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OSPE > Upper limb > Flashcards

Upper limb Flashcards

1
Q

what is the only bony articulation b/ upper limb and rest of skeleton?

A

sternoclavicular joint

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2
Q

what is the acromioclavicular joint?

A
  • synovial joint

- articulation b/ acromion and clavicle

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3
Q

what stabilises the acromioclavicular joint?

A

acromioclavicualr, conoid, trapezoid ligaments

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4
Q

what is protraction of the scapula?

A

scapula moves anteriorly and laterally

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5
Q

what is retraction of the scapula?

A

scapula moves posteriorly and medially

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6
Q

what is medial rotation of the scapula?

A

results in medial rotation of upper limb (from the arm)

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7
Q

what is the glenohumeral joint?

A
  • ball and socket
  • synovial joint
  • head of humerus and glenoid cavity
  • one of the most highly mobile joints in body (at cost of joint stability)
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8
Q

describe the elbow joint

A
  • synovial joint
  • motion in only one plane
  • trochlea of humerus with trochlear notch of ulna
  • capitulum of humerus with head of radius
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9
Q

what movements does the elbow allow?

A
  • flexion

- extension

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10
Q

what is the difference between pronation and supination?

A

Pronation - palm towards Pavement

Supination - turning palm towards Sky

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11
Q

where do the radius and ulna articulate with each other?

A
  • proximal radio-ulnar joint

- distal radio-ulnar joint

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12
Q

describe the proximal radio-ulnar joint

A
  • head of radius
  • radial notch of ulna
  • not part of elbow joint but shares same articular capsule
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13
Q

describe the distal radio-ulnar joint

A
  • head of ulna
  • ulnar notch of radius
  • has an articular disc (stabilises joint when radius pivots round ulna)
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14
Q

why is the wrist joint known as the radiocarpal joint?

A
  • ulna not part of wrist joint
  • separated by articular disc
  • only articulates with ulnar notch of radius distally
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15
Q

why is the pisiform a sesamoid bone?

A
  • embedded in the tendon of the flexor carpi ulnaris

- does not take part in formation of wrist joint

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16
Q

what goes through the carpal tunnel?

A
  • 4 tendons of flexor digitorum profundus
  • 4 tendons of flexor digitorum superficialis
  • tendon of flexor pollicis longus
  • median nerve
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17
Q

what forms the carpal tunnel?

A
  • carpal bones

- flexor retinaculum (strong fibrous band)

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18
Q

where does the flexor retinaculum attach?

A
  • scaphoid and trapezium bones on radial side

- pisiform and hook of Hamate on ulnar side

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19
Q

what is carpal tunnel syndrome?

A
  • 1 or more of the flexor tendons swells
  • further narrows canal
  • entrapment and compression of median nerve
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20
Q

what does pec major do?

A

adducts, flexes, medially rotates humerus

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21
Q

where does pec major arise?

A
  • medial half of clavicle
  • superior sixth CC
  • aponeurosis of external oblique
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22
Q

where does pec major insert?

A

into lateral lip of intertubercular sulcus

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23
Q

what is pec major innervated by?

A

medial and lateral pectoral nerve

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24
Q

how do you test the pec major?

A
  • ask pt to adduct their arm while their elbow is flexed against resistance
  • feel the action of pec major by placing your hand on the chest
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25
Q

what innervates pec minor?

A

medial pectoral nerve

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26
Q

what does pec minor do?

A

stabilises the scapula

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27
Q

where does pec minor originate?

A

anterior surface of ribs 3-5

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28
Q

where does pec minor insert?

A

coracoid process of scapula

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29
Q

where does the subclavius arise?

A

first costochondral joint

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30
Q

where does the subclavius insert?

A

middle third of clavicle

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31
Q

what does the subclavius do?

A

stabilises and depresses clavicle

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32
Q

where does the serratus anterior arise from?

A

lateral aspects of ribs 1-8

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33
Q

where does the serratus anterior insert?

A

medial border of scapula

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34
Q

what does the serratus anterior do?

A
  • laterally rotates scapula

- protracts the scapula against ribcage

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35
Q

what is the serratus anterior innervated by?

A

long thoracic nerve

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36
Q

what happens when the long thoracic nerve is damaged?

