BLK 1- Upper Limb Flashcards
(144 cards)
1
Q
The upper limb is characterized by
A
its mobility and ability to grasp, strike, and conduct fine motor skills
2
Q
Mobility/Stability of Shoulder Joint
A
High mobility, high instability
3
Q
Stability relies on
A
static, dynamic, and architecture
4
Q
what creates static stability
A
Ligaments, joint capsule, and labrum
5
Q
What creates dynamic stability
A
Skeletal muscles
6
Q
What is the Scapulohumeral rhythm
A
2:1- Glenohumeral : Scapulothoracic Movement
7
Q
What do you know about the Clavicle (shape, articulations, and function)
A
- āSā shaped tubular bone
- Articulates with the acromion laterally and the sternum medially
- rigid attachment for muscles
- often fractured in falls onto the shoulder
8
Q
What are the Clavicle Landmarks?
A
-impression for the costoclavicular ligament
-conoid tubercle
-trapezoid line
-subclavian groove
9
Q
What attaches to the impression for the costoclavicular ligament?
A
costoclavicular ligament
10
Q
What attaches to the conoid tubercle?
A
The conoid portion of the coracoclavicular ligament
11
Q
What attaches to the trapezoid line
A
the trapezoid portion of coracoclavicular ligament
12
Q
What attaches to the subclavian groove?
A
insertion of the subclavius muscle
13
Q
What muscles originate from the clavicle?
A
Deltoid, pectoralis major, sternocleidomastoid, sternohyoid
14
Q
What muscles insert on the clavicle?
A
trapezius and subclavius
15
Q
What do you know about the scapula?
A
-Flattened triangular bone
-anterior is concave
16
Q
Posterior Scapula spine separates what?
A
Supraspinous fossa and Infraspinous fossa
17
Q
What originates on the supraspinous fossa?
A
supraspinatus muscle
18
Q
Other landmarks on the posterior scapula?
A
- the spine terminates into the Acromion
- suprascapular notch
-Spinoglenoid foramen
19
Q
What attaches and inserts on the acromion
A
Origin for posterior deltoid muscle
Insertion site for the trapezius muscle
20
Q
Landmarks on the anterior scapula?
A
Coracoid process and suprascapular notch
21
Q
What are the origin and insertion from the coracoid process?
A
-Origin: short head of the biceps brachii and coracobrachialis muscles
- insertion for the pectoralis minor
22
Q
Landmarks on the lateral scapula?
A
glenoid fossa
23
Q
What do you know about the glenoid fossa?
A
-shallow, concave, smaller than the head of the humerus
-two bony projections: supraglenoid tubercle, infraglenoid tubercle
24
Q
What do you know about the humerus?
A
-long bone (longest in the upper limb)
25
What do you know about the head of the humerus?
-faces superiorly at 135 degrees
- faces slightly posteriorly
-covered in hyaline cartilage
26
What do you know about the Anatomic Neck of the humerus?
- close to the attachment of the joint capsule
- fractures have a poor prognosis, blood supply is often disrupted, avascular necrosis
27
What do you know about the surgical neck of the humerus?
- inferior to the greater/lesser tubercles
- fractures are more common and have a better prognosis
28
What do you know about the greater tubercle?
-most lateral projection of the shoulder (outermost part)
- Insertion site for 3/4 rotator cuff muscles
---------- supraspinatus, infraspinatus, teres minor
29
What do you know about the lesser tubercle?
-lies medial to the intertubercular groove
- insertion site for subscapularis muscle
30
What do you know about the intertubercular groove?
-between the two tubercles
-long head of biceps runs through the groove
- latissimus dorsi inserts into the floor of the groove
-pectoralis major inserts just lateral and teres major just medial to the groove
31
What do you know about the deltoid tuberosity and radial groove?
-mid-shaft of the lateral humerus
-insertion site for the deltoid muscle
32
What do you know about the sternoclavicular joint (SCJ)?
-diarthrodial (synovial) joint
- only direct joint connection of the upper extremity to the trunk
- medial clavicle articulates with the sternum
- saddle joint
33
What do you know about the anterior and posterior sternoclavicular ligaments?
