Upper Limb Flashcards
Inferior angle of scapula lies over what rib or interspace?
7th rib or interspace
Scapula: Infraspinous process and supraspinous fossa are separated by
Scapular spine
Scapular spine projects laterally over the shoulder joint as the
Acromion
Scapular spine projects anteriorly as ___________ from the upper border of the neck of the scapula
Coracoid process
Subclavian vessels and trunk of brachial plexus pass behind what part of the clavicle
Medial third
The hemispherical head of the humerus is separated from the greater and lesser tubercles by
Anatomical neck
The shaft below the greater and lesser tubercles of the humeral head is called
Surgical neck of humerus
Between the greater and lesser tubercles of humerus is the _________ for the attachment of long head of the biceps
Biccipital groove
Deltoid tuberosity is present on the _______ aspect of humeral midshaft as the site of insertion of deltoid muscle
Lateral aspect of midshaft
Articular surface of elbow joint for radial head
Capitellum
Articular surface of elbow joint for olecranon fossa of ulna
Trochlea
Above the trochlea is the ________ fossa anteriorly and _________ fossa posteriorly
Coronoid fossa anteriorly
Deeper olecranon fossa posteriorly
Vertical line down the front of the humeral shaft on lateral radiograph is called ______ - bisects the capitellum
Anterio humeral line
Hook shaped projection of bone that occasionally occurs about 5cm above the medial epicondyle and may be continuous with a fibrous band, the ligament of Struthers, attached above the epicondyle to form a foramen that transmits the median nerve and brachial artery
Supracondylar process
Flexors of the forearm arise from the
Medial epicondyle of humerus
Ossification of capitellum is at what year
1 -2 years
Ossification of radial head is at what year
3-6 years
Ossification of internal epicondyle is at what year
4 years
Ossification of trochlea is at what year
8 years
Ossification of olecranon is at what year
9 years
CRITOE fuses at
17-18 years
Ossification of external epicondyle is at what year
10 years
Most distal part of radius
Radial styloid
Radius is connected by ________ to ulna
Interosseous membrane
Triceps muscle is inserted to the
Tip of the olecranon
Square flat muscle that arises on the distal ulna and passes to the distal radius
Pronator quadratus
Wrist bone anterior to the surface of triquetral bones
Pisiform
The ________ is attached laterally to the scaphoid and the ridge of the trapezium, and medially to the pisiform and hook of hamate
It converts the arch of bones into the carpal tunnel, which conveys the flexors tendons of the fingers and thumb and the median nerve
Flexor retinaculum
Found on the dorsum of the wrist, attaches to the pisiform and triquetrum medially and the radius laterally
Extensor retinaculum
Carpal tunnel views are obtained by
Extending the wrist and taking an inferosuperior view that is centered over the anterior part of the wrist
First carpal bone to ossify
Capitate
Last carpal bone to ossify
Pisiform
Direction of ossification of wrist bones
Clockwise from capitate
Most mobile and least likely to fracture metacarpal bone
1st metacarpal bone
Metacarpal bone that has a styloid process extending from its base on the dorsal aspect
3rd metacarpal
What side of the hand is used for bone age
Left
Supernumerary bone found between scaphoid, trapezoid and capitate which may represent the tubercle of the scaphoid that has not fused with its upper pole
Os centrale
Supernumerary bone found on the lateral side of the scaphoid distal to the radial styloid
Os radiale externum
Tendons of the extensors of fingers are inserted into the
Base of the dorsum of the phalanges
Sternoclavicular and acromioclavicular joints are what type of joint
Synovial
Glenohumeral joint is what type
Ball and socket synovial
Contents of quadrilateral space
Circumflex humeral nerve and vessels
Long head of biceps is extra or intrasynovial and intra or extracapsular?!
