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MRCS > Upper limb > Flashcards

Upper limb Flashcards

1
Q

What are the proximal carpals ( lateral to medial, palmar aspect)

A

Scaphoid
Lunate
Triquetrum
Pisiform

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2
Q

Which of the carpals in considered a sesamoid bone and in which tendon does it lie

A

Pisiform
Lies within the tendon of flexor carpi ulnaris

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3
Q

What are the distal carpals (lateral to medial palmar aspect)

A

Trapezium
Trapezoid
Capitate
Hamate

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4
Q

What is a boxers #

A

of the 5th metacarpal
Distal section displaced anteriorly leading to the displacement of the finger

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5
Q

What is a Bennetts #

A

of the first metacarpal base
Due to forced abduction of the thumb

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6
Q

Why do Bennetts # often need surgical fixation

A

They extend into the first metacarpal joint, leading to instability and subluxation of the joint

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7
Q

Which muscles attaches on to the radial tuberosity

A

Biceps brachii

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8
Q

where does pronator teres attach to the radius

A

The middle lateral surface

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9
Q

Which 2 metacarpals does the radius articulate with

A

Scaphoid and Lunate

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10
Q

Describe a Colles #

A

Radial # with the distal aspect of the fracture being dorsally displaced (posterior)

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11
Q

Which # produces a dinner fork deformity

A

Colles #

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12
Q

Describe a Smiths #

A

Radial #- distal aspect of fracture with volar displacement (anterior)

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13
Q

Describe a Monteggia #

A

dislocation
# of the proximal ulna and dislocation of the radial head at the proximal radioulnar joint

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14
Q

Describe Galeazzi #

A

to the distal radius with ulna head dislocating at the distal radioulnar joint

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15
Q

Which parts of the ulna articulate with the humerus

A

Trochlear notch and coronoid process

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16
Q

Where does pronator quadratus attach to

A

The anterior surface of the shaft of the ulna

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17
Q

What attaches to the tuberosity of the ulna and where is it found

A

Brachialis attaches
Tuberosity of ulna - roughened area immediately distal to the coronoid process

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18
Q

Where does triceps brachii attach to

A

The superior surface of the olecranon

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19
Q

What separates the humeral head from the greater and lesser tuberosities

A

The anatomical neck of humerus

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20
Q

What is the greater tuberosity the attachment site for

A

3/4 Rotator cuff muscles
Supraspinatus
Infraspinatus
Teres Minor

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21
Q

Which muscle attaches to the middle facet of the greater tuberosity of the humerus

A

Infraspinatus

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22
Q

Which muscle attaches to the inferior facet of the greater tuberosity of the humerus

A

Teres Minor

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23
Q

Where is the lesser tuberosity of the humerus located

A

Medially

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24
Q

Which rotator cuff muscle attaches to the lesser tuberosity of the humerus

A

Subscapularis

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25
Q

Which muscle runs through the inter tubercular groove of the humerus

A

Long head of biceps brachii

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26
Q

Which muscles attach to the lips of the inter tubercular groove

A

Teres Major - medial lip
Latissmis dorsi
Pectoralis Major - lateral lip

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27
Q

Which nerve is at risk in a # of the surgical neck of humerus

A

Axillary nerve

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28
Q

What attaches to the conoid process of the clavicle

A

The conoid ligament - the medial part of the coracoclavicular ligament

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29
Q

What attaches to the trapezoid line of the clavicle

A

The trapezoid ligament - the lateral part of the coracoclavicular ligament

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30
Q

What are the 2 parts of the coracoclavicular ligament

A

The conoid ligament (medially) and the trapezoid ligament (laterally)

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31
Q

Which muscles attach to the shaft of the clavicle

A

Deltoid
Trapezius
Subclavius
Pectoralis major
Sternocleidomastoid
Sternohyoid

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32
Q

Describe the displacement of the lateral and medial aspects of a clavicle fracture

A

Lateral aspect - displaced inferiorly by the weight of the arm, and medially by pectoralis major
Medial aspect - pulled superiorly by sternocleidomastoid

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33
Q

Which muscles attach to the coronoid process of the scapula

A

Pectoralis minor
Coracobrachialis
Short head of biceps brachii

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34
Q

Which muscle attaches to the supraglenoid tubercle

A

Long head of biceps brachii

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35
Q

Which muscle attaches to the infraglenoid tubercle

A

Long head of triceps brachii

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36
Q

The acromioclavicular joint is reinforced posteriorly by which muscle

A

Trapezius muscle

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37
Q

What is the blood supply to the acromioclavicular joint

A

Suprascapular artery and thoracoacromial artery

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38
Q

Suprascapular nerve and lateral pectoral nerve innervate which joint of the upper limb

