Unit11: Proximal Upper Limb Flashcards

1
Q

What are the key bones involved in attachment points in the upper arm?

A

Humerus
Scapula

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2
Q

What are the two groups of muscles in the upper arm?

A

Anterior/ventral
posterior/dorsal

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3
Q

What muscles are found in the anterior compartment of the arm?

A

Coracobrachialis
Brachialis
Biceps brachii

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4
Q

What muscles are found in the posterior compartment of the the upper arm?

A

Triceps brachii
Anconeus

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5
Q

What are the features of the biceps brachii?

A

Two heads - short medial and long lateral
Long head - originates from superglenoid tubercule of scapula
Short head - corcoid process of the scapula
Both heads merge distally into a single belly
Inserts onto radial tuberosity and the antebrachial fascia

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6
Q

What are the position features of the brachialis muscle?

A

Originates from distal lateral half of anterior humerus - particularly the medial an dlateral intermuscular septum
Inserts onto ulnar tuberosity and coronoid process

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7
Q

What is the anatomical location of the coracobrachialis muscle?

A

Originates from the coracoid process of the scapula
Inserts along anteromedial surface of humerus

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8
Q

What is the anatomical location of the triceps brachi muscle?

A

Three head
Long - infraglenoid tubercle of the scapula
Medial - posterior surface of humeris (distal to radial groove and medial intramuscular septum)
Lateral head -posterior surface of humerus (proximal to radial groove and latera intermuscular septum)
All tendons merge and insert via a common tendon onto the olecranon process of the ulna.

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9
Q

What is the anatomical location of the anoconeus muscle?

A

Originates from the lateral epicondyle of the humerus
Inserts on the proximal end of the ulnar.

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10
Q

What is the anatomical location of the deltoid muscle?

A

Most superficial in the shoulder
Three subdivisions:
Clavicualr part from lateral third of clavicle
Acromial part - from acromium of scapula
Scapula spine part - orginates from spine of scapula

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11
Q

What muscles are found deep to the deltoid?

A

Rotator cuff muscles (4)
- subscapularis
- infraspinatus
- teres minor
- supraspinatous
Teres major

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12
Q

What are the shared features of the rotator cuff muscles?

A

All have a shared insertion of the proximal end of the humerus
Maintain stability of the shoulder joint by keeping the head of the humerus within the glenoid cavity

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13
Q

What is the anatomical location of the subscapularis muscle?

A

Origin: anterior surface of scapula = the subscapular fossa
Inserts onto the lesser tubercle of the humerus

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14
Q

What is the anatomical location of the infraspinatus muscle?

A

Originates from the infraspinous fossa of the scapula (posterior surface)
Inserts onto the greater tubercule of the humerus

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15
Q

What is the anatomical location of the teres minor?

A

Originates from the infraspinous fossa and lateral border of the scapula
Inserts on the greater tubercle of the humerus

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16
Q

What is the anatomical location of the supraspinatous muscle?

A

Originates from the supraspinous fossa of the scapula
Inserts onto the greater tubercle of the humerus.

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17
Q

What are the four cuff rotator muscles?

A
  1. Subscapularis
  2. Infraspinatus
  3. Teres minor
  4. Supraspinatus

(SITS)

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18
Q

What is the anatomical location of the teres major muscle?

A

Origin of the inferior angle of the scapula
Inserts onto the crest of the lesser tubercule.

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19
Q

What are the three types of rotator cuff injury?

A

Tendinitis - overuse must common in tennis and patients
Bursitis - inflammation of bursae
Strains and tears - from overuse or acute trauma

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20
Q

How can we prevent rotator cuff injury?

A

Shoulder stretches - increase flexibility
Strengthen shoulder blade and posterior shoulder to ensure muscle balance.

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21
Q

What are the two main superficial veins in the arm?

A

The basilic vein
The cephalic vein

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22
Q

Describe the course of the basilic vein.

