidomastoid
Which muscles attach to the coronoid process of the scapula
Pectoralis minor
Coracobrachialis
Short head of biceps brachii
Which muscle attaches to the supraglenoid tubercle
Long head of biceps brachii
Which muscle attaches to the infraglenoid tubercle
Long head of triceps brachii
The acromioclavicular joint is reinforced posteriorly by which muscle
Trapezius muscle
What is the blood supply to the acromioclavicular joint
Suprascapular artery and thoracoacromial artery
Suprascapular nerve and lateral pectoral nerve innervate which joint of the upper limb
Acromioclavicular joint
The sternoclavicular joint would be described as what kind of joint
Saddle joint
What are the ligaments associated with the sternoclavicular joint
Anterior and posterior sternoclavicular ligament
Interclavicular ligament
Costoclavicular ligament
What is the blood supply of the sternoclavicular joint
Internal thoracic artery
Suprascapular artery
What is the innervation of the sternoclavicular joint
Medial supraclavicular nerve
Nerve to subclavius
Which ligaments support the glenohumeral joint
Coracoacromial ligament
Coracohumeral ligament
Glenohumeral ligament (superior, middle, inferior)
Transverse humeral ligament
What does the transverse humeral ligament hold
The tendon of the long head of biceps brachii
What are the two main bursa of the glenohumeral joint
Subacromial
Subscapular
Where would you find the subacromial bursa
Deep to the deltoid and acromion, superficial to the supraspinatus tendon and joint tendon
What is the function of the subacromial bursa
Reduced friction beneath the deltoid
Where is the subscapular bursa found
Between the subscapularis tendon and the scapula
Which muscles are responsible for shoulder extension
Posterior Deltoid
Latissimus dorsi
Teres Major
Which muscles are responsible for shoulder flexion
Pectoralis Major
Anterior deltoid
Corachobrachialis
Which muscles are responsible for abduction of shoulder
Supraspinatus - first 0-15 degrees
Middle fibres of deltoid - 15-90 degrees
The rotation of which bone is required for full abduction of the shoulder
Trapezius
Serratus Anterior
Which muscles are responsible for adduction of the shoulder
Pectoralis major
Latissimus dorsi
Teres major
Which muscles are responsible for internal rotation of the arm
Subscapularis
Pectoralis major
Latissimus dorsi
Teres Major
Anterior Deltoid
Which muscles are responsible for external rotation of the arm
Infraspinatus
Teres Minor
What is the blood supply of the glenohumeral joint
Anterior and posterior circumflex humeral arteries (branches of the axillary artery)
Suprascapular artery (branch of thyrocervical a)
Impaction of the posterolateral humeral head against the anterior inferior glenoid has what eponymous name
Hill Sachs Lesion
What is a Bankart lesion
Detachment of the anterior inferior labrum +/- avulsion #
What are the 2 articulations of the elbow joint
Trochlear notch of the ulna and trochlea of the humerus
Head of radius and capitulum of humerus
Which bursa are found around the elbow
Intratendinous
Subtendinous
Subcutaneous
Where is intratendinous bursa of the elbow found
Within the tendons of the triceps brachii
Where is subtendinous bursa of the elbow found
Between the olecranon and the tendon of triceps brachii, reduces friction between the 2 structures between flexion and extension
What is the other name for the subcutaneous bursa of the elbow and where is it found
Between the olecranon and the overlying connective tissue
Which ligaments support the elbow
Radial collateral ligament
Ulnar collateral ligament
Describe the radial collateral ligament
Extends from the lateral side of the joint from the lateral epicondyle - blends with the annular ligament of the radius
Describe the ulnar collateral ligament
Originates from the medial epicondyle and attaches to the coronoid process and olecranon of the ulna
What are the movements of the elbow
Flexion
Extension
Which muscles are responsible for flexion of the elbow
Triceps Brachii
Anconeus
Which muscles are responsible for extension of the elbow
Brachialis, biceps brachii, brachioradialis
Elbow dislocation tends to occur in which direction
Posterior dislocation
What injuries may be associated with a posterior elbow dislocation
Tearing of the ulnar collateral ligament +/- ulnar nerve involvement
What are the two types of epidcondylitis
Medial epicondylitis - common flexor origin
Lateral epicondylitis - common extensor origin