A

Acromioclavicular joint

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39
Q

The sternoclavicular joint would be described as what kind of joint

A

Saddle joint

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40
Q

What are the ligaments associated with the sternoclavicular joint

A

Anterior and posterior sternoclavicular ligament
Interclavicular ligament
Costoclavicular ligament

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41
Q

What is the blood supply of the sternoclavicular joint

A

Internal thoracic artery
Suprascapular artery

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42
Q

What is the innervation of the sternoclavicular joint

A

Medial supraclavicular nerve
Nerve to subclavius

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43
Q

Which ligaments support the glenohumeral joint

A

Coracoacromial ligament
Coracohumeral ligament
Glenohumeral ligament (superior, middle, inferior)
Transverse humeral ligament

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44
Q

What does the transverse humeral ligament hold

A

The tendon of the long head of biceps brachii

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45
Q

What are the two main bursa of the glenohumeral joint

A

Subacromial
Subscapular

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46
Q

Where would you find the subacromial bursa

A

Deep to the deltoid and acromion, superficial to the supraspinatus tendon and joint tendon

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47
Q

What is the function of the subacromial bursa

A

Reduced friction beneath the deltoid

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48
Q

Where is the subscapular bursa found

A

Between the subscapularis tendon and the scapula

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49
Q

Which muscles are responsible for shoulder extension

A

Posterior Deltoid
Latissimus dorsi
Teres Major

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50
Q

Which muscles are responsible for shoulder flexion

A

Pectoralis Major
Anterior deltoid
Corachobrachialis

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51
Q

Which muscles are responsible for abduction of shoulder

A

Supraspinatus - first 0-15 degrees
Middle fibres of deltoid - 15-90 degrees

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52
Q

The rotation of which bone is required for full abduction of the shoulder

A

Trapezius
Serratus Anterior

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53
Q

Which muscles are responsible for adduction of the shoulder

A

Pectoralis major
Latissimus dorsi
Teres major

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54
Q

Which muscles are responsible for internal rotation of the arm

A

Subscapularis
Pectoralis major
Latissimus dorsi
Teres Major
Anterior Deltoid

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55
Q

Which muscles are responsible for external rotation of the arm

A

Infraspinatus
Teres Minor

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56
Q

What is the blood supply of the glenohumeral joint

A

Anterior and posterior circumflex humeral arteries (branches of the axillary artery)
Suprascapular artery (branch of thyrocervical a)

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57
Q

Impaction of the posterolateral humeral head against the anterior inferior glenoid has what eponymous name

A

Hill Sachs Lesion

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58
Q

What is a Bankart lesion

A

Detachment of the anterior inferior labrum +/- avulsion #

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59
Q

What are the 2 articulations of the elbow joint

A

Trochlear notch of the ulna and trochlea of the humerus
Head of radius and capitulum of humerus

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60
Q

Which bursa are found around the elbow

A

Intratendinous
Subtendinous
Subcutaneous

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61
Q

Where is intratendinous bursa of the elbow found

A

Within the tendons of the triceps brachii

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62
Q

Where is subtendinous bursa of the elbow found

A

Between the olecranon and the tendon of triceps brachii, reduces friction between the 2 structures between flexion and extension

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63
Q

What is the other name for the subcutaneous bursa of the elbow and where is it found

A

Between the olecranon and the overlying connective tissue

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64
Q

Which ligaments support the elbow

A

Radial collateral ligament
Ulnar collateral ligament

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65
Q

Describe the radial collateral ligament

A

Extends from the lateral side of the joint from the lateral epicondyle - blends with the annular ligament of the radius

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66
Q

Describe the ulnar collateral ligament

A

Originates from the medial epicondyle and attaches to the coronoid process and olecranon of the ulna

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67
Q

What are the movements of the elbow

A

Flexion
Extension

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68
Q

Which muscles are responsible for flexion of the elbow

A

Triceps Brachii
Anconeus

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69
Q

Which muscles are responsible for extension of the elbow

A

Brachialis, biceps brachii, brachioradialis

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70
Q

Elbow dislocation tends to occur in which direction

A

Posterior dislocation

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71
Q

What injuries may be associated with a posterior elbow dislocation

A

Tearing of the ulnar collateral ligament +/- ulnar nerve involvement

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72
Q

What are the two types of epidcondylitis

A

Medial epicondylitis - common flexor origin
Lateral epicondylitis - common extensor origin

