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Clinical anatomy > Upper Limb I > Flashcards

Upper Limb I Flashcards

1
Q

What does the pectoral girdle consist of?

A

➝ clavicle and the scapula (the humerus is not considered part of the pectoral girdle)

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2
Q

Where is the pectoral girdle complete and incomplete and why?

A

➝ incomplete posteriorly but anteriorly it is complete due to its articulation with the manubrium of the sternum

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3
Q

How many segments does the upper limb contain and how many bones?

A

➝ 3 segments containing a total of 30 bones

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4
Q

What are the three comparments of the upper limb?

A

➝ Arm proper

➝ Forearm

➝ Hand

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5
Q

What bone does the arm proper contain?

A

➝ humerus

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6
Q

What bones does the forearm contain?

A

➝ radius + ulna

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7
Q

What bones does the hand contain?

A

➝ Contains 8 carpal bones in the hand

➝ 5 metacarpals in the palm

➝ 14 phalanges in the digits

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8
Q

Where does the clavicle extend between?

A

➝ manubrium of the sternum and the acromion of the scapula

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9
Q

What shape does the clavicle have medially and why?

A

➝ convex shape that allows the brachial plexus and axillary neurovascular structures to run behind it.

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10
Q

Where do most clavicle fractures occur?

A

➝ between the lateral 1/3 and medial 2/3

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11
Q

What is the deformity that results from a fractured clavicle?

A

➝ bump under the skin

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12
Q

Label A,B,C,D and E

A

A - acromial end

B - sternal end (medial)

C - sternal end

D - coronoid tubercle

E - trapezoid line

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13
Q

What is the clavicle classed as?

A

➝ a long bone

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14
Q

What is the function of the clavicle?

A

➝ transmit force from the upper limb to the axial skeleton

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15
Q

What is the facet on the sternal end of the clavicle for and what joint does this form?

A

➝ for the articulation with the manubrium of the sternum

➝ known as the sternoclavicular joint

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16
Q

What does the shaft of the clavicle act as?

A

➝ attachment point for many muscles such as the deltoid the trapezius muscles

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17
Q

Which clavicular facet is the smallest?

A

➝ acromial end

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18
Q

How can you fracture the clavicle?

A

➝ falling with arms out

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19
Q

What does the scapula articulate with?

A

➝ humerus at the glenohumeral joint (glenoid fossa) , ➝ clavicle with the acromio-clavicular joint ( flap bone)

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20
Q

Label this image with the following

A
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21
Q

The shallow glenoid fossa allows a wide range of movement of the upper limb – what is the disadvantage of this?

A

➝ dislocates easily

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22
Q

What muscle originates in the subscapular fossa?

A

➝ subscapularis (rotator cuff)

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23
Q

What two muscles attach to the coracoid process?

A

➝ coracobrachialis

➝ short head of bicep muscle

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24
Q

Where do the proximal and distal ends of the humerus articulate?

A

➝ proximal aspect of the humerus is where it articulates at the glenohumeral joint

➝ distally it articulates at the elbow with the notch of the ulna

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25
Q

What are the greater and lesser tubercles separated by and what lies here?

A

➝ separated by the intertubercular sulcus which is where the long head of the biceps brachii lie

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26
Q

Where does the subscapularis insert?

A

➝ lesser tubercle of the humerus

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27
Q

Where do the circumflex humeral vessels lie and what lies alongside them?

A

➝ alongside the surgical neck of the humerus

➝ alongside the axillary nerve

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28
Q

Where is a common fracture site in the humerus?

A

➝ surgical neck

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29
Q

What does the capitulum articulate with?

A

➝ the radius

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30
Q

What is the function of the fossae?

A

➝ sliding for the forearm bones to allow for flexion and extension

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31
Q

Where does the ulna articulate?

A

➝ trochlea

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32
Q

What does the spine of the scapula do?

A

➝ runs horizontally across the scapula and divides it into two parts

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33
Q

What does the spine divide the scapula into?

A

➝ supraspinous region and the infraspinous region

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34
Q

What are the supraspinous and infraspinous regions marked by?

A

➝ supraspinous fossa and infraspinous fossa

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35
Q

What 2 muscles originate in the supraspinous and infraspinous fossae?

A

➝ supraspinatus and infraspinatus muscles

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36
Q

What three joints are the shoulder joints made from?

A

➝ Sternoclavicular joint

➝ Acromioclavicular joint

➝ Glenohumeral join

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37
Q

What is the joint capsule and where does it extend from and to?

