Upper Limb Anatomy Flashcards
In the upper limb, what veins are in the place of the pre-axial border and post-axial border?
Pre-axial border: Cephalic vein
Post-axial border: Basilic vein
In the upper limb, what peripheral nerve supply the shoulders?
What nerve roots do these nerves come from?
Supraclavicular nerve. C3-4
Not apart of the brachial plexus
What nerve root does Intercostobrachial nerve come from?
T2
Describe the peripheral nerve innervation (medially to laterally) of the anatomical arm
Intercostobrachial nerve (T2)
Medial cutaneous nerve of arm (brachial plexus)
Medial cutaneous nerve of forearm (brachial plexus)
Lower lateral cutaneous nerve of arm (radial nerve)
What is the function of pedicles in vertebra?
Connect transverse processes to vertebral bodies
What is in between the spinous process and the transverse processes of vertebrae?
Articular process
There are superior and inferior articular processes, in vertebra, when they connect, what do they form?
Facet joints
What connects the articular process to the spinous process?
Lamina
What is the function of the ligamentum flavum, anterior longitudinal ligament and posterior longitudinal ligament?
Ligamentum flavum and anterior longituidinal ligament both prevent hyperextension of the vertebral column
Posterior longitudinal ligament prevent hyperflexion of the vertebral column
In a ‘normal’ adult, what vertebra are found to be in the lordosis position?
Cervical and Lumbar
Describe the upper limb myotomes
C5: shoulder abduction and external rotation
C6: supination, elbow flexion and wrist extension
C7: pronation, elbow extension and wrist flexion
C8: finger flexion and extension
T1: finger abduction and adduction
Which two parts of the thoracic vertebrae and the rib are in contact?
Superior demifacet is in contact with the inferior facet of rib
Facet for the articular part of the the tubercle of the rib (on the transverse process) is in contact with the articular part of the tubercle of the rib
Do cervical spinal nerve roots come out above or below its respective vertebral body?
Above
Axillary artery is a continuation of what artery?
When does the axillary artery initially start?
Continuation of subclavian artery.
Starts at the lateral border of the first rib.
The axillary artery then becomes what artery?
Where does this initially occur?
Becomes the brachial artery at the inferior border of the teres major muscle.
What vein does the cephalic vein drain into?
Axillary vein
Brachial plexus.
What trunks do C5, C6 and C7 nerve roots enter?
Superior trunk- C5 and C6
Medial trunk - C7
What are the 2 divisions in the brachial plexus?
Anterior and posterior
What are the 3 cords in the brachial plexus?
LPM
Lateral
Posterior
Medial
What nerve roots make up the lateral cord in the brachial plexus?
C5, C6 and C7
What nerve roots make up each individual branch of the brachial plexus
3 mice: Musculocutaneous nerve: C5, C6, C7
2 assassinated: Axillary nerve: C5, C6
4 murdered: Median nerve: C6, C7, C8, T1
5 rats: Radial nerve: C5, C6, C7, C8, T1
2 unicorns: C8, T1
Where are brachial plexus roots found?
Posterior triangle of the neck
The cords of the brachial plexus are relative to what structure?
Axillary artery
Medial cord is medial to axillary artery
Injury to the upper roots of the brachial plexus is called Erb’s palsy.
How do the limbs characteristically look?
Medial rotation of the limb
Adduction of the arm
Extension of the elbow
What are 2 physical movements of the limb that cause lower brachial plexus injury?
What is this palsy called?
Which nerve roots and nerve are affected?
Forced hyperextension and hyperabduction
Klumpke’s palsy
C8 and T1 so ulnar nerve
Describe the characteristics typically seen in Klumpe’s palsy
3
‘Claw hand’:
- hyperextension of metatarsophalangeal joint
- flexion of proximal interphalangeal joint
- abduction of thumb
(- wasting of interossi)
What nerves supply pectoralis major and minor?
Pectoralis major: lateral and medial pectoral nerve
Pectoralis minor: medial pectoral nerve
Where does the pectoralis major insert itself?
What are 3 actions of the pectoralis major?