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73
Q

What is golfers elbow

A

Medial epicondylitis

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74
Q

What is tennis elbow

A

Lateral epicondylitis

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75
Q

What is a supracondylar elbow # and what is it MOA

A

Transverse # between the 2 epicondyles of the humerus
Often occurs due to a FOOSH

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76
Q

What is Volkmanns ischaemic contracture and what is it associated with

A

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

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77
Q

What articulates to form the proximal radioulnar joint

A

Articulation between the head of radius and the radial notch of the ulna

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78
Q

What artciulates to form the distal radioulnar joint

A

Articulation between ulnar notch of the radius and the ulnar head

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79
Q

The radioulnar joints allow what movement

A

Pronation and supination

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80
Q

Which muscles are responsible for pronation

A

Pronator quadratus
Pronator teres

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81
Q

Which muscles are responsible for supination

A

Supinator
Biceps Brachii

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82
Q

What are the 2 functions of the fibrocartilaginous disc as the distal radioulnar joint

A

Binds radius and ulna together during movement
Seperates the distal radioulnar joint from the wrist

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83
Q

What is the interosseous membrane in the forearm and what is its functions

A

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

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84
Q

Which bones articulate in the wrist joint

A

Proximal row of carpal bones - scaphoid, lunate, triquetrum
Distal end of radius and fibrocartilaginous disc

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85
Q

What are the 4 ligaments of the wrist joint

A

Palmar radiocarpal
Dorsal radiocarpal
Ulnar collateral
Radial collateral

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86
Q

Describe the palmar radoiocarpal ligament and its function

A

On the palmar aspect of hand, passing from the radius to both rows of carpal bones
Increases stability, ensures hand follows arm in supination

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87
Q

Describe the dorsal radiocardpal ligament and its function

A

Dorsal aspect of hand
From radius to both rows of carpal bones
Increases stability, ensures hands follows arm in pronation

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88
Q

Describe the radial and ulnar collateral ligaments

A

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

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89
Q

Which muscles are responsible for wrist flexion

A

Flexor carpi ulnaris
Flexor carpi radialis
+ assistance from flexor digitorum superficialis

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90
Q

Which muscles are responsible for wrist extension

A

Extensor carpi radialis longus and brevis
Extensor carpi ulnas
Assistance from extensor digitorum

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91
Q

Which muscles are responsible for wrist adduction

A

Extensor Carpi Ulnaris
Flexor carpi ulnas

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92
Q

Which muscles are responsible for wrist abduction

A

Extensor carpi radialis longus and brevis
Flexor carpi radialis
Abductor pollicis longus

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93
Q

What type of joint is the MCPJ

A

Condyloid synovial joint

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94
Q

Which ligaments support the MCPJ

A

Deep transverse metacarpal ligament
Palmar ligament
Collateral ligament

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95
Q

Which muscles allow thumb flexion and extension

A

Flexor pollicius brevis and longus
Extensor pollicis brevis and longus

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96
Q

Which muscles allow thumb abduction and adduction

A

Adductor pollicis brevis
Abductor pollicis longus and brevis

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97
Q

Axial rotation of the thumb is facilitated by simultaneous contraction of which muscles

A

Flexor pollicis brevis
Adductor pollicis brevis

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98
Q

Which muscles facilitate flexion and extension of digits 2-5

A

Flexor digitorum superficialis
Flexor digitorum profundus
Lumbricals
Flexor digiti minimi - 5th digit

Extensor digitorum
Extensor indices - 2nd digit
Extensor digiti minimi - 5th digit

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99
Q

Which muscles facilitate adduction and abduction of digits 2-5

A

Palmar interossei

Dorsal interossei
Abductor digiti minimi - 5th digit

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100
Q

What is the blood supply to the MCPJ

A

Princeps pollicis artery - supplies MCP of thumb
Palmar and dorsal metacarpal arteries
Radialis indicis artery - supplies MCP of index finger
Common palmar digital a

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101
Q

Innervation of MCPJ

A

Posterior interosseous - branch of radial nerve
Deep terminal branches of the ulnar nerves
Palmar branches of the median nerve

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102
Q

What are the ligaments associated with IPJ

A

Proper and accessory collateral ligaments

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103
Q

What is the volar plate

A

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

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104
Q

Where do the proper and accessory ligaments of the IPJ attach

A

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

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105
Q

What are the movements of proximal IPJ and which muscles are responsible

A

Flexion
Flexor digitorum superficialis
2y driver - flexor digitorum profundus

Extension
Extensor digitorum, lumbricals, interesse
Extensor indicies - 2nd fight

