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Upper Limb Flashcards

1
Q

what are the two essential functions of the brachial plexus?

A

supplies motor & sensory innervation to shoulder and arm

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2
Q

How is a nerve plexus formed?

A

Nerve fibres from two or more spinal segments intermingle then segregate to travel together to a common anatomical region

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3
Q

where do the brachial plexus nerves originate from in the spinal cord, what section?

A

C5-T1

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4
Q

what is the path of the fibres from spinal cord to target?

A

Roots, trunks, divisions, cords, terminal branches

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5
Q

how many roots are there and their origin from spinal cord?

A

5,
C5, C6, C7, C8, T1

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6
Q

how are the three trunks formed?

A

C5 and C6 = superior trunk
C7 = middle trunk
C8 and T1 = inferior trunk

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7
Q

how many divisions are there and what are they called?

A

6 divisions
2 for each trunk
Anterior and posterior for each trunk

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8
Q

how many cords are there and their names and why

A

3
lateral, posterior, medial
named according to position relative to axillary artery

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9
Q

how each cord is formed:

A

lateral = from both anterior divisons from upper and middle trunk
posterior = from all three posterior divisions
medial = from anterior division from lower trunk

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10
Q

what are the 5 terminal branches of the brachial plexus

A

musculocutaneous nerve
axillary nerve
radial nerve
median nerve
ulnar nerve

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11
Q

how is each terminal branch formed (from what cord)

A

musculocutaneous = lateral cord
axillary = posterior cord
radial = posterior cord
median = lateral and medial cord
ulnar = medial cord

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12
Q

what is a good reference point of the brachial plexus

A

the M characteristic formed by terminal branches of lateral and medial cords

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13
Q

C5 & C5, C6, C7

what branches arise from the brachial plexus roots? (2)

A

Dorsal scapular nerve - C5
long thoracic nerve - C5, C6, C7

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14
Q

both come from upper trunk

what branches arise from the brachial plexus trunk? (2)

A

Suprascapular nerve = upper trunk
Nerve to subclavius = upper trunk

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15
Q

what nerves arise from the brachial plexus divisions?

A

No nerves!

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16
Q

lateral cord = 1, posterior cord = 3, medial cord = 3

what nerves arise from the brachial plexus cords? (7)

A

Lateral cord = lateral pectoral nerve

posterior cord = upper, middle and lower subscapular nerve

medial cord = medial pectoral nerve, medial brachial cutaneous nerve, medial antebrachial cutaneous nerve

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17
Q

what happens when you fall on your head?

how can upper brachial plexus injury occur?

A

extreme lateral flexion of head, especially when shoulder is depressed

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18
Q

what does upper brachial plexus injury result in:

A

Erb-Duchenne Paralysis

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19
Q

what are characteristics of Erb-Duchenne Paralysis (3)

A

arm hangs limp at side
internally rotated
forearm also pronated

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20
Q

clinging on something with one arm when falling from somewhere

how can lower brachial plexus injury usually occur?

A

extreme abduction of the upper arm

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21
Q

what does lower brachial plexus injury usually effect in terms of spinal cord segments

A

C8 and T1

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22
Q

what does lower brachial plexus injury usually result in?

A

Klumpke’s Paralysis

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23
Q

what are characteristics of Klumpke’s paralysis

A

a “claw hand”, fingers are flexed in claw position

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24
Q

what are the two sensory signs of nerve injury

A

Loss of sensation
Paraesthesia

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25
Q

what is paraesthesia?

A

tingling, burning, or pins and needles sensation

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26
Q

terminal branches of brachial plexus, one other

what are frequently injured nerves located around the shoulder and arm region (6 nerves)

A

Long thoracic nerve

the 5 terminal branches of the brachial plexus:
axillary
radial
musculocutaneous
ulnar
median

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27
Q

where is the long thoracic nerve found, & what is supplies?

A

travels inferiorly on lateral chest wall to supply innervation to serratus anterior muscle

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28
Q

why is the long thoracic nerve easily injured? (2)

A
  1. located on superficial surface of muscle
  2. covered only by skin and subcutaneous fat
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29
Q

what is the classic sign of thoracic nerve injury?

A

winging of the scapula

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30
Q

how is winging of the scapula tested? (2)

A

patient supports weight with hands while leaning on wall

if injured, medialy boarder of scapula will make obvious dorsal protrusion

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31
Q

stability of scapula muscle

why does injury of the long thoracic nerve cause winging of the scapula? (2)

A

The nerve innervates the Serratus anterior

this muscle is crucial for movement and stability of the scapula.

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32
Q

process involves removal of one or both breasts

what type of operation typically causes long thoracic nerve injury?

A

Mastectomy:
surgical procedure involving removal of one or both breasts usually due to cancer

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33
Q

what is the axillary nerve a terminal branch of?

A

the posterior cord

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34
Q

innervates deltoid and teres minor muscles

square type space

location of the axillary nerve: (3)

A

travels posterior through quadrangular space in shoulder
around surgical neck of humerus

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35
Q

what is the surgical neck of the humerus? (1)

A

the narrow part just below the humeral head

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36
Q

what is the motor innervation of the axillary nerve? (2)

A

Deltoid
Teres Minor

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37
Q

what is the sensory innervation of the axillary nerve? (1)

A

patch of skin over lateral-posterior shoulder

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38
Q

Typical causes of axillary nerve injury: (2)

A

Fracture of upper neck of humerus
shoulder dislocation

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39
Q

what does axillary nerve injury result in terms of motor control? (3) which muscle causes this?

A

loss of shoulder abduction above 15 degrees (deltoid)

weakened external rotation of humerus (teres minor)

weakened stability of shoulder joint (Teres minor)

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40
Q

what is the sensory effect of axillary nerve injury? (1)

A

loss of sensation over posterior-lateral aspect of shoulder

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41
Q

what is the radial nerve a terminal branch of?

A

posterior cord

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42
Q

path of radial nerve: (5)

A

travels posterior around body of humerus

lies in radial groove

just distal to elbow joint, divides into many branches

extends all the way to lateral aspect of hand

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43
Q

what is the radial groove of the humerus? (2)

A

a shallow groove on the posterior aspect of the humerus

serves as a pathway for radial nerve

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44
Q

what is the motor innervation of the radial nerve? (3)

A

all extensor compartment muscles of arm and forearm

brachioradialis

supinator muscle

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45
Q

where is the brachioradilais muscle found (1) and what does it do? (3)

A

found on lateral side of forearm

flexion and extension of forearm

assist in flexion of elbow

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46
Q

what is the sensory innervation of the radial nerve?

