BRS Gross Anatomy > Upper Limb > Flashcards
Upper Limb Flashcards
Commonly fractured bone, first to ossify and last to complete ossification
Clavicle
Only bone ossified intramenbranously
Clavicle
Lateral end of the spine of scapula which articulates with the clavicle
acromion
Origin of coracobrachialis and biceps brachii, insertion of pectoralis minor, and the attachment site for coracoclavicular, coracohumeral and coracoacromial ligaments and the costocoracoid ligaments
Coracoid process
Transmits the suprascapular nerve
scapular notch
attachment site for humerus
glenoid cavity
attachment for supraspinatus, infraspinatus, teres minor muscles
greater tubercle
attachment of subscapularis
lesser tubercle
common site of fractures in the humerus with the axillary nerve and the posterior humeral circumflex artery
surgical neck
marks the insertion of the deltoid muscle
deltoid tuberosity
contain the radial nerve, separating the origin of the lateral head of the triceps above and the origin of the medial head below
spinal groove
spool-shaped medial articular surface and articulates with the trochlear notch of the ulna
trochlea
lateral articular surface, globular in shape, and articulates with the head of the radius
capitulum
posterior depression above the trochlea of the humerus that houses the olecranon of the ulna on full extension of the forearm
olecranon fossa
anterior depression above the trochlea of the humerus that accomodates the coronoid process of the ulna on flexion of the elbow
coronoid fossa
anterior depression above the capitulum that is occupied by the head of the radius during full flexion of the elbow joint
radial fossa
projects from the capitulum and provides the origin of the supinator and extensor muscles of the forearm
lateral epicondyle
projects form the trochlea and has a groove on the back for the ulnar nerve and superior ulnar collateral artery
medial epicondyle
Fracture of the radius
Colle’s fracture
surrounded by the annular ligament articulates with the capitulum
Head of the radius
part of the radius which articulates with proximal row of carpal bones of the hand
distal end of radius
attachment of biceps brachii tendon
radial tuberosity
Bones of the hands
Scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate and hamate ( Sandra Likes to Pat Tom’e Two Cold Hands)
Fracture of this bone manifests as deep tenderness in the anatomic snuff box, damage to the radial artery and cause avascular necrosis of the bone
Scaphoid
Fracture of this bone injures the ulnar nerve and the artery
Hamate
A 21 year old patient has a lesion of the upper trunk of the brachial plexus (Erb-Duchenne paralysis). Which of the following is the most likely diagnosis?
A. Paralysis of the rhomboid major
B. Inability to elevate the arm above the horizontal
C. Arm tending to lie in medial rotation
D. Loss of sensation to the medial side of the arm
E. Inability to adduct the thumb
C. Arm tending to lie in the medial rotation
lesion in the upper trunk of the brachial plexus results in the condition called waiter’s tip hand. The arm tends to lie in the medial rotation because of the paralysis of the lateral rotators and abductors of the arm.
A patient comes in with a gunshot wound and requires surgery in which his thoracoacromial trunk needs to be ligated. Which of the following arterial branches would maintain normal blood flow? A. Acromial B. Pectoral C. Clavicular D. Deltoid E. Superior thoracic
E. Superior thoracic.
It is a direct vessel from the thoracacromial trunk
The direct vessels from the TAT are the: CAPD
Acromial
Pectoral
Clavicular
Detoid
A 29 year old man comes in with a stab wound, cannot raise his arm hits arm above horizontal and exhibits a condition known as winged scapula. Which of the following structures of the brachial plexus would most likely be damaged? A. Medial cord B. Posterior cord C. Lower trunk D. Roots E. Upper Trunk
D. Roots
Winged scapula is caused by paralysis of the serratus anterior muscle that results from the damage of the long thoracic nerve which arises from the roots of the brachial plexus.
A 16 year old patient has weakness flexing the metacarpophalengeal joint of the ring finger and is unable to adduct the same finger. Which of the following muscles is most likely paralyzed? A. FDP B. Extensor Digitorum C. Lumbricals D. Dorsal interosseous E. Palmar Interosseous
E. Palmar interosseous
The dorsal and palmar interosseous and lumbrical muscles can flex the metacapophalangeal joints and extend the interpahangeal joints. The palmar interosseous muscles ADduct the fingers, while the dorsal interosseous muscles ABduct the fingers. The flexor digitorum profundus flexes the DIP joint
A 22 year old patient received a stab wound in the chest that injured the intercostobrachial nerve. Which of the following conditions results from the described lesion of the nerve?