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106
Q

Flexor digotorum profundus primarily flexes which joint

A

Distal IPJ

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107
Q

Where does the central slip tendon insert

A

Into the base of the middle phalanx

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108
Q

What is the function of the central slip tendon

A

TO extend the proximal IPJ

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109
Q

What is the classical appearance in a central slip tendon injury

A

PIPJ unable to extend, DIPJ is hyperextended due to the tension from the remaining extensor tendonds

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110
Q

Name which nerve roots form the superior, middle and inferior trunks of the brachial plexus

A

Superior - C5, C6
Middle - C7
Inferior - C8, T1

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111
Q

What forms the lateral cord of the brachial plexus

A

Anterior divison of the superior and middle trunk

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112
Q

What forms the posterior cord of the brachial plexus

A

Posterior division of the superior, middle and inferior trunk

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113
Q

What forms the medial cord of the brachial plexus

A

Anterior division of the posterior trunk

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114
Q

Give an overview of the median nerve
(roots, motor, sensory)

A

Roots - C5, C6, C7
Motor - muscles in the anterior compartment of the arm - corachobrachialis, biceps brachii, brachioradialis
Sensory - lateral cutaneous nerve of the forearm

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115
Q

What is the anataomical course of the median nerve.

A

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

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116
Q

What are the movements of the muscles innervated by the median nerve

A

Flexion of the upper arm at the shoulder and elbow
Supination - by biceps brachii

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117
Q

What happens with injury to the median nerve

A

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

118
Q

Give an overview of the axillary nerve
(roots, motor, sensory)

A

Roots - C5, C6
Motor - Teres minor (external rotation), deltoid, (abduction of the shoulder)
Sensory - Lateral cutaneous nerve of the forearm (regimental badge area)

119
Q

The axillary nerve is a direct continuation of which cord of the brachial plexus

A

Posterior cord

120
Q

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

A

Exits at the inferior border of subscapularis, via the quadrangular space
Accompanied by the posterior circumflex artery and vein

121
Q

What are the 3 terminal branches of the axillary nerve

A
122
Q

What are the 3 terminal branches of the axillary nerve

A

Posterior terminal branch
Anterior terminal branch
Articular branch

123
Q

What does the posterior terminal branch of the axillary nerve supply

A

The posterior fibres of deltoid, teres minor

124
Q

What does the anterior terminal branch of the axillary nerve supply

A

Anterior fibres of the deltoid
+ cutaneous branch to the anterior and anterolateral shoulder

125
Q

Which branch of which nerve wraps around the surgical neck of the humerus

A

Anterior temrminal branch of axillary nerve

126
Q

Which nerve supplies the glenohumeral joint

A

Articular branch of the axillary nerve

127
Q

Give an overview of the median nerve
(roots, motor, sensory)

A

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

128
Q

Describe the anatomical path of the median nerve

A

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)

129
Q

What are the 2 branches of the median nerve given off in the forearm

A

Anterior interosessous - supplies deep muscles of the forearm
Palmar cutaneous - supplies skin of palm

130
Q

What are the terminal branches of the median nerve

A

Recurrent branch
Palmar digital branch

131
Q

Which muscles in the superficial and intermediate layer of the forearm does the median nerve supply

A

Superficial - pronator Teres, flexor carpi radialis, palmares longus
Intermediate - Flexor digitorum superficialis

132
Q

What does the anterior interosseous branch of the median nerve supply

A

Deep flexors - Flexor pollicis longus, pronator quadratus, lateral half of flexor digitorum profundus

133
Q

What muscles in the hand are supplied by branches of the median nerve

A

Thenar muscles (abductor pollicis brevis, flexor pollicis brevis, opponens pollicis)
Lateral 2 lumbricals

134
Q

What is carpal tunnel syndrome

A

Most common mononeuropathy, due to increased tissue pressure within the carpal tunnel

135
Q

What are the 2 tests for CTS

A

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

136
Q

Give an overview of the radial nerve
(roots, motor, sensory)

A

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

137
Q

The radial nerve is a continuation of which cord of the brachial plexus

A

Posterior cord

138
Q

Give a summary of the anatomical course of the radial nerve

A

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

139
Q

What are the terminal branches of the radial nerve

A

Deep branch - posterior interossesous
Superficial branch

140
Q

Which muscles does the radial nerve supply

A

Triceps brachii
Brachioradialis
Extensor carpi radialis longus and brevis
Extensor digitorum
Extensor digiti minimi
Extensors carpi ulnaris
Anconeus