A

skin on dorsal surface (tricep side) of all arm and hand

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47
Q

what is the name of the extension of the radial nerve that supplies the brachioradialis

A

Posterior interosseus nerve (PIN)

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48
Q

what are characteristics of radial nerve injury? (2)

A

wrist drop due to loss of extensor muscles in forearm

loss of elbow extension

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49
Q

what causes radial nerve injury? (2)

A

fracture of middle of humerus

nerve compression

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50
Q

how can the radial nerve be compressed? (2)

A

crutches

sleeping with companions head resting on arm

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51
Q

which cord?

what is the musculocutaneous nerve a terminal branch of?

A

lateral cord

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52
Q

3 muscles in flexor compartment of upper arm

what does the musculocutaneous nerve provide motor innervation to?

A

coracobrachialis
brachialis
biceps brachii

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53
Q

what does the musculocutaneous nerve provide sensory innervation to?

A

lateral forearm

the specific branch of this nerve is called the antebrachial/lateral cutaneous nerve

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54
Q

has two names

what is the branch of the musculocutaneous nerve that supplies the lateral aspect of forearm

A

antebrachial/ lateral cutaneous nerve

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55
Q

what does damage to the musculocutaneous nerve result in (motor)? (2)

A

loss of elbow flexion
weakened elbow supination

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56
Q

which cord

what is the ulnar nerve a terminal branch of?

A

Medial cord

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57
Q

what does the ulnar nerve innervate in the upper arm?

A

no structures!

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58
Q

only muscles

what does the ulnar nerve innervate in forearm? (2)

A

flexor carpi ulnaris muscle
1/2 flexor digitorum profundus muscle

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59
Q

where is the flexor carpi ulnaris muscle found?

A

medial side of forearm

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60
Q

involved in hand movement

what does the flexor carpi ulnaris muscle do? (2)

A

flex & adduct hand at wrist joint

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61
Q

how middle is it in forearm?

where is the flexor digitorum profundus muscle found? (2)

A

deep layer of anterior compartment of forearm
medial in forearm, but slightly on side of ulna

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62
Q

important in rock climbing!

what does the flexor digitorum profundus muscle do? (1)

A

flexing the distal phalanges of the fingers - all fingers

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63
Q

I have injured it section of it

passage of the ulnar nerve (4)

A

travels medial to humerus
passes through cubital tunnel
runs medial in forearm
terminates in medial aspect of hand

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64
Q

i have injured it!

what is the cubital tunnel?

what bones form it, what tissue covers it, what nerve travels through

A

a tunnel formed by the medial epicondyle of the humerus & the olecranon process of the ulna.
reinforced by a fibrous band of connective tissue called cubital retinacululm
the ulna nerve passes through here

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65
Q

what is the sensory innervation of the ulnar nerve? (3)

A

medial 1/3 of hand, pinky and ring finger

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66
Q

how is the ulnar nerve commonly injured? (2)

A

entrapment as is passes medial lower end of humerus
fracture of lower end of medial humerus

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67
Q

what does injury of the ulnar nerve cause?

A

Tardy Ulnar Palsy
Claw hand - in ring and pinky finger

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68
Q

what is tardy Ulnar palsy? (2)

A

Paraesthesia of ring and pinky finger
los of fine motor control of these digits

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69
Q

is the middle “M” characteristic

what is the median nerve a terminal branch of?

A

medial and lateral cord

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70
Q

which structures in the upper arm does the medial nerve supply?

A

none!

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71
Q

passage of the median nerve (3)

A

medial to humerus
crosses to lateral side at lower end of humerus
gives off two nerve branches here

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72
Q

what two nerve branches does the median nerve give off?

A

Anterior interosseus nerve (AIN)
Median nerve proper

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73
Q

motor innervation to deep forearm muscles

what does the Anterior interosseus nerve (AIN) do? (3)

A

motor innervation to three muscles of forearm:
1. flexor pollicis longus
2. lateral half of flexor digitorum profundus
3. pronator quadratus

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74
Q

what does the flexor pollicis longus do? (1)

A

flexes thumb at interphalangeal joint (knuckle joint)

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75
Q

hints in the name!

what does the pronator quadratus do? (1)

A

pronates forearm

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76
Q

is a branch of the median nerve. 3 muscles in forearm, 2 in hand

what muscles does the median nerve proper innervate ?

A

forearm muscles:
* pronator teres
* Flexor carpi radialis
* palmaris longus

hand muscles:
* Thenar muscles
* lumbricals

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77
Q

hint is in the name

what does pronator teres do?

A

assists in pronates forearm

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78
Q

radialis!

what does flexor carpi radialis do? (2)

A

flexs and abducts hand at wrist joint

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79
Q

hint is in name - palm

what does the palmaris longus do? (1)

A

aids in flexion of hand at wrist

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80
Q

what is the sensory innervation of the median nerve proper (4)

A

palmar aspect of:
1. thumb
2. index finger
3. middle finger
4. lateral aspect of ring finger

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81
Q

what is median nerve injury mostly associated with? (1)

A

carpal tunnel syndrome

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82
Q

wht is carpal tunnel syndrome? (2)

A

the medial nerve is entrapped as it enters wrist under transverse carpal ligament
causes pararesthesia and pain along sensory innervation of medial nerve

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83
Q

think about passage of each terminal branch of brachial plexus

what 4 nerves surround the axillary artery as it emerges from beneath pectoralis minor

A

musculocutaneous
median
ulnar
radial

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84
Q

what nerves supply flexor and pronator muscles in the forearm? (2)

A

ulnar nerve
median nerve

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85
Q

what are the compartments and what they do?

how are the muscles of the upper arm arranged?

A

posterior compartment = extensor
anterior compartment = flexor

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86
Q

what is the name of the barrier between anterior and posterior compartments of upper arm, and what is it?

A

**intermuscular setpum:
** fibrous barrier that separates different muscle compartments within arm *

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87
Q

BBC

what are the three anterior muscles of the upper arm?

