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C&M Upper limb- movement Flashcards

1
Q

Origin, insertion and function of superior fibres of trapezius

A

Origin: external occipital protuberance, superior nuchal line, ligamentum nuchae & spinous process of C7
Insertion: lateral 1/3 of clavicle and acromion process
Function: Elevate scapula

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2
Q

Origin, insertion and function of middle fibres of trapezius

A

Origin: T1-T5 spinous processes
Insertion: superior border of spine of scapula (lateral 2/3)
Function: Retract scapula

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3
Q

Origin, insertion and function of inferior fibres of trapezius

A

Origin: T6-T12 spinous processes
Insertion: medial 1/3 of spine of the scapula
Function: Depress scapula

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4
Q

Innervation of trapezius

A

Accessory cranial nerve 11

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5
Q

Origin, insertion and function of levator scapulae

A

Origin: Transverse processes C1-C4
Insertion: medial border of scapula superior to root of spine
Function: elevate scapula and rotates scapula medially (downwards).

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6
Q

Origin, insertion and function of rhomboid major

A

Origin: spinous processes T2-T5
Insertion: medial border of scapula inferior to level of spine
Function: retract the scapula medially and superiorly. Used in squaring the shoulders

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7
Q

Origin, insertion and function of rhomboid minor

A

Origin: spinous processes of C7-T1
Insertion: medial border of scapula at the level of the spine
Function: retract the scapula medially and superiorly. Used in squaring the shoulders

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8
Q

Innervation of deep dorsal muscles (LS, RMa, Rmi)

A

Dorsal scapular nerve (C5)

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9
Q

Origin, insertion, function and innervation of serratus anterior

A

Origin: Ribs 1-9
Insertion: Medial border of scapula
Function: Protract scapula, rotate scapula laterally
Innervation: Long thoracic nerve (C5-C7)

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10
Q

Causes of winged scapula (medial border and inferior angle of scapula pull away from posterior thoracic wall)

A

Long thoracic nerve damage (superficial)
Penetrating injuries when arm abducted e.g. knife wound
Accidentally e.g. insertion of chest drain, during breast surgery (iatrogenic)
Neuritis (inflammation of the nerve)

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11
Q

How is the stability of the glenohumeral joint improved

A

Glenoid labrum- ring of cartilage
Ligaments
Biceps tendon
Rotator cuff muscles

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12
Q

Where is the glenohumeral joint weakest (therefore more likely to dislocate in this direction)

A

inferiorly

95% of shoulder (glenohumeral joint) dislocations occur in an anteroinferior direction

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13
Q

What structures prevent superior displacement of the humerus in the glenohumeral joint

A

Coracoacromial arch: Made up of the acromion, coracoid process + coracoacromial ligament

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14
Q

What is painful arc syndrome

A

Calcific Bursitis
Caused by inflammation e.g. after excessive use of glenohumeral joint
Pain during 50-130 degrees of shoulder abduction

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15
Q

Rotator cuff muscles

A

Supraspinatus
Infraspinatus
Teres Minor
Subscapularis

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16
Q

What is the only muscle that can initiate arm abduction

A

Supraspinatus

Abducts from 0-15 degrees then deltoid takes over

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17
Q

Origin, insertion, function and innervation of supraspinatus

A

Origin: Supraspinous fossa
Insertion: Greater tubercle
Function: Initiates abduction of arm (first 15°) and Stabilises glenohumeral joint
Innervation: Suprascapular nerve

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18
Q

Origin, insertion, function and innervation of infraspinatus

A

Origin: Infraspinous fossa
Insertion: Greater tubercle
Function: Lateral rotator of humerus and stabilises glenohumeral joint
Innervation: Suprascapular nerve

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19
Q

Origin, insertion, function and innervation of teres minor

A

Origin: Middle part of lateral border of scapula
Insertion: Greater tubercle
Function: Laterally rotates and adducts humerus (with infraspinatus) and Stabilises glenohumeral joint
Innervation: Axillary nerve