141
Q

Which branches of the radial nerve give sensory innervation to the arm

A

Lower lateral cutaneous nerve of the arm
Posterior cutaneous nerve of the forearm
Posterior nerve of arm
Superficial branch

142
Q

Wrist drop is a result of injury to which nerve

A

Radial nerve

143
Q

Is triceps brachii paralysed following injury to the radial nerve secondary to a humeral shaft #

A

No - weakened but not paralysed
Branches to the long and lateral head are given before the humeral shaft

144
Q

Injury to the radial nerve in the axilla will lead to what

A

Lack of extension of the elbow, wrist and fingers

145
Q

Give an overview of the ulnar nerve

A

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

146
Q

The ulnar nerve descends from the axilla inbetween which two structures

A

Axillary artery (lateral) and axillary vein (medial)

147
Q

What forms the ulnar tunnel

A

Medial epicondyle and olecranon

148
Q

The ulnar nerve pierces which muscle and then travels along which structure

A

Flexor carpi radialis
Travels deep to the muscle beside the ulna

149
Q

What are the 3 branches of the ulnar nerve

A

Muscular branch
Palmar cutaneous branch
Dorsal cutaneous branch

150
Q

Describe the path of the ulnar nerve at the wrist

A

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

151
Q

Which muscles in the forearm does the ulnar nerve supply

A

Flexor carpi ulnaris
Medial half of flexor digitorum profundus

152
Q

Which muscles in the hand does the ulnar nerve supply

A

Hypothenar - flexor digiti minimi, abducotr digiti minimi, opponens digiti minimi
Medial 2 lumbricals
Adductor pollicis
Palmar dorsal interossei
Palmar brevis

153
Q

Which musclesare found in the pectoral region

A

Pectoralis major
Pectoralis Minor
Serratus anterior
Subclavius

154
Q

Which is the most superficial muscle in the pectoral region

A

Pectoralis major

155
Q

What are the attachements of pectoralis major

A

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

156
Q

What is the function of pectoralis major

A

Adduction and medial rotation of the upper limb
Draws scapula anteroinferiorly
Upper limb flexion (clavicular head)

157
Q

What is the innervation of pectoralis major

A

Lateral and medial pectoral nerves

158
Q

Where is pectoralis minor found

A

Deep to pectoralis major

159
Q

Where does pectoralis minor attach

A

Originates from ribs 3-5 and inserts into the coronoid process of the scapula

160
Q

What is the function of pectoralis minor

A

Stabilisation of the scapula by drawing it inferiorly and anteriorly

161
Q

What is the nerve innervation of the scapula

A

Medial pectoral nerve

162
Q

Describe serratus anterior and which structure does it border

A

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

163
Q

What is the innervation to serratus anterior

A

Long thoracic nerve

164
Q

Where is subclavius found and what are its attachments

A

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

165
Q

What is the function of subclavius

A

To anchor and depress the scapula

166
Q

What is the innervation to subclavius

A

Nerve to subclavius

167
Q

What are the two groups of muscles of the shoulder

A

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

168
Q

What are the superficial extrinsic shoulder muslces

A

Trapezius and Latissimus Dorsi

169
Q

What are the attachments of Trapezius

A

Originates from the skull, nuchal ligament and spinous processes of C7-T12
Fibres attach the clavicle, acromion and clavicular spine

170
Q

What movements does Trapezius facilitate and what is its nervous supply

A

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

171
Q

What are the attachments of Latissimus dorsi

A

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

172
Q

What is the action of latissimus dorsi and which nerve innervates it

A

Extends, adducts and medially rotates the upper limb
Innervated by thoracodorsal nerve

173
Q

What are the deep extrinsic muscles of the shoulder

A

Levator Scapulae
2 Rhomboids

174
Q

What are the attachments of levator scapulae

A

Originates from teh transverse processes of C1-C4 and attaches to the medial border of the scapula

175
Q

Which nerve innervates levator scapulae

A

Dorsal scapular nerve

176
Q

What is the action of levator scapulae

A

Elevation of the scapula

177
Q

What are the two rhomboids and which is superior

A

Rhomboid Major
Rhomboid Minor
Rhomboid minor is situated superiorly to major

178
Q

Where does rhomboid major and minor attach

A

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

179
Q

What is the action of the Rhomboids and what supplies them

A

Retracts and rotates the scapula
Dorsal scapular nerve

180
Q

What are the intrinsic shoulder muscles

A

Deltoid
Teres major
Subscapularis
Infraspinatus
Supraspinatus
Teres Minor

181
Q

Where does the deltoid attach

A

The lateral third of the clavicle, the acromion and the spine of the scapula
Attaches to the deltoid tuberosity of the humerus

