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Upper limb > Upper limb 2 > Flashcards

Upper limb 2 Flashcards

1
Q

What shape is the scapula and what kind of bone is it?

A

Triangular flat bone

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2
Q

How many muscle attachments does the scapula have?

A

17

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3
Q

What are the 3 faces of the scapula?

A
  1. Costal surface
  2. Lateral surface
  3. Posterior surface
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4
Q

What is the costal surface of the scapula?

A
  • Anterior surface
  • Subscapular fossa (where subscapularis muscle originates)
  • Coracoid process (provides attachment to the short head of biceps brachii, coracobrachialis and pec major)
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5
Q

What is the lateral surface of the scapula? What does it face? What tubercles does it contain? What muscles attach to the tubercles?

A
  • Faces the humerus and glenoid fossa
  • Supraglenoid tubercle = origin long head of biceps brachii
  • Infraglenoid tubercle = origin of the long head of triceps brachii
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6
Q

What is the posterior surface of the scapula divided by? Gives rise to?

What other structure of the scapula does it give rise to?

A
  • Posterior surface is divided by spine
  • Gives rise to supraspinous fossa (where supraspinatus arsies)
  • Gives rise to infraspinous fossa (where infraspinatus arises)
  • Acromium is also present here, it articulates with the clavicle
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7
Q

What is subscapularis, supraspinatus and infraspinatus?

A

Look at picture

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8
Q

What are the other features of the scapula?

A
  • Superior border
  • Inferior border
  • Suprascapular notch
  • Medial border
  • Lateral border
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9
Q

What can cause a scapular fracture?

A

Uncommon.

-Can be caused by chest trauma (high speed collisions, crushing injuries, sports injuries)

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10
Q

Why does a fractured scapula not need fixing?

A

The tone of the surrounding muscles hold the pieces in place for healing to occur.

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11
Q

What is winged scapula?

What can cause damage to that nerve?

A
  • Damage of long thoracic nerve can cause paralysis of serratus anterior (origin ribs 1-8)
  • Causes scapula to protrude out of the back when pushing with arm
  • Long thoracic nerve can become damaged by shoulder trauma, repetitive movements at shpulder, pressing of nerve
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12
Q

What is the clavicle?

What does it attach?

A
  • Long sigmoid bone
  • Attaches upper limb to the trunk (torso)
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13
Q

What is the function of the clavicle?

A
  • Protects neurovasculature
  • Transmits forces from the upper limb to the axial skeleton
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14
Q

What are the key 5 characteristics of the clavicle?

A
  • Sternal end
  • Impression for costoclavicular ligament
  • Conoid tubercle
  • Trapezoid line
  • Acromial end
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15
Q

Elaborate on the sternal end

A
  • Has a large articular facet which articulates with the sternum (forming sternoclavicular joint)
  • Has a depression for costoclavicular ligament (fibrous ligament that stabilises movement at the sternoclavicular joint - attached to first rib and borders of clavicle)
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16
Q

What is the costoclavicular ligament?

A
  • The fibrous ligament that attaches from the first rib and its cartilage to the anterior and posterior borders of the clavicle
  • stabilises the sternoclavicular joint
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17
Q

Why is the clavicular shaft important?

(Origin of which 6 muscles?)

Why does it have a depression?

A
  • It’s the origin for deltoid, trapezius, subclavius, pec major, sternocleidomastoid and sternohyoid
  • Has a depression for subclavius
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18
Q

Elaborate on the acromial end

A
  • Has the acromial facet which articulates with the acromium
  • Conoid tubercle = provide attachment for conoid ligament (medial part of the coracoclavicular ligament)
  • Trapezoid line = attachment for lateral part of the coracoclavicular ligament = trapezoid ligament
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19
Q

What is the conoid tubercle?

A

-Allows attachment of conoid ligament which is the medial part of the coracoclavicular ligament

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20
Q

What is the trapezoid line?