-posterior is the strongest portion
- reinforced with the sternocleidomastoid tendon
- both prevent superior displacement as well as anterior and posterior displacement
34
Other Sternoclavicular Joint Ligaments
- Interclavicular: strengthens the capsule superiorly, limits superior displacement
-Costoclavicular: anchors the clavicle to the first rib, opposes pull of the sternocleidomastoid
35
clinical relevance of the Sternoclavicular joint?
- Responsible for 30 degrees of shoulder elevation
- posterior dislocation is emergent because of the potential to impinge vessels and nerves, or compression to the trachea and esophagus `
36
What do you know about the Acromioclavicular Joint (ACJ)?
- Diathrodial Synovial Joint
- Lateral end of the clavicle articulates with the medial aspect of the acromion
- covered with fibrocartilage
37
Capsuloliamentous structures of the ACJ
-Acromioclavicular is enclosed in a weak joint capsule
-major stability comes from superior and inferior AC ligaments
38
Two portions of the coraclavicular ligament?
Conoid, trapezoid (most lateral)
39
What is a ACJ Separation?
-common sports injury
-the result of a fall on the top of the shoulder
40
What do you know about the Scapulothoracic Articulation?
-the concave anterior surface of the scapula glides over the anterior surface of the ribcage
-rotation: contributes to 60/180 degrees of elevation, 2:1 scapulohumeral rhythm
41
What do you know about the Glenohumeral Joint (GHJ)?
- thought of as the shoulder joint
- the fossa is deepened by the glenoid labrum
- humerus can be 2-3x's as large as the glenoid
42
What are the static stabilizers of the glenohumeral joint?
- glenoid labrum
-joint capsule
-glenohumeral ligaments
- coracohumeral ligament
43
What do you know about the Glenoid Labrum?
-made of fibrocartilage
- superior and anterior portions have loose attachments, inferior has a firm attachment
- main function: increase stability, dubbles the depth to act as a bumper
-vascularity is limited, does not heal well on its own
44
What do you know about the Glenohumeral Joint Capsule?
- surrounds GHJ
- origin: glenoid rim
-insertion: anatomic neck of the humerus
45
3 Glenohumeral Joint Ligaments
1) superior
2) middle
3) inferior
- anterior
- posterior
- axillary pouch
46
What do you know about the Superior Glenohumeral Joint Ligament?
- Primary restraint to ER in the abducted to slight abducted position
- primary restraint to inferior translation
-secondary restraint to posterior translation
- Origin: upper pole of glenoid and bas of coracoid
- Insertion: superior to the lesser tubercle
47
What do you know about the Middle Glenohumeral Ligament?
- Prevents anterior translation @ 45 degrees abduction
- secondary restraint of ER at 90 degrees
- Origin: glenoid inferior to SGHL
- Insertion: anterior aspect of anatomic neck of the humerus
48
What do you know about the Inferior Glenohumeral Ligament?
-Contains 3 parts: Anterior/Posterior/ Axillary Pouch
- Primary Restraint to IR
- Origin: glenoid inferior to MGHL
- Insertion: inferior aspect of anatomic neck
49
What do you know about the coracohumeral ligament
- extraarticular ligament (outside of joint)
- primary restraint to inferior translation in the abducted position
- Origin: base of the coracoid process
- Insertion: superior to the greater tuberocity with an attachment to the capsule
50
What do you know about the Coracoacromial Ligament?
-"Roof" of the shoulder joint
- Origin: superior lateral coracoid process
- inserts: acromion, just anterior to ACJ
- Counters the pull of the pectoralis minor and coracobrachialis
- Primary role is to limit superior humeral translation
51
What do you know about bursae?
- fluid filled sacs
- between tendon and bone
- decreases friction of tendon on bone or skin on bone
- Two most important:
----- subscapular, subacromial
52
What is the primary muscle of the pectoral region?
the pectoralis major muscle
53
What is the origin and insertion of the pectoralis major?
Origin: clavicular head arises from the clavicle and the sternocostal head arises from the anterior surface of the sternum and the superior six costal cartilages
insertion: later to the intertubercular groove
54
What is the action of the pectoralis major
- horizontal adduction of humerus
-internal rotation of humerus
- Alone: clavicular end: helps flex the humerus
sternocostal head: helps extend the humerus from a flexed position; and horizontal adduction
55
What nerves innervate the pectoralis major?