Lateral lip of the bicipital groove of the humerus
1) Flex the humerus
2) Medially rotate the humerus
3) Adduct the humerus
Name 1 function of pectoralis minor muscle
Stabilises the scapula by drawing it inferiorly and anteriorly (againt the thoracic wall)
(It inserts on the coracoid process of the scapula and originates from the 3rd-5th ribs)
Contraction of serratus anterior leads to the stabilisation of the scapula by drawing it anteriorly so the arm can abduct above 90*.
What nerve innervates the serratus anterior.
Damage to this nerve can then lead to what?
Damage to the Long thoracic nerve can lead to winging of the scapula
What is the origin, insertion, innervation and function of Coracobrachialis?
Origin: coracoid process of scapula
Insertion: medial shaft of humerus
Innervation: musculocutaneous nerve
Function: Flex arm (at shoulder joint)
Describe the
A) First 90* abduction of the shoulder at the glenohumeral joint - include the nerves that innervate these muscles and the specific muscle fibres involved
B) 90-150 rotation of scapula at the scapulothoracic joint - include the nerves that innervated these muscles and the specific muscle fibres involved
A) 0-15: Supraspinatus muscle - Suprascapular nerve
15-90: Deltoid muscle, middle fibres - Axillary nerve
B) 90-150: Serratus anterior - Long thoracic nerve and Trapezius, upper fibres - Accessory nerve
What do the anterior and posterior deltoid fibre do?
Posterior: extend the arm (at shoulder joint)
Anterior: flex the arm (at the shoulder joint)
What connects the basilic vein to the cephalic vein?
Median cubital vein
Name all the axillary lymph node groups that form a 1 shape
All are relative to pectoralis minor
Anterior group Posterior group Lateral group Central group Apical group Infraclavicular group
What makes up all the borders of the axilla?
Base: Axillary fascia
Lateral: Humeral groove
Apex: Posterior clavicle, scapula, lateral border of 1st rib
Medial: Thoracic wall and serratus anterior
Anterior: Subclavius, pectoralis minor and major
Posterior: Subscapularis, latissimus dorsi and teres major
What fossa makes up the anterior surface of the scapula?
Subscapular fossa
What are the 2 names of the ligaments that connect the coracoid process, of the scapula, to the clavicle?
Which one is found more laterally and medially?
Lateral: Trapezoid ligament
Medial: Conoid ligament
What are the 3 anterior arm muscles names, innervations and functions?
BBC
Biceps brachii (short head and long head) - flex arm (at shoulder joint) and supination Coracobrachialis - flex arm (at shoulder joint) Brachialis -flex forearm (at elbow joint)
Innervated by musculocutaneous nerve
What is the origin of both heads of the biceps brachii?
Long head: supraglenoid tubercle of scapula
Short head: coracoid process of scapula
What is the function of subscapularis, infraspinatus and teres minor?
What are their innervations?
Subscapularis - medial rotation, Upper and lower subscapular nerves
Infraspinatus - lateral rotation, Suprascapular nerve
Teres minor - lateral rotation and adduction, Axillary nerve
What does the subacromial bursa seperate?
Supraspinatus tendon from the coracoacromial ligament, deltoid, acromion and coracoid process
What is the arterial supply to the posterior arm?
Profunda brachii artery
What is the insertion of triceps brachii?
What is the action and innervation of triceps brachii?
Olecranon of ulna
A: Extension of forearm (at elbow joint)
I: Radial nerve
What 3 muscles extend the arm at the shoulder joint?
What are each of their innervations?
Latissimus dorsi - thoracodorsal nerve
Teres major - lower subscapular nerve
Posterior fibres of deltoid muscle - axillary nerve
What 4 muscles medially rotate the arm at the shoulder joint?
What are each of their innervations?
STPL
Subscapularis - upper and lower subscapular nerve
Teres major - lower subscapular nerve
Latissimus dorsi - thoracodorsal nerve
Pectoralis major - medial and lateral pectoral nerves
What 3 arteries supply the shoulder?
Anterior and posterior circumflex humeral arteries
(Branches from axillary artery after it passes behind the pectoralis minor muscle)
Suprascapular artery
Quadrangular space is found in the posterior arm.
What are the 4 (lateral, medial, superior and inferior) borders of the quadrangular space?
What are the contents of the quadrangular space?
