Upper Limb Flashcards
bony features of the anterior surface of scapula
coracoid process
sub scapular fossa
glenoid cavity
bony features of the posterior surface of scapula
supraspinous fossa
infraspinous fossa
spine of scapula
acromion
which muscles attach to the medial border of the scapula
anterior serratus anterior posterior superior: levator scapulae middle (level of spine): rhomboid minor inferior: rhomboid major
which muscle attaches to the inferior angle of the scapula
latissimus dorsi
which muscle attaches to the spine of scapula
trapezius
which muscle attaches to the acromion
deltoid
which muscles attach to the coracoid process
short head of biceps and coracobrachialis
pec minor
what muscle attaches to the infraglenoid tubercle
long head triceps
where is the bicipital groove
between the greater and lesser tubercles
which muscles attach to the acromial end of clavicle
deltoid
trapezius
which muscle attaches to the central, inferior surface of clavicle
subclavius
which muscles attach to the sternal end of clavicle
pec major and sternocleidomastoid
attachments of pec major
clavicle, costal cartilage ribs 1-6 and sternum
TO outer lip bicipital groove
action of pec major
flexion and adduction of arm
medial rotation of humerus
innervation of pac major
medial (C8-T1) and lateral (C5-7) pectoral nerves from medial and lateral cords of brachial plexus
what is the general rule for the action of muscles in the upper limb
if it crosses the.... anterior surface it flexes posterior surface it extends medial surface it adducts lateral surface it abducts
attachments ofpec minor
ribs 3/4/5
TO coracoid process of scapula
action of pec minor
pulls shoulder anterior and inferior
elevates ribs if shoulder fixed (tripod stance)
innervation of pec minor
medial pectoral nerve (C8-T1) from medial cord of BP
attachments of serratus anterior
outer surface of upper 8 ribs
TO medial border of scapula
action of serratus anterior
protraction of scapula
innervation of serratus anterior
long thoracic nerve (C5,6,7) of BP
attachments of trapezius
superior nuchal ling of occipital bone, nuchal ligament, spinous processes of C7-T12
TO lateral third of clavicle, acromion and spine of scapula
action of trapezius
superior part: elevates scapula, rotates glenoid cavity
middle fibres: retract scapula
superior fibres: depress scapula
innervation of trapezius
sinal accessory nerve (CN XI)
cervical plexus C3,4 (pain)
attachments of latissimus dorsi
ilium, thoracolumbar fascia, spinous processes of lower 6 thoracic vertebrae
TO floor of bicipital groove
action of latissimus dorsi
extension medial rotation and adduction of arm
climbing/pull ups
innervation of latissimus dorsi
thoracodorsal nerve from posterior cord of brachial plexus (C6-8)
attachments of levator scapulae
transverse processes of atlas and axis, 3/4 cervical vertebrae
TO medial medial scapular border between superior angle and medial end of scapula spine
action of levator scapulae
help control scapular position, elevate shoulder (with trapezius)
if shoulder fixed, can laterally flex neck to same side
innervation of levator scapulae
direct C3,45 via dorsal scapular nerve
attachments of rhomboid major
2-5 thoracic spines
TO medial border of scapula (spine to inferior angle)
attachments of rhomboid minor
nuchal ligament and C7-T1 spines
TO medial end of spine of scapula
action of rhomboids
retraction of scapula
innervation of rhomboids
dorsal scapular nerve (C4,5)
attachments of deltoid
lateral 1/3 scapula, acromion, spine of scapula
TO deltoid tuberosity of humerus
action of deltoid
anterior fibres: flexion and medial rotation
posterior fibres: extension and lateral rotation
middle fibres: abduction of arm from 10-110 degrees
innervation of deltoid
axillary nerve (C5-6) from posterior cord of BP
what is the name of the space between deltoid and pec major
delto-pectoral groove
which structure runs through the delta-pectoral groove
cephalic vein
attachments of tires major
lateral border of scapula (posterior, lower 1/3)
TO medial lip of bicipital groove
action of teres major
adduction and medial rotation of arm
innervation of teres major
sub scapular branch of posterior cord of BP (C5,6)
attachments of subclavius
sternal end of 1st rib
TO medial third of underside of clavicle
action of subclavius
draw down and slightly forwards during abduction
