Upper Limb Flashcards
Humerus: Description
Single long bone of the arm Location: between the shoulder and the elbow
Humerus: Gross Anatomy
- Proximal: Rounded head covered with articular cartilage, greater and lesser tubercles, intertubercular groove
- Mid: Surgical neck inferior to the tubercles, deltoid tuberosity, spiral groove from radial nerve
- Distal: condyle of the humerus which consists of: capitulum, trochlear, medial and lateral epicondyles, radial fossa, olecranon fossa, coronoid fossa
Humerus: Articulations
- Proximal: the head of the humerus articulates with the glenoid of the scapula
- Distal: capitulum with the radial head, trochlear with the trochlear notch of the ulnar
Humerus: Ligaments
- Superior, middle, inferior and spiral glenohumeral ligaments
- Radial and ulnar collateral ligaments
Humerus: Relations
- Anterior: brachialis, bicep brachii, coracobrachialis
- Posterior: Profunda brachii, radial nerve, triceps brachii
- Lateral: deltoid
- Medial: brachial plexus, brachial artery, supratrochlear nodes
Humerus: Neurovasculature
Blood supply:
- Anterior and posterior humeral circumflex arteries and veins
- Perforators from profunda brachii
Lymphatics:
- Supratrochlear and axillary nodes
Innervation:
- Radial nerve
Humerus: Variants
- Supracondylar process
- Olecranon foramen
Elbow Joint: Description
The elbow joint is a complex synovial joint between the arm and the forearm
Has a joint capsule
Synovial
Elbow Joints: Movements
Combination hinge pivot joint:
Internal and external rotation of the arm
Flexion and extension of the arm
Elbow Joint: Articulation
- Proximal head of the radius the capitulum of the humerus
- Trochlea notch of the ulnar with the trochlear of the humerus
- Proximal radial head the proximal radial notch of the ulnar
Elbow Joint: Muscles
- Brachioradialis
- Biceps brachii
- Triceps brachii
Elbow Joint: Ligaments
- Annular ligament
- Proximal radial and ulnar collateral ligament complexes
- Oblique cord- thickening of the supinator
Elbow Joint: Fat Pads
- Coronoid and radial fossa fat pads anteriorly
- Olecranon fat pad posteriorly
Elbow Joint: Neurovasculature
Blood supply:
- Anastomotic arcade formed from branches of the radial, ulnar and brachial arteries
Nerves:
- Median, radial, ulnar and musculocutaneous nerves
Elbow Joints: Relations
- Anterior: biceps brachii tendon, brachialis muscle, median nerve, brachial artery
- Posteriorly: Olecranon bursae, triceps brachii tendon
- Laterally: Common extensor tendon, supinator muscle
- Medially: ulnar nerve
Elbow Joint: Variants
- Variation in carry angle between males and females, females have larger angles usually
- Synovial folds
- Capitellar and olecranon pseudofacets
- Accessory ossicles: os supratrochlear dorsale, patella cubiti
Glenohumeral Joint: Description
The shoulder joint also known as the gleno-humeral joint is a ball and socket synovial joint between the humerus and the glenoid.
Glenohumeral Joint: Movement
- Most mobile joint in the body
- Flex/extension, int. ext. rotation, ab and adduction
Glenohumeral joint: Articulation
Head of the humerus with the glenoid fossa of the scapula. The glenoid labrum adds depth to the glenoid fossa.
Glenohumeral Joint: Capsule
- Attached to the margin of the glenoid fossa to the anatomical neck of the humerus, the long head of the biceps travels through it.