A. Inability to move the ribs
B. Loss of the tactile sensation on the lateral aspect of the arm
C. Absence of the sweating on the posterior aspect of the arm
D. Loss of sensory fibers from the second intercostal nerve
E. Damage to the sympathetic preganglionic fibers
D. Loss of sensory fibers from the second intercostal nerve.
The intercostobrachial nerve arises from the lateral cutaneous branch of the second intercostal nerve and pierces the intercostal and serratus anterior muscles.
Supplies the skin on the medial side of the arm. Contains no skeletal motor fibers but does not contain sympathetic postganglionic fibers, which supply sweat glands.
A 16 year old boy fell from a motorcycle, and his radial nerve was severely damaged because of a fracture of the midshaft of the humerus. Which of the following conditions would most likely result from this accident?
A. Loss of wrist extension leading to wrist drop
B. Weakness pronating the forearm
C. Sensory loss over the ventral aspect of the base of the thumb
D. Inability to oppose the thumb
E. Inability to abduct the fingers
A. Loss of wrist extension leading to wrist drop
Injury to the radial nerve results in loss of wrist extension, leading to wrist drop.
Median nerve- innervates the pronator teres, pronator quadratus, opponens pollicis and the skin over the ventral aspect of the thumb.
Ulnar nerve- innervates the dorsal interosseous muscles, which act to abduct the fingers.
A 16 year old boy fell from a motorcycle, and his radial nerve was severely damaged because of a fracture of the midshaft of the humerus. Which of the following conditions would most likely result from this accident?
A. Loss of wrist extension leading to wrist drop
B. Weakness pronating the forearm
C. Sensory loss over the ventral aspect of the base of the thumb
D. Inability to oppose the thumb
E. Inability to abduct the fingers
A. Loss of wrist extension leading to wrist drop
Injury to the radial nerve results in loss of wrist extension, leading to wrist drop.
Median nerve- innervates the pronator teres, pronator quadratus, opponens pollicis and the skin over the ventral aspect of the thumb.
Ulnar nerve- innervates the dorsal interosseous muscles, which act to abduct the fingers.
A patient comes in complaining that she cannot flex her proximal interphalangeal joints. Which of the following muscles appear(s) to be paralyzed on further examination of her finger? A. Palmar interossei B. Dorsal interossei C. FDP D. FDS E. Lumbricals
D. Flexor Digitorum Superficialis
FDS flexes the interphalangeal joints . It flexes the DIP joints. The palmar and dorsal interossei and lumbricals can flex metacarpophalengeal joints and extend the interphalangeal IT joints. The palmar interossei abduct the joints.
A 21 year old woman walks in with a shoulder and arm injury after falling during horseback riding. Examination indicates that she cannot adduct her arm because of paralysis of which of the following muscles? A. Teres minor B. Supraspinatus C. Latissimus dorsi D. Infraspinatus E. Serratus anterior
C. Latissimus dorsi
The latissimus dorsi- adducts the arm,
supraspinatus muscles- abducts the arm
Infraspinatus and teres minor - rotate the arm laterally
serratus anterior-rotates the glenoid cavity of the scapula upward, abducts the arm, elevates it
A 35 year old man walks in with a stab wound on the most medial side of the proximal portion of the cubital fossa. Which of the following structures would most likely be damaged? A. Biceps brachii tendon B. Radial nerve C. Brachial artery D. Radial recurrent artery E. Median nerve
E. Median nerve
The contents from median to lateral
Median Nerve,-brachial artery-biceps brachii tendon-radial nerve
The police bring in a murder suspect who has been in a gunfight with a police officer. This suspect was struck by a bullet in the arm; his median nerve has been damaged. Which of the following symptoms is likely produced by this nerve damage? A. Waiter's tip hand B. Claw hand C. Wrist drop D. Ape Hand E. Flattening of the hypothenar eminence
D. Ape Hand
Injury to:
Median nerve- extension of the thumb (Ape’s hand)
Radial nerve- loss of wrist extension (Wrist drop)
Upper trunk of the brachial plexus- Waiter’s tip
Ulnar nerve- Claw hand, flattening of the hypothenar, atrophy of the hypothenar
An automobile body shop worker has his middle finger crushed while working on a transmission. Which of the following muscles is most likely to retain function? A. Extensor digitorum B. Flexor digitorum profundus C. Palmar interosseous D. Dorsal interosseous E. Lumbricals
C. Palmar interosseus
Extensor digitorum, flexor digitorum profundus, dorsal interosseous, and lumbrical muscles are attached to the middle digit, but no palmar interosseous muscle is attached to the middle digit.