What is golfers elbow
Medial epicondylitis
What is tennis elbow
Lateral epicondylitis
What is a supracondylar elbow # and what is it MOA
Transverse # between the 2 epicondyles of the humerus
Often occurs due to a FOOSH
What is Volkmanns ischaemic contracture and what is it associated with
Uncontrolled flexion of the hand, flexor muscles become sclerotic and short
It is due to direct damage or swelling causing interference to the brachial a. and the structures that its supplies
What articulates to form the proximal radioulnar joint
Articulation between the head of radius and the radial notch of the ulna
What artciulates to form the distal radioulnar joint
Articulation between ulnar notch of the radius and the ulnar head
The radioulnar joints allow what movement
Pronation and supination
Which muscles are responsible for pronation
Pronator quadratus
Pronator teres
Which muscles are responsible for supination
Supinator
Biceps Brachii
What are the 2 functions of the fibrocartilaginous disc as the distal radioulnar joint
Binds radius and ulna together during movement
Seperates the distal radioulnar joint from the wrist
What is the interosseous membrane in the forearm and what is its functions
Sheet of CT that joins the radius and ulna together, spanning the distance of the medial radial border and the lateral ulnar border
Functions - increases stability in pronation and supination, site of attachment for muscles in the anterior and posterior compartments, transmits force from the radius
Which bones articulate in the wrist joint
Proximal row of carpal bones - scaphoid, lunate, triquetrum
Distal end of radius and fibrocartilaginous disc
What are the 4 ligaments of the wrist joint
Palmar radiocarpal
Dorsal radiocarpal
Ulnar collateral
Radial collateral
Describe the palmar radoiocarpal ligament and its function
On the palmar aspect of hand, passing from the radius to both rows of carpal bones
Increases stability, ensures hand follows arm in supination
Describe the dorsal radiocardpal ligament and its function
Dorsal aspect of hand
From radius to both rows of carpal bones
Increases stability, ensures hands follows arm in pronation
Describe the radial and ulnar collateral ligaments
Ulnar collateral - runs from the ulnar styloid process to the triquetrum and Pisiform. Prevents excessive lateral (radial) deviation of the wrist
Radial collateral - Runs from the radial styloid process to the scaphoid and triquetrum. Prevents excessive medial (ulnar) deviation of the wrist
Which muscles are responsible for wrist flexion
Flexor carpi ulnaris
Flexor carpi radialis
+ assistance from flexor digitorum superficialis
Which muscles are responsible for wrist extension
Extensor carpi radialis longus and brevis
Extensor carpi ulnas
Assistance from extensor digitorum
Which muscles are responsible for wrist adduction
Extensor Carpi Ulnaris
Flexor carpi ulnas
Which muscles are responsible for wrist abduction
Extensor carpi radialis longus and brevis
Flexor carpi radialis
Abductor pollicis longus
What type of joint is the MCPJ
Condyloid synovial joint
Which ligaments support the MCPJ
Deep transverse metacarpal ligament
Palmar ligament
Collateral ligament
Which muscles allow thumb flexion and extension
Flexor pollicius brevis and longus
Extensor pollicis brevis and longus
Which muscles allow thumb abduction and adduction
Adductor pollicis brevis
Abductor pollicis longus and brevis
Axial rotation of the thumb is facilitated by simultaneous contraction of which muscles
Flexor pollicis brevis
Adductor pollicis brevis
Which muscles facilitate flexion and extension of digits 2-5
Flexor digitorum superficialis
Flexor digitorum profundus
Lumbricals
Flexor digiti minimi - 5th digit
Extensor digitorum
Extensor indices - 2nd digit
Extensor digiti minimi - 5th digit
Which muscles facilitate adduction and abduction of digits 2-5
Palmar interossei
Dorsal interossei
Abductor digiti minimi - 5th digit
What is the blood supply to the MCPJ
Princeps pollicis artery - supplies MCP of thumb
Palmar and dorsal metacarpal arteries
Radialis indicis artery - supplies MCP of index finger
Common palmar digital a
Innervation of MCPJ
Posterior interosseous - branch of radial nerve
Deep terminal branches of the ulnar nerves
Palmar branches of the median nerve
What are the ligaments associated with IPJ
Proper and accessory collateral ligaments
What is the volar plate
A thick fibrocartilaginosu structure, arching from the base of the PIPJ in a u shape