Clavicular Head: lateral pectoral nerve (c5,C6,C7)
Sternocostal Head: medial pectoral nerve (C8,T1)
56
What is the blood supply for pectoralis major?
-Thoracoacromial artery (pectoral branch)
-lateral thoracic artery
57
Origin and Insertion of Pectoralis Minor?
Origin: 3rd, 4th, and 5th ribs
Insertion: coracoid process
58
What nerve innervates the pectoralis minor?
medial pectoral nerve (C8,T1)
59
What is the action of the pectoralis minor?
pulls the shoulder girdle anteriorly and inferiorly
60
What is the blood supply of the pectoralis minor?
-Thoracoacromial artery (pectoral branch)
-lateral thoracic artery
61
What is the origin and insertion of the serratus anterior?
Overlies lateral aspect of thorax, saw tooth appearance
- Origin: external surface of lateral parts of ribs 1-8
- Insertion: anterior surface of medial border of scapula
62
what is the innervation of the serratus anterior?
long thoracic nerve (c5,c6,c7)
63
what is the action of the serratus anterior?
protracts the scapula, stabilizes against thoracic wall and rotates the scapula so the glenoid faces superior
64
what is the blood supply for the serratus anterior?
Lateral thoracic artery
65
What are the three sections of the trapezius?
- Upper (descending)
- Middle (transverse)
- Lower (ascending)
66
What is the origin/insertion/innervation of the upper trapezius?
origin: external occipital protuberance, nuchal line and ligament
- insertion: posterior aspect of the lateral 1/3 of the clavicle
- innervation: spinal accessory never (CN XI), C3 and C4 nerve root
67
What is the origin/insertion/innervation of the middle trapezius?
- origin: ligamentum nuchae
- insertion: medial aspect of the acromion
- innervation: spinal accessory never (CN XI), C3 and C4 nerve root
68
What is the origin/insertion/innervation of the middle trapezius?
- origin: all 12 thoracic vertebrae
- insertion: spine of the scapula
- innervation: spinal accessory never (CN XI), C3 and C4 nerve root
69
What is the action of the Trapezius?
Descending: elevation of the scapula, rotation upward of the scapula
Transverse: retraction of the scapula
Ascending: depression of the scapula, upward rotation of the scapula
70
What is the blood flow to the trapezius?
transverse cervical artery
71
What is the Origin and Insertion of the latissimus dorsi?
- Origin: spinous processes of inferior 6 thoracic vertbrae, thoracolumbar fascia
- insertion: floor of the intertubercular groove
72
What is the action of the Latissimus Dorsi?
adduction, extension, internal rotation of humerus (movement of freestyle swim)
73
What is the innervation and blood supply of the latissimus dorsi?
Innervation: thoracodorsal nerve (C6,C7,C8)
blood supply: thoracodorsal artery
74
What is the origin and insertion of the levator scapulae?
origin: transverse processes of the upper 4 cervical vertebrae
insertion: superior angle of the scapula & superior portion of the medial border
75
what is the action of the levator scapulae?
elevation and rotation of the scapula, tilts glenoid interiorly
76
What is the innervation and blood supply of the levator scapulae?
innervation: dorsal scapular nerve, and cervical nerves
blood supply: dorsal scapular artery
77
What is the origin and insertion of the rhomboid major?
origin: spinous processses of the 2-5th thoracic vertebrae
insertion: inferior aspect of the medial border of the scapula
78
what is the action of the levator scapulae?
retract and stabilize scapula, inferior rotation of scapula
79
what is the innervation and blood supply of the rhomboid major?
innervation: dorsal scapular nerve
blood supply: dorsal scapular artery
80
what is the origin and insertion of the rhomboid minor?
origin: lower part of the ligamentum nuchae and spinous processes of C7 and T1
insertion: superior to the rhomboid major on the medial border of the scapula
81
What is the action of the rhomboid minor?
retract and stabilize scapula, inferior rotation of the scapula
82
what is the innervation and blood supply of the rhomboid minor?
innervation; dorsal scapular nerve
blood supply: dorsal scapular artery
83
3 parts of the deltoid muscle?