A 14 year old boy falls on his out-stretched hand and has a fracture of the scaphoid bone. The fracture is most likely accompanied by a rupture of which of the following arteries? A. Brachial artery B. Ulnar artery C. Deep palmar arterial arch D. Radial artery E. Princeps pollicis artery
D. Radial artery
Scaphoid bone forms the floor of the anatomic snuffbox, through which the radial artery passes the palm. The radial artery divides into the princeps pollicis and the deep palmar arch.
A 12 year old boy walks in; he fell out of a tree and fractured the upper portion of his humerus. Which of the following nerves are intimately related to the humerus and are most likely to be injured by such a fracture? A. Axillary and muscuocutaneous B. Radial and ulnar C. Radial and axillary D. Median and musculocutaneous E. Median and ulnar
C. Radial and axillary
Axillary - posterior around the surgical neck of the humerus
Radial- radial groove of the middle of the shaft of the humerus
Ulnar- behind the medial epicondyle
Musculocutaneous nerve- not directly in contact with the humerus
A man injures his wrist on broken glass. Which of the following structures entering the palm superficial to the flexor retinaculum may be damaged?
A. Ulnar nerve and media nerve
B. Median nerve and flexor pollicis longus
C. Median nerve and flexor pollicis longus
D. Ulnar artery and ulnar nerve
E. Ulnar nerve and flexor digitorum superficialis
D. Ulnar artery and ulnar nerve
Structures entering the palm superficial to the flexor retinaculum include the ulnar nerve, ulnar artery, palmaris longus tendon and palmar cutaneous branch of the median nerve. The media nerve, the flexor pollicis longus, and the flexor digitorum superficialis and profundus run deep to the flexor retinaculum
A patient with Bennett’s fracture experiences an impaired thumb movement. Which of the following intrinsic muscle is most likely injured?
A. Abductor pollicis brevis
B. Flexor pollicis brevis (superficial head)
C. opponens pollicis
D. adductor pollicis
E. Flexor pollicis brevis (deep head)
C. Adductor pollicis
The opponens pollicis inserts on the first metacarpal. All other intrinsic muscles of the thumb, including the abductor pollicis brevis, the flexor pollicis brevis and the adductor pollicis muscles, insert on the proximal phalanges
A 27 year old pianist with a known carpal tunnel sydrome experiences difficulty in finger movements. Which of the following intrinsic muscles are paralyzed?
A. Palmar interossei and adductor pollicis
B. Dorsal interossei and lateral two lumbricals
C. Lateral two lumbricals and opponens pollicis
D. Abductor pollicis brevis and palmar interossei
E. Medial two and lateral two lumbriclas
C. Lateral two lumbricals and opponens pollicis
The opponens pollicis inserts on the first metacarpal. All other intrinsic muscles of the thumb, including the abductor brevis, the flexor pollicis brevis and the adductor pollicis muscles,insert on the proximal phalanges.
A 31 year old roofer walks in with tenosynovitis resulting from a deep penetrated wound in the palm by a big nail. Examination indicates that he has an infection in the ulnar bursa. This infection most likely resulted in necrosis of which of the following tendons?
A. Tendon of the flexor carpi ulnaris
B. Tendon of the flexor carpi longus
C. Tendon of the flexor digitorum profundus
D. Tendon of the flexor carpi radialis
E. Tendon of the palmaris longus
C. Tendon of flexor digitorum profundus
the ulnar bursa contains of both flexor digitorum superficialis and profundus muscles
radial bursa- flexor pollicis longus
flexor carpi ulnaris and palmaris longus - not contained in ulnar bursa.