- It is re-enforced by the rotator cuff except inferiorly where it is at its weakest
Glenohumeral Joint : Bursa
- Subacrominal – subdeltoid bursa
- Subscapular bursa (communicates with the joint by the foramen of Weitbrecht)
Glenohumeral Joint: Ligaments
- Superior, middle and inferior glenohumeral ligaments
- Coracohumeral ligaments
- Transverse humeral ligament
Glenohumeral Joint: Muscles
- abduction
- produced by the deltoid assisted by the supraspinatus
- adduction
- produced by the short scapular muscles (except supraspinatus) when the deltoid relaxes. Assisted by the pectoralis major and latissimus dorsi
- flexion
- clavicular head of the pectoralis major and the anterior fibers of the deltoid, assisted by the coracobrachialis and biceps
- extension
- latissimus dorsi, posterior fibers of the deltoid and the long head of the triceps
- rotation
- lateral rotation: infraspinatus and teres minor
- medial rotation: subscapularis and teres major
Glenohumeral Joint: Neurovasculature
Arterial supply:
- Anterior and posterior humeral circumflex and subscapular arteries
Innervation:
- Axillary (C5-C6), suprascapular, subscapular, musculocutaneous nerves
Lymphatics:
- Axillary
Glenohumeral joint: Variants
- Buford complex – cord like middle glenohumeral ligament
- Os acrominale
- Capsule attached to labrum
- Long head of biceps insertion – glenoid, glenoid and labrum, labrum only
Biceps Brachii: Description
The biceps brachii muscle (also known simply as biceps) is a two-headed muscle in the anterior compartment of the arm that flexes at the elbow and supinates the forearm.
Biceps Brachii: Attachments
- Origin:
- Short head: coracoid process of the scapula
- Long head: supraglenoid tubercle of the scapula
- Insertion:
- Radial tuberosity of the proximal radius
Biceps Brachii: Innervation
musculocutaneous nerve
Biceps Brachii: Action
- arm abduction, arm adduction and ventral flexion
- supination
- flexion of the supinated forearm
Biceps Brachii: Variants
- Duplicated long head of biceps tendon: can mimic longitudinal tear
- Bifid/bifurcated insertion: anatomic variant that arises from persistent division between the short head and long head of the distal biceps brachii tendon
Brachial Plexus: Description
A plexus of nerves innervating the arm and part of the upper thorax
Location: in the neck extending into the axilla, posterior to the clavicle
Supply: motor and sensory to upper limb and upper thorax
Brachial Plexus: Components
Roots – C5 to T1
Trunks – upper C5-6, middle C7, lower C8-T1
Divisions – anterior and posterior
Cords – named to their relation to the axillary artery – medial, lateral, posterior
Branches:
- Axillary (C5-6)
- Musculocutaneous (C5-7)
- Radial (all)
- Medial (all)
- Ulnar (C7, 8 T1)
Brachial Plexus: Course
Emerges between the middle and anterior scalenes
Course intimately related to the axiallary artery
Brachial Plexus: Variant Anatomy
- ~50% Pre-fixed – C4 contribution or Post-fixed – T2 contribution
- Variation in branching patterns
Venous drainage of the left upper limb: Description
Venous drainage of the upper limb is a vascular system for the return of deoxygenated blood from the capillary beds of the upper limb to the heart via the superior vena cava.
Venous drainage of the left upper limb: Deep System
The deep veins are located under the deep fascia. They are typically paired and lie on either side of an artery from which they take their name (venae comitantes).
Venous drainage of the left upper limb: Hand
- Deep venous palmar arch - receives the palmar metacarpal veins, drains to the radial veins
- Radial veins - Receives the deep venous palmar arch, run with the the radial artery, drains into the brachial veins
- Ulnar veins – Receives the surficial venous palmar arch, runs with the ulnar artery, drains into the brachial veins
- Brachial veins – Origin at the union of the radial and ulnar veins, course following the brachial artery, ending at the inferior border of teres major, at this point the brachial veins join the basilic vein to form the axiliary vein
- Axillary veins – the axillary vein continues with the axillary artery and is joined by the cephalic vein, subscapular vein, circumflex humeral vein, lateral thoracic vein and thoraco-acromial vein. It terminates at the lateral margin of the first rib where it becomes the subclavian vein.
