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Preclerkship > Upper limb anatomy > Flashcards

Upper limb anatomy Flashcards

1
Q

Which root is sensory and which is motor

A 
Dorsal = sensory
Ventral = motor
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2
Q

Root vs ramus

A 
Root = 1-way (input OR output)
Ramus = contains both sensory input + motor output
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3
Q

Except for T2-T12, all ____ branch and make lateral connections just outside the spinal cord =

A

Ventral rami

Make NERVE PLEXUSES

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4
Q

What is the important of a plexus?

A

Each muscle receives nerve supply from >1 spinal nerve –> damage to one doesn’t completely paralyze it

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5
Q

Brachial plexus nerves + spinal levels

A 
C5-C8 + T1
Axillary
Musculocutaneous
Median
Ulnar
Radial
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6
Q

Socket of shoulder joint =

What helps make it deeper?

A

Glenoid cavity

Labrum

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7
Q

a rounded protuberance at the end of some bones, forming an articulation with another bone

A

condyle

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8
Q

What part of the ulna posteriorly fits into a fossa of the humerus?

A

Olecranon (fits into olecranon fossa between medial and lateral epicondyles of the humerus)

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9
Q

ulna and radius each have a ___ process distally

A

styloid

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10
Q

Name the carpal bones (2 rows lateral –> medial starting with proximal row)

A

Some Lovers Try Positions That They Cannot Handle
Scaphoid Lunate Triquetrum Pisiform
Trapezium Trapezoid Capitate Hamate

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11
Q

Which carpal bones articulate with the radius?

A

Scaphoid + lunate

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12
Q

Which 3 nerves of the brachial plexus go all the way into the hand?

A

Radial, median, ulnar

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13
Q

5 branches (peripheral nerves) of the brachial plexus. Name the spinal levels and their targets: Axillary

A

C5-C6

Teres minor, deltoid

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14
Q

5 branches (peripheral nerves) of the brachial plexus. Name the spinal levels and their targets: Radial

A

C5-T1

Posterior compartments

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15
Q

5 branches (peripheral nerves) of the brachial plexus. Name the spinal levels and their targets: Musculocutaneous

A

C5-C7

Arm flexors

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16
Q

5 branches (peripheral nerves) of the brachial plexus. Name the spinal levels and their targets: Median

A

C5-T1

Forearm flexors

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17
Q

5 branches (peripheral nerves) of the brachial plexus. Name the spinal levels and their targets: Ulnar

A

C8-T1

Forearm flexors

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18
Q

Extensor compartment nerves of upper limb

A

Axillary nerve + radial nerve

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19
Q

WHAT ARE THE BRANCHES OF THE MF AORTA

A

Brachiocephalic (–> R subclavian + R common carotid)
L common carotid
L subclavian

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20
Q

Vasculature of the R arm

A

Brachiocephalic –> Subclavian artery –> axillary –> brachial –> radial + ulnar –> palmar arches (deep goes R –> U, superficial goes U–>R)

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21
Q

Blood samples often taken from what vein?

A

Median cubital vein

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22
Q

veins of the arm empty into which main vein?

A

Subclavian (–> brachiocephalic –> SVC)

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23
Q

Muscles acting on the shoulder: superficial layer (extrinsic back) (4)

A

Trapezius
Latissimus dorsi
Rhomboids (+/-)
Teres major

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24
Q

Muscles acting on the shoulder:deep layer (4)

A 
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
"SITS"
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25
Q

Muscles acting on the shoulder: pectoral (3)

A

Serratus anterior
Pectoralis major
Pectoralis minor

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26
Q

Muscles acting on the shoulder: brachium

A

Deltoid
Long head of biceps
Long head of triceps

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27
Q

What back muscle extends, adducts, and medially rotates the humerus?

A

Latissimus dorsi

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28
Q

What muscle elevates/depresses/retracts the scapula?

A

Trapezius

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29
Q

Teres major does what movements of humerus?

A

Adduction + medial rotation (inserts on the lesser tubercle = anterior)

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30
Q

Which rotator cuff muscle inserts at the lesser tubercle of the humerus?

A

Subscapularis

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31
Q

Rotator cuff: teres minor and infraspinatus insert at the ___ and therefore rotate the humerus ___

A

Greater tubercle of the humerus

laterally

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32
Q

Pectoralis minor moves the ____

Pectoralis major moves the _____

A

Minor –> scapula (protraction)

Major –> humerus (arm flexion/adduction

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33
Q

Winged scapula = lesion of ____ resulting in what?