182
Q

What are the actions of the deltoid

A

Anterior fibres - flexion and medial rotation
Posterior fibres - extension and lateral rotation
Middle fibres - abduction (after first 15 degrees from supraspinatus)

183
Q

What are the attachments of Teres Major

A

Posterior surface of the inferior angle of the scapula
Attaches to the medial lip of the intertubercular sulcus

184
Q

What border of which space does teres major form and what structures pass through this

A

Forms the inferior border of the quadrangular space
Axillary nerve and posterior circumflex artery pass through this to reach the posterior scapula

185
Q

What are the actions of Teres Major

A

Adducts and extends the shoulder
Medially rotates the arm

186
Q

Which nerve innervates Teres Major

A

Lower sub scapular nerve

187
Q

Where does supraspinatus attach

A

Supraspinous fossa of the scapula and onto the greater tubercle of the humerus

188
Q

What is the action of supraspinatus and which nerve supplies it

A

Abducts the arm 0-15 degrees, assists the deltoid for 15-90 degrees
Supplied by suprascapular nerve

189
Q

Where does infraspinatus attach

A

Infraspinous fossa of the scapula and onto the greater tubercle of the humerus

190
Q

What is the action of infraspinatus and which nerve supplies it

A

Laterally rotates the arm
Suprascapular nerve

191
Q

Where does subscapularis attach

A

Subscapular fossa, on the costal surface of the scapular, attaches onto the lesser tubercle of the humerus

192
Q

What is the action of subscapularis and what innervates it

A

Medial rotation of the arm
Upper and lower sub scapular nerves

193
Q

Where does teres minor attach

A

The posterior surface of the scapula, adjacent to the lateral border, inserts into the greater tubercle of the humerus

194
Q

What is the action of teres minor and what innervates it

A

Laterally rotates the arm
Innervated by axillary nerve

195
Q

Which two rotator cuffs laterally rotate the arm

A

Infraspinatus
Teres Minor

196
Q

Which is the only rotator cuff muscle to insert onto the lesser tubercle of the humerus

A

Subscapularis

197
Q

How many muscular compartments are in the upper arm

A

2
Anterior and posterior

198
Q

Which muscles are found in the anterior compartment of the upper arm

A

Biceps brachii
Brachioradialis
Coracobrachialis

199
Q

Which muscles are found in the posterior compartment of the arm

A

Triceps Brachii

200
Q

Which artery supplies the anterior compartment of the arm

A

Brachial artery

201
Q

Where is the origin of biceps brachii

A

Long head- supraglenoid tubercle of the scapula
Short head - Coracoid process of the scapula

202
Q

Where does biceps brachii insert

A

Inserts into the fascia of the forearm via the bicipital aponeurosis and onto the radial tuberosity

203
Q

The bicipital aponeurosis forms the roof of which structure

A

Cubital fossa

204
Q

What is the function of biceps brachii

A

Supination of the forearm
Flexion of the elbow and the shoulder

205
Q

What is the innervation of the anterior compartment of the arm

A

Musculocutaneous

206
Q

Which muscle in the upper arm has additional innervation from the radial nerve

A

Brachialis

207
Q

The biceps tendon reflex tests which nerve root

A

C6

208
Q

Which muscles lies deep to biceps brachii

A

Corachobrachialis

209
Q

What are the attachments of coracobrachialis

A

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)

210
Q

What is teh function of corachobrachialis

A

Flexion of the shoulder, weak adduction

211
Q

Where is brachialis found, and what structure does it form the floor of

A

Depp to biceps brachii
Forms the floor of cubital fossa

212
Q

What are the attachments of Brachialis

A

Medial and lateral surfaces of the humeral shaft
Inserts into the ulnar tuberosity

213
Q

What is the function of Brachialis

A

Flexion at the elbow

214
Q

Which head of the biceps commonly ruptures and what sign does it produce

A

Long head - produces Popeye sign

215
Q

What is the arterial supply to the posterior compartment of the arm

A

Profunda brachii artery

216
Q

Describe the 3 heads of triceps brachii

A

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)

217
Q

Where does the tendon of triceps brachii insert

A

Onto the olecranon

218
Q

What movement does the triceps brachii allow

A

Extension of the elbow

219
Q

What nerve supplies triceps brachii and the triceps reflex tests which nerve root

A

Radial nerve
C7

220
Q

How many layers are in the anterior compartment of the forearm, and what are they?