Venous drainage of the left upper limb: Superfical System
- Superficial venous palmer arch: accompanies the superficial palmer arch, drains the commo palmer digital veins, drains into the ulnar vein
- Dorsal venous network: formed from the dorsal metacarpal veins drains into the basilic and cephalic veins
- Cephalic – origin the dorsal venous plexus, runs up the superficial space of the lateral aspect of the arm, drains to the median cubital and axially vein
- Basilic – origin the dorsal venous network, up the superficial tissue of the medial aspect of the arm, also receives the median cubital vein, drains to the brachial veins mid arm
Carpal bones: Description
The carpal bones are the eight bones of the wrist. They form the articulation between the forearm and the hand.
Carpal Bones: Gross Anatomy
Unlike the metacarpals the carpals do not belong to individual fingers
The corresponding bones in the foot are the tarsals
Divided in 2 rows proximal and distal
Proximal:
- Scaphoid
- Lunate
- Triquetrum
- Pisiform (actually a sesamoid bone with the flexor carpi ulnaris tendon)
Distal:
- Trapezium
- Trapezoid
- Capitate
- Hamate
Carpal Bone: articulations
Articulations: All synovial
- Radiocarpal
- Intercarpal
- Carpometacarpal
Carpal Bones: Ligament
- Ulnar and radial collateral ligaments
- Palmar and dorsal radiocarpal ligaments
- Palmar and dorsal carpometacarpal ligaments
- Intercarpal ligaments
Carpal Bones: Vasculature
Arterial:
- Dorsal carpal arch, deep palmar arch, direct radial, and ulnar branches
Venous:
- Dorsal venous plexus, deep palmar venous arch, direct into the radial and ulnar veins
Carpal Bone: Variants
- Carpal coalition
- Bipartate scaphoid
- Type 1 or type 2 lunate
Lunate Bone: Description
The lunate is a bone of the proximal row of carpal bones
Location: between the scaphoid and triquetrum in the proximal carpal row
Lunate: Gross Features
- Semi-lunar in shape
- 4 articular facets (five in type 2)
Lunate: Articulations
- Radius
- Scaphoid
- Triquetrum
- Capitate
- Hamate (in type 2 lunate)
- Triangular fibrocartilage complex
Lunate: Ligaments
- Scapholunate
- Lunotriquetral
- Radiolunotriquetral
- Radioscapholunate
- Ulnolunate
Lunate: Vasculature
Blood supply:
Dorsal radiocarpal arch and dorsal intercarpal arch
Venous:
Dorsal venous plexus
Lunate: Variants
- Lunotriquetral coalition
- Os epilunatum
- Os hypolunatum
- Type 1 lunate – single distal articular facet for the capitate
- Type 2 lunate – additional distal articular facet for the hamate
Scaphoid: Description
- The scaphoid is a carpal bone
Location: Most lateral bone of the proximal carpal row
Scaphoid: Relations
- Lateral/dorsal: radial artery
- Medial: lunate and the carpal tunnel
- Distal: Trapezium
- Proximal: distal head of the radius
- Forms the radial portion of the carpal tunnel
Scaphoid: Gross anatomy
- Largest of the proximal row of carpal bones
- Boat shaped
- Dividable into proximal and distal poles, separated by a waist which is further dividable into proximal and distal waists
- Scaphoid tubercle is a bony prominence on the ventral surface serves as an attachment for the flexor retinaculum
Scaphoid: Articulation
Medial: Lunate
Proximal: Radius
Distal:
- Trapezium
- Trapizoid
- Medially with the capitate
Scaphoid: Ligaments
- Scapholunate
- Radioscapholunate
- Dorsal: Dorsal radiocarpal ligament
- Radial surface: radial collateral ligament
Scaphoid Vasculature
- Direct branches from the radial artery
- Dorsal radiocarpal arch
- Supply enters the distal pole to perfuse the proximal pole (risk of osteonecrosis with waist fracture)
- Venous drainage via the dorsal venous plexus and the radial veins
Scaphoid: variants
- Bipartite scaphoid
- Carpal coalition
- Scaphoid hypoplasia
Radius: Description
The radius is one of the two long bones of the forearm.
