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MBBS - Anatomy > Upper limb > Flashcards

Flashcards in Upper limb Deck (58)
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1
Q

What do the following terminology relate to/mean?

a) Brachialis
b) Ulnaris
c) Carpi
d) Digitorum
e) Pollicis
f) Superficialis
g) Profundus

A

a) Brachialis relates to the structures of the arm
b) Ulnaris relates to the position f the structures in the forearm
c) Carpi relates to the wrist
d) Digitorum relates to the fingers (or digits)
e) Pollicis relates to the thumb (or digits)
f) Superficialis means muscle closer to the surface
g) Profundus means the muscle is deep within the limb

2
Q

Name the bony structures of the shoulder

A
  • Clavicle
  • Acromion process
  • Humerus
  • Glenoid fossa
  • Intertubercular groove - found between the greater and lesser tubercule
  • Posterior aspect of scapula - spine of scapula, medial and lateral border of scapula, inferior angle, superior angle
  • Spine of scapula divides into infraspinous fssa and suprsaspinous fossa
  • Anterior aspect of scapula - subscapular fossa, coracoid process
3
Q

Label the bony structures of the anterior view of the shoulder

A
4
Q

Label the bony structures of the posterior view of the shoulder

A
5
Q

Label the bony structures of the humerus

A
6
Q

Name the muscles of the shoulder girdle

A
  • Trapezius
  • Rhomboids (major and minor)
  • Levator sccapulae
  • Serratus anterior
  • Pectoralis minor
7
Q

Describe the proximal and distal attachment, nerve supply and action of the following shoulder girdle muscles

a) Trapezius
b) Rhomboid (major and minor)
c) Levator scapulae
d) Serratus anterior
e) Pectoralis minor

A

a) Trapezius (Large triangular muscle covering back)

  • Attachment - attaches posteriouly to the external occiptal protuberence (base of skull) and goes on to attach to the lateral 1/3 clavicle, acromial process, lateral 1/3 spine of the scapula (superior aspect)
  • Nerve supply - spinal accessory
  • Actions - lateral rotation of scapula in abduction beyond 90 degrees

b) Rhomboids (minor and major)

  • Attachment - attaches to spinal processes C7-T5 and to medial border of scapula (deep to scapula)
  • Nerve supply - Dorsal scpaula (C4,5)
  • Action - Scapula retraction and medial rotation

c) Levator scapulae - thin muscle

  • Attachment - Attaches to cervicle vertebrae and then to superior angle of scapula
  • Nerve supply- Cervicle nerve (C3,4,5)
  • Action - Scapula elevation

d) Serratus anterior

  • Attachment - Attaches from medial border of scapula to ribs 1-8 in finger-like projections
  • Nerve supply - Long thoracic
  • Action - Scapula protraction and lateral rotation

e) Pectoralis minor - small muscle lying deep to spec. major

  • Attachment - Attaches from 1-4/2-5 to coracoid process of scapula
  • Nerve supply - Medial pectoral
  • Action - Anchors scapula by pulling it against chest wall
8
Q

Label the shoulder girdle muscles

A
9
Q

Name the muscles of the shoulder joint

A
  • Deltoid
  • Pectoralis major (sternal head and clavicular head)
  • Latissimus dorsi
  • Teres major
  • Rotator cuff muscles - supraspinatus, infraspinatos, teres minor, sub-scapularis
  • Coraco-brachialis
  • Triceps brachii and biceps brachii
10
Q

