Upper Limb Flashcards
Shoulder bones
- Clavicle
2. Scapula
Arm bones
- Humerus
- Ulna
- Radius
Hand bones
1. Carpals (SLTPTTCH) A. Scaphoid B. Lunate C. Triquetrum D. Pisiform E. Trapezium F. Trapezoid G. Capitate H. Hamate 2. Metacarpals 3. Phalanges
Synovial joint types
- Hinge
- Pivot
- Condyloid
- Saddle
- Ball and socket
- Plane
Hinge joint
Uniaxial
- Convex/concave
- Restricted flexion/extension
* ex: talocrural and humeroradial
Pivot joint
Uniaxial
- Rotation
- Round surface articulating w/ ring
* ex: radial-ulnar
Condyloid joint
Biaxial
- Flexion/extension
- Adduction/abduction
- Oval surface in elliptical socket
* ex: metacarpophalangeal
Saddle joint
Biaxial
- Flexion/extension
- Adduction/abduction
- Both convex/concave surfaces on both sides
* only example: thumb
Ball and socket joint
Multiaxial
- Round head in concave socket
* ex: hip and shoulder
Plane joint
Multiaxial
- Gliding out w/ flat articulating surface
* ex: tarsals, carpals, zygapophyseal
Shoulder joints
- Acromioclavicular (AC)
2. Glenohumeral
Acromioclavicular joint (AC)
Ligaments
- Coracromial
- Acromioclavicular
- Coracoclavicular
Glenohumeral joint
- Coracoacromial arch
- Glenoid labrum
- Ligaments:
A. Coroacromial
B. Coracohumeral (inc. SA)
C. Glenohumeral- Superior
- Middle
- Inferior
Elbow joints
- Humeroradial (hinge)
- Humeroulnar (hinge)
- Radioulnar (pivot)
- Ligaments:
A. Radial collateral lig
B. Joint capsule
C. Anularligament
D. Ulnar collateral- Posterior
- Anterior
- Transverse
Hand joints
- Distal radioulnar (pivot)
- Interphalangeal (IP)
A. Distal (DIP)
B. Proxmal (PIP) - Metacarpophalangeal (MCP)
- Carpoteacarpal (CMC)
- Midcarpal
- Radiocarpal (condyle)
- Thenar (saddle)
Muscle compartments
- Anterior: anterior division of brachial plexus
A. Primary fxn: flexion and adduction- Medial rotation, pronation, supination (biceps)
- Posterior: posterior division of brachial plexus
A. Primary fxn: extension and abduction- Lateral rotation, supination
- Separated by fascias
A. Shoulder: clavipectoral, pectoral, and axillary fascias
B. Brachial fascia: medial and lateral intermuscular septa
C. Antebrachial fascia: medial and lateral intermuscular and interosseous septa
D. Hand: palmer fascia- Thenar and hypothenar compartments
- No posterior compartment
Axillary fascia
- Superficial thoracic fascia
- Clavipectoral fascia
- Axillary fascia
Anterior shoulder muscles
- Pectoralis major
- Pectoralis minor
- Subclavius
- Serratus anterior
Pectoralis major
- Fxn: adduction, medial rotation, flexion, assists w/ respiration when shoulder fixed
- Prox: medial clavicle, sternum, costal cartilages 1-6, rectus sheath
- Distal: greater tuberosity (humerus)
- Innervation: medial (C8-T1), lateral (C5-C7), and pectoral n.
- Supply: thoracoacromial a. And lateral thoracic a.
Pectoralis minor
- Fxn: draws scapula downward, rotated glenoid inferiority, assists in respiration
- Prox: ribs 3-5
- Distal: coracoid process
- Innervation: medial pectoral n. (C8-T1)
- Supply: thoracoacromial a. And lateral thoracic a.
Subclavius
- Fxn: steadies sternoclavicular joint
- Post: 1st rib
- Distal: inferior clavicle
- Innervation: nerve to subclavius (C5-C6)
- Supply: thoracoacromial a. (Clavicular branch)
Serratus anterior
- Fxn: protracts and rotates shoulder
- Prox: medial border of scapula
- Distal: external surface of ribs 1-9
- Innervation: long thoracic n. (C5, C6, C7)
- Supply: lateral thoracic a.
