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Anatomy - Upper Limb Flashcards

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1
Q

Describe the arrangement of tendons palpable medial to the radial pulse

A

FCR, palmaris longus, FDS, FCU (inserting into pisiform), ulnar pulse

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2
Q

Describe the surface anatomy of the cephalic vein

A
  • Origin = within the superficial fascia just posterior to the radial styloid
  • Elbow = lies in the groove along the lateral border of biceps before piercing deep fascia
  • Shoulder = lies in the deltopectoral groove
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3
Q

List the 4 unique features of the clavicle

A
  1. No medullary cavity
  2. First to ossify in the foetus at week 5/6
  3. Develops in a membrane and not cartilage despite being a long bone
  4. Most commonly fracture long bone in the body
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4
Q

Describe the ligament structure connecting the clavicle to the coracoid process

A
  • Conoid ligament = connects conoid tubercle of clavicle to coracoid process
  • Trapezoid ligament = connects trapezoid line of clavicle to coracoid process (lateral to conoid ligament)
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5
Q

List the 3 prominent scapular landmarks

A
  • Spine
  • Acromion
  • Coracoid process
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6
Q

What separates the greater and lesser tubercles of the humerus?

A

Bicipital groove (contains long head of biceps)

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7
Q

What structures lie within the spiral groove of the humerus?

A
  • Radial nerve
  • Profunda vessels
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8
Q

Describe the structure of the distal humerus

A
  • Rounded capitulum laterally for articulation with the radial head
  • Spoon-shaped trochlea medially for articulation with the trochlea notch
  • Medial and lateral epicondyles are extracapsular
  • Anterior conoid fossa accepts coronoid process of ulna
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9
Q

Explain the deforming forces in PROXIMAL radius fractures

A

(If proximal to insertion of pronator teres)
- Proximal fragment = supinated by biceps
- Distal fragment = pronated by pronator teres
(Means the fracture must be splinted in supination so the distal fragment aligns with the proximal fragment)

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10
Q

Describe the arrangement of the carpus

A
  • Proximal row = scaphoid, lunate, triquetral, pisiform
  • Distal row = trapezium, trapezoid, capitate, hamate
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11
Q

What maintains the arch of the carpus?

A
  • Shape of the bones
  • Flexor retinaculum
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12
Q

Describe the articular surfaces of the glenohumeral joint

A
  • Head of humerus
  • Shallow glenoid fossa (deepened by glenoid labrum)
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13
Q

Describe the attachments of the GH joint capsule

A

Around the epiphyseal lines of the glenoid and humeral head. Extends down the diaphysis on the medial aspect of the neck of the humerus.

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14
Q

List the openings in the GH joint capsule

A
  1. Between greater and lesser tubercles for passage of the long head of biceps
  2. Between superior and middle glenohumeral ligament , via which the subscapular bursa communicates with the GH joint cavity
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15
Q

What dictates the stability of the shoulder joint?

A
  • Dynamic stabilisers = rotator cuff, long head of biceps, deltoid, long head of triceps, pec major, lat dorsi, teres major
  • Static stabilisers = GH ligaments, labrum, negative intra-articular pressure
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16
Q

List the ligaments of the glenohumeral joint

A
  • Superior, middle, and inferior GH ligaments
  • Coracohumeral ligament
  • Transverse humeral ligament
  • Coraco-acromial ligament
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17
Q

Describe the process of shoulder ABduction

A
  1. Initiated by supraspinatus followed by deltoid to 90 degrees
  2. 180 degrees is achieved through rotation of the scapula upwards by trapezius and serratus anterior
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18
Q

List the principle abductors of the shoulder

A
  • Supraspinatus
  • Deltoid
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19
Q

List the principle adductors of the shoulder

A
  • Pec major
  • Lat dorsi
  • Subscapularis
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20
Q

List the principle flexors of the shoulder

A
  • Biceps brachii
  • Pec major
  • Coracobrachialis
  • Deltoid (anterior fibres)
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21
Q

List the principle extensors of the shoulder

A
  • Triceps
  • Teres major
  • Lat dorsi
  • Deltoid (posterior fibres)
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22
Q