A

Continuation of the medial side of the dorsal venous arch on the dorsum of the hand
Continues up the medial surface of the posterior forearm until halfway up the forearm, then loops to the anterior surface (medial edge) of the forearm, passes medial through the cubital fossa, continues up the arm.
Pierces the deep fascia and merges with the brachial vein just inferior to teres major then continues as the axillary vein.

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23
Q

Describe the passage of the cephalic vein.

A

Continuous from the lateral end of the dorsal venous arch on the dorsum of the hand
Arches around the radial aspect to ascends up the anterolateral aspect of the forearm, passes over the cubital fossa laterally and ascends laterally to the biceps brachii muscle then travels in the deltopectoral groove, peircing the clavicopectoral fascia to drain into the axillary vein.

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24
Q

What is the median cubitubal vein?

A

Begins a few centimers inferior to the bend of the elbow in the cephalic vein
Travels in a superiomedial direction to act as a venous connection between the cephalic and basilic veins.

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25
Q

What is the medial antebrachial vein?

A

Drain palmar plexus venous plexus
Rains medially up the dorsal surface of the arm. Connects the basilic and cephalic vein by two possible ways.
1. drains into median cubital vein
2. Branches directly into the cephalic or basilic vein.

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26
Q

In what situation may the medial cubital vein be absent?

A

When the median antebrachial vein runs up the forearm and splits into the median basilic vein and the medial cephalic vein to join the basilic and cephalic vein respsctivly rather than indirectly br draining into the medial cubital vein.

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27
Q

What are the key features of the deep veins of the arms?

A

Sutiated underneath the deep fascia
Are paired veins found on either side of the artery.

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28
Q

What does it mean if a vein is described as vena comitantes and why is this important?

A

Paired veins that exist on either side of the artery.
Pulses from the artery aid venous return.

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29
Q

What connects the deep and superficial veins of the upper limb?

A

Perforating veins

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30
Q

What are the deep veins of the arm?

A

The brachial vein
The radial vein
The ulnar vein

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31
Q

What is the action of the supraspinatous muscle?

A

Abduction of the humerus - up to 15 degrees

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32
Q

What is the action of the infraspinatous muscle?

A

Lateral rotation of the humerus

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33
Q

What is the function of teres minor?

A

Lateral rotation of the humerus

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34
Q

What is the function of the subscapularis muscle?

A

Medial rotation of the humerus

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35
Q

What is the innervation of tje supraspinatous and infraspinatous muscle?

A

Suprascapular nerve C5-C6

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36
Q

What is the innervation of teres minor?

A

Axillary nerve C5-C6

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37
Q

What is the innervation of subscapularis muscle?

A

Upper and lower subscapularis nerve C5-7.

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38
Q

What is the function of the different parts of the trapezius muscle?

A

Descending part - elevate the scapula
Transverse part - retract the scapula
Ascending part - depress the scapula

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39
Q

What muscles depress the scapula?

A

Pectoralis minor
Serratus anterior
Trapezius (ascending part)

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40
Q

What muscles elevate the scapula?

A

Levator scapulae
Trapezius

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41
Q

What is the function of serratus anterior?

A

Protraction of the scapula

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42
Q

What muscles aid in the retraction of the scapula?

A

Trapezius (transverse part)
Rhomboid major
Rhomboid minor

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43
Q

What innervates serratus anterior?

A

The long thoracic nerve C5-7

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44
Q

What innervates the trapezius muscle?

A

The accessory nerve

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45
Q

What innervates the rhomboid major and minor muscles?

A

The dorsal scapula nerve C4-5

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46
Q

What innervates levator scapulae?

A

Anterior rami of third and fourth cervical nerves, dorsal scapular nerve C5.

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47
Q

What innervates the pectoralis minor muscle?

A

The medial and lateral pectoral nerves (C5-T1)

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48
Q

What is a good reference point if the scapula is in a downward or upward rotation of the scapula?