Describe the proximal and distal attachment, nerve supply and action of the following msucles in the shoulder joint:

a) Deltoid
b) Pectoralis major
c) Latissimus dorsi
d) Teres major

A

a) Deltoid - Triangular shape

  • Attachment - Lateral 1/3 clavicle, acromial process, laeral 1/3 spine of scapula to deltoid tubercule on lateral aspect of humerus
  • Nerve supply - Axillary
  • Action - Shoulder abduction 20-90 degrees

b) Pectoralis major

  • Attachment - sternal head (sternum to lateral lip of intertubercular groove) and clavicular head (clavicle to lateral lip of intertubercular groove)
  • Nerve supply - medial and lateral pectoral lnerves
  • Action - Shoulder flexion, medial rotation

c) Latissimus dorsi

  • Attachment - spinous processes, thoracocolumbar fascia of back, iliac crest to floor of intertubecular groove
  • Nerve supply - Thoracodorsal
  • Action - shoulder extension, medial rotation

d) Teres major

  • Attachment - inferior angle of scapula to medial lipof intertubecular groove
  • Nerve suuply - lower subscapular
  • Action - shoulder extension, medial rotation
11
Q

Rotator cuff muscles are part of the muscles in the shoulder joint. Describe the proximal and lateral attachment, nerve supply and action of the rotator cuff muscles

A

1.Supra-spinatus

  • Attachment - supraspinatus fossa to superior aspect of greater tubercule of humerus
  • Nerve supply - Suprascapular
  • Action - initiates shoulder abduction
  1. Infra-spinatus
  • Attachment - infraspinatous fossa to posterior aspect of greater tubercule of humerus
  • Nerve supply - Suprascapular
  • Action - Lateral rotation of shoulder
  1. Teres minor
  • Attachment - inferior border of scapula to posterior aspect of greater tubercule of humerus
  • Nerve supply - Suprascapular
  • Action - lateral rotation of shoulder
  1. Sub-scapularis
  • Attachment - Subscapular fossa to anterior aspect of lesser tubercle of humerus
  • Nerve supply - Upper and lower subscapular
  • Action - medial rotation of shoulder
12
Q

Name the muscles in the arm

A
  • Triceps brachii
  • Biceps brachii
  • Brachialis
  • Anconeus
  • Brachioradialis will fex the eblow in the mid-prone position but is counted in the posterior forearm compartment
13
Q

Describe the proximal and distal attachment, nerve supply and action of the following muscles in the arm:

a) Triceps brachii
b) Biceps brachii
c) Brachialis
d) Anconeus

A

a) Triceps brachii - 3 heads (medial, lateral and long head)

  • Attachment - posterior aspect of humerus (medial and lateral heads), infraglenoid tubercule (scapula) to olecranon process
  • Nerve supply - Radial
  • Action - Elbow flexion

b) Biceps brachii - long head and short head

  • Attachment - supra glenoid tubercule (long head) and coracoid process (short head) to bicipital tubersotiy of radias ulna via aponeurosis
  • Nerve supply - musculocutaneous
  • Action - Elbow flexion, supination of forearm + will also help to prevent superior dislocation of humerus

c) Brachialis

  • Attachment - anterior aspect humerus to coranoid process
  • Nerve cupply - musculocutaneous
  • Action - Elbow flexion

d) Anconeus

  • Attachment - lateral epicondyle of humerus to olecranon process
  • Nerve supply - Radial
  • Action - Abducts ulnar during pronation of forearm but muscle is not important
14
Q

Label the structures of the rotator cuff muscles

A
15
Q

Label the structures of the shoulder joint

A
16
Q

Label the structures in the arm

A
17
Q

Name the bones of the elbow

A
  • Spiral (radial) groove
  • Midal and lateral epicondyles
  • Trochlear (articulate with head of ulna)
  • Capitulum (articulates with head of radius)
  • Coronoid prcess
  • Olecranon process
  • Head of radius
  • Neck of radius
  • Radial notch
  • Bicipital tuberosity
18
Q

Label the bony structures of the elbow

A
19
Q

Name the bones and joint of the wrist and hand

A
  • Radius
  • Ulna
  • (Lister’s) dorsal tubercule
  • Styloid processes
  • Carpal bones: divided into proximal and distal row
  • Distal row - Trapezium (under thumb), trapezoid, capitate, hamate
  • Proximal row - Triquetrium, pisiform
  • Lunate
  • Scaphoid
  • Metacarpals
  • Phalanges
  • Carpo-metacarpal joints- between carpals and metacarpals
  • Metacarpo-phalangeal joints – between metacarpals and phalanges
  • Inter-phalangeal joints