A

3 layers
Superficial, intermediate, deep

221
Q

What movements do the muscles int eh anterior compartment of the arm facilitate

A

Pronation of the forearm
Flexion of the wrist
Flexion of the fingers

222
Q

The muscles in the anterior compartment of the arm are innervated by the median nerve, other than which muscles

A

Flexor carpi ulnaris
Medial half of flexor digitorum profundus
These are innervated by the ulnar nerve

223
Q

Which muscles are in the superficial layer of the anterior compartment of the forearm

A

Flexor carpi ulnaris
Palmaris longus
Flexor carpi radialis
Pronator teres

224
Q

Which muscles are in the intermediate layer of the anterior compartment of the forearm

A

Flexor digitorum superficialis

225
Q

Which muscles are in the deep layer of the anterior compartment of the forearm

A

Flexor pollicis longus
Flexor digitorum profundus
Pronator quadratus

226
Q

The superficial layer of muscles in the anterior compartment of the forearm all originate from which common origin

A

Medial epicondyle

227
Q

Flexor carpi ulnaris has 2 heads, other than the medial epicondyle of the humerus, where does it arise

A

Olecranon of the ulna

228
Q

Where does flexor carpi ulnaris insert

A

Pisiform
Hook of hamate
Base of 5th metacarpal

229
Q

Where does palmaris longus insert

A

Flexor retinaculum of the wrist

230
Q

Flexor carpi radialis attaches to the base of which metacarpals

A

2 and 3

231
Q

The lateral border of pronator teres forms the medial border of which structure

A

Cubital fosa

232
Q

What are the 2 origins of pronator teres and where does it insert

A

Medial epicondyle
Coronoid process of the ulna
Attaches to the midshaft of the radius

233
Q

Which structures pass between the two heads of flexor digitorum superficialis

A

Median nerve and ulnar artery

234
Q

Describe the attachments of flexor digitorum superficialis

A

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

235
Q

What is the action of FPS

A

Flexes the MCP joints, flexes the IP joints, flexes the wrist

236
Q

Describe the attachments of flexor digitorum profundus

A

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

237
Q

What is the action of FDP

A

Flex the distal IP joint

238
Q

What is the innervation of FDP

A

Medial half (ring and little fingers) - ulnar nerve
Lateral half (middle and index fingers) - anterior interossesous branch of the median nerve

239
Q

Where does flexor pollicis longus lie in relation to FDP

A

Lateral

240
Q

What is the attachments of FPL

A

Anterior surface of the radius and surrounding interosseous membrane
Attaches to the distal base of the thumb

241
Q

Where does pronator quadratus attach

A

Anterior surface of the ulna
Anterior surface of the radius

242
Q

The anterior interosseous branch of the median nerve innervates which muscles of the anterior compartment of the forearm

A

Flexor digitorum profundus
Flexor pollicis longus
Pronator quadratus

243
Q

How many layers of muscles in the posterior compartment of the arm, and what are their combined function

A

2 - Superficial and Deep
Extensor muscles

244
Q

Which muscles are in the superficial layer of the posterior compartment of the arm

A

Brachioradialis
Extensor carpi radialis longus and brevis
Extensor digitorum
Extensor digiti minimi
Extensor carpi ulnaris
Anconeus

245
Q

Which muscles are in the deep layer of the posterior compartment of the forearm

A

Supinator
Abductor pollicis longus
Extensor pollicis brevis
Extensor pollicis longus
Extensor indices

246
Q

Which muscle in the superficial layer of the posterior compartment of the arm is a flexor

A

Brachioradialis

247
Q

The radial artery adn nerve are sandwiched between which muscles

A

Brachioradialis and the deep flexor muscles

248
Q

What are the site of attachment of brachioradialis

A

Lateral supracondylar ridge of the humerus
Radial styloid process

249
Q

What movements are facilitated by extensor carpi radialis longus and brevis

A

Extension and abduction of the wrist

250
Q

Which metacarpals do ECRL and ECRB insert into

A

II and III

251
Q

Extensor digitorum splits into how many tendons and where do they insert

A

4 tendons
Inserts into the extensor hood of each finger

252
Q

Where does extensor digiti minimi lie in relation to extensor digitorum

A

Lies medially to extensor digitorum
Attaches with extensor digitorum to the extensor hood of the little finger

