Upper Limbs Flashcards
How many types of synovial joints are there? What are they?
1) ball and socket
2) hinge
3) pivot
4) plane
5) saddle
6) condyloid
How many types of synovial joints are there in the shoulder joints? What are they?
1) ball and socket
2) plane
3) saddle
What are the upper limbs designed for?
mobility and manipulation (completion of a task)
The upper limb is divided into…..
shoulder, arm, forearm, and hand regions
The arrangement of joints and increased range of motion of the upper limbs allow for what?
bilateral coordination of crude and fine motor skills
How are fine motor skills achieved?
directly through the hand and fingers, but range of motion and strength at the more proximal joints are necessary for proper positioning of the hand
more mobility = ________ stability
less
more mobility = less stability
What is another name for shoulder?
pectoral girdle
How is the upper limb attached to the rest of the body (proximally and posteriorly)?
proximally, the shoulder is compromising the manubrium of the sternum, the clavicles, and the scapulae, which forms an incomplete bony ring that connects the upper limb to the axial skeleton
posteriorly, the bony ring is supported by muscular attachments between the scapula and vertebral column
Where do you have the most dexterity?
fingers
What are the palpable points for the scapula?
Posteriorly, the medial and inferior borders of the scapula can be palpated as well as the spine (T3 level), superior angle (T2 level), and inferior angle (T7 level)
Following the spine out laterally to the point of the shoulder- here it becomes the acromion
The articulation between the distal clavicle and acromion (acromioclavicular joint) can be palpated anteriorly and the coracoid process just inferomedial to the acromioclavicular joint
What are the 2 axillary folds? What are they made up of? What do they provide?
The anterior axillary fold is made up of the lateral border of the pectoralis major muscle, while the posterior axillary fold is made up of the lateral borders of latissimus dorsi and teres major muscles
These folds provide anterior and posterior boundaries for the axilla
What are the proximal humeral bony landmarks?
the greater tubercle found just inferolateral to the acromion
What are the medial humeral bony landmarks?
the intertubercular groove can be palpated and the lesser tubercle most medially
the long head of the biceps brachii tendon lies in the
intertubercular groove
What are the distal humeral bony landmarks?
the medial and lateral epicondyles are easily palpated and serve as common tendon attachment sites for the forearm flexors and extensors, respectively
At the elbow, what process is easily palpable?
the olecranon process is easily palpable posteriorly
How can the radial head be found?
passive or active pronation/supination, the radial head can be located just distal to the lateral epicondyle
What is another name for anterior elbow?
cubital fossa
What is easily palpable or seen at the anterior elbow (cubital fossa)?
the biceps brachii tendon can be palpated easily with active elbow flexion
the brachial artery pulse can be found just medial to the biceps tendon
superficially, the median cubital vein may be visible through the skin (site for venus puncture)
What can you find in your wrist region/ be able to palpate?
both ulnar and radial styloid processes can be palpated with abduction and adduction of the hand, respectively
the radial artery pulse is found just lateral to the flexor carpi radialis tendon and the wrist
on the dorsum of the hand, the anatomical snuff box boundaries can be easily visualized with active thumb abduction and extension
the scaphoid bone and radial styloid process can be palpated within this space
In the hand, the thenar and hypothenar eminences represent the underlying intrinsic thumb and fifth digit (pinky) muscles, respectively
What are the boundaries and carpal bones of the snuffbox?
The floor of the snuffbox is made up of the scaphoid and trapezium carpal bones, which are located between the radial styloid process proximally and the base of the 1st metacarpal distally
Which carpal bone breaks the easiest?
the scaphoid bone
What does a fossa on bone mean?
depression
Bones of the upper limb (proximal to distal) include:
the clavicle, scapula, humerus, radius, ulna, carpal bones, metacarpals, and phalanges
What is the clavicle? Talk about its general location
an S-shaped bone that acts as a strut to connect the upper limb to the axial skeleton
medially, the clavicle is convex anteriorly and articulates with the manubrium (sternal end)
laterally, the clavicle is concave anteriorly and flattens to articulate with the acromion process (acromial end)
What are the scapular borders and angles? Where can you seen them best?
a triangular bone characterized by medial, lateral, and superior borders and superior and inferior angles
scapular structures are often best appreciated from lateral, posterior, and anterior views
What can you find in the lateral view of the scapula?
the glenoid fossa serves as the shallow socket portion of the glenohumeral (shoulder) joint, which articulates with the head of the humerus laterally
supraglenoid and infraglenoid tubercles are located superior and inferior to the fossa
What can you find in the lateral view of the scapula?
the glenoid fossa serves as the SHALLOW socket portion of the glenohumeral (shoulder) joint, which articulates with the head of the humerus laterally
supraglenoid and infraglenoid tubercles are located superior and inferior to the fossa
What can you find in the posterior view of the scapula?
