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ESA 2 > Upper Limb > Flashcards

Upper Limb Flashcards

1
Q

State the muscles and bones that make up the four borders of the axilla.

A

Anterior - pectoralis major/minor, subclavius
Medial - ribcage, intercostal muscles, serratus anterior
Posterior - latissimus dorsi, subscapularis, teres major, costal surface
Lateral - intertubecular groove of humerus

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2
Q

What forms the axillary sheath and what does it contain?

A

Fascia.

Contains major vessels and nerves

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3
Q

What are the two veins in the arm, and describe the changes as they pass through the axilla and over the first rib.

A

Cephic vein (follows deltoid, more lateral) and basilic vein (follows triceps, more medial). Merge to the axillary vein, then becomes the subclavian vein after passing over the first rib.

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4
Q

Describe the passage of the subclavian artery to the forearm.

A

Becomes the axillary artery in the anterior wall, passing the lateral border of the first rib.
Passes the inferior border of the teres major to become the brachial artery.
Then becomes the radial and ulnar arteries.

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5
Q

What are the nerve roots of the brachial plexus?

A

C5-8, T1

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6
Q

What muscle overlays the nerve roots of the brachial plexus?

A

Sternocleidomastoid

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7
Q

Where can the axillary nerve be found?

A

Deep behind the humerus, passes to the deltoid

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8
Q

Where can the radial nerve be found?

A

Passes down the radial groove

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9
Q

Where can the musculocutaneous nerve be found?

A

Passes between the biceps

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10
Q

Where can the ulnar nerve be found?

A

Posterior to the medial epicondyl of the humerus.

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11
Q

Where can the medial nerve be found?

A

Passes through the fossa.

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12
Q

What vein connects the basilic and cephalic veins in the cubital fossa?

A

Median cubital vein

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13
Q

Innervation of deltoid

A

Axillary nerve

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14
Q

Function of the deltoid

A

Abduction of the arm from 50 to 130 degrees

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15
Q

Function of the biceps brachii

A

Mainly for supination of the forearm, also for flexion.

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16
Q

Innervation of the biceps brachii

A

Musculocutaneous nerve

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17
Q

Attachments of the biceps brachii

A

Long head - tendon passes up intertubecular groove to attach to the supraglenoid tubercle

Short head - coracoid process

Fans to the bicipital aponeurosis and radial tuberosity.

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18
Q

Function of the brachialis

A

Flexion of the arm

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19
Q

Innervation of the brachialis

A

Musculocutaneous nerve

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20
Q

Function of the coracobrachialis

A

Flexion and adduction of the arm, stabilisation of the glenohumeral joint

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21
Q

Innervation of the coracobrachialis

A

Musculocutaneous nerve

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22
Q

What deep, posterior artery follows the course of the radial nerve?

A

Profunda brachii

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23
Q

What arteries wrap around the humeral head?

A

Posterior and anterior humeral circumflex artery

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24
Q

Function of the triceps brachii

A

Long - Aids in extention and adduction of the arm. Helps to stabalise the adducted glenohumeral joint.
Lateral - strongest. Primary muscle against resistance.
Medial - forearm extension, always active.

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25
Q

From lateral to medial, name the innervation and vasculature in the antecubital fossa.

A

Biceps tendon
Brachial artery
Medial nerve

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26
Q

Function of pronator teres

A

Pronation of the forearm

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27
Q

Innervation of the brachioradalis

A

Radial nerve

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28
Q

Give the muscle and innervation involved in extension at the elbow

A

Triceps

Radial nerve

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29
Q

Give the two joints that the shoulder articulates at.

A

Glenohumeral joint

Scapulothoracic joint

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30
Q

What is the glenoid labrum and what is it’s function?

A

A fibrocartilage rim around the glenoid cavity which increases the surface for articulation, providing more stability.

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31
Q

Why is the glenohumeral joint inherently unstable?

A

Shallow
Disproportion of articular surfaces
Multiplanar movements
Lax capsule

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32
Q

What muscles are the most important in improving stability of the glenohumeral joint?

A

Rotator cuff muscles

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33
Q

Attachments of the glenohumeral capsule

A 
Glenoid labrum
Glenoid cavity
Anatomical neck of the humerus
Bridges down intertubecular groove
Dips medially to the surgical neck
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34
Q

What is the function of the small anterior opening in the synovial membrane of the glenohumeral capsule?

A

So the joint can communicate with the subscapular bursa

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35
Q

Describe the synovial membrane of the glenohumeral joint

A

Lines the capsule and bone up to the edge of the articular surface. Secretes synovial fluid

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36
Q

Describe the three glenohumeral ligaments.

