Upper Limb Flashcards
Which plexus innervates the upper limb ?
Brachial plexus
Brachial plexus is made of what?
Anterior rami of C5 to C8 and T1
Brachial plexus is initially formed in the?
Neck
Clinical testing of lower cervical and T1 nerves is carried out by examining?
Dermatomes, myotomes and tendon reflexes
Musculocutaneous nerves
C5 TO C7
Median nerve
C6 to C8, T1
Radial nerve
C5 TO C8, T1
Ulnar nerve
C(7), 8, T1
Major spinal nerve associated with diaphragm is ________
C4
Median nerve innervates the muscles of anterior compartment of forearm except ____________
Flexor carpi ulnaris and medial-half of flexor digitorum profundus
Most intrinsic muscles of the hand are innervated by ____________ nerve except for _____________ , which are innervated by the ___________nerve
Ulnar nerve
Thenar muscles and two lateral lumbrical muscles
Median nerve
Infraglenoid tubercle is the site of attachment of which muscle?
Long head of triceps brachii
Subscapular fossa of scapula is site of attachment of which muscle?
Subscapularis muscle
Supraglenoid tubercle is site of attachment of which muscle?
Long head of biceps brachii
The ______________ border of scapula is strong and thick.
Lateral
Superior border of scapula, on its lateral end is marked by what 2 things?
- Coracoid process
2. Supra scapular notch
Greater and lesser tubercle is a prominent landmarks on the which end of humerus?
Proximal
What are the four rotator cuff muscles?
Greater tubercle - supraspinatus, infraspinatus, teres minor. inferior tubercle- subscapularis
Describe- ‘Lady between two majors’
It is a mnemonic for the muscle attachments present on the humerus in the order of lateral lip, bicipital groove and medial lip.
Explain SIT
SIT is the mnemonic to remember the muscles attached to the greater tubercle in the order of supraspinatus, infraspinatus and teres minor
The greater tubercle is _______ in position
Lateral
The lesser tubercle is _______ in position
Anterior
Name the tendon that passes through the inter-tubercular sulcus
Tendon of long head of biceps brachii
How is the lateral lip connected to the deltoid tuberosity
The later lip of the inter-tubercular sulcus is continuous with the deltoid tuberosity with a V shaped connection on the lateral surface of the humerus
What are the two structures that play an important role in the surgical neck of the humerus?
The axillary nerve and the posterior circumflex humeral artery
Name the three joints in the shoulder
Sternoclavicular joint acromioclavicular joint glenohumeral joint
The sternoclavicular joint occurs between the – end of clavicle and the – notch of the sternum along with the – cartilage
Proximal end of clavicle and the clavicular notch of the manubrium of sternum along with a small part of the coastal cartilage
What are the four ligaments that enforce the sternoclavicular joint
Anterior sternoclavicular ligament, posterior sternoclavicular ligament, inter-clavicular ligament, costoclavicular ligament
The acromioclavicular joint is a – type of joint
Synovial
Name the ligaments that are associated with the acromioclavicular joint
Acromioclavicular ligament, coracoclavicular ligament which is made of conoid ligament and trapezoid ligament.
The glenohumeral joint is a – type of joint
Ball and socket
The concavity of glenoid cavity is increased by the – structure. Also, comment on the nature of the structure
Glenoid labrum which is fibro cartilaginous in nature
The glenoid labrum is continuous with the – structure superiorly on the scapula. Also this structure continues on to the humerus through the – structure
Superiorly the glenoid labrum is continuous with the tendon of long head of biceps brachii which continues onto the humerus through the inter-tubercular groove
What feature of the synovial membrane accommodates the abduction of the arm
The synovial membrane is a loose inferiorly and this redundant region of the synovial membrane plays a major role in the abduction movement of the arm
Which structure holds the long head of biceps brachii in place, in the inter-tubercular Sulcus
The transverse humeral ligament
The two most superficial muscles of the shoulder – and –
Trapezius and deltoid muscles
What are the sites on the skull for the trapezius muscle?
C1 to TXII
What is ligamentum nuchae?
From C1 TO C7, the trapezius muscle attaches to the vertebrae through ligamentum nuchae
Innervation of the trapezius muscle is by the – nerve and the anterior rami of – and – cervical nerves
Innervation is by accessory nerve XI and the anterior rami of cervical nerves C3 AND C4
Deltoid muscle attachments:-
- Base attached to ________ and ________
- Apex attached to __________
- Position of attachment on humerus
- Scapula and clavicle
- Humerus
- Deltoid tuberosity on the latera surface of shaft of humerus
Deltoid muscle is innervated by – nerve
Axillary
What is the major function of deltoid muscle?
The major function of the deltoid muscle is the abduction of the arm beyond the initial 15° accomplished by the supraspinatous muscle.