It is attached to the proximal phalanx via Checkrein ligaments which insert distally into the base of the middle phalanx
Where do the proper and accessory ligaments of the IPJ attach
Arise from from the head of the proximal phalanx along the lateral aspect of the joint
Accompanied by the accessory ligament - attaches to the volar plate
What are the movements of proximal IPJ and which muscles are responsible
Flexion
Flexor digitorum superficialis
2y driver - flexor digitorum profundus
Extension
Extensor digitorum, lumbricals, interesse
Extensor indicies - 2nd fight
Flexor digotorum profundus primarily flexes which joint
Distal IPJ
Where does the central slip tendon insert
Into the base of the middle phalanx
What is the function of the central slip tendon
TO extend the proximal IPJ
What is the classical appearance in a central slip tendon injury
PIPJ unable to extend, DIPJ is hyperextended due to the tension from the remaining extensor tendonds
Name which nerve roots form the superior, middle and inferior trunks of the brachial plexus
Superior - C5, C6
Middle - C7
Inferior - C8, T1
What forms the lateral cord of the brachial plexus
Anterior divison of the superior and middle trunk
What forms the posterior cord of the brachial plexus
Posterior division of the superior, middle and inferior trunk
What forms the medial cord of the brachial plexus
Anterior division of the posterior trunk
Give an overview of the median nerve
(roots, motor, sensory)
Roots - C5, C6, C7
Motor - muscles in the anterior compartment of the arm - corachobrachialis, biceps brachii, brachioradialis
Sensory - lateral cutaneous nerve of the forearm
What is the anataomical course of the median nerve.
Terminal branch of the lateral cord
Emerges at the inferior border of the pectoralis major, leaves the axilla and pierces coracobrachialis
Passes down the flexor compartment, superficial to brachialis, deep to bicep brachii and gives articular branches to the humerus and elbow
Pierces the deep fascia, lateral to biceps brachii, emerging lateral to the biceps tendon and brachialis
Continues in the forearm as the lateral cutaenous nerve of forearm
What are the movements of the muscles innervated by the median nerve
Flexion of the upper arm at the shoulder and elbow
Supination - by biceps brachii
What happens with injury to the median nerve
Flexion of the shoulder and elbow are weakened but still carried out by pec major and brachioradialis
Supination weakened but still carried out by brachioradialis
Give an overview of the axillary nerve
(roots, motor, sensory)
Roots - C5, C6
Motor - Teres minor (external rotation), deltoid, (abduction of the shoulder)
Sensory - Lateral cutaneous nerve of the forearm (regimental badge area)
The axillary nerve is a direct continuation of which cord of the brachial plexus
Posterior cord
Where does the axillary nerve exit the axilla, which muscle is it closely related to at this point, through which space does it pass and what accompanies it
Exits at the inferior border of subscapularis, via the quadrangular space
Accompanied by the posterior circumflex artery and vein
What are the 3 terminal branches of the axillary nerve
What are the 3 terminal branches of the axillary nerve
Posterior terminal branch
Anterior terminal branch
Articular branch
What does the posterior terminal branch of the axillary nerve supply
The posterior fibres of deltoid, teres minor
What does the anterior terminal branch of the axillary nerve supply
Anterior fibres of the deltoid
+ cutaneous branch to the anterior and anterolateral shoulder
Which branch of which nerve wraps around the surgical neck of the humerus
Anterior temrminal branch of axillary nerve
Which nerve supplies the glenohumeral joint
Articular branch of the axillary nerve
Give an overview of the median nerve
(roots, motor, sensory)
Roots - C5-T1
Motor - flexor and pronator muscles of the anterior compartment of the arm, thenar muscles and lateral lumbricals
Sensory - lateral aspect of palm, lateral 3.5 fingers on palmar aspect
Describe the anatomical path of the median nerve
Derived from medial and lateral cords
Descends down the arm, lateral to the brachial artery, crossed the artery anteriorly to be situated medially
Enters the anterior compartment of the arm via the cubital fossa
Travels down the forearm between flexor digitorum profundus and superficial, giving off 2 branches
Enters the carpal tunnel - gives off 2 further branches (terminal branches)