Thumb = inter-phalangeal joint (only 1 inter-phalangeal joint)

Digits 2-5 = proximal inter-phalangeal joint and distal inter-phalangeal joint (2 inter-phalangeal joints)

20
Q

Label the bones of the hand and wrist

A
21
Q

Name the ligaments that hold the acromio-clavicular oint and sterno-clavicular joint and desscribe their role

A
  • Coraco-clavicular ligament - prevents clavicle from lifting away from coracoid process
  • Coraco-acromial ligament - prevents upward dislocation of head of humerus
  • Acromio-clavicular ligament - prvenes acromion process and clavicle from moving apart
22
Q

Describe the role of the subacromial bursa

A

Reduces friction between supraspinatus and acromion process and protects the tendon of supraspinatus

23
Q

Name the muscles in the anterior forearm

A

Superficial muscles

  • Carpi muscles: flexor carpi radialis and flexor carpi ulnaris
  • Palmaris longus
  • Flexor digitorum superficialis
  • Pronator teres

Deep muscles

  • Flexor digitorum profundus
  • Flexor pollicis longus
  • Pronator quadratus
24
Q

Describe the innervation in the antrerior forearm

A
  • Ulnar nerve innervates flexor carpi ulnaris and ulnar half of flexor digitorum profundus
  • Median nerve supplies remaining muscles in anterior forearm (palmaris longus, pronator teres, flexor carpi radialis, flexor digitorum superficialis, median half of flexor digitorum profundus, flexor pollicis longus, pronator quadratus)
25
Q

Describe the attachment, nerve supply and action of the following superficial muscles in the anterior forearm:

a) Carpi muscles: flexor carpi radialis and flexor carpi ulnaris
b) Flexor digitorum longus
c) Palmaris longus
d) Pronator teres

A

a) Carpi mucles: flexor carpi radialis and flexor carpi ulnaris

  • Attachment - common flexor origin (medial epicondyle) to wrist bone
  • Nerve supply - Median (flexor carpi radialis) =and Ulnar (flexor carpi ulnaris)
  • Action - wrist flexion

b) Flexor digitorum superficialis

  • Attachment - common flexor origin (medial epicondyle) to digits
  • Nerve supply - Median
  • Action - MCP and PIP flexion, wrist flexion

c) Palmaris longus - not everyone has this muscle

  • Attachment - common flexor origin to palmar fascia
  • Nerve supply - Median
  • Action - Tenses palmar fascia, wrist flexion

d) Pronator teres

  • Attachment - common flexor origin (medial epicodyle) and coronoid process of radius
  • Nerve supply - Median
  • Action - Pronatin of forearm
26
Q

Describe the attachment, nerve supply and action of the following deep muscles in the anterior forearm:

a) Flexor digitorum profundus
b) Flexor pollicis longus
c) Pronator quadratus

A

a) Flexor digitorum profundus

  • Attachment - Anterior aspect of proximal ulna and radius to digits
  • Nerve supply - Ulnar and median nerve
  • Action - Digits (MCP,PIP and DIP)

b) Flexor pollicis longus

  • Attachment - Anterior aspect of radius to thumb
  • Nerve supply - Median
  • Action - Thumb (1st digit) flexion

c) Pronator quadratus

  • Attachment - Anterior aspect of distal ulna
  • Nerve supply - Median
  • Action - Controls pronation in distal forearm
27
Q

Name the muscles in the posterior forearm

A

Superficial muscles

  • Brachioradialis
  • Extensor carpi radialis longus and extensor carpi radialis brevis
  • Extensor carpi ulnaris
  • Extensor digitorum longus
  • Extensor digiti minimi
  • Anconaneus

