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Musculoskeletal System > Upper limb > Flashcards

Upper limb Flashcards

1
Q

What are the bone(s) that constitute the pectoral girdle?

A

Scapula and clavicle

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2
Q

What are the bone(s) that constitute the arm?

A

Humerus

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3
Q

What are the bone(s) that constitute the forearm?

A

Ulna and radius

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4
Q

What are the bone(s) that constitute the hand?

A

1) Carpal
2) Metacarpal
3) Phalanges

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5
Q

What are the 6 joints of the upper limb?

A

1) Scapulohumeral
2) Acromioclavicular
3) Sternoclavicular
4) Elbow
5) Wrist
6) Carpometacarpal
7) Interphalangeal

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6
Q

What are the 3 types of joints?

A

1) Fibrous
- fibrous tissue → no/little mvt

2) Cartilaginous
- hyaline or fibrocartilage → small amount of mvt

3) Synovial joint
- bones covered by hyaline cartilage, separated by joint cavity → greatest degree of movement

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7
Q

What are 3 factors that determine the stability of a synovial joint?

A

1) Shape & arrangement of articular surfaces
2) Ligaments
3) Muscle tone

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8
Q

What are 3 factors that limit movement of synovial joint?

A

1) Shape of bone
2) Adjacent structures
3) Ligaments (intrinsic/extrinsic)

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9
Q

What are the 6 types of synovial joints?

A

1) Gliding
2) Pivot
3) Hinge
4) Condyloid
5) Saddle
6) Ball and Socket

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10
Q

In a plane/gliding joint, the articular surfaces are _______, permitting bones to slide or glide over one another.

A

Flat

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11
Q

What type of synovial joint allows for uniaxial flexion and extension?

A

Hinge joint

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12
Q

Which type of synovial joint allows the greatest range of motion in multiple axes?

A

Ball & Socket

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13
Q

What is a pivot joint and what type of movement does it allow?

A

A central bony pivot surrounded by a ligamentous ring.

Allows for rotation

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14
Q

What types of movement are allowed in a condyloid joint?

A

1) Flexion, extension
2) Abduction, Adduction
3) Small amount of rotation

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15
Q

How are the bones articulated in an ellipsoid joint?

A

Concave surface of bone articulates with convex surface of other (u-shape)

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16
Q

How are the bones articulated in a saddle joint?

A

Articular surfaces are concavo-convex (s-shaped like saddle)

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17
Q

What are the borders and angles of the triangular scapula bone?

A

Borders:
1) Medial
2) Lateral
3) Superior

Angles
1) Superior
2) Inferior

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18
Q

The anterior/costal surface of the scapula forms the ___________________

A

Subscapular fossa

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19
Q

The posterior surface of the scapula is divided by the spine which laterally projects as the _________________ which articulates with the _____________.

Laterally, the _____ fossa articulates with the head of the humerus. Its superior border is marked by ____________.

A

Spine → Acromion process → articulate w clavicle

Laterally: Glenoid fossa
Superior: Coracoid process
- projects antero-laterally and scapular notch

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20
Q

What are the rotator cuff muscles and where are their origins?

A

From posterior surface of scapula:
1) Supraspinatus
2) Infraspinatus
3) Teres minor

From costal surface of scapula:
4) Subscapularis

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21
Q

What is the function of the rotator cuff muscles?

A

Stabilises glenohumeral joint
- Holds head of the humerus against glenoid cavity of the scapula (stability)

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22
Q

Other than the rotator cuff muscles, what are the other muscles acting on the scapula and what are their actions?

A

1) Trapezious
- elevates, retracts and depress scapula

2) Levator scapula
- elevates scapula

3) Rhomboids
- retract scapula

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23
Q

What are the muscle(s) that elevate the scapula?

A

1) Trapezious
2) Levator Scapula

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24
Q

What are the muscle(s) that retract the scapula?

A

1) Trapezious
2) Rhomboids

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25
Q

What are the muscle(s) that depress the scapula?

A

Trapezious

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26
Q

What are the points of attachment of the deltoid muscle?

A

Posterior fibres → spine of scapula

Middle fibres → acromion of scapula

Anterior fibres → clavicle

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27
Q

What are the functions of the deltoid and which fibres mediate which?

A

All arm
Anterior: (i) Flexion (ii) Medial rotation

Middle: Abduction

Posterior: (i) Extension (ii) Lateral rotation

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28
Q

What is the origin and insertion of the serratus anterior?

A

Origin: Upper 8 ribs

Insertion: Medial border of scapula

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29
Q

What are 2 functions of the serratus anterior?

A

1) Rotate scapula
2) Hold scapula against thoracic wall

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30
Q

What does paralysis of the serratus anterior lead to?

A

Winged scapula

Lesion of long thoracic nerve → weakening of serratus anterior → winging of scapula

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31
Q

What are the 6 scapular movements?

A

1-2) Elevation/Depression
3-4) Abduction/Adduction
5-6) Upward/Downward rotation

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32
Q

What is the shoulder joint?

A

Head of humerus articulates with Glenoid fossa to form the glenohumeral joint (ball and socket)

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33
Q

What are the 6 movements of the shoulder?

A

1-2) Flexion/Extension
3-4) Abduction/Adduction
5-6) Medial/Lateral rotation
7) Circumduction

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34
Q

What are 4 movements of the forearm?

A

1-2) Flexion/Extension
3-4) Supination/Pronation

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35
Q

What are 8 movements of the hand?

