Upper limb & Back - anat Flashcards
what levels of the spine does the trapezius attach to?
C7-T12
where is the corocoid and acromion of the scapula?
what is ligament between the acromion and clavicle?
acromicoclavicular
what is the ligament between the corocoid and acromion?
corocoacromial ligament
what 4 muscles make up the rotator cuff muscles?
- subscapularis
- infraspinatous
- teres minor
- superaspinatous
what are the movements of the shoulder and what muscles do this
infraspinatus and teres minor laterally rotates the humerus
supraspinatous works with the deltoid muscle abduct humerus
subscapularis works with scapularis to move it forward
abduction: supraspinatus
rotation: infraspinatous, teres minor, subscapularis
which is the most common muscle to be torn in a shoulder dislocation?
supraspinatus
what are the functions of the rotator cuff muslces
- stabilisation
- concavity compression
- movement (abduction, adduction, rotation)
where does the 2 heads of the biceps brachii connect to?
medial head: coracoid process
lateral head: scapula (goes under the tendon of the subscapularis)
what is the ligament attached to the subscapularis?
transverse ligament
latissimus (lateral) dorsi (back)
- ins
levator scapulae
pectolaris major
pectolaris minor
serratus anterior
deltoid
subscapularis
teres major
is lower down the scapula and the humerus than the teres minor
+ where does it insert and originate
**Think about mneomics used
triceps brachii
- long heads love the glenoid
long head of triceps originates at the infraglenoid tubercle
C shaped
+ where does it insert and originate
+ what actions can it do
**Think about mneomics used
biceps brachii
ORIGIN
- make a letter C using ur hand
- thumb is short
short head originates at APEX of coracoid process
long head runs through the bicipital groove, does a medial turn, and originates at supraglenoid tubercule
INSERT
- make a C at flexor elbow
**inserts at radial tuberousity and bicipital aponeurosis **
ACTIONS
- connects over 2 joints
1. shoulder flexion
2. elbow flexion
3. suprination (since it is connected to the radial tuberousity)
brachialis
- working ‘brach’ stage (backstage)
= **deep to the biceps, but 50% stronger than biceps when doing elbow flexion **
**tough for me
coracobrachialis
origin: coracoid process
insertion: anterior medial side of the humerus
movement: shoulder flexion and shoulder adduction
which 3 muscles are innervated by the musculocutaneous nerve?
BBC (big black cock)
brachialis (breaking trends –> innervated by both radial and musculocutaneous nerve)
biceps brachii
coracobrachialis
brachioradialis
(attaches the humerus to the radius)
(low yield)
ancouneus
(memory tip: if you make a cone out of your arm, the tip is the anconeus)
how to remember ulnar vs radial
thumb moves in a radius = radial
what is the olecranon
where the ulnar and humerus join
what is the purpose of the articular cartilidge?
reduce friction
what provides stability BETWEEN the radius and the ulnar?
- interosseus memberane
- oblique CORD
- QUADRATE ligament
- annular ligament
what is within the joint capsule?
synovial fluid
what ligament wraps around the radius?
annular ligament
what are the 3 ligaments that make up the lateral collateral ligament
**picture shows LATERAL view
- ulnar lateral collateral ligament (from humerus to ulnar)
- radial lateral collateral ligament (from radius to ulnar)
- annular ligament (start and ends at ulnar, wraps around radius)
what 3 ligaments make up the medial collateral ligament? (connects ulnar to humerus)
**picture shows MEDIAL view
- posterior bundle (fan shaped)
- transverse ligament
- anterior bundle
where does the biceps brachii vs triceps brachii connect to?
biceps: radius (flexor)
triceps: ulnar (extensor)
what are the 8 carpal bones?
pisiform (only on the anterior side, so can’t see it in a posterior side)
tri|QUETRUM (3 corners)
lunate
scaphoid
TRAPEZ|IUM
TRAPEZ|OID
capi|TATE
ham|ATE
please take lovely susan to the coffee house
what is in the carpal tunnel? (nerves, arteries etc.)
what are the names of the metacarpals and where is it attached to?
metacapral 1-5 (1 is thumb, 5 is pinky)
metacarpal 1 attached to trapezium
metacarpal 2 attached to trapezoid
metacarpal 3 attached to CAPITATE
metacarpal 4 & 5 attached to hamate
levels of organisation in the hand
- ulnar and radius
- carpal
- metacarpal
- proximal phalanges
- middle phalanges
- distal phalanges
what are the 4 muscles in the superficial layer of the ANTERIOR forearm?