A

Biceps Brachii
Brachialis
Coracobrachialis

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88
Q

What are the two heads of the Biceps Brachii and there position relative to each other:

A

Long head - more lateral
Short head - medial

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89
Q

origin and insertion of both heads of biceps brachii:

A

Short head:
* origin = coracoid process of scapula

Long head:
* origin = supraglenoid tubercle of scapula

common insertion = radial tuberosity

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90
Q

Coracobrachialis origin and insertion

A

origin = coracoid process
insertion = midshaft of anterior humerus

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91
Q

coracobrachialis function (1)

A

weak adductor of the arm

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92
Q

brachialis origin and insertion

A

origin = distal part of anterior humerus
insertion = ulna tuberosity and ulnar coracoid process

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93
Q

function of the brachialis (1)

A

elbow flexion

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94
Q

Why is the Biceps Brachii a supinator of the forearm as well? (1)

A

due to its tendon attachment along back of radial tuberosity

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95
Q

what nerve supplies anterior muscles in upper arm

A

musculocutaneous nerve

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96
Q

what are the three sets of muscles invovled in movement of the arm

A
  1. flexion and extension of elbow
  2. pronation and supination of forearm
  3. flexion and extension of wrist
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97
Q

where do the brachial plexus divisions occur within the body

A

approx lower neck to axilla region

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98
Q

what are the superficial veins of the arm and where are they found (3)

A
  1. cephalic vein = most lateral upper arm
  2. Basilic vein = most medial on upper arm
  3. Median cubital vein = located going from medial to lateral across anterior elbow hinge. joins basilic and cephalic vein
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99
Q

answer is in order from most lateral to medial

what are the 4 superficial anterior muscles of the forearm?

A

Pronator Teres
Flexor Carpi radialis
Palmaris Longus
Flexor Carpi Ulnaris

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100
Q

what is the common flexor attachment of all 4 flexor muscles of the forearm?

A

Medial epicondyle of the humerus

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101
Q

origin and insertion of pronator teres

A

origin = medial epicondyle of humerus & proximal ulna
insertion = midshaft of radius, lateral side

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102
Q

function of pronator teres (1)

A

pronation of forearm

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103
Q

where does the word teres come from? what does it mean

A

refers to shape of muscle in cross section - “round”

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104
Q

Flexor Carpi radialis origin and insertion

A

origin = medial epicondyle of humerus
insertion = second and third metacarpal

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105
Q

function of flexor carpi radialis (2)

A

flexes wrist
Wrist abduction

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106
Q

how name of FCR helps in function and location (3)

A

Flexor - flexes
Carpi - inserts onto metacarpals
Radialis - location on radial side

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107
Q

Palmaris Longus origin and insertion

A

origin - medial epicondyle of humerus
insertion - palmar aponeurosis

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108
Q

what is the palmar aponeurosis & location

A

thick dense layer of fibrous tissue
located in the palm of the hand

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109
Q

what is the palmar aponeruosis a continuation of?

A

the antebrachial fascia

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110
Q

what is the function of Palmar Longus (1)

A

Weak wrist flexion

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111
Q

presence of PL in population

A

absent in 10-15% of population!

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112
Q

Flexor Carpi Ulnaris origin and insertion

A

Origin - Medial epicondyle of humerus
Insertion - Pisiform Carpal bone

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113
Q

function of Flexor Carpi radialis (2)

A

wrist flexion
wrist adduction

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114
Q

what are the intermidate (level of deepness) anterior muscles of the forearm

A

Flexor digitorum superficialis (FDS)

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115
Q

2 heads

origin of the flexor digitorum superficialis

A

medial epicondyle of humerus
radial head

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116
Q

where does the division of the FDS occur, and how many segments does it split into?

A

Mid forearm
4 segments - one for each finger

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117
Q

attachment of FDS:

A

middle phalanges of each finger

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118
Q

function of FDS (2)

A

wrist flexion
flexion of fingers

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119
Q

Brachioradialis origin and insertion

A

origin - lateral supracondylar ridge of humerus
insertion - styloid process of radius

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120
Q

function of the brachioradialis muscle (2)

A

flex arm at elbow joint
stabiliation of elbow joint when strong grip is required

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121
Q

in order from most deep to most superficial

what are the 3 deep muscles of the anterior forearm?

A

Pronator quadratus
Flexor pollicus Longus
Flexor Digitorum profundus

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122
Q

what is the interosseous membrane? (2)

A
  • fibrous connective tissue structure located between ulna and radius
  • spans length of forearm
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123
Q

what is the role of the interosseous membrane (2)

A
  • provides stability and support to forearm by maintaining appropriate spatial relationhip betwen radius and ulna
  • important for attachments of deep flexor muscles
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124
Q

pronator quadratus origin and insertion

A

origin - anteriomedial aspect of ulna
insertion - anterior surface of radius

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125
Q

function of pronator quadratus (1)

A

pronation of forearm

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126
Q

flexor pollicis longus origin and insertion

A

origin - midshaft of radius
insertion - distal phalanges thumb

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127
Q

function of flexor pollicis longus (1)

A

flexes thumb at interphalangeal joint

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128
Q

flexor digitorum profundus origin and insertion

A

origin - proximal ulna
attachment - distal phalanges of 4 fingers

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129
Q

innervation of the 3 deep flexor muscles of the forearm:

A

PQ - median nerve (AIN)
Flexor pollicis longus - median nerve (AIN)
flexor digitorum profundus - median nerve (AIN) and ulnar nerve

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130
Q

which fingers are innervated by which nerve

flexor digitorum profundus nerve innervation:

A

AIN nerve - index and midle finger
Ulnar nerve - ring and pinky finger

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131
Q

what are the 3 extensor muscles of the forearm

A

Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor carpi ulnaris

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132
Q

what is the name of the origin that is shared between the extensor muscles of the forearm?

A

lateral epicondyle of the humerus

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133
Q

extensor carpi radialis & Brevis origin and insertion

A

origin - lateral epicondyle of the humerus
insertion - 2nd and 3rd metacarpals

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134
Q

origin & insertion of the extensor carpi ulnaris

A

origin - lateral epicondyle of humerus & medial side of ulna
insertion - 5th metacarpal

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135
Q

what do all 3 extensor muscles of wrist pass under as they enter the wrist?

A
  • extensor retinaculum
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136
Q

what does the extensor retinaculum act as for the extensor muscles of the forearm

A

a pulley

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137
Q

how many muscles produce pronation and what are they?