Contents: posterior circumflex humeral artery and axillary artery.
Superior: teres minor
Inferior: teres major
Lateral: surgical neck of humerus
Medial: long head of triceps brachii
What inserts at the lateral lip, floor and medial lip of the intertubercular sulcus/bicipital groove?
‘A lady between 2 majors’
Lateral lip: Pectoralis major
Floor: Latissimus dorsi
Medial lip: Teres major
Name 3 back muscles innervated by Dorsal scapular nerve.
Levator scapulae
Rhomboid minor
Rhomboid major
What is the function of the rhomboid muscles?
Retracts the medial border of the scapula thus allowing the glenoid fossa to be pulled inferiorly
Radial collateral ligament function
Ensures articulation between radial head and capitulum of humerus during supination and pronation
Annular ligament of radius function
Stabilises the proximal radioulnar joint by ensuring the articulation between the radial head and radial notch in the ulnar
What muscles perform supination, at the proximal and distal radio-ulnar joints, when there is and isn’t resistance?
No resistance: Supinator
Resistance: Biceps brachii
Name muscles that perform pronation, at the proximal and distal radio-ulnar joints
Pronator quadratus
Pronator teres
Name 2 important bursa in the elbow and discuss where they are found
(Subcutaneous) Olecranon bursa: subcutaneous connective tissue overlying the olecranon
Subtendinous bursa: between the triceps brachii tendon and tip of olecranon
(Olecranon is a part of the ulna)
What structure binds the radius and ulna together and separates the distal radio-ulnar joint from the wrist joint?
TFCC: Triangular fibrocartilage complex
Where is the common flexor and common extensor origin in the upper limb?
Common flexor origin: medial epicondyle of the humerus
Common extensor origin: lateral epicondyle of the humerus
Brachioradialis muscle is found in the posterior compartment of the forearm but is seen in the anterior compartment.
What is Brachioradialis’ function and innervation?
Name 4 superficial muscle that can be seen in the anterior forearm.
Name them laterally to medially.
Name their innervations
What are their functions
Brachioradialis- radial nerve - elbow flexor
Pass, fail, pass, fail (all originate from common flexor origin):
Pronator teres - median nerve - pronation
Flexor carpi radialis - median nerve - wrist flexor and abduction
Palmaris longus - median nerve - wrist flexor
Flexor carpi ulnaris - ulnar nerve - adduction and wrist flexor
Where does brachioradialis originate from?
Lateral supracondylar ridge of the humerus
What nerve can be found between the 2 heads of flexor carpi ulnaris and pronator teres?
Flexor carpi ulnaris: ulnar nerve
Pronator teres: MEDIAN nerve
Name 3 deep muscles found in the anterior forearm and discuss their positions.
What are their innervations and functions?
Deep: Pronator quadratus - median nerve - pronation
Lateral: Flexor pollicis longus - median nerve - PIPJ flexor, MCPJ flexor
Medial: Flexor digitorum profundus - median and ulnar nerve - DIPJ flexor, wrist flexor and MCPJ flexor
Flexor digitorum superficialis is a middle layer muscle in the anterior forearm.
What is its innervation and functions?
Median nerve - PIPJ flexor, MCPJ flexor and wrist flexor
Cubital fossa borders
Floor (2), Roof (3), Medial (1), Lateral (1) and Superior (1) border
Roof: skin, fascia, bicipital aponeurosis
Floor: Supinator and Brachialis
Medial border: Pronator teres
Lateral border: Brachioradialis
Superior border: Hypothetical line between the humeral epicondyles
What are the contents of the cubital fossa?
Lateral to medial
Really Need Beer To Be At My Nicest
Radial nerve
Biceps tendon
Brachial artery
Median nerve
What peripheral nerve innervates the thumb and first 2 and a half fingers of the posterior palm?
Radial nerve
Peripheral innervation of the forearm:
The medial and lateral cutaneous nerves of the forearm innervate the medial and lateral arm respectively.
What nerves do these peripheral nerves brach off from?