- Anterior, lateral, posterior
84
What is the origin and insertion of the anterior deltoid?
-origin: lateral 1/3 of the clavicle
-insertion: deltoid tubercle of the humerus
85
What is the action of the anterior deltoid?
forward flexion and internal rotation of humerus
86
What is the innervation and blood flow of the anterior deltoid?
-innervation: axillary nerve
- blood flow: anterior humeral circumflex artery , thoracoacromial artery: deltoid branch, acromial branch
87
what is the origin and insertion of the posterior deltoid muscle?
- origin: spine of the scapula
- insertion: deltoid tubercle of the humerus
88
What is the action of the posterior deltoid muscle?
extension and external rotation of the humerus
89
What is the innervation and blood flow of the posterior deltoid muscle?
Innervation: axillary nerve
blood flow: posterior humeral circumflex artery
90
What is the origin and insertion of the teres major?
Origin: posterior surface of inferior angle of the scapula
insertion: just medial to the intertubercular groove
91
What is the action of the teres major?
adduction, extension and internal rotation of the humerus
92
What is the innervation and blood supply of the teres major?
-innervation: lower subscapular nerve
blood supply: subscapular and post humeral circumflex
93
What is the origin and insertion of the supraspinatus?
origin: supraspinous fossa
insertion: superior facet of greater tubercle
94
what is the action fo the supraspinatus:
initiiates the first 5-15 degrees of abduction of the humerus
95
what is the innervation and blood supply for the supraspinatus?
innervation: suprascapular nerve
blood supply: supracapular artery
96
What is the origin and insertion of the infraspinatus?
origin: infraspinus fossa
insertion: middle facet of greater tubercle
97
What is the origin and insertion of the infraspinatus?
origin: infraspinus fossa
insertion: middle facet of the greater tubercle
98
what is the action of the infraspinatus?
external rotation of the humerus
99
what is the innervation and blood supply of the infraspinatus?
innervation: suprascapular nerve (C5, C6)
blood supply: supra scapular artery
100
what is the origin and insertion of the teres minor?
-origin: middle 1/2 of lateral border of the scapula
insertion: inferior facet of greater tubercle
101
what is sthe action of the teres minor?
external rotation
102
what is the innervation and blood supply of the teres minor?
Innervation: axillary nerve
blood supply: circumflex scapular and posterior humeral circumflex arteries
103
What is the origin and insertion of the subscapularis?
origin: subscapular fossa
insertion: lesser tubercle of the humerus
104
what is the action of the subscapularis?
internal rotation of the humerus
105
what is the innervation and blood supply of the subscapularis?
-innervation: upper and lower subscapular nerves
- blood supply: subscapular artery
106
What are the walls of the axillia
apex: cervico-axillary canal
base: skin, subcutaneous tissue, and deep fascia
anterior wall: pectoralis minor and major and clavicle fascia
posterior wall: scapula and subscapularis muscle, post axillary fold
107
blood supply to the upper limb:
right subclavian artery, left subclavian artery, subclavian artery
108
Subclavian Artery gives rise to:
- vertebral artery
- thyrocervical trunk
- internal thoracic trunk
- dorsal scapular artery
109
Once the subclavian artery passes the first rib it becomes:
the axillary artery
110
The axillary artery has how many parts
3 parts
111
what do you know about the first part of the axillary artery?
it has one branch, gives off the superior thoracic artery
112
what do you know about the second part of the axillary artery?
it has two branches, lateral thoracic artery and thoracoacromial artery ( clavicular branch, acromial branch, deltoid branch, pectoral branch)
113
what do you know about the third part of the axillary artery?
lateral pectoralis minor to lower border of teres major muscle, three branches,
- subscapular artery (circumflex scapular, thoracodorsal artery)
- anterior circumflex humeral artery
- posterior circumflex humeral artery
114
What is scapular anastomosis?
- a collection of arteries that join in a region to ensure an area has blood flow
- suprascapular artery with its infraspinous branch, circumflex scapular artery, dorsal scapular artery
115
What is the brachial plexus?
a network of nerves that supply the upper limb, C5-T1, broken down into (roots, trunk, divisions, cords, and branches)
116
What are the roots of the brachial plexus?