List the principle ERs of the shoulder

A
  • Infraspinatus
  • Teres minor
  • Deltoid (posterior fibres)
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23
Q

List the principle IRs of the shoulder

A
  • Pec major
  • Lat dorsi
  • Teres major
  • Deltoid (anterior fibres)
  • Subscapularis
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24
Q

What ligaments are involved in the sternoclavicular joints

A
  • Costoclavicular
  • Anterior and posterior sternoclavicular
  • Interclavicular
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25
What ligament supports the superior radio-ulnar joint?
Annular ligament
26
What structures form the articular surfaces of the wrist?
- Proximal = distal radius, articular disc of distal radio-ulnar joint - Distal = scaphoid, lunate, triquetral
27
What type of joint is the wrist joint?
Condyloid synovial joint
28
What is the surface marker of the wrist joint?
Proximal wrist crease
29
What prevents the MCP joints spreading?
Deep transverse ligaments
30
Describe the ligamentous arrangement about the MCP and IP joints
- Posterior = joint capsule is replaced by the expansion of the extensor tendon for that digit - Anterior = capsule is formed by dense plate of fibrocartilage - Lateral = collateral ligaments that are lax in extension and taught in flexion
31
Describe how the long flexors of the digits insert
- FDP inserts into the bases of the four distal phalanges (pierces the FDS tendon) - FDS inserts into the sides of the bases of the four middle phalanges
32
Describe the digits extensor insertion arrangement
Aponeurotic expansion covers the dorsum of the proximal phalanx. This then attaches to the middle phalanx via a central slip and the distal phalanx by two lateral slips. The margins are reinforced by the tendons of the intrinsic muscles of the fingers.
33
What is the axilla?
Zone of transition between the neck and the upper limb. Shaped like an irregular pyramid.
34
Outline the boundaries of the axilla
- Base = skin and fascia - Medial wall = rib cage covered by serratus anterior - Lateral wall = bicipital groove of humerus - Anterior wall = pec major, pec minor, subclavius, clavipectoral fascia - Posterior wall = subscapularis, teres major, latissimus dorsi
35
List the structures that pass through the cervico-axillary opening
- Axillary artery and its branches - Axillary vein - Cords of the brachial plexus - Axillary lymph nodes - Intercostobrachial nerve - Axillary fat
36
Define the cubital fossa
A zone of transition between the arm and the forearm. Situated in front of the elbow joint.
37
Outline the boundaries of the cubital fossa
- Superior = line drawn between medial and lateral epicondyles - Inferomedially = pronator teres - Inferolaterally = brachioradialis - Roof = deep fascia/bicipital aponeurosis - Floor = brachialis muscle
38
List the contents of the cubital fossa from medial to lateral
- Median nerve - Brachial artery - Biceps tendon
39
What are the attachments of the transverse carpal ligament?
- Radial = scaphoid tubercle, trapezium - Ulnar = pisiform, hook of hamate
40
List the contents of the carpal tunnel
- 10 tendons = 4 FDS, 4 FDP, 1 FPL, 1 FCR ( in own compartment) - Median nerve (superficial palmar branch is given off BEFORE entry)
41
Outline the borders of the anatomical snuffbox
- Medial = EPL tendon - Lateral = APL and EPB tendons
42
List the contents of the anatomical snuffbox
- Base of 1st metacarpal - Scaphoid - Trapezium - Radial styloid - Dorsal branch of the radial artery
43
Outline the borders of the quadrangular space
- Medial = long head of biceps - Lateral = humeral shaft - Superior = teres minor - Inferior = teres major
44
What are the contents of the quadrangular space
- Axillary nerve - Posterior circumflex humeral artery
45
Outline the borders of the triangular space
- Inferior = teres major - Lateral = long head of triceps - Superior = inferior border of teres minor
46
What are the contents of the triangular space?
Scapular circumflex artery
47
Outline the borders of the triangular interval
- Superior = teres major - Lateral = lateral head of triceps - Medial = long head of triceps
48
What are the contents of the triangular interval?
- Radial nerve - Profunda brachii
49
Describe the course of the axillary artery