Deep muscles

  • Extensor indices
  • Extensor pollicis long and extensor pollicis brevis
  • Abductor pollicis longus
  • Supinator
28
Q

Describe the innervation of the posterior forearm

A

Innervated by the radial nerve

29
Q

Describe the attachment, nerve supply and action of the following superficial muscles in the posterior forearm:

a) Brachioradialis
b) Extensor carpi radialis longus and extensor carpi radialis brevis
c) Extensor carpi ulnaris
d) Extensor digitorum longus
e) Extensor digiti minimi

A

a) Brachioradialis

  • Attachment - lateral supraepicondylar ridge (elbow) to distal radius
  • Nerve supply- Superficial branch of radial
  • Action - Pronates/supnates to mind-prone position + elbow flexion in mid-prone position

b) Extensor carpi radialis longus and extensor carpi radialis brevis (deep)

  • Attachment - common extensor origin (lateral epicondyle) to radius
  • Nerve supply - Superficial branch of radial
  • Action - Wrist extension

c) Extensor carpi ulnaris

  • Attachment - Common extensor origin (lateral epicondyle) to radius
  • Nerve supply - Deep radial
  • Action - Wrist extension

d) Extensor digitorum longus

  • Attachment - Common extensor origin (lateral epicondyle) to digits (dorsal aspects of digits 2-5)
  • Nerve supply - Deep radial
  • Action - Extension of lateral 4 digits

e) Extensor digiti minimi

  • Attachment - Common extensor origin (lateral epicondyle) to dorsal aspect 5th digit (little finger)
  • Nerve supply - Deep radial
  • Action - Extension od 5th digit (little finger)
30
Q

Describe the attachment, nerve supply and action of the following deep muscles in the posterior forearm

a) Extensor indices
b) Extensor pollicis longus and brevis
c) Abductor pollicis longus
d) Supinator

A

a) Extensor indicis

  • Attachment - Posterior aspect of forearm bones and interosseous membrane to dorsal aspect of 2nd digit
  • Nerve supply - Deep radial
  • Action - extension of 2nd digit (index finger)

b) Extensor pollicis longus and brevis

  • Attachment - Posterior aspect of forearm bones and interosseous membrane to dorsalspect of thumb (extensor pollicis longus) and dorsal aspect of1st digis (extensor pollicis brevis)
  • Nerve supply - Deep radial
  • Action - Extension of thumb (1st digit) and wrist

c) Abductor pollicis longus

  • Attachment - Poseterior aspect of forearm bones and interosseous membrane to base of 1st metacarpal aspect (thumb)
  • Nerve supply - deep radial
  • Action - thumb abduction

d) Supinator

  • Attachment - Common extensor origin (lateral epicondyle)
  • Nerve supply - deep brach of radial
  • Action - Supination of forearm
31
Q

Label the muscles in the superficial compartment of the anterior forearm

A
32
Q

Label the muscles in the deep compartment of the anterior arm

A
33
Q

Label the muscles in the superficial compartment of the posterior forearm

A
34
Q

Label the muscles in the deep compartment of the posterior compartment

A
35
Q

Name the intrinsic muscles of the hand

A

Thenar muscles

  • Abductor pollicis brevis
  • Flexor pollicis brevis
  • Opponens pollicis

Hypothenar eminence

  • Flexor digiti minimi brevis
  • Abductor digiti minimi
  • Opponens digiti minimi

Interosseous muscles

  • Palmar interosseous
  • Dorsal interosseous

Adductor pollicis

36
Q

Describe the attachment, nerve supply and action of the following thenar muscles in the intrinsic hand:

a) Abductor pollicis brevis
b) Flexor pollicis brevis
c) Opponens pollicis

A

a) Abductor pollicis brevis

  • Attachment- radial carpal bones and flexor retinaculum
  • Nerve supply - median
  • Action - thumb abduction

b) Flexor pollicis brevis

  • Attachment - radial carpal bones and flexor retinaculum
  • Nerve supply - median
  • Action - thumb flexion

c) Opponens pollicis

  • Attachment - radial carpal bones and fllexor retinaculum
  • Nerve supply - median
  • Action - thumb opposition
37
Q

