Upper Limb Flashcards
What is the gross anatomy of the scapula?
Glenoid fossa
- for articulation fo the head of the humeus
- supraglenoid tubercle (attachment of biceps)
- infraglenoid tubercle (attachment of triceps)
- lined with glenoid labrum
Spine (posteriorly)
- divides into supraspinous fossa + infraspinous fossa
Acromion (superior)
- articulates with clavicle
Coracoid process
- for coracoclavicular ligament, attachment of trapezoid and conoid
- for giving origin of short head of biceps, coracobrachialis
What are the ligaments involved with the scapula?
- acromioclavicular ligament
- coracoacromial ligament
- coracoclavicular ligament (trapezoid and conoid)
What are the joints involved with the scapula?
Glenohumeral joint
- synovial joint
- uses glenohumeral ligament, rotator cuff
acromioclavicular joint
- synovial
- incomplete disc between acromion + clavicle
What are the core muscles involved with the scapula?
Rotator cuff muscles
Rhomboids
Serratus anterior
levator scapulae
What are the relations to the scapula?
Scapula anastomosis
- suprascapular A: 1st part of the subclavian A.
- dorsal scapular A: 2nd part subclavian + anastomoses with the posterior intercostal A
- subscapular A: 3rd part of the axillary A
What are the anatomical variants associated with the scapula?
Sprengel deformity (when there is a congenitally raised scapula)
Acromial variation - can have an accessory ossicle: 7 types
flat undersurface
concave undersurface
hooked undersurface
convex undersurface
What is the superior thoracic aperture?
Connects the root of the neck to the superior mediastinum
What is the gross anatomy of the superior thoracic aperture?
Anterior: manubrium of the sternum
Lateral: first rib, costal cartilage
Posterior: T1 vertebra
What are the contents of the superior thoracic aperture?
Viscera
- thymus
- lung apices
- trachea
- oesophagus
What are the arteries in the superior thoracic aperture?
Arteries
- subclavian arteries
- common carotid arteries
What are the veins in the superior thoracic aperture?
Veins
- subclavian veins
- internal jugular veins
What are the nerves in the superior thoracic aperture?
Nerves
- brachial plexus (behind anterior scalene)
- phrenic nerve (anterior to anterior scalene)
- vagus nerve (anterior to anterior scalene)
- recurrent laryngeal nerve (medial to anterior scalene)
What are the nerves in the superior thoracic aperture?
brachial plexus - behind anterior scalene
vagus N - anterior to anterior scalene
phrenic N - anterior to anterior scalene
recurrent laryngeal N - medial to anterior scalene
What are the lymphatics contained in the superior thoracic aperture?
Thoracic duct
Right lymphatic duct
What are the muscles involved with the superior thoracic aperture?
sternocleidomastoid
anterior scalene
sternohyoid
sternothyroid
prevertebral fascia
What are the variants associated with the superior thoracic aperture?
cervical rib
c1 fibrous band
bifid c1
hypoplastic c1
c1 pseudoarticulation
What is anterior to scalenus anterior?
Phrenic N (under the prevertebral fascia)
Vagus N
Ascending cervical A
Transverse cervical / suprascapular A
Thoracic duct
Carotid sheath
lower belly of omohyoid
deep cervical nodes
What is posterior to scalene anterior?
Brachial plexus
2nd part subclavian artery
anterior rami C3 - T1
Costocervical trunk
Superior intercostal and deep cervical arteries
Scalenus medius
What is medial to scalene anterior?
longus coli
carotid tubercle
pyramidal space
carotid sheath
stellate ganglion
vertebral artery
middle cervical ganglion
inferior thyroid artery
1st part subclavian artery
ansa subclavia
thyrocervical trunk
vertebral vein
What is lateral to scalene anterior?
trunks of brachial plexus
3rd part of subclavian A
What is the clavicle?
link between the shoulder and the thorax
S shaped bone
What is the structure of the clavicle?
