Upper limb 2 Flashcards
1
Q
What shape is the scapula and what kind of bone is it?
A
Triangular flat bone
2
Q
How many muscle attachments does the scapula have?
A
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3
Q
What are the 3 faces of the scapula?
A
- Costal surface
- Lateral surface
- Posterior surface
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)
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
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
7
Q
What is subscapularis, supraspinatus and infraspinatus?
A
Look at picture
8
Q
What are the other features of the scapula?
A
- Superior border
- Inferior border
- Suprascapular notch
- Medial border
- Lateral border
9
Q
What can cause a scapular fracture?
A
Uncommon.
-Can be caused by chest trauma (high speed collisions, crushing injuries, sports injuries)
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.
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
12
Q
What is the clavicle?
What does it attach?
A
- Long sigmoid bone
- Attaches upper limb to the trunk (torso)
13
Q
What is the function of the clavicle?
A
- Protects neurovasculature
- Transmits forces from the upper limb to the axial skeleton
14
Q
What are the key 5 characteristics of the clavicle?
A
- Sternal end
- Impression for costoclavicular ligament
- Conoid tubercle
- Trapezoid line
- Acromial end
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)
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
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
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
19
Q
What is the conoid tubercle?
A
-Allows attachment of conoid ligament which is the medial part of the coracoclavicular ligament
20
Q
What is the trapezoid line?
A
Provides attachment to trapezoid ligament (lateral part of the coracoclavicular ligament)
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
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
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
24
Q
What is the greater tubercle?
A
- Located laterally
- Provides attachment for 3 rotator cuff muscles - infraspinatus, supraspinatus and teres minor
25
What is the lesser tubercle?
Located medially. Provides attachment for subscapularis
26
What is the intertubercular (bicipital groove)?
- Groove where tendon of long head of biceps brachii runs
- Attachment for pec major and lat dorsi
27
What are the key features of the shaft?
-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
28
What are the features of the distal humerus?
- 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
29
What is the medial supracondylar ridge?
Origin for brachialis and pronator teres and medial head of triceps brachii
30
What is the lateral supracondylar ridge?
Origin of the common extensors e.g brachioradilais, extensor carpi radialis
31
What is the lateral epicondyle?
-Provides attachment for supinator and some extensors (anconeus, extensor carpi ulnaris)
32
What is the medial epicondyle?
- Ulnar nerve passes through inferiorly
- Flexors attach here (common flexor origin)
33
What is the trochlea?
Articulates with the trochlear notch of ulna
34
What is the capitulum?
Articulates with the radius
35
What does the coronoid fossa do? What does the radial fossa do?
During flexion and extension:
- Coronoid fossa accommodates the ulna
- Radial fossa accommodates the radius
Olecranon fossa accommodates the olecranon of the ulna
36
What is surgical neck fracture of the humerus?
What is it caused by?
What key structures are at risk?
- 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
37
What muscles are at risk of paralysis due to surgical neck fracture of the humerus?
What movement will this affect?
- 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
38
Why may there be a loss in sensation of skin at the lower end of deltoid in a surgical neck fracture of the humerus?
Because the axillary nerve also supplies the skin there
39
What is a midshaft humeral fracture?
What structures would it affect? Where are these structures found?
- Fracture of shaft of humerus
- Radial nerve (supplies extensors of wrist) and profunda brachii artery
- These structures are found in the spiral groove
40
What muscles are paralysed due to a mid-shaft humeral fracture?
What else is affected?
What clinical presentation does it cause?
- 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
What is wrist drop?
Unopposed flexion of the wrist
42
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?
Because radial nerve also supplies the dorsal surface of the hand and the proximal ends of the lateral 3.5 fingers dorsally
43
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?
- 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
How can the the anterior interosseous nerve be tested?
-Ask the patient to make on okay sign, testing for weakness of flexor pollicus longus because the nerve supplies the flexor pollicus longus
45
What is the flexor pollicus longus supplied by?
Anterior interosseous nerve (branch of median nerve)
46
What is medial epicondylitis (Golfer's elbow)?
What is it caused by?
What is the treatments?
