Upper Limb I Flashcards
What does the pectoral girdle consist of?
➝ clavicle and the scapula (the humerus is not considered part of the pectoral girdle)
Where is the pectoral girdle complete and incomplete and why?
➝ incomplete posteriorly but anteriorly it is complete due to its articulation with the manubrium of the sternum
How many segments does the upper limb contain and how many bones?
➝ 3 segments containing a total of 30 bones
What are the three comparments of the upper limb?
➝ Arm proper
➝ Forearm
➝ Hand
What bone does the arm proper contain?
➝ humerus
What bones does the forearm contain?
➝ radius + ulna
What bones does the hand contain?
➝ Contains 8 carpal bones in the hand
➝ 5 metacarpals in the palm
➝ 14 phalanges in the digits
Where does the clavicle extend between?
➝ manubrium of the sternum and the acromion of the scapula
What shape does the clavicle have medially and why?
➝ convex shape that allows the brachial plexus and axillary neurovascular structures to run behind it.
Where do most clavicle fractures occur?
➝ between the lateral 1/3 and medial 2/3
What is the deformity that results from a fractured clavicle?
➝ bump under the skin
Label A,B,C,D and E

A - acromial end
B - sternal end (medial)
C - sternal end
D - coronoid tubercle
E - trapezoid line
What is the clavicle classed as?
➝ a long bone
What is the function of the clavicle?
➝ transmit force from the upper limb to the axial skeleton
What is the facet on the sternal end of the clavicle for and what joint does this form?
➝ for the articulation with the manubrium of the sternum
➝ known as the sternoclavicular joint
What does the shaft of the clavicle act as?
➝ attachment point for many muscles such as the deltoid the trapezius muscles
Which clavicular facet is the smallest?
➝ acromial end
How can you fracture the clavicle?
➝ falling with arms out
What does the scapula articulate with?
➝ humerus at the glenohumeral joint (glenoid fossa) , ➝ clavicle with the acromio-clavicular joint ( flap bone)
Label this image with the following


The shallow glenoid fossa allows a wide range of movement of the upper limb – what is the disadvantage of this?
➝ dislocates easily
What muscle originates in the subscapular fossa?
➝ subscapularis (rotator cuff)
What two muscles attach to the coracoid process?
➝ coracobrachialis
➝ short head of bicep muscle
Where do the proximal and distal ends of the humerus articulate?
➝ 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
What are the greater and lesser tubercles separated by and what lies here?
➝ separated by the intertubercular sulcus which is where the long head of the biceps brachii lie
Where does the subscapularis insert?
➝ lesser tubercle of the humerus
Where do the circumflex humeral vessels lie and what lies alongside them?
➝ alongside the surgical neck of the humerus
➝ alongside the axillary nerve
Where is a common fracture site in the humerus?
➝ surgical neck
What does the capitulum articulate with?
➝ the radius
What is the function of the fossae?
➝ sliding for the forearm bones to allow for flexion and extension
Where does the ulna articulate?
➝ trochlea
What does the spine of the scapula do?
➝ runs horizontally across the scapula and divides it into two parts
What does the spine divide the scapula into?
➝ supraspinous region and the infraspinous region
What are the supraspinous and infraspinous regions marked by?
➝ supraspinous fossa and infraspinous fossa
What 2 muscles originate in the supraspinous and infraspinous fossae?
➝ supraspinatus and infraspinatus muscles
What three joints are the shoulder joints made from?
➝ Sternoclavicular joint
➝ Acromioclavicular joint
➝ Glenohumeral join
What is the joint capsule and where does it extend from and to?
➝ fibrous sheath which extends from the neck of the humerus to the border of the glenoid fossa
What is the joint capsule fromed from?
➝ glenohumeral ligaments : superior, middle, inferio
Where does the coracohumeral ligament attach?
➝ from the base of the coracoid process to the greater tubercle of the humerus
What is the function of the coracohumeral ligament?
➝ helps to stabilise the superior aspect of the joint
What 2 things is the coracoclavicular ligament made from?
➝ trapezoid ligament
➝ conoid ligament
Label this diagram


What is the relationship between the ulnar nerve and the medial condyle?
➝ passes posterior to the medial epicondyle
From where in the shoulder does the tendinous attachment of the short head of biceps arise?
➝ coracoid process
What kind of a joint is the shoulder joint?
➝ ball and socket joint (synovial joint) which allows a wide range of movements
What are the 6 movements at the shoulder joint?
➝ Flexion and extension of the upper limb
➝ Abduction and adduction
➝ Medial and lateral rotation
➝ Circumduction
➝ Retraction (like rowing)
➝ Protraction (reaching forward)
What are the 3 joints shown in the diagram?


