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Anatomy > Upper Limb > Flashcards

Upper Limb Flashcards

1
Q

Pectoralis Major

A

Most superficial muscle of reigon. Large & fan shaped.

Function

Adducts & medially rotates the upper limb and draws the scapula anterioinferiorly. Clavicular head also acts individually to flex upper limb.

Innervation

Lateral & medial pectoral nerves

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2
Q

Pectoralis Minor

A

Function

  • Stabilises the scapula by drawing it anterioferiorly against the thoracic wall
  • Protection of the scapula
  • If arm & scapula are fixed, elevates the rib for deep breathing (runners etc)

Innervation

Medial pectoral nerve

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3
Q

Serratus Anterior

A

Function

  • Rotates the scapula, allowing arm to be held above 90o
  • Holds scapula against rib-cage

Innervation

  • Long thoraic nerve
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4
Q

Subclavius

A

Small muscle underneath the clavicle, runs horizontally.

Function

  • Anchors & depresses clavicle
  • Provides minor protection to neurovasuclar structures underneath

Innervation

Nerve to Subclavius

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5
Q

Clinical Relevance - Winging of Scapula

A
  • Serratus anterior holds scapula against the ribcage
  • If there is damage to the thoraic nerve then serratus anterior becomes paralysed
  • The scapula gives a winged appearance, no longer being held against ribcage
  • Long thoraic nerve palsy is most commonly down to traction issues, where the upper limb is stretched violently
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6
Q

Trapezius

A

Superficial extrinsic muscle. Broad, flat & triangular

Function

  • Upper fibres elevate scapula & rotates it during arm abduction
  • Middle fibres retract scapula
  • Lower fibres pull the scapula inferiorly

Innervation

Accessory nerve

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7
Q

Latissimus Dorsi

A

Covers wide area of lower back, fibres converge into tendon (twist) that attaches to humerus

Function

Extends, adducts & medially rotates the upper limb

Innervation

Thoracodorsal nerve

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8
Q

Levator Scapulae

A

Small, strap-like muscle

Function

Elevates the scapula

Retracts & rotates the scapula

Innervation

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9
Q

Rhomboid Major

A

Situated inferiorly to the rhomboid minor

Function

Retracts & rotates the scapula

Innervation

Dorsal scapular nerve

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10
Q

Rhomboid Minor

A

Situated superiorly to the major

Function

Retracts & rotates scapula

Innervation

Dorsal scapula nerve

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11
Q

Clinical Relevance - Testing Accessory Nerve

A
  • Accessory nerve damage is usually iatrogenic (due to a medical procedure e.g lymph node biopsy, jugular vein cannular)
  • To test nerve, trapezius function can be assessed
  • Ask patient ot shrug their shoulders
  • Other features of damage include: muscle atrophy, asymmetrical neckline & partial paralysis of the sternocleidmastoid
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12
Q

Deltoid

A

Can be divided into anterior, middle & posterior

Function

  • Anterior fibres - flexion and medial rotation
  • Posterior fibres - extension and lateral rotation
  • Middle fibres - major abductor of the arm (takes over from supraspinatus, first 15o)

Innervation

Axillary nerve

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13
Q

Teres Major

A

Function

Adducts the shoulder & medially rotates the arm

Innervation

Lower subscapular nerve

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14
Q

Rotator Cuff

A
  • A group of four muscles: supraspinatus, infraspinatus, subscapularis, teres minor
  • Provides the glenohumeral joint with additional stability
  • Collectively pulls the humeral head to the glenoid fossa
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15
Q

Supraspinatus

A

Attachments

Originates: supraspinous fossa of the scapula

Attaches: greater tubercle of the humerus

Function

Abducts the arm 0-15o, assists deltoid for 15-90o

Innervation

Suprascapular nerve

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16
Q

Infraspinatus

A

Attachments

Originates: Infraspinous fossa of scapula

Attaches: greater tubercle of the humerus

Function

Laterally rotates the arm

Innervation

Suprascapular nerve

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17
Q

Subscapularis

A

Attachments

Originates: subscapular fossa, on costal surface of the scapula

Attaches: lesser tubercle of the humerus

Function

Medially rotates the arm

Innervation

Upper & lower subscapular nerves

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18
Q

Teres Minor

A

Attachments

Originates: posterior surface of the scapula, adjacent to lateral border

Attaches: greater tubercle of the humerus

Function

Laterally rotates the arm

Innervation

Axillary nerve

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19
Q

Clinical Relevance - Tendonitis

A
  • Rotator cuff tendonitis refers to the inflamation of the tendons of the rotator cuff muscles
  • Secondary to repetitive use of shoulder joint
  • Supraspinatus most commonly affected - rubs and causes degenerative changes
  • Conservative treatment: rest, analgesia & physiotherapy
  • Severe cases: steriod injections & surgery
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20
Q