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20
Q

Origin, insertion, function and innervation of subscapularis

A

Origin: subscapular fossa
Insertion: Lesser tubercle
Function: Medial rotator and adductor of humerus and stabilises glenohumeral joint
Innervation: Upper and Lower sub scapular nerves (C5-C6)

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21
Q

Origin, insertion, function and innervation of teres major

A

Origin: inferior angle of scapula
Insertion: Medial lip of intertubercular of humerus
Function: Adducts and medially rotates humerus
Innervation: Lower subscapular nerve (C5 – C6)

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22
Q

Which muscle is most likely to be torn in a rotator cuff injury

A

Supraspinatus
Symptoms- pain when arm is overhead and weakness
Test - abduct arm fully, lower arm slowly with control. At about 90°, arm will fall suddenly to side.

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23
Q

What is the most common cause of glenohumeral dislocation

A

excessive extension and lateral rotation of humerus

usually in young adults

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24
Q

Which nerve can be damage in shoulder dislocation

A

Axillary nerve - passes inferior to the humeral head and winds round the surgical neck of the humerus.
Leads to deltoid atrophy + regimental badge anaesthesia

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25
Nerve roots of Musculocutaneous nerve
C5-C7
26
Nerve roots of Median nerve
C6-T1
27
Nerve roots of ulnar nerve
C7-T1
28
Nerve roots of axillary nerve
C5-C6
29
Nerve roots of radial nerve
C5-T1
30
Boundaries of the quadrangular space
Superior: Teres minor Inferior: Teres major Medial: Long head of triceps brachii Lateral: Surgical neck of the humerus
31
Contents of the quadrangular space
Axillary nerve | Posterior circumflex humeral artery and vein
32
Quandrangular space syndrome- Transient blockage of the posterior humeral circumflex artery and axillary nerve
Typically occurs when the arm lies in a position of abduction, extension, and external rotation Patients note shoulder pain and paraesthesia down the arm Often associated with fibrotic bands in quadrangular space Uncommon condition that mostly affects athletes who perform overhead movements e.g. tennis
33
When does limb development occur
Mid to late embryonic phase: 4 to 8 weeks
34
Origin of limb buds
Buds consist of a core of tissue = lateral plate mesoderm Mesoderm core differentiates into mesenchyme = bones and connective tissue of the limbs Skeletal muscle of the limbs = paraxial mesoderm/somites
35
Somite Differentiation
Ventral part= sclerotome = vertebral column | Dorsolateral part = dermamyotome = dermis + skeletal muscles
36
Myotome differentiation
Dorsal epimere = back muscles which are innervated by the dorsal rami of spinal nerves Ventral hypomere = muscles of thoracic and abdominal walls and muscles of limbs which are innervated by the ventral rami of spinal nerves
37
What does the posterior condensation of the hypomere become
Extensors and supinators of the upper limbs | Extensors and abductors of lower limb
38
What does the anterior condensation of the hypomere become
Flexors and pronators of the upper limbs | Flexors and adductors of the lower limb
39
When does limb rotation occur
6-8 weeks
40
What direction do upper limbs rotate
90° laterally so flexors lie anteriorly
41
What direction do lower limbs rotate
90° medially so flexors lie posteriorly
42
What are the 3 axes that limb development occurs along
1. Craniocaudal- the thumb is most cranial digit and the little finger is most caudal 2. Proximodistal- from the shoulder/hip to the hand/foot 3. Dorsoventral-
43
How is proximodistal growth controlled
By growth factors secreted by the Apical ectodermal ridge (AER)
44
How is the AER formed
The lateral plate mesoderm forming the mesenchymal core of the limb bud secretes a fibroblast growth factor Fgf 10 This induces thickening of the overlying ectoderm along the tip of the limb bud - the AER
45
What FGFs does the AER express
Fgf 4 and 8 Causes rapid proliferation of mesenchymal cells underlying the AER – the progress zone (this maintains proximodistal growth).