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


Label the
interclavicular ligament and the costoclavicular ligament


What is the function of the glenoid labrum?
➝ expands the depth of the glenoid fossa
Which two ligaments are the strongest ligaments that provide support and attachment for upper limb?
➝ acromioclavicular ligament
➝ superior and posterior ligaments
What movements normally occur at the acromioclavicular and sternoclavicular joints?
ACROMIOCLAVICULAR
➝ Protraction - retraction
➝ Elevation - depression
➝ Axial rotation
STERNOCLAVICULAR
➝ Elevation - depression
➝ Protraction - retraction
➝ Axial rotation
What are the functions of the costoclavicular and coracoclavicular ligaments?
➝ help to attach the clavicle securely to the first costal cartilage and scapula respectively.
What is bursitis?
➝ inflammation of bursa in the shoulder
Which is the most common Bursa to inflame in the shoulder?
➝ subacromial
What is adhesive capsulitis?
➝ 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.
How is friction in the shoulder joint reduced?
➝ by presence of synovial fluid sacs called bursa
What is the function of scapulohumeral muscles?
➝ attach the pectoral girdle to the rest of the trunk
What are the scapulohumeral muscles divided into?
➝ superficial and deep
What are the superficial scapulohumeral muscles?
➝ trapezius
➝ latissimus dorsi
What are the 3 deep scapulohumeral muscles?
➝ levator scapulae
➝ rhomboid minor
➝ rhomboid major
What is the function of the trapezius muscle?
➝ elevates the scapula + rotates it
➝ inferior part depresses the scapula
What is anterior dislocation of the glenohumeral joint usually caused by?
➝ excessive extension and lateral rotation of the humerus
Why do most dislocations of the humeral head occur downwards?
➝ presence of the coracoacromial arch and the support of the rotator
cuff
What is the function of the latissimus dorsi?
➝ works closely with muscles of the anterior chest wall in raising the trunk to the arm (pull ups
What is the function of the levator scapulae?
➝ Works with the trapezius in elevating the scapula
What is the function of rhomboid minor?
➝ Elevates and retracts scapula
What is the function of rhomboid major?
➝ Elevates and retracts scapula
Label
1) trapezius
2) levator scapulae
3) rhomboid major
4) latissimus dorsi
5) rhomboid minor


Where does latissimus dorsi attach?
➝ onto the humerus
Where does the trapezius attach?
➝ onto the scapula
Where is the deltoid?
What 3 fibers does the deltoid have?
➝ clavicular fibers which assist in arm flexion
➝ acromial fibers
➝ posteriorly the spinal fibers which assist in arm extension
What happens when all fibers of the deltoid contract at once?
➝ shoulder joint is abducted – its function is abduction of the arm at the shoulder joint
What 3 movements does pectoralis major do?
- rotates the humerus medially (arm wrestling)
- flexion of the humerus (throwing underarm ball)
- adducts the humerus (flapping arms)
What are the two heads of pectoralis major?
➝ sterno-costal head
➝ clavicular head
What is the antagonist to pectoralis major?
- deltoid
What goes between the delto-pectoral groove?
➝ cephalic vein
What is the clinical importance of the delto-pectoral triangle?
➝ coracoid process can be palpated
➝ bondy landmark in diagnosis of dislocation and when performing brachial plexus block
Label the
1) deltoid
2) trapezius
3) deltopectoral groove
4) cephalic vein