Clinical Relevance - Suprascapular Ligament

A
  • Can have ossification (calcification) which will compress the nerve/artery
  • Can lead to atrophy of the intra/supraspinatus due to lack of innervation
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21
Q

Biceps Brachii

A

Function

Supination of the forearm & flexes arm at elbow & shoulder

Innveration

​Musculotaneous nerve

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22
Q

Coracobrachialis

A

Function

Flexion of the arm at the shoulder & weak adduction

Innervation

Musculocutaneous nerve

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23
Q

Brachialis

A

Function

Flexion at elbow

Innervation

Musculotaneous nerve, with contribution from radial nerve

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24
Q

Clinical Relevance - Rupture of Biceps Tendon

A
  • Long head of biceps brachii is a more common tendon to rupture
  • When flexing elbow, characteristic is the ‘popeye sign’ - a bulge of the muscle belly
  • Patient would not notice much weakness, due to brachialis & supinator muscle action
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25
Q

​Triceps Brachii

A

Found in the posterior compartment of the upper arm. Made up of a long, lateral & medial head

Function

Extension of the arm at the elbow

Innervation

​Radial nerve but in some individuals, long head is innervated by axillary nerve

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26
Q

Flexor Carpi Ulnaris

A

Function

Flexion & adduction at wrist

Innervation

Ulnar nerve

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27
Q

Palmaris Longus

A

Function

Flexion at wrist

Innervation

Median nerve

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28
Q

Pronator Teres

A

Forms the lateral border of the cubital fossa

Function

Pronation of forearm

Innervation

Median nerve

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29
Q

Flexor Digitorum Superficialis

A

Only muscle to make up the intermediate compartment - between superficial & deep layers

Function

Flexes metacarpophalangeal joints & proximal interphalangeal joints at 4 fingers

Flexes at wrist

Innervation

Median Nerve

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30
Q

Flexor Digitorum Profundus

A

Function

Only muscle that can flex interphalangeal finger joints

Flexes at metacarpophalangeal joints & at wrist

Innervation

Medial half (acts on little & ring finger) - ulnar nerve

Lateral half (middle & index finger) - anterior interosseous branch of median nerve

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31
Q

Flexor Pollicis Longus

A

Lies laterally to the Flexor Digitorum Profundus

Function

Flexes at the interphalangeal & metacarpophalangeal joint of the thumb

Innervation

Median nerve

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32
Q

Pronator Quadratus

A

Function

Pronates the forearm

Innervation

Median nerve

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33
Q

Brachioradialis

A

Paradoxical muscle - origin & innervation of an extensor muscle but is actually a flexor

Function

Flexes at elbow

Innervation

Radial nerve

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34
Q

Extensor Digitorum

A

Functions

Extends medial four fingers at MCP & IP joints

Innervation

Radial nerve (deep branch)

​

35
Q

Extensor Carpi Radialis Longus & Brevis

A

Function

Due to position, able to extend & abducts the wrist

Innervation

Radial nerve

36
Q

Extensor Digiti Minimi

A

Thought to originate from the extensor digitorum muscle - in some people they are fused together. Anatomically:

Function

Extends the little finger & contributes to extension at the wrist

Innervation

Radial nerve (deep branch)

37
Q

Extensor Carpi Ulnaris

A

Function

Due to position, able to extend & adduct at wrist

Innervation

Radial nerve (deep branch)

38
Q

Aconeus

A

Blended with fibres of the triceps brachii & the two muscles can be indistinguishable

Function

Extends & stabilises the elbow joint

Abducts the ulna during pronation of forearm

Innervation

Radial nerve

39
Q

Clinical Relevance - Tennis Elbow

A
  • Tennis Elbow aka Lateral Epicondylitis is inflammation of the posterium of the lateral epicondyle
  • Peak age of onset: 40-50 years old
  • Caused by repeated use of the supericial extensor muscles
  • Strains their common tendious attachment to the lateral epicondyle
40
Q

Supinator

A

Lies on the floor of the cubital fossa

Attachments

First head originates: lateral epicondyle of humerus

Second head originates: posterior surface of ulna

Inserts: together into posterior surface of radius

Function

Supinates forearm

Innervation

Radial nerve (deep branch)

41
Q

Abductor Pollicis Longus

A

Function

Abducts the thumb

Innervation

Radial nerve (posterior interosseous branch)

42
Q

Extensor Pollicis Longus

A

Function

Extends all joints of thumb: carpometacarpal, metacarpophalangeal & interphalangeal

Innervation

Radial nerve (posterior interossesous branch)

43
Q

Extensor Indicis Proprius

A

Function

Extends the index finger

Innervation

Radial nerve (posterior interosseous branch)

44
Q

Clinical Relevance - Wrist Drop

A
  • Sign of radial nerve injury, proximal to elbow

Two common characteristic sites of damage:

  • Axilla - injured via humeral dislocations/fractures
  • Radial groove of humerous - injured via a humeral shaft fracture

In an event of a radial nerve lesion, all muscles in the extensor compartment of forearm get paralysed.