A

Long thoracic nerve

Inactive serratus anterior (so pec minor pulls scapula forward)

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34
Q

Deltoid is innervated by ___ nerve and responsible for what movements?

A

Axillary nerve

Flexion, extension, abduction

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35
Q

Abduction of shoulder involves what 4 muscles in what order to get from 0 –> 180 degrees?
(note - supplied by 4 diff nerves!)

A

Supraspinatus –> deltoid –> trapezius –> serratus anterior

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36
Q

Up to 30o arm abduction, what joint? a

After 30o, what joint?

A

First just glenohumeral

then glenohumeral + scapulothoracic

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37
Q

Which arm flexor is also innervated by the radial nerve?

A

Brachialis

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38
Q

3 arm flexors

A

Biceps (supination)
Coracobrachialis (shoulder flexion)
Brachialis (elbox flexion)

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39
Q

Popeye sign =

A

Rupture of biceps tendon (long-head)

*generally not surgically repaired, brachialis does most of the work

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40
Q

Which heads of the triceps extend the arm? Which extend the forearm?

A

All extend forarm (insert in ulna via triceps brachii tendon)
Only long head extends arm because it originates on scapula, medial/lateral originate on humerus)

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41
Q

common origin of the flexor compartment (forearm)

A

Medial epicondyle

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42
Q

Common origin of the extensor compartment (forearm)

A

Lateral epicondyle

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43
Q

Forearm flexor innervated by radial nerve

A

Brachioradialis

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44
Q

Name 5 SUPERFICIAL forearm flexors from lat to med

A

Brachioradialis then Pass Fail Pass Fail
Pronator teres (pronation)
Flexor carpi radialis (abduction +flexion of hand)
Palmis longus (flexion at wrist, weak elbow flexion)
Flexor carpi ulnaris (adduction/flexion of hand)

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45
Q

Middle + Deep forearm flexors (3)

A

Flexor digitorum superficialis
Flexor digitorum profundus
Pronator quadratus

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46
Q

Thick fibrous band across base of wrist (anterior) to protect/hold tendons =

A

Flexor retinaculum

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47
Q

Flexor digitorum superficialis does what? Innervation?

A

Flexes phalanges @ PIP

Medial nerve

48
Q

Flexor digitorum profundus does what? Innervation?

A

Flexes wrist, metacarpophalangeal, PIP and DIP joints of 2nd-5th digits
Median + ulnar nerve

49
Q

Holding tendons in place at back of wrist =

A

Extensor retinaculum

50
Q

Forearm extensors (lateral –> medial)

A

Extensor carpi radialis (longus + brevis) - abduct hand
Extensor digitorum
Extensor digiti minimi
Extensor carpi ulnaris

51
Q

Deep lateral forearm extensor that supinates arm

A

Supinator

52
Q

2 types of epicondylitis

A

Medial collateral ligament (flexors) = golfer’s elbow (overuse flexion)
Lateral collateral ligament (extensors) = tennis elbow (overuse extension)

53
Q

Outcropping muscles of forearm (4)

A 
Abductor pollicus longus
Extensor pollicus longus 
Extensor pollicus brevis
Extensor indicis (2nd digit)
54
Q

What is the action of the 4 lumbricals of the hand?

A

Flex the metacarpophalangeal joints
Extend the PIP & DIP joints
(N= median for 1-2, ulnar for 3-4)

55
Q

intrinsic muscle sets of the hand (5)

A 
Lumbricals (1-4)
Dorsal interossei (1-4)
Palmar interossei (1-3)
Thenar group
Hypothenar group
56
Q

What do the dorsal interossei do?

A

Abduct digits from axial line

N = ulnar

57
Q

What do the palmar interossei do? N =

A

Adduct digits toward axial line

N = ulnar

58
Q

What muscle does all the fancy thumb motions (flexion, extension, opposition, adduction, abduction)

A

Thenar muscles (N = median & ulnar)

59
Q

4 joints of the pectoral girdle

A

Glenohumeral
Sternoclavicular
Acromioclavicular
Scapulothoracic (not a true joint)

60
Q

Important prominences of the scapula

A

Spine (posterior)
Acromion (lateral)
Coracoid (anterolateral)

61
Q

Ligaments of the AC joint

A

Acromioclavicular ligament

Coracoclavicular ligaments

62
Q

“shoulder dislocation” occurs at what joint?