A

Superior, middle and inferior.
Extend between the glenoid labrum and humerus.
Part of the fibrous capsule and reinforces the capsule anteriorly.
Can only be seen from inside the capsule.

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37
Q

Describe the extracapsular ligaments.

A

Coracromial ligament - most important. Between the acromion and coracoid process. Supports and stabilises the shoulder joint.

Coracohumeral ligament - from the base of the coracoid process to the anterior part of the greater tubercle. Strengthens the upper part of the capsule of the shoulder joint.

Transverse humeral ligament - holds the tendon of the long head of the biceps in place during shoulder movement. Inserts into the intertubecular groove.

All together forms the coracoacromial arch, a strong osseoligamentous structure which overlies the humeral head. This prevents the upper displacement of the humerus.

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38
Q

State the four muscles which make up the rotator cuff.

A

Supraspinatus, infraspinatus, teres minor and subscapular

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39
Q

Function of the supraspinatus

A

Initiation and first 15 degrees of abduction of the arm

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40
Q

Innervation of the supraspinatus

A

Suprascapular nerve (C5/6)

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41
Q

Function of the infraspinatus

A

Lateral rotation of the arm

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42
Q

Innervation of the infraspinatus

A

Suprascapular nerve (C5/6)

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43
Q

Function of the teres minor

A

Lateral rotation

Weak adductor

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44
Q

Innervation of the teres minor

A

Axillary nerve

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45
Q

Function of the subscapular muscle

A

Medial rotation of the arm

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46
Q

Innervation of the subscapular muscle

A

Upper and lower subscapular nerve

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47
Q

Describe the tendinous cuff of the glenohumeral joint

A

Tendons blend together to form a cuff.
Fuses with the capsule and strengthens it.
Tone in the muscles holds the head close to the glenoid cavity.

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48
Q

What separates the supraspinatous tendon from the arch?

A

Subacromial bursa

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49
Q

What movement of the arm risks impingement of soft tissue?

A

Abduction

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50
Q

Describe the function of the subscapular bursa

A

Facilitates movement of the tendon of subscapularis muscle over the scapula and communicates with the joint cavity.

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51
Q

Describe the function of the subacromial bursa.

A

Facilitates movement of the supraspinatus tendon under the coracoacromial arch and deltoid muscle over the capsule and greater tubercle of the humerus.

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52
Q

What is the function of the suprascapular artery?

A

Supplies the skin over the acromion and upper part of the chest.
Has a small role in supplying the sternocleidomastoid and subscapularis.

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53
Q

What is the origin of the suprascapular nerve?

A

Upper trunk of the brachial plexus

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54
Q

What is the function of the suprascapular nerve?

A

Innervates the supraspinatus and infraspinatous muscle.

Sensory for the acromioclavicular and glenohumeral joints

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55
Q

What is the origin of the axillary nerve?

A

Posterior cord of the brachial plexus

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56
Q

What is the function of the axillary nerve?

A

Innervates the deltoid, teres minor and long head of the triceps brachii.
Sensory from the shoulder joint and regimental badge area.

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57
Q

Where does the lateral pectoral nerve penetrate?

A

Deep surface of the pectoralis major

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58
Q

What are the axillary nerve and posterior circumflex artery vulnerable to at the front of the humerus?

A

Intramuscular injection of the deltoid muscle

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59
Q

What are the axillary nerve and posterior circumflex artery vulnerable to at the back of the humerus?

A

Injury during shoulder joint dislocation and surgical neck fractures

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60
Q

Function of the aconeus

A

Abduction of the ulna, accessory extensor at the elbow.

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61
Q

Innervation of extensor carpi radialis longus

A

Radial nerve

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62
Q

Function of extensor carpi radialis longus

A

Extension and abduction of the wrist

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63
Q

Innervation of the extensor carpi radialis brevis

A

Deep branch of radial nerve

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64
Q

Function of extensor carpi radialis brevis

A

Extension and abduction of the wrist

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65
Q

Innervation of the supinator

A

Posterior interosseus nerve

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66
Q

Function of the supinator

A

Supination

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67
Q

Innervation of abductor pollicus longus

A

Posterior interosseus nerve

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68
Q

Function of abductor pollicus longus.

A

Accessory extensor of the thumb

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69
Q

Innervation of extensor pollicus brevis

A

Posterior interosseus nerve

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70
Q

Function of the extensor pollicus brevis

A

Extends metacarpophalangeal and carpometacarpal joint.