A

1-2) Flexion/Extension
3-4) Pronation/Supination
5-6) Radial/Ulnar deviation
7) Cylindrical grasp
8) Tip
9) Hook/snap
10) Palmar
11) Spherical grasp
12) Lateral

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36
Q

True or false: The deltoid is multipennate.

A

True.
Has posterior, middle and anterior fibres

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37
Q

Which nerve innervates the serratus anterior?

A

Long thoracic nerve

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38
Q

What are 2 joints formed by the humerus?

A

1) Glenohumeral
2) Elbow

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39
Q

The intertubercular groove of the humerus is formed by the _______________ on the head of the bone. This is the site of attachment for the _________________.

A

Intertubercular groove formed by greater and lesser tubercle on head of humerus

Site of attachment for long head of biceps tendon

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40
Q

Where does the deltoid muscle attach to on the humerus?

A

Deltoid tuberosity

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41
Q

Where is the radial groove of the humerus and what is its function?

A

Posterior diaphysis for radial nerve

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42
Q

Which nerve may be lesioned after a fracture at the surgical neck of a humerus?

A

Axillary nerve

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43
Q

Which nerve may be lesioned after a fracture at the shaft of a humerus?

A

Radial nerve

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44
Q

Which nerve may be lesioned after a fracture at the supracondylar ridge of a humerus?

A

Median nerve

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45
Q

Which nerve may be lesioned after a fracture at the medial epicondyle of a humerus?

A

Ulnar nerve

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46
Q

The glenoid cavity is deepened by the _________________.

A

Glenoid labrum (fibrocartilaginous ring)

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47
Q

What is the difference between the surgical and anatomical neck of the humerus?

A

Surgical: between head and greater tuberosity

Anatomical: below greater and lesser tuberosity

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48
Q

What are the articular surfaces of the glenohumeral joint covered by?

A

Hyaline cartilage

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49
Q

The humeral head is held in the glenoid cavity by the _________________.

A

Rotator cuff muscles:
1) Supraspinatus
2) Infraspinatus
3) Teres minor
4) Subscapularis

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50
Q

What are the 4 ligaments associated with the shoulder joint?

A

Strengthen joint capsule:
1) Glenohumeral (anterior)
2) Coracohumeral (superior)
3) Transverse humeral

Prevents superior displacement of head of humerus:
4) Coracoacromial

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51
Q

A fibrous capsule lined by synovial membrane surrounds the shoulder joint and is attached to __________________________.

A

Margin of glenoid cavity and anatomical neck of humerus

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52
Q

What muscle(s) facilitate shoulder flexion?

A

1) Pectoralis major
2) Anterior deltoid
3) Biceps
4) Coracobrachialis

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53
Q

What muscle(s) facilitate shoulder extension?

A

1) Posterior deltoid
2) Latissimus dorsi

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54
Q

What muscle(s) facilitate shoulder abduction?

A

1) Supraspinatus
2) Middle deltoid

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55
Q

What muscle(s) facilitate shoulder adduction?

A

1) Pectoralis major
2) Latissimus dorsi

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56
Q

What muscle(s) facilitate lateral rotation of the shoulder?

A

Infraspinatus

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57
Q

What muscle(s) facilitate medial rotation of the shoulder?

A

Subscapularis

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58
Q

How is the arm raised vertically 180 degrees?

A

1) Scapulothoracic upward rotation → 60°
- by Serratus anterior

2) Glenohumeral abduction → 120°
i) Supraspinatus initiates
ii) Middle fibres of deltoid abducts

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59
Q

What is Hilton’s Law?

A

The nerves supplying a joint also supply the muscles moving the joint and the skins covering their attachment (myotome=dermatome)

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60
Q

Describe the innervation of the shoulder joint.

A

Somatic pain:
1) Suprascapular nerve
2) Axillary nerve

(Joints also transmit proprioception)

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61
Q

What is the most commonly dislocated joint and why?

A

Shoulder joint
i) wide range of movement
ii) inferior aspect unprotected by muscles

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62
Q

Which nerve may be injured in an anterior dislocation of the shoulder?

A

Axillary nerve

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63
Q

What are 3 factors influencing the stability of the shoulder joint?

A

1) Tonus of rotator cuff muscle holds the head of humerus in the glenoid cavity

2) Ligament

3) Coracobrachialis, long/short head of biceps resist downward dislocation

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64
Q

Which direction is shoulder dislocation is more common?

A

Anterior

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65
Q

What is the “stabilising bone” of the elbow?

A

Ulna

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66
Q

What are 4 components of the ulna?

A

1) Olecranon
2) Trochlea notch
3) Coronoid process
4) Distal head

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67
Q

The styloid process of the humerus is (smaller/larger) than the ulnar styloid process.

A

Larger

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68
Q

What type of joint is the elbow joint?

A

Hinge

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69
Q

What are the 3 articulations of the elbow joint?

A

1) Trochlea of humerus + Trochlear notch of ulna

2) Capitulum of humerus + Upper surface of radial head

3) Head of radius + Radial notch of ulna

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70
Q

The elbow joint is surrounded by a fibrous capsule which is weak ________________________ allowing for _________________.

A

Weak anterior and posteriorly → allowing for flexion and extension

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71
Q

What are the ligaments of the elbow joint?

A

Strengthen elbow joint:
1) Medial and lateral collateral

Hold proximal radio-ulnar joint (radial head against radial notch):
2) Annular ligament (encircles radial head)

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72
Q

What are the nerves of the elbow joint?