A

➝ fibrous sheath which extends from the neck of the humerus to the border of the glenoid fossa

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38
Q

What is the joint capsule fromed from?

A

➝ glenohumeral ligaments : superior, middle, inferio

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39
Q

Where does the coracohumeral ligament attach?

A

➝ from the base of the coracoid process to the greater tubercle of the humerus

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40
Q

What is the function of the coracohumeral ligament?

A

➝ helps to stabilise the superior aspect of the joint

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41
Q

What 2 things is the coracoclavicular ligament made from?

A

➝ trapezoid ligament

➝ conoid ligament

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42
Q

Label this diagram

A
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43
Q

What is the relationship between the ulnar nerve and the medial condyle?

A

➝ passes posterior to the medial epicondyle

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44
Q

From where in the shoulder does the tendinous attachment of the short head of biceps arise?

A

➝ coracoid process

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45
Q

What kind of a joint is the shoulder joint?

A

➝ ball and socket joint (synovial joint) which allows a wide range of movements

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46
Q

What are the 6 movements at the shoulder joint?

A

➝ Flexion and extension of the upper limb

➝ Abduction and adduction

➝ Medial and lateral rotation

➝ Circumduction

➝ Retraction (like rowing)

➝ Protraction (reaching forward)

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47
Q

What are the 3 joints shown in the diagram?

A
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48
Q

Label the

1) coracoclavicular (conoid and trapezoid)
2) acromioclavicular
3) superior, middle and inferior glenohumeral
4) transverse humeral ligament

A
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49
Q

Label the

interclavicular ligament and the costoclavicular ligament

A
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50
Q

What is the function of the glenoid labrum?

A

➝ expands the depth of the glenoid fossa

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51
Q

Which two ligaments are the strongest ligaments that provide support and attachment for upper limb?

A

➝ acromioclavicular ligament

➝ superior and posterior ligaments

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52
Q

What movements normally occur at the acromioclavicular and sternoclavicular joints?

A

ACROMIOCLAVICULAR

➝ Protraction - retraction
➝ Elevation - depression
➝​ Axial rotation

STERNOCLAVICULAR

➝ Elevation - depression
➝ Protraction - retraction
➝ Axial rotation

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53
Q

What are the functions of the costoclavicular and coracoclavicular ligaments?

A

➝ help to attach the clavicle securely to the first costal cartilage and scapula respectively.

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54
Q

What is bursitis?

A

➝ inflammation of bursa in the shoulder

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55
Q

Which is the most common Bursa to inflame in the shoulder?

A

➝ subacromial

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56
Q

What is adhesive capsulitis?

A

➝ painful and disabling disorder

➝ in which the shoulder capsule becomes inflamed and stiff

➝greatly restricting motion and causing chronic pain.

➝ Pain is usually worse at night.

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57
Q

How is friction in the shoulder joint reduced?

A

➝ by presence of synovial fluid sacs called bursa

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58
Q

What is the function of scapulohumeral muscles?

A

➝ attach the pectoral girdle to the rest of the trunk

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59
Q

What are the scapulohumeral muscles divided into?

A

➝ superficial and deep

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60
Q

What are the superficial scapulohumeral muscles?

A

➝ trapezius

➝ latissimus dorsi

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61
Q

What are the 3 deep scapulohumeral muscles?

A

➝ levator scapulae

➝ rhomboid minor

➝ rhomboid major

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62
Q

What is the function of the trapezius muscle?

A

➝ elevates the scapula + rotates it

➝ inferior part depresses the scapula

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63
Q

What is anterior dislocation of the glenohumeral joint usually caused by?

A

➝ excessive extension and lateral rotation of the humerus

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64
Q

Why do most dislocations of the humeral head occur downwards?

A

➝ presence of the coracoacromial arch and the support of the rotator

cuff

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65
Q

What is the function of the latissimus dorsi?

A

➝ works closely with muscles of the anterior chest wall in raising the trunk to the arm (pull ups

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66
Q

What is the function of the levator scapulae?

A

➝ Works with the trapezius in elevating the scapula

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67
Q

What is the function of rhomboid minor?

A

➝ Elevates and retracts scapula

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68
Q

What is the function of rhomboid major?

A

➝ Elevates and retracts scapula

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69
Q

Label

1) trapezius
2) levator scapulae
3) rhomboid major
4) latissimus dorsi
5) rhomboid minor

A
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70
Q

Where does latissimus dorsi attach?

A

➝ onto the humerus

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71
Q

Where does the trapezius attach?