innervation of subclavius
nerve to subclavius C5,6
in which direction is dislocation of the shoulder most common and why
anteroinferior
no muscle in the underside of shoulder joint, so humeral head moves down and forward through the gap
attachments of subscapularis
sub scapular fossa
TO lesser tubercle of humerus
action of subscapularis
medial rotation of arm
innervation of subscapularis
upper and lower sub scapular nerves (C5,6,7) from posterior cord of BP
attachments of supraspinatus
supraspinous fossa
TO upper facet of greater tubercle
action of supraspinatus
abducts arm first 10-15 degrees
innervation of supraspinatus
supra scapular nerve (C5,6) from superior trunk of BP
attachment of infraspinatus
infraspinous fossa
TO middle facet of greater tubercle of humerus
action of infrapsinatus
lateral rotation of arm
innervation of infrapsinatus
suprascapular nerve (C5,6) from superior trunk of BP
attachment of teres minor
upper 2/3 of lateral border of scapula
TO lower facet of greater tubercle
action of teres minor
lateral rotation of arm
innervation of teres minor
axillary nerve (C5,6) branch of posterior cord of BP
which ligaments attach to the lesser tubercle of humerus
superior, middle and inferior glenohumeral ligaments
which ligament attaches to the greater tubercle of humerus
coracohumeral ligament
which ligament stretches between the greater and lesser tubercles
transverse humeral ligament
what is the function of the transverse humeral ligament
holds the biceps tendon in place
which ligaments are associated with the clavicle
acromioclavicular coracoclavicular Coraoacromial anterior and posterior sternoclavicular costoclavicular
what are the borders of the quadrangular space
superior: teres minor
inferior: teres major
lateral: humerus
medial: long head biceps
what passes through the quadrangular space
axillary nerve
posterior circumflex humeral artery
borders of the triangular space
base: teres major
medial: long head biceps
lateral: humerus
what passes through the triangular space
radial nerve and profunda brachii artery
anterior boundaries of axilla
pec major and minor
subclavius
fascia
floor of axilla
skin and arm/thoracic wall
roof of axilla
rib 1
clavicle
scapula
posterior wall of axilla
subscapularis
teres major
latissimus dorsi
long head triceps
lateral wall of axilla
humerus
medial wall of axilla
serrates anterior and wall of thorax
what are the contents of the axilla
vessels, nerves, lymphatics of upper limb
short head of biceps and coracobrachialis
adipose tissue
what is the most anterior of the major vessels of axilla
axillary vein
when does the axillary vein become the axillary vein
at the lower margin of teres major
basilic vein –> axillary vein
when does the axillary vein transition to the subclavian vein
lateral border of rib 1
the axillary artery is a branch of which artery
subclavian
at which point does the axillary artery transition to the brachial artery
inferior margin of teres major
where is the 1st part of the axillary nerve in relation to pec minor
proximal to pec minor
what is the name of the branch arising from the 1st part of axillary artery
superior thoracic artery
where is the 2nd part of axillary nerve in relation to pec minor
deep to pec minor
which branches arise from 2nd part of axillary artery
thoracoacromial
lateral thoracic
where is the 3rd part of axillary artery in relation to pec minor
distal to pec minor
which branches arise from the 3rd part of axillary artery
anterior and posterior circumflex arteries
subscapular artery
which nodes in the axilla drain lymph from the upper limb
humeral nodes
which nodes in the axilla drain lymph from the thorax and breast tissue
pectoral
where are the humeral nodes
posterior to axillary vein
where are the pectoral nodes
inferior margin of pec minor
subscapular nodes drain which structures
back, shoulder, neck
where are the subscapular nodes
posterior axillary wall
where are the apical nodes
superior margin of pec minor
which nerve roots make up the brachial plexus
anterior rami of C5-T1
sympathetic contribution to brachial plexus
grey rami communicantes (post-ganglionic sympathetic fibres)
between which muscles do the roots of the brachial plexus pass
between anterior and mid scalene muscles
trunks of brachial plexus
superior trunk = C5,6
middle trunk = C7