A

2:
pronator teres
pronator quadratus

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138
Q

how many muscles produce supination and what are they

A

2:
supinator
biceps

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139
Q

origin (3) and insertion of supinator muscle

A

origin - lateral epicondyle, annular ligament, and supinator crest of ulna
insertion - radius

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140
Q

what is the “parallel” muscle of pronator teres

A

Supinator muscle - due to very similar length, insertion and origin just on opposite sides of arm

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141
Q

what branch (nerve) runs through the supinator muscle

A

radial nerve (PIN)

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142
Q

how many muscles produce flexion of the fingers, and what are they?

A

2
* flexor digitorum profundus
* flexor digitorum superficialis

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143
Q

what is the deepest finger flexor

A

flexor digitorum profundus

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144
Q

what type of muscles are the muscles that flex the fingers? (1)

A

long muscles

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145
Q

what are the tendons called that arise from each muscle to attach to the fingers- frmo both finger flexing muscles)

A

profundus tendon
superficialis tendon

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146
Q

passage of profundus tendons (6)

A
  • arise in distal half of forearm
  • all bundled together as they enter carpal tunnel
  • When exiting carpal tunnel, gives rise to 4 muscles known as lumbricals
  • each finger tendon enters each fingers flexor tendon sheath
  • emerges etween two halves of superficialis tendons
  • inserts onto base of distal phalanges
147
Q

passage of the superficialis tendons: (6)

A
  • arise in distal half of forearm
  • all bundled together as they enter carpal tunnel
  • each finger tendon enters each fingers flexor tendon sheath
  • splits into two halves after exiting flexor tendon sheath
  • pass around profundus tendon
  • reunite deep to profundus tendon and insert into middle phalanges
148
Q

action of flexor digitorum profundus muscle: (2)

A

flex both IP and MP joints

149
Q

action of flexor digitorum superficialis muscle (2)

A

flex proximal IP joint and MP joint

150
Q

what is the IP joint? and what are the two types

A

the interphalangeal joint between the phalanges of the finger
the two types:
1. proximal - between proximal and middle phalanges
2. distal - between middle and distal phalanges

151
Q

what is the MP joint?

A

joint between the etacarpal bone and the proximal phalanges

152
Q

superior, medial, and lateral

what are the 3 boundaries of the cubital fossa

A

superior - imaginary line connecting medial and lateral epicondyles of humerus
medial - formed by pronator teres
lateral boundary - brachioradialis muscle

153
Q

what is the floor and roof of the cubital fossa

A

roof - fascia
floor - muscles

154
Q

contents of the cubital fossa (7)

A
  • brachial artery - bifurcates here into –>
  • radial and ulnar arteries
  • medain nerve
  • tendons of biceps brachii
  • cephalic and basillic vein
155
Q

how can the ulnar nerve be compressed within the cubital fossa? (2)

A
  • pinched against medial epicondyle as it passes through cubital tunnel
  • can be compressed by two heads of flexor carpi radiallis muscle
156
Q

which muscles of the anterior forearm does the median nerve innervate? (7)

A
  1. Pronator teres
  2. Flexor carpi radialiis
  3. Palmaris Longus
  4. Flexor Digitorum Superficialis
  5. Flexor Digitorum Profundus (lateral)
  6. Pollicis Longus
  7. Pronator Quadratus
157
Q

what muscles of the anterior forearm are innervated by the ulnar nerve? (2)

A
  1. Flexor Carpi Ulnaris
  2. Flexor Digitorum Profundus (medial)
158
Q

Artery names from subclavian artery at base of neck (4)

A

Axillary artery –> Brachial artery –> radial & ulnar artery

159
Q

Deep veins of the arm (4)

A

Axillary vein
Brachial veins
Radial & ulnar veins

160
Q

what is the palmer view of the hand

A

a view of the hand where the palm is seen

161
Q

what are the two main eminences of the hand?

A

Hypothenar eminence
Thenar eminence

162
Q

why are the two eminences prominent on the palmar view of the hand?

A

due to the many muscles located within these areas

163
Q

ulnar nerve passage in the hand: (3)

A
  • passes down ulnar side of wrist
  • divides into digital branches within hypothenar eminence
  • 2 branches for pinky, one for medial side of ring finger
164
Q

passage of the median nerve in the hand: (2)

A
  • passes into wrist through crpal tunnel
  • divides into common digital nerves for fingers excluding pinky and including thumb
  • splits further into proper digital nerves
165
Q

how many proper digital nerve branches does the median nerve give off?

A

7
* 1 for ring finger, 2 for each other digit (including thumb)

166
Q

where does the radial nerve innervate on the palmer side of the hand? (1)

A
  • base of thumb on palmer side
167
Q

what arteries supply the hand with blood? (2)

A

ulnar and radial artery

168
Q

What is the superficial palmer arch? (3)

A
  • an “arch” shaped vessel in the palm of the hand
  • formed by the superficial branches of both ulnar and radial arteries anastomosing
  • in palm of hand
169
Q

what artery is the main contributer of the superficial palmer arch?

A

ulnar artery

170
Q

What is the deep palmer arch? (3)

A
  • an “arch” shaped vessel in the palm of the hand
  • formed by the deep branches of both ulnar and radial arteries anastomosing
  • in palm of hand
171
Q

what is the main contributer of the deep palmer arch?

A

radial artery

172
Q

what is the palmer aponeurosis? (3)

A
  • a connective tissue structure that sits in the middle of the palm
  • superficially to muscles
  • provides attachment for other structures
173
Q

which group of muscles form the thenar eminence?

A

thenar muscles

174
Q

which group of muscles form the hypothenar eminence?

A

hypothenar muscles

175
Q

what is the difference in location between intrinsic and extrinsic muscles of the hand?

A

intrinsic = found in hand only
extrinsic = originate from forearm/ outside hand

176
Q

what are the 4 groups of intrinsic muscles in the hand?

A
  1. interosseous muscles
  2. lumbricals
  3. short muscles of the thumb
  4. short muscles of the little finger
177
Q

how many interosseous muscles are there? how to remember this

A

7
* one for each side of fingers, put only one for lateral side of pinky

178
Q

what are the two groups of interosseous muscles?