Describe the attachment, nerve supply and action of the following hypothenar muscles of the intrinsic hand:

a) Flexor digiti minimi brevis
b) Abductor digiti minimi
c) Opponens digiti minimi

A

a) Flexor digiti minimi brevis - lieslaterally to abductor digiti minimi

  • Attachment - Hook of hamate to 5th digit
  • Nerve supply - Ulnar nerve
  • Action - Flexion of 5th digit (little finger)

b) Abductor digiti minimi

  • Attachment - Pisiform to 5th digit
  • Nerve supply - Ulnar nerve
  • Action - Abduction of 5th digit

c) Opponens digiti minimi - deep to other hypothenar muscles

  • Attachment - Hook of hamate to 5th digit
  • Nerve supply- Ulnar nerve
  • Action - Little finger opposition
  • Attachment -
  • Nerve supply -
  • Action -
38
Q

Describe the attachment, nerve supply and action of the lumbricals muscles of the intrinsic hand

A
  • Attachment - Tendons of flexor digitorum superficialisto extensor expansions
  • Nerve supply - lateral two lumbricals (index + middle fingers) innervated by median nerve and median two lumbricals (little + ring fingers) innervated by ulnar nerve
  • Action - normal digital sweep (flexion of MCP and extension of PIP and DIP joints)
39
Q

Describe the attachment, nerve supply and action of the following interosseous muscles of the intrinsic hand

a) Palmar interosseous
b) Dorsal interosseous

A

a) Palmar interosseous

  • Attachment - palmar aspect of metacarpals 2,4,5 to extensor expansions
  • Nerve supply - ulnar
  • Action - abduction of digits 2-5

b) Dorsal interosseous

  • Attachment - dorsal aspect of metacarpals 2,4,5
  • Nerve supply - ulnar
  • Action - abduction of digits 2-5
40
Q

Describe the attachment, nerve supply and action of the adductor pollicis muscle of the intrinsic hand

A
  • Attachment - 2nd and 3rd metacarpals to 1st metacarpal (thumb)
  • Nerve supply - Ulnar
  • Action - Adduction of 1st digit (thumb)
41
Q

Label the thenar muscles of the intrinsic hand

A
42
Q

Label the hypothenar muscles of the intrinsic hand

A
43
Q

Describe the anatomy of the main branches of the brachial plexus

A
  • The nerve routes emerge from the cervical vertebra (C5,C6,C7,C8 and T1)
  • C5 and C6 form the upper trunk
  • C7 continues on its own as the middle trunk
  • C8 and T1 form the lower trunk
  • Anterior divisions of upper and lower trunk form a cord that sits lateral to the artery = lateral cord
  • Anterior division of lower trunk forms the medial cord
  • Posterior divison from each trunk come together and sit behing the artery = posterior cord
  • From the lateral cord we get the musculocutaneous nerve (innervatesuscles in the anterior compartment of the arm) and median nerve (innervates forearm muscles)
  • From the medial cord we get the ulnar nerve (innervates forearm muscles) and median nerve
  • From the posterior cord we get the axillary nerve (scoops round neck and innervates the deloid muscle and teres minor) and radial nerve (passes lateral epicondyleof humerus and innervates posterior aspect of the forearm)
44
Q