- 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
What is lateral epicondylitis (Tennis elbow)?
What are the symptoms?
What is the treatment?
- Inflammation and microtearing of fibres in the extenstor tendons of the forearm
- Pain in the lateral epicondyle
- NSAIDs and physical therapy
48
What does the proximal ulna do?
What are the landmarks?
- 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
What is the olecranon?
What muscle inserts here?
- It is the tip of the elbow
- Articulates with the olecranon fossa of humerus
- Triceps brachii inserts here
50
What is the coronoid process?
What ligament attaches here?
What muscle attaches here?
- Serves for attachment of ulnar collateral ligament
- Brachialis inserts here
51
What is the trochlear notch?
Formed by the olecranon and coronoid process
52
What is radial notch?
Articulates with head of radius
53
What is the ulnar tuberosity?
Insertion of brachialis
54
How many surfaces and borders does ulna have?
3 surfaces and 3 borders
55
What is the anterior surface of the ulna?
Origin of pronator quadratus
56
What is the posterior surface of the ulnar?
Provides attachment for many muscles
57
What is the medial surface of the ulna?
Provides no attachment for muscles
58
What is the posterior border?
Subcutaneous and palpable
59
What is the interosseous border?
Attachment for interosseous membrane. This membrane transfers forces from radius to ulna
60
What does the distal ulna have?
Styloid process and head, with the head articulating with the ulnar notch of the radius to form the distal radio-ulnar joint
61
What is the main cause of the ulna fractures?
What site of the ulna is most likely to be fractured?
- Hit by an object
- Shaft of ulna
- Usually, the normal muscle tone will pull the proximal ulna posteriorly
62
What is Monteggia's fracture?
- Usually a force from behind the ulna
- Proximal shaft of ulna is fractured; head of radius dislocates anteriorly at the elbow
63
What is Galeazzi's fracture?
A fracture to the distal radius, with ulna head dislocating at the distal radio-ulnar joint
64
What does the proximal radius consist of?
- Head (which articulates with the capitulum of the humerus and radial notch of the ulna)
- Neck
- Radial tuberosity
65
What is the shaft of the radius?
- Triangular
- Has 3 surfaces and borders (lateral surface is pronator teres insertion)
66
What is the distal radius?
- 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
What attach to the radial styloid process?
- Brachioradialis
- Radial collateral ligament
68
What is the ulnar notch?
Articulates with the head of the ulnar at the distal radioulnar joint
69
What are the two facets of the radius for?
Articulation with scaphoid and lunate
70
What are the 3 fractures of the radius?
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
How many carpal bones are there and how are they organised?
- 8 irregular bones
- Organised into 2 rows (proximal and distal)
72
What bones make up the proximal row of the carpal bones?
Scaphoid, lunate, triquetrum, pisiform
(pisiform is a sesamoid bone in the flexor carpi ulnaris tendon)
73
What bones make up the distal row of carpal bones?
Trapezium, trapezoid, capitate, hamata
74
What do the carpals form in the coronal plane?
Carpal arch, which is covered by superficial flexor retinaculum to form the carpal tunnel
75
What carpal bones articulate with the radius at the wrist joint?
Scaphoid and lunate
76
What are metacarpals?
-5 bones from the thumb side to the pinkie side
77
What is the structure of a metacarpal?
What shape for medial and lateral surfaces, why?
- Base
- Shaft
- Head
- Medial and lateral surfaces are concave, allowing attachment of interossei muscles
78
What are the interossei muscles?
- Muscles found near the metacarpals
- There are 3 or 4 palmar interossei muscles
- There are 4 dorsal interossei muscles
79
What are the two metacarpal fractures?
- Boxer's fracture
- Bennett's fracture
80
What is a boxer's fracture? What happens to the pinkie?
- Fractures of the 5th metacarpal neck due to punching a hard object
- The distal part becomes displaced, shortening the pinkie
81
What is Bennett's fractures?
-Fractures of the 1st metacarpal due to hyperabduction of the thumb
82
What are phalanges?
- Bones of the fingers
- 4 digits have proximal, middle and distal phalanges
- The thumb has a proximal and distal phalanx
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