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Locomotor Anatomy > Upper Limb > Flashcards

Upper Limb Flashcards

1
Q

Overview of the shoulder joint

A

High mobility

Limited stability

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2
Q

What are the bones of the shoulder joint?

A

-Clavicle
-Scapula (Acromion)
=Both together= Pectoral girdle
=Joins axial to appendicular skeleton
-Humerus (proximal)

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3
Q

What are the ligaments of the shoulder joint?

A

-Coraco-acromial ligament
-Capsule and Glenohumeral ligaments
-(Long head of biceps brachii= muscle)
=Multi-axial synovial ball and socket joint
=Articulation between head of humerus and glenoid fossa

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4
Q

What are the roles of the superficial muscles?

A
  • Produce varied movements of scapula/ shoulder
  • Multi-fibred/ multi-directional muscles
  • Muscles most important at shoulder joint
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5
Q

What are the anterior superficial muscles of the shoulder?

A

-Deltoid
=anterior- flexion and medial rotation of humerus
=Posterior= extension
=Middle= abduction of humerus
= Insertion= Deltoid tuberosity
=Innervation= Axillary nerve (branch of brachial plexus)
-Pectoralis major
=Large fan shaped muscle on anterior chest wall
=Flexion, adduction of humerus, internal/medial rotation
=Origin= clavicle and sternum
=Insertion= intertubercular sulcus
=Innervation= medial and lateral pectoral

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6
Q

What are the posterior superficial muscles of the shoulder?

A

-Trapezius: superior, middle, inferior
=Large, superficial muscle of back
=Elevation (superior), depression (inferior), rotation and retraction (middle)
=Origin= occipital bone (C7-T12 vertebrae)
=Insertion= Lateral 1/3 clavicle, scapula
=Innervation= Accessory nerve
-Deltoid: middle, posterior
-Latissimus dorsi

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7
Q

Describe the Rotator Cuff

A

-4 Scapular muscles
-Stabilise and rotate shoulder
-Anterior
=Subscapularis- medial rotation, subscapular fossa
=Teres Major- lateral rotation
-Posterior
=Supraspinatus- abduction
=Infraspinatus- lateral rotation
=Teres Minor, Major
All attach to greater tubercle except subscapularis (lesser)

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8
Q

Overview of Elbow joint

A 
-Hinge
=Flexion
=Extension
-Pronation and supranational at radial ulnar joint
-High stability
-Limited mobility
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9
Q

What are the features of the elbow joint?

A
  • Fibrous capsule- membrane thickened on medial and lateral aspects to form collateral ligaments
  • Lateral (radial) collateral ligament= strong supporting, blend with annular
  • Annular ligament= helps maintain contact of radial head with radial notch and capitulum during pronation and supination (envelopes head of radius)
  • Medial (ulnar) collateral ligament= supplies stability
  • Interosseous membrane
  • Trochlear notch
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10
Q

What are the movement features of the anterior upper limb?

A
  • Anterior arm
  • Anterior forearm
  • Medial epicondyle (CFO)
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11
Q

What are the movement features of the posterior upper limb?

A
  • Posterior arm
  • Posterior forearm
  • Lateral epicondyle (CEO)
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12
Q

What are the anterior muscles of the arm?

A

-Biceps brachii
=Long head- under transverse humeral ligament to intertubercular sulcus to joint space to glenoid labrum
=Short head- medial aspect, coracoid process
=flexion and supination
-Brachialis- distal end, powerful flexor
=flexion
-Coracobrachialis (deep to short head biceps brachii)
(BBC)
All innervated by musculocutaneous nerve, plus brachialis innervation of radial nerve

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13
Q

What are the posterior muscles of the arm?

A 
-Triceps brachii
=Long Head- infer glenoid ligament, extensor
=Medial Head
=Lateral Head
Innervated by radial nerve
Extension
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14
Q

What are the muscles of the forearm?

A
  • Brachiordialis= flexion and mid-pronation of forearm (posterior), radial nerve
  • Pronator trees
  • Pronator quadratus
  • Supinator
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15
Q

Describe the Brachial plexus

A
  • Complex nerve bundle innervating upper limb
  • Arises from anterior rami of spinal nerves C5-T1, somatic (sensory motor innervation)
  • Arranged around axillary artery
  • 5 roots (C5-T1)
  • 3 trunks
  • 6 divisions
  • 3 cords
  • 5 named nerves/ branches
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16
Q

Describe the roots of the Brachial Plexus

A

5
Top two will merge (C5 and C6)
Middle C7
Bottom two merge (C8 and T1)

17
Q

Describe the trunks of the Brachial Plexus

A

Top two roots merge to form superior/upper trunk
C7 root= middle trunk
Bottom two roots merge to form inferior/ lower trunk
So 3 trunks

18
Q

Describe the divisions of the Brachial Plexus

A

Each trunk divides into 2 (posterior and anterior divisions)

19
Q

Describe the cords of the Brachial Plexus

A

Organised around axillary artery

  • 2 anterior cords= lateral and medial
  • Posterior cord (behind axillary artery)
20
Q

What are the named nerve branches?