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71
Q

Innervation of extensor indices

A

Posterior interosseus nerve

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72
Q

Function of extensor indicies

A

Extends the index finger

73
Q

Innervation of extensor pollicus longus

A

Posterior interosseus nerve

74
Q

Innervation of extensor carpi ulnaris

A

Posterior interosseus nerve

74
Q

Function of extensor carpi ulnaris

A

Extends and adducts the wrist

74
Q

Innervation of extensor digiti minimi

A

Posterior interosseus nerve

74
Q

Function of extensor digiti minimi

A

Extends the little finger

74
Q

Innervation of extensor digitorum

A

Posterior interosseus nerve

74
Q

Function of extensor digitorum

A

Extends the four fingers and wrist

74
Q

Innervation of the aconeus

A

Radial nerve

80
Q

Function of extensor pollicus longus

A

Extends all joints of the thumb

81
Q

What muscles produce the hinge movement in the forearm?

A

Biceps brachii
Triceps brachii
Brachioradialis

82
Q

What part of the humerus articulates with the ulna?

A

Trochlea

83
Q

What part of the humerus articulates with the radius?

A

Capitulum

84
Q

What type of joint is the elbow?

A

Synovial hinge joint

85
Q

What is the maximum extension with the ulna at the elbow?

A

170 degrees

86
Q

What ligaments strengthen the elbow laterally and medially?

A

Laterally - Radial collateral ligament

Medially - Ulnar collateral ligament

87
Q

What joint shares a capsule with the elbow?

A

Proximal radioulnar joint

88
Q

Describe the ulnar collateral ligament

A

3 bands
Anterior - large, stiff and rigid. Attaches the distal humerus to the coronoid process
Posterior - fan like. Attaches the humerus to the ulna.
Oblique - deeper socket for the trochlea of the humerus in the trochlear notch

89
Q

Describe the radial collateral ligament

A

Fan-like band passing from the humerus to radius. Blends with the annular ligament.

90
Q

What two bursae are important in the elbow and where are they found?

A

Subcutaneous olecranon bursa - superficial, over the olecranon process. Posterior.

Subtendinous olecranon bursa - beneath the triceps tendon over the olecranon process.

91
Q

Describe the inbuilt redundancy of vasculature in the elbow.

A

Recurrent branches of the radial and ulnar arteries pass around the elbow and anastamose with others.

92
Q

Describe the proximal radioulnar joint

A

Pivot joint.
The head of the radius is sat in the radial notch. Annular ligament wraps around the radial head, forming a ligamentous collar which prevents subluxation of the radius.

93
Q

Describe a pulled elbow.

A

Common in children.
Caused by traction in the forearm which causes subluxation of the radius which can lead to dislocation.
Most common in children because the annular ligament isn’t fully descended and the ligaments aren’t as strong. The radial head is also not fully developed.

94
Q

Describe the difference between subluxation and dislocation

A

Subluxation is partial dislocation, so the bone may be misaligned but is still in contact.
In dislocation there is complete loss of contact of the joint surfaces.

95
Q

Describe the muscles that allow pronation of the forearm.

A

Pronator quadratus - deep and distal

Pronator teres - superficial and proximal

96
Q

What muscles are involved in supination of the forearm?

A

Supinator - proximal

Biceps brachii

97
Q

Describe articulation of the radius with the humerus on supination.

A

Head of the radius rotates at the capitulum of the humerus - mini ball and socket joint.

98
Q

Describe the interosseus membrane

A

Fibrous joint which runs inferomedially. Allows distribution of force from the radius to the ulna.

99
Q

Describe the distal radioulnar joint.

A

The distal head of the ulna articulates with the ulnar notch of the radius.
Has the articular disc which is a specialisation of ligaments.
Clear separation between the distal joint and wrist.
No true pivoting, but the articular disc allows stretching.
Has the sacciform recess - specialisation of the synovial membrane which allows twisting of the capsule.

100
Q

What bones articulate at the wrist joint?

