Upper Limb

Question 1

What are the anterior axioclavicular muscles of the shoulder region?

Answer 1

Upper trapezius, subclavius, pectoralis minor, serratus anterior, sternocleidomastoid

Question 2

What are the posterior axioscapular muscles of the shoulder region?

Answer 2

Upper trapezius, middle trapezius, lower trapezius, levator scapulae, rhomboid major, rhomboid minor

Question 3

What are the bones of the shoulder girdle?

Answer 3

Sternum, clavicle, scapula, humerus

Question 4

What are the ligaments of the shoulder girdle?

Answer 4

ACJ: Superior acromioclavicular, inferior acromioclavicular, conoid, trapezoid, coracoacromial
SCJ: Interclavicular, anterior sternoclavicular, posterior sternoclavicular, costoclavicular
ACJ: Superior acromioclavicular, inferior acromioclavicular, conoid, trapezoid, coracoacromial
GHJ: coracohumeral, superior glenohumeral, middle glenohumeral, inferior glenohumeral (anterior and posterior, axillary pouch), transverse

Question 5

What are the axiohumeral muscles?

Answer 5

Pectoralis major, pectoralis minor, latissimus dorsi, teres major

Question 6

From what vertebrae does the brachial plexus arise?

Answer 6

C5-C7, T1

Question 7

Describe the sections which make up the brachial plexus?

Answer 7

Roots: Anterior Rami of the 5th, 6th, 7th and 8th Cervical Nerve, Anterior Rami of the 1st Thoracic Nerve, long thoracic nerve branches from 5-7th Roots
Trunks: Superior made of 5th and 6th, Middle made of 7th, Inferior made of 8th and 1st
Divisions: Posterior and Anterior Division of the Superior Trunk, Posterior and Anterior Divisions of the Middle Trunk, Posterior and Anterior Divisions of the Inferior Trunk
Cords: Ant Div of Superior and Middle Trunks make Lateral Cord, Post Div of Superior, Middle and Inferior Trunks make Posterior Cords, Ant Div of Inferior Trunk make Medial Cord
Branches: Medial pectoral nerve, medial brachial cutaneous nerve, medial antebrachial cutaneous nerve, ulnar nerve and medial half of median nerve arises from Median Cord; lateral pectoral nerve musculocutaneous, lateral portion of median nerve arise from the Lateral Cord; upper subscapular nerve, thoracodorsal nerve, lower subscapular nerve, axillary nerve, radial nerves arise from the Posterior Cord

Question 8

Which 2 nerves do not arise from the cords of the brachial plexus?

Answer 8

Subclavian nerve which arises from the 5th and 6th trunks, and long thoracic nerve which branches from 5-7th Roots

Question 9

What are the attachments of the upper, middle and lower trapezius? How are they innervated?

Answer 9

Upper: O: external occipital protuberance, superior nuchal line of the occipital bone, nuchal ligament, spinous process of C7. I: Posterior aspect of the lateral one third of the clavicle, acromion of the scapula
Middle: O: Spinous processes of the C7-T4 vertebrae. I: Acromion of the scapula, medial half of the spine of the scapula
Lower: O: Spinous processes of T5-T12 vertebrae. I: Medial half of the spine of the scapula
Innervated by Accessory Nerve

Question 10

What are the attachments of the levator scapulae and rhomboids? How are they innervated?

Answer 10

Levator Scapulae: O: transverse processes of the C1-C2 vertebrae, posterior tubercles of transverse processes of C3-C4 vertebrae. I: Superior angle of the scapula, medial border to spine of the scapula
Rhomboid Major: O: Spinous processes of T2-T5 vertebrae. I: Medial border of the scapula inferior to the spine of the scapula
Rhomboid Minor: O: Nuchal ligament and spinous processes of C7-T1 vertebrae. I: Medial border of scapula adjacent to spine of scapula
Innervated by Dorsal Scapula Nerve

Question 11

What are the attachments of the rotator cuff muscles? How are they innervated?

Answer 11

Supraspinatus: O: Supraspinous fossa of the scapula. I: Greater tubercle of humerus. Inerrvation: Suprascapular nerve (C5-C6)
Infraspinatus: O: Infraspinaous fossa of scapula. I: Greater tubercle of humerus. Innervation: Suprascapular nerve (C5-C6)
Subscapularis: O: Subscapular fossa of scapula. I: Lesser tubercle of humerus. Innervation: Upper and lower subscapular neveres
Teres minor: O: Posterior aspect of superior half of scapula’s lateral border. I: Greater tubercle of the humerus. Innervation: Axillary Nerve

Question 12

What are the attachments and actions of the deltoid and teres major? How are they innervated?