the scapula is unevenly divided posteriorly into supraspinous and infraspinous fossae by a ridge of bone called the spine of the scapula
the spine extends laterally and ends at the acromion process (point of the shoulder)
What can you find in the anterior view of the scapula?
the scapula has a concave anterior surface called the subscapular fossa
arising from the neck of the scapula of the anterior superior surface is the beak-like coracoid process
the suprascapular notch lies medial to the root of the coracoid process
What is another name for arm or brachium?
humerous
What is the largest bone of the upper limb?
humerous
What type of bone is the humerous?
long bone
What humeral structures can you see proximally?
a round head (ball portion of the shoulder joint) that is covered with articular cartilage
the anatomical neck lies between the head and greater/lesser tubercles—two bony prominences that serve as muscle attachment sites
the greater tubercle is positioned more superolaterally, whereas the lesser is more inferomedially
the intertubercular groove (sulcus; bicipital groove) lies between the tubercles
extending inferiorly from the greater and lesser tubercle are the lateral and medial lips of the intertubercular groove
the surgical neck is found just distal to the tubercles
What are the characteristics of the humeral shaft?
primarily smooth, except for a small midshaft deltoid tubercle laterally and a spiral (radial) line posteriorly
What humeral structures can you see distally?
a spool-shaped medial condyle (trochlea) and a rounded lateral condyle (capitulum) that articulate with the ulna and radius
superior to the condyles are the medial and lateral epicondyles
the coronoid and radial fossae are located between the epicondyles anteriorly and the olecranon fossa posteriorly
What is the difference between the anatomical neck and surgical neck on the humerus bone?
the anatomical neck is where the humeral shaft attaches to the epiphysis, whereas the surgical neck is an area on the humeral shaft that is more likely to fracture
What are the bones of the forearm?
the ulna medially and the radius laterally
these bones articulate proximally at the elbow with the humerus and distally at the wrist with the carpal bones
they are connected along their length by an interosseous membrane
What is another name for the forearm?
antebrachium
Describe the ulnar features
characterized proximally by a large trochlear notch framed anteriorly by the coronoid process and posteriorly by the olecranon process, a shallow radial notch, and a raised ulnar tuberosity
the trochlear notch articulates with the trochlea of the humerus, while the radial notch articulates with the head of the radius
distally, the ulna tapers into a head and styloid process
Describe the radial features
characterized proximally by a head, neck, and raised radial tuberosity
the head articulates with the capitulum of the humerus
distally, the radius expands and possesses a styloid process
How many carpal bones are there?
8 bones, 2 rows (4 in each)
T/F:
the proximal row of the carpal bones articulate with the ulna
FALSE
What are the bony structures of the hand?
carpal and metacarpal bones make up the bony structure of the hand (palm and dorsum)
What are the bony structures of the fingers (digits)?
phalanges form digits 1-5
How are carpal bones arranged?
into proximal and distal rows
Bones of the proximal row contribute to which joint? Be specific
the wrist (radiocarpal) joint
What can you find in the proximal row of the carpal bones?
from lateral to medial (radial to ulnar), the proximal row consists of the scaphoid, lunate, triquetrum, and pisiform.
Is the radius medial or lateral?
lateral
Is the ulna medial or lateral?
medial
What are the 3 bones that articulate with the wrist joint?
scaphoid, lunate, and triquetrum (there’s also pisiform in the proximal row of carpal bones but it does not reach the distal radius)
What can you find in the distal row of the carpal bones?
consists of the trapezium, trapezoid, capitate, and hamate
What does the distal row of carpal bones articulate with?
the bases of the five metacarpal bones
What are the bony characteristics of the metacarpals?
metacarpals have a proximal base, middle shaft, and distal head
What does the metacarpals head articulate with?
the base of the proximal phalanges
What are the bony characteristics of the phalanges and where are they found?
proximal, middle, and distal phalanges are found in digits two through five, while the first digit (thumb or pollex) only has a proximal and distal phalanx
What are the types of synovial joints you DON’T see in the carpals?
ball and socket joint + pivot joint
Joints of the upper limb include….
all joints of the shoulder complex, elbow (humeroradial and humeroulnar), forearm (proximal and distal radioulnar), and hand (wrist, intercarpal, CMC, MCP, and IP)
What supports the upper limb joints and permit a wide range of movement?
a series of ligaments and capsular structures
Shoulder complex joints include:
1) glenohumeral
2) acromioclavicular
3) sternoclavicular
What type of synovial joint is the glenohumeral joint? Where does it sit?
ball and socket between the head of the humerus and shallow glenoid fossa
What is the glenohumeral joint supported by?