A

Glenohumeral joint

63
Q

“shoulder separation” occurs at what joints?

A

Acromioclavicular and sternoclavicular

64
Q

3 joints of elbow

A

Radiocapitellar (capitulum of humerus)
Ulnotrochlear
- radiocapitellar + ulnotrochlear –> hinge joint of elbow
Proximal radioulnar (pronation/supination)

65
Q

3 important ligaments of elbow

A

Ulnar collateral ligament
Radial collateral ligament
Annular ligament of radius

66
Q

Name the 6 main forearm flexors

A 
Brachioradialis
Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris
Flexor digitorum superficialis
67
Q

Name the 5 main forearm extensors

A 
Supinator
Extensor carpi radialis (longus + brevis)
Extensor digitorum
Extensor digiti minimi
Extensor carpi radialis
68
Q

Which carpal one is only visible on palmar aspect of hand

A

Pisiform (p = palm)

69
Q

Which carpal bones form the anatomical snuff box of the hand? Tendons of which muscles?

A

Scaphoid + trapezium

EPB/APL + EPL

70
Q

Which carpal bone is most commonly fractured

A

Scaphoid

71
Q

Each interphalangeal joint of hand is a ___ joint with it’s own ___ and _____

A

Synovial
Capsule
Lateral/collateral ligaments

72
Q

The thumb is a ___ joint

A

Saddle

73
Q

___ joint is what we typically think of as the “wrist”. Important ligaments? (4)

A 
Radiocarpal joint
Ulnar carpal collateral ligament
Radial carpal collateral ligament
Dorsal/palmar radiocarpal ligaments
Dorsa/palmar radioulnar ligament
Palmar ulnocarpal ligament
74
Q

What is a colle’s fracture? What usually causes it? Sign on x-ray?

A

Fracture of radius where styloid process pushed posteriorly
usually FOOSH
Dinnerfork deformity

75
Q

What is thoracic outlet syndrome? What 3 areas can this occur?

A

Compression of brachial plexus/subclavian vessels

3 areas: interscalene triangle, costoclavicular space, pectoralis minor space

76
Q

What is the test for thoracic outlet syndrome?

A

Wright’s test (hyperabduction)

Arm into external rotation + abduction –> check for radial pulse ablation

77
Q

What nerve goes through the carpal tunnel? What bounds it? How many tendons go through?

A

Median nerve
Floor = carpal bones
Root = flexor retinaculum
9 (2 per digit + one for thumb)

78
Q

Implications of carpal tunnel syndrome?

A

Thenar muscle weakness + skin paresthesia

79
Q

Shoulder is most prone to dislocation ____

A

Infero-anteriorly (least stabilizing structures/ligaments)

80
Q

What is the most common site of bursitis in the rotator cuff?

A

Subacromial bursa (between acromion and supraspinatus)

81
Q

What is subacromial impingement syndrome?

A

inflammation and irritation of the rotator cuff tendons as they pass through the subacromial space, resulting in pain, weakness, and reduced range of motion within the shoulder

82
Q

2 possible pathologies that can cause SIS?

A

Rotator cuff tendinosis
Subacromial bursitis
(chicken & egg situation)

83
Q

THe proximal radioulnar joint is what kind of joint?

A

Pivot joint (facilitates supination/ pronation, annular ligament of radius loops around)

84
Q

The main large bursa of the elbow

A

Olecranon bursa

85
Q

What nerve can become entrapped in the cubital tunnel?

A

Ulnar nerve

86
Q

Where can the ulnar nerve be found on elbow palpation?

A

Medial para-olecranon groove just behind medial epicondyle

87
Q

What is the carrying angle?

A

Valgus physiological deviation of upper limb (up to 10 degrees in men, 20 in women); allows us to swing arms and carry stuff without abducting shoulders

88
Q

Difference between smith fracture and colle’s fracture?

A 
Smith = distal radius anteriorly displaced
Colles = posteriorly displaced (dinner fork sign)
89
Q

How do you differentiate between Dupuytren’s contracture (thickened palmar fascia) vs torn tendon?
Name 4 conditions DC is associated with

A

Passive movement. DC will be rigid

Diabetes, epilepsy, alcoholism, liver disease/cirrhosis

90
Q

What are osteophytes? Most common cause

A

Bone spurs caused by joint damage

Osteoarthritis

91
Q

What are bouchard’s nodes and heberden’s nodes? What else might you see in the same disease?