- Commences at the lateral border of the first rib as a continuation of the subclavian artery - Passes posterior to the pectoralis minor which divides it into three sections - Continues as the brachial artery at the lower end of teres major - Is largely covered by pec major
50
Describe the course of the axillary artery
- Commences at the lateral border of the first rib as a continuation of the subclavian artery - Passes posterior to the pectoralis minor which divides it into three sections - Continues as the brachial artery at the lower end of teres major - Is largely covered by pec major
51
List the branches of the axillary artery
- Superior thoracic (1st part) - Thoraco-acromial (2nd part) - Lateral thoracic (2nd part) - Subscapular (3rd part) - Anterior and posterior circumflex humeral (3rd part)
52
Describe the course of the brachial artery
Continuation of the axillary artery at the inferior border of teres major. Ends in the cubital fossa opposite the neck of the radius by dividing into radial and ulnar arteries. Runs superficially lying immediately deep to the deep fascia except where it is crossed at mid-humerus by the median nerve
53
Describe the course of the radial artery
- Commences at the level of the radial neck by lying on biceps tendon - Overlapped by brachioradialis in its upper half - Closely related to the radial nerve mid-radius - Palpable between tendons of brachoradialis and FCRat the wrist - Enters the anatomical snuffbox by passing deep to APL and EPB tendons - Terminates the the deep palmar branch
54
List the branches of the radial artery in the forearm
- Radial recurrent artery - Palmar carpal branch - Dorsal carpal branch
55
Describe the course of the ulnar artery
Larger of the two terminal branches of the brachial artery - Commences opposite the radial neck and passes beneath the muscles from the common flexor origin - Lies on FDP and is crossed by FCU - Median nerve crosses superficially, separated from it by the deep head of pronator teres - Becomes superficial in the distal forearm between FCU and FDS - Crosses flexor retinaculum to form the superficial palmar branch - Accompanied by the ulnar nerve on its medial side in the distal 2/3rd of the forearm
56
How is the brachial plexus divided?
- 5 roots - 3 trunks - 6 divisions - 3 cords - 5 branches
57
What forms the roots of the brachial plexus?
Formed by the anterior rami of C5-T1
58
What forms the trunks of the brachial plexus?
- Upper trunk = C5 and C6 roots - Middle trunk = C7 root alone - Inferior trunk = C8 and T1 roots
59
What forms the divisions of the brachial plexus?
Each trunk divides into anterior and posterior divisions which then unite to form cords
60
What forms the cords of the brachial plexus?
- Lateral cord = formed from the anterior divisions of the upper and middle trunks - Medial cord = formed from the anterior division of the inferior trunk - Posterior cord = formed from all three posterior divisions
61
What forms the main branches of the brachial plexus?
- Lateral cord continues as the musculocutaneous nerve - Medial cord continues as the ulnar nerve - Posterior cord continues as the radial AND axillary nerve - A cross-communication between the lateral and medial cords forms the median nerve
62
What nerves arise directly from the roots
- Nerve to rhomboids - Nerve to subclavius - Long thoracic nerve
63
What nerves arise directly from the trunks?
Suprascapular nerve (from the upper trunk to supply supra and infraspinatus)
64
What nerves arise from the lateral cord of the plexus?
- Musculocutaneous - Lateral pectoral - Lateral root of median nerve
65
What nerves arise from the median cord of the plexus?
- Ulnar nerve - Medial pectoral - Medial cutaneous nerves of the arm and forearm - Medial root fo the median nerve
66
What nerves arise from the posterior cord of the plexus?
- Radial nerve - Axillary nerve - Subscapular - Nerve to latissiumus dorsi (thoracodorsal)
67
Outline the dermatomal distribution of the upper limb
C4 = skin over shoulder tip C5 = radial side of upper arm C6 = radial side of forearm C7 = skin of the hand C8 = ulnar side of forearm T1 = ulnar side of upper arm T2 = skin of axilla
68
Describe the course of the axillary nerve
Arises from the posterior cord of the brachial plexus. Exits the axilla via the quadrangular space (with posterior circumflex humeral vessels) and winds around the surgical neck of the humerus.
69
When is the axillary nerve commonly injured?