inferior trunk = C8,T1
which nerves are branches of the roots of the brachial plexus
contribution to phrenic nerve (C5)
C5-7 long thoracic nerve
what muscle does the long thoracic nerve innervate
serratus anterior
which is the trunk to have branches off it
superior trunk
what are the branches of the superior trunk
suprascapular nerve
nerve to subclavius
what does the supra scapular nerve innervate
infraspinatus and supraspinatus
what does nerve to subclavius innervate
subclavius
what are the division of the brachial plexus
each trunk splits into an anterior and posterior division
how do the divisions combine
all the posterior division combine to form the posterior cord
the anterior divisions of the middle and superior trunks combine to form the lateral cord
the anterior division of the inferior trunk continues alone to form the medial cord
the anterior divisions are associated with which compartments of the upper limb
anterior compartments of arm and forearm
flexors
the posterior divisions are associated with which compartments of the upper limb
posterior compartments of arm and forearm
extensors
which structures are cords named in relation to
axillary artery
eg medial, lateral or posterior to axillary artery
which fibres are present in the lateral cord
C5-7
which nerve arises from the lateral cord
lateral pectoral nerve
the posterior cord contains which nerve roots
C5-T1
which peripheral nerves arise from the posterior cord
subscapular and thoracodorsal nerves
which roots are present in the medial cord
C8-T1
which peripheral nerves arise from the medial cord
medial pectoral nerve
medial cutaneous nerves
which branches arise from the lateral cord
musculocutaneous
lateral root of median
which branches arise from posterior cord
axillary and martial
which branches arise from the medial cord
ulnar and medial root of median
which group of muscles are contained in the anterior compartment of the arm
flexors of arm and elbow
which nerve innervates the anterior compartment of the arm
musculocutaneous nerve (C5-6)
what are the muscles of the anterio compartment of the arm
biceps brachii
coracobrachialis
brachialis
attachments of biceps brachia
long head = supraglenoif fossa of scapula
short head = coracoid process
common insertion into radial tuberosity
where is the bicipital aponeurosis
distal attachment in the cubital fossa
what are the actions of biceps brachia
supination (most powerful supinator)
flexion of elbow
weak flexion of shoulder
attachments of coracobrachialis
coracoid process to medial mid-shaft of humerus
actions of coracobrachialis
flexion of arm
assists adduction
innervation of coracobrachialis
musculocutnaeous nerve (C5,6,7)
which nerve pierces the surface of coracobrachialis
musculocutaneous nerve
attachments of brachialis
distal half of anterior surface of humerus to ulnar tuberosity and coronoid process
action of brachialis
flexion of elbow
innervation of brachialis
musculocutaneous nerve (C5,6) small contribution from lateral fibres of radial nerve (C7)
muscles of the posterior compartment of the arm
triceps brachii
attachments of triceps brachii
long head: infraglenoid tubercle
medial head: posterior surface of humeral shaft, inferior to radial groove
lateral head: posterior surface of humeral shaft, superior to radial groove
common insertion: olecranon of ulna
action of triceps
elbow extension
innervation of triceps
radial nerve (C6-8)
the brachial artery is a continuation of…
axillary artery
when does the axillary artery transition to brachial artery
after passing teres major
what is the first branch of brachial artery
profunda brachii
deep brachial
which space does the profucda brachii pass through
triangular space to reach posterior compartment
what is the terminal branch of profound brachii
radial collateral artery
which artery do the superior and inferior ulnar collateral arteries arise from
brachial artery
what are the terminal bracnhes of the brachial artery
ulnar and radial arteries
what are the borders of the cubital fossa
lateral: brachioradialis
medial: pronator teres
roof: skin, fascia, bicipital aponeurosis
floor: brachialis
how do the cephalic and basilic veins communicate
via the median cubital vein
describe the course of the cephalic vein from the cubital fossa