A

➝ onto the scapula

72
Q

Where is the deltoid?

A
73
Q

What 3 fibers does the deltoid have?

A

➝ clavicular fibers which assist in arm flexion

➝ acromial fibers

➝ posteriorly the spinal fibers which assist in arm extension

74
Q

What happens when all fibers of the deltoid contract at once?

A

➝ shoulder joint is abducted – its function is abduction of the arm at the shoulder joint

75
Q

What 3 movements does pectoralis major do?

A
  • rotates the humerus medially (arm wrestling)
  • flexion of the humerus (throwing underarm ball)
  • adducts the humerus (flapping arms)
76
Q

What are the two heads of pectoralis major?

A

➝ sterno-costal head

➝ clavicular head

77
Q

What is the antagonist to pectoralis major?

A
  • deltoid
78
Q

What goes between the delto-pectoral groove?

A

➝ cephalic vein

79
Q

What is the clinical importance of the delto-pectoral triangle?

A

➝ coracoid process can be palpated

➝ bondy landmark in diagnosis of dislocation and when performing brachial plexus block

80
Q

Label the

1) deltoid
2) trapezius
3) deltopectoral groove
4) cephalic vein

A
81
Q

What does the inferior border of the pectoralis major form?

A

➝ axillary fold

82
Q

What muscle is deep to the pectoralis major?

A

➝ pectoralis minor

83
Q

What is the function of the pectoralis minor?

A

➝ stabilizes and depresses the scapula

➝ When you stretch the upper limb to get something out of reach

84
Q

What is the pectoralis minor attached to?

A

➝ coracoid process

85
Q

What muscle forms the medial wall of the axillary region?

A

➝ serratus anterior

86
Q

What is the function of the serratus anterior?

A

➝ protraction and rotation of the scapula

87
Q

What is the rotator cuff?

A

➝ group of muscles whose tendons surround the glenohumeral joint

88
Q

What are the 4 rotator cuff muscles?

A

➝ S - subscapularis

➝ I-infraspinatus

➝ T - teres minor

➝ S - supraspinatus

89
Q

Which rotator cuff muscle doesn’t rotate the humerus?

A

➝ supraspinatus

90
Q

What is the function of the supraspinatus?

A

➝ initiates abduction of the arm

91
Q

What do the tendons of the rotator cuff do?

A
92
Q

What does tonic contraction of the rotator cuff muscles do?

A

➝ holds the humerus against the glenoid cavity

93
Q

What are the 2 posterior rotator cuff muscles?

A

➝ supraspinatus

➝ infraspinatus

94
Q

What are the supra and infraspinatus attached to?

A

➝ supra and infraspinous fossae

95
Q

What is the function of infraspinatus?

A

➝ lateral rotation of the humerus and holding the head of the humerus into the glenoid fossa

96
Q

What is the function of teres minor?

A

➝ involved in adduction and lateral rotation of the humerus and stabilizing the joint

97
Q

What is the anterior rotator cuff muscle?

A
  • subscapularis
98
Q

What is the function of subscapularis and where is it found?

A
  • Subscapularis sits in the subscapular fossa and attaches to the lesser tubercle
  • Medially rotates the humerus and assist in adduction
99
Q

How do you carry out a test for rotator cuff injury?

A
  • arm drop test
100
Q

Label the

1) pectoralis minor
2) serratus anterior

A
101
Q

Label the

1) infraspinatus
2) supraspinatus
3) teres minor
4) subscapularis

A
102
Q

Label this with

1) anterior compartment
2) posterior compartment
3) biceps brachii
4) brachialis
5) medial head of triceps
6) lateral head of triceps

A
103
Q

What is the origin and insertion of the supraspinatus

A
  • origin : supraspinous fossa of scapula
  • insertion :superior facet of greater tubercle of humerus
104
Q

What is the origin and insertion of the infraspinatus?

A
  • origin : infraspinous fossa of scapula
  • insertion : greater tubercle of humerus
105
Q

What is the origin and insertion of teres minor?

A
  • origin : lateral border of the scapula
  • insertion : inferior facet of greater tubercle of the humerus
106
Q

What is the origin and insertion of the subscapularis?

A
  • origin : subscapular fossa of scapula
  • insertion : lesser tubercle of humerus
107
Q

What is the most superficial muscle in the arm?

A
  • biceps brachii
108
Q

Where do the tendons of the long head of the biceps go?