A
  • 4 dorsal interossei
  • 3 palmer interossei
179
Q

where does each interossei arise? (2)

A
  • shaft of own fingers metacarpal & its neighbours
180
Q

long & short

insertion of the interossesi: (2)

A

long part (tendon)- distal phalanges
short part (tendon) - proximal phalanges

181
Q

what is the extensor mechanism of the finger? (3)

A
  • a fibrous structure
  • located on dorsal side of each finger
  • extending from the metacarpophalangeal joint to distal phalanges
182
Q

what is the function of the extensor mechanism of the fingers? (4)

A
  • extension of fingers
  • stabilization of Metacarpophalangeal joint
  • attachment for intrinsic muscles
  • prevents ‘bowstringing’ of extensor tendons
183
Q

role of the interosseous muscles: together (2)and seperately (2)

A
  • together - flex fingers at MP joint & extend both IP joints
  • seperately - produce ulna or radial deviation
184
Q

how does the fine movement of fingers occur? (4)

A

due to complex interactions between interossei, lumbricals, and long flexors and extensors

185
Q

location, size, heads, arteries passing through, and function

the first dorsal interosseous muscle:

A
  • located between index and thumb
  • very large relative
  • 2 heads - arising from 1st and 2nd metcarpals
  • radial artery passes between two heads
  • powerful radiation of index finger
186
Q

what are the pair of muscles involved in the “key pinch” action (holding a key action)

A
  1. first dorsal interosseous muscls
  2. adductor pollicis
187
Q

how many lumbrical muscles are there?

A

4 - one for each finger

188
Q

where does each lumbrical muscle arise from?

A

the side of one or both adjoining digitorum profundus tendons

189
Q

insertion of each lumbrical

A

Radial side of extensor mechanism

190
Q

where is the insertion of the lumbrical and long part of interosseous tendon relative to each other on the extensor mechanism?

A

lumbrical insertion is just distal to long part of interosseous tendon

191
Q

action of the lumbricals (2)

A

extends IP joint
radial deviation of MP joint

192
Q

how many short (intrinsic) muscles of the thumb are there?

193
Q

which of the short muscles of the thumb lies seperate to the rest?

A

Adductor pollicis

194
Q

adductor pollicis origin: (2)

A

two heads:
* transverse head - third metacarpal
* oblique head - ligaments at base of carpal tunnel

195
Q

insertion of adducotr pollicis (2)

A
  • ulnar sesamoid bone
  • base of proximal phalanges of thumb
196
Q

function of adductor pollicis (1)

A

adduction at carpometacarpal joint

197
Q

anatomical feature of the palm

what do the 3 other short muscles of the thumb make up?

A

thenar eminence

198
Q

what are the 3 short muscles of the thumb that are lose together also known as?

A

the thenar muscles

199
Q

what 3 muscles make up the group of thenar muscles?

A
  1. flexor pollicis brevis
  2. adbuctor pollicis brevis
  3. opponens pollicis (deepest)
200
Q

flexor pollicis brevis origin (2) and insertion (1)

A

origin:
* flexor retinaclulum
* trapezoid

insertion:
* base of proximal phalanges of thumb

201
Q

function of flexor pollicis brevis?
(1)

A

flexes thumb at metacarpophalangeal joint

202
Q

origin (2) and insertion (1) of abductor pollicis Brevis

A

origin:
* trapezium
* flexor retinaculum

Insertion:
* base of proximal phalanges of thumb

203
Q

function of abductor pollicis Brevis (1)

A

abducts thumb away from palm (moves thumb away from other fingers)

204
Q

Opponens pollicis origin (2) and insertion (1)

A

origin:
* trapezium
* flexor retinaculum

Insertion:
* radial side of first metacarpal

205
Q

function of Opponens pollicis

A

brings thumb in contact with tip of other fingers

206
Q

(2)functions of the thenar muscles together: what the actions are (2) are what it actually looks like (3)

A

abduction and flexion at carpometacarpal joint - brings thumb away from hand and across the palm - rotating it medially

207
Q

what bulge on the palm that is an anatomical feautre of the hand do the three short muscles of the finger together make up?

A

hypothenar eminence

208
Q

how many muscles make up the hypothenar eminence?

209
Q

what are the three short muscles of the little finger?

A
  1. abductor digiti minimi
  2. flexor digiti minimi
  3. Opponens digiti minimi - deep
210
Q

abducotr digit minimi origin (1) and insertion (2)

A

origin:
* pisiform bone

insertion:
* base of proximal phalanges
* partly also in extensor mechanism

211
Q

the same as another intrinsic hand muscle

function of abductor digiti minimi (1)

A

ulna deviation

212
Q

flexor digiti minimi origin (2) and insertion (1)

A

origin:
* hammate bone
* flexor retinaculum

insertion:
* proximal phalanges

213
Q

function of flexor digiti minimi (1)

A

helps interosseous muscles in flexing MP joint

214
Q

Opponens digiti minimi origin (1) and insertion (1)

A

origin - hook of hammate bone
insertion - ulna side of 5th metacarpal

215
Q

function of Opponens digit minimi (1)

A

flexor of 5th metacarpal at carpometacarpal joint

216
Q

what nerve and artery passes underneath the flexor and opponens uscle of the hypothenar group?

A

ulnar nerve
ulnar artery

217
Q

passage of the ulnar artery in the forearm: (6)

A
  • passes beneath pronator teres
  • gives off common interosseous artery
  • passes benath two heads of flexor digitorum superficialis
  • runs down forearm between flexor digitorum superficialis and profundus
  • in distal forearm, emerges with ulnar nerve
  • passes through tunnel at side of flexor retinaculum
218
Q

passage of radial artery in forearm: (5)

A
  • runs down forearm deep to brachioradialis
  • lies on top of pronator teres
  • emerges in distal forearm from brachioradialis
  • lies superficially between boarder of radius and tendon of flexor carpi radialis
  • gives off superficial and deep branches at wrist
219
Q

median nerve forearm passage: (5)

A
  • travels between two heads of pronator teres
  • then passes through 2 heads of flexor digitorum superficialis
  • travels down forearm between flexor digitorum superficialis and profundus
  • emerges at wrist at radial side of superficialis tendons
  • passes through carpal tunnel
220
Q

what two tendons cross over the median nerve at the wrist joint?

