Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK > Upper limb > Flashcards

Upper limb Flashcards

1
Q

What does the radius articulate with?

A

The capitulum of the humerus at the elbow, and with the carpal bones at the wrist; with the ulna at the proximal and distal radioulnar joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the significance of the radial tuberosity?

A

Place of attachment of the biceps brachii

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the names of the projections of the radius at the distal end?

A

The lateral side projects distally as the styloid process

On the medial side there is the ulnar notch (articulates with ulna)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is a Colles’ fracture?

A

FOOH, fracturing the radius, resulting in posterior displacement of the wrist and hand, it produces what is known as the ‘dinner fork deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a Smith’s fracture?

A

Falling onto the back of the hand, fracture of the distal radius; it is the opposite of a Colles’ fracture, as the distal fragment is now placed anteriorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What bony landmarks articulate between the humerus and the ulna?

A

The trochlea of the humerus, the trochlear notch (formed by the coronoid process and olecranon) of the ulna

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the location and function of the radial notch

A

Found on the lateral surface of the trochlea notch, receives the broad periphery of the radial head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the significance of the tuberosity of the ulna?

A

It is where the brachialis muscle attaches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How many borders does the shaft of the ulna have?

A

3, it is triangular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which border of the ulna shaft can be palpated on the postero-medial side of the arm?

A

The posterior border

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Name the important feature of the distal end of the ulna

A

The styloid process; it projects from the posterior medial part of the bone. It is smaller and more proximal than the styloid process of the radius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does the ulna participate in the wrist joint?

A

It doesn’t reach the wrist joint, and hence does not

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe how a fracture of the olecranon process might occur, and what happens

A

Fall on a flexed elbow; one of the fragments can be pulled proximally by the triceps, although this depends on where the fracture occurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe the palpation and importance of the olecranon

A

Can be palpated at the elbow, on the posterior side; the superior surface is the place of attachment of the triceps brachii

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the importance of the interosseous membrane in respect to a fracture of either the radius or ulna?

A

A fracture of one bone is likely to be associated with the dislocation of the nearest joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the position of the proximal ulna fragment following a fracture of the shaft

A

Points posteriorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe Monteggia’s fracture

A

Usually caused by a force from behind the ulna; the shaft of the ulna is fractured, and the head of the radius dislocates anteriorly at the elbow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe Galeazzi’s fracture

A

Fracture to the radius, the ulna head is dislocated at the distal radio-ulnar joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Name the superficial, intermediate, and deep muscles of the anterior compartment of the forearm

A

Superficial: flexor carpi ulnaris, palmaris longus, flexor carpi radialis, pronator teres
Intermediate: flexor digitorum superficialis
Deep: flexor digitorum profundus, flexor pollicus longus, pronator quadratus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Name the superficial and deep muscles in the posterior compartment of the forearm

A

Superficial: brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris, anconeus
Deep: supinator, abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, extensor indicis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

The superficial muscles in the anterior compartment of the forearm all originate from where?

A

They all originate from a common tendon, which originates from the medial epicondyle of the humerus (they hence all cross the elbow joint)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the action of the flexor carpi ulnaris? What is its innervation?

A

Flexion and adduction at the wrist; ulnar nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the action of the palmaris longus? What is its innervation?

A

Flexion at the wrist; median nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which structure is just underneath the palmaris longus? In what percentage of the population is the palmaris longus absent?

A

Median nerve; 15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the action of the flexor carpi radialis? What is its innervation?

A

Flexion and abduction at the wrist; median nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the significance of the pronator teres with regard to the cubital fossa?

A

The lateral border of the pronator teres forms the medial border of the cubital fossa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the action of the pronator teres? What is its innervation?

A

Pronates the forearm; median nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Which two structures can be found passing between the two heads of the flexor digitorum superficialis?

A

The median nerve and ulnar artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

To where do the four distal tendons of the flexor digitorum superficialis attach?

A

The middle phlanges of the four fingers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the actions of the flexor digitorum superficialis?

A

Flexes the metacarpophalangeal joints, and proximal interphalangeal joints at the 4 fingers, and flexes the wrist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the innervation of the flexor digitorum superficialis?

A

The median nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

The tendons of which two muscles pass through the carpal tunnel?

A

Flexor digitorum superficialis and flexor digitorum profundus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

To what do the tendons of the flexor digitorum profundus attach?

A

The distal phlanges of the four fingers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the actions of the flexor digitorum profundus?

A

It is the only muscle that can flex the distal interphalangeal joints at the wrist; it also flexes the metacarpophalangeal joints and at the wrist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the innervation of the flexor digitorum profundus?

A

Medial half is innervated by the ulnar nerve; the lateral half is innervated by the median nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Describe the position of the flexor pollicis longus relative to the flexor digitorum profundus

A

The flexor pollicis longus lies laterally to the flexor digitorum profundus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the actions of the flexor pollicis longus?

A

Flexes the interphalangeal joint and metacarpophalangeal joint of the thumb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the innervation of the flexor pollicis longus?

A

Median nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Describe the shape and location of the pronator quadratus

A

Square shaped muscle, lies deep to the tendons of the flexor digitorum profundus and flexor pollicis longus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is the action of the pronator quadratus? What is its innervation?

A

Acts to pronate the forearm; median nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

When is the brachioradialis most visible?

A

When the forearm is half pronated, and flexing at the elbow against resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is the action of the brachioradialis? Why is this of interest?

A

It produces flexion at the elbow, but as its origin and innervation are characteristic of an extensor muscle, it is classified in the extensor compartment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the innervation of the brachioradialis?

A

Radial nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Where are the extensor carpi radialis longus and extensor carpi radialis brevis found?

A

Laterally in the posterior forearm, the brevis lies deep to the longus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Where do the extensor carpi radialis longus and brevis attach?

A

II (longus) and III (brevis) metacarpal bones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is the innervation of the extensor carpi radialis longus and brevis?

A

Radial nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is the main extensor of the fingers?

A

The extensor digitorum; it makes up most of the posterior surface of the forearm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is the action of the extensor digitorum?

A

Extension of the medial four fingers at the metacarpalpholangeal and interphalangeal joints of the hand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is the action of the extensor digitorum?

A

Extension of the medial four fingers at the metacarpalpholangeal and interphalangeal joints of the hand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is the innervation of the extensor digitorum?

A

Radial nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Describe the location of the extensor digiti minimi relative to the extensor digitorum

A

Medially, slightly deep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is the action of the extensor digiti minimi?

A

Acts to extend the little finger, and also contributes to extension at the wrist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is the innervation of the extensor digiti minimi?

A

Radial nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Where is the extensor carpi ulnaris found in the forearm

A

Posterior, medial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Where does the extensor carpi ulnaris attach?

A

The base of metacarpal V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is the action of the extensor carpi ulnaris? What is its innervation?

A

Extends and adducts the wrist; the radial nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Which muscle is most medial of those in the extensor compartment of the forearm?

A

The anconeus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Which other muscle can it be hard to distinguish the anconeus from?

A

The anconeus is blended with the fibres of the triceps brachii

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is the action of the anconeus? What is its innervation?

A

Acts to move the ulna during pronation and extends at the elbow joint; radial nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is wrist drop a characteristic sign of?

A

Radial nerve injury in the axilla or radial groove

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What happens in wrist drop?

A

No radial innervation of extensors at wrist; they are paralysed. Unnoposed flexion (wrist drop) occurs due to action of flexor muscles (median nerve)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Which two muscles form the floor of the cubital fossa?

A

The supinator and brachialis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Which structure lies between the two heads of the supinator?

A

The radial nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What is the action of the supinator? What is its innervation?

A

Supinates the forearm; radial nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Which border of the anatomical snuffbox does the abductor pollicis longus contribute to?

A

Lateral border

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Describe the location of the abductor pollicis longus

A

Distal to the supinator on the lateral side of the forearm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is the action of the abductor pollicis longus? What is its innervation?

A

Abducts the thumb; radial nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What is the position of the extensor pollicis brevis relative to the abductor pollicis longus?

A

Medial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Apart from the abductor pollicis longus, which muscle makes up most of the lateral border of the anatomical snuffbox?

A

Extensor pollicis brevis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

<p>

| What is the action of the extensor pollicis brevis? What is its innervation?</p>

A

<p>

| Extend the metacarpophlanageal and carpometacarpal joints of the thumb; radial nerve</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What is the action of the extensor pollicis longus? What is its innervation?

A

Extends all the joints of the thumb; radial nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What is the action of the extensor indices? Why is it important?