A
  • serratus anterior can’t hold scapula in protracted state against ribcage
  • it protrudes
  • winging of scapula
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37
Q

how do test the serratus anterior?

A
  • ask pt to push their arm out
  • feel action of serratus anterior
  • place hand on posterolateral side of chest and resist them pushing their arm out
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38
Q

where does latissimus dorsi insert?

A

intertubercular groove of humerus (between pec major and teres major)

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39
Q

where does latissimus dorsi originate?

A
  • vertebrae T7-T12
  • iliac crest
  • ribs 9-12
  • inferior angle of scapula
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40
Q

what innervates the latissimus dorsi?

A

long scapular nerve

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41
Q

what are the function of the latissimus dorsi?

A

extend, adduct, medially rotate upper limb

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42
Q

how do you test the latissimus dorsi?

A
  • pt adduct arm while elbow is flexed against resistance

- stand behind pt and feel action

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43
Q

what are the 3 parts of the trapezius?

A
  • descending
  • transverse
  • ascending
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44
Q

where does the trapezius originate?

A
  • occipital bone
  • nuchal ligament
  • spinoud processes of C7-T12
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45
Q

where does trapezius insert?

A
  • clavicle
  • acromion
  • scapular spine
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46
Q

what is the function of the trapezius?

A
  • elevate and rotate scapula
  • retract scapula
  • depress scapula
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47
Q

what innervates the trapezius?

A

accessory nerve

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48
Q

how do you test the trapezius?

A

raise shoulders against resistance

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49
Q

where does levator scapulae originate?

A

transverse processes of C1-C4

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50
Q

where does levator scapulae attach?

A

medial border of scapula

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51
Q

what innervates the levator scapulae?

A

dorsal scapular nerve

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52
Q

what is the function of levator scapulae?

A

helps elevation of scapula

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53
Q

where does rhomboid major originate?

A
  • spinous processes of T2-T5

- attaches to medial border of scapula

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54
Q

what innervates the rhomboid major?

A

dorsal scapular nerve

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55
Q

what does the rhomboid major do?

A

retracts and medially rotates scapula

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56
Q

where does the rhomboid minor originate?

A
  • spinous processes of C7-T1
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57
Q

where does the rhomboid minor attach?

A

medial border of scapula

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58
Q

what does the rhomboid minor do?

A

retraction and medial rotation of scapula

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59
Q

what innervates rhomboid minor?

A

dorsal scapular nerve

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60
Q

what are the intrinsic shoulder muscles?

A
  • deltoid
  • teres major
  • rotator cuff muscles
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61
Q

in general where do the intrinsic shoulder muscles originate and attach to?

A

originate from scapula/clavicle

attach to humerus

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62
Q

where does the deltoid originate?

A
  • acromion
  • spine of scapula
  • lateral third of clavicle
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63
Q

what does the deltoid do?

A

main abductor of arm

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64
Q

what innervates deltoid?

A

axillary nerve

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65
Q

where does the deltoid insert?

A

deltoid tuberosity

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66
Q

how do you test the function of the deltoid?

A
  • pt needs to flex elbow and raise their arm to the side

- resist abduction of arm and feel deltoid

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67
Q

where does teres major originate?

A

lateral aspect of inferior angle of scapula

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68
Q

where does teres major insert?

A

medial lip of intertubercular sulcus

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69
Q

what are the functions of the teres major?

A

adduct, retract, medially rotate humerus

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70
Q

what innervates the teres major?

A

lower subscapular nevre

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71
Q

where do all the rotator cuff muscles (RCM) attach?

A

to the tubercles of the humerus to stabilise glenohumeral joint

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72
Q

what is different about the subscapularis?

A
  • only RCM to originate anteriorly to scapula at subscapular fossa
  • only RCM to attach to lesser tubercle of humerus
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73
Q

what does the subscapularis do?

A

medially rotates the arm

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74
Q

what innervates the subscapularis?

A

upper and lower subscapular nerves

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75
Q

where does the supraspinatous originate? what innervates it?

A
  • supraspinous fossa of scapula

- suprascapular nerve

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76
Q

what is the function of the supraspinatous?