A

1) Musculocutaneous
2) Radial
3) Ulnar

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73
Q

At which joint(s) does elbow flexion and extension occur?

A

Humero-radial and Humero-ulnar joints

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74
Q

At which joint(s) does elbow pronation and supination occur?

A

Proximal radio-ulnar joint

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75
Q

What muscle(s) facilitate elbow flexion?

A

1) Biceps
2) Brachialis
3) Brachioradialis

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76
Q

What muscle(s) facilitate elbow extension?

A

1) Triceps
2) Anconeus

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77
Q

What muscle(s) facilitate elbow pronation?

A

1) Pronator teres
2) Pronator quadratus

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78
Q

What muscle(s) facilitate elbow supination?

A

1) Biceps
2) Supinator

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79
Q

What is a subluxation?

A

Incomplete or partial dislocation of a joint or organ.

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80
Q

What is the usual consequence of a subluxation of the the radial head from the annular ligament?

A

Posterior dislocation of the elbow joint

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81
Q

What is the most likely dislocation of a fall with elbows flexed?

A

Posterior dislocation

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82
Q

What is the carrying angle?

A

Angle formed by the axes of the arm and forearm when the forearm is in full extension and supination

(Internal angle of deviation of ulna from long axis of humerus)

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83
Q

The carrying angle is generally (wider/narrower) in females.

A

Wider

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84
Q

What is the function of the carrying angle?

A

Allows forearms to clear the hips in swinging movements when carrying objects.

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85
Q

In the hand there are:
__ carpal bones
__ metacarpal bones
__ proximal phalanges
__ middle phalanges
__ distal phalanges

A

In the hand there are:
8 carpal bones
5 metacarpal bones
5 proximal phalanges
4 middle phalanges
5 distal phalanges

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86
Q

Which type of joint is the wrist joint?

A

Ellipsoid

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87
Q

What are the articulating surfaces of the wrist joint?

A

Distal end of radius + articular disc of distal radio-ulnar joint + proximal carpal bones (scaphoid, lunate, triquetrum)

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88
Q

What are the 3 nerves that innervate the wrist joint?

A

1) Median
2) Radial
3) Ulnar

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89
Q

The fibrous capsule surrounding the wrist joint is strengthened by which ligaments?

A

1) Palmar radiocarpal
2) Dorsal radiocarpal
3) Ulnar collateral
4) Radial collateral

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90
Q

The radial collateral ligament runs from the _______ to the _______ and ___________.

A

Radius to scaphoid and trapezium

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91
Q

The ulnar collateral ligament runs from the _______ to the _______ and ___________.

A

Ulna to triquetrum and pisiform

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92
Q

What are the 8 movements of the wrist joint?

A

1-2) Flexion/Extension
3-4) Pronation/Supination
5-6) Abduction/Adduction
7-8) Radial/Ulnar deviation

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93
Q

What muscle(s) facilitate wrist flexion?

A

1) Flexor carpi radialis
2) Flexor carpi ulnaris

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94
Q

What muscle(s) facilitate wrist extension?

A

1) Extensor carpis radialis longus
2) Extensor carpis radialis brevis
3) Extensor carpi ulnaris

95
Q

What muscle(s) facilitate wrist abduction?

A

1) Abductor pollicis longus
2) Flexor carpi radialis
3) Extensor carpi radialis longus
4) Extensor carpi radialis brevis

96
Q

What muscle(s) facilitate wrist adduction?

A

1) Flexor carpi ulnaris
2) Extensor carpi ulnaris

97
Q

What is the most common fracture from a fall on an outstretched arm?

A

Distal radius fracture

98
Q

What is the most common fracture from a fall on an outstretched arm with the wrist extended and abducted?

A

Scaphoid fracture

99
Q

What is the most common fracture from a fall on a dorsiflexed wrist?

A

Anterior dislocation of the lunate → Carpal tunnel syndrome

100
Q

What type of joint is the 1st digit carpo-metacarpal joint?

A

Saddle type

101
Q

What are the articulating surfaces of the 1st digit carpo-metacarpal joint?

A

Trapezium + base of 1st metacarpal bone

102
Q

The fibrous capsule surrounding the 1st digit carpo-metacarpal joint is strengthened by which ligaments?

A

Anterior and posterior carpometacarpal and metacarpal ligaments

103
Q

What are the 4 movements of the thumb?

A

1-2) Flexion/Extension
3-4) Abduction/Adduction
5) Opposition
6) Circumduction

104
Q

What type of joint is an interphalangeal joint?

A

Hinge joint

105
Q

What type of joint is a metacarpophalangeal joint?

A

Condyloid joint

106
Q

What are the articulating surfaces of a metacarpophalangeal joint?

A

Head of metacarpal + base of phalanx

107
Q

The metacarpophalangeal joints are stabilised by which ligaments?

A

1) Palmar ligaments
- united by transverse metacarpal ligaments
2) Collateral ligaments

108
Q

What are the movements allowed by the metacarpophalangeal joint?

A

1-2) Flexion/Extension
3-4) Abduction/Adduction

109
Q

What are the 8 carpal bones of the hand?

A

Some Lovers Try Positions That They Cannot Handle

Lateral to medial
1) Scaphoid
2) Lunate
3) Triquetrum
4) Pisiform
- next row -
5) Trapezium
6) Trapezoid
7) Capitate
8) Hamate

110
Q

Where is the sesamoid bone?

A

Between the metacarpal bone and proximal phalanges of the 1st digit of the hand

111
Q

How can articular pathologies be differentiated from periarticular?