A

palmaris longus
flexor carpi radialis

221
Q

median nerve motor innervation in hand:

A
  • thenar muscles
222
Q

sensory nerve passage of median nerve in hand (3)

A
  • 3 common digital nerves
  • split off into 2 palmar digitital nerves for: thumb, index and middle finger.
  • only 1 for lateral half of ring finger
223
Q

sensory distribution of median nerve in palmer hand: (5)

A
  • thumb
  • index finger
  • middle finger
  • lateral half of ring finger
  • lateral half of palm from lateral half of ring finger
224
Q

ulnar nerve passage in the forearm: (5)

A
  • passes between two heads of flexor carpi ulnaris
  • runs down flexor carpi ulnaris and flexor digitorum superficialis
  • halfway down forearm, gives off dorsal sensory branch
  • at wrist, runs along radial side of flexor carpi ulnaris
  • passes through side tunnel in edge of flexor retinaculum
225
Q

is a branch of the ulnar nerve

where does the dorsal sensory branch travel to?

A

back/ dorsal side of hand

226
Q

what also passes through side tunnel in edge of flexor retinaculum as well as ulnar nerve? (1)

A

ulnar artery

227
Q

ulnar nerve passage in hand: (5)

A

divides into superficial and deep branches

superficial:
* divides into palmer digitial nerves for little finger and ulna side of ring finger

deep:
* passes between hypothenar muscles
* runs across palm in front of interossei
* passes inbetween two heads of adductor pollicis

228
Q

what are the sensory and motor branches of the ulnar nerve in the hand? (2)

A

sensory = superficial
motor = deep

229
Q

why does the deep branch of the ulnar nerve pass inbetween two heads of adductor pollicis (1)

A

to reach most radial of interossei to innervate it

230
Q

sensory innervation of ulnar nerve in hand (both sides) (2)

A
  • imaginary line stretching down palm from medial half of ring finger
  • same for dorsal side
231
Q

motor innervation of ulnar nerve in the hand: (4)

A
  1. hypothenar muscles
  2. all interossei
  3. adductor pollicis
  4. ulnar two lumbrical muscles
232
Q

what 2 long muscles are involves in finger flexion?

A
  1. flexor digitorum profundus
  2. flexor digitorum superficialis
233
Q

flexor digitorum profundus origin: (2)

A
  • anterior and medial surface of ulna
  • interosseous membrane
234
Q

2 heads

flexor digitorum superficialis origin: (1 & 2)

A

radial head:
* radius

humeroulnar head;
* part of common flexor tendon from medial epicondyle of humerus
* also from adjoining ulna

235
Q

why is there a gap between the two heads of flexor digitorum superficialis?

A

median nerve and ulnar artery both pass through

236
Q

what does lumbricals mean?

237
Q

what strutures pass through the carpal tunnel? (4)

A
  • flexor digitorum profundus
  • flexor digitorum superficialis
  • median nerve
  • flexor pollicis longus
238
Q

what is the carpal tunnel surrounded by?

A

the flexor retinaculum

239
Q

what is the flexor retinaculum also known as?

A

the transverse carpal ligament

240
Q

what is the flexor retinaculum? (3)

A
  • a strong fibrous band
  • surrounds the carpal tunnel
  • forms a flexible but strong roof over carpal tunnel
241
Q

function of the flexor retinaculum (2)

A
  • provides protection for structures passing through carpal tunnel
  • prevents bowstringing of the hand tendons
242
Q

what is “bowstringing”?

A

the excessive movement or displacement of tendons away from their normal position during flexion or extension

243
Q

how does the flexor retinaculum prevent bowstringing?

A
  • supportive roof & floor around carpal tunnel, preventing excessive movement of the tendons in flexion an extension
244
Q

how many rotator cuff muscles are there and what are they

A

4:
* subscapularis
* supraspinatus
* infraspinatus
* teres minor

245
Q

what is the main function of the rotator cuf muscles as a whole (3)

A
  • provide stability to the glenohumeral joint
  • by compressing and depressing it
  • against the glenoid fossa
246
Q

what muscles do the rotator cuff muscles lie beneath (4)

A
  1. pectoralis major
  2. deltoid
  3. trapezius
  4. latissimus dorsi
247
Q

where is the glenoid fossa of the scapula? (3)

A
  • the shallow groove
  • where the humeral head sits
  • within the shoulder joint
248
Q

approximately how much of the humeral head sits within the glenoid fossa?

249
Q

location of the supraspinatus: (2)

A
  • sits in supraspinous fossa
  • above spine of scapula
250
Q

origin and insertion of supraspinatus

A

origin - supraspinous fossa
insertion - greater tuberosity of humerus - superior facet

251
Q

path of supraspinatous (1)

A

passes under the acromion

252
Q

what is the acromion a part of? and its location

A

the scapula:
* situated at top of scapula

253
Q

what does the acromion articulate with and what does it form?

A

the clavicle

forms the acromioclavicular joint

254
Q

function of the supraspinatus (1)

A

abduction of the humerus

255
Q

innervation of the supraspinatus

A

suprascapular nerve

256
Q

where does the suprascapular nerve arise from?

A

superior trunk of the brachial plexus

257
Q

location of the infraspinatus (2)

A
  • below spine of scapula
  • in infraspinous fossa
258
Q

origin and insertion of infraspinatus

A

origin - infraspinous fossa
insertion - greater tuberosity of humerus - middle facet

259
Q

function of the infraspinatus (1)

A

lateral rotation of the humerus

260
Q

innervation of the infraspinatus

A

suprascapular nerve

261
Q

Teres minor location (2)

A
  • just inferior to infraspinatus
  • lateral boarder of scapula
262
Q

origin and insertion of the teres minor:

A

origin - lateral boarder of scapula
insertion - greater tuberosity of humerus - inferior facet

263
Q

function of teres minor (1)

A

lateral rotation of humerus

264
Q

innervation of the teres minor

A

axillary nerve

265
Q

origin and insertion of the subscapularis

A

origin - subscapular fossa
insertion - lesser tuberosity of the humerus

266
Q

what is the subscapular fossa? (2)

A
  • a depression in the scapula
  • occupying almost all anterior part of scapula
267
Q

what is the strongest muscle of the rotator cuff muscles and how much “cuff strength” does it have?

A

subscapularis - 50%

268
Q

what muscles make up the thenar eminence? (3)

A

abductor pollicis brevis
flexor pollicis brevis
opponens pollicis

269
Q

function of the subscapularis (1)

A

medial rotation of the humerus

270
Q

innervation of the subscapularis (2)

A

subscapular nerve - upper & lower

271
Q

where do the upper and lower subscapular nerves arise from?