What are the 2 branches of the median nerve given off in the forearm
Anterior interosessous - supplies deep muscles of the forearm
Palmar cutaneous - supplies skin of palm
What are the terminal branches of the median nerve
Recurrent branch
Palmar digital branch
Which muscles in the superficial and intermediate layer of the forearm does the median nerve supply
Superficial - pronator Teres, flexor carpi radialis, palmares longus
Intermediate - Flexor digitorum superficialis
What does the anterior interosseous branch of the median nerve supply
Deep flexors - Flexor pollicis longus, pronator quadratus, lateral half of flexor digitorum profundus
What muscles in the hand are supplied by branches of the median nerve
Thenar muscles (abductor pollicis brevis, flexor pollicis brevis, opponens pollicis)
Lateral 2 lumbricals
What is carpal tunnel syndrome
Most common mononeuropathy, due to increased tissue pressure within the carpal tunnel
What are the 2 tests for CTS
Tinel’s sign - tapping the nerve in the carpal tunnel to elicit pain in its nervous distribution
Phalens test - holding the wrist in flexion for 60 seconds to elicit pain/numbness in the median nerve distribution
Give an overview of the radial nerve
(roots, motor, sensory)
Roots - C5-T1
Motor - innervates triceps brachii and the extensor muscles of the forearm (posterior)
Sensory - most of the skin of the posterior forearm, lateral aspect of dorsum of hand, dorsal surface of lateral 3.5 digits
The radial nerve is a continuation of which cord of the brachial plexus
Posterior cord
Give a summary of the anatomical course of the radial nerve
Arises in the axilla, posterior to the axillary artery
Exits inferiorly via the triangular interval, supplies the long and lateral head of triceps
Descends down the arm in the radial groove of the humerus, gives of branch to medial head of triceps
Travels anterior to the lateral epicondyle of the humerus through the cubital fossa
What are the terminal branches of the radial nerve
Deep branch - posterior interossesous
Superficial branch
Which muscles does the radial nerve supply
Triceps brachii
Brachioradialis
Extensor carpi radialis longus and brevis
Extensor digitorum
Extensor digiti minimi
Extensors carpi ulnaris
Anconeus
Which branches of the radial nerve give sensory innervation to the arm
Lower lateral cutaneous nerve of the arm
Posterior cutaneous nerve of the forearm
Posterior nerve of arm
Superficial branch
Wrist drop is a result of injury to which nerve
Radial nerve
Is triceps brachii paralysed following injury to the radial nerve secondary to a humeral shaft #
No - weakened but not paralysed
Branches to the long and lateral head are given before the humeral shaft
Injury to the radial nerve in the axilla will lead to what
Lack of extension of the elbow, wrist and fingers
Give an overview of the ulnar nerve
Roots - C8, T1
Motor - flexor carpi ulnaris, medial half of flexor digitorum profundus, intrinsic muscles of the hand
Sensory - medial 1.5 fingers and associated palm
The ulnar nerve descends from the axilla inbetween which two structures
Axillary artery (lateral) and axillary vein (medial)
What forms the ulnar tunnel
Medial epicondyle and olecranon
The ulnar nerve pierces which muscle and then travels along which structure
Flexor carpi radialis
Travels deep to the muscle beside the ulna
What are the 3 branches of the ulnar nerve
Muscular branch
Palmar cutaneous branch
Dorsal cutaneous branch
Describe the path of the ulnar nerve at the wrist
Travels superficial to the flexor retinaculum, medial to the ulnar artery
Enters the hand via ulnar canal ( Guyen’s canal) and terminates by giving the superficial and deep branches
Which muscles in the forearm does the ulnar nerve supply
Flexor carpi ulnaris
Medial half of flexor digitorum profundus
Which muscles in the hand does the ulnar nerve supply
Hypothenar - flexor digiti minimi, abducotr digiti minimi, opponens digiti minimi
Medial 2 lumbricals
Adductor pollicis
Palmar dorsal interossei
Palmar brevis
Which musclesare found in the pectoral region
Pectoralis major
Pectoralis Minor
Serratus anterior
Subclavius
Which is the most superficial muscle in the pectoral region
Pectoralis major
What are the attachements of pectoralis major
Clavicular head - from anterior surface of medial clavicle
Sternocostal head - from anterior surface of the sternum, 6 superior CC and aponeurosis of the external oblique muscle.