A

Articular:
1) BOTH passive and active movements painful
2) Tender along joint line
3) Pain in all planes of joint movement

Periarticular:
1) Passive movement is less painful than active movement
2) Tender at structure of involvement
3) Pain in certain planes of movement, stress test positive

112
Q

What are the signs and a/w of rotator cuff tendinitis?

A

1) Pain in lateral aspect of arm
2) Weakness
3) Painful arc
4) Night pain
5) Positive impingement sign
6) Age >40

113
Q

What is the difference between muscular dystrophy and atrophy

A

Dystrophy: weakness
Atrophy: wasting

114
Q

What are the muscles of the pectoral girdle?

A

1) Pectoralis major
2) Pectoralis minor
3) Serratus anterior

115
Q

Pectoralis major:
Function:
Origin:
Insertion:
Innervation:

A

Pectoralis major:
Function:
i) adduction of humerus
ii) medially rotates humerus
ii) flexion of arm

Origin: sternum, superior 6 costal cartilage and clavicle

Insertion: Lateral lip of bicipital groove of humerus

Innervation: Lateral and medial pectoral nerve

116
Q

Pectoralis minor:
Function:
Origin:
Insertion:
Innervation:

A

Pectoralis minor:
Function: stabilises scapula by drawing it against thoracic wall

Origin: 3-5 ribs near costal cartilage

Insertion: coracoid process of scapula

Innervation: medial pectoral nerve

117
Q

Serratus anterior:
Function:
Origin:
Insertion:
Innervation:

A

Serratus anterior:
Function: protraction and upward rotation scapula

Origin: 1-8 ribs on lateral surface

Insertion: Superior/inferior angles and medial border of scapula

Innervation: long thoracic nerve (C5, C6, C7)

118
Q

What causes the “winged scapula” in a long thoracic nerve lesion?

A

Paralysis of serratus anterior → unable to pull scapula anteroinferiorly
→ winging of scapula

119
Q

What are the rotator cuff muscles?

A

1) Supraspinatus
2) Infraspinatus
3) Teres minor
4) Subscapularis

120
Q

What are the intrinsic shoulder muscles?

A

1) Deltoid

Rotator cuff muscles:
2) Supraspinatus
3) Infraspinatus
4) Teres minor
5) Subscapularis

121
Q

Supraspinatus:
Function:
Origin:
Insertion:
Innervation:

A

Supraspinatus:
Function: abduction of arm (assist deltoid)

Origin: supraspinous fossa of scapula

Insertion: greater tubercle of humerus

Innervation: Suprascapular nerves (C4, 5, 6)

122
Q

Infraspinatus:
Function:
Origin:
Insertion:
Innervation:

A

Infraspinatus:
Function: laterally rotates arm

Origin: infraspinous fossa

Insertion: posterior aspct of greater tubercle and shoulder joint capsule

Innervation: Suprascapular nerve (C5, 6)

123
Q

Teres minor:
Function:
Origin:
Insertion:
Innervation:

A

Teres minor:
Function: laterally rotates arm

Origin: Middle portion of lateral border of scapula

Insertion: inferior aspect of greater tubercle

Innervation: Axillary nerve (C5, 6)

124
Q

Subscapularis:
Function:
Origin:
Insertion:
Innervation:

A

Subscapularis:
Function:
i) medially rotate
ii) adducts the arm

Origin: subscapularis fossa

Insertion: lesser tubercle of humerus

Innervation: subscapular (C5, 6 , 7)

125
Q

Deltoid:
Function:
Origin:
Insertion:
Innervation:

A

Deltoid:
i) Anterior
- flex and medial rotate arm
- from clavicle

ii) Middle
- abducts arm
- from spine of scapula

iii) Posterior
- extends and laterally rotates arm
-acromion of the scapula

Insertion: (all)
- deltoid tuberosity of humerus

Innervation: (all)
- axillary nerve (C5,6)

126
Q

What are the extrinsic shoulder muscles?

A

1) Trapezius
2) Latissimus dorsi

127
Q

What is the main function of the rotator cuff muscles?

A

Stabilises glenohumeral joint
- holds head of humerus against glenoid cavity of scapula

128
Q

What are the functions of the trapezius?

A

1) Elevate shoulder (superior)

2) Retract shoulder (middle)

3) Depress shoulder (inferior)

129
Q

Trapezius:
Function:
Origin:
Insertion:
Innervation:

A

Trapezius:
Function: move shoulder
i) superior → elevate
ii) middle → retract
iii) inferior → depress

Origin:
i) superior nuchal line of occipital bone
ii) C7-T12

Insertion:
i) lateral third of clavicle
ii) acromion process of scapula
iii) spine of scapula

Innervation: Accessory nerve (C11)

130
Q

Latissimus dorsi:
Function:
Origin:
Insertion:
Innervation:

A

Latissimus dorsi:
Function: moves shoulder
i) adducts
ii) Medially rotates
iii) extends arm

Origin:
i) T7-12
ii) L1-L5
iii) Iliac crest

Insertion: intertubular sulcus of humerus

Innervation: thoracodorsal nerve

131
Q

What are the functions of the latissimus dorsi?

A

1) Adduction
2) Extension
3) Internal rotation of arm

132
Q

What are the muscles involved in shoulder flexion?

A

1) Deltoid (Anterior)
2) Pectoralis major
3) Biceps
4) Coracobrachialis muscles

133
Q

What are the muscles involved in shoulder extension?