A

Extends the index finger; allows the index finger to be independent of the other fingers during extension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What is the innervation of the extensor indices?

A

Radial nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What type of joints are the radioulnar joints? What movement do they allow?

A

They are both synovial pivots, responsible for the pronation and supination of the forearm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What is the proximal radioulnar joint formed by?

A

The head of the radius, articulating with the radial notch of the ulna

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Which ligament keeps the radius in place at the proximal radioulnar joint?

A

The anular radial ligament; it forms a collar around the joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Which muscles produce pronation at the radioulnar joints?

A

The pronator teres and pronator quadratus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Which muscles produce supination at the radioulnar joints?

A

The biceps brachii, and the supinator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What is the distal radioulnar joint formed by?

A

The head of the ulnar and the ulnar notch on the medial side of the radius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Which ligaments strengthen the distal radioulnar joint?

A

The anterior (palmar radioulnar) and posterior (dorsal radioulnar) ligaments, and the articular ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What are the functions of the articular ligament at the distal radioulnar joint?

A

It binds the radius and ulna together, holding them together during movement of the joint; it separates the distal radioulnar joint from the wrist joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What are the three functions of the interosseous membrane between the radius and ulna?

A

Holds the radius and ulna together during pronation and supination of the forearm; provides attachment for muscles; transfers force from the radius to the ulna

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Name the carpal bones in the proximal and distal rows

A

Proximal: scaphoid, lunate, triquetrum, pisiform
Distal: trapezium, trapezoid, capitate, hamate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What is the shape of the lunate bone?

A

Crescent shaped

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What type of bone is the pisiform? Name the tendon of relevance

A

Sesamoid, formed in the tendon of the flexor carpi ulnaris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What does the trapezium articulate with?

A

The metacarpal of the thumb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What is the name of the projection on the palmar surface of the hamate?

A

The hook of hamate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Which two carpal bones are most commonly fractured? How?

A

The scaphoid and lunate; fall on outstretched hand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What is the main clinical sign of a fractured scaphoid?

A

Tenderness/pain in the anatomical snuffbox

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Why does a fracture of the scaphoid need to be dealt with quickly?

A

Fracture can cut off the blood supply to the proximal part, causing it to undergo avascular necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What is the anatomical snuffbox?

A

Triangular depression found on the lateral aspect of the dorsum of the hand, at the level of the carpal bones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What is the lateral border of the anatomical snuffbox?

A

Tendons of the abductor pollicis longus and extensor pollicis brevis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Which structure is of importance in the anatomical snuffbox?

A

The radial nerve; it passes diagonally through the anatomical snuffbox on its path into the hand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What is the medial border of the anatomical snuffbox?

A

Tendon of the extensor pollicis longus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What is the proximal border of the anatomical snuffbox?

A

Styloid process of the radius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What is the base of the anatomical snuffbox?

A

Scaphoid and trapezium carpal bones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What articulation occurs in the anatomical snuffbox?

A

Scaphoid and radius articulate to form part of the wrist joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Which bones articulate to form the wrist joint?

A

Distal end of radius, and proximal row of carpal bones (except pisiform)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Which three general things contribute to the stability of the wrist joint?

A

Joint capsule, structure of the joint, and associated ligaments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Describe the two layers of the wrist joint capsule

A

Fibrous outer layer attaches to the radius, ulna and proximal carpal bones; the internal layer is comprised of a synovial membrane, secreting synovial fluid which lubricates the joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

At the wrist joint, which bony landmark prevents excessive abduction?

A

Styloid process of the radius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Name the four important ligaments at the wrist joint

A

Palmar radiocarpal, dorsal radiocarpal, ulnar collateral, radial collateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Describe the structure and function of the palmar radiocarpal ligament

A

Found on the anterior side of the hand; passes from the radius to both rows of carpals; adds to stability and ensures hand follows forearm during supination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Describe the structure and function of the dorsal radiocarpal ligament

A

Found on the posterior side of the hand; passes from the radius to both rows of carpals; contributes to stability and ensures that hand follows forearm during pronation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Describe the location of the ulnar collateral ligament

A

Runs from the styloid process to the triquetrum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Describe the location of the radial collateral ligament

A

Runs from the styloid process to the scaphoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

What type of joint is the wrist joint? What movements does it allow?

A

Synovial ellipsoid; allows for movement along two axes (flexion /extension, adduction/abduction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Which muscles produce flexion at the wrist joint?

A

Mainly the flexor carpi radialis and flexor carpi ulnaris, with assistance from the flexor digitorum superficialis, flexor digitorum profundus and palmaris longus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Which muscles produce extension at the wrist joint?

A

Mainly the extensor carpi radialis longus, extensor carpi radialis brevis, and extensor carpi ulnaris, with assistance from the extensor digitorum, extensor pollicis longus and extensor indicis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Which muscles produce adduction at the wrist joint?

A

Extensor carpi ulnaris and flexor carpi ulnaris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Which muscles produce abduction at the wrist joint?

A

Abductor pollicis longus, flexor carpi radilias, extensor carpi radialis longus and brevis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

How can you suffer an anterior dislocation of the lunate? What can this cause?

A

Falling on a dorsiflexed wrist; can compress carpal tunnel, causing carpal tunnel syndrome. The lunate can also undergo avascular necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

In which direction are the metacarpal bones numbered?

A

Thumb (I) to little finger (V)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

How does the shape of the metacarpals aid in the attachment of interossei muscles?

A

They are concave both medially and laterally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

What do the proximal ends of the metacarpal bones articulate with?

A

Each other, and the carpal bones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

What do the distal ends of the metacarpal bones articulate with?

A

A phalanx, at metacarpophalangeal joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

What is boxer’s fracture?

A

Fracture of the neck of the 5th and occasionally fourth metacarpal bones; usually caused by a clenched fist striking a hard object

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

What do the fingers look like with a boxer’s fracture?

A

Shorter; the distal metacarpal fragments are pushed proximally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

How many phalanges are there in the one hand?

A

14; 3 for digits II to IV (proximal, middle, distal) and 2 for digit I (proximal, distal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

What are the two groups of muscles that act on the hand? Where are they found?

A

Extrinsic muscles; found in forearm, largely produce fine motor skills
Intrinsic muscles; found within the hand, generally produce the fine motor skill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

What are the intrinsic muscles of the hand?

A

Adductor pollicis, interossei, thenar, palmaris brevis, lumbricals and hypothenar muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

What is the thenar eminence?

A

Prominent bulge at base of thumb on lateral side of palm; produced by thenar muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

What is the action of the thenar muscles? Which other muscle is of note?

A

Along with the adductor pollicis, they are responsible for the fine movements of the thumb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Name the thenar muscles. What is their innervation?

A

Opponens pollicis, abductor pollicis brevis, flexor pollicis brevis; median nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

Which is the largest of the thenar muscles? Briefly describe its position.

A

Opponens pollicis; lies deep to the other two thenar muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

What is the action of the opponens pollicis?

A

It opposes the thumb, by medially rotating and flexing the metacarpal on the trapezium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

Describe the position of the abductor pollicis brevis, relative to the other thenar muscles

A

Anterior to opponens pollicis; proximal to flexor pollicis brevis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

What is the action of the abductor pollicis brevis?

A

Abduction of the thumb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

Which is the most distal of the thenar muscles?

A

The flexor pollicis brevis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

What is the action of the flexor pollicis brevis?

A

Acts to flex the metacarpophalangeal joint of the thumb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

What is the hypothenar eminence?

A

An eminence on the medial side of the palm, at the base of the little finger; it is produced by the hypothenar muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

Name the hypothenar muscles. What is their innervation?

A

Opponens digiti minimi, abductor digiti minimi, flexor digiti minimi brevis; ulnar nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

What is the position of the opponens digiti minimi relative to the other hypothenar muscles?

A

Deep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

What is the action of the opponens digit minimi?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

What is the position of the abductor digiti minimi relative to the other hypothenar muscles?

A

Superficial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

What is the action of the abductor digiti minimi?

A

Abduction of the little finger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

What is the position of the flexor digiti minimi brevis relative to the other hypothenar muscles?

A

Lateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

What is the action of the flexor digiti minimi brevis?

A

Acts to flex the metacarpophalangeal joint of the little finger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

What are the places of origination of the hypothenar muscles?

A

Hook of hamate, pisiform

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

What are the names of the two other muscles in the palm that do not fit into the hypothenar or thenar muscles?

A

Adductor pollicis, palmaris brevis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

Describe the shape of the adductor pollicis. Which structure is of note?