Distal attachment - intertubercular sulcus of the humerus
What is the function of pectoralis major
Adduction and medial rotation of the upper limb
Draws scapula anteroinferiorly
Upper limb flexion (clavicular head)
What is the innervation of pectoralis major
Lateral and medial pectoral nerves
Where is pectoralis minor found
Deep to pectoralis major
Where does pectoralis minor attach
Originates from ribs 3-5 and inserts into the coronoid process of the scapula
What is the function of pectoralis minor
Stabilisation of the scapula by drawing it inferiorly and anteriorly
What is the nerve innervation of the scapula
Medial pectoral nerve
Describe serratus anterior and which structure does it border
Found laterally in the chest wall, consists of several strips which originate from the lateral aspects of ribs 1-8 - the attach to the costal surface of the medial scapula
Forms the medial border of the axilla
What is the innervation to serratus anterior
Long thoracic nerve
Where is subclavius found and what are its attachments
Small muscle, located directly below the clavicle running horizontally
Originates from the junction of the first rib and its CC, inserts onto the inferior surface of the middle third of the clavicle
What is the function of subclavius
To anchor and depress the scapula
What is the innervation to subclavius
Nerve to subclavius
What are the two groups of muscles of the shoulder
Intrinsic shoulder muscles - originate from the scapula or the clavicle and attach to the humerus
Extrinsic shoulder muscles - originate from the torso and attach to bones of the shoulder
What are the superficial extrinsic shoulder muslces
Trapezius and Latissimus Dorsi
What are the attachments of Trapezius
Originates from the skull, nuchal ligament and spinous processes of C7-T12
Fibres attach the clavicle, acromion and clavicular spine
What movements does Trapezius facilitate and what is its nervous supply
Upper fibres - elevate and abduct the scapula in abduction of the arm
Middle fibres, retract the scapula
Lower fibres - pull the scapula inferiorly
Motor innervation - accessory nerve
What are the attachments of Latissimus dorsi
Broad attachment
Spinous processes from T7-T12, iliac crest, thoracolumbar fascia and 3 inferior ribs
Fibres converge into a tendon which attaches to the intertubercular sulcus of the humerus
What is the action of latissimus dorsi and which nerve innervates it
Extends, adducts and medially rotates the upper limb
Innervated by thoracodorsal nerve
What are the deep extrinsic muscles of the shoulder
Levator Scapulae
2 Rhomboids
What are the attachments of levator scapulae
Originates from teh transverse processes of C1-C4 and attaches to the medial border of the scapula
Which nerve innervates levator scapulae
Dorsal scapular nerve
What is the action of levator scapulae
Elevation of the scapula
What are the two rhomboids and which is superior
Rhomboid Major
Rhomboid Minor
Rhomboid minor is situated superiorly to major
Where does rhomboid major and minor attach
Major - Spinous processes of T2-T5, attaches to the medial border of the scapula, between the scapula spine and inferior angle
Minor - spinous processes C7-T1, attaches to the medial border of the scapula at the level of the spine
What is the action of the Rhomboids and what supplies them
Retracts and rotates the scapula
Dorsal scapular nerve
What are the intrinsic shoulder muscles
Deltoid
Teres major
Subscapularis
Infraspinatus
Supraspinatus
Teres Minor
Where does the deltoid attach
The lateral third of the clavicle, the acromion and the spine of the scapula
Attaches to the deltoid tuberosity of the humerus
What are the actions of the deltoid
Anterior fibres - flexion and medial rotation
Posterior fibres - extension and lateral rotation
Middle fibres - abduction (after first 15 degrees from supraspinatus)
What are the attachments of Teres Major
Posterior surface of the inferior angle of the scapula
Attaches to the medial lip of the intertubercular sulcus