Answer 12

Anterior Deltoid: O: Lateral one third of the clavicle. I: Deltoid Tuberosity of the humerus.
Middle Deltoid: O: Acromion of scapula. I: deltoid tuberosity of the humerus.
Posterior Deltoid: O: Spine of the scapula. I: Deltoid tuberosity of humerus.
Deltoid is innervated by Axillary nerve
Teres Major: O: Posterior aspect of the inferior angle of the scapula. I: Crest of the lesser tubercle of the humerus. Innervated by Lower Subscapular nerve

Question 13

What are the attachments of pectoralis major and minor and serratus anterior? How are they innervated?

Answer 13

Pectoralis Major: O: Clavicular head: anterior aspects of medial half of the clavicle. Sternocostal head: manubrium, sternal body, true ribs and their costal cartilage. Abdominal part: external abdominal oblique aponeurosis. I: Crest of the greater tubercle of the humerus.
Pectoralis Minor: O: Anterior ends of third and fifth ribs. I: Coracoid process of the scapula.
Pectoral muscles innervated by Medial and lateral pectoral nerves (C5-T1).
Serratus Anterior: O:External surfaces of 1st to 9th ribs. I: Ventral edge of the medial border of the scapula. Long Thoracic Nerve (C5-7)

Question 14

What are the attachments and actions of sternocleidomastoid muscle and subclavius? How are they innervated?

Answer 14

Sternocleidomastoid: O: Sternal head: anterior surface of manubrium of sternum. Clavicular head: medial third of the clavicle. I: Mastoid process of the temporal bone, and superior nuchal line of the occipital bone. Accessory Nerve
Subclavius: O: Superior surface of costal end of first rib and first rib’s costal cartilage. I: Inferior surface of middle third of clavicle. Innervated by nerve to subclavius muscle (C5-6)

Question 15

Describe the actions of the scapula and how the muscles of the shoulder are involved.

Answer 15

Glenohumeral flexion is achieved by upwards rotation, external rotation (scap abd) and posterior tilt of the scapula with the upper and lower trapezius. Glenohumeral extension is achieved by down rotation, internal rotation (scap add) and anterior tilt of the scapula with levator scapulae, rhomboid major and minor, serratus anterior and upper and middle trapezius

Question 16

Name all muscles in the anterior and anteriomedial compartments of the upper limb.

Answer 16

Arm: Coracobrachialis, long and short heads of the Biceps Brachii, Brachialis
Forearm: (most superficial) Pronator teres (small and proximal), flexor carpi radialis (lateral), palmaris longus (middle), flexor carpi ulnaris (medial), (next level) flexor digitorum superficialis (large, flat and multi-tendoned), (most deep) flexor pollicus longus (middle of radius and thin), flexor digitorum profundus (medial and multi-tendoned), pronator quadratus (at wrist, deepest and square)

Question 17

Name all muscles in the posterior and posterolateral compartment of the upper limb.

Answer 17

Arm: long, lateral and medial heads of Triceps Brachii, Anconeus
Forearm: Brachioradialis (most lateral and superficial), extensor carpi radialis longus (long and thin), extensor carpi radialis brevis (long and thin, more posterior), extensor digitorum (most posterior, superficial and multi-tendoned), extensor carpi ulnaris (long and thin, terminates medial), (middle) extensor digiti minimi (long thin and deep to extensor carpi ulnaris), (deep) supinator (short and wraps around lateral elbow and radius), abductor pollicus longus (most proximal slants down towards thumb), extensor pollicus brevis (nestled between abductor pollicus longus and extensor pollicus longus, small), extensor pollicus longus (long and thin, ulna to thumb), extensor indicis (small muscle, long tendon, from ulna to index finger)

Question 18

Name the attachments and innervation of Biceps Brachii, Coracobrachialis and Brachialis.

Answer 18

Biceps Brachii: O: Long head; Supraglenoid tubercle and labrum of the scapula, short head; coracoid process of the scapula. I: radial tuberosity of the radius. Innervated by Musculocutaneous Nerve.
Coracobrachialis: O: coracoid process of scapula. I: middle third of body of the humerus on the medial aspect. Innervated by Musculocutaneous Nerve
Brachialis: O: distal half of the humerus on the anterior aspect. I: coronoid process and tuberosity of the ulna. Innervated by Musculocutaneous and radial nerves

Question 19

Name the attachments and innervation of Triceps Brachii and Arconeus.

Answer 19

Triceps Brachii: O: Long head; infraglenoid tubercle of the scapula, Lateral head; posterior surface of humerus, superior to the radial groove, Medial head; posterior radial surface,m inferior to the radial groove. I: Olecranon of the ulna and adjacent antebrachial fascia. Innervated by radial nerve.
Anconeus: O: Posterior aspect of lateral epicondyle of the humerus. I: Olecranon, proximal end of body of the ulna. Innervation radial nerve.