A

1) Deltoid (posterior)
2) Latissimus dorsi
3) Teres major

134
Q

What are the muscles involved in shoulder abduction?

A

1) Deltoid (middle)
2) Supraspinatus

135
Q

What are the muscles involved in shoulder adduction?

A

1) Pectoralis major
2) Latissimus dorsi
3) Teres major
4) Teres minor

136
Q

What are the muscles involved in shoulder lateral rotation?

A

1) Infraspinatus
2) Teres minor
3) Deltoid (posterior)

137
Q

What are the muscles involved in medial rotation of the shoulder?

A

1) Subscapularis
2) Latissimus dorsi
3) Teres major
4) Deltoid (anterior)

138
Q

What forms the base and apex of the axilla?

A

Apex:
1) Clavicle
2) 1st rib
3) Superior border of scapula

Base:
Skin and fascia extending from thoracic wall to arm

139
Q

What are the bounds of the axilla?

A

Anterior: pectoralis major/minor

Posterior: Subscapularis and scapula

Medially: Serratus anterior and 1-4 ribs

Lateral: bony wall formed by intertubular groove in humerus

140
Q

What are the muscles of the arm (not forearm)?

A

1) Biceps brachii
2) Brachialis
3) Coracobrachialis
4) Triceps brachii

141
Q

Biceps brachii:
Function:
Origin:
Insertion:
Innervation:

A

Biceps brachii:
Function: moves forearm
elbow flexed → supination
elbow extended →flexion

Origin:
long head → supraglenoid tubercle
short head → coracoid process

Insertion:
radial tuberosity → bicipital aponeurosis

Innervation: musculocutaneous nerve (C5-7)

142
Q

Brachialis:
Function:
Origin:
Insertion:
Innervation:

A

Brachialis:
Function: flexion of forearm

Origin: midpoint of humerus

Insertion:
i) coronoid process
ii) ulnar tuberosity

Innervation: Musculocutaneous nerves (C5-7)

143
Q

Coracobrachialis:
Function:
Origin:
Insertion:
Innervation:

A

Coracobrachialis:
Function: move arm
i) adduction
ii) flexion

Origin: tip of coracoid process of scapula

Insertion: mid point of humerus

Innervation: musculocutaneous nerve (C5-7)

144
Q

Triceps brachii:
Function:
Origin:
Insertion:
Innervation:

A

Triceps brachii:
Function:
i) main extensor of elbow joint
ii) extension of arm
iii) resist displacement of head of humerus

Origin:

Insertion:

Innervation: radial nerve

145
Q

What are the bounds of the cubital fossa?

A

Floor: brachialis and supinator

Roof: deep fascia and bicipital aponeurosis

Medial: pronator teres

Lateral: brachioradialis

Superiorly: imaginary line connecting lateral and medial epicondyles

146
Q

What are the contents of the cubital fossa?

A

1) Median nerve
2) Bifurcation of brachial artery
3) Tendon of biceps brachii
4) Radial nerve

147
Q

Which vein of the cubital fossa is commonly used for venipuncture?

A

Median cubital vein

148
Q

What structure separates the median cubital vein from the underlying brachial artery and median nerve?

A

Bicipital aponeurosis

149
Q

Along the cubital fossa, the cephalic vein runs (medial/lateral) to the biceps brachii while the basilic vein runs (medial/lateral) when in SAT.

A

Cephalic: lateral
Basilic: medial

150
Q

The flexors and pronators are in the _________ compartment of the forearm while the extensors and supinators are in the ______________.

A

Flexor and pronator: Anterior
Extensor and supinator: Posterior

151
Q

What are the 5 superficial and 3 deep muscles of the flexor muscles of the forearm?

A

Superficial:
1) Pronator teres
2) Flexor carpi ulnaris
3) Flexor carpi radialis
4) Palmaris longus
5) Flexor digitorum superficialis

Deep:
1) Flexor digitorum profundus
2) Flexor pollicis longus
3) Pronator quadratus

152
Q

Pronator teres:
Function:
Origin:
Insertion:
Innervation:

A

Pronator teres:
Function:
i) pronates the forearm
ii) flexes elbow joint

Origin:
i) medial epicondyle of humerus
ii) coronoid process of ulna

Insertion: lateral surface of radius

Innervation: median nerve

153
Q

Flexor carpi ulnaris:
Function:
Origin:
Insertion:
Innervation:

A

Flexor carpi ulnaris:
Function:
i) flexion
ii) adduction of wrist

Origin:
i) medial epicondyle of humerus
ii) olecranon of ulna

Insertion:
i) pisiform
ii) hook hamate
iii) 5th metacarpal bone

Innervation: ulnar nerve

154
Q

Flexor carpi radialis:
Function:
Origin:
Insertion:
Innervation:

A

Flexor carpi radialis:
Function: flexes and abducts wrist

Origin: medial epicondyle of humerus

Insertion: base of 2nd metacarpal

Innervation: radial nerve

155
Q

Palmaris longus:
Function:
Origin:
Insertion:
Innervation:

A

Palmaris longus:
Function: flexion of wrist

Origin: medial epicondyle of humerus

Insertion:
i) flexor retinaculum
ii) palmar aponeurosis

Innervation: median nerve

156
Q

Flexor digitorum superficialis:
Function:
Origin:
Insertion:
Innervation:

A

Flexor digitorum superficialis:
Function: flexion of (i) middle (ii) proximal phalanges

Origin:
i) Medial epicondyle of humerus
ii) coronoid process of ulna
iii) superior half of radius