A
  • intertubercular groove and attaches onto the supraglenoid tubercle
  • insert on the tuberosity of the radius and wraps around the ulna (distal attachment)
109
Q

What is a function of the biceps brachii that isn’t flexion?

A
  • supination of the forearm
110
Q

What is the function of the brachialis muscle?

A
  • flexes the elbow in all positions
111
Q

Where does the coracobrachialis pass and where does it insert?

A
  • passes between the tip of the coracoid process and inserts onto the medial process of the humerus
112
Q

What movement does the coracobrachialis do?

A
  • flex and adducts the shoulder joint
  • important in resisting dislocation at the joint
113
Q

Label this image with

1) short head
2) long head
3) biceps brachii

A
114
Q

Label this with

1) brachialis
2) coracobrachialis

A
115
Q

What kind of a muscle is the triceps brachii?

A
  • fusiform muscle
116
Q

What are the heads of the triceps brachii?

A
  • long head
  • lateral head
  • medial head
117
Q

What is the function of the triceps brachii?

A
  • main extensor of the elbow
  • resists inferior displacement of the head of the humerus along with some deltoid fibers and the coracobrachialis
118
Q

Label this with

1) lateral head
2) long head
3) medial head

A
119
Q

What kind of a joint is the elbow joint and how many articulations does it have?

A
  • Complex hinge synovial joint involving 3 separate articulations
120
Q

What are the movements the elbow joint does?

A
  • Flexion and extension at the elbow joint
  • Pronation and supination of the forearm at the proximal radioulnar joint
121
Q

What muscles are responsible for flexion and extension at the elbow joint?

A
  • Flexion is occurring with assistance of the muscles of the flexor compartment : biceps brachii, brachialis and the brachioradialis
  • Extension : triceps brachii
122
Q

What contributes to the stability of the elbow joint?

A
  • fibrous membrane of the joint
123
Q

Label this with

1) radial collateral ligament
2) ulna collateral ligament

A
124
Q

Label this with

1) capitulum
2) olecranon
3) trochlea
4) proximal radioulnar joint
5) radiohumeral joint
6) ulnohumeral joint

A
125
Q

Label this with

1) annular ligament
2) radial collateral ligament

A
126
Q

What movements occur at the humeroradial, humeroulnar, and proximal radioulnar joints?

A
  • pronation and supination
127
Q

What is Lateral Epicondylitis (Tennis Elbow)?

A
  • A painful condition that may repeated forceful flexion and extension of the wrist and strain the attachment of the common tendon
  • producing inflammation of the periosteum of the lateral epicondyle and the common extensor attachment of the muscles.
128
Q

Where is pain felt in Tennis elbow?

A
  • over the lateral epicondyle and radiates down the posterior surface of the forearm
129
Q

Which nerve is affected in Tennis Elbow?

A
  • radial nerve
130
Q

What is golfers elbow?

A
  • medial epicondylitis
  • is tendinosis of the medial epicondyle on the inside of the elbow
131
Q

Which structure is at risk of injured with a humeral shaft fracture?

A
  • radial nerve
132
Q

What is the characteristic appearance of the hand with radial nerve injury?

A
  • can’t make a fist
  • claw hand
133
Q

What is subluxation and how does it happen?

A
  • incomplete dislocation of the head of the radius .
  • It occurs due to sudden lifting /jerking by the upper limb as the forearm is pronated.
  • tears the distal attachment of the annular ligament, causing the radial head to move distally, partially out of the torn annular ligament.
  • The proximal part of the torn ligament may become trapped between the head of the radius and the capitulum of the humerus.
134
Q

How is subluxation treated?

A
  • supination of the forearm during elbow flexion.
135
Q

How do the radius and ulna move during pronation/supination?

A
  • distally the ulnar notch of the radius slides anteriorly over the convex surface of the head of the ulna
136
Q

How are the radius and ulna held together?

A
  • interosseus membrane
  • articular disc at the distal radio ulnar joint
137
Q

What is the cubital fossa?

A
  • Shallow, triangular depression in the anterior surface of elbow
138
Q

What are the doubdaries of the cubital fossa?

A
  • Superiorly an imaginary line connecting medial and lateral epicondyles
  • Medially m. pronator teres
  • Laterally m.brachioradialis
  • Floor : m.brachialis and m.supinator
139
Q

What are the contents of the cubital fossa?

A
  • Brachial artery and terminal branches (radial and ulnar) between biceps tendon and median nerve
  • Deep veins
  • Median nerve
  • Radial nerve
140
Q

What are the 5 terminal nerves of the brachial plexus?