S shaped
Medial 2/3 makes one curve
lateral 1/3 makes the other curve
Point between the two curves is where fractures are most likely to occur
Conoid tubercle / trapezoid line
What is the ossification / fusion dates of the clavicle?
It is the first bone to ossify at 5-6 weeks
Completely fused at 20 weeks
What are the joints involved with the clavicle?
Acromioclavicular - has incomplete disc
Sternoclavicular - has complete disc
both are synovial
What are the ligaments involved with the clavicle?
Acromioclavicular ligament
Coracoclavicular ligament - trapezoid, conoid
Costoclavicular ligament
Sternoclavicular ligament
**interclavicular ligament
What are the important muscles with the clavicle?
Pec major
Sternocleidomastoid
Trapezius
Deltoid
Subclavius
What are the important relations with the clavicle?
Subclavian artery
Subclavian vein (anterior scalene will be between vein + artery)
What are common anatomical variants associated with the clavicle?
forked clavicle
Supraclavicular foramen
coracoclavicular joint (between conoid tubercle of clavicle + coracoid process of scapula)
What is the first rib?
It is the most superior rib
Anatomical landmark
Parietal pleura is in contact with the inner border
What is important about the structure of the first rib?
Head - has only one facet which articulates with T1
Neck - crossed by sympathetic trunk
Tubercle - articulates with the facet of transverse process
Scalene Tubercle - for attachment of scalene anterior
Body - groove for subclavian artery (posterior to scalene tubercle) and is inferior to trunks of brachial plexus, groove for subclavian vein (anterior to scalene tubercle)
What are the joints involved with the first rib?
Costotransverse
Costovertebral
Costochondral
What are the key relations of the first rib?
Superior - clavicle, anterior scalene, subclavian vein, subclavian artery, brachial plexus
Inferior - parietal pleura, neurovascular bundle (intercostal A/V/N)
Anterior - sympathetic trunk + superior /supreme intercostal A (from costocervical trunk)
Posterior - internal thoracic artery and vein
What are the ligaments involved with the first rib?
Radiate
Superior / lateral costotransverse
Costo clavicular ligament
What are the muscles involved with the first rib?
Anterior scalene
Middle scalene
Subclavius
External intercostal
Internal intercostal
Innermost intercostal
What are the arteries / veins/ nerves involved with the first rib?
Intercostal A/V/N
Superior / supreme intercostal A
What are the anatomical variants associated with the first rib?
bifid rib
fibrous articulation / fusion with cervical rib
rudimentary/hypoplastic rib
What are the different parts of the humerus?
Proximal -
Head
Greater tubercle (for rotator cuff except subscap)
Lesser tubercle (for subscap)
Bicipital groove between the 2
Shaft -
Radial (spiral) groove
Deltoid tuberosity
Distal -
Olecranon fossa
Condyle - medial and lateral
Epicondyles - medial and lateral
Trochlea and Capitulum
What are the joints / ligaments involved with the humeus?
Glenohumeral joints (with tendons of the rotator cuff)
Elbow joint (TURC)
- with radial collateral ligament + annular ligament
- ulnar collateral ligament
- both are synovial
What are the key relations of the humerus?
At surgical neck
- axillary nerve / posterior circumflex humeral artery
- At shaft (in radial groove), RADIAL NERVE and profunda brachii
- at lateral epicondyle - radial N
- at medial epicondyle;
Anterior: median N and brachial artery
Posterior: ulnar N
Medially
- median nerve and brachial artery
What are the anatomical variants associated with the humerus?
Olecranon foramen (can replace the olecranon fossa)
Supracondylar process - Associated with ligament (of struthers) which attaches above epicondyle to create a foramen to transmit median n. and brachial a.
What is key about the ossification of the humeus?
Primary centre in mid shaft at 8 weeks
Secondary centre is at head of humerus, greater and lesser tuberosities at 1 year