An 18 year old boy involved in an automobile accident presents with arm that cannot abduct. His paralysis is caused by damage to which of the following nerves? A. Suprascapular and axillary B. Thoracodorsal and upper subscapular C. Axillary and musculocutaneous D. Radial and lower subscapular E. Suprascapular and dorsal scapular
A. suprascapular and axillary - supraspinatus and deltoid muscle
Thoracodorsal nerves - lats - adduction, extend and rotate
Upper and lower subscapular nerves - subscapularis
lower subscapular nerve- teres major - adduct and rotate arm medially
musculocutaneous - flexors of the arm
Radial - extensors
A 17 yr old boy with a stab wound received multiple injuries on the upper part of the arm and required surgery. If the brachial artery were ligated at its origin, which of the following arteries would supply blood to the profunda brachii artery? A. Lateral thoracic B. Subscapular C. Posterior humeral circumflex D. Superior ulnar collateral E. Radial recurrent
C. Posterior humeral circumflex
Posterior humeral circumflex anastomoses with an ascending branch of the profunda brachii artery. Lateral thoracic and subscapular do not
the posterior ulnar collateral and the radial recurrent are located on the lower portions of the profunda brachii
A 23 year old woman who receives a deep cut to her ring finger by a kitchen knife is unable to move the metacarpophalangeal joint. Which of the following pairs of nerves was damaged? A. median and ulnar B. radial and median C. musculocutaneous and ulnar D. ulnar and radial E. radial ad axillary
D. Ulnar and radial
The metacarpophalangeal joint of the middle finger is flexed by the lumbrical, plamar, and dorsal interosseous muscles, which are innervated by the ulnar nerve . Extensor digitorum is innervated by radia nerve- extension
A 27 year old baseball player is hit on his forearm by a high-speed ball during the World Series, and the muscles that form the floor of the cubital fossa appear to be torn. Which of the following groups of muscles have lost their functions? A. Brachioradialis and supinator B. Brachialis and supinator C. Pronator teres and supinator D. Supinator and pronator quadratus E. Brachialis and pronator
B. Brachialis and supinator
They form the floor of the cubital fossa. They form the lateral and medial boundaries, respectively.
A 23 year old man complains of numbness on the medial side of the arm following a stab wound in the axilla. On examination , he is diagnosed with an injury of his medial brachial cutaneous nerve.In which of the following structures are the cell bodies of the damaged nerves involved in the numbness located? A. Sympathetic chain ganglion B. Dorsal root ganglion C. Anterior horn of the spinal cord D. Laterior horn of the spinal cord E. Posterior horn of the spinal cord
B. Dorsal root ganglion
The medial branch cutaneous nerve contains sensory fibers that have cell bodies in the dorsal root ganglia, and an injury of these GSA fibers causes numbness of the medial side of the arm.
A 38 year old homebuilder was involved in an accident and is unable to supinate his forearm. Which if the following nerves are most likely damaged? A. Suprascapular and axillary B. Musculocutaneous and median C. Axillary and radial D. Radial and musculocutaneous E. Median and ulnar
D. Radial and musculocutaneous
The supinator and biceps brachii muscles, responsible for supination, are innervated by the radial and musculocutaneous nerves.
A 31 year old patient complains of sensory loss over the anterior and posterior surfaces of the medial third of the hand and the medial one and one half fingers. He is diagnosed by a physician as having "funny bone" symptoms. Which of the following nerves is injured? A. Axillary B. Radial C. Median D. Ulnar E. Musculocutaneous
D. Ulnar
The ulnar nerve supplies sensory fibers to the skin over the palmar and dorsal surfaces of the medial third of the hand and the medial one and one-half fingers. The median nerve innervates the skin of the lateral side of the palm; the palmar side of the lateral three and one-half fingers. The radial nerve innervates the skin of the radial side of the hand and the radial two and one-half digits over the proximal phalanx.
A patient with a deep stab wound in the middle of the forearm has impaired movement of the thumb. Examination indicates a lesion of the anterior interosseous nerve. Which of the following muscles is paralyzed?