A

The glenoid fossa - if looking upwards in in upward rotation

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49
Q

What muscles aid the upwards rotation of the scapula?

A

Trapezius (descending, transverse and ascending part)
Serratus anterior

50
Q

What muscles aid in downwards rotation of the scapula?

A

Levator scapulae
Rhomboid major
Rhomboid minor
Pectoralis minor

51
Q

What is the function of pectoralis major in relation to the shoulder joint?

A

Internal rotation of the humerus
Adduction of the humerus

52
Q

What is the function of the deltoid muscle?

A

Flexion of the shoulder
Abduction of the humerus
Extension of the shoulder
(think of the three different fibre directions)

53
Q

What is the function of teres major?

A

Internal rotation
Adduction of humerus

54
Q

What is the function of the latissimus dorsi?

A

Internal rotation of the humerus
Adduction of humerus
Extension of shoulder

55
Q

What innervates the deltoid muscle?

A

The axillary nerve

56
Q

What innervates pectoralis major?

A

Medial and lateral pectoral nerves (C5-T1)

57
Q

What innervates latissimus dorsi muscle?

A

Thoracodorsal nerve (C6-8)

58
Q

What innervates teres major?

A

Lower subscapular nerve (C5-7)

59
Q

What is the function of biceps brachii?

A

supinates forearm, flexes forearm at elbow
By both the short head and the long head

60
Q

What innervates the biceps brachii muscle?

A

The musculocutaneous nerve (C5-6)

61
Q

What is the action of coracobrachialis?

A

Adducts and flexes arm at glenohumerual joint

62
Q

What nerve innervates coracobrachialis?

A

Musculcuntaneous nerve C5-6

63
Q

What is the action of the brachialis muscle?

A

Flexes forearm at the elbow

64
Q

What innervates the brachialis muscle?

A

Musculocutaneous nerve C5-6
Ulnar nerve C7

65
Q

Describe the reasoning behind the functional difference of the biceps brachii and brachialis muscle as flexors at the elbow.

A

Brachialis - main flexor at the elbow, due to attachment on ulnar, ulnar does not rotate during supination or pronation so insertion is always in correct position to contract and cause flexion

Biceps brachii - only flex the arm greatly when in supination, because in pronation the insertion point on the radius is not in the correct position to flex the arm due to the radius rotating.

66
Q

What is the innervation of triceps brachii?

A

Radial nerve

67
Q

What is the function of the triceps brachii?

A

All head extend the forearm ar the elbow joint

68
Q

What bony features should you be able to identify on the scapulae?

A

The spine
The acromium
The glenoid fossa
The coracoid process
Infraglenoid tubercule
Supraglenoid tubercule

69
Q

What is the bicipital aponeurosis?

A

Inserts on the radial bone
However forms an aponeurosis which attaches to the ulnar.

70
Q

What are the key bony features of the clavicle?

A

The lateral surface - rounded for articular with the acromion
The medial surface - flat and wide for articulation with the manubrium of the sternum and first costal cartilage.
Conoid tubercule

71
Q

What are the different borders of the scapula?

A

Superior border
Lateral border
Medial border
Linked by an inferior angle and a superior angle

72
Q

Describe the bony attachments at the elbow with the humerus

A

The coronoid fossa - coronoid process of the ulnar
Radial fossa - with the radius bone
Olecranon fossa - olecranon of the ulnar bone, prevents over extension of the elbow.

73
Q

What makes up the pectoral girdle?

A

The clavicle, scapula, humerus.

74
Q

What is clinically important to remember about the glenohumeral joint and dislocation?

A

GHJ is extremely mobile but not very stable
Dislocation is relatively common
Anteroinferior dislocation is the most common
Once it has been dislocated once a repeated dislocation is more common

75
Q

What are some consequences of anterior dislocation of the glenohumeral joint dislocation?

A

Can tear the glenoid labrum and lead to compression of the axillary nerve with the humeral head
Lengthening of humerus can also stretch the axillary nerve causing radial paralysis.