The flexor muscles remain unaffected (innervated by median nerve). Unopposed flexion at the wrist joint = wrist drop

45
Q

Thenar Muscles

A
  • Three short muscles located at the base of the thumb
  • Bellies produce a bulge, thenar eminence
  • Responsible for fine movements of the thumb
  • All muscles innervated by the median nerve
46
Q

Opponens Pollicis

A

Largest & lies underneath other two muscles

Function

Opposes the thumb by medially rotating and flexing the metacarpal on the trapezium

Innervation

Median nerve

47
Q

Abductor Pollicis Brevis

A

Function

Abducts the thumb

Innervation

Median nerve

48
Q

Flexor Pollicis Brevis

A

Function

Flexes the metacarpophalangeal (MCP) of thumb joint

Innervation

Median nerve. Deep head is innervated by the deep branch of ulnar nerve

49
Q

Hypothenar Muscles

A
  • Produce hypothenar eminence - muscular protusion on medial side of palm (base of little finger)
  • Ulnar nerve innervates the three muscles
50
Q

Opponens Digiti Minimi

A

Lies deep to other hypothenar muscles

Function

Rotates the little finger metacarpal towards the palm, producing opposition

Innervation

Ulna nerve

51
Q

Abductor Digiti Minimi

A

Most superficial of hypothenar muscles

Function

Abducts little finger

Innervation

Ulna nerve

52
Q

Flexor Digiti Minimi Brevis

A

Lies laterally to the abductor digiti minimi

Function

Flexes the MCP joint of little finger

Innervation

Ulnar nerve

53
Q

Lumbricals

A
  • Four lumbricals in hand, associated with a finger
  • Crucial to finger movement - linking extensor tendons to flexor tendons
  • Denervation of these muscles is basis for the unlar claw & hand of benediction

Function

Flexion at the MCP joint & extension at the interphalangeal (IP) joints of each digit

Innervation

Lateral two (index & middle): median nerve

Medial two (little & ring): ulnar nerve

54
Q

Dorsal Interossei

A

Most superficial of all dorsal muscles - can be palpated on the dorsum of hand (4 in total)

Function

  • adduct the fingers at MCP joint
  • assist lumbricals in the flexion at MCP joints & extension of IP joints

Innervation

Ulnar nerve

55
Q

Palmar Interossei

A
  • three palmar interossei muscles
  • located anteriorly on hand

Function

Adducts fingers at the MCP joint

Innervation

Ulnar nerve

56
Q

Palmaris Brevis

A

Small thin muscle found superficially in the subcutaneous tissue of the hypothenar eminence

Function

  • wrinkles skin of the hypothenar eminence
  • deepens curvature of hand, improving grip

Innervation

Ulnar nerve

57
Q

Adductor Pollicis

A

Large triangular muscle with two heads. Radial atery passes anteriorly through the space between two heads, forming deep plamar arch.

Function

Adductor of thumb

Innervation

Ulnar nerve

58
Q

Axilla Region Borders

A

Apex - first rib, scapula, clavicle

Lateral wall - humerus

Medial wall - serratus anterior & thoracic wall (ribs & intercostal muscles)

Anterior wall - pectoralis major, minor & subclavius muscles

Posterior wall - subscapularis, teres major & lattisimus dorsi

59
Q

Axilla Reigon Contents

A
  • Axillary artery - 3 parts, one medial, one lateral & one posterior to pectoralis minor (medial & posterior travel in axilla)
  • Axillary vein
  • Brachial plexus
  • Axillary lymph nodes
  • Biceps brachii (short head)
  • Coracobrachialis
60
Q

Clinical Relevance

A

Thoracic Outlet Syndrome

  • vessels & nerves of axilla may become compressed between bones in the apex
  • common causes - trauma, repetitive motion, cervical rib
  • presents with pain in the affected limb (dependent on nerve), tingling, muscle weakness & discolouration

