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Phase 1 flashcards > Upper Limb MSK anatomy > Flashcards

Upper Limb MSK anatomy Flashcards

1
Q

what is the pectoral girdle/ shoulder girdle?

A

clavicle, scapula and the muscles attached to these bones

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2
Q

what is the arm?

A

region between the shoulder and elbow joints

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3
Q

what is the forearm?

A

region between the elbow and wrist joint

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4
Q

what is the glenohumeral joint?

A

shoulder joint
synovial ball and socket joint formed by the articulation between the scapula and proximal humerus

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5
Q

what type of joint is the elbow?

A

synovial hinge joint

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6
Q

which bones articulate at the elbow joint?

A

distal humerus articulates with the ulna and radius

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7
Q

which joints join the radius and ulna?

A

radioulnar

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8
Q

what do the radioulnar joints allow?

A

pronation and supination of the forearm and hand

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9
Q

what is the radiocarpal joint?

A

wrist joint
synovial joint formed by the articulation between the distal radius and two of the carpal bones

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10
Q

which movements does the radiocarpal joint allow?

A

flexion, extension, abduction and adduction

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11
Q

anterior movement of the scapula

A

protraction

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12
Q

posterior movement of the scapula

A

retraction

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13
Q

name movements that the shoulder joint can make

A

flexion, extension, abduction, adduction, medial (internal) rotation, lateral (external) rotation, circumduction

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14
Q

what happens to the scapula when we raise our upper limb?

A

rotates

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15
Q

which movements can the elbow joint make?

A

flexion and extension

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16
Q

which movements can the radioulnar joints make?

A

pronation and supination

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17
Q

which movements can the wrist joint make?

A

flexion and extension, abduction and adduction

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18
Q

which movements can the fingers make?

A

flexion and extension, abduction and adduction

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19
Q

what is the ridge of bone on the posterior surface of the scapula?

A

spine

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20
Q

what does the lateral end of the spine of the scapula expand to form?

A

acromion

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21
Q

what does the acromium articulate with?

A

lateral end of the clavicle

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22
Q

what is the pectoral girdle?

A

clavicle, scapula and attached muscles

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23
Q

what is the shallow fossa on the lateral aspect of the scapula?

A

glenoid fossa

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24
Q

which joint is between the scapula and humerus?

A

glenohumeral joint

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25
Q

which projection of bone is superior to the glenoid fossa?

A

supraglenoid tubercle

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26
Q

which projection of bone is inferior to the glenoid fossa?

A

infraglenoid tubercle

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27
Q

what is the long bone of the arm?

A

humerus

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28
Q

what is the groove at the head of the humerus?

A

anatomical neck

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29
Q

name the sites of muscle attachments on the proximal humerus

A

greater tubercle
lesser tubercle

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30
Q

where is the surgical neck in relation to the tubercles?

A

just distal

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31
Q

which nerve runs close to the surgical neck and is vulnerable in fractures of the surgical neck or dislocation of the humeral head?

A

axillary nerve

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32
Q

which groove marks the path of the radial nerve?

A

radial/ spiral groove

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33
Q

which nerve is vulnerable in mid shaft humeral fractures?

A

radial

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34
Q

is there any bony articulation between the scapula and the posterior thoracic wall? why?

A

no
the scapula is surrounded by muscles

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35
Q

name the movements of the scapula?

A

protraction, retraction, elevation, depression, rotation

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36
Q

what movement does the scapula make when we raise our arms?

A

rotation

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37
Q

by now many degrees does the scapula rotate for every 2 degree abduction of the shoulder?

A

1 degree

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38
Q

which muscles comprise the anterior pectoral girdle?

A

pec major, pec minor, serratus anterior

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39
Q

which muscle protracts the scapula?

A

serratus anterior

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40
Q

name the two large muscles of the posterior pectoral girdle

A

trapezius, latissimus dorsi

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41
Q

name the smaller, deeper muscles of the posterior pectoral girdle

A

levator scapulae
rhomboid major
rhomboid minor

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42
Q

what do the posterior pectoral girdle muscles attach the scapula to (except latissimus dorsi)?

A

vertebral column

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43
Q

where does latissimus dorsi insert?

A

humerus

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44
Q

action of trapezius

A

upper part - elevates
middle parts - retracts
lower part - depresses
rotates scapula

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45
Q

action of latissimus dorsi

A

extends, adducts and medially rotates humerus

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46
Q

action of levator scapulae

A

elevates the scapula

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47
Q

action of rhomboid major

A

retracts the scapula

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48
Q

action of rhomboid minor

A

retracts the scapula

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49
Q

origin of trapezius

A

skull, cervical and thoracic vertebrae

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50
Q

insertion of trapezius

A

clavicle and scapula (spine and acromium)

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51
Q

origin of latissimus dorsi

A

lower thoracic vertebrae

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52
Q

insertion of latissimus dorsi

A

humerus - upper anterior

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53
Q

origin of levator scapulae

A

upper cervical vertebrae

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54
Q

insertion of levator scapulae

A

medial border of scapula

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55
Q

origin of rhomboid minor

A

C7 and T1

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56
Q

insertion of rhomboid minor

A

media border of scapula

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57
Q

origin of rhomboid major

A

thoracic vertebrae

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58
Q

insertion of rhomboid major

A

medial border of scapula

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59
Q

innervation of the posterior pectoral region

A

mostly brachial plexus

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60
Q

which muscle in the posterior pectoral region is not innervated by the brachial plexus?

A

trapezius

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61
Q

innervation of trapezius

A

accessory nerve

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62
Q

which branch of the brachial plexus innervated latissimus dorsi?

A

thoracodorsal nerve

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63
Q

name movements of the shoulder joint

A

flexion, extension, abduction, adduction, medial rotation, lateral rotation, circumduction

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64
Q

name the scapulohumeral muscles (attach scapula to humerus)

A

deltoid, supraspinatus, infraspinatus, subscapularis, teres minor, teres major

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65
Q

function of rotator cuff muscles

A

provide stability to the shoulder joint

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66
Q

name the rotator cuff muscles

A

supraspinatus, infraspinatus, subscapularis, teres minor

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67
Q

which is the large muscle over the lateral aspect of the shoulder?

A

deltoid

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68
Q

origin of deltoid from the scapula

A

spine and acromium (plus clavicle)

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69
Q

what does the deltoid attach?

A

humerus to lateral part of clavicle and spine of scapula

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70
Q

where do the rotator cuff muscles, deltoid and teres major have their action?

A

shoulder joint

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71
Q

which bone do the rotator cuff muscles and deltoid and teres major originate from?

A

scapula

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72
Q

which bone do the rotator cuff muscles, deltoid and teres major insert onto?

A

humerus

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73
Q

what is the name of the place where the deltoid inserts onto the humerus?

A

deltoid tuberosity

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74
Q

action of deltoid at the shoulder joint

A

powerful abductor of the shoulder joint after 20 degrees
anterior and posterior fibres contribute to flexion and extension of the shoulder respectively

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75
Q

can deltoid initiate abduction?

A

no, another muscle initiates the first 20 degrees before deltoid takes over

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76
Q

which nerve innervates deltoid?

A

axillary nerve - from brachial plexus

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77
Q

which aspect of the scapula does teres major arise from?

A

posterior surface of scapula, inferior part of lateral border

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78
Q

which aspect of the humerus does teres major insert onto?

A

anterior humerus

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79
Q

action of teres major on the shoulder joint?

A

medial rotator and adduction

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80
Q

where do the rotator cuff muscles attach to the humerus?

A

tubercles of the humerus

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81
Q

which rotator cuff muscles originate from the posterior surface of the scapula?

A

supraspinatus, infraspinatus, teres minor

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82
Q

which rotator cuff muscles insert onto the greater tubercle?

A

supraspinatus, infraspinatus, teres minor

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83
Q

which structures form the boundaries of the quadrilateral space?

A

teres minor above
teres major below
long head of triceps medially
surgical neck of humerus laterally

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84
Q

which nerve travels through the quadrilateral space?

A

axillary

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85
Q

what does the axillary nerve innervate?

A

deltoid and teres minor

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86
Q

which rotator cuff muscle originates from the anterior surface of the scapula?

A

subscapularis

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87
Q

where does subscapularis insert?

A

lesser tubercle of the humerus

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88
Q

action of supraspinatus

A

first 20 degrees of abduction of the shoulder joint

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89
Q

origin of supraspinatus

A

supraspinous fossa on scapula

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90
Q

insertion of supraspinatus

A

greater tubercle - superior facet

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91
Q

action of infraspinatus

A

lateral rotation

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92
Q

origin of infraspinatus

A

infraspinous fossa

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93
Q

insertion of infraspinatus

A

greater tubercle - middle facet

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94
Q

action of teres minor

A

lateral rotation of the shoulder joint

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95
Q

origin of teres minor

A

lateral border of the scapula

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96
Q

insertion of teres minor

A

greater tubercle - inferior facet

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97
Q

action of subscapularis

A

medial rotation of the shoulder joint

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98
Q

origin of subscapularis

A

subscapular fossa of scapula

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99
Q

insertion of subscapularis

A

lesser tubercle of humerus

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100
Q

clinical importance of supraspinatus

A

travels from the supraspinous fossa to the greater tubercle, travels under the acromium
tendon can become inflamed and pinched between he acromium and humerus during movements of the shoulder
called ‘impingement’
presents as a painful arc

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101
Q

why is the shoulder joint easily dislocated?

A

poor fit of articular surfaces to allow extensive range of movement
loose joint capsule

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102
Q

how do the rotator cuff muscles provide stability?

A

contraction of the rotator cuff muscles holds the head of the humerus in the shallow glenoid
rotator cuff tendons fuse with the capsule of the shoulder joint

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103
Q

which other features contribute to the stability of the shoulder?

A

rim of fibrocartilage around the margin of the glenoid fossa deepens the shallow fossa and aids stability - glenoid labrum
capsule is reinforced by ligaments
tendon of biceps brachii, which lies in the anterior arm, also reinforces the joint

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104
Q

what separate the arm into anterior and posterior compartments?

A

intermuscular septa

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105
Q

which is the only muscle to lie in the posterior compartment of the arm?

A

triceps brachii

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106
Q

how many muscle bellies/ heads does triceps brachii have?

A

3

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107
Q

the three heads of triceps brachii converge via a common tendon onto which single insertion point?

A

olecranon of the ulna

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108
Q

action of triceps brachii

A

extension of the forearm at the elbow

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109
Q

name the three heads of triceps?

A

long, lateral and medial head

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110
Q

origin of the long head of triceps

A

infraglenoid tubercle of the scapula

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111
Q

origin of the lateral head of triceps

A

posterior humerus, proximal to the radial groove

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112
Q

origin of the medial head of triceps

A

posterior humerus, distal to the radial groove

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113
Q

innervation of triceps

A

radial nerve (terminal branch of brachial plexus)

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114
Q

where does the radial nerve run?

A

posterior aspect of the humerus in the radial (spiral) groove between the medial and lateral heads of triceps

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115
Q

adhesive capsulitis

A

‘frozen shoulder’
pain and stiffness in the shoulder
capsule of the joint becomes inflamed, stiff and tight
adhesions may develop

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116
Q

rotator cuff injury

A

by acute trauma or repetitive use
tendons may degenerate with age
tears are usually painful at rest and on movement
if supraspinatus tendon becomes injured and inflamed, it may become impinged between the acromium and humeral head, as the space here is small
first pat of abduction is not painful, but between 60 and 120 degrees of abduction, the inflamed tendon is compressed against the acromium, and this is when patients experience pain
beyond this, pain subsides again
this presentation is called a ‘painful arc’ and is indicative of supraspinatus tendon pathology
an inflamed tendon may ultimately rupture

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117
Q

dislocation of the shoulder

A

humeral head moves out of glenoid fossa - can injure axillary nerve
more common anteriorly

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118
Q

axillary nerve injury - cause and presentation

A

close proximity to surgical neck of humerus
injured in fractures to this area of dislocation of the shoulder joint
motor fibres innervate deltoid and teres minor
sensory fibres innervate a patch of skin over the upper lateral arm
injury to the axillary nerve results in weakness or paralysis of deltoid - difficulty abducting shoulder
altered sensation or numbness over the upper lateral arm

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119
Q

radial nerve injury - cause and presentation

A

runs in the radial groove of the posterior humerus, close to the bone
fractures of humeral shaft can injure the nerve
weakness of nerve downstream of the point where the nerve is injured
weakness of triceps
impaired elbow extension
radian nerve lesion at the level of the mid arm affects wrist movement because the radial nerve innervates all the muscles of the posterior forearm, which extend the wrist

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120
Q

which muscles abduct the shoulder?

A

Initiated by supraspinatus (first 20 degrees or so)
● Deltoid then takes over
● Rotation of the scapula is required to raise the arm above the head – this
requires the action of trapezius.

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121
Q

describe the movements of the scapula and the humerus during shoulder abduction

A

Abduction of the arm at the shoulder is initiated by supraspinatus (first 20 degrees or so)
● Deltoid then takes over
● As the arm rises, the humerus laterally rotates – this keeps the articular
surfaces in contact with each other; in full abduction (with the arm above the
head) the humerus has rotated 90 degrees.
● For every 2 of abduction at the shoulder joint the scapula rotates 1 degree Rotation
tilts the glenoid fossa cranially.

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122
Q

Which nerve innervates trapezius? How would you test if the nerve was functioning?

A

The accessory nerve / cranial nerve XI (11). Specifically, its spinal root.
● The most straightforward way to test the function of the nerve is to ask the
patient to shrug the shoulders (i.e. elevate the scapula). You would be comparing movement on both sides and looking for symmetry.

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123
Q

Which nerve is at risk of injury in shoulder dislocation? What functional deficits would result and how would you examine a patient to test for these deficits?

A

The axillary nerve (C5-C6 fibres)
● Potential function deficits are weakness / paralysis of deltoid and teres minor
(motor fibres of the nerve) and impaired sensation / numbness over the skin
of the upper lateral shoulder (sensory fibres of the nerve).
● Motor function – tested by asking the patient to abduct the arm; look for
weakness compared with the unaffected arm
● Sensory function – use light touch over the skin of the upper lateral to arm and compare sensation with the opposite side; ask the patient if it feels the same or different to the unaffected side.

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124
Q

What structures stabilise the shoulder joint?

A

The rotator cuff is the key stabilising factor
● The tendon of the long head of biceps and the glenoid labrum also contribute
to stability.

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125
Q

Which parts of the pectoral girdle and shoulder joint can be palpated on examination?

A

Clavicle, acromion, spine of the scapula and lateral border of the scapula.

126
Q

In a patient with a mid-shaft humeral fracture:
a) What movements could you test to try and ascertain whether the radial nerve
had been injured?

A

The radial nerve innervates triceps (> extends the elbow) and the posterior
compartment of the forearm (> extends the wrist). Therefore assessment should involve asking the patient to extend the elbow and then extend the wrist. The patient is asked to do this against gravity and against resistance. In the latter, the examiner applies a little force against the movement the patient is asked to perform – this tests the strength of the movement and again should be compared to the other side.
● Weakness of elbow extension and / or wrist extension would indicate a radial nerve injury. ‘Wrist-drop’ is the term given to the appearance of the wrist and hand when the forearm extensors are weak / paralysed.

127
Q

In a patient with a mid-shaft humeral fracture:
b) Why might triceps be weak compared to the unaffected arm, but not paralysed?

A

Remember that triceps has 3 heads which arise from different regions proximally. When the radial nerve is injured in the mid-humeral region, muscles innervated ‘downstream’ will be affected. However, by the time the nerve is at the mid-humeral level, it has already given off branches to the proximal parts of the muscle – these are unaffected and those parts of the muscle will still function. Therefore triceps will be weak, but not completely paralysed.

128
Q

Which muscles comprise the rotator cuff, and where do they insert on the humerus?

A

They are supraspinatus (inserts on the superior facet, greater tubercle), infraspinatus (inserts on the middle facet, greater tubercle), teres minor (inserts on the inferior facet, greater tubercle) and subscapularis (inserts on the lesser tubercle).

129
Q

boundaries of the axilla

A

anterior wall - pec major and minor
posterior wall - subscapularis, trees major and latissimus dorsi
lateral wall - upper humerus
medial wall - serrates anterior and chest wall
apex - first rib, clavicle and scapula
base - skin and fascia between the chest wall and arm

130
Q

contents of the axilla

A

fat
lymph nodes
axillary artery - major artery of the upper limb
axillary vein - major vein of the upper limb
brachial plexus - specifically cords and branches - innervates upper limb

131
Q

what do axillary lymph nodes drain?

A

upper limb, chest, scapular region, abdominal wall as far as umbilicus

132
Q

how many groups of lymph nodes are there in the axilla?

A

5
central, pectoral, humeral, sub scapular, apical

133
Q

which lymph nodes drain lymph from all other lymph noes in the axilla?

A

apical nodes

134
Q

which lymph nodes are likely to be involved in the spread of cancer (metastasis)?

A

apical

135
Q

which group of lymph nodes are associated with breast cancer?

A

axillary

136
Q

which artery is a continuation of the subclavian?

A

axillary
then brachial

137
Q

where does the subclavian run?

A

under the clavicle into the axilla

138
Q

where does the axillary artery give branches relative to pec minor?

A

one above pec minor
two behind pec minor
three below pec minor

139
Q

which artery is the continuation of the axillary artery?

A

brachial

140
Q

where does the axillary artery become the brachial artery?

A

as it crosses the inferior border of trees major

141
Q

which vein drains the upper limb?

A

axillary

142
Q

which vein is the axillary vein continuous with?

A

subclavian

143
Q

how can we half bleeding from axillary vessels?

A

compress them against the humerus

144
Q

innervation of the upper limb

A

brachial plexus

145
Q

which spinal segments form the brachial plexus?

A

C5, C6, C7, C8 and T1

146
Q

segments of the brachial plexus

A

roots, trunks, division, cords, branches
really thirsty drink cold beer

147
Q

where are the brachial plexus nerve roots found?

A

neck

148
Q

where are the brachial plexus trunks found?

A

neck

149
Q

name the trunks of the brachial plexus

A

superior, middle, inferior

150
Q

which spinal segments form the superior trunk?

A

C5 and C6

151
Q

name the trunks of the brachial plexus

A

superior, middle, inferior

152
Q

where do the trunks divide, and how?

A

under the clavicle
each trunk divides into an anterior and posterior division

153
Q

how are the brachial plexus cords named?

A

relative to their position around the second part of the axillary artery

154
Q

name the cords of the brachial plexus

A

lateral, posterior, medial

155
Q

what forms the lateral cord of the brachial plexus?

A

anterior cord of the superior and middle trunks

156
Q

what forms the posterior cord of the brachial plexus?

A

posterior divisions of all the trunks

157
Q

what forms the medial cord of the brachial plexus?

A

anterior division of the inferior trunk

158
Q

where are the brachial plexus branches located?

A

axilla

159
Q

which branches does the posterior cord give off?

A

axillary and radial

160
Q

which branch is a continuation of the posterior cord?

A

radial

161
Q

which cord does the axillary branch originate from?

A

posterior cord

162
Q

origin of the musculocutanous branch

A

lateral cord

163
Q

origin of the axillary branch

A

posterior cord

164
Q

origin of the radial branch

A

posterior cord

165
Q

origin of the ulnar branch

A

medial cord

166
Q

origin of the median branch

A

lateral and medial cords

167
Q

what does the axillary nerve innervate?

A

deltoid and teres minor
small region of skin over the upper lateral arm

168
Q

which spinal segments does the axillary nerve contain fibres from?

A

C5 and C6

169
Q

where does the axillary nerve run?

A

close to the surgical neck of the humerus

170
Q

why is the axillary nerve vulnerable?

A

runs close to the surgical neck of the humerus
vulnerable to injury in fractures of the surgical neck of the humerus or dislocations of the humeral head

171
Q

innervation of triceps in the posterior arm

A

radial nerve

172
Q

innervation of all the muscles in the posterior compartment of the forearm

A

radial nerve
these muscles are extensors of the wrist and digits

173
Q

innervation of skin over the arm, forearm and hand

A

radial nerve

174
Q

what does the radial nerve innervate?

A

triceps in the posterior arm
muscles in the posterior compartment of the forearm - extensors of the wrist and digits
regions of skin over the arm, forearm and hand

175
Q

which spinal segments does the radial nerve contain fibres from?

A

C5-T1

176
Q

where does the radial nerve run?

A

radial (spiral) groove on the posterior surface of the humerus

177
Q

which nerve is vulnerable in mid shaft fractures of the humerus?

A

radial

178
Q

how many muscles does the musculocutanous nerve innervate in the anterior arm?

A

3

179
Q

which spinal segments contributes to the musculocutaneous nerve?

A

C5-C7

180
Q

what does the musculocutaneous nerve innervate?

A

region of skin over the forearm

181
Q

which nerve from the brachial plexus is rarely injured in isolation?

A

musculocutaneous

182
Q

do the median and ulnar nerves innervate any arm muscles?

A

no

183
Q

where do the median and ulnar nerve innervate?

A

anterior forearm and hand

184
Q

which cords form the median nerve?

A

lateral and medial cords

185
Q

from which spinal segments does the median nerve receive fibres from?

A

C6 - T1

186
Q

what does the median nerve innervate?

A

most of the muscles of the anterior forearm (these muscles are on the anterior portion of the arm when the body is in the anatomical position)

small muscles of the thumb

skin over the lateral aspect of the palm of the hand and over the lateral digits

187
Q

function of the anterior forearm muscles

A

flexors of the wrist and digits

188
Q

where is the cubital fossa?

A

anterior aspect of the elbow

189
Q

anterior aspect of the elbow

A

cubital fossa

190
Q

where is the median nerve most vulnerable?

A

cubital fossa

191
Q

which spinal segments contribute to the ulnar nerve?

A

C8-T1

192
Q

what does the ulnar nerve innervate?

A

most of the small muscles in the hand

skin over the medial aspect of the hand and medial digits

193
Q

which nerve is vital for fine movements of the digits?

A

ulnar nerve

194
Q

which nerve is vital for flexing the wrist and digits?

A

median nerve

195
Q

where is the ulnar nerve vulnerable to injury?

A

behind the medial epicondyle as it lies in a superficial position here

196
Q

muscles of the anterior compartment of the arm

A

biceps brachii, brachialis, coracobrachialis

197
Q

function of the muscles of the anterior arm

A

flexion of the forearm

198
Q

innervation of the muscles of the anterior arm

A

musculocutaneous nerve

199
Q

which muscle lies most superficially in the anterior arm?

A

biceps brachii

200
Q

how many muscle bellies does biceps brachii have?

A

two
long and short head

201
Q

where are both heads of biceps brachii attached proximally?

A

scapula

202
Q

where on the scapula are the long and short head of biceps brachii attached?

A

long head - supraglenoid tubercle
short head - coracoid process

203
Q

where do the muscle bellies of biceps brachii converge?

A

radial tuberosity of the radius

204
Q

the tendon of which head of biceps pierces the capsule of the shoulder joint and helps to stabilise the joint?

A

long

205
Q

function of biceps

A

flexor of the elbow
crosses the elbow so is also a flexor of the shoulder joint
supinates the forearm WHEN the elbow is flexed e.g a screwdriver works better when the elbow is flexed

206
Q

which muscle lies deep to biceps?

A

brachialis

207
Q

attachments of brachialis

A

anterior aspect of the lower half of the shaft of the humerus
crosses the elbow joint to insert distally upon the ulna tuberosity

208
Q

does brachialis act on the shoulder joint? why or why not?

A

no
does not cross the shoulder joint

209
Q

action of brachialis

A

powerful flexor of the elbow joint

210
Q

attachments of coracobrachialis

A

coracoid process and medial aspect of middle part of humerus

211
Q

action of coracobrachialis

A

weak flexor of the shoulder joint

212
Q

what is the (ante)cubital fossa?
what shape is it and how many borders does it have?

A

region anterior to the elbow joint
triangular shaped region with three borders

213
Q

name the borders of the cubital fossa

A

lateral, medial, superior (or base)

214
Q

which muscle forms the lateral border of the cubital fossa?

A

brachoradialis

215
Q

which muscle forms the medial border of the cubital fossa?

A

pronator teres

216
Q

what forms the superior border/ base of the cubital fossa?

A

imaginary line drawn between the medial and lateral epicondyles of the humerus

217
Q

contents of the cubital fossa

A

tendon of biceps brachii
bicipital aponeurosis (fascial extension of the biceps tendon)
brachial artery
terminal branches of the brachial artery (radial and ulnar arteries)
median nerve
radial nerve
superficial veins in the subcutaneous tissue over the cubital fossa

218
Q

where does the tendon of biceps brachii insert?

A

radial tuberosity

219
Q

which tendon is tapped with a tendon hammer to examine the biceps reflex?

A

biceps

220
Q

what is the bicipital aponeurosis?

A

fascial extension of the biceps tendon
separates the superficial veins from the deeper structures in the fossa - the brachial artery and median nerve

221
Q

where does the brachial artery lie relative to the biceps tendon?

A

medial

222
Q

terminal branches of the brachial artery

A

radial artery
ulnar artery

223
Q

which artery is vulnerable in venepuncture and cannulation?

A

brachial

224
Q

where does the median nerve lie relative to the brachial artery?

A

medial to the brachial artery

225
Q

does the median nerve innervate any arm muscles?

A

no, only anterior forearm and hand

226
Q

where does the radial nerve lie?

A

deep to brachioradialis

227
Q

where are the veins in the cubital fossa?

A

superficial
in the subcutaneous tissue

228
Q

why are the superficial veins in the cubital fossa clinically relevant?

A

venepuncture (taking blood)
intravenous access - placing a cannula for administering fluids or drugs

229
Q

which structures may accidentally be punctured during venepuncture?

A

median nerv
brachial artery
probably not radial nerve as it lies deep to brachioradialis

230
Q

side effects of axillary lymph node removal

A

fluid accumulation and swelling in the affected upper limb

231
Q

which nerves are vulnerable when axillary lymph nodes are removed?

A

long thoracic nerve
thoracodorsal nerve

232
Q

what does the long thoracic nerve innervate?

A

serratus anterior (SALT - serratus anterior, long thoracic)

233
Q

where does the long thoracic nerve lie?

A

superficially on the surface of serratus anterior in the medial wall of the axilla

234
Q

consequence of injury to the long thoracic nerve

A

weakness of serratus anterior

235
Q

visible sign of injury to the long thoracic nerve

A

winged scapula
long thoracic innervates serratus anterior
serratus anterior holds the medial border of the scapula flat against the posterior chest wall
if the muscle is paralysed, the medial border lifts off the chest wall and appears to stick out

236
Q

what does the thoracodorsal nerve innervate?

A

latissimus dorsi

237
Q

where does the thoracodorsal nerve lie?

A

along the subscapularis muscle, which forms the posterior wall of the axilla

238
Q

where is the ulnar nerve vulnerable? why?

A

behind the medial epicondyle
it is superficial here

239
Q

symptoms of an injury to the ulnar nerve at the medial epicondyle

A

motor impairments of the hand
sensory impairments in the hand (medial side of the hand and medial 1 1/2 fingers)

240
Q

hitting which nerve results in the ‘funny bone’ sensation

A

ulnar nerve

241
Q

what is Erb’s Palsy?

A

UPPER parts of the brachial plexus are affected
paralysis of the lateral rotators of the shoulder and the extensors of the wrist
affected limb appears medially rotated with the wrist flexed
typically caused by trauma - mechanisms that stretch the head away from the shoulder
caused by trauma
- someone is thrown from a motorbike or horse
- in newborns in the baby’s shoulder becomes stuck during delivery and the neck is excessively stretched

242
Q

what is Klumpke’s Palsy?

A

LOWER parts of the brachial plexus are affected
paralysis of the small muscles of the hand
caused by trauma
- mechanisms that forcefully and suddenly pull the arm upwards which stretches the lower nerves of plexus
- may be sustained during delivery if the arm is forcefully pulled

243
Q

what is Horner’s syndrome?

A

injury to T1 spinal nerve
T1 spinal nerve carries sympathetic fibres supplying the face
occurs when sympathetic nerve supply to the face is interrupted
triad of
- ptosis (drooping of the eyelid)
- miosis (constricted pupil)
- anhidrosis (lack of sweating)
on one side of the face

244
Q

brachial plexus block

A

form of regional anaesthesia for surgery on the upper limb
local anaesthetic is infiltrated around the nerves of the plexus, which anaesthetises the upper limb
under ultrasound guidance

245
Q

Describe the route of arterial blood from the left ventricle to the right axillary artery and from the left ventricle to the left axillary artery.

A

Left ventricle to right axillary artery:
Aorta > brachiocephalic trunk > right subclavian > right axillary

Left ventricle to left axillary artery:
Aorta > left subclavian > left axillary

246
Q

Draw and label a diagram of the brachial plexus showing the roots, trunks, divisions, cords and the five terminal branches.

A

Refer to the image in your Upper Limb handbook.
● You do not need to be able to add all the small branches to the plexus.

247
Q

Describe how the cords of the brachial plexus are situated relative to the second part of the axillary artery.

A

The lateral cord lies laterally, the medial cord medially and the posterior cord
lies posteriorly to the artery

248
Q

Which regions of the body drain directly to the axillary lymph nodes? Briefly outline the clinical importance of the axillary lymph nodes.

A

They drain the upper limb, breast, chest wall, scapular region and the abdominal
wall as far as the umbilicus.
● There are five groups of lymph nodes in the axilla; anterior, posterior, lateral,
central and apical.
● The apical nodes receive lymph from all other lymph nodes in the axilla and
therefore are often involved in the spread of cancer (metastasis).
● The axillary lymph nodes are particularly associated with breast cancer. Detection of a lump in the armpit may be the first sign of breast malignancy. The
axillary lymph nodes can also enlarge in response to infection.
● Axillary lymph nodes can be biopsied to assess whether a breast malignancy has metastasized. They can be removed as part of the patient’s treatment. Removal of the nodes can lead to fluid accumulation and swelling in the affected upper
limb.

249
Q

What key structures are found in the cubital fossa? Where are they located relative to each other?

A

The biceps tendon, brachial artery and median nerve.
● The brachial artery and median nerve both lie medial to the biceps tendon.

250
Q

bones of the forearm

A

radius and ulna

251
Q

what connects the radius and ulna in real life?

A

interosseous membrane

252
Q

how does the ulna articulate with the humerus?

A

trochlea notch of the ulna articulate with the trochlea of the humerus

253
Q

how does the radius articulate with the humerus?

A

radial head articulates with the capitellum of the humerus

254
Q

movements of the elbow joint

A

flexion and extension

255
Q

name of the joint between the radius and ulna
how many of these are there and where are they?

A

radioulnar
two, one proximal, one distal

256
Q

what movements do the radioulnar joints allow?

A

pronation and supination of the forearm and hand

257
Q

which forearm bone pivots around the other?

A

the radius pivots around the ulna

258
Q

joint between the radius and the small bones of the wrist (carpus)

A

radiocarpal

259
Q

name the proximal row of carpal bones from lateral to medial

A

scaphoid, lunate, triquetral, pisiform (which is not a true carpal bone, but rather is a small bone that develops in the tendon of flexor carpi ulnaris)

260
Q

name the distal row of carpal bones from lateral to medial

A

trapeziUM (base of the thUMb), trapezoid, Capitate (located Centrally and is the largest carpal bone) and the hamate

261
Q

why isn’t the pisiform a true carpal bone?

A

a small bone that develops in the tendon of flexor carpi ulnaris

262
Q

what does the hamate bear anteriorly?

A

bony process (the hook) which is palpable

263
Q

most commonly fractured carpal bone

A

scaphoid

264
Q

which bones lie distal to the carpus?

A

metacarpals

265
Q

what are the bones of the digits?

A

phalanges

266
Q

how many phalanges in each finger?

A

three

267
Q

how many phalanges in each thumb?

A

two

268
Q

what bounds the cubital fossa laterally?

A

brachioradialis

269
Q

what bounds the cubital fossa medially?

A

pronator teres

270
Q

name important structures in the cubital fossa

A

biceps tendon
median nerve
brachial artery which bifurcates into the radial and ulnar arteries
superficial veins

271
Q

how many muscles in the anterior compartment of the arm?

A

eight

272
Q

generalisations of the muscles in the anterior compartment of the arm

A

arranged in 3 layers - superficial, middle, deep
most act as flexors of the wrist, fingers or thumb
most are innervated by the median nerve

273
Q

muscles in the superficial layer of the anterior compartment of the arm from lateral to medial

A

pronator teres
flexor carpi radialis
palmaris longus
flexor carpi ulnaris

274
Q

where are the muscles in the superficial layer of the anterior compartment of the arm attached to proximally?

A

medial epicondyle of the humerus (also called the common flexor origin)

275
Q

action of pronator teres

A

pronator of the proximal radioulnar joint

276
Q

action of flexor carpi radialis

A

flexes and abducts the wrist
insets onto the radial side of the wrist

277
Q

describe palmaris longus

A

small muscle belly but long, thin, easily recognised tendon when present
approx 15% of us do not have one

278
Q

where does the tendon of palmaris longus insert?

A

fascia of the palm of the hand

279
Q

function of flexor carpi ulnaris

A

flexes and adducts the wrist

280
Q

where does flexor carpi ulnaris insert?

A

ulnar side of the wrist

281
Q

innervation of flexor carpi ulnaris

A

ulnar nerve

282
Q

which is the only muscle in the middle muscle layer?

A

flexor digitorum superficialis

283
Q

function of flexor digitorum superficialis

A

flexor of the digits

284
Q

how many tendons does flexor digitorum superficialis give rise to?

A

four

285
Q

which digits do the tendons of flexor digitorum superficialis attach to?

A

digits 2-5
pointer finger

286
Q

innervation of flexor digitorum superficialis

A

dual innervation

lateral half of the muscle
- gives rise to tendons that travel to the index and middle fingers
- is innervated by median nerve

medial half
- gives rise to tendons that travel to the ring and little fingers
- is innervated by ulnar nerve

287
Q

function of flexor pollicis longus

A

flexes the thumb
‘pollex’ = thumb

288
Q

deepest forearm muscle

A

pronator quadratus

289
Q

function of pronator quadratus

A

pronates the distal radioulnar joint

290
Q

which are the only two anterior forearm muscles that are not flexors?

A

pronator trees and pronator quadratus

291
Q

which are the only anterior forearm muscles not be innervated by the median nerve?

A

flexor carpi ulnas
medial half of flexor digitorum superficialis

292
Q

what is the carpal tunnel?

A

narrow passageway at the wrist

293
Q

what forms the floor and sides of the carpal tunnel?
what forms the roof?

A

carpal bones

fibrous band - flexor retinaculum

294
Q

which bones is the flexor retinaculum attached to medially and laterally?

A

medially
- hook of the hamate
- pisiform

laterally
- scaphoid
- trapezium

295
Q

how many tendons pass through the carpal tunnel?

A

9

296
Q

which tendons pass through the carpal tunnel?

A

flexor digitorum superficialis (4 tendons, to digits 2-5)
flexor digitorum profundus (4 tendons, to digits 2-5)
flexor pollicis longus (1 tendon to the thumb [1st digit])

297
Q

which nerve travels through the carpal tunnel?

A

median

298
Q

what is carpal tunnel syndrome?

A

compression of the median nerve

299
Q

presentation of carpal tunnel syndrome

A

impaired or altered sensation over the skin of the hand supplied by the median nerve
tingling, numbness or pain in the hand

weakness of the hand muscles supplied by the median nerve - particularly the small muscles of the thumb

300
Q

consequences of untreated carpal tunnel syndrome

A

small muscles of the thumb atrophy

301
Q

treatment of carpal tunnel syndrome

A

divide the flexor retinaculum to alleviate compression

302
Q

terminal branches of the brachial artery

A

radial and ulnar artery

303
Q

which artery can easily be palpated at the wrist?

A

radial

304
Q

which artery travels laterally in the forearm?

A

radial

305
Q

which artery travels medially in the forearm?

A

ulnar

306
Q

where does all venous blood of the upper limb ultimately drain?

A

axillary vein

307
Q

two important superficial veins of the upper limb

A

cephalic vein
basilic vein

308
Q

which vein courses laterally in the forearm?

A

cephalic vein

309
Q

which vein courses medially in the forearm?

A

basilic

310
Q

which vein connects the cephalic and basilic veins in the cubital fossa?

A

median cubital vein

Phase 1 flashcards (27 decks)

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