76
Q

What treatment can be given to prevent a repeat anterior glenohumeral joint dislocation?

A

Capsule can be tightened and the labrum stabilised arthorscopically
Coracoid process is severed and transferred to the anterior inferior border of the glenoid

77
Q

Name the muscle

A

Subscapularis

78
Q

Name the muscle

A

Infraspinatous muscle

79
Q

Name the muscle

A

Supraspinatous muscle

80
Q

Name the muscle

A

Teres minor

81
Q

Name the muscle

A

Transverse part of trapezius

82
Q

Name the muscle

A

Descending part of trapezius

83
Q

Name the muscle

A

Ascending part of trapezius

84
Q

Name the muscle

A

Rhomboid major

85
Q

Name the muscle

A

Rhomboid minor

86
Q

Name the muscle

A

Levator scapulae

87
Q

Name the muscle

A

Seratus anterior

88
Q

Name the muscle

A

Pectoralis minor

89
Q

Name the muscle

A

Pectoralis major

90
Q

Name the muscle

A

Deltoid muscle

91
Q

Name the muscle

A

Teres major

92
Q

Name the muscle

A

Latissimus dorsi

93
Q

Name the muscle

A

Short head of biceps brachii

94
Q

Name the muscle

A

Long head of biceps brachii

95
Q

Name the muscle

A

Coracobrachialis

96
Q

Name the muscle

A

Brachialis

97
Q

Name the muscle

A

Medial head of triceps brachii

98
Q

Name the muscle

A

Long head of triceps brachii

99
Q

Name the muscle

A

Lateral head of triceps brachii

100
Q

What are the features of the clavicle

A
101
Q

What are the features of the clavicle?

A
102
Q

What makes up the borders of the scapula?
Green

A
103
Q

What are the key bony features of the scapula? Purple

A
104
Q

What are the yellow features of the scapula?

A
105
Q

What are the green labels?

A

Superior border
Superior angle
Medial border
Inferior angle
Lateral border

106
Q

What are the blue labels?

A

Infraglenoid tubercule
Glenoid cavity
Coracoid process
Acromion
Articular surface for clavicle
Subscapular fossa

107
Q

Label the image

A

Spinous process
Acromion
Superior angle
Supraglenoid fossa
Coracoid process
Glenoid cavity
Infraglenoid tubercule
Lateral border
Inferior angle

108
Q

What are the blue labels?

A

Head
Anatomical neck
Surgical neck

109
Q

What are the red labels?

A

Lateral lip, floor and medial lip of inter tubercule sulcus
Deltoid tuberosity
Coracobrachialis

110
Q

What are the yellow labels?

A

Superior facet on greater tubercule
Greater tubercule
Inter tubercular sulcus
Lesser tubercle
Inter tubercular sulcus

111
Q

What are the blue labels?

A

Anatomical neck
Surgical neck

112
Q

What are the green labels?

A

Greater tubercule
Superior, middle and inferior facet

113
Q

What are the yellow labels.

A

Lateral supraepicondylar ridge
Lateral epicondyle
Medial epicondyle
Medial supraepicondylar ridge

114
Q

What are the green labels?

A

Radial fossa
Condyle - capitulum and trochlea
Coronoid fossa

115
Q

What are the labels?

A

Olecranon fossa
Trochlea

116
Q

What ligament is this?

A

Acromoclavicular

117
Q

What ligament is this?

A

Trapezoid ligament

118
Q

What ligament is this?

A

Conoid ligament

119
Q

What ligament is this?

A

Fibrous layer of joint capsule of glenohumeral joint

120
Q

What ligament is this?

A

Coracohumeral ligament

121
Q

What ligament is this?

A

Glenoid labrum

122
Q

What ligaments play an important role in supporting the should joint?

A

Trapezoid
Conoid
Coracohumeral
Acromioclavicular
Glenoid labum
Joint capsule of Glenoid humeral joint