A

Large, triangular, two heads; radial artery passes anteriorly between the two heads

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

What is the action of the adductor pollicis? What is its innervation?

A

Adduction of the thumb; ulnar nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

Describe the structure and location of the palmaris brevis

A

Small, thin muscle, found very superficially in the subcutaneous tissue of the hypothenar eminence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

What is the action of the palmaris brevis? What is its innervation?

A

Acts to wrinkle the skin of the hypothenar eminence, deepening the curvature of the hand, imporving grip; ulnar nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

What are the lumbricals?

A

Four muscles, each associated with a finger, that link the extensor tendons to the flexor tendons; crucial for hand movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

What is the denervation of the lumbricals the basis for?

A

The ulnar claw and the hand of Benediction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

What does each lumbical originate from?

A

A tendon of the flexor digitorum profundus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

How do the lumbrical muscles pass along the finger?

A

Dorsally and laterally, they insert into the extensor hood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

What is the action of the lumbricals?

A

They act to flex at the metacarpophalangeal joint of each finger, and extend at the interphalangeal joints of each finger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

What is the innervation of the lumbricals?

A

The ulnar nerve innervates the medial two, and the median nerve innervates the lateral two

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

Where are the inerossei muscles found in the hand? What are the two groups?

A

Between the metacarpals; dorsal and palmar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

Which muscles are most superficial on the dorsal side of the hand?

A

The dorsal interossei muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

What is the specific action of the dorsal interossei muscles? What is their innervation?

A

Act to abduct the fingers at the metacarpophalangeal joint; ulnar nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

How many palmar and dorsal interossei muscles are there?

A

3 palmar, 4 dorsal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

What is the action of the palmar interossei muscles? What is their innervation?

A

Adduction of the fingers; the ulnar nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

What is the general action of all interossei muscles of the hand?

A

Assist the lumbricals in flexion at the metacarpophalangeal joints, and extension at the interphalangeal joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

Which bones and what else form the carpal tunnel?

A

Pisiform, triquetrum, lunate, capitate, trapezoid trapezium, flexor retinaculum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

Which structures are of importance within the carpal tunnel?

A

Median nerve, tendons of the flexor digitorum superficialis, flexor digitorum profundus and flexor pollicis longus (9 tendons)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

What is carpal tunnel syndrome?

A

Compression of the median nerve within the carpal tunnel; thought to be due to increased pressure/thickening of tendon sheaths

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

What are the typical signs of carpal tunnel syndrome?

A

Pins and needles in the sensory distribution of the median nerve and weakness of thenar muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

Why is some median nerve function retained in carpal tunnel syndrome?

A

The palmar cutaneous branch of the median nerve travels superficial to the flexor retinaculum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

Which muscles produce the characteristic shape of the shoulder?

A

Deltoid and trapezius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

Which level of the vertebrae does the trapezius origination extend down to?

A

T12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

What is the motor and sensory innervation of the trapezius muscle?

A

Motor: accessory nerve; Sensory: ventral rami of 3rd and 4th cervical nerves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

What is the action of the trapezius?

A

Upper fibres: elevate the scapula and rotate it during abduction of the arm
Middle fibres: retract the scapula
Lower fibres: pull the scapula inferiorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

How can you test the accessory nerve?

A

Test how well the trapezius is functioning; get the patient to elevate the shoulder against resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

Describe the latissimus dorsi muscle

A

Flat, wide, found laterally on the back of the trunk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

What is the action of the latissimus dorsi?

A

It acts to extend the arm at the shoulder, adduction at the shoulder and medial rotation of the arm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

What is the innervation of the latissimus dorsi?

A

Thoracodorsal nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

Describe the location of the levator scapulae

A

Lies in the back and neck, deep to the trapezius and sternocleidomastoid muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

What is the action of the levator scapulae?

A

Elevates the scapula, rotates the scapula, and tilts the glenohumeral joint inferiorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

What us the innervation of the levator scapulae?

A

Dorsal scapular nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

What are the rhomboid muscles?

A

Pair of muscles, rhomboid major and rhomboid minor; they lie deep to the trapezius and have a rhomboid appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

What is the difference in size between the rhomboids?

A

Major is twice the width of minor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

What is the innervation of the rhomboid muscles?

A

Dorsal scapular nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

What is the action of the rhomboids?

A

Retract the scapula, rotate the scapula to tilt the glenohumeral joint, and also fix the scapula to the thoracic wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

What are the divisions of the deltoid muscle?

A

Anterior, middle and posterior; each can act independently or together when required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

What is the innervation of the deltoid?

A

Axillary nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

What is the action of the anterior and posterior fibres of the deltoid?

A

Anterior fibres flex the arm at the shoulder, posterior fibres extend the arm at the shoulder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

What is the action of the middle fibres of the deltoid?

A

Major abductor of the arm; they take over from the supraspinatus, which abducts the first 15 degrees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

What is the quadrangular space?

A

A ‘gap’ that the axillary artery and posterior circumflex humeral artery pass through to reach the posterior scapular region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
182
Q

What is the relevance of the teres major in regard to the quadrangular space?

A

Forms the inferior border

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
183
Q

What is the innervation of the teres major?

A

Lower subscapular nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
184
Q

What is the action of the teres major?

A

Adduction of the shoulder, and medial rotation of the arm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
185
Q

How would you test the deltoid muscle?

A

Examiner resists patient’s abduction of the limb by the deltoid; if the deltoid is acting normally, contraction of the middle part of the muscle can be palpated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
186
Q

Which border of the axilla is the pectoralis major part of?

A

Pectoralis major makes up most of the anterior wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
187
Q

Which border of the axilla is the serratus anterior part of?

A

Medial wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
188
Q

Describe the two heads of the pectoralis major

A

There is a clavicular head (attaches to the clavicle) and a sternocostal head (attaches to the sternum/ribs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
189
Q

Where do the heads of the pectoralis major convene?

A

The edge of the intertubecular groove of the humerus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
190
Q

What is the action of the pectoralis major?

A

The two heads can work independently and synergistically; together, they act to adduct and medially rotate the humerus at the shoulder, the clavicular head also performs flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
191
Q

Where do the fibres of the pectoralis minor attach?

A

The corocoid process of the scapula; this attachment forms a ‘bridge’, which vessels passing into the upper limb must pass underneath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
192
Q

Compare the size and location of the pectoralis minor to the pectoralis major

A

Pectoralis minor is much smaller and lies posterior to the pectoralis major

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
193
Q

What is the innervation of the pectoralis minor

A

Medial pectoral nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
194
Q

Which border of the axilla does the pectoralis minor contribute to?

A

Anterior wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
195
Q

What is the action of the serratus anterior?

A

Main action is to rotate the scapula, allowing the arm to be raised over 90 degrees. It also holds the scapula against the ribcage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
196
Q

What is the innervation of the serratus anterior?

A

Long thoracic nerve

197
Q

What causes winging of the scapula?

A

Damage to the long thoracic nerve, resulting in paralysis of the serratus anterior

198
Q

Describe the structure and location of the pectoralis major

A

Large, fan shaped, most superficial in region. It makes up most of the anterior wall of the axilla.

199
Q

What is the innervation of the pectoralis major?

A

Innervation is by the medial and lateral pectoral nerves, derived from the brachial plexus

200
Q

What action is changed with winging of the scapula?

A

When pushing the affected limb, the scapula is no longer held against the rib cage (no serratus anterior action), and protrudes out of the back

201
Q

How can damage to the long thoracic nerve occur?

A

Trauma to the shoulder, repetitive movements involving the shoulder or by structures becoming inflamed and pressing on the nerve

202
Q

What is the anatomical position?

A

Person standing upright, facing forward, hands by side, feet parallel and toes pointing forward

203
Q

What are the three anatomical planes?

A

Sagittal, Coronal, Transverse

204
Q

Distinguish between medial and lateral

A

Lateral is away from the midline, medial is towards the midline (the midline being a line in sagittal plane, splitting the right and left halves evenly)

205
Q

Distinguish between anterior and posterior

A

Anterior refers to the ‘front’ and posterior to the ‘back’

206
Q

Distinguish between superior and inferior

A

Refers to the vertical axes; superior means ‘higher’, inferior means ‘lower’

207
Q

Distinguish between proximal and distal

A

Used mainly to describe limbs; they describe the position of a structure with reference to its origin, proximal meaning closer to the origin and distal meaning further away

208
Q

Distinguish between flexion and extension

A

Flexion refers to a movement that decreases the angle between two body parts, extension refers to a movement that increases the angle between two body parts

209
Q

Distinguish between abduction and adduction

A

Abduction is a movement away from the midline, adduction is a movement towards the midline

210
Q

Distinguish between elevation and depression

A

Elevation refers to a movement in a superior direction, depression refers to a movement in an inferior direction

211
Q

Distinguish between pronation and supination

A

Occurs only when the fore-arm is semi-flexed; pronation moves the palm of the hand so that it is facing posteriorly, supination moves the palm of the hand so that it is facing anteriorly

212
Q

Distinguish between dorsiflexion and plantarflexion

A

Both terms describe movement at the ankle. Dorsiflexion refers to extension so that the foot points more superiorly, plantarflexion is flexion at the ankle so that the foot points more inferiorly

213
Q

Distinguish between opposition and reposition

A

Opposition brings the thumb and little finger together, reposition is a movement that places the thumb and the little finger away from each other

214
Q

Which side of the scapula is termed the costal surface?