- Shoulder dislocation - Fracture of the surgical neck of the humerus - Crutch palsy
70
What is the radial nerve root?
C5-T1
71
Describe the course of the radial nerve
- Arises from the posterior cord of the brachial plexus - Initially lies behind the axillary artery and passes backwards between the long and medial heads of triceps to enter spiral groove - Accompanied by profunda brachii artery in the groove - At the lower end of the humerus it pierces the lateral intermuscular septum to re-enter the anterior compartment between brachialis and brachioradialis - Gives off the PIN at the level of the lateral epicondyle - Radial nerve continues as the superficial radial nerve deep to brachioradialis - Ends by dividing into cutaneous nerves that supply the posterior aspects of the radial 3.5 digits
72
Describe the course of the PIN?
- Branches from the radial nerve at the level of the lateral epicondyle - Pierces the supinator 3cm distal to the radial head to lie on the IO membrane in the extensor compartment
73
What is the distribution of the PIN?
All forearm extensors except ECRL, brachioradialis and triceps
74
List the cutaneous branches of the radial nerve
- Posterior cutaneous nerve of the arm and forearm - Lower lateral cutaneous nerve of the arm
75
Musculocutaneous nerve roots?
C5-7
76
Describe the course of the musculocutaneous nerve
Arises from the lateral cord of the plexus. Pierces coracobrachialis running between biceps and brachialis. Ends as the lateral cutaneous nerve of the forearm.
77
When is the musculocutaneous nerve injured?
Deltopectoral approach to the shoulder. Compressed between coracobrachialis and biceps brachii.
78
Ulnar nerve root
C8, T1
79
Describe the course of the ulnar nerve
- Arises from the medial cord of the plexus - Lies medial to the axillary and brachial artery until mid humerus - Pierces the intermuscular septum to descend on the anterior face of triceps - Passes behind the medial epicondyle to enter the forearm - Descends under FCU - In the distal 2/3rd of the forearm it is accompanied by the ulnar artery that lies on its radial side - 5cm above the wrist the dorsal cutaneous branch passes deep to FCU to supply the dorsal aspects of the ulnar 1.5 digits and ulnar side of the hand - Crosses the flexor retinaculum before dividing into the superficial and deep terminal branches
80
Outline the distribution of the ulnar nerve
- Muscular = FCU, medial half of FDP, hypothenar muscles, interossei, 3rd and 4th lumbricals, and adductor pollicis - Sensory = ulnar side of both aspects of the hand and both surfaces of the ulnar 1.5 fingers
81
Median nerve root
C5-T1
82
Describe the course of the median nerve
- Arises from the unity of the medial and lateral cords of the plexus - Initially lies anterior to the 3rd part of the axillary artery - Continues along lateral aspect of brachial artery - Crosses over the brachial artery at mid-humerus to the medial side - Enters the forearm between the heads of pronator teres and gives off the AIN - Continues deep to FDS - At the wrist, it becomes superficial on the ulnar side of FCR where it gives off the palmar cutaneous branch - Passes through the carpal tunnel where it branches into the recurrent branch to the thenar muscles and the two common palmar digital nerves
83
List the branches of the median nerve and their distribution
- Muscular branches = to pronator teres, palmaris longus, FDS, FCR - AIN = FPL, FDP (medial half), PQ - Palmar cutaneous = proximal aspects of the palm - Two common palmar digital = radial 2 lumbricals, digital nerves to fingers - Recurrent branch = FPB, APB, OP (thenar muscles)
84
List the compartments of the arm and their contents
- Anterior (flexor) = biceps brachii, brachialis, coracobrachialis (all innervated by musculocutaneous nerve) - Posterior (extensor) = triceps, anconeus (innervated by radial nerve)
85
How is the anterior (flexor) compartment of the forearm divided?
- Superficial group = Pronator teres, FCR, PL, FCU, FDS - Deep group = FPL, FDP, PQ
86
How is the posterior (extensor) compartment of the forearm divided?
- Superficial group = brachioradialis, ECRL, ECRB, EDC, EDM, ECU - Deep group = supinator, APL, EPB, EPL, EIP
87
How are the extensor compartments of the wrist divided?
1 = EPB, APL 2 = ECRL, ECRB 3 = EPL 4 = EDC, EIP 5 = EDM 6 = ECU
88
List the thenar muscles
APB, FPB, OP

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