stays superficial, runs through the deltopectoral groove before piercing the clavipectoral fascia to reach the axillary vein
describe the course of the basilic vein
goes deeper and follows the brachial artery to become the axillary vein
branches of which nerve run alongside the basilic vein
medial cutaneous nerve from medial cord of BP
branches of which nerve run alongside the cephalic vein
lateral cutaneous nerve from lateral cord of BP
lateral cutaneous nerve is the terminal branch of which BP branch
musculocutaneous nerve
from medial to lateral, what are the contents of the cubital fossa
median nerve
bifurcation of brachial artery
tendon of biceps
the radial recurrent and anterior ulnar recurrent arteries are branches of which arteries and what do they contribute to
radial and ulnar arteries respectively
elbow anastomosis
which branches of the ulnar artery supply deep structures of the forearm
common interosseous, which splits into anterior and posterior
what is the function of the intermuscular septa
separate the muscles into compartments
which structures are associate with the medial inter muscular septum of the arm
median nerve and basilic vein
which structures are associated with the lateral inter muscular septum of the arm
radial nerve and deep brachial artery
which bony feature is closely associated with the ulnar nerve
medial epicondyle
which bony features is closely associated with the axillary nerve
head of humerus
which bony feature is closely associated with the radial nerve
radial groove of humerus
where is the common extensor origin
extensors of forearm
lateral epicondyle
where is the common flexor origin
flexors of forearm
medial epicondyle
main actions of the anterior compartment of the forearm
flexion of the wrist and digits
pronation of the forearm
what is the main nerve of the anterior compartment of the forearm
median nerve
which muscles are not innervated by the median nerve in the anterior compartment, and are innervated by which nerve
flexor carpi ulnaris and medial half of flexor digitorum profundus
ULNAR NERVE
which is the most superficial muscle of the anterior compartment of the forearm
palmaris longus
attachments of palmaris longs
medial epicondyle to palmar fascia/aponeurosis
what is the action of palmaris longs
tighten fascia and aid in wrist flexion
innervation of palmaris longs
median nerve (C7,8)
attachments of the pronator trees
medial epicondyle of humerus and coronoid process of ulna to lateral surface of radius
action of pronator teres
pronation
assists in elbow flexion
innervation of pronator teres
median nerve (C6,7)
which muscle makes up the medial boundary of the cubital fossa
pronator teres
attachments of flexor carpi ulnaris
medial epicondyle to base of pisiform, hamate and 5th metacarpal
attachments of flexor carpi radialis
medial epicondyle to base of 2nd metacarpal
action of flexor carpi ulnaris
flexion and adduction of wrist
action of flexor carpi radialis
flexion and abduction of wrist
innervation of flexor carpi ulnaris
ulnar nerve (C7,8)
innervation of flexor carpi radialis
median nerve (C6,7)
attachments of flexor digitorum superficialis
medial epicondyle and coronoid process of ulna to middle phalanges (lateral) of digits 2-5
action of flexor digitorum superficialis
flexion of MCP, PIP, wrist and (elbow) joints
innervation of flexor digitorum superficialis
median nerve (C7,8, T1)
attachments of flexor digitorum profundus
ulna and interosseous membrane to distal phalanges of digits 2-5 (palmar)
action of flexor digitorum profundus
flexion of MCP, PIP, DIP, wrist
innervation of flexor digitorum profundus
medial half: ulnar nerve (C8-T1)
lateral half: median nerve (C8-T1 - anterior interosseous branch)
attachments of flexor pollicis longus
radius and interosseous membrane of distal phalanx of thumb (palmar)
action of flexor pollicis longus
flexion of MCP and IP of thumb and wrist
innervation of flexor pollicis longus
median nerve (C8-T1 - anterior interosseous branch)
attachments of pronator quadratus
distal anterior ulna to distal anterior radius
action of pronator quadratus
pronation and helps to stabilise distal radioulnar joint
innervation of pronator quadrates
median nerve (C8,T1 - anterior interosseous branch)
where does the anterior interosseous artery run
in fascia anterior to interosseous membrane
roots of median nerve
C6-T1