Lymph Node Biopsy

  • 75% of lymph from breast drains into the axilla lymph nodes
  • Biospy to test for cancer, removal to prevent spreading (axillary clearance)
  • Long thoraic nerve may become damaged, resulting in winged scapula
61
Q

Cubital Fossa Borders

A

Lateral border - brachiodialis muscle

Medial border - pronator teres muscle

Superior border - hypothetical line between epicondyles of humerus

Floor - proximally by brachialis, distally by supinator muscle

Roof - consists of skin & fascia, reinforced by bicipital aponeurosis

62
Q

Cubital Fossa Contents

A
  • Radial nerve
  • Biceps tendon
  • Brachial artery
  • Median nerve

Mneumonic - Really Need Beer To Be At My Nicest

63
Q

Clinical Relevance - Cubital Fossa

A

Brachial Pulse & Blood Pressure

  • Can be felt immeadiately when palpating medial to the biceps tendon in the cubital fossa
  • When measuring blood pressure, stethoscope must be placed here to heat korotkoff sounds

Venepuncture

  • Medial cubital vein located superficially in roof
  • Connects basilic & cephalic veins
  • Can be accessed easily - common site for venepuncture

Supracondular Fractures

  • common in young people falling on hyper-extended elbow (sometimes flexed)
  • displaced fracture fragments may impinge & damage cubital fossa
  • direct damage/post-fracture swelling can cause lack of forearm blood supply from brachial artery
  • ischaemia can cause Volkmann-s ischaemic contracture - uncrontrolled flexion of hand as flexors become short
  • also can be damage to median or radial nerves
64
Q

Carpal Tunnel Borders

A
  • Narrow passageway found on anterior portion of wrist
  • Entrance to palm for several tendons & median nerve

Carpal Arch

concave on palmar side, forming base & sides of carpal tunnel

lateral - scaphoid & trapezium tubercles

medial - hook of hamate & pisiform

Flexor Retinaculum

thick connective tissue that forms roof

turns carpal arch into tunnel by briding space between the medial & lateral parts

originates on lateral side & inserts into medial side of carpal arch

65
Q

tCarpal Tunnel Contents

A

Tendons

  • the tendon of flexor pollicis longus
  • four tendons of flexor digitorum profundus
  • four tendons of flexor digitorum superficialis

8 tendons surrounded by a single synovial sheath, 1 (flexor pollicis longus) surrounded by it’s own synovial sheath

Sheaths allow free movement of tendons

​Median Nerve

  • once it passes through the carpal tunnel, splits into two branches: reccurent branch & palmar digital nerves
  • palmer digital nerves give sensory innervation to palmer skin, dorsal nail beds & lateral 3 1/2 digits
  • palmer digital nerves give motor innervation to lateral two lumbricals
  • recurrent branch supplies thenar muscle group
66
Q

Clinical Relevance - Carpal Tunnel Syndrome

A
  • Caused by compression of median nerve in carpal tunnel
  • Most common mononeuropathy & can be caused by thickening of ligaments & tendon sheaths
  • Left untreated can cause weakness to thenar muscles
  • Clinical features include: numbness, tingling & pain along median nerve (forearm). Often wakes patients in sleep & is worse in mornings
67
Q

Anatomical Snuffbox Borders

A

Ulnar (medial) border: tendon of extensor pollicis longus

Radial (lateral) border: tendons of extensor pollicis brevis & abductor pollicis longus

Proximal border: styloid process of the radius

Floor: carpal bones, scaphoid & trapezium

Roof: skin

68
Q

Anatomical Snuffbox Contents

A
  • Radial artery (pulse can be palpated in some individuals)
  • Superficial branch of the radial nerve - found in skin & subcutaneous tissue
  • Cephalic vein
69
Q

Clinical Relevance - Scaphoid Fracture

A
  • Most commonly fractured carpal bone (FOOSH - falling on outstreched hand)
  • Causes pain & tenderness in anatomical snuffbox
  • Risk of avascular necrosis - ‘retrograde blood supply’ at distal end that may interrupt blood supply to proximal part rendering it avascular
  • Scaphoid is supplied by two vascular branches of radial artery - volar branch is weaker than dorsal branch
  • avascular necrosis (death of bone tissue) can cause non-union (failure to heal fractures properly)
  • Having a missed scaphoid fracture makes patient more likely to develop osteoarthritis of wrist in later life
70
Q

Muscle Groups (& Blood Supply) - Anterior Compartment of Forearm

A

Pronators of Wrist

  • pronator teres & quadratus
  • median nerve

Flexors of Wrist

  • flexor carpi ulnaris & radialis
  • ulnar nerve

Flexors of Fingers

  • flexor digitorum profundus & superficialis
  • median nerve (flexor digitorum profundus is also innervated by ulnar nerve)