Extrasynovial but intracapsular
Number of glenohumeral ligaments
3- anterior thickenings of capsule from upper part of glenoid to lesser tuberosity and inferior part of the head of humerus, and in the posterior capsule
Weak ligament of glenohumeral joint that is not supported by overlying muscles
Anterior and inferior parts
Ligament between greater and lesser humeral tuberosities
Transverse humeral ligament
Short muscles known as the rotator cuff muscles consist of
Subscapularis, infraspinatus, teres minor and supraspinatus
Longer muscles of shoulder include
Long head of biceps Pectoralis major Latissimus dorsi Teres major Deltoid muscles
What muscle passes on the superior aspect of the shoulder joint to the greater tuberosity of humerus where calcification occur owing to degenerative change
Supraspinatus muscle
What is the largest bursa in the body that separates supraspinatus muscle from acromion
Subacromial- subdeltoid bursa
The coracoacromial arch is composed of
Tip of the coracoid
Coracoacromial ligament
Acromion
Acromioclavicular articulation
Most common type of acromial shape
Type 1 curved
Least common acromial arch that produces symptomatic impingement of the supraspinatus tendon
Type 3 flat with marginal hook
Types of coracoacromial arch
Type 1 curved
Type 2 flat
Type 3 flat with a marginal hook
3 forms of bicipitolabral complex
Type 1- long head of biceps inserts to the osseous glenoid immediately above the labrum
Type 2- biceps tendon inserts to the superior surface of the labrum
Type 3- long head of biceps inserts into labrum to produce a meniscoid type insertion
What type of bicipitolabral complex insertion predisposes to superior labral tears
Type 3
Identified as a triangular structure in both the coronal and axial planes and is continuous with a fold of the joint capsule, the inferior glenohumeral ligament
Anteroinferior labrum
Injury at the anteroinferior labrum following anterior dislocation, with blunt trauma and traction stresses imposed by the inferior glenohumeral ligament may result in disruption of the labrum called
Perthe’s lesion
Disruption of anteroinferior labrum and associated bone
Bankaart lesion
Medialization of anteroinferior labrum beneath a rind of periosteum
ALPSA lesion (anterior labral periosteal sleeve avulsion)
Avulsion of the inferior glenohumeral ligament from humerus
HAGL injury (humeral avulsion of the glenohumeral ligament
Superior stability of glenohumeral joint
Superior labrum, long head of biceps, joint capsule, supraspinatus tendon, subacromial bursa and structures of the coracoacromial arch
Posterior stability of glenohumeral joint
Angulation of osseous glenoid, posterior labrum, capsule, posterior tendons of rotator cuff, infraspinatus and teres minor
Anterior stability of glenohumeral joint
Labrum, capsule and its associated folds or glenohumeral ligaments, subscapularis muscle
Synovial hinge joint which incorporates the humeroulnar, humeroradial, and superior radioulnar joints as one cavity
Elbow joint
Medial thickenings of the elbow joint capsule
Radial and ulnar collateral ligaments
Ligament that surrounds the head of the radius and rotates within it. It is attached
Annular ligament
Elbow ossification centers occurs 1-2 years earlier in girls or boys?
Girls
What elbow fat pad is abnormally seen
Posterior fat pad
Responsible for medial elbow joint stability and resistance to valgus strain.
Ulnar collateral ligament
3 discrete tendon bundles of ulnar collateral ligament
Anterior, posterior, transverse
What bundle in the ulnar collateral ligament is the most important contributor to stability and is therefore most frequently injured
Anterior
Four components of lateral collateral ligament
Radial collateral ligament
Lateral ulnar collateral ligament
Annular
Accessory annular
Radial collateral ligament is responsible for
Lateral joint stability
Lateral ulnar collateral ligament is responsible for
Posterolateral stability
Annular and accessory annular ligaments are responsible for
Stability of proximal radioulnar joint
Short head of the biceps muscle arises from
Apex of coracoid
Long head of biceps arises from
supraglenoid tubercle
Triceps muscle lies in what compartment of the arm
Posterior
3 heads of triceps
Long head, lateral head, medial head
Long head of triceps arises from
Infraglenoid
Lateral head of triceps arises from
Lateral and posterior aspect of humerus
Medial head of triceps arises distally from
Medial and posterior aspects of the humerus
Commonest cause of elbow pain in adult population
Lateral epicondylitis or tennis elbow