through which structure foes the median nerve pass to enter the hand
carpal tunnel
which muscles does the median nerve pass between as it enters the forearm
pronator teres
which branch of median nerve supplies deeper muscles of forearm
anterior interosseous branch
which branch is given off the median nerve immediately before the carpal tunnel
palmar cutaneous branch
roots of ulnar nerve
C(7),8,T1
the ulnar artery is a branch of which artery
brachial
carpal bones
scaphoid, lunate, triquetral, pisiform, trapezium, trapezoid, capitate, hamate
what forms the roof of the carpal tunnel
flexor retinaculum
what are the attachments of the flexor retinaculum
medial: pisiform, hook of hamate
lateral: tubercle of scaphoid and ridge of trapezium
what are the contents of the carpal tunnel
long tendons for fingers and thumb
- 4 tendons of flexor digitorum profundus and superficialis
- flexor pollicis longus
median nerve
where does tendon of flexor carpi radialis pass in the wrist
through a space between a septum trapezium
attachments of anconeus
lateral epicondyle to olecranon of ulna
action of anconeus
extension of elbow
innervation of anconeus
radial nerve (C7,8 - T1)
attachments of brachioradialis
distal humerus (supracondylar rage) to radius proximal to styloid process
action of brachioradialis
flexion of the elbow, especially when the forearm is in the semipro position
innervation of brachioradialis
radial nerve (C5,6,7)
what are the divisions of the radial Neve
deep branch (posterior interosseous) superficial
main actions of posterior compartment of the forearm
extension of digits and wrist, abduction of thumb, supination
innervation of posterior compartment of arm
radial nerve
attachments of extensor carpi radialis longus
supracondylar ridge to base of 2nd metacarpal
attachments of extensor carpi radialis brevis
lateral epicondyle of humerus to base of 3rd metacarpal
action of extensor carpi radialis longus/brevis
wrist extension and abduction
innervation of extensor carpi radialis longus
radial nerve C6,7
innervation of extensors carpi radialis braves
radial nerve (C7,8)
attachments of extensor carpi ulnaris
lateral epicondyle of humerus to base of 5th metacarpal
action of extensor carpi ulnaris
wrist extension and adduction
innervation of extensor carpi ulnaris
radial nerve (C7,8 - posterior interosseous)
attachments of extensor digitorum
lateral epicondyle of humerus to dorsal expansion of digits 2-5
action of extensor digitorum
extension of MCP mostly, also PIP and DIP of digits 2-5
what is the dorsal expansion
fascia, sheet of connective tissue
innervation of extensor digitorum
radial nerve C7,8 posterior interosseous
attachments of extensor digiti minimi
lateral epicondyle to dorsal expansion of 5th digit
action of extensor digiti minimi
extension of MCP, PIP and DIP of little finger
innervation of extensor digiti minimi
radial nerve C7,8 posterior interosseous
attachments of extenor indices
posterior surface of ulna (and interosseous membrane) to dorsal expansion of digit 2
action of extensor indicies
extension of MCP, PIP, DIP of index finger
innervation of extensor indices
radial nerve C7,8 posterior interosseous
attachments of extensor pollicis longus
ulnar and interosseous membrane to base of distal phalanx of thumb
action of extensor pollicis longus
extension of CMC, MCP and IP joints of thumb, wrist
innervation of extensor pollicis longus
radial nerve C7,8 posterior interosseous
attachments of extensor pollicis brevis
radius and interosseous membrane to base of proximal phalanx of thumb
action of extensor pollicis brevis
extension of CMC and MCP of thumb, wrist
innervation of extensor pollicis brevis
radial nerve C7,8 posterior interosseous
attachments of abductor pollicis longus
radius, interosseous membrane and ulna to base of 1st metacarpal
action of abductor pollicis longus
abducts thumb, extension at CMC joint, extension of wrist
innervation of abductor pollicis longus
radial nerve C7,8 posterior interosseous
attachments of supinator
crest of ulna, lateral epicondyle of humerus, radial collateral and annular ligament to lateral radius
action of supinator
supination of forearm
innervation of supinator
radial nerve C7,8 posterior interosseous branch
which muscles are innervated pre-division of the radial nerve
triceps, anconeous, brachioradialis, extensor carpi radialis ongus