- pronator teres
- flexor carpi radialis
- palmaris longus
- flexor carpi ulnaris
where are the insertions of the 4 superficial muscles in the ANTERIOR forearm?
flexor carpi radialis
- use middle finger
- origin: medial epicondyle
- insertion: metacarpal (base of 2nd and 3rd)
flexor carpi ulnaris
- Pinky finger –> Pisiform
- insertion: pisiform, hook of hamate, 5th metacarpal
what is the 1 muscle in the intermediate layer of the ANTERIOR forearm?
flexor digitorium superficialis
- put thumb under 4th finger
- does not go to the distal tips
what are the 3 muscles in the deep layer of the ANTERIOR forearm?
- 3 steps of ‘P’unching somebody
- flexor digitorum PROFUNDUS
(flex the digits // it is very deep, so profound)
- flexor POLICIS longus
(flex the thumb // long at the end, since the muscle is long)
- PRONATOR quadratus
(to pronate (looks like a quadrant))
what nerve is most of the muscles in the arm innervated by?
and what are the other 2 muscles, and what are they innervated by
median nerve
only 2 innervated by ulnar nerve
1. flexor carpi ULNARIS
2. flexor digitalium PROFUNDUS
what is the muscle in the intermediate layer of the ANTERIOR forearm?
flexor digitorum superficialis
- right above flexor digitorum profundus
how many muscles are in the superficial vs deep layer of the POSTERIOR forearm?
superficial: 7
deep: 5
what are the 7 muscles in the superficial layer of the POSTERIOR forearm?
beer lifting, break dancing muscles unless atrophied
- brachioradialis
- extensor carpi radialis Longus
- extensor carpi radialis BREvis
originate on lateral epicondyle
4. extensor Digitorium
5. Extensor Digiti Minimi
6. Extensor carpi Ulnaris
- inserts on base of 5th metacarpal (also where flexor carpi ulnari inserts too)
- anconeus
what are the 5 muscles of the deep layer?
- pronator teres
- extensor indivis
- abductor pollicis longus
- extensor pollicis brevis
- extensor pollicis longus
what are the core muscles, and what is their role?
- rectus abdominis
- transverse abdominis
- internal & external oblique
- erector spinae
- multifidus
- pelvic floor muscles
- diaphgram
- quadratus lumborum
- hip muscles
what is the reccomendation for back pain?
strengthen core muscles
strengthen pelvic floor muscles –> urine and faeces continence
what is the cheapest way of diagnosing osteoperosis?
- ask for fragility fracture (fractures from low trauma)
- look out for kyphosis and height loss
what is the most likely reason for individuals losing height?
vetebral fractures (decrease in 1 inch over the past 2 years) due to osteoperosis
what is the formula for bone STRENGTH, and how to diagnose these
bone strength = bone DENSITY + bone QUALITY
density: grams of mineal/ area
quality: architecture, turnover, damage accumulation, mineralisation
what is the 2 types of bones?
osteoclasts vs blasts vs cytes
osteoclasts: remove the bone
osteoblasts: put in new bone
osteocytes: cells hibernating in the bone
in the case of osteoperosis: osteoclasts > osteoblasts
when rank ligand interacts with rank receptors… ____ will differentiate more
osteoclasts differentiate more
= resorption pit
= more pseudocytes
= more chemicals to dissolve the bone
osteoblasts: WNT signalling pathway
sclerostin bind to LRP
= increase osteoblast activity
= build up the bone
what causes osteoclast apoptosis?
KILLS OSTEOCLASTS
bisphosphonates
= disrupt microtubule/ microfilaments formation
= less osteoclast actitity
=
PREVENT MATURATION OF OSTEOCLASTS
denosumab (mAB)
= black RANK receptor
= blocks interation with rank ligand and
= osteoclasts cannot be activated
=
what are 2 ways to stimulate osteoblast activity?
- add PTH
- anti sclerostin
how to stimulate osteoblast activity naturally?
exercise more
= more tension
= stimulate osteoblasts
= increase bone formation
(eg. astronauts in space have little tension, so they have more osteoCLAST activity)
what is good for osteoperosis - high or low turnover state?
low turnover state
describe the decline in bone mass in men vs women?
F: estrogen cause osteblast formation
= menopause cause drop in estrogen
= decrease osteoblast formation
= succeptible to osteoperosis
F: osteoperosis in 60yo
M: osteoperosis at 70/80yo
what are the risk factors for osteoperosis?
NON-MODIFIABLE
- gender (female)
- age
- race: white/ asian
- genetic predisposition (female
- small body frame
- late menarchy (first occurence of menstruation)
- pre mature menopause
MODIFIABLE
- STERIOIDS!!!!!