What border of which space does teres major form and what structures pass through this
Forms the inferior border of the quadrangular space
Axillary nerve and posterior circumflex artery pass through this to reach the posterior scapula
What are the actions of Teres Major
Adducts and extends the shoulder
Medially rotates the arm
Which nerve innervates Teres Major
Lower sub scapular nerve
Where does supraspinatus attach
Supraspinous fossa of the scapula and onto the greater tubercle of the humerus
What is the action of supraspinatus and which nerve supplies it
Abducts the arm 0-15 degrees, assists the deltoid for 15-90 degrees
Supplied by suprascapular nerve
Where does infraspinatus attach
Infraspinous fossa of the scapula and onto the greater tubercle of the humerus
What is the action of infraspinatus and which nerve supplies it
Laterally rotates the arm
Suprascapular nerve
Where does subscapularis attach
Subscapular fossa, on the costal surface of the scapular, attaches onto the lesser tubercle of the humerus
What is the action of subscapularis and what innervates it
Medial rotation of the arm
Upper and lower sub scapular nerves
Where does teres minor attach
The posterior surface of the scapula, adjacent to the lateral border, inserts into the greater tubercle of the humerus
What is the action of teres minor and what innervates it
Laterally rotates the arm
Innervated by axillary nerve
Which two rotator cuffs laterally rotate the arm
Infraspinatus
Teres Minor
Which is the only rotator cuff muscle to insert onto the lesser tubercle of the humerus
Subscapularis
How many muscular compartments are in the upper arm
2
Anterior and posterior
Which muscles are found in the anterior compartment of the upper arm
Biceps brachii
Brachioradialis
Coracobrachialis
Which muscles are found in the posterior compartment of the arm
Triceps Brachii
Which artery supplies the anterior compartment of the arm
Brachial artery
Where is the origin of biceps brachii
Long head- supraglenoid tubercle of the scapula
Short head - Coracoid process of the scapula
Where does biceps brachii insert
Inserts into the fascia of the forearm via the bicipital aponeurosis and onto the radial tuberosity
The bicipital aponeurosis forms the roof of which structure
Cubital fossa
What is the function of biceps brachii
Supination of the forearm
Flexion of the elbow and the shoulder
What is the innervation of the anterior compartment of the arm
Musculocutaneous
Which muscle in the upper arm has additional innervation from the radial nerve
Brachialis
The biceps tendon reflex tests which nerve root
C6
Which muscles lies deep to biceps brachii
Corachobrachialis
What are the attachments of coracobrachialis
Coronoid process of the scapula
Medial side of the humerus at the level of the deltoid tubercle (passes through the axilla to get to this point)
What is teh function of corachobrachialis
Flexion of the shoulder, weak adduction
Where is brachialis found, and what structure does it form the floor of
Depp to biceps brachii
Forms the floor of cubital fossa
What are the attachments of Brachialis
Medial and lateral surfaces of the humeral shaft
Inserts into the ulnar tuberosity
What is the function of Brachialis
Flexion at the elbow
Which head of the biceps commonly ruptures and what sign does it produce
Long head - produces Popeye sign
What is the arterial supply to the posterior compartment of the arm
Profunda brachii artery
Describe the 3 heads of triceps brachii
Long head - orginates from the infraglenoid tubercle
Lateral head - originates from the humerus, superior to the radial groove
Medial head - originates from the humerus, inferior to the radial groove (lies deep to the other muscles)
Where does the tendon of triceps brachii insert
Onto the olecranon
What movement does the triceps brachii allow
Extension of the elbow
What nerve supplies triceps brachii and the triceps reflex tests which nerve root
Radial nerve
C7
How many layers are in the anterior compartment of the forearm, and what are they?
