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)
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
3
Q
How many segments does the upper limb contain and how many bones?
A
➝ 3 segments containing a total of 30 bones
4
Q
What are the three comparments of the upper limb?
A
➝ Arm proper
➝ Forearm
➝ Hand
5
Q
What bone does the arm proper contain?
A
➝ humerus
6
Q
What bones does the forearm contain?
A
➝ radius + ulna
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
8
Q
Where does the clavicle extend between?
A
➝ manubrium of the sternum and the acromion of the scapula
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.
10
Q
Where do most clavicle fractures occur?
A
➝ between the lateral 1/3 and medial 2/3
11
Q
What is the deformity that results from a fractured clavicle?
A
➝ bump under the skin
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
13
Q
What is the clavicle classed as?
A
➝ a long bone
14
Q
What is the function of the clavicle?
A
➝ transmit force from the upper limb to the axial skeleton
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
16
Q
What does the shaft of the clavicle act as?
A
➝ attachment point for many muscles such as the deltoid the trapezius muscles
17
Q
Which clavicular facet is the smallest?
A
➝ acromial end
18
Q
How can you fracture the clavicle?
A
➝ falling with arms out
19
Q
What does the scapula articulate with?
A
➝ humerus at the glenohumeral joint (glenoid fossa) , ➝ clavicle with the acromio-clavicular joint ( flap bone)
20
Q
Label this image with the following
A
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
22
Q
What muscle originates in the subscapular fossa?
A
➝ subscapularis (rotator cuff)
23
Q
What two muscles attach to the coracoid process?
A
➝ coracobrachialis
➝ short head of bicep muscle
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
25
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
26
Where does the subscapularis insert?
➝ lesser tubercle of the humerus
27
Where do the circumflex humeral vessels lie and what lies alongside them?
➝ alongside the surgical neck of the humerus
➝ alongside the axillary nerve
28
Where is a common fracture site in the humerus?
➝ surgical neck
29
What does the capitulum articulate with?
➝ the radius
30
What is the function of the fossae?
➝ sliding for the forearm bones to allow for flexion and extension
31
Where does the ulna articulate?
➝ trochlea
32
What does the spine of the scapula do?
➝ runs horizontally across the scapula and divides it into two parts
33
What does the spine divide the scapula into?
➝ supraspinous region and the infraspinous region
34
What are the supraspinous and infraspinous regions marked by?
➝ supraspinous fossa and infraspinous fossa
35
What 2 muscles originate in the supraspinous and infraspinous fossae?
➝ supraspinatus and infraspinatus muscles
36
What three joints are the shoulder joints made from?
➝ Sternoclavicular joint
➝ Acromioclavicular joint
➝ Glenohumeral join
37
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
38
What is the joint capsule fromed from?
➝ glenohumeral ligaments : superior, middle, inferio
39
Where does the coracohumeral ligament attach?
➝ from the base of the coracoid process to the greater tubercle of the humerus
40
What is the function of the coracohumeral ligament?
➝ helps to stabilise the superior aspect of the joint
41
What 2 things is the coracoclavicular ligament made from?
➝ trapezoid ligament
➝ conoid ligament
42
Label this diagram
43
What is the relationship between the ulnar nerve and the medial condyle?
➝ passes posterior to the medial epicondyle
44
From where in the shoulder does the tendinous attachment of the short head of biceps arise?
➝ coracoid process
45
What kind of a joint is the shoulder joint?
➝ ball and socket joint (synovial joint) which allows a wide range of movements
46
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)
47
What are the 3 joints shown in the diagram?
48
Label the
1) coracoclavicular (conoid and trapezoid)
2) acromioclavicular
3) superior, middle and inferior glenohumeral
4) transverse humeral ligament
49
Label the
interclavicular ligament and the costoclavicular ligament
50
What is the function of the glenoid labrum?
➝ expands the depth of the glenoid fossa
51
Which two ligaments are the strongest ligaments that provide support and attachment for upper limb?
➝ acromioclavicular ligament
➝ superior and posterior ligaments
52
What movements normally occur at the acromioclavicular and sternoclavicular joints?
ACROMIOCLAVICULAR
➝ Protraction - retraction
➝ Elevation - depression
➝ Axial rotation
STERNOCLAVICULAR
➝ Elevation - depression
➝ Protraction - retraction
➝ Axial rotation
53
What are the functions of the costoclavicular and coracoclavicular ligaments?
➝ help to attach the clavicle securely to the first costal cartilage and scapula respectively.
54
What is bursitis?