- sedentary lifestyle (eg. post surgery)
- annorexia
- malabsorption/ nutrition
- primary hyperparahyperthyrodism
- thyrotoxicosis
- primary hypergonadism (testosterone important for bone health)
- RA (osteoclasts activated & chronic inflammatory state –> bone erosion)
- secondary hyperPTH –> CKD
LIFESTYLE
- smoking
- alchol
- prolonger parenteral nutriton
- low body weght
DRUGS
- chronic steroid therapy
- excessive thyroid therapy
- anticoagulation (since vit K is important in osteoperosis)
- anticonvulsant (acts with vit D)
- GnRH antagonists (= no esterogen = no estrogen protection)
how to diagnose osteoperosis
- DXA hip and spine (to measure BMD)
= can predict fractures of hip and spine (which are the bones more prone to fracture)
what is the OSTA
- who is it used for
- what is the formula
- what is the sex
OSTA: osteoperosis self assessment tool for **post menopausal asian females **
age (year) - weight (kg)
0-20: moderate risk
> 20: high risk
fragility fracture vs traumatic fracture
fragility fracture: patient falls from a height LESS than their own height
traumatic fracture: patient falls from a height MORE than their own height/ blunt injury
if it is a fragility fracture… need to do a MBD
T score of bone mineral density test
-1 is considered normal
-1 to -1.5: osteopenic
-2 to -1.5: osteoperosis
Fracture: patient has osteoperosis until proven otherwise
what is fracture reduction in terms of efficacy
what are the 3 reasons to do a BMD
- patient wants to know bone strength
- monitor treatment response (patient compliance/ non adherence)
- patient satisfaction (improve adherence)
what happens in osteomalacia?
**HOW TO DECREASE
inadequate mineralisation of bone
osteomalacia
= low vitamin D and low calcium
= increase PTH
= increase osteoclast activity
why is ALP high?
increased osteoblast activity
= more bone resorption
= high ALP
which osteoperosis drug to avoid if patient haas reflux oesophagitis?
oral bisphosphonate
**patient is not supposed to lie down after taking the medication
which osteoperosis drug would you give to a patient if they have an eGFR < 30
(if their kidneys are not good)
subcutaneous denosumab
what happens when there is low vit D
low vit D
= cannot absorb calcium in GIT
= low Ca2+
= hypocalcemia (will persist if there is a decrease in the
what are some of the signs of hypocalcemia
when giving potent oral bisphosphonate, check…
- vitamin D levels (if not patient may get hypocalcemia)
- check creatine levels
what are the muscles involved in shoulder flexion and extension?
flexion:
1. pect major
2. anterior deltoid
extension:
1. posterior deltoid
2. lattismus dorsi
what are the muscles involved in shoulder abduction and adduction?
abduction:
1. middle deltoid
2. supraspinatous
adduction
1. pect major
2. lat dorsi
what are the muscles involved in shoulder medial rotation and lateral rotation?
(just 1 muscle each)
medial rotation:
1. subscapularis
lateral rotation:
1. infraspinatus
what muscles are activated when raising the arm vertically?
0-15: supraspinatus
15-90: middle deltoid
**greater tubercle of humerus hits acromion process of scapula
90-180: rotation of scapular (serratus anterior)
what are the 3 different types of joints?
- fibrous joint (skull) –> little/ no movement possible
- cartilaginous joint (spine/ pubic synphysis)–> hyaline or fibrocartilage
- synovial joint (hip, elbow) –> bones covered by HYALINE CARTILAGE and seperated by a JOINT CAVITY
what is the significance of the bicipital groove?
allows for long head of bicep to pass through
where does the ulnar nerve run at the elbow?
behind the medial epicondyle
trochlea vs capitulum
–> which one is on the lateral side, which one is on the medial side
trochlea with ulnar –> medial
capitulum with radius –> lateral
describe the anatomical position of the radial groove
on the posterior humerus
radial nerve runs through it
which nerve would be impacted in a injury to the surgical neck of humerus
axillary nerve
which nerve would be impacted in an injury to the humeral shaft?
radial nerve
= no innervation to extensor muscles in forearm
= wrist drop (seen in radial nerve palsy)
which nerve would be impacted in a subcondylar fracture?
median nerve
which nerve is impacted in an injury to the medial epicondyle?
ulnar nerve
which way is most common for shoulder dislocation?
and which nerve is impacted?
anterior - inferiorly
axillary nerve impacted (innervates the deltoids and teres minor)
what causes wrist drop?
injury at both axilla and radial groove
what are the short muscles of the hand supplied by the median nerve?
LOAF
lumbricals (1st and 2nd)
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