A
  • musculocutaneous
  • axillary
  • radial
  • median
  • ulnar
141
Q

What does the musculocutaneous supply?

A
  • Musculocutaneous travels into the biceps brachii muscle.
142
Q

What does the axillary supply?

A
  • axilla
143
Q

What does the radial nerve lie deep to?

A
  • radial nerve lies deep to the brachial artery
144
Q

What is the ulnar nerve lateral to?

A
  • lateral to the brachial artery
145
Q

What is the anatomical relationship between the ulnar nerve and the medial epicondyle?

A
  • posterior to it
146
Q

Where does the radial nerve emerge?

A
  • into the cubital fossa between brachialis and brachioradialis
147
Q

What branches does the radial nerve form?

A
  • superficial branch
148
Q

What is the relationship between the artery and the tendon of biceps?

A
  • artery is medial to the tendon
149
Q

Between what muscles do the roots of the brachial plexus emerge?

A
  • anterior scalene
  • middle scalene
150
Q

At what spinal level are the roots of the ulnar nerve?

A
  • C7, C8, T1
151
Q

Where does the ulnar nerve go?

A
  • Passes through the arm, posterior to the medial epicondyle of the humerus and into the anterior compartment of the forearm
  • Passes down the medial side of the forearm between the flexor carpi ulnaris and flexor digitorum profundus
  • Passes into the hand superficial to flexor retinaculum
152
Q

What does the ulnar nerve innervate?

A
  • Innervates all intrinsic muscles of the hand except three thenar muscles and two lateral lumbricals
  • flexor carpi ulnaris and flexor digitorum profundus
153
Q

At what spinal level is the median nerve?

A
  • C5, C6, C7, C8, T1
154
Q

Where does the median nerve go?

A
  • Passes through the arm and into the forearm through the cubital fossa
  • Continues into the hand through the carpal tunnel
155
Q

What does the median nerve innervate?

A
  • Innervates most of the muscles in the anterior/flexor compartment of the forearm
  • flexors of the arm
156
Q

What spinal level are the roots of the musculocutaneous nerve?

A
  • C5,C6,C7
157
Q

Where does the musculocutaneous nerve go?

A
  • coracobrachialis muscle, continuing between brachialis and biceps muscles
  • Emerges as lateral cutaneous nerve of forearm, lateral to m. Biceps brachii
158
Q

What does the musculocutaneous nerve innervate?

A
  • Innervates 3 muscles of anterior compartment of the arm
159
Q

What are the spinal levels of the axillary nerve?

A
  • C5, C6
160
Q

Where does the axillary nerve go?

A
  • Posterior to the axillary artery in the axilla, passing medial to the surgical neck of the humerus before dividing into 3 terminal branches:
161
Q

What are the 3 terminal branches of the axillary nerve and what do they innervate?

A
  • Posteriorterminal(posterior deltoid and teres minor)
  • Anterior Terminal(anterior deltoid)
  • Articular Branch(glenohumeral joint)
162
Q

What are the spinal levels of the radial nerve?

A
  • C5, C6, C7, C8, T1
163
Q

Where does the radial nerve go?

A
  • passes diagonally from medial to lateral through
    the posterior compartment
  • It passes anteriorly through the lateral intermuscular septum and enters the anterior compartment of the forearm
164
Q

What does the radial nerve innervate?

A
  • all muscles in the posterior/extensor compartment of the arm and forearm
165
Q

What sensory innervation does the radial nerve provide?

A
  • Sensory innervation to skin on the posterior aspect of arm and forearm and dorsal lateral surface of the hand
166
Q

The Axillary nerve comes from which cord?

A
  • posterior cord
167
Q

Damage to the axillary causes which muscle to atrophy?

A
  • deltoid
168
Q

Which nerve roots supply the long thoracic nerve?

A
  • C5, C6 C7
169
Q

When can long thoracic get injured?

A
  • mastectomy
170
Q

What is the consequence of damaging long thoracic?

A
  • paralysis of the serratus anterior muscle
  • winged scapula
171
Q

Label this image

A
172
Q

What structures are at risk of injury with a fractured clavicle?

A
  • subclavian vessels
  • brachial plexus
  • lung apex
173
Q

What is this image showing?

A
  • superiorly displaced clavicle
174
Q

Which nerve is a commonly injured structure with this type of dislocation?

A
  • axillary nerve
175
Q

Which rotator cuff muscle and aretery are likely to be affected with a dislocated humerus?

A
  • supraspinatus
  • axillary

Clinical anatomy (10 decks)

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