A

Provides attachment to trapezoid ligament (lateral part of the coracoclavicular ligament)

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21
Q

Why is clavicle susceptible to fracture?

How do fractures happen?

A
  • Because of its size
  • Fall on shoulder or onto an outstretched hand
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22
Q

Which part of the clavicle fractures more common?

A
  • 80% occur in the middle third
  • 15% occur in the lateral third
  • 5% occur in the medial third
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23
Q

What does the proximal humerus consist of?

A
  • Head = articulates with the glenoid fossa
  • Anatomical neck
  • Surgical neck = axillary nerve wraps around here, circumflex humeral arteries are found here
  • Greater tubercle = located laterally. Provides attachment for supraspinatus, infraspinatus and teres minor NOT subscapualris)
  • Lesser tubercle = located medially. Provides attachment for subscapularus

Intertubercular (bicipital groove) = tendon of long head of biceps brachii runs; attachment points for pec major and lat dorsi

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24
Q

What is the greater tubercle?

A
  • Located laterally
  • Provides attachment for 3 rotator cuff muscles - infraspinatus, supraspinatus and teres minor
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25
Q

What is the lesser tubercle?

A

Located medially. Provides attachment for subscapularis

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26
Q

What is the intertubercular (bicipital groove)?

A
  • Groove where tendon of long head of biceps brachii runs
  • Attachment for pec major and lat dorsi
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27
Q

What are the key features of the shaft?

A

-Deltoid tuberosity = roughening for attachment of deltoid

Spiral groove = radial nerve and profunda brachii artery are found

  • Anteriorly = coracobrachialis, deltoid, brachialis and brachioradialis attach
  • Posteriorly = medial and lateral heads of triceps brachii attach above and below spiral groove
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28
Q

What are the features of the distal humerus?

A
  • Medial supracondylar ridge (origin for brachialis, pronator teres and medial head of triceps brachii)
  • Lateral supracondylar ridge (origin for common extensors and minor attachment for triceps brachii )
  • Lateral epicondyle = provides attachment for supinator and some extensors, radial collateral ligament
  • Medial epicondyle = ulnar nerve passes through inferiorly
  • Trochlea = articulates with the trochlear notch of ulna
  • Capitulum = articulates with radius
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29
Q

What is the medial supracondylar ridge?

A

Origin for brachialis and pronator teres and medial head of triceps brachii

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30
Q

What is the lateral supracondylar ridge?

A

Origin of the common extensors e.g brachioradilais, extensor carpi radialis

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31
Q

What is the lateral epicondyle?

A

-Provides attachment for supinator and some extensors (anconeus, extensor carpi ulnaris)

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32
Q

What is the medial epicondyle?

A
  • Ulnar nerve passes through inferiorly
  • Flexors attach here (common flexor origin)
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33
Q

What is the trochlea?

A

Articulates with the trochlear notch of ulna

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34
Q

What is the capitulum?

A

Articulates with the radius

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35
Q

What does the coronoid fossa do? What does the radial fossa do?

A

During flexion and extension:

  • Coronoid fossa accommodates the ulna
  • Radial fossa accommodates the radius

Olecranon fossa accommodates the olecranon of the ulna

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36
Q

What is surgical neck fracture of the humerus?

What is it caused by?

What key structures are at risk?

A
  • Fracture at the surgical neck of the humerus
  • Caused by direct flow to that area or falling onto an outstretched hand
  • Axillary nerve and posterior circumflex artery are at risk
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37
Q

What muscles are at risk of paralysis due to surgical neck fracture of the humerus?

What movement will this affect?

A
  • Axillary nerve damage will cause paralysis of deltoid and teres minor
  • The axillary nerve also innervates the skin over the lower deltoid so sensation in this region may be lost
  • Will affect abduction of the affected limb
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38
Q

Why may there be a loss in sensation of skin at the lower end of deltoid in a surgical neck fracture of the humerus?

A

Because the axillary nerve also supplies the skin there

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39
Q

What is a midshaft humeral fracture?