Insertion: middle phalanges of 4 medial digits

Innervation: median nerve

157
Q

Flexor digitorum profundus:
Function:
Origin:
Insertion:
Innervation:

A

Flexor digitorum profundus:
Function: flexes distal inter-phalangeal of medial 4 digits

Origin:
i) ulna
ii) interosseus membrane

Insertion:
i) base of distal phalanges of medial 4 digits

Innervation: median 1/2 → ulnar nerve; lateral 1/2 → median nerve

158
Q

Flexor digitorum longus:
Function:
Origin:
Insertion:
Innervation:

A

Flexor digitorum longus:
Function:
i) flexion of phalanges of thumb
ii) flexes metacarpophalangeal and carpometacarpal joints of thumb

Origin:
i) radius
ii) Interosseus membrane

Insertion: base of distal phalanx of thumb

Innervation: median nerve

159
Q

What are the bounds of the carpal tunnel?

A

Floor: concavity of carpal bones

Roof: Flexor retinaculum

Medial: hook of hamate and pisiform

Lateral: scaphoid and trapezium

160
Q

The carpal tunnel contains __ tendons, surrounded by ________ and the ________________.

A

Carpal tunnel:
- 9 tendons
- synovial sheaths
- median nerve

161
Q

What are the branches of the brachial plexus?

A

1) Posterior cord
2) Lateral cord
3) Medial cord

162
Q

Supinator:
Function:
Origin:
Insertion:
Innervation:

A

Supinator:
Function: supination of forearm

Origin:
i) lateral epicondyle of humerus
ii) supinator crest
iii) supinator fossa of ulna

Insertion:
anterior, lateral and posterior aspects of proximal radius

Innervation: median nerve

163
Q

Pronator quadratus:
Function:
Origin:
Insertion:
Innervation:

A

Pronator quadratus:
Function: initiates pronation of radioulnar joints

Origin: distal 1/4 of ulna

Insertion: distal 1/4 of radius

Innervation: median nerve

164
Q

What are 3 muscles that extend, abduct and adduct the hand at the wrist joint, their innervation and their (i) origin (ii) insertion.

A

All by radial nerve

1) Extensor carpi radialis longus
- extend and ABduct
i) lateral SUPRAcondyle of humerus
ii) base of 2nd metacarpal

2) Extensor carpi radialis brevis
- extend and ABduct
i) lateral epicondyle of humerus
ii) base of 3rd metacarpal

3) Extensor carpi ulnaris
- extend and ADduct
i) lateral epicondyle of humerus
ii) base of 5th metacarpal

165
Q

Extensor digitorum:
Function:
Origin:
Insertion:
Innervation:

A

Extensor digitorum:
Function:
i) extensor of medial 4 digits
ii) extension of proximal phalanges at metacarpophalangeal joints
iii) extends hand at wrist joint

Origin: lateral epicondyle of humerus

Insertion: extensor expansion of medial 4 digits

Innervation: Interosseus nerve (C7-8)

166
Q

Extensor digit minimi:
Function:
Origin:
Insertion:
Innervation:

A

Extensor digit minimi:
Function: extend 5th digit at metacarpophalangeal and interphalangeal joints

Origin: lateral epicondyle of humerus

Insertion: extensor expansions of 5th digits

Innervation: Interosseous nerve

167
Q

Extensor tendons expand to form extensor expansions which wrap around head of the metacarpals and proximal phalanges. What are the 3 bands that why are divided into and what is their function?

A

Provides attachment for short muscles of the hand
- 2 lateral bands (distal phalanx)
- 1 median band (middle phalanx)

168
Q

What are the 4 deep extensors of the forearm and what do they act on?

A

1) Abductor pollicis longus
- (i) abduct (ii) extends thumb @ CMCJ

2) Extensor pollicis brevis
- extend thumb @ MCPJ

3) Extensor pollicis longus
- extends distal phalanx

4) Extensor indicis
- extends finger @ PIPJ

169
Q

What are the bounds of the anatomic snuff box of the hand?

A

Anterior:
i) Abductor pollicis longus
ii) Extensor pollicis brevis

Posterior:
i) Extensor pollicis longus

170
Q

What are the contents of the anatomical snuff box of the wrist?

A

1) Radial artery
2) Scaphoid
3) Trapezium

171
Q

Thenar muscles: _____________________________ are responsible for ___________ of the thumb and are innervated by?

A

1) Abductor pollicis brevis
2) Flexor pollicis brevis
3) Opponens pollicis

Responsible for:
i) circumduction
ii) opposition

Innervated by median nerve

172
Q

Abductor pollicis brevis:
Function:
Origin:
Insertion:
Innervation:

A

Abductor pollicis brevis:
Function: abduct thumb @ CMCJ

Origin:
i) Flexor retinaculum
ii) Tubercles of scaphoid & trapezium

Insertion: base of proximal thumb phalanx

Innervation: Median nerve

173
Q

Flexor pollicis brevis:
Function:
Origin:
Insertion:
Innervation:

A

Flexor pollicis brevis:
Function: flex thumb @ CMCJ & MCPJ

Origin:
i) Flexor retinaculum
ii) Tubercles of scaphoid & trapezium

Insertion: base of proximal phalanx of thumb

Innervation: median nerve

174
Q

Opponens pollicis:
Function:
Origin:
Insertion:
Innervation:

A

Opponens pollicis:
Function: opposes thumb @ CMCJ

Origin:
i) Flexor retinaculum
ii) Tubercles of scaphoid & trapezium

Insertion: lateral 1st metacarpal

Innervation: median nerve

175
Q

Adductor pollicis:
Function:
Origin:
Insertion:
Innervation:

A

Adductor pollicis:
Function: adducts the thumb

Origin:
i) oblique head-bases of 2nd & 3rd metacarpals
ii) transverse head
iii) body of 3rdmetacarpal

Insertion: base of 1st proximal phalanx

Innervation: ulnar nerve

176
Q

What are the short muscles of the hand?