A

main abductor of humerus for first 15 degrees

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77
Q

where does the infraspinatous originate? what innervates it?

A
  • infraspinous fossa of scapula

- suprascapular nerve

78
Q

what is the function of infraspinatous?

A

laterally rotate arm

79
Q

where does the teres minor originate and insert?

A
  • originate: lateral border of scapula

- insert: greater tubercle

80
Q

what innervates the teres minor?

A

axillary nerve

81
Q

what is the function of the teres minor?

A

laterally rotate humerus

82
Q

what muscles are the anterior muscles of the arm?

A
  • biceps brachii
  • brachialis
  • coracobrachialis
83
Q

what are the anterior muscles of the arm innervated by and supplied by?

A

musculocutaneous nerve

brachial artery

84
Q

what does the biceps brachii do?

A
  • superficial flexor

- mian supinator of forearm

85
Q

where does the short head originate from?

A

coracoid process of scapula

86
Q

where does the long head orignate from?

A
  • supraglenoid tubercle of scapula
  • descends down humerus through intertubercular groove
  • merges with short head
87
Q

where does the biceps brachii attach?

A

radial tuberosity

88
Q

how do you test the function of the biceps brachii?

A
  • flex elbow against resistance

- stabilise elbow joint

89
Q

what are the intrinsic shoulder muscles?

A
  • deltoid
  • teres major
  • rotator cuff muscles
90
Q

where does brachialis attach?

A

distally to ulnar tuberosity

91
Q

where does the deltoid originate?

A
  • acromion
  • spine of scapula
  • lateral third of clavicle
92
Q

what does the deltoid do?

A

main abductor of arm

93
Q

what innervates deltoid?

A

axillary nerve

94
Q

where does the deltoid insert?

A

deltoid tuberosity

95
Q

how do you test the function of the deltoid?

A
  • pt needs to flex elbow and raise their arm to the side

- resist abduction of arm and feel deltoid

96
Q

where does teres major originate?

A

lateral aspect of inferior angle of scapula

97
Q

where does teres major insert?

A

medial lip of intertubercular sulcus

98
Q

what are the functions of the teres major?

A

adduct, retract, medially rotate humerus

99
Q

what innervates the teres major?

A

lower subscapular nevre

100
Q

where do all the rotator cuff muscles (RCM) attach?

A

to the tubercles of the humerus to stabilise glenohumeral joint

101
Q

what is different about the subscapularis?

A
  • only RCM to originate anteriorly to scapula at subscapular fossa
  • only RCM to attach to lesser tubercle of humerus
102
Q

what does the subscapularis do?

A

medially rotates the arm

103
Q

what innervates the subscapularis?

A

upper and lower subscapular nerves

104
Q

where does the pronator teres attach?

A

pronator tuberosity on lateral spect of shaft of radius

105
Q

what is the function of the supraspinatous?

A

main abductor of humerus for first 15 degrees

106
Q

where does the infraspinatous originate? what innervates it?

A
  • infraspinous fossa of scapula

- suprascapular nerve

107
Q

what is the function of infraspinatous?

A

laterally rotate arm

108
Q

what does FCR do?

A

flexion, abduction of wrist

109
Q

what innervates the teres minor?

A

axillary nerve

110
Q

what is the function of the teres minor?

A

laterally rotate humerus

111
Q

what muscles are the anterior muscles of the arm?

A
  • biceps brachii
  • brachialis
  • coracobrachialis
112
Q

what are the anterior muscles of the arm innervated by and supplied by?

A

musculocutaneous nerve

brachial artery

113
Q

what does the biceps brachii do?

A
  • superficial flexor

- mian supinator of forearm

114
Q

where does the short head originate from?

A

coracoid process of scapula

115
Q

where does the long head orignate from?

A
  • supraglenoid tubercle of scapula
  • descends down humerus through intertubercular groove
  • merges with short head
116
Q

where does the biceps brachii attach?

A

radial tuberosity

117
Q

how do you test the function of the biceps brachii?

A
  • flex elbow against resistance

- stabilise elbow joint

118
Q

what is the origin of the brachialis?

A

middle of humeral shaft

119
Q

where does brachialis attach?

A

distally to ulnar tuberosity

120
Q

what is the function of the brachialis?