What does the inferior border of the pectoralis major form?
➝ axillary fold
What muscle is deep to the pectoralis major?
➝ pectoralis minor
What is the function of the pectoralis minor?
➝ stabilizes and depresses the scapula
➝ When you stretch the upper limb to get something out of reach
What is the pectoralis minor attached to?
➝ coracoid process
What muscle forms the medial wall of the axillary region?
➝ serratus anterior
What is the function of the serratus anterior?
➝ protraction and rotation of the scapula
What is the rotator cuff?
➝ group of muscles whose tendons surround the glenohumeral joint
What are the 4 rotator cuff muscles?
➝ S - subscapularis
➝ I-infraspinatus
➝ T - teres minor
➝ S - supraspinatus
Which rotator cuff muscle doesn’t rotate the humerus?
➝ supraspinatus
What is the function of the supraspinatus?
➝ initiates abduction of the arm
What do the tendons of the rotator cuff do?
What does tonic contraction of the rotator cuff muscles do?
➝ holds the humerus against the glenoid cavity
What are the 2 posterior rotator cuff muscles?
➝ supraspinatus
➝ infraspinatus
What are the supra and infraspinatus attached to?
➝ supra and infraspinous fossae
What is the function of infraspinatus?
➝ lateral rotation of the humerus and holding the head of the humerus into the glenoid fossa
What is the function of teres minor?
➝ involved in adduction and lateral rotation of the humerus and stabilizing the joint
What is the anterior rotator cuff muscle?
- subscapularis
What is the function of subscapularis and where is it found?
- Subscapularis sits in the subscapular fossa and attaches to the lesser tubercle
- Medially rotates the humerus and assist in adduction
How do you carry out a test for rotator cuff injury?
- arm drop test
Label the
1) pectoralis minor
2) serratus anterior


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


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


What is the origin and insertion of the supraspinatus
- origin : supraspinous fossa of scapula
- insertion :superior facet of greater tubercle of humerus
What is the origin and insertion of the infraspinatus?
- origin : infraspinous fossa of scapula
- insertion : greater tubercle of humerus
What is the origin and insertion of teres minor?
- origin : lateral border of the scapula
- insertion : inferior facet of greater tubercle of the humerus
What is the origin and insertion of the subscapularis?
- origin : subscapular fossa of scapula
- insertion : lesser tubercle of humerus
What is the most superficial muscle in the arm?
- biceps brachii
Where do the tendons of the long head of the biceps go?
- intertubercular groove and attaches onto the supraglenoid tubercle
- insert on the tuberosity of the radius and wraps around the ulna (distal attachment)
What is a function of the biceps brachii that isn’t flexion?
- supination of the forearm
What is the function of the brachialis muscle?
- flexes the elbow in all positions
Where does the coracobrachialis pass and where does it insert?
- passes between the tip of the coracoid process and inserts onto the medial process of the humerus
What movement does the coracobrachialis do?
- flex and adducts the shoulder joint
- important in resisting dislocation at the joint
Label this image with
1) short head
2) long head
3) biceps brachii


Label this with
1) brachialis
2) coracobrachialis


What kind of a muscle is the triceps brachii?
- fusiform muscle
What are the heads of the triceps brachii?
- long head
- lateral head
- medial head
What is the function of the triceps brachii?
- main extensor of the elbow
- resists inferior displacement of the head of the humerus along with some deltoid fibers and the coracobrachialis
Label this with
1) lateral head
2) long head
3) medial head


What kind of a joint is the elbow joint and how many articulations does it have?
- Complex hinge synovial joint involving 3 separate articulations
What are the movements the elbow joint does?
- Flexion and extension at the elbow joint
- Pronation and supination of the forearm at the proximal radioulnar joint
What muscles are responsible for flexion and extension at the elbow joint?
- Flexion is occurring with assistance of the muscles of the flexor compartment : biceps brachii, brachialis and the brachioradialis
- Extension : triceps brachii
What contributes to the stability of the elbow joint?
- fibrous membrane of the joint
Label this with
1) radial collateral ligament
2) ulna collateral ligament