A

Scaphoid
Lunate
Triquetrium
Radius

101
Q

Function of opponens pollicis

A

Opposes the thumb by medially rotating and flexing the metacarpophalangeal

102
Q

Innervation of opponens pollicis

A

Median nerve

103
Q

Function of abductor pollicis brevis

A

Abducts the thumb

104
Q

Innervation abductor pollicis brevis

A

Median nerve

105
Q

Function of flexor pollicis brevis

A

Flexes the metacarpophalangeal joint of the thumb

106
Q

Innervation of flexor pollicis brevis

A

Median nerve

107
Q

Function of abductor digiti minimi

A

Abducts the little finger

108
Q

Innervation of abductor digiti minimi

A

Ulnar nerve

109
Q

Function of opponens digiti minimi

A

Rotates the metacarpal of the little finger towards the palm, producing opposition

110
Q

Innervation of opponens digiti minimi

A

Ulnar nerve

111
Q

Function of flexor digiti minimi brevis

A

Flexes the metacarpophalangeal joint of the little finger

112
Q

Innervation of flexor digiti minimi brevis

A

Ulnar nerve

113
Q

Function of the lumbricles of the hand

A

Link extensor tendons to flexor tendons
Flexion of the metacarpophalangeal joint of the four fingers
Extension of the interphalangeal joints of the four fingers

114
Q

Innervation of the lumbricles of the hand

A

I and II - median nerve

III and IV - ulnar nerve

115
Q

How many interossei are there on the dorsal and palmar surfaces?

A

Dorsal - 4

Palmar -

116
Q

Innervation of the interossei of the hand

A

Ulnar nerve

117
Q

Innervation of adductor pollicis

A

Ulnar nerve

118
Q

Innervation of palmaris brevis

A

Ulnar nerve

119
Q

Function of the dorsal interossei

A

Abducts in index, middle and ring fingers and assists in flexion of the metacarpophalangeal joints and extension at the interphalangeal joints.

120
Q

Function of the palmar interossei

A

Adduct the fingers

Assists in flexion of the metacarpophalangeal joints and extension at the interphalangeal joints.

121
Q

Function of adductor pollicis

A

Adducts the thumb

122
Q

Function of palmaris brevis

A

Tenses the skin of the palm on the ulnar side during gripping.

123
Q

Function of flexor carpi ulnaris

A

Flexion and adduction at the wrist.

124
Q

Innervation of flexor carpi ulnaris

A

Ulnar nerve

125
Q

Function of palmaris longus

A

Causes flexion at the wrist

126
Q

Innervation of palmaris longus

A

Median nerve

127
Q

Function of flexor carpi radialis

A

Flexion and abduction at the wrist

128
Q

Innervation of flexor carpi radialis

A

Median nerve

129
Q

Function of pronator teres

A

Forms the medial border of the cubital fossa

Pronation of the forearm

130
Q

Innervation of pronator teres

A

Median nerve

131
Q

Function of flexor digitorum superficialis

A

Flexes the metacarpophalangeal joints and proximal interphalangeal joints of the four fingers.
Flexes at the wrist.

132
Q

Innervation of flexor digitorum superficialis

A

Median nerve

133
Q

Function of flexor digitalis profundus

A

Flexes distal interphalangeal joints and the wrist

134
Q

Innervation of flexor digitalis profundus

A

Median nerve and ulnar nerve

135
Q

Function of flexor pollicis longus

A

Flexor of the phalanges of the thumb and assists in flexing the wrist when the thumb is fixed

136
Q

Innervation of flexor pollicis longus

A

Median nerve

137
Q

Function of pronator quadratus

A

Pronates the forearm

138
Q

Innervation of pronator quadratus

A

Median nerve

139
Q

Where does the common extensor tendon of the forearm attach?

A

Lateral epicondyle

140
Q

Where does the common flexor tendon of the forearm attach?

A

Medial epicondyle

141
Q

Describe the pathology of lateral epicondylitis (tennis elbow)

A

Inflammation of the periosteum of the lateral epicondyle.
Caused by repeated use of the superficial extensor muscles which strains their common tendinous attachment to the lateral epicondyle.

142
Q

Describe the potential causes of wrist drop and explain the pathology behind it.

A

Axilla - humeral dislocation or fracture of the proximal humerus
Radial groove - mid-shaft fracture of the humerus.

It’s a sign of radial nerve injury proximal to the elbow.

All extensor muscles are paralysed so the tone of flexor muscles causes unopposed flexion.

143
Q

Give all the superior muscles in the anterior compartment of the forearm from lateral to medial

A

Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris

144
Q

Give the intermediate muscle of the anterior compartment of the forearm

A

Flexor digitorum superficialis.

145
Q

Give the deep muscles of the anterior compartment of the forearm.

A

Flexor digitalis profundus
Flexor pollicis longus
Pronator quadratus

146
Q

The majority of muscles in the anterior compartment of the forearm have the same innervation.
What nerve is this, and state the exceptions.

A

Median nerve.
Exceptions are flexor carpi ulnaris (ulnar nerve) and flexor digitalis profundus (medial - ulnar nerve, lateral - median nerve)

147
Q

Give the superficial muscles of the posterior compartment of the forearm from lateral to medial.