Medial epicondylitis also known as
Golfer’s elbow
Nerve within the anteromedial soft tissues of the elbow
Median nerve
Nerve found anterior to the lateral epicondyle
Radial nerve
Nerve found within the cubital tunnel immediately posterior to the medial epicondyle
Ulnar nerve
Inferior radioulnar joint is what type of joint
Synovial pivot joint
Radiocarpal joint is what type of joint
Synovial
Articulates with the head of ulna, ulnar notch and upper surface of the articular disc ( triangular cartilage)
Inferior radioulnar joint
Articulates with the distal radius, distal surface of triangular cartilage and proximal surfaces of the scaphoid, lunate and triquetral bones
Radiocarpal joint
Repetitive wrist flexion and extension, particularly repetitive extension of the thumb
First extensor compartment syndrome (de Quervain’s tenosynovitis)
Second most commonly fractures bone or the wrist
Scaphoid
Proximla 70-80% of th scaphoid is supplied by
Dorsal branch of the radial artery
Fibro-osseous canal superficial to the flexor retinaculum, intimately related to both the pisiform and hook of hamate
Guyon’s canal
Guyon’s canal contain the
Ulnar nerve, artery and vein
Flexion deformity of DIP joint resulting from loss of extensor tendon continuity to the distal phalanx
Mallet finger
Caused by disruption or the central slip of extensor tendon combined with tearing of the triangular ligament on the dorsum of the misdle phalanx, allowing the lateral bands of the extensor tendon to slip below the axis of Aapup articulation
Extensor tendon injury: Boutonniere deformity
Avulsion of flexor digitorum profundus tendon from its insertion into the base of the distal phalanx
Jersey finger- flexor digitorum profundus tendon injury
What muscle covers the upper lateral aspect of the humerus
Deltoid muscle
Muscles that lie anterior to the humerus in its upper third
Flexors of the shoulder- coracobrachialis and biceps muscles
Muscles that lie anterior to the lower part of the humerus
Flexors of the elbow- brachialis and biceps muscles
Muscles that lies posterior to the humerus
Extensors of the elbow- triceps muscle
The neurovascular bundle of brachial artery, basilic vein and median nerve lies superficially, medial to the
Humerus
Upper limb receives its blood supply from
Subclavian artery
Subclavian artery has four branches namely
Vertebral artery
Thyrocervical trunk
Internal thoracic artery
Costocervical trunk
Subcalvian artery becomes the axillary artery at the
Outer border of first rib
Supplies the inferior thyroid, suprascapular and transverse cervical arteries
Thyroocervical trunk
Six arteries to the chest wall and shoulder
Superior thoracic artery Acromiothoracic trunk Lateral thoracic artery Subscapular artery Anterior and posterior circumflex humeral arteries
Brachial artery begins at the
Lower border of teres major
Branches of brachial artery
Profunda brachii srtery
Nutrient artery to the humerus
Muscular branches
Branches to the elbow joint
Larger and deeper than radial artery
Ulnar artery
Superficial veins of the upper limb
Cephalic, basilic, median veins
Veins in the dorsum of hand
Cephalic and basilic
Veins in the palmar side of hand
Median nerve
Cephalic vein is at what side
Radial side
Basilic vein is at what side
Medial side
Vein where cephalic and basilic veins meet
Median cubital vein
The neurovascular bundle of brachial artery, basilic vein and median nerve lies superficially, medial to the
Humerus
Upper limb receives its blood supply from
Subclavian artery
Subclavian artery has four branches namely
Vertebral artery
Thyrocervical trunk
Internal thoracic artery
Costocervical trunk
Subcalvian artery becomes the axillary artery at the
Outer border of first rib
Supplies the inferior thyroid, suprascapular and transverse cervical arteries
Thyroocervical trunk
Six arteries to the chest wall and shoulder
Superior thoracic artery Acromiothoracic trunk Lateral thoracic artery Subscapular artery Anterior and posterior circumflex humeral arteries
Brachial artery begins at the
Lower border of teres major
Branches of brachial artery
Profunda brachii srtery
Nutrient artery to the humerus
Muscular branches
Branches to the elbow joint
Larger and deeper than radial artery
Ulnar artery
Superficial veins of the upper limb
Cephalic, basilic, median veins
Veins in the dorsum of hand
Cephalic and basilic
Veins in the palmar side of hand
Median nerve
Cephalic vein is at what side
Radial side
Basilic vein is at what side
Medial side
Vein where cephalic and basilic veins meet
Median cubital vein