Describe the smaller branches of the brachial plexus

A
  • Dorsal scapula nerve comes off C5 and innervates rhomboid and levator scapulae
  • Long thoracic nerve comes off C5,6 and 7 and travels down mid-axillary line to innervate serratus anterior
  • Smaller nerves coming from upper trunk - nerve to subclavius (innervates subclavius) and suprascapular nerve (innervates supraspinatus and infraspinatus)
  • 3 smaller nerve leaving the posterior cord (excluding axillary and radial) - upper subscapular nerve (innervate subscapularis muscle), lower subscapular nerve (innervates subscapularis muscle) and thoracodorsal nerve (innervates latissimus dorsi) - ULTRA
  1. Upper subscapular
  2. Lowersubscapular
  3. Thoracodorsal
  4. Radial
  5. Axillary
  • Smaller nerve leaving the lateral cord - lateral pectoral nerve innervates clavicular head of pectoralis major
  • Smaller nerve leaving the median cord - medial pectoral nerve (innervates sternal head of pectorlis major and pec minor) and medial cutaneous nerve of arm and medial cutaneous nerve of foreram (innervates skin on arm and forearm)
45
Q

Label the innervations of the muscles in the upper limb

A
46
Q

Which cords does the median nerve recieve contribution from? and what shape does it form as it travels into the arm and forearm to innervate the forearm muscles

A
  • Recieves contributions from the lateral and medial cord
  • Forms an M shape
47
Q

Musculocutaneous nerve (C5/C6/C7)

a) What is the motor supply and action?
b) What is the sensory supply?
c) What is the typical mechanism of injury

A

a) Elbow flexion (supplies biceps brachii) and supination
b) Lateral part of the forearm
c) Isolated injury rare - usually injured as part of brachial plexus injury

48
Q

Axillary nerve

a) What is the motor supply and action?
b) What is the sensory supply?
c) What is the typical mechanism of injury?

A

a) Shoulder abduction (deltoid muscle)
b) Inferior region of the deltoid muscle
c) Humeral neck fracture/dislocaction - results in flattened deltoid

49
Q

Radial nerve

a) What is the motor supply and action?
b) What is the sensory supply?
c) What is the typical mechanism of injury?

A

a) Extension (forearm, wrist, fingers, thumb)
b) Small area between the dorsal aspect of the 1st and 2nd metacarpals
c) Humeral midshaft fracture - palsy results in wrist drop

50
Q

Median nerve

a) What is the motor supply?
b) What is the senssory supply?
c) What is the typical mechanism of injury?

A

a) Supplies all the muscles on the front of the forearm except flexor carpi ulnaris and the ulnar half of flexor digitorum profundus and the LOAF muscles in the hand

LOAF muscles

  • Lateral 2 lumbricals
  • Opponens pollicis
  • Abductor pollicis brevis
  • Flexor pollicis brevis

b) Palmar aspect of lateral 3 1/2 fingers
c) Wrist lesion can lead to carpal tunnel syndrome

51
Q

Ulnar nerve

a) What muscles does it innervate and what is the motor action?
b) What is the sensory supply?
c) What is the main mechanism of injury?

A

a) Intrinsic hand muscles excep LOAF

  • Lateral 2 lumbricals
  • Opponens pollicis
  • Abductor pollicis brevis
  • Flecor pollicis brevis

b) Medial 1 1/2 fingers
c) Medial epicondyle fracture (supracondylar fracture) - damage may result in ‘claw hand’

52
Q

Long thoracic nerve

a) What is the motor supply?
b) What is the common mechanism of injury?

A

a) Serratus anterior
b) Often during sport e.g., following a blow to the ribs. Also possible complication of mastectomy.

Damage results in a winged scapula

53
Q

Describe the composition of the vertebral column

A
  • The column is composed of 33 seperate vertebrae, stacked on top of each other, and grouped intofive regions
  • 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebra, 1 sacral vertebra (5 fused to form one single bony structure). The vertebral column finishes at 4 coccygeal vertebrae
54
Q

Label the following features of the vertebrae on the illustration below

A
55
Q

Label the following features of the peripheral nervous system

A
56
Q

Label the following features of the intervertebral disc on the illustration below

A
57
Q

Name the three masses of the erector spinae

A
  • Spinalis
  • Longissimus
  • Iliocostalis
58
Q

Label the three masses of the erector spinae on the illustration below

A