Posterior shoulder muscles
- Deltoid
- Rotator cuff (SITS)
- Teres major
Deltoid
- Fxn: flexion, medial rotation, adduction, abduction, extension, lateral rotation
- Prox: lateral 1/3 clavicale, acromion, scapular spine
- Distal: deltoid tuberosity (humerus)
- Innervation: Axillary (C5, C6)
- Supply: posterior circumflex humeral a.
Teres major
- Fxn: medial rotation, adduction, extension
- Prox: inferior angle of scapula
- Distal: crest of lesser tubercle
- Innervation: lower subscapular n. (C6)
- Supply: subscapular a.
Rotator cuff
SITS
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis
Supraspinatus
- Fxn: abduction (first 15 degrees)
- Prox: supraspinous fossa
- Greater tubercle (humerus)
- Innervation: suprascapular n. (C5, C6)
- Supply: suprascapular a.
Infraspinatus
- Fxn: lateral rotation
- Prox: infraspinous fossa
- Distal: greater tubercle (humerus)
- Innervation: suprascapular n. (C5, C6)
- Supply: suprascapular a.
Teres minor
- Fxn: lateral rotation, weak adduction
- Prox: lateral border scapula
- Distal: greater tubercle (humerus)
- Innervation: axillary n. (C5, C6)
- Supply: circumflex scapular a.
Subscapularis
- Fxn: medial rotation
- Prox: subscapular fossa
- Distal: lesser tubercle (humerus)
- Innervation: subscapular n. (C5, C6)
- Supply: subscapular a.
Anterior arm muscles
- Biceps brachii
- Brachialis
- Coracobrachialis
Biceps brachii
- Long head
A. Fxn: elbow flexion and supination, shoulder flexion, abduction, and medial rotation
B. Prox: Supra glenoid tubercle (scapula)
C. Distal: radial tuberosity
D. Innervation: musculocutaneous n. (C5 - C7)
E. Supply: brachial a.
2. Short head A. Fxn: same as long head B. Prox: coracoid process C. Distal: radial tuberosity D. Innervation: musculocutaneous n. (C5-C7)
Brachialis
- Fxn: elbow flexion
- Prox: distal 1/2 anterior humerus
- Distal: ulnar tuberosity
- Innervation: musculocutaneous (C5-C7), radial n. (C5-C8)
- Supply: brachial a.
Coracobrachialis
- Fxn: flexion, adduction, medial rotation
- Prox: coracoid process
- Distal: crest of lesser tubercle (humerus)
- Innervation: musculocutaneous (C5-C7)
- Supply: brachial a.
Posterior arm muscles
- Triceps brachii
2. Anconeus
Triceps brachii
Long, medial, and lateral heads
1. Fxn: elbow extension, shoulder extension and adduction
- Prox: infraglenoid tuberacle (scapula) and posterior humerus
- Distal: olecranon (ulna)
- Innervation: radial n. (C5-C8)
- Supply: deep brachial a.
Anconeus
- Fxn: extends elbow and tightens joint
- Prox: lateral epicondyle (humerus)
- Distal: olecranon (ulna)
- Innervation: radial n. (C5-C8)
- Supply: deep brachial a.
Quadrangular space
- Contains:
A. Axillary n.
B. Posterior circumflex humeral a.
2. Borders: A. Teres minor (superior) B. Teres major (inferior) C. Long head triceps brachii (medial) D. Humerus (lateral)
Triangular space
- Contains:
A. Scapular circumflex a. - Borders:
A. Teres minor (superior)
B. Teres major (inferior)
C. Long head triceps brachii (lateral)
Triceps hiatus
- Contains:
A. Radial n.
B. Deep brachial a. - Borders:
A. Teres minor (superior)
B. Long head triceps brachii (medial)
C. Humerus (lateral)
Anterior forearm muscles
- Flexor carpi radialis
- Palmaris longus (variable)
- Flexor carpi ulnaris (2 heads)
- Pronator teres (2 heads)
- Flexor digitorum superficialis (2 heads)
- Flexor digitorum profundus
- Flexor pollicis longus
- Pronator quadratus
Pronator teres
Humeral and ulnar heads
1. Fxn: elbow flexion (weak), forearm pronation
- Prox: medial epicondyles, coronoid process
- Distal: lateral radius
- Innervation: median n. (C6-T1)
- Supply: anterior ulnar recurrent a.