What structures would it affect? Where are these structures found?

A
  • Fracture of shaft of humerus
  • Radial nerve (supplies extensors of wrist) and profunda brachii artery
  • These structures are found in the spiral groove
40
Q

What muscles are paralysed due to a mid-shaft humeral fracture?

What else is affected?

What clinical presentation does it cause?

A
  • Radial nerve innervates extensors of the wrist so when this nerve is damaged or has swollen up, the extensors will be paralysed
  • Radial nerve also innervates proximal 3.5 digits on the dorsal part of the hand and dorsal surface of the hand. So damage to radial nerve can affect the sensation there
  • Clinical presentation = wrist drop = unopposed flexion of the wrist
41
Q

What is wrist drop?

A

Unopposed flexion of the wrist

42
Q

Why might there be some sensory loss over the dorsal surface of the hand and proximal ends of lateral 3.5 fingers dorsally in a midshaft humeral fracture?

A

Because radial nerve also supplies the dorsal surface of the hand and the proximal ends of the lateral 3.5 fingers dorsally

43
Q

What is a supracondylar fracture?

What type of fracture is it?

What is the cause?

What structure can be damaged? What does this cause?

What nerves can be damaged?

A
  • Fracture of the distal humerus (just above the elbow joint)
  • Can be transverse or oblique
  • Falling on an outstretched hand
  • Brachial artery can become damaged, causing Volkmann’s ischaemic contracture (uncontrolled flexion of flexors due to them being short and fibrotic)
  • Damage to anterior interosseous nerve (branch of median nerve), ulnar nerve or radial nerve
44
Q

How can the the anterior interosseous nerve be tested?

A

-Ask the patient to make on okay sign, testing for weakness of flexor pollicus longus because the nerve supplies the flexor pollicus longus

45
Q

What is the flexor pollicus longus supplied by?

A

Anterior interosseous nerve (branch of median nerve)

46
Q

What is medial epicondylitis (Golfer’s elbow)?

What is it caused by?

What is the treatments?

A
  • Inflammation of flexor pronator muscle tendons (so all of the flexor muscle tendons as they insert into the medial supracondyle)
  • Valgus force on elbow, serving tennis ball, hammering, typing
  • Treatment is NSAIDs, rest and ice
47
Q

What is lateral epicondylitis (Tennis elbow)?

What are the symptoms?

What is the treatment?

A
  • Inflammation and microtearing of fibres in the extenstor tendons of the forearm
  • Pain in the lateral epicondyle
  • NSAIDs and physical therapy
48
Q

What does the proximal ulna do?

What are the landmarks?

A
  • Articulates with the trochlea of the humerus
  • Olecranon (triceps brachii insert here)
  • Coronoid process (brachialis inserts here)
  • Trochlear notch (formed by olecranon and coronoid process)
  • Radial notch (articulates with head of radius)
  • Ulnar tuberosity (insertion of brachialis - along with coronoid process)
49
Q

What is the olecranon?

What muscle inserts here?

A
  • It is the tip of the elbow
  • Articulates with the olecranon fossa of humerus
  • Triceps brachii inserts here
50
Q

What is the coronoid process?

What ligament attaches here?

What muscle attaches here?

A
  • Serves for attachment of ulnar collateral ligament
  • Brachialis inserts here
51
Q

What is the trochlear notch?

A

Formed by the olecranon and coronoid process

52
Q

What is radial notch?

A

Articulates with head of radius

53
Q

What is the ulnar tuberosity?

A

Insertion of brachialis

54
Q

How many surfaces and borders does ulna have?

A

3 surfaces and 3 borders

55
Q

What is the anterior surface of the ulna?

A

Origin of pronator quadratus

56
Q

What is the posterior surface of the ulnar?

A

Provides attachment for many muscles

57
Q

What is the medial surface of the ulna?

A

Provides no attachment for muscles

58
Q

What is the posterior border?