A

The side facing the ribcage (anterior)

215
Q

Which muscle originates from the costal surface, and to what does it attach?

A

The subscapularis muscle, to the subscapular fossa

216
Q

What is the name of the hook like projection originating from the superior and lateral aspect of the scapula?

A

The coracoid process

217
Q

Name 3 features of the lateral border of the scapula

A

The glenoid fossa, the supraglenoid tubercle, the infraglenoid tubercle

218
Q

What are the four prominent features of the posterior surface of the scapula?

A

The spine, the infraspinous fossa, the supraspinous fossa, and the acromion

219
Q

How would a fracture of the scapula occur?

A

Severe chest trauma, such as in a high speed road collision or in a crushing injury

220
Q

Why does a fracture of the scapula not require much intervention?

A

The muscle tone should hold the pieces together in order for healing to occur

221
Q

What type of bone is the clavicle?

A

Long bone

222
Q

Describe the medial and lateral attachments of the clavicle

A

Medial attachment to sternum, lateral attachment to acromion of the scapula

223
Q

Where is the conoid tubercle? What function does it serve?

A

Found near the acromial end of the clavicle; it is the attachment point of the conoid ligament, the medial part of the coracoclavicular ligament

224
Q

What is the lateral part of the coracoclavicular ligament and where does it attach?

A

Trapezoid ligament, attaches to the trapezoid line, near the acromial end of the clavicle

225
Q

What is the impression at the sternal end of the clavicle for?

A

The binding of the costoclavicular ligament

226
Q

What are the three functions of the clavicle?

A

Attaches limb to upper trunk, protects underlying neurovascular structures, transmits force from upper limb to axial skeleton

227
Q

How do fractures of the clavicle occur? What structures are at risk?

A

Fall onto shoulder/outstretched hand. There can be some nervous damage, due to the close proximity of the supraclavicular nerves

228
Q

What happens to the lateral end of the clavicle after a clavicular fracture?

A

It is displaced inferiorly by the weight of the arm, and medially by the pectoralis major

229
Q

What happens to the medial end of the clavicle after a clavicular fracture?

A

The medial end is pulled superiorly by the sternocleidomastoid muscle

230
Q

Why can a fracture of the clavicle result in ‘waiter’s tip’

A

There can be damage of the supraclavicular nerves; they innervate the lateral rotators of the upper limb; loss off function will result in unopposed medial rotation

231
Q

What forms the apex of the axilla? What is its importance?

A

The clavicle, first rib and the scapula. Structures passing into the upper limb from the thorax usually do so through the apex of the axilla

232
Q

What is thoracic outlet syndrome?

A

The space between the clavicle and the first rib can become narrowed, and the vessels and nerves that pass through may become compressed

233
Q

What can cause thoracic outlet syndrome?

A

Trauma (fractured clavicle) and repetitive use (lifting occupations etc)

234
Q

How does thoracic outlet syndrome present?

A

Pain in the affected limb (where the pain is depends on the nerves affected), tingling, muscle weakness and discolouration

235
Q

Where is the greater tubercle on the humerus? What is its major purpose?

A

Located laterally, it has a posterior and anterior face; it serves as the attachment site for 3 rotator cuff muscles

236
Q

What does the head of the humerus do?

How does it project?

A

Projects medially and superiorly to articulate with the glenoid cavity

237
Q

What are the four rotator cuff muscles?

A

Supraspinatus, infraspinatus, teres minor, and subscapularis

238
Q

Which rotator cuff muscle attaches to the lesser tubercle?

A

Subscapularis

239
Q

What purpose does the intertubecular sulcus serve?

A

Tendons of the pectoralis major, teres minor and latissiumus dorsi attach to the lips of the sulcus

240
Q

What is the name of the landmark of the humerus where the deltoid muscle attaches? Where is it located?

A

Deltoid tuberosity; lateral side

241
Q

What lies in the radial groove? Describe its location

A

The radial nerve and profunda brachii artery; runs diagonally down posterior surface of humerus, parallel to the deltoid tuberosity

242
Q

Why is the lateral supraepicondylar ridge roughened?

A

It is a place of attachment for many of the extensor muscles in the posterior forearm

243
Q

Where can the ulnar nerve be palpated?

A

Posterior side of the medal epicondyle

244
Q

What does the trochlea articulate with?

A

The ulna; the trochlea is located medially and extends onto the posterior of the bone

245
Q

Which bony landmark is located laterally to the trochlea? What does it do?

A

The capitulum, which articulates with the radius

246
Q

What are the three fossae of the humerus?

A

Coronoid, radial and olecranon

247
Q

What structures are of concern with a fracture to the surgical neck of the humerus?

A

The axillary nerve and the posterior circumflex artery

248
Q

What will damage to the axillary nerve result in?

A

Axillary nerve damage will result in paralysis of the deltoid and teres minor muscles- patient unable to abduct. It also innervates the skin of the regimental badge region (loss of sensation)

249
Q

What structures are at risk with a mid-shaft fracture of the humerus? Why?

A

The radial nerve and profunda brachii artery; they are tightly bound in the radial groove

250
Q

What will happen if there is damage to the radial nerve at the radial groove?

A

Wrist drop; (unopposed flexion), the radial nerve innervates the extensors. There will be some sensory loss over the dorsal (posterior) surface of the hand and the proximal ends of the lateral 3 and a half fingers dorsally

251
Q

What is a supraepicondylar fracture? How does it occur?

A

Occurs by falling on a flexed elbow. It is a transverse fracture, spanning between the two epicondyles

252
Q

Which vascular structure is at risk with a supraepicondylar fracture? What can interference of its supply cause?

A

Brachial artery; the resulting ischaemia can cause Volkmann’s ischaemic contracture - uncontrolled flexion of the hand, as flexors become fibrotic and short

253
Q

Which nervous structures are at risk with a supraepicondylar fracture?

A

There can be damage to all 3 nerves (median, radial, ulnar)

254
Q

Which nervous structure can a fracture to the medial epicondyle of the humerus damage? What will result?

A

Damage to the ulnar nerve, resulting in a deformity known as ulnar claw, and loss of sensation over the medial 1 and ½ fingers if the hand, on both the dorsal and palmar surfaces

255
Q

What is the rotator cuff?

A

A group of 4 muscles, originating from the scapula which attach to the humeral head, pulling it into the glenoid fossa, providing extra stability

256
Q

What is the action of the supraspinatus muscle? What is its innervation?

A

It is responsible for the first 15 degrees of abduction at the shoulder, assisting the deltoid for the rest; suprascapular nerve

257
Q

What is the action of the infraspinatus muscle? What is its innervation?

A

Acts to laterally rotate the arm; suprascapular nerve

258
Q

What is the action of the subscapularis muscle? What is its innervation?

A

Acts to medially rotate the arm; upper and lower subscapular nerves

259
Q

What is the action of the teres minor? What is its innervation?

A

Acts to laterally rotate the arm; axillary nerve

260
Q

What is the function of the subacromial bursa?

A

Reduces friction between the supraspinatus tendon and the coracoacromial arch during abduction of the arm

261
Q

Which degenerative changes result in ‘painful arc’? What is ‘painful arc’?

A

Pain in the middle of abduction; under repetitive use, there are degenerative changes in the subacromial bursa and supraspinatus tendon

262
Q

How is the coraco-acromial arch related to rotator cuff tendonitis?

A

Repetitive use of the rotator cuff muscles can cause the head of the humerus and the tendons of the muscles to irritate the coraco-acromial arch, which in turn causes greater inflammation of the rotator cuff tendons

263
Q

What forms the lateral wall of the axilla?

A

The intertubecular groove of the humerus and tendon of the long head of the biceps

264
Q

What forms the medial wall of the axilla?