what is the action of the dorsal interossei
abduction of digits
what are the boundaries of the anatomical snuff box
tendons of extensor pollicis longus, extensor pollicis brevis, abductor pollicis longus
what makes up the floor od then anatomical snug box
trapezium and scaphoid
which vessels run through the snuff box
radial artery (deep)
superficial branch of radial nerve
cephalic vein
what type of joints are present in the intercarpal joints
synovial plane
what type of joints are CMC joints
synovial saddle (thumb) synovial plane (digits)
what type of joints are MCPs
synovial condyloid
what type of joints are the PIPs and DIPs
synovial hinges
attachments of palmar is brevis
palmar aponeurosis and flexor retinaculum to dermis
action of palmaris brevis
grip
innervation of palmaris brevis
ulnar nerve (C8-T1) superficial branch
which muscles are found in the thenar eminence
abductor pollicis brevis
flexor pollicis brevis
opponens pollicis
attachments of abductor pollicis brevis
scaphoid and trapezium to base of proximal phalanx of thumb
action of abductor pollicis brevis
abduction of thumb CMC joint
innervation of abductor pollicis brevis
median nerve (C8-T1) recurrent branch
attachments of flexor pollicis brevis
flexor retinaculum, capitate, trapezium to base of proximal phalanx of thumb
action of flexor pollicis brevis
CMC joint flexion
innervation of flexor pollicis brevis
median nerver (C8-T1) recurrent branch
attachments of opponens pollicis
trapezium to first MC
action of opponens pollicis
opposition of CMC joint
innervation of opponens pollicis
median nerve (C8-T1) recurrent branch
what is the deepest muscle of the thenar eminence
opponens pollicis
attachments of adductor policies
transverse head from 3rd MC
oblique head from capitate and 2nd/3rd MCs
to base of proximal phalanx of thumb
action of adductor pollicis
adduction of CMC joint
flexion of MCP thumb
innervation of adductor pollicis
ulnar nerve (C8-T1) deep branch
muscles of hypthenar eminence
abductor digiti minimi
flexor digiti minimi
opponens digiti minimi
attachments of abductor digiti minimi
pisiform bone to base of 5th proximal phalanx and dorsal digital expansion
action of abductor digiti minimi
abduction and flexion of MCP of little finger
innervation of abductor digiti minimi
ulnar nerve (C8-T1) deep branch
attachments of flexor digiti minimi
hamate, flexor retinaculum to base of 5th MC
action of flexor digiti minimi
flexion of MCP of little finger
innervation of flexor digiti minimi
ulnar nerve (C8-T1) deep branch
attachments of opponens digiti minimi
hamate and flexor retinaculum to 5th MC
action of opponens digiti minimi
weak opposition of little finger
innervation of opponens digiti minimi
ulnar nerve (C8-T1) deep branch
attachments of lumbricals
tendon of flexor digitorum profundus to dorsal digital expansion
which lumbricals are unipennate/bipennate
unipennate = 1st and 2nd bipennate = 3rd and 4th
action of lumbricals
flexion of MCP joint
extension of IP joint
innervation of lumbricals
1st/2nd: median nerve (digital C8-T1)
3rd/4th: ulnar nerve (deep C8-T1)
attachments of palmar interossei
1st: 2nd metacarpal to use of 2nd proximal phalanx and dorsal expansion
2nd: 4th MC to base of 4th proximal phalanx and dorsal expansion
3rd: 5th MC to base of 5th proximal phalanx and dorsal expansion
action of palmar interossei
adduction towards middle finger
flexes MCP, extends PIP
innervation of palmar interossei
ulnar nerve (deep C8-T1)
attachments of dorsal interossei
1st: 1st and 2nd MC to 2nd proximal phalanx and dorsal digital expansion
2nd: 2nd and 3rd MC to 3rd proximal phalanx and dorsal digital expansion
3rd: 3rd and 4th MC to 3rd proximal phalanx and dorsal digital expansion
4th: 4th and 5th MC to 4th proximal phalanx and dorsal digital expansion
action of dorsal interossei
abduction
MCP flexion, IP flexion
innervation of dorsal interossei
ulnar nerve
deep C8-T1
which artery supplies the majority of the deep palmar arch
ulnar artery
which artery supplies the majority of the superficial palmar arch
radial artery
course of digital branches of palmar arches
travel down lateral surfaces of digits
course of radial artery in the hand
passes along floor of snuffbox over scaphoid and trapezium into hand, passes between heads of adductor pollicis to anastomose with ulnar artery