A

4 lumbricals

177
Q

Lumbricals:
Function:
Origin:
Insertion:
Innervation:

A

Lumbricals:
Function:
i) flex digits @ MCPJ
ii) extend IPJ

Origin: tendons of flexor digitorum profundus

Insertion: lateral extensor expansions of digits 2-5

Innervation:
1&2: median nerve
3&4: lateral extensor expansions of digits 2-5

178
Q

What are the 2 interossei muscles?

A

1) Dorsal interossei
2) Palmar interossei

179
Q

Dorsal interossei:
Function:
Origin:
Insertion:
Innervation:

A

Dorsal interossei:
Function: abduct digits

Origin: metacarpals

Insertion:
i) extensor expansion
ii) bases of proximal phalanges

Innervation: ulnar nerve

180
Q

Palmar interossei:
Function:
Origin:
Insertion:
Innervation:

A

Palmar interossei:
Function: adduct digits

Origin: metacarpals

Insertion:
i) extensor expansion
ii) bases of proximal phalanges

Innervation: ulnar nerve

181
Q

What are the 3 types of veins in the upper limb?

A

1) Superficial veins
- dorsal venous network (dorsum of hand) → lateral cephalic / medial basilic veins

2) Deep venae comitantes
- accompany arteries

3) Perforating veins
- communication between superficial and deep veins

182
Q

Which vein links the cephalic and basilic veins in front of the elbow?

A

Median cubital vein

183
Q

The median cubital vein courses along the _________ and drains into the _______________.

A

along Deltopectoral groove

Drains into axillary vein

184
Q

What 2 veins form the axillary vein, where?

A

Basilic + Venae comitantes
@ axilla

185
Q

What nerve roots form the brachial plexus?

A

C5-8, T1

186
Q

What is a brachial plexus block used for?

A

Upper limb surgeries

187
Q

What do sudomotor sympathetic fibres supply?

A

Smooth muscle around sweat gland

188
Q

What do vasomotor sympathetic fibres supply?

A

Smooth muscle around vessels

189
Q

What do pilomotor sympathetic fibres supply?

A

Arrector pili

190
Q

What nerves are assessed in a biceps brachii tendon reflex?

A

C5,6

191
Q

What nerves are assessed in a triceps tendon reflex?

A

C6,7,8

192
Q

What is the most likely diagnosis of a px how presents with:
i) paralysis of deltoid, biceps, brachialis and brachioradialis
ii) abducted shoulder, medially rotated arm and extended elbow (waiter’s tip position)

A

Erb’s palsy
- injury to superior trunk of brachial plexus (C5, 6)

193
Q

What (i) nerve roots and (ii) muscles are affected in Erb’s palsy?

A

i) C5, 6
ii) paralysis of deltoid, biceps, brachialis and brachioradialis

194
Q

What condition is associated with waiter’s tip position?

A

Erb’s palsy
- abducted shoulder, medially rotated arm and extended elbow

195
Q

What is a common nerve condition of both (i) a fall landing on the shoulder and (ii) pulling of a baby’s head during per-vaginal delivery?

A

Erb’s palsy
- separation of neck and shoulder

196
Q

What structure is the landmark for differentiating the cords of the brachial plexus?

A

Axillary artery

197
Q

What are 2 common etiologies for axillary nerve injury?

A

1) Anterior dislocation of glenohumeral joint

2) Fracture of surgical shaft of humerus

198
Q

Which cord(s) of the brachial plexus and nerve roots does the musculocutaneous nerve arise from?

A

Lateral cord (C5-6)

199
Q

Which cord(s) of the brachial plexus and nerve roots does the axillary nerve arise from?

A

Posterior cord

200
Q

Which cord(s) of the brachial plexus and nerve roots does the radial nerve arise from?

A

Posterior cord

201
Q

Which cord(s) of the brachial plexus and nerve roots does the radial nerve arise from?

A

Posterior cord

202
Q

Which cord(s) and nerve roots does the median nerve arise from?

A

Lateral cord and medial cord

203
Q

Which cords and nerve roots does the ulnar nerve arise from?

A

Medial cord

204
Q

What is the neurological condition associated with claw hand?

A

Klumpke’s palsy (inferior trunk of brachial plexus: C8, T1)

205
Q

Which nerve roots and muscles are affected in Klumpke’s palsy?

A

C8, T1 (Inferior trunk) → Ulnar nerve → short muscles (lumbricals, interossei) → claw hand

206
Q

What is a common nerve condition of both (i) catching a fall from height with 1 arm (ii) breech birth?

A

Klumpke’s palsy (C8, T1)
- Claw hand

207
Q

What are the (i) motor and (ii) sensory innervations of the musculocutaneous nerve (C5-7)?

A

Motor:
i) Coracobrachialis
ii) Bicep brachii
iii) Brachialis

Sensory:
Lateral aspect of forearm

208
Q

Which movement would be affected in a musculocutaneous nerve lesion?

A

1) Flexion of forearm
2) Supination of forearm

209
Q

What are the (i) motor and (ii) sensory innervations of the median nerve (C6-8, T1)?