A
  • Musculocutaneous nerve (lateralcord)
  • Axillary nerve (posterior)
  • Median nerve (lateral and median)
  • Ulnar nerve (medial)
  • Radial nerve (posterior)
21
Q

Describe the blood supply to the upper limb

A
  • Subclavian artery (arises at bifurcation of innominate artery on RHS/ arch of aorta on LHS, divided into 3 parts by anterior scalene muscle)
  • Axillary artery (from lateral border of 1st rib to inferior border of teres major, divided into 3 parts by pectoralis minor muscle)
  • Brachial artery (closely related to median nerve, bifurcates into radial and ulnar around neck of radius with variation)
  • Radial artery (runs through anatomical snuffbox= structure formed by three tendons, primarily contributes to deep palmar arch)
  • Ulnar artery (larger than radial, primarily contributes to superficial palmar arch)
  • Palmer arches
22
Q

Describe the superficial drainage of the upper limb

A
  • Axillary vein
  • Cephalic vein= drains lateral side of forearm to axillary vein via medial cubital vein
  • Basilic vein= drains medial side of forearm to axillary vein
  • Median cubital vein
  • Superficial veins drain into a dorsal venous network on back of hand
23
Q

Describe the deep drainage of the upper limb

A
  • Subclavian vein
  • Brachial vein
  • Radial and ulnar veins
24
Q

What is the Carpal Tunnel?

A 
Passage of tendons into hand/ Osseo-fibrous tunnel
Deep to transverse carpal ligament
9 tendons:
-Flexor digitorium superficialis x4
-Flexor digitorium profundus x4
-Flexor pollicis longus x1
Median nerve runs through 
Ulnar NVM runs outwith tunnel
=Floor= carpal arch
=Roof= Flexor reticulum
-Paraesthesia, hypoesthesia, anaesthesia in lateral three and a half digits
25
Q

What are the ligaments associated with the carpal tunnel?

A
  • Palmar carpal ligament

- Transverse carpal ligament

26
Q

What are the main supporting ligaments of the glenohumeral joint?

A 
-Glenohumeral ligaments (anterior superior plane, attach to lesser tubercle)
=Superior, Middle, Inferior
-Coracohumeral ligament
(Coracoid process to Greater Tubercle)
-Transverse humeral ligament
(Between tubercles)
-Coracoacromial ligament 
9superior aspect of joint vault)
(Loose membrane for abduction)
27
Q

Describe the Glenoid Labrum

A

-Glenoid ligament
-Intra-capsular structure, fibrocartilaginous ring that lines margin of glenoid cavity
(thin, small, triangular)
-Improves joint fit
-The superior aspect of the glenoid labrum continuous with long head of biceps brachii

28
Q

Describe how pronation and supination occurs at the radio- ulnar joint

A

-Occurs at proximal and distal radio-ulnar joints (around head of radius)
-Supinators:
=Biceps brachii (cross over cubital fossa and attach onto radial tuberosity)
=Supinator (lateral, arises from lateral epicondyle, and supinator crest, inserts onto lateral proximal radial shaft)
-Pronators:
=Pronator teres (head of ulna and distal humerus, crosses forearm anteriorly and laterally, to mid shaft of radius- superficial)
=Pronator quadratus (deep muscle of forearm, spans distal end of ulnar and radius

29
Q

Describe the compartments of the forearm

A

Anterior:
-Flexors= common origin (Medial epicondyle)
-Extrinsic hand muscles
-Primary nerve supply= Median
-Movements of wrist, flexion of fingers, pronation
Posterior:
-Extensors= common origin (Lateral epicondyle)
-Nerve supply= Radial

30
Q

What are the layers of the anterior compartment of the forearm?

A
  • Superficial= 4 muscles
  • Intermediate= 1 muscle
  • Deep layer= 3 muscles
31
Q

Describe the Musculocutaneous nerve

A

anterior compartment of arm

  • Large terminal branch of lateral cord
  • Anterior branch
  • Motor and sensory
  • Pierces coracobrachialis
  • Passes between biceps and brachialis
  • Innervates all 3 (BBC) (motor aspect)
  • Terminates as the lateral cutaneous nerve of the forearm
32
Q

Describe the median nerve

A

Most of anterior forearm

  • Large nerve derived of anterior cords
  • M shape in axillary space as lateral and medial branches
  • Enter cubital fossa
  • Primary innovator of flexor compartment of forearm
  • Passes through carpal tunnel
  • Wide motor and sensory distribution within the hand
33
Q

Describe the Ulnar nerve

A

Most of hand

  • Derived primarily from medial cord
  • Courses medially within the arm and forearm
  • Passes posterior to medial epicondyle
  • Innervates 1.5 muscles within forearm
  • Primary innervator within hand
34
Q

Describe the Axillary nerve

A

Shoulder region (deltoid)

  • A branch of the posterior cord
  • Passes through quadrangular space (bound by teres minor, major and humerus and triceps brachii)
  • Innervates deltoid and teres minor muscles
  • Provides sensory innervation to patch on lateral arm= Sergeants Patch
  • Anterior dislocation of GHJ risks damage to axillary nerve
35
Q

Describe the Radial nerve

A

Posterior compartment of arm and forearm

  • Largest nerve of Brachial Plexus
  • Arises as the terminal branch of posterior cord
  • Runs within the spiral groove of the arm beneath deltoid tuberosity
  • Posterior to anterior, divide into superficial and deep branch
  • Provides motor and sensory innervation to all posterior compartments of upper limb
  • Sensory to hand
  • Mid shaft fractures of humerus risk damage
36
Q

What are the compartment actions at the wrist and what are they innervated by?

A 
Anterior= flexion= median nerve (ulnar nerve to 2 muscles closely associated with ulna)
Posterior= extension= radial nerve

Locomotor Anatomy (6 decks)

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