A

Subcutaneous and palpable

59
Q

What is the interosseous border?

A

Attachment for interosseous membrane. This membrane transfers forces from radius to ulna

60
Q

What does the distal ulna have?

A

Styloid process and head, with the head articulating with the ulnar notch of the radius to form the distal radio-ulnar joint

61
Q

What is the main cause of the ulna fractures?

What site of the ulna is most likely to be fractured?

A
  • Hit by an object
  • Shaft of ulna
  • Usually, the normal muscle tone will pull the proximal ulna posteriorly
62
Q

What is Monteggia’s fracture?

A
  • Usually a force from behind the ulna
  • Proximal shaft of ulna is fractured; head of radius dislocates anteriorly at the elbow
63
Q

What is Galeazzi’s fracture?

A

A fracture to the distal radius, with ulna head dislocating at the distal radio-ulnar joint

64
Q

What does the proximal radius consist of?

A
  • Head (which articulates with the capitulum of the humerus and radial notch of the ulna)
  • Neck
  • Radial tuberosity
65
Q

What is the shaft of the radius?

A
  • Triangular
  • Has 3 surfaces and borders (lateral surface is pronator teres insertion)
66
Q

What is the distal radius?

A
  • Has the radial styloid process (where brachioradialis and radial collateral ligament attach)
  • Ulnar notch (which articulates with head of ulna at distal radioulnar joint)
  • 2 facets which articulate with scaphoid and lunate
67
Q

What attach to the radial styloid process?

A
  • Brachioradialis
  • Radial collateral ligament
68
Q

What is the ulnar notch?

A

Articulates with the head of the ulnar at the distal radioulnar joint

69
Q

What are the two facets of the radius for?

A

Articulation with scaphoid and lunate

70
Q

What are the 3 fractures of the radius?

A
  1. Colles fracture - falling onto outstretched hand (anterior), causing fracture at distal radius
  2. Fractures of the radial head - falling onto outstretched hand; radial head is forced into capitulum of humerus, causing it to fracture
  3. Smith’s fracture - falling onto back of hand. (Opposite of Colle’s fracture)
71
Q

How many carpal bones are there and how are they organised?

A
  • 8 irregular bones
  • Organised into 2 rows (proximal and distal)
72
Q

What bones make up the proximal row of the carpal bones?

A

Scaphoid, lunate, triquetrum, pisiform

(pisiform is a sesamoid bone in the flexor carpi ulnaris tendon)

73
Q

What bones make up the distal row of carpal bones?

A

Trapezium, trapezoid, capitate, hamata

74
Q

What do the carpals form in the coronal plane?

A

Carpal arch, which is covered by superficial flexor retinaculum to form the carpal tunnel

75
Q

What carpal bones articulate with the radius at the wrist joint?

A

Scaphoid and lunate

76
Q

What are metacarpals?

A

-5 bones from the thumb side to the pinkie side

77
Q

What is the structure of a metacarpal?

What shape for medial and lateral surfaces, why?

A
  • Base
  • Shaft
  • Head
  • Medial and lateral surfaces are concave, allowing attachment of interossei muscles
78
Q

What are the interossei muscles?

A
  • Muscles found near the metacarpals
  • There are 3 or 4 palmar interossei muscles
  • There are 4 dorsal interossei muscles
79
Q

What are the two metacarpal fractures?

A
  • Boxer’s fracture
  • Bennett’s fracture
80
Q

What is a boxer’s fracture? What happens to the pinkie?

A
  • Fractures of the 5th metacarpal neck due to punching a hard object
  • The distal part becomes displaced, shortening the pinkie
81
Q

What is Bennett’s fractures?

A

-Fractures of the 1st metacarpal due to hyperabduction of the thumb

82
Q

What are phalanges?

A
  • Bones of the fingers
  • 4 digits have proximal, middle and distal phalanges
  • The thumb has a proximal and distal phalanx
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Upper limb (2 decks)

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