3 layers
Superficial, intermediate, deep
What movements do the muscles int eh anterior compartment of the arm facilitate
Pronation of the forearm
Flexion of the wrist
Flexion of the fingers
The muscles in the anterior compartment of the arm are innervated by the median nerve, other than which muscles
Flexor carpi ulnaris
Medial half of flexor digitorum profundus
These are innervated by the ulnar nerve
Which muscles are in the superficial layer of the anterior compartment of the forearm
Flexor carpi ulnaris
Palmaris longus
Flexor carpi radialis
Pronator teres
Which muscles are in the intermediate layer of the anterior compartment of the forearm
Flexor digitorum superficialis
Which muscles are in the deep layer of the anterior compartment of the forearm
Flexor pollicis longus
Flexor digitorum profundus
Pronator quadratus
The superficial layer of muscles in the anterior compartment of the forearm all originate from which common origin
Medial epicondyle
Flexor carpi ulnaris has 2 heads, other than the medial epicondyle of the humerus, where does it arise
Olecranon of the ulna
Where does flexor carpi ulnaris insert
Pisiform
Hook of hamate
Base of 5th metacarpal
Where does palmaris longus insert
Flexor retinaculum of the wrist
Flexor carpi radialis attaches to the base of which metacarpals
2 and 3
The lateral border of pronator teres forms the medial border of which structure
Cubital fosa
What are the 2 origins of pronator teres and where does it insert
Medial epicondyle
Coronoid process of the ulna
Attaches to the midshaft of the radius
Which structures pass between the two heads of flexor digitorum superficialis
Median nerve and ulnar artery
Describe the attachments of flexor digitorum superficialis
2 heads - one originates from medial epicondyle of the humerus, one from the radius
Splits into 4 tendons at the wrist whch travel through the carpal tunnel, and attach at the base of the middle phalanx of the 4 digits
What is the action of FPS
Flexes the MCP joints, flexes the IP joints, flexes the wrist
Describe the attachments of flexor digitorum profundus
Originates at the ulna and assocaited interosseous membrane, at the wrist splits into 4 tendons which travel through the carpal tunnel and attach to the distal phalanges
What is the action of FDP
Flex the distal IP joint
What is the innervation of FDP
Medial half (ring and little fingers) - ulnar nerve
Lateral half (middle and index fingers) - anterior interossesous branch of the median nerve
Where does flexor pollicis longus lie in relation to FDP
Lateral
What is the attachments of FPL
Anterior surface of the radius and surrounding interosseous membrane
Attaches to the distal base of the thumb
Where does pronator quadratus attach
Anterior surface of the ulna
Anterior surface of the radius
The anterior interosseous branch of the median nerve innervates which muscles of the anterior compartment of the forearm
Flexor digitorum profundus
Flexor pollicis longus
Pronator quadratus
How many layers of muscles in the posterior compartment of the arm, and what are their combined function
2 - Superficial and Deep
Extensor muscles
Which muscles are in the superficial layer of the posterior compartment of the arm
Brachioradialis
Extensor carpi radialis longus and brevis
Extensor digitorum
Extensor digiti minimi
Extensor carpi ulnaris
Anconeus
Which muscles are in the deep layer of the posterior compartment of the forearm
Supinator
Abductor pollicis longus
Extensor pollicis brevis
Extensor pollicis longus
Extensor indices
Which muscle in the superficial layer of the posterior compartment of the arm is a flexor
Brachioradialis
The radial artery adn nerve are sandwiched between which muscles
Brachioradialis and the deep flexor muscles
What are the site of attachment of brachioradialis
Lateral supracondylar ridge of the humerus
Radial styloid process
What movements are facilitated by extensor carpi radialis longus and brevis
Extension and abduction of the wrist
Which metacarpals do ECRL and ECRB insert into
II and III
Extensor digitorum splits into how many tendons and where do they insert
4 tendons
Inserts into the extensor hood of each finger
Where does extensor digiti minimi lie in relation to extensor digitorum
Lies medially to extensor digitorum
Attaches with extensor digitorum to the extensor hood of the little finger
Which additional movement can extensor carpi ulnaris produce
Adduction
Aconeus is blended with the fibres of which muscle
Triceps brachii
What is the action of aconeus
Extends and stabilises the elbow joint
Abducts the ulna during pronation of the elbow
The deep muscles of the posterior forearm act on which fingers
Thumb
Index finger