A

main flexor of forearm

121
Q

what is the relationship b/brachialis and cubital fossa?

A

brachialis is the floor of the cubital fossa

122
Q

where do the brachialis and coracobrachialis lie compared to the biceps brachii?

A

deep

123
Q

where does the coracobrachialis originate?

A

coracoid process of scapula

124
Q

what does the coracobrachialis do?

A

assist in flexion and adduction of humerus

125
Q

what is the only muscle in the posterior compartment?

A

triceps brachii

126
Q

what is the triceps brachii made up of?

A

3 heads that converge together to form a common tendon

common tendon inserts distally at olecranon of ulna

127
Q

where do the 3 heads originate?

A

Long head: infraglenoid tubercle

Medial and lateral head: posterior surface of humerus

128
Q

what does the triceps do?

A

extension of forearm

129
Q

what is the triceps innervated by?

A
  • radial nerve
130
Q

how do you test the triceps?

A

Pt to extend elbow whilst resisting movement

stabilise elbow joint

131
Q

what are the superficial muscles of the anterior compartment of the forearm?

A
  • pronator teres
  • flexor carpi radialis
  • palmaris longus
  • felxor carpi ulnaris
132
Q

where does the pronator teres originate?

A

common flexor tendon at medial epicondyle of humerus

** point of origin for all superficial and intermediate flexors of forearm

133
Q

what does the pronator teres do?

A

pronate radius about ulna

134
Q

what is pronator teres innervated by?

A

median nerve

135
Q

where does FCR insert?

A

base of second and third metacarpal

136
Q

what does FCR do?

A

flexion, abduction of wrist

137
Q

where does palmaris longus attach? what does it do?

A
  • flexor retinaculum and palmar aponeurosis

- assist in flexion of wrist joint

138
Q

where does the FCU attach?

A
  • pisiform
  • hamate
  • base of 5th metacarpal (little finger)
139
Q

what is special about the innervation of FCU?

A

only superficial muscle that is not innervated by median nerve
innervated by ULNAR nerve

140
Q

what does FCU do?

A

flexion, ulnar deviation of wrist

141
Q

how do you test the superficial flexors of anterior forearm?

A
  • pt makes arms like a boxer and bend elbows in front of them
  • pt turns their wrists around and push down against resistance
  • must stabilise wrist
142
Q

what is in the intermediate layer of muscle within the anterior forearm?

A

only flexor digitorum superficialis

143
Q

where does the FDS originate?

A

2 heads which originate form common flexor tendon and radius

144
Q

what passes between the 2 heads of the FDS?

A

median nerve

ulnar artery

145
Q

what then happens when the FDS travels distally?

A
  • gives off 4 tendons at the wrist
  • these travel through carpal tunnel in common flexor sheath
  • attach to four intermediate phalanges of hand
146
Q

what does the FDS do?

A
  • flexion of wrist

- flexes metacarpophalangeal joints and proximal interphalangeal joints of last 4 digits

147
Q

what innervates the FDS?

A

median nerve

148
Q

how do you test the FDS?

A
  • pt flexes last 4 digits at interphalangeal joint against resistance
  • stabilise the medial four proximal interphalangeal joint
  • stabilise other digits
149
Q

where does the FPL originate?

A

shaft of radius and surrounding interosseous membrane

150
Q

where does the FPL attach?

A

base of distal phalanx of thumb

151
Q

what is the function of the FPL?

A

works in flexion of thumb interphalangeal joint

152
Q

where does the FDP originate?

A

ulna and associated interosseous membrane

153
Q

where does the FDP attach?

A

distal phalanges of last 4 digits

154
Q

what does the FDP function in?

A

flexion of distal interphalangeal joints, flexion of metacarpophalangeal joints

155
Q

what is FDP innervated by?

A
  • ulnar nerve (medial 2 tendons)

- median nerve (lateral 2 tendons)

156
Q

how do you test the FDP?

A

ask patient to flex their last 4 digits at distal interphalangeal joints against resistance

157
Q

where does the pronator quadratus originate?

A

distal aspect of ulnar shaft

158
Q

where does the pronator quadratus insert?