A 
Brachioradialis
Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor digitorum
Extensor digiti minimi
Extensor carpi ulnaris
Aconeus
148
Q

Give the deep muscles of the posterior compartment of the forearm from lateral to medial.

A 
Supinator
Abductor pollicis longus
Extensor pollicis brevis
Extensor pollicis longus
Extensor indices
149
Q

Give the function of the trapezius

A

Upper - elevates and rotates the scapula during abduction of the arm
Middle - retracts the scapula
Lower - pulls the scapula inferiorly

150
Q

Innervation of the trapezius

A

Accessory nerve

151
Q

How would you check for damage of the accessory nerve?

A

Shrug the shoulders against resistance

152
Q

Function of levator scapulae

A

Elevates the scapula

153
Q

Innervation of levator scapulae

A

Dorsal scapular nerve

154
Q

Function of rhomboid major and minor

A

Retracts and rotates the scapula

155
Q

Innervation of rhomboid major and minor

A

Dorsal scapular nerve

156
Q

Nerves originating from the lateral cord of the brachial plexus

A

Musculocutaneous

Median (part)

157
Q

Nerves originating from the posterior cord of the brachial plexus

A

Radial nerve

Axillary nerve

158
Q

Nerves originating from the medial cord of the brachial plexus

A 
Ulnar nerve
Median nerve (part)
159
Q

Root origin of the musculocutaneous nerve

A

C5

C6

160
Q

Root origin of the median nerve

A

C5
C6
C8
T1

161
Q

Root origin of the radial nerve

A

C7

162
Q

Roor origin of the ulnar nerve

A

C8

T1

163
Q

Describe the cause and symptoms of Erb’s palsy

A

Upper brachial plexus injury generally caused during delivery of the neonate
Nerves with C5/C6 nerve roots damaged - Musculocutaneous, median, nerve to subclavius and suprascapular
Loss of shoulder abduction, lateral rotation, supination and flexion.
Causes ‘waiter’s tip’

164
Q

Describe the cause and symptoms of Klumpke palsy

A

Upper brachial plexus injury caused by excessive abduction of the arm.
Damages T1 so the ulnar and median nerves are affected.
All the small muscles of the hand are affected and there is loss of sensation along the medial arm

No flexor muscles are affected as they are innervated by a different nerve root.

165
Q

Give the three bursa that can be found around the shoulder joint.

A

Subcoracoid bursa
Subscapular bursa
Subacromial bursa

166
Q

Describe the glenohumeral ligament and give its function

A

Stabilises the anterior aspect of the joint.

Three bands run with the joint capsule from the glenoid fossa to the anatomical neck of the humerus.

167
Q

Describe the coracohumeral ligament and give its function

A

Supports the superior part of the joint capsule

Base of the coracoid process to the greater tubercle of the humerus

168
Q

Describe the transverse humeral ligament and give its function

A

Holds the tendon of the long head of the biceps in the intertubecular groove

Spans the distance between the two tubercles of the humerus

169
Q

Describe the coracoacromial ligament and it’s function

A

Overlies the shoulder joint, preventing superior displacement of the humeral head

Runs between the acromion and coracoid process to form the coraco-acromial arch

170
Q

What arteries supply the glenohumeral joint?

A

Posterior circumflex humeral artery
Suprascapular artery
Branches of these then anastamose around the joint.

171
Q

What nerves supply the shoulder joint?

A

Axillary
Suprascapular
Lateral pectoral
(all from roots C5/C6)

172
Q

What type of joint is the shoulder?

A

Ball and socket synovial joint

173
Q

What muscles allow extension at the shoulder?

A

Posterior deltoid
Latissimus dorsi
Teres major

174
Q

What muscles allow flexion at the shoulder?

A

Biceps brachii (both heads)
Pectoralis major
Anterior deltoid
Coracobrachialis

175
Q

What muscles allow medial rotation at the shoulder?

A 
Subscapularis
Pectoralis major
Latissimus dorsi
Teres major
Anterior deltoid
176
Q

What muscles allow lateral rotation at the shoulder?

A

Infraspinatus

Teres minor

177
Q

Describe painful arc in the shoulder

A

Pain in the middle of abduction caused by rotator cuff tendonitis.
Inflammation of the muscle tendons, usually caused by overuse.
Causes degenerative changes in the subacromial bursa, and the supraspinatous tendon, which increases friction between the structures of the joint.

ESA 2 (46 decks)

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