a joint capsule, glenohumeral and coracohumeral ligaments, and rotator cuff muscles
the joint is deepened by fibrocartilaginous glenoid labrum
What is the glenohumeral joint movement like? What makes it vulnerable to injury?
permits flexion, extension, abduction, adduction, medial rotation, lateral rotation, and circumduction
its wide range of motion makes it vulnerable to injury
What type of synovial joint is the acromioclavicular joint? Where does it sit?
plane joint between the acromion and the acromial end of the clavicle
What is the acromioclavicular joint supported by?
a joint capsule, directly by the acromioclavicular ligament and indirectly by the coracoclavicular ligament (conoid and trapezoid portions)
What is the acromioclavicular joint movement like?
permits rotation of the acromion on the clavicle during scapular movement
What type of synovial joint is the sternoclavicular joint? Where does it sit?
saddle joint (functionally ball and socket) between the manubrium and the sternal end of the clavicle
What is the sternoclavicular joint supported by?
a joint capsule and anterior/posterior sternoclavicular, interclavicular, and costoclavicular ligaments
has an articular disc
What is the sternoclavicular joint movement like?
permits clavicular elevation, depression, and anterior/posterior movement during humeral movement
MIDTERM MATERIAL:
What does the coracohumeral ligament prevent?
upward displacement of humeral head
What type of synovial joint is the elbow joint and what is it supported by?
hinge-shaped joint, supported by a fibrous capsule
What does the elbow joint movement permit? What is this movement supplied by?
allows for flexion and extension movements
supplies by anastomoses around joint (from brachial, profunda brachii, radial and ulnar arteries) and median, radial, and ulnar nerves
The elbow joint is made up of 2 joints. What are they called?
1) humeroradial
2) humeroulnar
What does the humeroradial joint articulate?
between the capitulum and radial head
What is the humeroradial joint supported by?
radial collateral and annular ligaments (also supports proximal radioulnar joint by maintaining position of radial head in radial notch of ulna)
What does the humeroulnar joint articulate?
between the trochlea and trochlear notch
What is the humeroulnar joint supported by?
the ulnar collateral ligament (anterior, posterior, and oblique bands)
What type of synovial joint does the forearm have? What does this allow in terms of movement? How is it supported?
pivot-type joint allows for pronation and supination
supported by a fibrous capsule and ligaments
What are the 2 forearm joints?
proximal radioulnar and distal radioulnar
What does the proximal radioulnar joint articulate? What is its movement?
between the radial head and radial notch of the ulna
allows for rotation of the head in the notch
What is the proximal radioulnar joint supported by and supplied by?
the annular ligament
supplied by elbow anastomoses and musculocutaneous, median, and radial nerves
Which forearm joint is more stable? Which one has more mobility?
proximal radioulnar - more stable
distal radioulnar - more mobility
What does the distal radioulnar joint articulate? What is its movement?
between the ulnar head and ulnar notch of the radius with an articular disc
the ulna is relatively fixed, allowing the radius to move during pronation/supination
What is the distal radioulnar joint supported by and supplied by?
weak anterior and posterior ligaments and the interosseous membrane
supplied by anterior and posterior interosseous arteries and nerves
Where does pronation and supination occur?
at the proximal and distal radioulnar joints
How does pronation/supination work- how is it supported?
supported by annular ligament
the the distal radioulnar joint, the distal radius is parallel to the ulna in the supinated position and crosses anterior and medial to the ulna in the pronated position
the palm of the hand faces anterior when the forearm is supinated and posteriorly when the forearm is pronated
The wrist and hand are made up of a collection of small synovial joints that permit fine movement at the wrist and fingers, including…..
flexion, extension, abduction, adduction, and opposition (1st/5th digits only)
What are the wrist and hand joints supplied by collectively?
by the carpal arterial arches and associated digital branches and radial, median, and ulnar nerves
The wrist holds the radiocarpal joint. What does it articulate?
between the radius and proximal row of carpal bones (minus pisiform)
the ulna does not contribute to this joint, which is supported by radial and ulnar collateral ligaments of the wrist and radiocarpal ligaments (palmar and dorsal)
The hand is a collection of what joints? How are they supported?
intercarpal, CMC, MCP, and IP joints
supported by fibrous capsules and ligaments
Where is the potential site for nerve compression in the hand?
pisohamate ligament creates an osseofibrous tunnel (Guyon’s canal) through which the deep branch of the ulnar nerve travels
Deep to the skin of the upper limb lies a________ ______ that contains varying amounts of loose connective and adipose tissues
superficial fascia
Deep to the skin of the upper limb lies a superficial fascia that contains varying amounts of loose connective and adipose tissues
What travels in the superficial fascia?
superficial veins, lymphatic vessels, and cutaneous nerves, which is continuous with the superficial fascia of the neck and trunk