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


Label this with
1) annular ligament
2) radial collateral ligament


What movements occur at the humeroradial, humeroulnar, and proximal radioulnar joints?
- pronation and supination
What is Lateral Epicondylitis (Tennis Elbow)?
- 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.
Where is pain felt in Tennis elbow?
- over the lateral epicondyle and radiates down the posterior surface of the forearm
Which nerve is affected in Tennis Elbow?
- radial nerve
What is golfers elbow?
- medial epicondylitis
- is tendinosis of the medial epicondyle on the inside of the elbow
Which structure is at risk of injured with a humeral shaft fracture?
- radial nerve
What is the characteristic appearance of the hand with radial nerve injury?
- can’t make a fist
- claw hand
What is subluxation and how does it happen?
- 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.
How is subluxation treated?
- supination of the forearm during elbow flexion.
How do the radius and ulna move during pronation/supination?
- distally the ulnar notch of the radius slides anteriorly over the convex surface of the head of the ulna
How are the radius and ulna held together?
- interosseus membrane
- articular disc at the distal radio ulnar joint
What is the cubital fossa?
- Shallow, triangular depression in the anterior surface of elbow
What are the doubdaries of the cubital fossa?
- Superiorly an imaginary line connecting medial and lateral epicondyles
- Medially m. pronator teres
- Laterally m.brachioradialis
- Floor : m.brachialis and m.supinator
What are the contents of the cubital fossa?
- Brachial artery and terminal branches (radial and ulnar) between biceps tendon and median nerve
- Deep veins
- Median nerve
- Radial nerve
What are the 5 terminal nerves of the brachial plexus?
- musculocutaneous
- axillary
- radial
- median
- ulnar
What does the musculocutaneous supply?
- Musculocutaneous travels into the biceps brachii muscle.
What does the axillary supply?
- axilla
What does the radial nerve lie deep to?
- radial nerve lies deep to the brachial artery
What is the ulnar nerve lateral to?
- lateral to the brachial artery
What is the anatomical relationship between the ulnar nerve and the medial epicondyle?
- posterior to it
Where does the radial nerve emerge?
- into the cubital fossa between brachialis and brachioradialis
What branches does the radial nerve form?
- superficial branch
What is the relationship between the artery and the tendon of biceps?
- artery is medial to the tendon
Between what muscles do the roots of the brachial plexus emerge?
- anterior scalene
- middle scalene
At what spinal level are the roots of the ulnar nerve?
- C7, C8, T1
Where does the ulnar nerve go?
- 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
What does the ulnar nerve innervate?
- Innervates all intrinsic muscles of the hand except three thenar muscles and two lateral lumbricals
- flexor carpi ulnaris and flexor digitorum profundus
At what spinal level is the median nerve?
- C5, C6, C7, C8, T1
Where does the median nerve go?
- Passes through the arm and into the forearm through the cubital fossa
- Continues into the hand through the carpal tunnel
What does the median nerve innervate?
- Innervates most of the muscles in the anterior/flexor compartment of the forearm
- flexors of the arm
What spinal level are the roots of the musculocutaneous nerve?
- C5,C6,C7
Where does the musculocutaneous nerve go?
- coracobrachialis muscle, continuing between brachialis and biceps muscles
- Emerges as lateral cutaneous nerve of forearm, lateral to m. Biceps brachii
What does the musculocutaneous nerve innervate?
- Innervates 3 muscles of anterior compartment of the arm
What are the spinal levels of the axillary nerve?
- C5, C6
Where does the axillary nerve go?
- Posterior to the axillary artery in the axilla, passing medial to the surgical neck of the humerus before dividing into 3 terminal branches:
What are the 3 terminal branches of the axillary nerve and what do they innervate?
- Posteriorterminal(posterior deltoid and teres minor)
- Anterior Terminal(anterior deltoid)
- Articular Branch(glenohumeral joint)
What are the spinal levels of the radial nerve?
- C5, C6, C7, C8, T1
Where does the radial nerve go?
- 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
What does the radial nerve innervate?
- all muscles in the posterior/extensor compartment of the arm and forearm
What sensory innervation does the radial nerve provide?
- Sensory innervation to skin on the posterior aspect of arm and forearm and dorsal lateral surface of the hand
The Axillary nerve comes from which cord?
- posterior cord
Damage to the axillary causes which muscle to atrophy?
- deltoid
Which nerve roots supply the long thoracic nerve?
- C5, C6 C7
When can long thoracic get injured?
- mastectomy
What is the consequence of damaging long thoracic?
- paralysis of the serratus anterior muscle
- winged scapula
Label this image


What structures are at risk of injury with a fractured clavicle?
- subclavian vessels
- brachial plexus
- lung apex
What is this image showing?

- superiorly displaced clavicle
Which nerve is a commonly injured structure with this type of dislocation?

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