➝ inflammation of bursa in the shoulder
55
Which is the most common Bursa to inflame in the shoulder?
➝ subacromial
56
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.
57
How is friction in the shoulder joint reduced?
➝ by presence of synovial fluid sacs called bursa
58
What is the function of scapulohumeral muscles?
➝ attach the pectoral girdle to the rest of the trunk
59
What are the scapulohumeral muscles divided into?
➝ superficial and deep
60
What are the superficial scapulohumeral muscles?
➝ trapezius
➝ latissimus dorsi
61
What are the 3 deep scapulohumeral muscles?
➝ levator scapulae
➝ rhomboid minor
➝ rhomboid major
62
What is the function of the trapezius muscle?
➝ elevates the scapula + rotates it
➝ inferior part depresses the scapula
63
What is anterior dislocation of the glenohumeral joint usually caused by?
➝ excessive extension and lateral rotation of the humerus
64
Why do most dislocations of the humeral head occur downwards?
➝ presence of the coracoacromial arch and the support of the rotator
cuff
65
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
66
What is the function of the levator scapulae?
➝ Works with the trapezius in elevating the scapula
67
What is the function of rhomboid minor?
➝ Elevates and retracts scapula
68
What is the function of rhomboid major?
➝ Elevates and retracts scapula
69
Label
1) trapezius
2) levator scapulae
3) rhomboid major
4) latissimus dorsi
5) rhomboid minor
70
Where does latissimus dorsi attach?
➝ onto the humerus
71
Where does the trapezius attach?
➝ onto the scapula
72
Where is the deltoid?
73
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
74
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
75
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)
76
What are the two heads of pectoralis major?
➝ sterno-costal head
➝ clavicular head
77
What is the antagonist to pectoralis major?
* deltoid
78
What goes between the delto-pectoral groove?
➝ cephalic vein
79
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
80
Label the
1) deltoid
2) trapezius
3) deltopectoral groove
4) cephalic vein
81
What does the inferior border of the pectoralis major form?
➝ axillary fold
82
What muscle is deep to the pectoralis major?
➝ pectoralis minor
83
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
84
What is the pectoralis minor attached to?
➝ coracoid process
85
What muscle forms the medial wall of the axillary region?
➝ serratus anterior
86
What is the function of the serratus anterior?
➝ protraction and rotation of the scapula
87
What is the rotator cuff?
➝ group of muscles whose tendons surround the glenohumeral joint
88
What are the 4 rotator cuff muscles?
➝ S - subscapularis
➝ I-infraspinatus
➝ T - teres minor
➝ S - supraspinatus
89
Which rotator cuff muscle doesn't rotate the humerus?
➝ supraspinatus
90
What is the function of the supraspinatus?
➝ initiates abduction of the arm
91
What do the tendons of the rotator cuff do?
92
What does tonic contraction of the rotator cuff muscles do?
➝ holds the humerus against the glenoid cavity
93
What are the 2 posterior rotator cuff muscles?
➝ supraspinatus
➝ infraspinatus
94
What are the supra and infraspinatus attached to?
➝ supra and infraspinous fossae
95
What is the function of infraspinatus?
➝ lateral rotation of the humerus and holding the head of the humerus into the glenoid fossa
96
What is the function of teres minor?
➝ involved in adduction and lateral rotation of the humerus and stabilizing the joint
97
What is the anterior rotator cuff muscle?
* subscapularis
98
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
99
How do you carry out a test for rotator cuff injury?
* arm drop test
100
Label the
1) pectoralis minor
2) serratus anterior
101
Label the
1) infraspinatus
2) supraspinatus
3) teres minor
4) subscapularis
102
Label this with
1) anterior compartment
2) posterior compartment
3) biceps brachii
4) brachialis
5) medial head of triceps
6) lateral head of triceps
103
What is the origin and insertion of the supraspinatus
* origin : supraspinous fossa of scapula
* insertion :superior facet of greater tubercle of humerus
104
What is the origin and insertion of the infraspinatus?
* origin : infraspinous fossa of scapula
* insertion : greater tubercle of humerus
105
What is the origin and insertion of teres minor?
* origin : lateral border of the scapula
* insertion : inferior facet of greater tubercle of the humerus
106
What is the origin and insertion of the subscapularis?
* origin : subscapular fossa of scapula
* insertion : lesser tubercle of humerus
107
What is the most superficial muscle in the arm?
* biceps brachii
108
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)
109
What is a function of the biceps brachii that isn't flexion?