Flexors of Thumb

  • flexor pollicis longus & brevis
  • median nerve

General Blood Supply

Anterior Arm = brachial artery & veins

Anterior Forearm = radial/ulnar arteries & venae comitantes

71
Q

Clinical Relevance - Tendon Injuries Hand

A
  • Tendons of the digits may be severed when the hand is injured
  • To find out what tendons have been damaged, the patient should be asked to flex the fingers at both the distal & proximal interphalangeal joints:

If there is movement only in the distal phalanges - flexor digitorum superficialis damaged

If there is movement in the only middle phalanges - flexor digitorum profundus damaged

If no movement at all - both damaged

72
Q

Clinical Relevance - Linburg-Comstock

A
  • Common anatomical variation in the hand - involuntary flexion of the index/middle finger when flexing thumb
  • Caused by extra tissue holding tendons together so they cannot move independently
  • Opperation to remove tissue possible - important for musicians
  • Another common anatomical variation is the presence of a palmaris longus (seen when wrist flexed & thumb and little finger opposed)
73
Q

Hand Innervation

A
  • Medial side (1/2 ring & little finger) innervated by ulnar nerve
  • Lateral side (thumb, index, middle & 1/2 ring finger) is innervated by median nerve
  • Ring finger is innervated by both nerves
74
Q

Carpal Tunnel Syndrome Tests

A

Phalen’s

  • flex wrists maximally & push dorsal side of hands together for 1 minute
  • if tingling is felt on lateral side of hand (thumb to 1/2 ring finger) carpal tunnel syndrome can be concluded
  • pressure on median nerve

Tinel’s

  • tap over carpal tunnel at wrist & whole distribution of median nerve from index finger to elbow
  • Positive test if tingling or numbness is felt on the lateral fingers (thumb to 1/2 ring finger) - median nerve damage
75
Q

Clinical Relevance - Allen’s Test

A
  • shows anastomotic nature of the palmar arches - if there is a likely obstruction in the median or ulnar artery
  • open & close hand quickly several times then squeeze hand tightly (clench fist)
  • with thumbs, compress radial & ulnar arteries
  • open hand & release one thumb (one artery at a time)
  • if blood flows into hand quickly - healthy artery
  • compare with other hand to see if an artery is impared
76
Q

Supination VS Pronation

A
  • Supination is a stronger movement - supinator muscles (supinator & biceps brachii) are larger & more developed so are more powerful and don’t tire easily
  • Pronation is a weaker movement - pronator muscles are smaller & weaker (pronator teres & quadratus) so forearm will tire easily
  • Reason why screws require an anti-clockwise movement (supination) to tighten
77
Q

Muscle Groups - Hand

A

Lumbricals

  • flex metacarpophalangeal joints & extend interphalangeal joints​
  • median & ulnar nerve

Palmar Interossei

  • adducts digits 2-4
  • ulnar nerve

Dorsal Interossei

  • abducts digits 2-4
  • ulnar nerve

Thenar Muscles

  • fine movements of thumb
  • median nerve

Hypothenar Muscles

  • abducts, flexes and rotates 5th digit​
  • ulnar nerve
78
Q

Clinical Relevance - Venous Patterns

A
  • Important for venepuncture & intravenous access
  • Cephalic & basilic veins are most prominent and superficial
  • Basilic vein is larger than cephalic vein so is usually the most common vessel used for intravenous access (however there is anatomical variation between patients)
79
Q

Interossei

A

Palmar Interossei

  • anterior compartment of hand
  • adduct digits
  • PAD - Palmar interossei ADduct

Dorsal Interossei

  • Posterior compartment of hand
  • adbucts digits
  • DAB - Dorsal interossei ABduct
80
Q

General Nerves & Veins

A

Radial

  • mainly extensor muscles

Median

  • mainly flexor muscles
  • thenar muscles
  • 1st two lumbricals (little & ring)

Ulnar

  • mainly intrinsic muscles of hand (hypothenar)

Musculotaneous

  • three main muscles of anterior arm
81
Q

Extensor Retinaculum

A
  • thickened fibrous band that traverses wrist
  • holds extensor tendons in position
  • prevents bow-stringing - if reticulum was torn, tendons would come more superior & take the shortest route when digits extend
82
Q

Tendons in Digits

A
  • Two tendons & muscle bellies in the index (2nd) and little (5th) finger - move independently/more freely
  • Interconnections in the dorsal of the hand - middle (3rd)/ ring (4th) finger cannot move alone as easily
83
Q
A

Anatomy (6 decks)

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