A

The serratus anterior and thoracic wall (ribs and intercostal muscles)

265
Q

What forms the anterior wall of the axilla?

A

The pectoralis major, underlying pectoralis minor and the subclavius muscle

266
Q

What forms the posterior wall of the axilla?

A

The subscapularis, teres major and latissimus dorsi

267
Q

Name the vascular, muscular and lymph contents of the axilla?

A

The axillary artery and axillary vein, biceps brachii and coracobrachialis tendons, and the axillary lymph nodes

268
Q

What are the two largest tributaries of the axillary vein?

A

The cephalic and basilic veins

269
Q

What are the three parts of the axillary artery? What are their positions?

A

One medial to the pectoralis minor, one posterior to the pectoralis minor, and one lateral to the pectoralis minor; the medial and posterior parts travel in the axilla

270
Q

Where does the majority of the lymph from the breast drain?

A

Into the axillary lymph nodes; they can be biopsied if breast cancer is suspected

271
Q

What is axillary clearance? What can be damaged during the procedure?

A

The removal of the axillary lymph nodes; this is may be performed in patients with breast cancer, to prevent its spread. The long thoracic nerve may be damaged

272
Q

What articulations form the shoulder joint? What is its anatomical name?

A

The glenoid cavity of the scapula with the head of the humerus; the glenohumeral joint

273
Q

Why does the glenohumeral joint have inherent stability?

A

The glenoid cavity is relatively shallow, and the humeral head is large, and it is this disproportion that gives the inherent instability

274
Q

What reduces the disproportion in size between the glenoid cavity and the humeral head?

A

The glenoid fossa is deepened by a fibrocartilaginous rim, called the glenoid labrum

275
Q

Which nerves supply the glenohumeral joint? Where are they derived from?

A

The axillary, suprascapular and subscapular nerves; they are derived from C5 and C6

276
Q

What is the blood supply of the glenohumeral joint?

A

Circumflex humeral arteries and suprascapular arteries

277
Q

Where does the joint capsule of the glenohumeral joint attach? What property of it adds to mobility at the joint?

A

To the anatomical neck of the humerus and the border of the glenoid fossa; it is lax, although this adds to instability

278
Q

What is the function of the inner surface of the joint capsule of the shoulder?

A

Synovial membrane; produces synovial fluid to reduce friction between structures at the joint

279
Q

What occurs at ‘holes’ in the joint capsule of the shoulder?

A

Synovial membrane protrudes to form bursae; they act to reduce rubbing between the structures around the joint during movement

280
Q

What are the 3 clinically important bursae at the shoulder joint that do not form holes in the joint capsule?

A

Subacromial, subscapular, subdeltoid

281
Q

What is the location of the subacromial bursa? What is its function?

A

Between the acromion of the scapula and the joint capsule and supraspinatus tendon; it allows relatively friction free movement of the tendon under the coracoacromial arch and deltoid

282
Q

What is the location of the subscapular bursa?

A

Between the tendon of the subscapularis muscle and the joint capsule

283
Q

What is the location of the subdeltoid bursa?

A

Between the deltoid and the joint capsule

284
Q

What are the ligaments of the shoulder joint?

A

Superior, middle and inferior glenohumeral ligaments (they appear as one ligament), the coracohumeral ligament, and the transverse humeral ligament

285
Q

Describe the location of the coracohumeral ligament

A

Between the base of the coracoid process and the greater tubercle of the humerus

286
Q

Describe the location of the transverse humeral ligament

A

Between the two tubercles of the humerus, holding the tendon of the long head of the biceps in the intertubecular groove

287
Q

Describe the location and function of the coracoacromial ligament

A

Joins the acromion and coracoid process of the scapula in a protective arch, that lies over the humeral head; this prevents superior displacement of the humeral head

288
Q

Which muscles perform extension at the shoulder joint?

A

The posterior deltoid, latissimus dorsi, and teres major

289
Q

Which muscles perform flexion at the shoulder joint?

A

Biceps brachii (both heads), pectoralis major, anterior deltoid and coracobrachialis

290
Q

Which muscles perform abduction at the shoulder joint?

A

Initially, by the supraspinatus, then the middle fibres of the deltoid take over; past 90 degrees, the scapula is rotated by the trapezius and serratus anterior

291
Q

Which muscles perform adduction at the shoulder joint?

A

Pectoralis major, latissimus dorsi, teres major and anterior deltoid

292
Q

Which muscles perform medial rotation at the shoulder joint?

A

Subscapularis, pectoralis major, latissimus dorsi, teres major and anterior deltoid

293
Q

Which muscles perform lateral rotation at the shoulder joint?

A

Infraspinatus and teres minor

294
Q

What factors contribute to mobility at the shoulder joint?

A

It is a ball and socket joint; the disproportion of size between the glenoid cavity and humeral head

295
Q

What factors contribute to stability at the shoulder joint?

A

Rotator cuff muscles (attach to tubercles of the humerus, pulling the humeral head into the glenoid cavity), the glenoid labrum (deepens cavity, reducing risk of dislocation), and the ligaments

296
Q

How is an anterior dislocation of the shoulder joint usually caused?

A

Trauma to a fully abducted arm usually from a posterior direction

297
Q

Which nerves may be damaged with an anterior dislocation of the shoulder?

A

Axillary nerve as it runs in close proximity to the joint (causes paralysis of deltoid, regimental badge), and radial nerve damage can also occur, as it is tightly bound in the radial groove

298
Q

Which structures, other than nerves, may tear during an anterior dislocation of the shoulder?

A

Rotator cuff muscles and joint capsule

299
Q

How many muscles are in the anatomical arm? What are they (anterior and posterior)?

A

4;
Anterior: biceps brachii, brachialis, coracobrachialis
Posterior: triceps brachii

300
Q

What is the action of the biceps brachii?

A

Supination of the forearm; flexion of the arm at the shoulder and elbow

301
Q

What is the innervation of the biceps brachii?

A

Musculotaneous nerve

302
Q

Which spinal cord segment is tested by tapping the biceps tendon?

A

C6

303
Q

What is the bicipital aponeurosis?

A

A connective tissue sheath given off the biceps tendon as it enters the forearm

304
Q

What is the significance of the bicipital aponeurosis?

A

Forms the roof of the cubital fossa, blending with the deep fascia of the forearm

305
Q

What is ‘popeye sign’? What is it suggestive of?

A

Bulge of upper arm during flexion at the elbow; rupture of the tendon of the long head of the biceps brachii

306
Q

Why would a patient not notice much weakness in the upper limb with a rupture of the tendon of the long head of the biceps brachii?

A

Action of brachialis and supinator compensate

307
Q

What is the action of the coracobrachialis? What is its innervation?

A

Flexion of the arm at the shoulder; musculotaneous nerve

308
Q

What forms the base of the cubital fossa?

A

The brachialis muscle

309
Q

Which muscle is the main flexor of the elbow?

A

The brachialis

310
Q

What is the action of the brachialis muscle?

A

Flexion at the elbow

311
Q

What is the innervation of the brachialis muscle?

A

Musculotaneous nerve (small lateral portion is innervated by the radial nerve)

312
Q

What are the three heads of the triceps brachii? Which one lies deeper than the other two?

A

Medial, lateral, and long; the medial head is deeper than the other two

313
Q

What is the action of the triceps brachii?

A

Perform extension of the arm at the elbow

314
Q

What is the innervation of the triceps brachii?

A

Radial nerve

315
Q

Which spinal segment does a tap on the triceps tendon test?

A

C7

316
Q

What are the five parts of the brachial plexus?

A

Roots, trunks, divisions, cords, branches

317
Q

Which rami form the roots of the brachial plexus?

A

Anterior rami of cervical nerves 5, 6, 7, and 8, and the first thoracic nerve, T1

318
Q

What are the trunks of the brachial plexus? Which roots supply each trunk?

A

Superior (C5 and C6), middle (C7), and inferior (C8 and T1)

319
Q

What are the three cords of the brachial plexus?

A

Lateral, posterior, and medial

320
Q

Which divisions form the lateral cord of the brachial plexus?

A

Anterior superior, and anterior middle

321
Q

Which divisions form the posterior cord of the brachial plexus?

A

Posterior superior, posterior middle, and posterior inferior

322
Q

Which divisions form the medial cord of the brachial plexus?

A

Anterior inferior

323
Q

What are the branches of the brachial plexus? Which cords do they originate from?

A 
Musculotaneous (lateral cord)
Axillary (posterior cord)
Median (lateral and medial cords)
Radial (posterior)
Ulnar (medial)
324
Q

How does Erb’s palsy usually occur?