C5,C6, C7, C8, T1
117
What nerves originate off of the roots of the brachial plexus?
- Dorsal Scapular Nerve off of C5
- Long thoracic nerve off of C5,C6,C7
118
What are the trunks of the Brachial Plexus?
-superior trunk c5 and c6 roots
-middle trunk c7 root
-inferior trunk c8 and t1
119
What branches come off of the superior trunk?
- nerve to suclavius
- suprascapular nerve
120
What are the two divisions of the brachial plexus that lead to the threecords?
- anterior divisions of the superior and middle trunks form the lateral cord
- anterior division of the inferior trunk continues as the medial cord
- posterior divisions of all three trunks for the posterior cord
121
What are the terminal branches?
- musculocutaneous nerve
- axillary nerve
- radial nerve
- medial nerve
- ulnar nerve
122
What do you know about the Musculocutaneous nerve?
terminal branch of the lateral cord, pierces the coracobrachialis
- continues as the lateral antebrachial cutaneous nerve
- innervates the muscles of the ante compartment of the arm (coracobrachialis, biceps brachii, and brachialis) and the skin of the lateral aspect of the forearm
123
What do you know about the median nerve?
-terminates from the combination of the lateral and medial cords
- travels with the brachial artery
- gives off branch called anterior interosseous nerve
- innervates all flexor muscles in the forearm escept the flexor carpi ulnaris and the ulnar half of the flexor digitorum profundus, five intrinsic muscles in the thenar portion of the hand, and lateral palmar skin
124
What do you know about the ulnar nerve?
- terminal branch from the medial cord
- runs down the medial aspect of the arm posterior to the medial epicondyle and through the ulnar groove of the humerus
- innervates flexor carpi ulnaris and the ulnar half of the flexor digitorum profundus
125
What do you know about the axillary nerve?
- smaller terminal branch of the posterior cord
- travels posteriorly with the posterior circumflex humeral artery through the quadrangular space
-innervates deltoid, teres minor and glenohumeral joint
126
what do you know about the radial nerve?
-longest terminal nerve of the posterior cord
- innervates the triceps muscle
- runs deep to the triangular interval
127
Where does the lateral pectoral nerve originate?
the lateral cord
128
where does the upper subscapular nerve originate?
posterior cord
129
where does the thoracodorsal nerve originate?
the posterior cord
130
where does the lower subscapular nerve originate?
the posterior cord
131
where does the medial pectoral nerve originate
the medial cord
132
where does the medial brachial cutaneous nerve originate?
the medial cord
133
where does the medial antebrachial cutaneous nerve originate?
the medial cord
134
What do you know about the lateral pectoral nerve?
- lateral cord, innervates the pectoralis major muscles (clavicular head)
135
What do you know about the medial pectoral nerve
- branch of the medial cord, innervates the pecoralis minor and continues to innervate the inferior part of pectoralis major
136
What do you know about the medial cutaneous nerve
- branch of the medial cords, supplies the skin of the arm
137
What do you know about the medial antebrachial nerve
- branch of the medial cord, supplies skin over the medial side of the forearm
138
What do you know about the suprascapular nerve
branches from the posterior cord, innervates the superior portion of the subscapularis
139
What do you know about the lower subscapular nerve?
-branches from posterior cord, innervates inferior portion of subscapularis and teres major
140
What do you know about the thoracodorsal subscapular nerve
- branch of the posterior cord , innervates latissimus dorsi
141
What do you know about the quadrangular space
area of the posterior shoulder
- borders: lateral- surgical neck of the humerus, medial- long head of triceps, superior- teres minor, inferior teres major
- circumflex humeral artery and axillary nerve occupy the space
142
What do you know about the triangular space
-area of the posterior shoulder
- borders: lateral- long head of triceps. superior- teres minor, inferior- teres major
- circumflex scapular artery passes under the area
143
What do you know about the triangular interval
- area of posterior shoulder
- borders: medial- long head of triceps, lateral- humerus, superior- teres major
- profunda brachii artery and radial nerve lie in this interval
144
What do you know about the triangle of auscultation?
- near inferior angle of the scapula
- gap in the musculature: latissimus dorsi, trapezius, scapula
- 6/7 ribs and 6th rib space are relatively exposed
