Upper Limb Anatomy Flashcards
Clavicle most commonly fractures at … The bones move …
Lateral 1/3, medial 2/3
Lateral 1/3 moves inferomedially (pulled down by upper limb) and medial 2/3 moves superior (pulled by trapezius)
Clavicle fractures endanger
Subclavian artery and veins, brachial plexus devisoin and suprascapular nerves
Innervation of rotator cuff
Supraspinatus: suprascapular nerve
Infraspinatus: suprascapular
Teres minor: axillary nerve
Subscapularis: upper and lower subscapula nerves
attachments and action of subscapularis
subscapular fossa to lesser tubercule of humerus causing internal rotation of humerus.
Testing of rotator cuff muscles
Supraspinatus: empty can test
Infraspinatus: resisted external rotation
Subscapularis: lift off test
Teres minor: resisted internal rotation
Axillary lymph nodes drainage
Pectoral Nodes: drain upper outer quadrant of breast
Lateral nodes: drain upper arm
Posterior nodes: posterior chest wall
Central nodes: drain posterior, pectoral and lateral nodes
Apical nodes: drain central and hence all others
Passing through axilla
axillary artery and vein, cords and branches of brachial plexus and axillary lymph
Quadrilateral space of thorax
superiorly bordered by teres minor, inferiorly by teres major, medially by long head of triceps, laterally by surgical neck of humerus.
Contains axiallary nerve and posterior circimflex artery
Structures endangered in surgical neck of humerus fracture and anteroinferior dislocations of humerus
Triangular interval
superior border teres minor, medial border long head biceps, lateral border humerus
Contains radial nerve and deep brachial artery
Triangular space
Bordered superiorly by teres minor, inferiorly by teres major and laterally by long head of triceps
Contains circumflex scapular artery and vein
Damage to axiallry nerve occurs via surgical neck fractures. What is result?
Deltoid paralysis and inability to abduct past 30 degrees. Loss of sensation on regimental patch. May have bleeding from posterior circumflex humeral artery
Midshaft humerus fractures endager
Radial nerve in radial groove and deep brachial artery. May cause wrist drop
Medial epichodylar fractures endanger
ulnar nerve resulting in minor ulnar claw (ulnar paradox) and loss of sensation to medial 1.5 digits
Medial supracondylar ridge fractures endager
median nerve and brachial artery
Biceps brachii attachments and innervation, best action
Short head : coracoid process
Long head: supraglenoid tubercle
Innervation: musculocutaneous
Best action: whilst supinated
Pop-eye sign: biceps tendon not attatched.
Anterior arm actions and innervation
Actions: flexion of shoulder and elbow, supination of forearm
Innervation: musculocutaneous nerve. Except brachialis which is partially innervated by radial nerve
Pop-eye sign
rupture of biceps tendon
Cubital fossa borders and contents
medial border is lateral border of pronator teres, lateral border is medial border of brachioradialis, superior border imaginary line bewteen epichondyles
Contents: median nerve, radial nerve (maybe), median cubital vein
Posterior arm and forearm innervation
Radial nerve
Colles fracture
transverse fracture causing posterior duisplacement of distal radius
FOOSH fracture
Smith fracture
falling on flexed hand
Transverse fracture causing anterior displacement of distal radius
Anterior forearm innervation
median nerve except flexor carpi ulnaris and medial 1/2 of flexor digitorum profundus by ulnar nerve
Anterior forearm muscle attatchments
medial epichondyle
difference between flexor digitorum profundus and superficialis
profundus flexes distal IP joint and superficialis won’t
Nursemaids elbow
dislocation of radius from annular ligament
Student’s elbow
inflammation of olecranon bursa
Carpal tunnel
4 flexor digitorum profundus tendons, 4 flexor digitorum superficialis tendon, 1 flexor policis longus tendon and median nerve bound by flexor retinaculum
median nerve
lateral 3.5 digits sensation
guyons canal
carries ulnar nerve and artery. Compression causes loss to medial 1.5 digits
Carpal bones
Scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capatate hamate
From radius to ulnar in 2 lines
innervation of muscles of hand
All innervated by ulnar except LOAF
Lateral 2 lumbricals
Opponens pollucis
Abductor pollicis brevis and flexor pollicis brevis
Including posterior hand muscles
Anatomical snuffbox
feel scaphoid (fracture) and trapezium and can feel radial artery. Cephalic vein in here as well
Brachial plexus nerves
Musculocutaneous Median Axillary Radial Ulnar
Klumpkes paralysis
abducted arm being pulled
C8 and T1 damaged
Results in weakness of intrinsic arm muscles (ulnar claw) and horners syndrome (T1)
Erb’s Duchene palsy
traction of head and neck damaging C5 and C6
Presents as medially rotated arm and extended and pronated forearm (waiters tip)
Long thoracic nerve
from C5, C6, C7 and innervates seratus anterior anterior
Severing causes winging of scapula (protracted and posterior scapular)
C5, 6 7 wings to heaven
Axillary nerve
motor to deltoid, sensory to regiumental patch
Damaged surgical neck humerus
C5, C6
musculocutaneous nerve
motor to coracobrachial, biceps and brachialis, sensory to lateral skin of forearm
C5, C6, C7
Radial nerve
motor to forearm and arm extensors and sensory to dorsal lateral 3.5 digits of hand
Damaged midshaft humerus of fracture
Roots C5,6,7,8,T1
median nerve
motor to anterior forearm (except 2) and LOAF
Sensory to palmar lateral 3.5 digits of hand
damage in carpal tunnel
Loss causes hand of benediction, thenar eminence of wasting , loss of sensation to palmar lateral 3.5
C5, C6, C7, C8, T1
ulnar nerve
motor to 2 anterior forearm muscles and all intrinsic hand muscles except LOAF
Damage at medial epicondyle of humerus and guyons canal
Causes ulnar claw, fromet sign and wasting of hypothenar emminence and loss of sensation to medial 1.5 didgits of hands
C7, C8, T1
Myotomes
Shoulder abduction: C5, 6 Shoulder adduction: C6,7,8 Elbow flexion: C5,6 Elbow extension: C7,8 Wrist flexion: C6,7 Wrist extention: C7,8 Finger flexion: C7,8 Finger extention: C7,8 Finger abduction and adduction: C8, T1