A

adjacent area of radial shaft

159
Q

what is the funciton of pronator quadratus

A

pronation of radius

160
Q

how do you test the pronator quadratus?

A

pronate forearm against resistance

161
Q

what are the superficial muscles of the posterior compartment of the forearm?

A
  • brachioradialis
  • extensor carpi radialis longus
  • extensor carpi radialis brevis
  • extensor digitorum
  • extensor digiti minimi
  • extensor carpi ulnaris
  • anconeus
162
Q

what is the main role of muscles in the posterior compartment of the forearm?

A

extensors of the wrist joint and joints of hand

all innervated by radial nerve

163
Q

why is the brachioradialis an anomaly in the posterior compartment?

A

it works to flex the elbow

164
Q

what is the anconeus? Where does it originate?

A

small triangle shaped muscle

originates from lateral epicondyle of humerus

165
Q

where does the anconeus insert?

A

into olecranon and posterior surface of ulna

166
Q

what are the muscles in the deep compartment of the forearm?

A
  • supinator
  • abductor pollicis longus
  • extensor pollicis brevis
  • extensor pollicis longus
  • extensor indicis
167
Q

what are the 2 tests for posterior compartment of the forearm?

A
  1. Extensors of wrist: pt flatten hand and extend wrist back against resistance
  2. Extensors of digits: pt places hands flat on table and raise fingers up
168
Q

what are the intrinsic muscles of the hand?

A
  • interossei
  • lumbricals
  • thenar muscles
  • hypothenar muscles
  • adductor pollicis
169
Q

where are the interossei muscles? What innervates them?

A

located between metacarpal bones

innervated by ulnar nerve

170
Q

where do the interossei originate and insert?

A

Originate: metacarpals
Insert: proximal phalanges of digit upon which they function

171
Q

what do the interossei do?

A

palmar interossei: deep on palmar side of hand, function to adduct digits at metacarpophalangeal
dorsal interossei: superficially on dorsal surface, abduct digits at metacarpophalangeal

172
Q

how do you test the palmar interossei?

A

place a piece of paper b/ each of the four medial digits and ask them to adduct digits and stop you pulling piece of paper b/ fingers

173
Q

how do you test the dorsal interossei?

A

ask pt to adduct each digit one by one while you provide resistance and stabilise metacarpophalangeal joint

174
Q

Where do the 4 lumbricals originate?

A

radial side of FDP tendons

175
Q

what is the function of the lumbricals?

A
  • flex metacarpophalangeal joints

- extend interphalangeal joint

176
Q

what innervates the lumbricals?

A
  • 2nd/3rd digits = median nerve

- 4th/5th digits = ulnar nerve

177
Q

what causes ulnar claw?

A
  • paralysis of medial 2 lumbricals due to ulnar neuropathy
178
Q

what are the thenar muscles?

A

located at base of thumb, produces a bulge = thenar eminence

179
Q

what do the thenar muscles do?

A

responsible for fine movements of thumb

180
Q

what innervates thenar muscles?

A

median nerve

181
Q

what are the 3 hypothenar muscles?

A
  • abductor digiti minimi
  • flexor digiti brevis
  • opponens digiti minimi
182
Q

what do the hypothenar muscles do?

A

fine control of little finger

183
Q

what forms the hypothenar eminence?

A

hypothenar muscles produce a bulge proximally and medially under little finger

184
Q

how do you test the thenar and hypothenar muscles?

A

tested together
ask pt to touch their thumb to their little finger as hard as they can
examiner try and disconnect thumb and finger

185
Q

where does the SCM originate?

A
  • sternal manubrium

- medial 1/3 of clavicle

186
Q

where does the SCM attach?

A

mastoid process of temporal bone

187
Q

what does the SCM do?

A

functoins to rotate head

188
Q

what does contraction of both SCMs result in?

A
  • flexion of neck

- extension of head at atlanto-occipital joint

189
Q

what innervates the SCM?

A

accessory nerve

190
Q

how do you test the function of the SCM?

A

place dorsal aspect of hand on pt cheek
ask pt ti run head to side of hand against resistance
palpate SCM at same time

191
Q

what are the 5 parts of the brachial plexus?

A 
roots
trunks
divisions
cords
branches

OSPE (8 decks)

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