* supination of the forearm
110
What is the function of the brachialis muscle?
* flexes the elbow in all positions
111
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
112
What movement does the coracobrachialis do?
* flex and adducts the shoulder joint
* important in resisting dislocation at the joint
113
Label this image with
1) short head
2) long head
3) biceps brachii
114
Label this with
1) brachialis
2) coracobrachialis
115
What kind of a muscle is the triceps brachii?
* fusiform muscle
116
What are the heads of the triceps brachii?
* long head
* lateral head
* medial head
117
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
118
Label this with
1) lateral head
2) long head
3) medial head
119
What kind of a joint is the elbow joint and how many articulations does it have?
* Complex hinge synovial joint involving 3 separate articulations
120
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
121
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
122
What contributes to the stability of the elbow joint?
* fibrous membrane of the joint
123
Label this with
1) radial collateral ligament
2) ulna collateral ligament
124
Label this with
1) capitulum
2) olecranon
3) trochlea
4) proximal radioulnar joint
5) radiohumeral joint
6) ulnohumeral joint
125
Label this with
1) annular ligament
2) radial collateral ligament
126
What movements occur at the humeroradial, humeroulnar, and proximal radioulnar joints?
* pronation and supination
127
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.
128
Where is pain felt in Tennis elbow?
* over the lateral epicondyle and radiates down the posterior surface of the forearm
129
Which nerve is affected in Tennis Elbow?
* radial nerve
130
What is golfers elbow?
* medial epicondylitis
* is tendinosis of the medial epicondyle on the inside of the elbow
131
Which structure is at risk of injured with a humeral shaft fracture?
* radial nerve
132
What is the characteristic appearance of the hand with radial nerve injury?
* can't make a fist
* claw hand
133
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.
134
How is subluxation treated?
* supination of the forearm during elbow flexion.
135
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
136
How are the radius and ulna held together?
* interosseus membrane
* articular disc at the distal radio ulnar joint
137
What is the cubital fossa?
* Shallow, triangular depression in the anterior surface of elbow
138
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
139
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
140
What are the 5 terminal nerves of the brachial plexus?
* musculocutaneous
* axillary
* radial
* median
* ulnar
141
What does the musculocutaneous supply?
* Musculocutaneous travels into the biceps brachii muscle.
142
What does the axillary supply?
* axilla
143
What does the radial nerve lie deep to?
* radial nerve lies deep to the brachial artery
144
What is the ulnar nerve lateral to?
* lateral to the brachial artery
145
What is the anatomical relationship between the ulnar nerve and the medial epicondyle?
* posterior to it
146
Where does the radial nerve emerge?
* into the cubital fossa between brachialis and brachioradialis
147
What branches does the radial nerve form?
* superficial branch
148
What is the relationship between the artery and the tendon of biceps?
* artery is medial to the tendon
149
Between what muscles do the roots of the brachial plexus emerge?
* anterior scalene
* middle scalene
150
At what spinal level are the roots of the ulnar nerve?
* C7, C8, T1
151
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
152
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
153
At what spinal level is the median nerve?
* C5, C6, C7, C8, T1
154
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
155
What does the median nerve innervate?
* Innervates most of the muscles in the anterior/flexor compartment of the forearm
* flexors of the arm
156
What spinal level are the roots of the musculocutaneous nerve?
* C5,C6,C7
157
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
158
What does the musculocutaneous nerve innervate?
* Innervates 3 muscles of anterior compartment of the arm
159
What are the spinal levels of the axillary nerve?
* C5, C6
160
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:
161
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)
162
What are the spinal levels of the radial nerve?
* C5, C6, C7, C8, T1
163
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
164
What does the radial nerve innervate?
* all muscles in the posterior/extensor compartment of the arm and forearm
165
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
166
The Axillary nerve comes from which cord?
* posterior cord
167
Damage to the axillary causes which muscle to atrophy?
* deltoid
168
Which nerve roots supply the long thoracic nerve?
* C5, C6 C7
169
When can long thoracic get injured?
* mastectomy
170
What is the consequence of damaging long thoracic?
* paralysis of the serratus anterior muscle
* winged scapula
171
Label this image
172
What structures are at risk of injury with a fractured clavicle?
* subclavian vessels
* brachial plexus
* lung apex
173
What is this image showing?
* superiorly displaced clavicle
174
Which nerve is a commonly injured structure with this type of dislocation?
* axillary nerve
175
Which rotator cuff muscle and aretery are likely to be affected with a dislocated humerus?
* supraspinatus
* axillary