Flexor carpi radialis
- Fxn: wrist flexion and abduction
- Prox: medial epicondyle
- Distal: Base MC 2
- Innervation: median n. (C6-T1)
- Supply: radial a.
Palmaris longus
- Fxn: elbow flexion (weak), tightens palmar aponeurosis
- Prox: medial epicondyle
- Distal: palmar aponeurosis
- Innervation: median n. (C6-T1)
- Supply: posterior ulnar recurrent a.
Flexor carpi ulnaris
Humeral and ulnar heads
1. Fxn: wrist flexion and adduction
- Prox: medial epicondyle and olecranon (ulna)
- Distal: pisiform, hook of hamate, and base MC 5
- Innervation: ulnar n. (C8-T1)
- Supply: posterior ulnar recurrent a.
Flexor digitorum superficialis
Humeroulnar and radial heads
1. Fxn: elbow flexor (weak), wrist flexion, MCP and PIP flexion digits 2-5
- Prox: medial epicondyle and proximal radius
- Distal: middle phalanges 2-5
- Innervation: median n. (C6-T1)
- Supply: radial and ulnar a.
Flexor digitorum profundus
- Fxn: wrist flexion, MCP, PIP, and DIP flexion of digits 2-5
- Prox: prox 2/3 ulna and interosseous membrane
- Distal: distal phalanges digits 2-5
- Innervation: median n. (C6-T1) and ulnar n. (C8-T1)
- Supply: ulnar a.
Flexor pollicis longus
- Fxn: wrist flexion and abduction, flexion of CMC, MCP, IP of digit 1
- Prox: radius and interosseous membrane
- Distal: distal phalanx digit 1
- Innervation: median (C6-T1)
- Supply: radial a. And interosseous a.
Pronator quadratus
- Fxn: hand pronation
- Prox: distal 1/4 ulna
- Distal: distal 1/4 radius
- Innervation: median n. (C6-T1)
- Supply: interosseous a.
Posterior forearm muscles
- Brachioradialis
- Extensor carpi radialis longus
- Extensor carpi radialis brevis
- Extensor digitorum
- Extensor carpi ulnaris (2 heads)
- Extensor digiti minimi
- Supination
- Abductor pollicis longus
- Extensor pollicis longus
- Extensor pollicis brevis
- Extensor indicis
Brachioradialis
- Fxn: elbow flexion, forearm pronation
- Prox: distal humerus
- Distal: styloid process (radius)
- Innervation: radial (C5-C8)
- Supply: radial recurrent a.
Extensor carpi radialis longus
- Fxn: elbow flexion (weak), wrist extension and abduction
- Prox: lateral supreacondylar ridge
- Distal: Base MC 2
- Innervation: radial n. (C5–C8)
- Supply: radial and radial recurrent a.
Extensor carpi radialis brevis
- Fxn: elbow flexion (weak), wrist extension an abduction
- Prox: lateral epicondyle
- Distal: base MC 3
- Innervation: radial n. (C5-C8)
- Supply: radial and radial recurrent a.
Extensor digitorum
- Fxn: wrist extension, MCP, POP, DIP extension digits 2-5 and abduction fingers
- Prox: lateral epicondyle
- Distal: dorsal digital expansion of digits 2-5
- Innervation: Radial n. (C5-C8)
- Supply: posterior interosseous a.
Extensor digiti minimi
- Fxn: wrist extension and abduction, MCP, PIP, DIP, extension and abduction digit 5
- Prox: lateral epicondyle
- Distal: dorsal digital expansion of digit 5
- Innervation: radial n. (C5-C8)
- Supply: posterior interosseous a.
Extensor carpi ulnaris
- Fxn: wrist extension and adduction
- Prox: lateral epicondyle
- Distal: base MC 5
- Innervation: radial n. (C5-C8)
- Supply: posterior interosseous a.
Abductor pollicis longus
- Fxn: wrist and CMC (digit 1) abduction
- Prox: posterior ulna And radius
- Distal: base MC 1
- Innervation: radial (C5-C8)
- Supply: posterior interosseous a.
