Upper limb sheet 4

Question 1

Ask your model to demonstrate a tight grip in the hand
Name the joints of Hand involved in the movement. What movement is occurring at the 1st CMC joint?

Answer 1

Interphalangeal, metacarpophalangeal, carpometacarpal,

Flexion occurs at the 1st CMC joint

Question 2

Now, list all other movements of 1st CMC joint. Name the muscles responsible for flexion at the 1st CMC joint.

Answer 2

Flexion, extension, abduction, adduction, opposition

Flexor pollicis longus/ brevis

Question 3

In which planes and axis does wrist flexion & extension and radial and ulnar deviation movement occur.

Answer 3

Flex/ ext = sagittal, mediolateral axis

Rad/ ulnar deviation = frontal, anteroposterior axis

Question 4

Explain a Helping/True neutraliser with example(s) in the upper limb / lower limb

Answer 4

True - counters movement of agonist, doesn’t contribute to wanted movement

Helping - counters unwanted movement of agonist, helps with wanted movement

e.g. bicep brachii does elbow flexion, pronator teres = helping neutraliser, pronator quadratus = true netraliser

Question 5

Classify the wrist joint. Explain articulating surfaces.
Name the carpal bones. Identify ligaments associated with the wrist.

Answer 5

Synovial ellipsoid joint

Allows flex/ext and radial/ ulnar deviation

Articulation of proximal carpal bones with distal radius

Ligaments = dorsal radiocarpal, palmar radiocarpal (intracapsular)

Radial collateral, ulnar collateral (extracapsular)

Proximal carpals = Scaphoid, luante, triquetrum, pisiform
Distal carpals = Trapezium, trapezoid, capitate, hamate

Question 6

Explain the attachments, morphology and actions of Teres minor. Name the nerve supply.

Answer 6

thick, flat, fusiform, rectangular muscle

Origin: Upper 2/3 of lateral border of scapula

Insertion: Inferior facet of greater tubercle of humerus

Actions: External rotation, adduction, extension

Nerve supply: axillary nerve

Question 7

Explain the attachments, morphology and actions of Subscapularis. Name the nerve supply.

Answer 7

Large, triangular shaped muscle located under the scapula

Origin: Medial 2/3 of subscapular fossa

Insertion: Lesser tubercle of humerus, front of shoulder capsule

Actions: Internal rotation, abduction and extension in certain positions

Nerve: Upper/ lower subscapular nerves from brachial plexus

Question 8

Explain the attachments, morphology and actions of Pec Major. Name the nerve supply.

Answer 8

Thick, large superior muscle of chest wall, clavicular and sternocostal fibres.

Origin: medial 1/2 clavicle, manubrium, sternum, upper 6 costal cartilages and aponeurosis of external oblique

Insertion: Lateral lip of intertubercular groove of humerus, crest of greater tubercle of humerus

Action: Flexion of shoulder, adduction, medial rotation, some extension if arm is flexed

Nerve: clavicular fibres = lateral pectoral nerve, sternocostal fibres = medial pectoral nerve

Question 9

What is the root value of Sciatic nerve. Outline the course and and name the muscles supplied by the nerve?

Answer 9

L4,5,S1,2,3,

Supplies hamstrings (apart from short head of biceps femoris), adductor magnus

Derived from lumbosacral plexus to apex of popliteal fossa

Question 10

Name two muscles that flex or extend or side flex or rotate the cervical spine.

Answer 10

Extensors = erector spinae, trapezius, semispinalis cervicis/ capitis, levator scapulae

Flexors = sternocleidomastoid, longus colli/ capitis

Side flexors = sternocleidomastoid, trapezius, scalenes, levator scapulae

Rotators = sternocleidomastoid, semispinalis, splenius

Question 11

Name muscles/ ligaments attaching at greater tubercle, lesser tubercle, corocoid process

Answer 11

Greater tubercle = Teres minor

Lesser tubercle = subscapularis

Corocoid process = Biceps