253
Q

Which additional movement can extensor carpi ulnaris produce

A

Adduction

254
Q

Aconeus is blended with the fibres of which muscle

A

Triceps brachii

255
Q

What is the action of aconeus

A

Extends and stabilises the elbow joint
Abducts the ulna during pronation of the elbow

256
Q

The deep muscles of the posterior forearm act on which fingers

A

Thumb
Index finger

257
Q

The radial nerve passes inbetween the 2 heads of which muscle

A

Supinator

258
Q

Abductor policis longus inserts into which metacarpal and forms the lateral border of which anatomical structure

A

I
Anatomical snuffbox

259
Q

Which branch of the radial nerve innervates abductor policies longus

A

Posterior interosseous branch

260
Q

Extensor policis longus forms which border of the anatomical snuffbox

A

Medial border

261
Q

Radial nerve injury leads to what clinical presentation and why

A

Wrist drop
Paralysis of all extensor muscles, leading to unopposed flexion of the wrist

262
Q

Where are the thenar muscles found, how many are there and what are they called

A

Thumb
3 muscles
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

263
Q

What is the innervation of the thenar muscles

A

Median nerve - recurrent branch

264
Q

How are the thenar muscles arranged

A

Opponens pollicis - largest muscle, lies underneath the other two
Abductor pollicis brevis - lies anterolaterally
Flexor pollicis brevis - medially

265
Q

Which muscles make up the hypothenar eminence

A

Oponnens digiti minimi
Abductor digiti minimi
Flexor digiti minimi brevis

266
Q

What is the innervation of the hypothenar muscles

A

Ulnar nerves

267
Q

Describe the attachment of lumbricals

A

Originate from a tendon of the flexor digitorum profundus, pass dorsally around each finger and insert into the extensor hood

268
Q

What is the innervation of the lumbricals

A

Lateral 2 lumbricals - innervated by the median nerve
Medial 2 lumbricals - innervated by the ulnar nerve

269
Q

What is the action of the lumbricals

A

Flexion of the MCP joint
Extension at the IP joint

270
Q

What is the action of the dorsal interossei compared to the palmar interossei

A

Dorsal - abduction
Palmar - adduction

271
Q

Which nerve supplies the interossei

A

Ulnar

272
Q

Where is palmaris brevis found and what is its action

A

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

273
Q

The radial arteyr passed through which muscle in the hand and what does it then form

A

Passes between the 2 heads of the adductor pollicis

274
Q

What are the borders of the axilla

A

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

275
Q

What is the contents of the axilla

A

Axillary artery
Axillary vein
Brachial plexus
Axillary lymph nodes
Biceps brahii and coracobrachialis

276
Q

What are the boundaries of the quadrangular space

A

Teres minor (sup)
Teres major (inf)
Surgical neck of humerus (lat)
long head of biceps brachii (med)

277
Q

What are the boundaries of the clavipectoral triangle

A

Pectoralis major
Deltoid
Clavicle

278
Q

What are the borders of the cubital fossa

A

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

279
Q

What is the content of the cubital fossa

A

Radial nerve
Biceps tendon
Brachial artery
Median nerve

280
Q

What are the borders of the ulnar tunnel

A

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

281
Q

How many extensor tendon compartments are found in the wrist

A

6

282
Q

What is in extensor compartment one, and where is it locateed

A

Extensor pollicis brevis
Abductor pollicis longus
Located laterally (radial)

283
Q

What is in extensor compartment 2

A

Extensor carpi radialis brevis
Extensor carpi radialis longus

284
Q

What is in extensor compartment 3, and what separates it from compartment 2

A

Extensor pollicis longus
Separated from compartment 2 by listers tubercle

285
Q

What is in extensor compartment 4

A

Extensor digitorum
Extensor indices

286
Q

What is in extensor compartment 5

A

Extensor digit minimi

287
Q

What is in extensor compartment 6

A

Extensor carpi ulnaris

288
Q

The flexor retinaculum at the wrist spans between which bones

A

hook of hamate and pisiform - medially
scaphoid and trapezium - laterally

289
Q

Which tendons are found in teh carpal tunnel

A

The tendon of flexor pollicis longus
Four tendons of flexor digitorum profundus
Four tendons of flexor digitorum superficialis

290
Q

What are the borders of the anatomical snuffbox

A

medial (ulnar) - extensor pollicis longus
lateral (radial) - extensor pollicis brevis and abductor pollicis longus
Proximal - styloid process of radius
Floor - scaphoid and trapezium

291
Q

What are the contents of the anatomical snuff box

A

Radial artery
Superficial branch of radial nerve
Cephalic vein

MRCS (17 decks)

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