A

Difficult birth or blow to the shoulder

325
Q

Which nerves are affected with Erb’s Palsy?

A

Those derived from solely C5 or C6 roots; musculotaneous, axillary, suprascapular and nerve to subclavius

326
Q

Which muscles are paralysed with Erb’s palsy?

A

Supraspinatus, infraspinatus, subclavius, biceps brachii, brachialis, corachobrachialis, deltoid and teres minor

327
Q

Which movements are lost or greatly weakened in people with Erb’s palsy?

A

Abduction at the shoulder, lateral rotation of the arm, supination of the forearm, and flexion at the shoulder

328
Q

Where is there sensation loss for people with Erb’s palsy?

A

The sensory areas that are supplied by the axillary and musculotaneous nerves; down the lateral side of the arm

329
Q

What are the characteristic signs of Erb’s palsy?

A

Affected limb hangs limply medially rotated by unopposed action of the pectoralis major, forearm pronated due to loss of biceps brachii; known as waiter’s tip

330
Q

How does Klumpke’s palsy commonly occur?

A

Excessive abduction of the arm e.g. a person catching a branch as they fall from a tree

331
Q

Which nerves are affected in Klumpke’s palsy?

A

Those derived from T1; ulnar and median nerves

332
Q

Which muscles are paralysed with Klumpke’s palsy?

A

All the small muscles in the hand (the flexor muscles in the arm are innervated by different roots)

333
Q

Where is sensation loss with Klupke’s palsy?

A

Along the medial side of the arm

334
Q

What are the characteristic signs of Klumpke’s palsy?

A

A clawed hand, hyperextension occurs at the metacarpophalangeal joints and flexion occurs at the interphalangeal joints

335
Q

Which roots does the musculotaneous contain fibres of?

A

C5, C6, C7

336
Q

Describe the course of the musculotaneous nerve after it leaves the axilla

A

Pierces the corachobrachialis muscle, near the point of insertion on the humerus; then passes down the arm, anterior to the brachialis muscle, posterior to the biceps brachii; it emerges laterally to the biceps tendon, and continues in the forearm as the lateral cutaneous nerve of the forearm

337
Q

Which muscles does the musculotaneous nerve innervate? What actions does it hence control?

A

Biceps brachii, brachialis, coracobrachialis; flexion of the upper arm at the shoulder and elbow, and the biceps brachii also performs supination of the forearm

338
Q

Does the musculotaneous nerve have any sensory function?

A

Lateral cutaneous nerve provides sensory function to the lateral side of the forearm

339
Q

How would damage to the musculotaneous nerve likely occur?

A

It is uncommon as relatively protected, but a stab wound could damage it

340
Q

Which muscles would be paralysed by a lesion to musculotaneous nerve?

A

Biceps brachii, brachialis, coracobrachialis

341
Q

What actions would be compromised by a lesion to the musculotaneous nerve?

A

Flexion at shoulder weakened but still performed by the pectoralis major; flexion at the elbow affected but still performed by the brachioradialis; supination greatly weakened, but still produced by the supinator

342
Q

Where would there be loss of sensation with a lesion of the musculotaneous nerve?

A

Lateral side of the forearm

343
Q

Which roots of the brachial plexus is the axillary nerve derived from?

A

C5 and C6

344
Q

Describe the course of the axillary nerve after formation in the brachial plexus

A

Travels inferiorly and laterally, exiting the axilla through the quadrangular space

345
Q

Which muscles and hence which actions does the axillary nerve contribute to?

A

Deltoid; flexion and extension of the arm at the shoulder, major abductor of the arm past 15 degrees; Teres minor; lateral rotation of arm

346
Q

What sensory function does the axillary nerve contribute to?

A

Gives rise to lateral cutaneous nerve of arm; innervates the skin over the posterior deltoid, the ‘regimental badge’ area

347
Q

What is the quadrangular space?

A

Route for nerves and vessels to pass from the anterior to posterior arm (below glenohumeral joint)

348
Q

Which structures pass through the quadrangular space?

A

Axillary nerve and posterior circumflex artery

349
Q

What are the superior and lateral boundaries of the quadrangular space?

A

Superior: subscapularis muscle and teres minor
Lateral: surgical neck of humerus

350
Q

What are the inferior and medial borders of the quadrangular space?

A

Inferior: teres major muscle
Medial: long head of triceps brachii

351
Q

How is the axillary nerve commonly injured?

A

Anterior dislocation of the humerus at the glenohumeral joint, or a fracture of the surgical neck

352
Q

What functional loss will occur with an injury to the axillary nerve?

A

Paralysis of the deltoid and teres minor; patient will be unable to abduct the affected limb

353
Q

What sensory loss will occur with an injury to the axillary nerve?

A

If the lateral cutaneous nerve supply is interrupted, there will be loss of sensation over the regimental badge area

354
Q

What can be palpated in long standing cases of axillary nerve damage? Why?

A

Greater tuberosity of the humerus; deltoid rapidly atrophies

355
Q

Which roots of the brachial plexus does the radial nerve contain fibres of?

A

All 5; C5, C6, C7, C8, & T1

356
Q

How does the radial nerve exit the axilla? What does it innervate just after leaving?

A

Posteriorly; supplies branches to long and medial heads of triceps brachii

357
Q

Which artery does the radial nerve accompany as it travels in the radial groove? What branch of the nerve arises here?

A

Profunda brachii artery; branch to the lateral triceps brachii arises here

358
Q

After leaving the radial groove, describe the course of the radial nerve

A

Anteriorly over the lateral epicondyle of the humerus, through the cubital fossa, and into the forearm, where it divides into motor and sensory branches

359
Q

What are the motor innervations and hence functions of the radial nerve?

A

Triceps brachii muscle (extension at elbow), posterior compartment of forearm (extension of wrist, and hand joints, and supination)

360
Q

What is the sensory innervation of the radial nerve?

A

Cutaneous branches of the radial nerve supply skin for most of the back the arm and hand

361
Q

Describe how the radial nerve could be damaged in the axilla

A

Dislocation of humerus at glenohumeral joint, or fractures of proximal humerus; can also happen via excessive pressure on the axilla

362
Q

What motor function loss occurs with damage to the radial nerve in the axilla?

A

Triceps and muscles in posterior compartment of forearm are paralysed; inability to extend at elbow, wrist, or fingers; unopposed flexion – wrist drop

363
Q

Why can supination still occur when the radial nerve is damaged?

A

Action of biceps brachii, innervated by the musculotaneous nerve

364
Q

What sensory loss will there be with damage to the radial nerve in the axilla?

A

Whole of cutaneous innervation of radial nerve; most of the back of the arm and hand

365
Q

How is the radial nerve most commonly damaged in the radial groove?

A

Midshaft humeral fracture

366
Q

Why is extension at the elbow still possible in patients with damage to the radial nerve in the radial groove?

A

Majority of branches have already arisen is the triceps brachii not paralysed with damage

367
Q

What motor function is lost with damage to the radial nerve in the radial groove?

A

Extension at the wrist and hand (muscles in posterior compartment paralysed), wristdrop occurs

368
Q

What sensory loss occurs with damage to the radial nerve in the radial groove?

A

Forearm cutaneous branches have already arisen, so there is only sensory loss on the dorsum of the hand

369
Q

How is the deep branch of the radial nerve in the forearm damaged?

A

Fractures of the radial head, or posterior dislocation of the radius at the elbow joint

370
Q

Which muscles of the posterior compartment are NOT damaged with damage to the deep branch of the radial nerve in the forearm?

A

Supinator and extensor carpi radialis longus; wristdrop will not occur (ECRL is a strong extensor)

371
Q

What sensory loss occurs with damage to the deep branch of the radial nerve in the forearm?

A

None, it is a motor nerve

372
Q

How is the superficial radial nerve commonly damaged in the forearm?

A

Stabbing/laceration

373
Q

What motor loss occurs with damage to the superficial radial nerve in the forearm?

A

None, it is a sensory nerve

374
Q

What sensory loss occurs with damage to the superficial radial nerve in the forearm?

A

There will be sensory loss in the dorsum of the hand

375
Q

Which roots does the median nerve contain fibres of?

A

C5, C6, C7, C8, T1

376
Q

Describe the position of the median nerve relative to the brachial artery after leaving the axilla

A

Initially lateral to brachial artery, then halfway down crosses over to become medial, continuing into the cubital fossa

377
Q

Which to muscles does the median nerve travel in between as it passes through the forearm?