Extensor pollicis longus
- Fxn: wrist extension and abduction, CMC adduction (digit 1), MCP, IP extension (digit 1)
- Prox: posterior ulna
- Distal: base of distal phalanx (digit 1)
- Innervation: radial n. (C5-C8)
- Supply: posterior interosseous a.
Extensor pollicis brevis
- Fxn: wrist abduction, CMC and MCP extension (digit 1)
- Prox: posterior radius
- Distal: base of proximal phalanx (digit 1)
- Innervation: radial n. (C5-C8)
- Supply: posterior interosseous a.
Extensor indicis
- Fxn: wrist extension, MCP, PIP, DIP extension (digit 2)
- Prox: posterior ulna
- Distal: posterior digital expansion digit 2
- Innervation: radial n. (C5-C8)
- Supply: posterior interosseous a.
Supinator
- Fxn: supination
- Prox: olecranon, lateral epicondyle
- Distal: proximal radius
- Innervation: radial n. (C5-C8)
- Supply: radial and posterior interosseous a.
Anterior hand muscles
1. Superficial thenar A. Adductor pollicis transverse B. Adductor pollicis oblique C. Abductor pollicis brevis 2. Superficial hypothenar muscles A. Abductor digiti minimi B. Opponens digiti minimi 3. Deep thenar A. Flexor pollicis brevis B. Opponens pollicis 4. Deep hypothenar A. Flexor digiti minimi brevis 5. Lumbricals 6. Palmer interossei 7. Dorsal interossei
Adductor pollicis
Transverse and oblique heads
1. Fxn: adduction CMC (thumb), flexion of MCP (digit 1)
- Prox: MC3, capitate, bases MC 2 and 3
- Distal: base proximal phalanx 1
- Innervation: ulnar n. (C8-T1)
- Supply: deep palmar arch
Abductor pollicis brevis
- Fxn: abduction CMC (digit 1)
- Prox: scaphoid, trapeze, flexor retinaculum
- Distal: base proximal phalanx digit 1
- Innervation: recurrent branch median n.
- Supply: superficial palmar branch of radial artery
Flexor pollicis brevis
Superficial and deep heads
1. Fxn: flexion of CMC (digit 1)
- Prox: flexor retinaculum, capitate, trapezium
- Distal: base of proximal phalanx digit 1
- Innervation: median (C6-T1) and ulnar (C8-T1)
- Supply: superficial palmar branch of radial a.
Opponens pollicis
- Fxn: opposition of CMC (digit 1)
- Prox: trapezium
- Distal: MC 1
- Innervation: recurrent branch of median n. (C6-T1)
- Supply: superficial palmar branch of radial a.
Opponens digiti minimi
- Fxn: draws MC w/in palm during opposition
- Prox: hook of hamate, flexor retinaculum
- Distal: MC 5
- Innervation: ulnar n. (C8-T1)
- Supply: deep palmar branch and deep carpal branch of ulnar a.
Flexor digiti minimi
- Fxn: flexion of MCP digit 5
- Prox: hook of hamate, flexor retinaculum
- Distal: base of proximal phalanx digit 5
- Innervation: ulnar n. (C8-T1)
- Supply: deep palmar br. And deep carpal br. Of ulnar a.
Abductor digiti minimi
- Fxn: flexion and abduction of MCP, extension PIP and DIP digit 5
- Prox: pisiform
- Distal: proximal phalanx and dorsal digital expansion digit 5
- Innervation: ulnar n. (C8-T1)
- Supply: deep palmar br. And deep carpal br. Of ulnar a.