A

posterior cord of the brachial plexus

272
Q

what is the most commonly injured muscle of the rotator cuff muscles? (1) why? (2)

A

supraspinatous:
* upon elevation of arm, space between acromion and supraspinatus tendon narrows
* therefore, this tendon can get easily pinched, inflammed and torn

273
Q

what type of action is usually associated with rotator cuff injury?

A

overhead arm action

274
Q

what is the most common rotator cuff related injury? & what is this

A

sub-acromial impingement syndrome:
* relates to conditions associated with sub acromial space

275
Q

what are the 2 most common pathologies within sub-acromial impingement syndrome, and what are they due to

A

supraspinatus tendonitis - due to overuse
subacromial bursitis - inflammation of subacromial bursa

276
Q

what is a rare pathology within sub-acromial impingement syndrome? and definition (2)

A

Bony spurs - small bony spurs (spikes) projecting off acromion, can pinch bursa/tendon below

277
Q

main symptom of sub-acromial impingement syndrome? why is this so?

A

pain between 60-120 degrees of arm - it is where sub acromial space is most narrow

278
Q

why do some rotator cuff injuries effecting just one muscle require rehabilitation of the whole rotator cuff? (2)

A
  • if all muscles are strengthened, the humeral head will be better depressed and compressed
  • so more clearance between humerus and acromion during arm movement
279
Q

what are the muscles in the posterior upper arm?

280
Q

how many heads does the triceps have? their names

A

3:
lateral
medial
long

281
Q

what does the long head of the triceps do that is unique compared to the other heads? (1)

A

attaches onto the scapula, not humerus

282
Q

what do all three heads of the triceps attach onto? why?

A

olecranon process of the ulna

they become one tendon more distally

283
Q

origin and insertion of lateral head of triceps

A

origin - superior half of posterior humerus, superior to radial groove

insertion - olecranon process of ulna

284
Q

origin of medial head of triceps:

A

lower half of posterior humerus - inferior to radial groove

285
Q

origin of long head of triceps (2)

A

infraglenoid tubercle of the scapula

286
Q

Teres major origin and insertion:

A

origin - lower lateral boarder of scapula
insertion - medial lip of bicipital groove

287
Q

Teres major function (3)

A
  • Shoulder extension (arm backwards behind body)
  • adductor of humerus
  • internal humerus rotation
288
Q

relationship between position of teres major and long head of triceps (1)

A

fibres of teres major are on the anterior side of the long head of the triceps

289
Q

what important branches of the axillary artery is given off within the teres major-long head cross over region? (2)

A
  1. posterior circumflex humeral artery
  2. deep brachial artery - just inferior
290
Q

what important anatomical feature occurs when axillary artery crosses teres major?

A

axillary artery becomes brachial artery

291
Q

what is the posterior-circumflex humeral artery accompanied by in its passage?

A

axillary nerve

292
Q

path of the posterior-circumflex humeral artery and axillary nerve at teres major: (1)

A

both wrap around surgical neck of humerus

293
Q

path of the deep brachial artery:(3)

A
  • exits through triangular space
  • wraps around middle third of humerus
  • travels through spiral groove of humerus
294
Q

what is the deep brachial artery accompanied by on its path:

A

radial nerve

295
Q

what sort of fracture of the humerus is most likely to cause radial nerve and brachial artery damage?

A

fracture of the mid-shaft of the humerus

296
Q

innervation of the triceps heads:

A

radial nerve - all three heads

297
Q

comes in pairs

what are the 6 scapula movements?

A

elevation & depression
protraction & retraction
upward & downward rotation

298
Q

what are the superficial back & shoulder muscles? (3)

A
  1. deltoid
  2. trapezius
  3. latissimus dorsi
299
Q

what are the 3 muscles deep to the trapezius involved in scapula movement?

in order from superior to inferior for extra points!

A
  1. levator scapulae
  2. Rhomboid minor
  3. Rhomboid major
300
Q

what are the 3 muscles deep to the trapezius innervated by? (3,1,1)

A

levator scapulae - dorsal scapular nerve, cervical nerves C3 and C4

rhomboid minor - dorsal scapular nerve
rhomboid major - dorsal scapular nerve

301
Q

Teres major vs minor attachments and hence which does which rotation of arm

A

Teres major - medial lip of bicipital groove, medial rotation of arm
Teres minor - greater tubercle, lateral rotation of arm

302
Q

what part of the scapular do the subscapular nerves and vessels pass through?

A

suprascapular notch

303
Q

which vessels and veins pass through the suprascapular notch? (3)

A

suprascapular artery
suprascapular vein
suprascapular nerve

304
Q

ligament

what covers the suprascapular notch

A

superior transverse scapular ligament

305
Q

where are the quadrangular and triangular space in relation to each other?

A

quadrangular is slightly superior to triangular space - almost adjacent

306
Q

boarders of the triangular space: (3)

A

superior - teres minor
inferior - teres major
lateral - long head of triceps

307
Q

most lateral to medial for extra point!

what is the location of the posterior forearm muscles? (7)

A
  • Brachioradialis
  • Extensor carpi radialis longus
  • Extensor carpi radialis Brevis
  • Extensor indicis proprius
  • Extensor digitorum Communis
  • Extensor Digiti Minimi
  • Extensor Carpi Ulnaris
308
Q

what is the innervation of the posterior muscles of the forearm?

A

Radial nerve supplies all (or a branch)

309
Q

which extensor muscle of the posterior forearm does not arise from the lateral epicondyle & supracondylar ridge region?

A

extensor indicis proprius

310
Q

where does the extensor indicis proprius arise? (2)

A
  • distal third of posterior ulna
  • interosseous membrane
311
Q

location of the lateral epicondyle and supracondylar ridge in relation to each other (1)

A

supracondylar ridge is just superior to lateral epicondyle

312
Q

what is the clinical significance of the common attachment region of the extensor forearm muscles? and name (2)

A

often inflamed and painful - tennis elbow

313
Q

what is the similar condition of inflammation of medial epicondyle flexor muscles of the forearm? (1)

A

golfers elbow

314
Q

which muscle of the posterior muscles of the forearm is a clear outlier to the rest (1) and why? (2)

A

brachioradialis - involved in elbow joint flexion, & does not cross wrist

315
Q

what muscle lies immediately adjacent to the brachioradialis?