What is the function of Levator scapulae muscle?
Elevates the scapula
The levator scapulae originates from transverse process of ____ to ______ vertebra. Also, it is innervated by _______ and ____ and ____ spinal nerve
Originates from C1 TO C4
Innervated by dorsal scapular nerve and directly from C3 AND C4 spinal nerves.
Rhomboid minor originates from:
Rhomboid major originates from:
Rhomboid muscles are innervated by:
Rhomboid muscles help in :
- Lower end of ligamentum nuchae and spines of CVII AND T1 VERTEBRAE
- Spines of TII TO TV
- Dorsal scapular nerve
- Retract and elevate the scapula
Innervation of Supraspinatous and infraspinatus
Supra scapular nerve ( C5, C6)
Function of supraspinatous and infraspinatus muscles
Supraspinatous initiates abduction of the arm. Infraspinatus laterally rotate the humerus
Innervation of Teres minor
Axillary nerve (C5, C6)
Innervation of Teres major
Inferior subscapular nerve (C5, C6, C7)
Teres minor and Teres major function
Laterally rotates the humerus ( part of rotator cuff muscles)
Mention the important function or the feature that triceps brachii gives rise to in the posterior scapular region
The importance of triceps brachii in the posterior scapular region is that its vertical course between the Teres minor in Teres major together with these muscles and the humorous forms spaces through which nerves and vessels pass between regions
Suprasacpular foramen:-
Mention the structures that pass through the supra scapular foramen
Supra scapular artery and the supra scapular vein pass over the supra scapular ligament while the supra scapular nerve passes under. The mnemonic to remember this is ARMY OVER NAVY
Quandrangular space:-
Define the structures that form the border of this space. mention the structures that pass through this space
The borders are formed by - the inferior margin of Teres minor, the surgical neck of humerus, the superior margin of Teres Major and the lateral margin of long head of triceps brachii.
The structures that pass through the space are the axillary nerve and the posterior circumflex humeral artery and vein.
Triangular space :-
Mention the structures that form the border of the space. Also, mention the structures that pass through this space.
The structures that form the border of the triangular space are the inferior margin of Teres minor, superior margin of Teres major and the medial margin of long head of triceps brachii.
Structures that pass through this are the circumflex scapular artery and vein.
Triangular interval:-
Mention the structures that form the triangular interval. Mention the structures that pass through the triangular interval. Also, mention the significance of the triangular interval.
The borders of the triangular interval are formed by the inferior margin of Teres Major, the lateral margin of long head of triceps brachii and the shaft of the humerus. the structures that pass through this interval are the radial nerve, the profunda brachii artery (deep artery of the arm) and the associated veins. the significance of this interval is that since it is below the inferior margin of the Teres major which defines the inferior boundary of the axilla, this interval serves as a passageway between the anterior and posterior compartment of the arm and between the posterior compartment of the arm and axilla.
The lateral epicondyle is much more pronounced than the medial epicondyle- True or False?
False
Much of the radial tuberosity, the proximal part of radius is roughened for the attachment of what?
Biceps brachii tendon
The proximal end of ulna is much larger than the proximal end of radius- True or false?
True
The superior end of proximal part of ulna is roughened for the attachment of which muscle?
Triceps brachii muscle
The anterior compartment of the arm contains ____ number of muscles. Name them.
Also, the above mentioned muscle(s) is/are innervated by ___________ nerve.
3
Coracobrachialis, Brachialis and biceps brachii
Musculocutaneous nerve
The coracobrachialis muscle originates from the __________ and goes to the __________ side of the mid-shaft of humerus.
Coracoid process of scapula
Medial side
What is the function of coracobrachialis muscle
Flexing the arm
Innervation of coracobrachialis
Musculocutaneous nerve (C5, C6, C7)
How many heads does biceps brachii muscle have. Also, mention the place that both the heads originate from.
Biceps brachii muscle has two heads - the short head of the muscle originates from the coracoid process of the scapula in coordination with the coracobrachialis muscle which originates from the coracoid process of the scapula too. The long head of biceps brachii muscle originates from above the supra glenoid tubercle of the scapula
Explain the pathway of both biceps brachii muscle and the fate of them in the arm.
The long head of biceps brachii muscle originates from the supraglenoid tubercle and passes through the head of the humerus and inserts itself into the inter-tubercular groove and joins with its muscle belly together with that of short head of biceps brachii ( which originates in the coracoid process). The long and short heads converge to form a single tendon which inserts itself on to the radial tuberosity. As the tendon enters the forearm, a flat sheet of connective tissue also called the bicipital aponeurosis, fans out from the medial side of the tendon to blend with the deep fascia covering the anterior compartment of the forearm.