Palmaris brevis
- Fxn: tightens palmar aponeurosis
- Prox: palmar aponeurosis
- Distal: skin of hypothenar eminence
- Innervation: ulnar (C8-T1)
- Supply: superficial palmar arch
1st lumbrical
- Fxn: flexion MCP digits 2-5, extension proximal and distal IP digits 2-5
- Prox: flexor digitorum profundus tendon (radial side)
- Distal: 2nd dorsal digital expansion
- Innervation: median n. (C6-T1)
- Supply: deep palmar arch
2nd lumbrical
- Fxn: flexion MCP, extension PIP and DIP digits2-5
- Prox: flexor digitorum profundus tendon (radial side)
- Distal: 3rd dorsal digital expansion
- Innervation: median n. (C6-T1)
- Supply: deep palmar arch
3rd lumbrical
- Fxn: flexion MCP, extension PIP and DIP digits 2-5
- Prox: flexor digitorum profundus tensor (medial and lateral sides)
- Distal: 4th dorsal digital expansion
- Innervation: ulnar n. (C8-T1)
- Supply: deep palmar arch
4th lumbrical
- Fxn: flexion MCP, extension PIP and DIP digits 2-5
- Prox: flexor digitorum tensor (medial and lateral sides)
- Distal: 5th dorsal digital expansion
- Innervation: ulnar (C8-T1)
- Supply: deep palmar arch
1st palmar interossei
- Fxn: flexion MCP digits 2,4,5; extension and adduction PIP and DIP digits toward digit 3
- Prox: MC 2 (ulnar side)
- Distal: 2nd dorsal digital expansion and base proximal phalanx 2
- Innervation: ulnar n. (C8-T1)
- Supply: deep palmar arch
2nd palmar interossei
- Fxn: flexion MCP digits 2,4,5; extension and adduction PIP and DIP digits toward digit 3
- Prox: MC 4 (radial side)
- Distal: 4th dorsal digital expansion and base proximal phalanx 4
- Innervation: ulnar n. (C8-T1)
- Supply: deep palmar arch
3rd palmar interossei
- Fxn: flexion MCP digits 2,4,5; extension and adduction PIP and DIP digits toward digit 3
- Prox: MC 5 (radial side)
- Distal: 5th dorsal digital expansion and base proximal phalanx 5
- Innervation: ulnar n. (C8-T1)
- Supply: deep palmar arch
1st dorsal interossei
- Fxn: flexion MCP digits 2-4, extension and abduction PIP and DIP digits away from digit 3
- Prox: MC 1 and 2
- Distal: 2nd dorsal digital expansion and radial side proximal phalanx 2
- Innervation: ulnar n. (C8-T1)
- Supply: Deep palmar arch
2nd dorsal interossei
- Fxn: flexion MCP digits 2-4, extension and abduction PIP and DIP digits away from digit 3
- Prox: MC 2 and 3
- Distal: 3rd dorsal digital expansion and radial side proximal phalanx 3
- Innervation: ulnar n. (C8-T1)
- Supply: Deep palmar arch
3rd dorsal interossei
- Fxn: flexion MCP digits 2-4, extension and abduction PIP and DIP digits away from digit 3
- Prox: MC 3 and 4
- Distal: 3rd dorsal digital expansion and radial side proximal phalanx 3
- Innervation: ulnar n. (C8-T1)
- Supply: Deep palmar arch
4th dorsal interossei
- Fxn: flexion MCP digits 2-4, extension and abduction PIP and DIP digits away from digit 3
- Prox: MC 4 and 5
- Distal: 4th dorsal digital expansion and radial side proximal phalanx 4
- Innervation: ulnar n. (C8-T1)
- Supply: Deep palmar arch
Anterior hand fascia
- Flexor retinaculum (carpal tunnel)
2. Extensor retinaculum
Erb-Duchenne Palsy
- Lesion: C5-C6
- Impacts: anterior and posterior branches of upper trunk
A. Axillary
B. Musculocutaneous
C. Suprascapular
D. Connected peripheral n. Sometimes - Symptoms: all muscles w/ C5/C6 innervation
A. Paralysis of abductors and lateral rotators of shoulder
B. Paralysis of elbow flexors and forearm supinators - Clinical appearance
A. “Waiter’s tip”
B. Deltoid atrophy- arm hangs at side
C. Medial rotation of arm
D. Pronation of forearm
E. Flexed wrist and fingers
F. Sensory loss: shoulder and lateral arm and hand
Klumpke paralysis
- “Strap-hanger’s” syndrome
- Lesion: C8-T1
- Impact: lower trunk
A. Ulnar and median (partial) nerves - Symptoms: loss to intrinsic muscles of hands (flexors) and weakness extrinsic hand flexors
- Clinical appearance:
A. “Claw hand”
B. Atrophy forearm flexors, pronators, and intrinsic hand muscles
C. Arm supination
D. Sensory loss medial arm, forearm, hand
Horner’s syndrome
- Loss T1 sympathetics
- Affects eyes:
A. Miosis - dilation
B. Ptosis - drooping
C. Anhidrosis - not sweat glands