A

extensor carpi radialis longus

316
Q

what are the primary wrist extensors? (3)

A
  • extensor carpi radialis longus
  • extensor carpi radialis brevis
  • extensor carpi ulnaris
317
Q

extensor carpi radialis longus insertion: (1)

A

2nd metacarpal

318
Q

extensor carpi radialis Brevis insertion (1)

A

3rd metacarpal

319
Q

extensor carpi ulnaris insertion (1)

A

5th metacarpal (base)

320
Q

what are the 3 long finger extensor muscles?

A
  1. extensor digitorum communis
  2. extensor digiti minimi
  3. extensor indicis proprius
321
Q

extensor digitorum communis insertion (1)

A

distal phalanges of all digits (not thumb)

322
Q

path of extensor tendons: (7)

A
  1. 4 tendons emerge in distal forearm
  2. pass together under extensor retinaculum
  3. extensor tendons fan out after exiting extensor retinaculum
  4. have connecting fibres just before MP join
  5. attaches to MP joint
  6. Gives rise to extensor hood
  7. Divides into three parts for each phalanges
323
Q

function of extensor digitorum communis (3)

A

extension of fingers at all 3 joints:
* MP - main effect
* 2 IP joints

324
Q

extensor indicis proprius insertion (1)

A

distal phalanges of index finger

325
Q

extensor digiti minimi insertion (1)

A

distal phalanges of little finger

326
Q

which fingers have two extensor muscles compared to the rest that have one? (2)

A

index and pinky

327
Q

what hand movement illustrates how some fingers have more extensor muscles than others? (3)

A

spider man “thwip” - easy to extend index and pinky independently, but is not as easy to do middle and ring finger

328
Q

where is the extensor indicis proprius (EIP) tendon seen in relation to the extensor digitorum (EDC) index finger tendon? (1)

A

EIP is seen more medial to central hand

329
Q

where is the extensor digiti minimi (EDM) tendon relative to the extensor digitorum communis (EDC) tendon? (1)

A

EDM is more lateral to central hand

330
Q

how are all extensor tendons of the forearm and fingers kept in place? (1)

A

extensor retinaculum

331
Q

what is the extensor retinaculum? (2)

A
  • a fibrous tissues
  • located over dorsum of wrist joint
332
Q

what muscle do the extensor muscles of the thumb lie immediately deep too?

A

extensor digitorum communis

333
Q

what are the three extensor muscles of the thumb?

A
  1. abductor pollicis longus
  2. extensor pollicis brevis
  3. extensor pollicis longus
334
Q

abductor pollicis longus origin (3)

A
  • posterior surface of ulna & radius
  • interosseous membrane
335
Q

insertion of adductor pollicis longus (1)

A

1st metacarpal

336
Q

function of adductor pollicis longus: (1)

A

adduction of thumb

337
Q

what joint does abductor pollicis longus act on?

A

carpometacarpal joint

338
Q

extensor pollicis brevis origin (2)

A
  • posterior radius
  • interosseous membrane
339
Q

insertion of extensor pollicis brevis (1)

A

proximal phalanges of thumb

340
Q

what is the function of extensor pollicis Brevis? (1)

A

extension of proximal phalanges of thumb

341
Q

what joints does the EPB act on? (2)

A
  1. carpometacarpal joint
  2. metacarpophalangeal joint
342
Q

extensor pollicis longus origin (2)

A
  • posterior ulna
  • interosseous membrane
343
Q

insertion of extensor pollicis longus (1)

A

distal phalanges of thumb

344
Q

what joints does the EPL act on? (3)

A
  1. carpometacarpal joint
  2. metacarpophalangeal joint
  3. interphalangeal joint
345
Q

what is the location of the 3 extensor muscles of the thumb most ulna to radial?

A
  • extensor pollicis longus
  • extensor pollicis brevis
  • abductor pollicis longus
346
Q

what two extensor muscles of the thumb travel together

A
  • abductor pollicis longus
  • extensor pollicis brevis
347
Q

origin of thumb extensor muscles on forearm in order of most proximal to distal (3)

A
  • abductor pollicis longus
  • extensor pollicis longus
  • extensor pollicis brevis
348
Q

which artery travels between extensor pollicis brevis and extensor pollicis longus?

A

radial artery

349
Q

what space is formed by the extensor pollicis longus and the tendons of EPB and APL?

A

the anatomical snuff box

350
Q

what does the flexor carpi ulnaris actually attach onto? (1)

A

pisiform bone

351
Q

how is the flexor carpi ulnaris pull transmitted to the 5th metacarpal? (3)

A

via two ligaments:
* Pisohamate ligament - transmits pull from pisiform to hamate
* Pisometacarpal ligament - transmits pull from pisiform to 5th metacarpal

352
Q

what are the 3 functional groups of the posterior forearm muscles?

A
  • wrist action muscles
  • digits acting muscles
  • thumb acting muscles
353
Q

which muscles act at the wrist joint in the posterior forearm? (3)

A
  1. extensor carpi ulnaris
  2. extensor carpi radialis longus
  3. extensor carpi radialis brevis
354
Q

what are the muscles in the deep layer of the posterior forearm? (5)

A
  • supinator
  • abductor pollicis longus
  • extensor pollicis brevis
  • extensor pollicis longus
  • extensor indicis
355
Q

role of palmer interosseous muscles vs dorsal interosseous muscles:

A

Palmer - adduction of digits
Dorsal - abduction of digits

way to remember: PAD and DAB

356
Q

what are dermatomes? (1)

A

specific areas of skin supplied by a single spinal nerve or segment

357
Q

what are myotomes (1)

A

specific groups of muscles primarily innervated by a single spinal nerve or segment

358
Q

teres major origin and insertion:

A
  • origin - lateral scapula
  • insertion - anterior humerus
359
Q

subscapularis origin and insertion:

A
  • origin - subscapular fossa
  • insertion - anterior humerus
360
Q

how does the lattissimus dorsi make up the posterior boundary of the axilla? (1)

A
  • terminal part attaches to anterior humerus
361
Q

what is the blood supply to the deltoid? (3)

A
  • deltoid branch of the thoraco-acromial artery
  • anterior and posterior circumflex artery
  • subscapular artery
361
Q

origin and insertion of latissimus dorsi:

A

origin:
* T7 to posterior iliac spine

insertion:
* bicipital groove

362
Q

function of the latissimus dorsi (2)

A
  • adductor of humerus
  • depressor of scapula

Anatomy (5 decks)

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