A. Flexor pollicis longus and brevis
B. Flexor pollicis longus and opponens pollicis
C. Flexor digitorum profundus and pronator quadratus
D. Flexor digitorum profundus and superficialis
E. Flexor pollicis brevis and pronator quadratus
C. Flexor digitorum profundus and pronator quadratus
AIN - branch of the median nerve and supplies flexor pollicis longus, half of your flexor digitorum profundus and the pronator quadratus.
median nerve - supplies pronator teres, flexor digitorum superficialis, palmaris longus and flexor carpi radialis muscles.
muscular branch median nerve- thenar muscles
A 29 year old patient comes in; he cannot flex the dista interphalangeal joint of the index finger. His physician determines that he has nerve damage from a supracondylar fracture. Which of the following conditions is also a symptom of this nerve damage?
A. Inability to flex the DIP joint of the ring finger
B. Atrophy of the hypothenar eminence
C. Loss of sensation over the distal part of the second digit
D. Paralysis of all the dumb muscles
E. Loss of supination
C. Loss of sensation over the distal part of the second digit
FDP flexes the DIP joints of the index and middle fingers and is innervated by the median nerve, which also supplies sensation over the distal part of the second digit.
A 27 year old man with cubital tunnel syndrome complains of numbness and tingling in the ring and little finger and back and sides of his hand because of damage to a nerve in the tunnel at the elbow. Which of the following muscles is most likely to be paralyzed? A. Flexor digitorum superficialis B. Opponens pollicis C. Two medial lumbricals D. Pronator teres E. Supinator
C. Two medial lumbricals
The ulnar nerve innervates the two medial lumbricals. However, the median nerve innervates the two lateral lumbricals, the flexor digitorum superficialis, the opponens pollicis and the pronator teres muscles
A secretary comes in to your office complaining of pain in her wrists from typing all day. You determine that she likely has carpal tunnel syndrome. Which of the following conditions would help you determine the diagnosis?
A. Inability to adduct the little finger
B. Inablity to flex the DIP joint of the ring finger
C. Flattened thenar eminence
D. Loss of skin sensation of the medial one and one-half fngers
E. Atrophied adductor pollicis muscle
C. Flattened thenar eminence
Carpal tunnel= median nerve, flexor pollicis longus, flexor digitorum profundus, flexor digitorum superficialis.
Injury from the carpal tunnel which damages the median nerve causes flatenning of the thenar muscles.
The middle finger has no attachment to the adductors
The ulnar nerve innervates the medial half of the flexor digitorum profundus allowing flexion of the DIP.
The ulnar nerve also supplies he median one and one half fingers and adductor pollicis muscle
A man is unable to hold typing paper between his index and middle fingers. Which of the following nerves was likely injured? A. Radial nerve B. Median nerve C. Ulnar nerve D. Musculocutaneous nerve E. Axillary nerve
C. Ulnar nerve
index finger is adducted by the palmar interosseous muscle, and the middle finger is adducted by the dorsal interosseous muscle. Both are innervated by the ulnar nerve.
The victim of an automobile accident has a destructive injury of the proximal row of carpal bones. Which of the following bones is most likely damaged? A. Capitate B. Hamate C. Trapezium D. Triquetrum E. Trapezoid
D. Triquetrium
Proximal row:
Scaphoid-Lunate-Triquetrum-Pisiform
Distal row:
Trapezium- Trapezoid-Capitate-Hamate
A patient has a torn rotator cuff of the shoulder joint as the result of an automobile accident. Which of the following muscle tendons is intact and has normal function? A. Supraspinatus B. Subscapularis C. Teres major D. Teres minor E. Infraspinatus
C. Teres major
Rotator cuff - supraspinatus, infraspinatus, subscapularis and teres minor muscle.
Stabilizes the shoulder joint.
Teres major inserts on the medial lip of the intertubercular groove of the humerus.
A patient complains of having pain with repeated movements of his thumb (claudication). His physician performs the Allen’s Test and finds insufficiency of the radial artery. Which of the following conditions would be a result of the radial artery stenosis?