A

Osteophytes formed at PIPs and DIPS respectively in osteoarthritis
Also see squaring of the wrist due to osteophytes at the first CMC joint

92
Q

“sausage digits”

A

Dactylitis (can be seen in psoriatic arthritis)

93
Q

What are you looking for if you get the pt to do the “Prayer Sign”?

A

Swan neck deformities (extend PIP, flex DIP)
Boutonnier’s deformities (PIP flex, extend DIP - like pushing button)
^signs of RA

94
Q

In RA the ___ are typically spared from swelling

A

DIP

95
Q

What 2 hand bumps do you easily feel (right beside the wrist)

A

Pisiform (medial by pinky)

Scaphoid (lateral by thumb)

96
Q

Shoulder Physical Exam: Inspection

Asymmetrical height of shoulders could indicate what?

A

Scoliosis

Sprengel’s deformity (high-riding scapula)

97
Q

Test to check for internal rotation of the scapula

A

Apley scratch test

98
Q

Main pathologies you’re looking for in shoulder special tests (5)

A

1) Supraspinatus tear
2) Subacromial impingement syndrome
3) Bicipital tendinitis
4) Acromioclavicular joint pathology (e.g. OA)
5) Instability

99
Q

Special test for supraspinatus tear

A

Drop arm test

100
Q

Special tests for SIS (4)

A

1) Painful arc (abduction)
2) Neer’s test (passive full flexion)
3) Hawkins-Kennedy Test (hold hawk, push down)
4) Empty can test (push down)

101
Q

Special tests for bicipital tendinitis (2)

A

1) Speed’s test (push down)

2) Yergason’s test (thumbs up, you try to pronate them, they resist)

102
Q

Special tests for acromioclavicular joint pathology (2)

A 
Scarf test (wrap hand like scarf, push while stabilizing ipsilateral shoulder)
AC Joint distraction test (adduction behind back)
103
Q

Test for inferior shoulder instability

A

Pull down on arm –> SULCUS sign

104
Q

Test for recurrent anterior subluxation/anterior shoulder instability)?

A

Apprehension test
Relocation test
Anterior release sign

105
Q

Name 6 special tests for the elbow

A

MCL/LCL stability (vagus/varus with arm at 30 degrees)
Anterio-posterior stability (arm at 90, try to move humerus)
Tennis elbow (start with arm out wrist extended)
Golfer’s elbow (same but wrist flexed)
Tinel’s sign (tap ulnar nerve) - cubital tunnel syndrome
Elbow flexion test (60 seconds CTS)

106
Q

What is quervain’s tenosynovitis

A

inflammation of tendons of lateral snuffbox (extensor pollicis brevus/abductor pollicis longus)

107
Q

Tests for carpal tunnel syndrome

A

Tinel’s sign (same as cubital but in this case tap median nerve)
Phalen’s sign (hold dorsal hands together 60 seconds)

108
Q

How can you test for DeQuervain’s tenosynovitis?

A

Finkelstein’s test (thumb in fist, ulnar deviation)

109
Q

Name 4 stability tests in the hand exam

A

1) Wrist stability (sublux up & down)
2) Piano key sign (push down in ulnar head) - distal radioulnar ligament stability, RA can impact
3) MCP stability (flexed!) - like ant-post drawer test, also valgus/varus
4) IP stability (varus/valgus)

110
Q

Median nerve motor and sensory testing

A 
Motor = "okay" sign
Sensory = palmar pad of index finger
111
Q

Radial nerve motor and sensory testing

A 
Motor = thumbs up
Sensory = dorsal 1st web space
112
Q

Ulnar nerve motor and sensory testing

A 
Motor = finger abduction
Sensory = palmar pad of pinky finger
113
Q

Heads of humerus, radius, ulna (proximal vs distal)

A 
Humerus = proximal
Radius = proximal
Ulna = distal (by styloid)
114
Q

Subacromial bursitis =

A 
Supraspinatus tendonitis 
(chicken and egg, they come together)
115
Q

4 compartments of the forearm

A 
Superficial volar (flexor carpi U/R, pronator teres, flexor digitorum superficialis)
Deep volar (FDP, FPL)
Dorsal (supinator, extensors)
Lateral Mobile Wad of Henry (brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis)
116
Q

Compartments of the arm

A

Anterior: biceps brachii, brachialis, coracobrachialis
Posterior: triceps brachii
Deltoid

Preclerkship (25 decks)

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