Question 20

Name the attachments and innervation of the muscles of the anteriomedial compartment of the forearm.

Answer 20

Pronator teres: O: medial supracondyle ridge of humerus. I: Middle one third of anterolateral aspect of the radius.
Flexor carpi radialis: O: medial epicondyle of humerus. I: palmar aspects of bases of second and third metacarpal bones.
Palmaris longus: O: medial epicondyle of humerus. I: palmar aponeuosis and flexor retinaculum of hand.
flexor carpi ulnaris: O: medial epicondyle of the humerus, proximal two thirds of the body of the ulna and olecranon of ulna. I: Pisiform, hook of hamate and palmar aspect of the base of the fifth metacarpal bone.
Flexor digitorum superficialis: O: medial epicondyle of humerus sublime tubercle of the ulna, proximal half of anterior border of radius. I: Palmar aspects of the bodies of middle phalanges of the index, middle ring and little fingers.
Flexor pollicus longus: O: anterior surface of the radius and adjacent interosseus membrane of forearm. I: Palmar aspect of base of distal phalanx of thumb.
flexor digitorum profundus: O: medial aspect of coronoid process of ulna and superior three quarters of anterior and medial surface of the body of the ulna. I: palmar aspects of the bases of the distal phalanges of index, middle, ring and little fingers.
pronator quadratus: O: anterior aspect of the distal one quarter of the ulna. I: anterior aspect of the distal one quarter of the radius.

Pronator teres, Flexor carpi radialis, palmaris longus and flexor digitorum superficialis are innervated by the Median Nerve. Flexor carpi ulnaris is innervated by the ulnar nerve. Flexor Pollicis Longus and Pronator quadratus are innervated by the Anterior antebrachial interosseus nerve. Flexor digitoum profundus is innervated by the ulnar nerve medially and the anterior interosseous branch of the medial nerve laterally.

Question 21

Name the attachments and innervation of the muscles of the posteriolateral compartment of the forearm.

Answer 21

Brachioradialis: O: superior two thirds of lateral supracondylar ridge of humerus. I: lateral aspect of distal part of the radius.
extensor carpi radialis longus: O: inferior one third of lateral supracondylar ridge of humerus. I: Dorsal aspect of base of second metacarpal bone.
extensor carpi radialis brevis: O: lateral epicondyle of the humerus. I: dorsal aspect of base of third metacarpal bone.
extensor digitorum: O: lateral epicondyle of the humerus. I: dorsal aspects of the bases of both the middle and distal phalanges of the index, middle, ring and little fingers.
extensor carpi ulnaris: O: lateral epicondyle of humerus and posterior border of the ulna. I: medial aspect of the base of the fifth metacarpal bone.
extensor digiti minimi: O: lateral epicondyle of the humerus. I: extensor expansion of the little finger.
supinator: O: lateral epicondy,e of the humerus, supinator crest and supinator fossa of the ulna. I: anterior, lateral and posterior aspects of the proximal one third of the radius.
abductor pollicus longus: O: posterior aspects of proximal half of the ulna and middle one third of radius, adjacent interosseus membrane of forearm. I: lateral aspect of base of first metacarpal bone.
extensor pollicus brevis: O: posterior surface of the distal half of the radius and adjacent interosseus membrane of the forearm. I: dorsal aspect of base of proximal phalanx of the thumb.
extensor pollicus longus: O: posterior surface of the middle one third of ulna and adjacent interosseus membrane of the forearm. I: dorsal aspect of the base of the distal phalanx of the thumb.
extensor indicis: O: posterior surface of distal one third of the ulna and adjacent interosseuos membrane of the forearm. I: extensor expansion of the index finger.

Brachioradialis, extensor carpi radialis longus, is innervated by the radial nerve
Extensor carpi radialis brevis is innervated by the deep branch of the radial nerve and the posterior antebrachial interosseous nerve.
Extensor digitorum, extensor carpi ulnaris, extensor digiti minimi, supinator, abductor pollicis longus, extensor pollicis longus, extensor pollicis brevis and extensor indicis are innervated by the posterior antebrachial interosseous nerve.

Question 22

Describe the ligaments of the elbow.

Answer 22

Annular ligament of the radius, which encircles the proximal head of the radius, attaching it to the ulna.
Radial collateral ligament (2 shaped like a capital A) which stabilizes the proximal head of the radius on the lateral aspect.
Quadrate ligament which secures the radius to the ulna and occurs between the 2 bones.
Ulnar Collateral Ligament, which secures the ulna to the humerus and has three bands; anterior, posterior and inferior.