A

Flexor digitorum profundus and flexor digitorum superficialis

378
Q

Describe two important branches of the median nerve as it passes through the forearm, and their functions

A

Anterior interosseous nerve, supplying deep flexor muscles, and palmar cutaneous nerve, which innervates skin on the palmar, lateral aspect of the hand

379
Q

How does the median nerve enter the hand? Which muscles in the hand does it innervate?

A

Through the carpal tunnel; thenar muscles, and lateral to lumbricals

380
Q

Which muscles does the median nerve innervate in the forearm?

A

Pronator teres, palmaris longus, flexor carpi radialis, flexor digitorum superficialis, lateral flexor digitorum profundus, flexor pollicis longus and pronator quadratus

381
Q

What are the general actions of the muscles in the forearm innervated by the median nerve?

A

Flexion at the wrist and of digits of the hand, and pronation

382
Q

What is the name of the branch of the median nerve that innervates the thenar muscles?

A

Recurrent branch

383
Q

What are the two branches of the median nerve that innervate the skin? Where do they innervate?

A

Palmar cutaneous: skin of the hand

Digital cutaneous: lateral three and a half digits on palmar side and fingertips on dorsal side

384
Q

How does damage to the median nerve commonly occur at the elbow? Which muscles are paralysed?

A

Supracondylar fracture of the humerus; flexors and pronators in forearm (except those with ulnar innervation), and thenar muscles and lateral 2 lumbricals in hand

385
Q

What actions will be lost with damage to the median nerve at the elbow?

A

Pronation, flexion very weak (often accompanied by adduction), flexion at thumb prevented, and flexion of digits II and III at the MCP joints lost, and inability to extend at ICP joints of these digits

386
Q

What are the characteristic signs of median nerve damage at the elbow?

A

Thenar wasting, full flexion of only the little and ring fingers; ‘hand of benediction’

387
Q

How is the median nerve commonly damaged at the wrist? (not carpal tunnel) Which muscles are paralysed?

A

Laceration of flexor retinaculum; lateral lumbricals and thenar muscles = same signs as damage at elbow

388
Q

Which roots does the ulnar nerve contain fibres from?

A

C8 and T1

389
Q

Describe the course of the ulnar nerve down the arm?

A

Descends down medial side of the arm, passes posterior to the medial epicondyle, pierces the two heads of the flexor carpi ulnaris in the forearm, then passes down the forearm alongside the ulna; at the wrist it travels superficially to the flexor retinaculum in the ulnar canal

390
Q

What muscles does the ulnar nerve supply? What actions does it hence control?

A

Forearm: flexor carpi ulnaris and medial half of flexor digitorum profundus (flexes hand and fingers and adduction at wrist)
Hand: hypothenar muscles, medial two lumbricals, adductor pollicis, interossei of the hand

391
Q

What are the sensory functions of the ulnar nerve?

A

Palmar cutaneous and dorsal cutaneous branches innervate medial half of the hand and surfaces of medial 1 and a half fingers;

392
Q

What is the ulnar tunnel?

A

Space between the pisiform and hamate, bridged by a piece of fibrous tissue from the flexor retinaculum

393
Q

What is ulnar tunnel syndrome?

A

Entrapment of ulnar nerve as it passes through the ulnar tunnel; degree of motor and sensory impairment depends on location of nerve entrapment

394
Q

Where is the ulnar nerve vulnerable to damage at the elbow?

A

Medial epicondyle; fracture of the medial epicondyle is the most common way of damaging the ulnar nerve

395
Q

Which actions will be affected by damage to the ulnar nerve at the medial epicondyle?

A

Flexion of wrist occurs but is accompanied by abduction; abduction and adduction of the fingers cannot occur, movement of little and ring fingers greatly reduced

396
Q

What is the characteristic sign of ulnar nerve damage?

A

Cannot grip paper placed between fingers

397
Q

How does damage to the ulnar nerve commonly occur at the wrist?

A

Lacerations

398
Q

What is the sensory loss of damage to the ulnar nerve just proximal the wrist?

A

Palmar branch usually severed; sensory loss over the palmar side of the ulnar nerve supply (medial palm and 1 and a half fingers), but not dorsal

399
Q

What is the cubital fossa?

A

Area of transition between the anatomical arm and forearm, on the anterior surface if the elbow

400
Q

What are the lateral, medial, and superior borders of the cubital fossa?

A

Lateral: medial border of the brachioradialis
Medial: lateral border of pronator teres
Superior: imaginary line between condyles of humerus

401
Q

What is the floor and roof of the cubital fossa?

A

Floor: brachialis, and more distally the supinator
Roof: skin, fascia, reinforced by bicipital aponeurosis

402
Q

What are the contents of the cubital fossa? (lateral to medial)

A

Radial nerve, biceps tendon, brachial artery, median nerve

403
Q

Which pulse can be palpated in the cubital fossa?

A

Brachial pulse; palpate medial to biceps tendon

404
Q

What important structure runs superficial to the cubital fossa?

A

Median cubital vein, common site for venepuncture

405
Q

Where does the arterial supply to the upper limb begin?

A

Subclavian artery; right branches from brachiocephalic trunk, left directly from aorta

406
Q

When are the subclavian arteries called the axillary arteries?

A

After crossing the 1st rib (into the axilla)

407
Q

Describe the position of the axillary artery relative to the pectoralis minor?

A

Deep

408
Q

Which arteries arise at the level of the humeral surgical neck from the axillary artery?

A

Posterior and anterior circumflex humeral arteries, and the subscapular artery

409
Q

At what position does the axillary artery become the brachial artery?

A

Teres major muscle

410
Q

What is the danger of an axillary aneurysm?

A

Could put pressure on brachial plexus, manifesting clinically as pain and loss of sensation in the cutaneous distribution of the affected nerves

411
Q

What does the brachial artery give rise to immediately distal to the teres major?

A

Profunda brachii artery; runs in radial groove, supplies triceps brachii

412
Q

Describe the location of the brachial artery relative to the median nerve as it descends down the arm

A

Immediately posterior

413
Q

Where does the brachial artery bifurcate to give the radial and ulnar nerves?

A

As it crosses the cubital fossa, under the brachialis muscle

414
Q

What is a possible clinical manifestation of an occluded brachial artery?

A

Volkmann’s contracture; necrosis and paralysis of muscles makes them fibrotic and contractious, causing the flexion deformity

415
Q

What are the respective areas supplied by the radial and ulnar arteries?

A

Radial: posterior aspect, Ulnar: anterior aspect

416
Q

How do the radial and ulnar arteries anastomose in the hand?

A

Two arches; the superficial palmar arch and the deep palmar arch

417
Q

What structures does the radial artery supply in the hand?

A

Contributes to supply of the thumb and lateral side of the index finger

418
Q

What structures does the ulnar artery supply in the hand?

A

Digits 3-5 and the medial side of the index finger

419
Q

Describe the course of the ulnar artery as it moves into the hand

A

Anterior to the flexor retinaculum, lateral to the ulnar nerve

420
Q

What are the names of the arteries supply the digits?

A

Common palmar digital arteries (arise from superficial palmar arch)

421
Q

Describe the location of the superficial palmar arch in the hand

A

Anterior to the flexor tendons, just deep to the palmar aponeurosis

422
Q

Describe the course of the radial artery as it enters the hand

A

Dorsally, crossing the floor of the anatomical snuffbox; it turns medially and moves between the heads of the adductor pollicus

423
Q

What are then two main veins of the upper limb?

A

Cephalic (antero-lateral) and basilica (medial)

424
Q

Which veins join to form the axillary vein at the teres major?

A

Basilic vein and brachial veins (venae comitantes)

425
Q

Which vessel connects the basilic and cephalic veins, superficial to the cubital fossa?

A

The median cubital vein (venepuncture)

426
Q

What type of joint is the elbow? Which actions can it perform?

A

Synovial hinge; extension and flexion

427
Q

Which muscles perform extension at the elbow joint?

A

Triceps brachii and anconeus

428
Q

Which muscles perform flexion at the elbow?

A

Brachialis, biceps brachii and brachioradialis

429
Q

What are the thickenings at the medial and lateral sides of the joint capsule? What purpose do they serve?

A

Collateral ligaments; stabilise the joint

430
Q

Describe the location of the radial collateral ligament of the elbow joint

A

Found on the lateral side, extending from the lateral epicondyle, and blending with the anular ligament

431
Q

Describe the location of the ulnar collateral ligament of the elbow

A

Originates from the medial epicondyle, attaches to coronoid process and olecranon of ulna

432
Q

Name the three important bursae of the elbow joint

A

Intratendinosus, subtendinous, subcutaneous

433
Q

Where is the intratendinous bursa of the elbow joint formed?