The radial nerve passes inbetween the 2 heads of which muscle
Supinator
Abductor policis longus inserts into which metacarpal and forms the lateral border of which anatomical structure
I
Anatomical snuffbox
Which branch of the radial nerve innervates abductor policies longus
Posterior interosseous branch
Extensor policis longus forms which border of the anatomical snuffbox
Medial border
Radial nerve injury leads to what clinical presentation and why
Wrist drop
Paralysis of all extensor muscles, leading to unopposed flexion of the wrist
Where are the thenar muscles found, how many are there and what are they called
Thumb
3 muscles
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
What is the innervation of the thenar muscles
Median nerve - recurrent branch
How are the thenar muscles arranged
Opponens pollicis - largest muscle, lies underneath the other two
Abductor pollicis brevis - lies anterolaterally
Flexor pollicis brevis - medially
Which muscles make up the hypothenar eminence
Oponnens digiti minimi
Abductor digiti minimi
Flexor digiti minimi brevis
What is the innervation of the hypothenar muscles
Ulnar nerves
Describe the attachment of lumbricals
Originate from a tendon of the flexor digitorum profundus, pass dorsally around each finger and insert into the extensor hood
What is the innervation of the lumbricals
Lateral 2 lumbricals - innervated by the median nerve
Medial 2 lumbricals - innervated by the ulnar nerve
What is the action of the lumbricals
Flexion of the MCP joint
Extension at the IP joint
What is the action of the dorsal interossei compared to the palmar interossei
Dorsal - abduction
Palmar - adduction
Which nerve supplies the interossei
Ulnar
Where is palmaris brevis found and what is its action
Originates from the palmar aponeurosis and flexor retinaculum, attaching to the dermis of the skin on teh medial margin of the hand
Wrinkles the skin of the hypothenar eminence and deepens the curvature of the hand improving grip
The radial arteyr passed through which muscle in the hand and what does it then form
Passes between the 2 heads of the adductor pollicis
What are the borders of the axilla
Apex - lateral border of the first rib, superior border of scapula, posterior border of the clavicle
Lateral wall - intertubercular sulcus of the humerus
Medial wall - serratus anterior and the thoracic wall
Anterior wall - pec major and minor
Posterior wall - Scapularis, teres major, Lat Dorsi
What is the contents of the axilla
Axillary artery
Axillary vein
Brachial plexus
Axillary lymph nodes
Biceps brahii and coracobrachialis
What are the boundaries of the quadrangular space
Teres minor (sup)
Teres major (inf)
Surgical neck of humerus (lat)
long head of biceps brachii (med)
What are the boundaries of the clavipectoral triangle
Pectoralis major
Deltoid
Clavicle
What are the borders of the cubital fossa
Lateral border - brachioradialis
Medial border - Pronator teres
Superior border - line drawn between the epicondyles
Roof - bicipital aponeurosis, fascia, sublet fat, skin
Floor - brachialis and supinator
What is the content of the cubital fossa
Radial nerve
Biceps tendon
Brachial artery
Median nerve
What are the borders of the ulnar tunnel
Medial - medial epicondyle of the humerus
Lateral - olecranon of the ulna
Floor - elbow joint capsule, medial collateral ligament of the elbow
Roof - cubital tunnel retinaculum
How many extensor tendon compartments are found in the wrist
6
What is in extensor compartment one, and where is it locateed
Extensor pollicis brevis
Abductor pollicis longus
Located laterally (radial)
What is in extensor compartment 2
Extensor carpi radialis brevis
Extensor carpi radialis longus
What is in extensor compartment 3, and what separates it from compartment 2
Extensor pollicis longus
Separated from compartment 2 by listers tubercle
What is in extensor compartment 4
Extensor digitorum
Extensor indices
What is in extensor compartment 5
Extensor digit minimi
What is in extensor compartment 6
Extensor carpi ulnaris
The flexor retinaculum at the wrist spans between which bones
hook of hamate and pisiform - medially
scaphoid and trapezium - laterally
Which tendons are found in teh carpal tunnel
The tendon of flexor pollicis longus
Four tendons of flexor digitorum profundus
Four tendons of flexor digitorum superficialis
What are the borders of the anatomical snuffbox
medial (ulnar) - extensor pollicis longus
lateral (radial) - extensor pollicis brevis and abductor pollicis longus
Proximal - styloid process of radius
Floor - scaphoid and trapezium
What are the contents of the anatomical snuff box
Radial artery
Superficial branch of radial nerve
Cephalic vein