Lateral cutaneous nerve of forearm - from musculocutaneous nerve
Medial cutaneous nerve of forearm - from the brachial plexus
What significant vessels are found at the medial (1) and lateral (2) humeral epicondyles
Medial - ulnar nerve passes behind the medial epicondyle (to enter the forearm)
Lateral - profunda brachii artery and radial nerve
What are the 3 branches given off by the Ulnar nerve in the forearm?
Muscular branch
Palmar cutaneous branch
Dorsal cutaneous branch
The ulnar nerve and artery enter through the ______ canal to enter the palm.
The ulnar ______ is found more medially to the ulnar _______.
The _______ canal is found above the ______ _______.
A) Guyon’s/Ulnar
B) ulnar nerve found more medially to ulnar artery
C) Guyon’s canal is found above the flexor retinaculum
What is the function of Extensor carpi radialis brevis, ECRB?
Wrist extension and wrist abduction
What superficial posterior forearm muscle originates from the lateral supracondylar ridge, along with Brachioradialis?
Extensor carpi radialis longus
Medial to Brachioradialis
Name 3 superficial posterior forearm muscles, laterally to medially, that originate from the common extensor origin
- Extensor carpi radialis brevis
- Extensor digitorum
- Extensor digiti minimi
Where does Extensor carpi ulnaris insert?
What is its innervation?
What are its 2 functions?
Insertion: 5th metacarpal
Innervation: posterior interosseous branch of radial nerve
Functions: wrist extension and wrist adduction
Name 3 deep posterior forearm muscles, laterally to medially, that act on the thumb
Abductor pollicis longus
Extensor pollicis brevis
Extensor pollicis longus
What are the 3 contents of the anatomical snuff box?
Name them laterally (radial side) to medially (ulnar side)
Radial artery
Superficial branch of radial nerve
Cephalic vein
What is the roof, floor, medial, lateral and proximal borders of the anatomical snuff box?
Roof: skin
Floor: trapezium and scaphoid
Proximal: styloid process of radius
Lateral: tendons of abductor pollicis longus and extensor pollicis brevis
Medial: tendon of extensor pollicis longus
What 4 main structures pass through the carpal tunnel to enter the palm?
Flexor pollicis longus tendon
Flexor digitorum superficialis tendons x4 (spiderman fingers to know the arrangment)
Flexor digitorum profundus tendons x4
Median nerve
What specifically forms the radio-carpal joint?
Radius articular surface for carpal bones articulates with scaphoid and lunate bones
In the anatomical position, name all the carpal bones, in a clockwise direction, starting at capitate (8)
Capitate Trapezoid Trapezium Scaphoid Lunate Triquetrum Pisiform Hamate
Name the 3 intrinsic hand muscles found in the thenar compartment, laterally to medially.
What are their innervations?
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
-all median nerve innervation: (Meat LOAF (M stands for Median nerve. L stands for I and II Lumbricals, both unipennate))
Adductor pollicis insertion site is the ulnar side of the base of the 1st proximal phalanx (along with flexor pollicis brevis).
What is its origins?
What is its innervation?
Innervation: ulnar nerve (just like most of intrinsic hand muscles - apart from Meat LOAF)
Origins:
1) Transverse head: (shaft of) 3rd metacarpal
2) Oblique head: capitate and (base of) 2nd and 3rd metacarpal
Name 3 intrinsic hypothenar muscles and discuss their placements (deep, medial, lateral)
Deep: Opponens digiti minimi
Lateral: Flexor digiti minimi brevis
Medial: Abductor digiti minimi
What are the 2 actions of the 4 lumbricals?
What 2 great muscles do the lumbricals connect?
Action: (Make ‘L’ shape) - Flex metacarpophalangeal joint and extend interphalangeal joints of 4 fingers
Connects: flexor digitorum profundus and extensor digitorum
How many palmar and dorsal interossi muscles are there?
What are their functions?
3 PAD 4 DAB:
3 Palmar interossi muscles: adduct index, ring and little finger towards the middle finger
4 Dorsal interossi muscles: abduct the fingers and assist the lumbricals in metacarpophalangeal flexion and interphalangeal extension
What is the deep and superficial palmar branches mainly supplied by?
Deep palmar branch: Radial artery
SUperficial palmar branch: Ulnar artery
Common digital arteries come off from what palmar branch - superficial or deep?
Superficial