A

Within the tendons of the triceps brachii

434
Q

Where is the subtendinous bursa of the elbow joint found?

A

Between the olecranon and the tendon of the triceps brachii, reducing friction between the two structures during extension and flexion of the forearm

435
Q

Where is the subcutaneous bursa of the elbow joint found?

A

Between the olecranon and overlying connective tissue

436
Q

Describe subcutaneous bursitis of the elbow

A

Repeated friction and pressure causes the bursa to become inflamed; because it is relatively superficial it can also become infected and cause inflammation

437
Q

Describe subtendinous bursitis of the elbow

A

Caused by repeated flexion and extension of the forearm, commonly seen in assembly line workers; usually flexion is more painful because more pressure is put on the bursa

438
Q

How does dislocation of the elbow joint usually occur in young children?

A

Fall on hand with elbow flexed

439
Q

Describe what happened during an elbow dislocation in a young child. Where does the humerus go? Which ligament is usually torn? Which nerve is at risk?

A

Distal end of humerus driven through weakest part of the joint capsule, the anterior side; the ulnar collateral ligament is usually torn, and the ulnar nerve can be involved

440
Q

What is the most common direction of elbow dislocation?

A

Posterior (elbow dislocations named by position of ulna and radius, not humerus)

441
Q

What is ‘tennis elbow’?

A

Pain and inflammation in and around the lateral epicondyle, from the common extensor tendinous origin; an overuse strain

442
Q

What is ‘golfer’s elbow’?

A

Pain and inflammation in and around the medial epicondyle, from the common flexor tendinous origin; an overuse strain

443
Q

Which muscles perform scapular retraction?

A

Both rhomboids, middle trapezius

444
Q

Which muscles perform scapular protraction?

A

Serratus anterior, pectoralis minor

445
Q

Which muscles perform scapular elevation?

A

Upper trapezius, levator scapulae

446
Q

Which muscles perform scapular depression?

A

Lower trapezius, pectoralis minor, subclavius, latissimus dorsi

447
Q

Which muscles perform scapular lateral rotation (upward)?

A

Lower and upper trapezius, serratus anterior

448
Q

Which muscles perform medial scapular rotation? (downward)

A

Pectoralis minor, rhomboids, levator scapulae

449
Q

What are some common risk factors for carpal tunnel syndrome?

A

TRAMP; trauma, rheumatoid arthritis, acromegaly, myxoedema, pregnancy

450
Q

Which myotome performs abduction of the arm at the glenohumeral joint?

A

C5

451
Q

Which myotome performs flexion of the forearm at the elbow joint?

A

Primarily C6 (some C5)

452
Q

Which myotome performs extension of the forearm at the elbow joint?

A

Mainly C7 (some 6/8)

453
Q

Which myotome performs flexion of the forearm of the fingers?

A

C8

454
Q

Which myotome performs abduction and adduction of the index, middle and ring fingers?

A

T1

455
Q

What type of bones are the carpals?

A

Irregular

456
Q

What are the nerve roots of the pectoral nerves?

A

C7, C8, T1

457
Q

Which structures does the coracoid process compress when the arm is abducted?

A

Anterior to posterior; subclavian vein, subclavian artery, cords of the brachial plexus

458
Q

What is the action of the pectoralis minor?

A

Depresses the shoulder tip (infermedial rotation of the scapula)

459
Q

Which structures are contained with the axillary sheath?

A

Axillary artery, axillary vein and cords and branches of the brachial plexus

460
Q

Which muscles form the anterior axillary fold?

A

Mostly pectoralis major (pectoralis minor adds superiorly)

461
Q

Which muscles form the posterior axillary fold?

A

Teres major and latissimus dorsi

462
Q

In a female patient why would you be concerned about enlargement of lymph nodes in the axilla?

A

Axillary lymph receives from the breast; in breast carcinoma, malignant cells may enter the lymph and produce enlargement

463
Q

Which important vein lies immediately posterior to the sternoclavicular joint?

A

Brachiocephalic vein

464
Q

Which parts of the brachial plexus are most at risk to injury as a result of a clavicular fracture?

A

Trunks and divisions

465
Q

How would you acutely assess motor function of a person with a clavicular fracture, with suspected nerve damage

A

Don’t! You’ll get sued…

466
Q

What would be observable differences in determining whether an artery or vein is ruptured as a result of trauma?

A

Artery may show pulsatile release of blood from an open wound; if there was damage to a major artery the patient would most likely be unconscious and dying; vein rupture would be non-pulsatile, patient conscious, haematoma forming

467
Q

Describe the location of the brachial artery in relation to the median nerve in the upper arm and cubital fossa

A

Upper arm it is medial to the median nerve; in the cubital fossa it lies lateral

468
Q

What lies immediately anterior to the brachial artery and median nerve in the cubital fossa?

A

Bicipital aponeurosis; collagen from distal radial tendon, passing obliquely across cubital fossa and merging with fascia of flexors

469
Q

What is the cubital tunnel?

A

Formed by tendinous arch joing humeral and ulnar heads of the attachment of flexor carpi ulnaris; the median nerve enters the forearm through it

470
Q

What clinical term is given to describe numbness and tingling? What clinical term is used to describe loss of feeling or sensation?

A

Paraesthesia; anaesthesia is loss of feeling or sensation

471
Q

What is the most common direction of humeral dislocation at the glenohumeral joint?

A

Weakest at inferior aspect, so dislocates in this direction but ends up anterior due to pull of muscles

472
Q

What would be seen in clinical examination as a result or a torn supraspinatus tendon?

A

Failure of abduction in first 15 degrees, when lowering fully abducted arm slowly and smoothly, the limb suddenly drops

473
Q

Why can the upper limb become swollen with lymphatic fluid following axillary clearance?

A

Excision of the axillary lymph and lymphatic vessels leads to disturbance of the normal lymphatic drainage of the upper limb; the lymph nodes in the axilla receive lymph from the whole of the upper limb

474
Q

Which myotome performs adduction at the shoulder?

A

C6, C7, (C8)

475
Q

Which myotome performs pronation?

A

C7, C8

476
Q

Which myotome performs supination?

A

C6

477
Q

Where is the axis of rotation in movements of pronation and supination

A

The axis passes longitudinally along the head of the radius (proximally) and through the distal radio-ulnar joint at the wrist

478
Q

What is a ‘pulled’ elbow? Describe what happens

A

Subluxation or dislocation of the articulating surface of the bones forming the proximal radio-ulnar joint; the injury results when a person is lifted by the upper limb with the forearm in a pronated position; the pulling of the upper limb tears the distal attachment of the annular ligament (surrounding the radial head) where it is loosely attached to the neck of the radius; the radial head moves distally and out of the torn ligament

479
Q

Why is a ‘pulled’ elbow more common in children?

A

The radial head an annular ligament have not fully formed

480
Q

Why is supination more powerful than pronation?

A

Strength of the biceps brachii is greater than the pronators

481
Q

What will avascular necrosis of the scaphoid (weeks after injury) look like on X-ray?

A

The proximal segment will look less opaque as it is being resorbed

482
Q

Which bony structure can be palpated around the elbow?

A

Medial and lateral epicondyles, olecranon process of ulna and head of radius

483
Q

Why would a superficial laceration at the wrist result in loss of sensory function of the palm only?

A

Damage to palmar cutaneous branch of median nerve (may also be ulnar nerve damage); digits supplied by digital branch that arises after passage through carpal tunnel

484
Q

What is the common action of the lumbricals and interossei muscles?

A

Flexion at MCP and extension as IP joints

485
Q

What is inflammation of a tendon and it’s synovial sheath known as?

A

Tenosynovitis

486
Q

Why can swelling proximal to the wrist joint be linked to infection in the tip of the thumb or little finger?

A

The synovial tendon sheath of the thumb and 4th finger are continuous with the common flexor synovial sheath; the 1st, 2nd, and 3rd fingers normmaly have separate synovial sheaths

487
Q

Where is the most reliable area for testing sensation of the radial nerve in the hand?

A

Small area on the first interdigital webspace, on the dorsum of the hand

488
Q

What are the medial and lateral attachments of the flexor retinaculum?

A

Medially attached to the pisiform and hook of hamate; laterally attached to the tubercle of the scaphoid and trapezium bones

489
Q

Give causes of carpal tunnel syndrome

A

Tenosynovitis (thickening of synovium), repetitive trauma (compression forces and stretching), oedema, fractures, dislocations, inherited small bone fractures

MSK (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions