Upper Limb MSK anatomy Flashcards
1
Q
what is the pectoral girdle/ shoulder girdle?
A
clavicle, scapula and the muscles attached to these bones
2
Q
what is the arm?
A
region between the shoulder and elbow joints
3
Q
what is the forearm?
A
region between the elbow and wrist joint
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
5
Q
what type of joint is the elbow?
A
synovial hinge joint
6
Q
which bones articulate at the elbow joint?
A
distal humerus articulates with the ulna and radius
7
Q
which joints join the radius and ulna?
A
radioulnar
8
Q
what do the radioulnar joints allow?
A
pronation and supination of the forearm and hand
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
10
Q
which movements does the radiocarpal joint allow?
A
flexion, extension, abduction and adduction
11
Q
anterior movement of the scapula
A
protraction
12
Q
posterior movement of the scapula
A
retraction
13
Q
name movements that the shoulder joint can make
A
flexion, extension, abduction, adduction, medial (internal) rotation, lateral (external) rotation, circumduction
14
Q
what happens to the scapula when we raise our upper limb?
A
rotates
15
Q
which movements can the elbow joint make?
A
flexion and extension
16
Q
which movements can the radioulnar joints make?
A
pronation and supination
17
Q
which movements can the wrist joint make?
A
flexion and extension, abduction and adduction
18
Q
which movements can the fingers make?
A
flexion and extension, abduction and adduction
19
Q
what is the ridge of bone on the posterior surface of the scapula?
A
spine
20
Q
what does the lateral end of the spine of the scapula expand to form?
A
acromion
21
Q
what does the acromium articulate with?
A
lateral end of the clavicle
22
Q
what is the pectoral girdle?
A
clavicle, scapula and attached muscles
23
Q
what is the shallow fossa on the lateral aspect of the scapula?
A
glenoid fossa
24
Q
which joint is between the scapula and humerus?
A
glenohumeral joint
25
which projection of bone is superior to the glenoid fossa?
supraglenoid tubercle
26
which projection of bone is inferior to the glenoid fossa?
infraglenoid tubercle
27
what is the long bone of the arm?
humerus
28
what is the groove at the head of the humerus?
anatomical neck
29
name the sites of muscle attachments on the proximal humerus
greater tubercle
lesser tubercle
30
where is the surgical neck in relation to the tubercles?
just distal
31
which nerve runs close to the surgical neck and is vulnerable in fractures of the surgical neck or dislocation of the humeral head?
axillary nerve
32
which groove marks the path of the radial nerve?
radial/ spiral groove
33
which nerve is vulnerable in mid shaft humeral fractures?
radial
34
is there any bony articulation between the scapula and the posterior thoracic wall? why?
no
the scapula is surrounded by muscles
35
name the movements of the scapula?
protraction, retraction, elevation, depression, rotation
36
what movement does the scapula make when we raise our arms?
rotation
37
by now many degrees does the scapula rotate for every 2 degree abduction of the shoulder?
1 degree
38
which muscles comprise the anterior pectoral girdle?
pec major, pec minor, serratus anterior
39
which muscle protracts the scapula?
serratus anterior
40
name the two large muscles of the posterior pectoral girdle
trapezius, latissimus dorsi
41
name the smaller, deeper muscles of the posterior pectoral girdle
levator scapulae
rhomboid major
rhomboid minor
42
what do the posterior pectoral girdle muscles attach the scapula to (except latissimus dorsi)?
vertebral column
43
where does latissimus dorsi insert?
humerus
44
action of trapezius
upper part - elevates
middle parts - retracts
lower part - depresses
rotates scapula
45
action of latissimus dorsi
extends, adducts and medially rotates humerus
46
action of levator scapulae
elevates the scapula
47
action of rhomboid major
retracts the scapula
48
action of rhomboid minor
retracts the scapula
49
origin of trapezius
skull, cervical and thoracic vertebrae
50
insertion of trapezius
clavicle and scapula (spine and acromium)
51
origin of latissimus dorsi
lower thoracic vertebrae
52
insertion of latissimus dorsi
humerus - upper anterior
53
origin of levator scapulae
upper cervical vertebrae
54
insertion of levator scapulae
medial border of scapula
55
origin of rhomboid minor
C7 and T1
56
insertion of rhomboid minor
media border of scapula
57
origin of rhomboid major
thoracic vertebrae
58
insertion of rhomboid major
medial border of scapula
59
innervation of the posterior pectoral region
mostly brachial plexus
60
which muscle in the posterior pectoral region is not innervated by the brachial plexus?
trapezius
61
innervation of trapezius
accessory nerve
62
which branch of the brachial plexus innervated latissimus dorsi?
thoracodorsal nerve
63
name movements of the shoulder joint
flexion, extension, abduction, adduction, medial rotation, lateral rotation, circumduction
64
name the scapulohumeral muscles (attach scapula to humerus)
deltoid, supraspinatus, infraspinatus, subscapularis, teres minor, teres major
65
function of rotator cuff muscles
provide stability to the shoulder joint
66
name the rotator cuff muscles
supraspinatus, infraspinatus, subscapularis, teres minor
67
which is the large muscle over the lateral aspect of the shoulder?
deltoid
68
origin of deltoid from the scapula
spine and acromium (plus clavicle)
69
what does the deltoid attach?
humerus to lateral part of clavicle and spine of scapula
70
where do the rotator cuff muscles, deltoid and teres major have their action?
shoulder joint
71
which bone do the rotator cuff muscles and deltoid and teres major originate from?
scapula
72
which bone do the rotator cuff muscles, deltoid and teres major insert onto?
humerus
73
what is the name of the place where the deltoid inserts onto the humerus?
deltoid tuberosity
74
action of deltoid at the shoulder joint
powerful abductor of the shoulder joint after 20 degrees
anterior and posterior fibres contribute to flexion and extension of the shoulder respectively
75
can deltoid initiate abduction?
no, another muscle initiates the first 20 degrees before deltoid takes over
76
which nerve innervates deltoid?
axillary nerve - from brachial plexus
77
which aspect of the scapula does teres major arise from?
posterior surface of scapula, inferior part of lateral border
78
which aspect of the humerus does teres major insert onto?
anterior humerus
79
action of teres major on the shoulder joint?
medial rotator and adduction
80
where do the rotator cuff muscles attach to the humerus?
tubercles of the humerus
81
which rotator cuff muscles originate from the posterior surface of the scapula?
supraspinatus, infraspinatus, teres minor
82
which rotator cuff muscles insert onto the greater tubercle?
supraspinatus, infraspinatus, teres minor
83
which structures form the boundaries of the quadrilateral space?
teres minor above
teres major below
long head of triceps medially
surgical neck of humerus laterally
84
which nerve travels through the quadrilateral space?
axillary
85
what does the axillary nerve innervate?
deltoid and teres minor
86
which rotator cuff muscle originates from the anterior surface of the scapula?
subscapularis
87
where does subscapularis insert?
lesser tubercle of the humerus
88
action of supraspinatus
first 20 degrees of abduction of the shoulder joint
89
origin of supraspinatus
supraspinous fossa on scapula
90
insertion of supraspinatus
greater tubercle - superior facet
91
action of infraspinatus
lateral rotation
92
origin of infraspinatus
infraspinous fossa
93
insertion of infraspinatus
greater tubercle - middle facet
94
action of teres minor
lateral rotation of the shoulder joint
95
origin of teres minor
lateral border of the scapula
96
insertion of teres minor
greater tubercle - inferior facet
97
action of subscapularis
medial rotation of the shoulder joint
98
origin of subscapularis
subscapular fossa of scapula
99
insertion of subscapularis
lesser tubercle of humerus
100
clinical importance of supraspinatus
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
101
why is the shoulder joint easily dislocated?
poor fit of articular surfaces to allow extensive range of movement
loose joint capsule
102
how do the rotator cuff muscles provide stability?
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
103
which other features contribute to the stability of the shoulder?
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
104
what separate the arm into anterior and posterior compartments?
intermuscular septa
105
which is the only muscle to lie in the posterior compartment of the arm?
triceps brachii
106
how many muscle bellies/ heads does triceps brachii have?
3
107
the three heads of triceps brachii converge via a common tendon onto which single insertion point?
olecranon of the ulna
108
action of triceps brachii
extension of the forearm at the elbow
109
name the three heads of triceps?
long, lateral and medial head
110
origin of the long head of triceps
infraglenoid tubercle of the scapula
111
origin of the lateral head of triceps
posterior humerus, proximal to the radial groove
112
origin of the medial head of triceps
posterior humerus, distal to the radial groove
113
innervation of triceps
radial nerve (terminal branch of brachial plexus)
114
where does the radial nerve run?
posterior aspect of the humerus in the radial (spiral) groove between the medial and lateral heads of triceps
115
adhesive capsulitis
'frozen shoulder'
pain and stiffness in the shoulder
capsule of the joint becomes inflamed, stiff and tight
adhesions may develop
116
rotator cuff injury
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
117
dislocation of the shoulder
humeral head moves out of glenoid fossa - can injure axillary nerve
more common anteriorly
118
axillary nerve injury - cause and presentation
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
119
radial nerve injury - cause and presentation
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
120
which muscles abduct the shoulder?
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.
121
describe the movements of the scapula and the humerus during shoulder abduction
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.
122
Which nerve innervates trapezius? How would you test if the nerve was functioning?
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.
123
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?
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.
124
What structures stabilise the shoulder joint?
The rotator cuff is the key stabilising factor
● The tendon of the long head of biceps and the glenoid labrum also contribute
to stability.
125
Which parts of the pectoral girdle and shoulder joint can be palpated on examination?
Clavicle, acromion, spine of the scapula and lateral border of the scapula.
126
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?
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
In a patient with a mid-shaft humeral fracture:
b) Why might triceps be weak compared to the unaffected arm, but not paralysed?
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
Which muscles comprise the rotator cuff, and where do they insert on the humerus?
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
boundaries of the axilla
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
contents of the axilla
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
what do axillary lymph nodes drain?
upper limb, chest, scapular region, abdominal wall as far as umbilicus
132
how many groups of lymph nodes are there in the axilla?
5
central, pectoral, humeral, sub scapular, apical
133
which lymph nodes drain lymph from all other lymph noes in the axilla?
apical nodes
134
which lymph nodes are likely to be involved in the spread of cancer (metastasis)?
apical
135
which group of lymph nodes are associated with breast cancer?
axillary
136
which artery is a continuation of the subclavian?
axillary
then brachial
137
where does the subclavian run?
under the clavicle into the axilla
138
where does the axillary artery give branches relative to pec minor?
one above pec minor
two behind pec minor
three below pec minor
139
which artery is the continuation of the axillary artery?
brachial
140
where does the axillary artery become the brachial artery?
as it crosses the inferior border of trees major
141
which vein drains the upper limb?
axillary
142
which vein is the axillary vein continuous with?
subclavian
143
how can we half bleeding from axillary vessels?
compress them against the humerus
144
innervation of the upper limb
brachial plexus
145
which spinal segments form the brachial plexus?
C5, C6, C7, C8 and T1
146
segments of the brachial plexus
roots, trunks, division, cords, branches
really thirsty drink cold beer
147
where are the brachial plexus nerve roots found?
neck
148
where are the brachial plexus trunks found?
neck
149
name the trunks of the brachial plexus
superior, middle, inferior
150
which spinal segments form the superior trunk?
C5 and C6
151
name the trunks of the brachial plexus
superior, middle, inferior
152
where do the trunks divide, and how?
under the clavicle
each trunk divides into an anterior and posterior division
153
how are the brachial plexus cords named?
relative to their position around the second part of the axillary artery
154
name the cords of the brachial plexus
lateral, posterior, medial
155
what forms the lateral cord of the brachial plexus?
anterior cord of the superior and middle trunks
156
what forms the posterior cord of the brachial plexus?
posterior divisions of all the trunks
157
what forms the medial cord of the brachial plexus?
anterior division of the inferior trunk
158
where are the brachial plexus branches located?
axilla
159
which branches does the posterior cord give off?
axillary and radial
160
which branch is a continuation of the posterior cord?
radial
161
which cord does the axillary branch originate from?
posterior cord
162
origin of the musculocutanous branch
lateral cord
163
origin of the axillary branch
posterior cord
164
origin of the radial branch
posterior cord
165
origin of the ulnar branch
medial cord
166
origin of the median branch
lateral and medial cords
167
what does the axillary nerve innervate?
deltoid and teres minor
small region of skin over the upper lateral arm
168
which spinal segments does the axillary nerve contain fibres from?
C5 and C6
169
where does the axillary nerve run?
close to the surgical neck of the humerus
170
why is the axillary nerve vulnerable?
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
innervation of triceps in the posterior arm
radial nerve
172
innervation of all the muscles in the posterior compartment of the forearm
radial nerve
these muscles are extensors of the wrist and digits
173
innervation of skin over the arm, forearm and hand
radial nerve
174
what does the radial nerve innervate?
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
which spinal segments does the radial nerve contain fibres from?
C5-T1
176
where does the radial nerve run?
radial (spiral) groove on the posterior surface of the humerus
177
which nerve is vulnerable in mid shaft fractures of the humerus?
radial
178
how many muscles does the musculocutanous nerve innervate in the anterior arm?
3
179
which spinal segments contributes to the musculocutaneous nerve?
C5-C7
180
what does the musculocutaneous nerve innervate?
region of skin over the forearm
181
which nerve from the brachial plexus is rarely injured in isolation?
musculocutaneous
182
do the median and ulnar nerves innervate any arm muscles?
no
183
where do the median and ulnar nerve innervate?
anterior forearm and hand
184
which cords form the median nerve?
lateral and medial cords
185
from which spinal segments does the median nerve receive fibres from?
C6 - T1
186
what does the median nerve innervate?
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
function of the anterior forearm muscles
flexors of the wrist and digits
188
where is the cubital fossa?
anterior aspect of the elbow
189
anterior aspect of the elbow
cubital fossa
190
where is the median nerve most vulnerable?
cubital fossa
191
which spinal segments contribute to the ulnar nerve?
C8-T1
192
what does the ulnar nerve innervate?
most of the small muscles in the hand
skin over the medial aspect of the hand and medial digits
193
which nerve is vital for fine movements of the digits?
ulnar nerve
194
which nerve is vital for flexing the wrist and digits?
median nerve
195
where is the ulnar nerve vulnerable to injury?
behind the medial epicondyle as it lies in a superficial position here
196
muscles of the anterior compartment of the arm
biceps brachii, brachialis, coracobrachialis
197
function of the muscles of the anterior arm
flexion of the forearm
198
innervation of the muscles of the anterior arm
musculocutaneous nerve
199
which muscle lies most superficially in the anterior arm?
biceps brachii
200
how many muscle bellies does biceps brachii have?
two
long and short head
201
where are both heads of biceps brachii attached proximally?
scapula
202
where on the scapula are the long and short head of biceps brachii attached?
long head - supraglenoid tubercle
short head - coracoid process
203
where do the muscle bellies of biceps brachii converge?
radial tuberosity of the radius
204
the tendon of which head of biceps pierces the capsule of the shoulder joint and helps to stabilise the joint?
long
205
function of biceps
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
which muscle lies deep to biceps?
brachialis
207
attachments of brachialis
anterior aspect of the lower half of the shaft of the humerus
crosses the elbow joint to insert distally upon the ulna tuberosity
208
does brachialis act on the shoulder joint? why or why not?
no
does not cross the shoulder joint
209
action of brachialis
powerful flexor of the elbow joint
210
attachments of coracobrachialis
coracoid process and medial aspect of middle part of humerus
211
action of coracobrachialis
weak flexor of the shoulder joint
212
what is the (ante)cubital fossa?
what shape is it and how many borders does it have?
region anterior to the elbow joint
triangular shaped region with three borders
213
name the borders of the cubital fossa
lateral, medial, superior (or base)
214
which muscle forms the lateral border of the cubital fossa?
brachoradialis
215
which muscle forms the medial border of the cubital fossa?
pronator teres
216
what forms the superior border/ base of the cubital fossa?
imaginary line drawn between the medial and lateral epicondyles of the humerus
217
contents of the cubital fossa
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
where does the tendon of biceps brachii insert?
radial tuberosity
219
which tendon is tapped with a tendon hammer to examine the biceps reflex?
biceps
220
what is the bicipital aponeurosis?
fascial extension of the biceps tendon
separates the superficial veins from the deeper structures in the fossa - the brachial artery and median nerve
221
where does the brachial artery lie relative to the biceps tendon?
medial
222
terminal branches of the brachial artery
radial artery
ulnar artery
223
which artery is vulnerable in venepuncture and cannulation?
brachial
224
where does the median nerve lie relative to the brachial artery?
medial to the brachial artery
225
does the median nerve innervate any arm muscles?
no, only anterior forearm and hand
226
where does the radial nerve lie?
deep to brachioradialis
227
where are the veins in the cubital fossa?
superficial
in the subcutaneous tissue
228
why are the superficial veins in the cubital fossa clinically relevant?
venepuncture (taking blood)
intravenous access - placing a cannula for administering fluids or drugs
229
which structures may accidentally be punctured during venepuncture?
median nerv
brachial artery
probably not radial nerve as it lies deep to brachioradialis
230
side effects of axillary lymph node removal
fluid accumulation and swelling in the affected upper limb
231
which nerves are vulnerable when axillary lymph nodes are removed?
long thoracic nerve
thoracodorsal nerve
232
what does the long thoracic nerve innervate?
serratus anterior (SALT - serratus anterior, long thoracic)
233
where does the long thoracic nerve lie?
superficially on the surface of serratus anterior in the medial wall of the axilla
234
consequence of injury to the long thoracic nerve
weakness of serratus anterior
235
visible sign of injury to the long thoracic nerve
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
what does the thoracodorsal nerve innervate?
latissimus dorsi
237
where does the thoracodorsal nerve lie?
along the subscapularis muscle, which forms the posterior wall of the axilla
238
where is the ulnar nerve vulnerable? why?
behind the medial epicondyle
it is superficial here
239
symptoms of an injury to the ulnar nerve at the medial epicondyle
motor impairments of the hand
sensory impairments in the hand (medial side of the hand and medial 1 1/2 fingers)
240
hitting which nerve results in the 'funny bone' sensation
ulnar nerve
241
what is Erb's Palsy?
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
what is Klumpke's Palsy?
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
what is Horner's syndrome?
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
brachial plexus block
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
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.
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
Draw and label a diagram of the brachial plexus showing the roots, trunks, divisions, cords and the five terminal branches.
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
Describe how the cords of the brachial plexus are situated relative to the second part of the axillary artery.
The lateral cord lies laterally, the medial cord medially and the posterior cord
lies posteriorly to the artery
248
Which regions of the body drain directly to the axillary lymph nodes? Briefly outline the clinical importance of the axillary lymph nodes.
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
What key structures are found in the cubital fossa? Where are they located relative to each other?
The biceps tendon, brachial artery and median nerve.
● The brachial artery and median nerve both lie medial to the biceps tendon.
250
bones of the forearm
radius and ulna
251
what connects the radius and ulna in real life?
interosseous membrane
252
how does the ulna articulate with the humerus?
trochlea notch of the ulna articulate with the trochlea of the humerus
253
how does the radius articulate with the humerus?
radial head articulates with the capitellum of the humerus
254
movements of the elbow joint
flexion and extension
255
name of the joint between the radius and ulna
how many of these are there and where are they?
radioulnar
two, one proximal, one distal
256
what movements do the radioulnar joints allow?
pronation and supination of the forearm and hand
257
which forearm bone pivots around the other?
the radius pivots around the ulna
258
joint between the radius and the small bones of the wrist (carpus)
radiocarpal
259
name the proximal row of carpal bones from lateral to medial
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
name the distal row of carpal bones from lateral to medial
trapeziUM (base of the thUMb), trapezoid, Capitate (located Centrally and is the largest carpal bone) and the hamate
261
why isn't the pisiform a true carpal bone?
a small bone that develops in the tendon of flexor carpi ulnaris
262
what does the hamate bear anteriorly?
bony process (the hook) which is palpable
263
most commonly fractured carpal bone
scaphoid
264
which bones lie distal to the carpus?
metacarpals
265
what are the bones of the digits?
phalanges
266
how many phalanges in each finger?
three
267
how many phalanges in each thumb?
two
268
what bounds the cubital fossa laterally?
brachioradialis
269
what bounds the cubital fossa medially?
pronator teres
270
name important structures in the cubital fossa
biceps tendon
median nerve
brachial artery which bifurcates into the radial and ulnar arteries
superficial veins
271
how many muscles in the anterior compartment of the arm?
eight
272
generalisations of the muscles in the anterior compartment of the arm
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
muscles in the superficial layer of the anterior compartment of the arm from lateral to medial
pronator teres
flexor carpi radialis
palmaris longus
flexor carpi ulnaris
274
where are the muscles in the superficial layer of the anterior compartment of the arm attached to proximally?
medial epicondyle of the humerus (also called the common flexor origin)
275
action of pronator teres
pronator of the proximal radioulnar joint
276
action of flexor carpi radialis
flexes and abducts the wrist
insets onto the radial side of the wrist
277
describe palmaris longus
small muscle belly but long, thin, easily recognised tendon when present
approx 15% of us do not have one
278
where does the tendon of palmaris longus insert?
fascia of the palm of the hand
279
function of flexor carpi ulnaris
flexes and adducts the wrist
280
where does flexor carpi ulnaris insert?
ulnar side of the wrist
281
innervation of flexor carpi ulnaris
ulnar nerve
282
which is the only muscle in the middle muscle layer?
flexor digitorum superficialis
283
function of flexor digitorum superficialis
flexor of the digits
284
how many tendons does flexor digitorum superficialis give rise to?
four
285
which digits do the tendons of flexor digitorum superficialis attach to?
digits 2-5
pointer finger
286
innervation of flexor digitorum superficialis
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
function of flexor pollicis longus
flexes the thumb
'pollex' = thumb
288
deepest forearm muscle
pronator quadratus
289
function of pronator quadratus
pronates the distal radioulnar joint
290
which are the only two anterior forearm muscles that are not flexors?
pronator trees and pronator quadratus
291
which are the only anterior forearm muscles not be innervated by the median nerve?
flexor carpi ulnas
medial half of flexor digitorum superficialis
292
what is the carpal tunnel?
narrow passageway at the wrist
293
what forms the floor and sides of the carpal tunnel?
what forms the roof?
carpal bones
fibrous band - flexor retinaculum
294
which bones is the flexor retinaculum attached to medially and laterally?
medially
- hook of the hamate
- pisiform
laterally
- scaphoid
- trapezium
295
how many tendons pass through the carpal tunnel?
9
296
which tendons pass through the carpal tunnel?
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
which nerve travels through the carpal tunnel?
median
298
what is carpal tunnel syndrome?
compression of the median nerve
299
presentation of carpal tunnel syndrome
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
consequences of untreated carpal tunnel syndrome
small muscles of the thumb atrophy
301
treatment of carpal tunnel syndrome
divide the flexor retinaculum to alleviate compression
302
terminal branches of the brachial artery
radial and ulnar artery
303
which artery can easily be palpated at the wrist?
radial
304
which artery travels laterally in the forearm?
radial
305
which artery travels medially in the forearm?
ulnar
306
where does all venous blood of the upper limb ultimately drain?
axillary vein
307
two important superficial veins of the upper limb
cephalic vein
basilic vein
308
which vein courses laterally in the forearm?
cephalic vein
309
which vein courses medially in the forearm?
basilic
310
which vein connects the cephalic and basilic veins in the cubital fossa?
median cubital vein