Innervation of biceps brachii
Musculocutaneous nerve (C5, C6)
Brachialis muscle:
Origin:-
Above of beneath Biceps muscle?
Innervated by:-
Attaches itself finally to:-
Distal half of anterior aspect of humerus
Beneath
Ulnar tuberosity
Musculocutaneous nerve
Innervation of Brachialis
Musculocutaneous nerve (C5, C6)
What are the muscles of the posterior compartment of the arm?
The only muscle of the posterior compartment of the arm is Triceps brachii
How many heads does triceps brachii have? What are their origins?
3 heads
- Long head- originates from infraglenoid tubercle of scapula
- Lateral head- originates from linear roughening superior to radial groove on humerus
- Medial head- originates from posterior surface of shaft of humerus inferior to the radial groove.
What happens to the three heads of triceps brachii?
The three heads converge to form a large tendon which inserts on the superior surface of olecranon process
Innervation of triceps brachii
Radial nerve (C6, C7, C8)
The major artery of the arm is ___________
Brachial artery
______________ is the largest branch of the brachial artery.
Profunda Brachii artery
The two large subcutaneous vein of the arm are – and –
Basilic and cephalic vein
The anular ligament if the radius is significant in what way in the forearm?
It allows the radial head to slide against the radial notch of the ulna and pivot on the capitulum during pronation and supination.
Explain how the anterior and posterior border of the radius are located.
The anterior border begins on the medial side of the bone as a continuation of the radial tuberosity. In the superior third of the bone, it crosses the shaft diagonally from medial to lateral, as the oblique line of the radius. The posterior border is distinct only in the middle third of the bone.
The roughening for pronator teres is present on the __________ surface of the radius.
Middle of the lateral surface.
The posterior surface of the radius is characterised by the ______________ tubercle which acts as the tendon for the _____________ ( extensor/flexor) muscle of the thumb - the muscle is _________________.
Dorsal
Extensor
Extensor pollicis longus
The styloid process of the radius is present on its ___________ surface.
Lateral
The distal end of the radius bone is marked by facets for articulation of ____________&__________ carpal bones
Scaphoid and lunate
The ulnar styloid process is ___________ in position.
Medial
The roughening for the attachment of Pronator quadratus muscle is present on ______________ surface of ulna.
Medial
The ulnar styloid process is ___________ in position.
Medial
The roughening for the attachment of Pronator quadratus muscle is present on ______________ surface of ulna.
Medial
Interosseous membrane is a _________(thin/thick) ____________(cartilaginous/collagenous) sheet.
Collagenous
Collagen fibre within the interosseous sheet pass ____________ from radius to ulna.
Inferiorly
Interosseous membrane is a _________(thin/thick) ____________(cartilaginous/collagenous) sheet.
Collagenous
Collagen fibre within the interosseous sheet pass ____________ from radius to ulna.
Inferiorly
During pronation and supination, the radius and ulna are held in position by _______,________&________.
Anular ligament of radius
Interosseous membrane
Articuar disc at radio-ulnar joint
Two muscles involved in supination:
Contraction/relaxation of these muscles cause supination;
Supinator
Biceps brachii
Contraction
Two muscles involved in pronation;
Contraction/relaxation of these muscles cause pronation ;
Pronator Teres
Pronator quadratus
Contraction
Trace the path of Pronator Teres
Pronator Teres runs from the medial epicondyle of humerus to the lateral surface of the radius
Trace the path of Pronator quadratus
Pronator quadratus extends between the anterior surfaces of the distal ends of both radius and ulna.
Which muscle maintains the position of the palm of the hand over a central axis during pronation?
Aconeus
Track the path of aconeus muscle.
Runs from lateral epicondyle to the lateral surface of the proximal end of ulna.
Anterior compartment of forearm- flexor/extensor?
Flexor
Muscles of anterior compartment of forearm occur in how many layers? Name the layers.
3
Superficial, intermediate and deep.
Name the muscles of the superficial layer of the forearm in the order of medial to lateral
- Flexor carpi ulnaris
- Palmaris longus
- Flexor carpi radialis
- Pronator teres
Name the muscles of the intermediate layer of the forearm.
Only one-Flexor digitorum superficialis
How many heads does flexor digitorum superficialis muscle have? Mention the origin of each of them.
- Humeral-ulnar head: Originates mainly from the medial head of humerus and medial edge of coronoid process of ulna
- Radial head: originates from anterior oblique line of radius.
Name the muscles of the deep layer of the forearm.
- Flexor digitorum profundus
- Flexor pollicis longus
- Pronator quadratus
Origin of Flexor digitorum profundus
Anterior and medial surfaces of ulna and from the adjacent half of the anterior surfaces of the interosseous membrane
Origin of flexor pollicis longus
Anterior surface of radius and adjacent half of anterior surface of interosseous membrane