A

Motor:
i) All flexors except (1) flexor carpi radialis and (2) ulnar half of flexor digitorum profundus
ii) 3 thenar
iii) radial 2 lumbricals

Sensory:
Palmar surface of lateral 3.5 digits (including nail beds on dorsal side)

210
Q

How would a median nerve lesion at the elbow and wrist differ?

A

Elbow:
i) No pronation
ii) Weak wrist flexion
iii) Ulnar deviation at rest
iv) Thumb abducts
v) Wasting of thenar eminence (hand is flat and ape-like)

Wrist: (Carpal tunnel)
- Thenar muscles paralysed → no opposition and abduction of thumb

211
Q

What are the (i) motor and (ii) sensory innervations of the Ulnar nerve (C7-8, T1)?

A

Motor:
i) Flexor carpi ulnaris
ii) Medial 1/2 of flexor digitorum profundus
iii) Hypothenar msucles
iv) Interossei
v) 3/4 lumbricals
vi) Adductor pollicis

Sensory:
Both dorsal and palmar side medial 1.5 fingers

212
Q

How would a ulnar nerve injury at the wrist present?

A

Injury @ elbow
1) → medial 1/2 of flexor digitorum profundus is paralysed → less unopposed action of extensors on the 4/5th digits → Claw hand

2) Sensory loss over 1.5 fingers

213
Q

Explain the ulnar paradox.

A

Injury @ elbow → medial 1/2 of flexor digitorum profundus is paralysed
→ less unopposed action of extensors on the 4/5th digits
→ only hyperextension of MCPJ, no flexion of PIPJ

214
Q

Explain the pathophysiology of claw hand.

A

Ulnar nerve injury at wrist → paralysis of all intrinsic muscles of hand (expect 2 radial)
→ unopposed action of extensors and flexor digitorum profundus + paralysis of 4/5 lumbricals
→ MCPJ of 4/5 digits hyperextended + PIPJ flexed

215
Q

What is carpal tunnel syndrome?

A

Median nerve entrapment @ elbow
→ numbness and tingling in 4/5 digits
→ LT → muscle wasting → ape hand

216
Q

What are the (i) motor and (ii) sensory innervations of the radial nerve?

A

Motor:
i) Extensor muscles of arm
ii) Extensor muscle of forearm

217
Q

Which nerve of the forearm pierces the supinator?

A

Radial nerve

218
Q

After passing behind the humerus in the spiral groove and entering the cubital fossa, the radial nerve divides into the _________ and ____________ which provides ___________ and _____________ innervation respectively

A

Superficial branch: fully sensory

Deep branch: fully motor

219
Q

How does a radial nerve injury at the (i) axilla differ from that of the (ii) midshaft of the humerus (iii) radial head?

A

i) Axilla: paralysis of
a) Triceps
b) Brachioradialis
c) Supinator
d) Extensors of wrist and digits
→ wrist drop

ii) Radial groove:
Weakened:
a) Triceps
Paralysis:
b) Brachioradialis
c) Supinator
d) Extensors of wrist and digits
→ wrist drop

iii) Radial head
- NO sensory loss
a) only unable to extend thumb and MCPJ of other digits

219
Q

What is the (i) motor (ii) Sensory innervations of the Axillary nerve?

A

Motor:
i) Teres minor
ii) Deltoid

Sensory:
i) Inferior part of deltoid

220
Q

Which arteries anastomose with the axillary artery?

A

1) Dorsal/Suprascapular artery
2) Subscapular artery
- can form collateral circulation if axillary artery is compromised

221
Q

What is the origin of the axillary artery?

A

Subclavian artery

222
Q

Which artery should be compressed to control bleeding due to a stab wound in the axilla?

A

Axillary artery (3rd part)

223
Q

What parts of the body do the axillary artery supply?

A

1) Thoracic wall
2) Shoulder

224
Q

In the axilla, the axillary artery extends form the ____________ to the ____________.

A

Lateral border of 1st rib to inferior border of teres major

225
Q

What are the branches of the axillary artery?

A

1st:
- superior thoracic

2nd:
- thoracoacromial
- lateral thoracic

3rd:
- subscapular
- anterior circumflex humeral
- posterior circumflex humeral

226
Q

What are the 2 anastomoses of the brachial artery?

A

1) Radial recurrent
- with collateral artery from deep artery

2) Ulnar recurrent
- with superior inferior collateral arteries from brachial artery

227
Q

The brachial artery arises from the __________ and gives rise to the __________.

A

Axillary artery
→ Radial and ulnar arteries

228
Q

In the cubital fossa, the brachial artery lies _____ to the median nerve.

A

Lateral

229
Q

What are the branches of the brachial artery?

A

1) Radial artery
2) Ulnar artery
3) Deep artery (accompany radial nerve)
4) Superior and inferior ulnar collateral arteries

230
Q

Which artery is compressed when taking blood pressure with a sphygmonamanometer?

A

Brachial artery

231
Q

What are the arteries that anastomose with both the radial and ulnar arteries at the wrist?

A

Dorsal and palmar arches

232
Q

The superficial palmar arch is a direct continuation of the _______ which enters the hand (anterior/posterior) to the flexor retinaculum, while the deep palmar arch is a direct continuation of _____.

A

Superificial: Ulnar
Deep: Radial (+ anastomoses from ulnar)

Superficial palmar arch anterior to flexor retinaculum

Musculoskeletal System (22 decks)

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