A. A marked decrease in the blood flow in the superficial palmar arterial arch
B. Decreased pulsation in the artery passing superficial to the flexor retinaculum
C. Ischemia of the entire extensor muscles of the forearm
D. A marked decrease in the blood flow in the priceps pollicis artery.
E. A low blood pressure in the anterior interosseous artery.
D. A marked decrease in the blood flow in the priceps pollicis artery
The radial artery divides into the priceps pollicis artery and the deep palmar arterial arch. Thus, stenosis in the radial artery resultsin a decrease blood flow in the priceps pollicis arter.
A patient bleeding from the shoulder secondary to a knife wound is in fair condition due to vascular anastomosis. Which of the following arteries is most likely a direct branch of the subclavian artery that is involved in the anastomosis? A. Dorsal Scapular artery B. Thoracoacromial artery C. Circumflex scapular artery D. Transverse cervical artery E. suprascapular artery
A. Dorsal Scapular artery
Dorsal scapular artery rises directly behind from the third part of the subclavian artery and replaces the deep (descending) branch of the transverse cervical artery.
Suprascapular and transverse cervical arteries are branches of thyrocervical trunk of the subclavian artery. Thoracoacromial artery, from the axillary, has pectoral, clavicular, acromial, and deltoid branches.
A 20 year old carpenter suffers a crush injury of his entire little finger. Which of the following muscles is most likely to be spared? A. Flexor digitorum profundus B. Extensor digitorum C. Palmar interossei D. Dorsal interossei E. Lumbricals
D. Dorsal interossei
Dorsal interossei serves as adductor of the hands except that of the little finger. It has its own adductor. All the rest are connected to the little finger.
A 7 year old boy falls from a tree house and is brought to the emergency department of a local hospital. On examination, he has weakness in rotating his arm laterally because of an injury of a nerve. Which of the following conditions is most likely to cause a loss of nerve function?
A. Injury to the lateral cord of the brachial plexus
B. Fracture of the anatomic head of the humerus
C. Knife wound on the teres major muscle
D.Inferior dislocation of the head of the humerus
E. A tumor in the triangular space in the shoulder region.
D. Inferior dislocation of the head of humerus
Dislocation leads to damage of the axillary nerve. Arises from the posterior cord of the brachial plexus. runs through the quadrangular space with the posterior humeral circumflex vessels around the surgical neck of the humerus, supplies the deltoid and teres minor which are the lateral rotators of the arm.
A 49 year old woman is diagnosed as having a large lump in her right breast. Lymph from the cancerous breast drains primarily into which of the following nodes?
A. Apical nodes
B. Anterior (pectoral) nodes
C. Parasternal (internal thoracic) nodes
D. Supraclavicular nodes
E. Nodes of the anterior abdominal wall
B. Anterior (pectoral) nodes
75% of the lymph from the breast goes to the axillary nodes or more specifically the anterior (pectoral) nodes.
A 17 yr old boy fell from his motorcycle and complains the numbness of the lateral part of the arm. Examination reveals that the axillary nerve is severed. Which of the following types of axons is most likely spared? A. Postganglionic sympathetic axons B. Somatic afferent axons C. Preganglionic sympathetic axons D. General somatic efferent axons E. General visceral efferent axons
C. Preganglionic sympathetic axons
Axillary nerve does not have preganglionic sympathetic general visceral efferent but contains postganglionic sympathetic GVE fibers. The axillary nerve also contains GSA, GSE and general visceral afferent fibers.
A 24-year-old carpenter suffers a crush injury of his entire little fi nger. Which of the following muscles is most likely to be spared? (A) Flexor digitorum profundus (B) Extensor digitorum (C) Palmar interossei (D) Dorsal interossei (E) Lumbricals
D. Dorsal interossei
Dorsal interossei serves as adductor of the hands except that of the little finger. It has its own adductor. All the rest are connected to the little finger.
A rock climber falls on his shoulder, resulting in a chipping off of the lesser tubercle of the humerus. Which of the following structures would most likely have structural and functional damage? (A) Supraspinatus muscle (B) Infraspinatus muscle (C) Subscapularis muscle (D) Teres minor muscle (E) Coracohumeral ligament
C. Subscapularis muscle
The subscapularis muscle inserts on the lesser tubercle of the humerus.
The supraspinatus, infraspinatus, and teres minor muscles insert on the greater tubercle
of the humerus. The coracohumeral ligament attaches to the greater tubercle.