Location: Lateral in the forearm, extending from the elbow to the wrist
Radius: Features
Proximal: Head, neck and tuberosity insertion of the biceps brachii tendon
Mid: Shaft – thicker that the ulnar and becoming more thick distally
Distal: Carpal articular facet, ulnar notch, radial styloid, Lister’s tubercle (Dorsal)
Radius: Articulation
Proximal:
- Radial head with the capitulum of the humerus
- Radial head with the radial notch of the ulnar
Distal:
- Distal radius facet with the scaphoid and lunate
- Ulnar notch with the ulnar head
Radius: Ligaments
- Radial collateral ligaments of the elbow and wrist
- Radial annular ligament
- Interosseous membrane of the forearm
- Radial carpal ligaments (dorsal and palmar)
- Radioulnar ligaments (dorsal and palmer)
Radius: Neurovasculature
Blood supply:
Radial artery and vein
Lymphatics:
Supratrochlear
Axillary
Innervation:
Anterior and posterior interosseous nerves
Radius: Variants
Radio-ulnar synostosis
Hypoplastic or absent radius
Ulna: Description
The ulna is one of the two long bones of the forearm.
Location: medially with in the forearm
Ulna: Gross anatomy
Wider toward the proximal end
Features:
Proximal: Olecranon, trochlear notch, coronoid process, radial notch, sublime tubercle (medial) (flexor digitorum), ulnar tuberosity (brachialis)
Mid: Shaft
Distal: head, styloid process, fovea, groove for extensor carpi ulnaris
Ulna: Articulation
- Trochlear notch with the trochlear of the humerus
- Radial head with the radial notch
- Ulnar head with the ulnar notch (radius)
- Wrist via the triangular fibrocartilage complex
Ulna: Ligaments
Proximal: medial collateral ligament of the elbow, annular ligament
Medial: interosseous membrane, oblique cord
Distal: triangular fibrocartilage complex, ulnar collateral ligament of the wrist
Ulna: Variants
Ulnar variance (relative length difference between the radius and ulnar)
Ulna: Neurovasculature
Blood supply:
Ulnar and common interosseous artery
Lymphatics:
Supratrochlear
Axillary
Innervation:
Anterior and posterior interosseous nerves
Scapula: Description
The scapulae are bones of the pectoral girdle.
Location: Superior/posterior thoracic wall
Function: Movement and support of the shoulder girdle and shoulder
Scapula: Gross Anatomy
The scapula is a flat triangular bone with apex down.
Features:
- Inferior, lateral and superior angles
- Superior, medial and lateral borders
- Posteriorly the scapula is divided into a supraspinatus and infraspinatus fossa by the scapular spine
- Anteriorly there is the subscapular fossa
- Laterally is the glenoid fossa
- Superiorly is the acromion and coracoid process
Scapula Articulation
Acromion with the distal clavicular head, glenoid with the humeral head
Scapula: Ligaments
- Transverse scapula ligament across the scapular notch (with the suprascapular nerve below and the vessels above)
- Coracoacromial
- Coracoclavicular
- Coracohumeral
- Glenohumeral superior, middle and inferior
- Acromioclavicular
Scapula: vasculature
Blood supply:
Anastomotic network formed by:
- Suprascapular
- Dorsal scapular
- Subscapular
Lymphatics:
- Axillary
Scapula Muscles
- Rotator cuff + teres major
- Long head of the triceps and biceps
Scapula Variants
Os acrominale
Clavicle: Description
The clavicle is the only bone connecting the pectoral girdle to the axial skeleton. It is also the only horizontal long bone
Clavicle: Gross anatomy
S-shaped
Features:
Medial:
- Rounded medial end
- Costal tuberosity
- Groove for subclavius
Distal:
- Conoid tubercle
- Flat distal end
- Trapezoid line
Clavicle: articulations
- Medial end with the sternum
- Distal end with the acromion