46
What does inserting FGF soaked beads into embryos cause
Supernumerary limb growth
47
How is dorsoventral growth controlled
Dorsal ectoderm express Wnt7 Ventral ectoderm expresses Engrailed-1 Engrailed 1 inhibits Wnt7
48
How is craniocaudal growth controlled
Zone of Polarising Activity (ZPA) - small region of mesenchyme in the caudal part of the limb bud Where sonic hedgehog (Shh) gene is expressed
49
Which direction does Shh diffuse to
from ZPA in a cranial direction
50
What does Shh do
High concentration of Shh induces formation of caudal structures e.g. little finger Low concentration induces formation of cranial structures e.g. thumb.
51
What happens when you transplant the ZPA so that there are 2 on a limb
Mirror image polydactyly of the limb
52
What is amelia
Complete absence of a Limb | e.g. early loss of Fgf signalling
53
What is phocomelia
Digits develop prematurely. Proximal elements of limb absent aka flipper limb. Can be due to genetic factors or teratogen e.g. Thalidomide inhibits Fgf 10 and 8 expression
54
What is meromelia
Partial absence of a Limb | e.g. later or partial loss of Fgf signalling
55
What direction do most dislocations of the elbow occur in
Posterior dislocation- The distal end of humerus is driven through the weak anterior part of the joint capsule
56
What nerve can be affected in elbow dislocations and what are the symptoms
Ulnar nerve injury | Numbness of medial part of palm and medial 1.5 fingers and weakness of flexion and adduction of the wrist
57
What are the 3 flexors of the elbow joint
Brachialis- main flexor Biceps Brachii Brachioradialis- accessory flexor of elbow joint when forearm is mid-pronated
58
The origins of triceps brachii
Long head - Infraglenoid tubercle (scapula) Lateral head - Posterolateral humerus above spiral groove Medial head - Posteromedial humerus below spiral groove
59
Insertion of triceps brachii
Olecranon process
60
Innervation of triceps brachii
Radial nerve (C5-T1)
61
What is the function of the annular ligament of the radius
Maintains stability of radius | Allows rotation of the radius during pronation and supination of the forearm.
62
Why is the radius more prone to subluxation/dislocation in childhood
Annular ligament relatively weak
63
What nerve controls pronation
Median nerve | Pronator teres and pronator quadratus contract
64
What nerves control supination
Radial and musculocutaneous nerves | Supinator and biceps brachii contract
65
What is Golfers elbow
Inflammation at insertion of wrist flexor tendons into the medial epicondyle
66
What is Tennis elbow
Inflammation at insertion of the wrist extensor tendons into the lateral epicondyle
67
What nerve can be damaged when the medial epicondyle is avulsed
Ulnar nerve
68
What nerve can be damaged when the surgical neck of the humerus is fractured
Axillary nerve
69
What nerve can be damaged when the shaft of the humerus is fractured
Radial nerve in the radial groove
70
What structures can be damaged when the supracondylar humerus is fractured
Median nerve- supplies flexors of the forearm | Brachial artery - stopping all blood flow past elbow, can lead to necrosis of forearm and possibly amputation
71
Which tendon does not pass through the carpal tunnel and goes straight to the flexor retinaculum
Flexor Carpi Radialis
72
Which structures lie above the flexor retinaculum
Ulnar nerve + Ulnar artery (in Guyons canal) | Palmaris Longus tendon
73
Which nerve supplies most of the intrinsic hand muscles
Ulnar nerve | EXCEPT thenar muscles and 1st and 2nd lumbricals – median nerve
74
Which branch of the median nerve supplies the thenar muscles
Recurrent branch
75
Which branch of the median nerve is given off before it enters the carpal tunnel
Palmar cutaneous branch- supplies lateral side of palmar skin
76
What do the digital branches of the median nerve supply
1st and 2nd lumbricals Palmer - lateral 3 ½ digits Dorsal - distal half of lateral 3 ½ digits
77
What is the action of the lumbricals
Flexion at metacarpophalangeal joint and extension at interphalangeal joint "bye-bye" muscles
78
Symptoms of carpal tunnel syndrome
Wasting of thenar eminence because recurrent branch of median nerve is affected Pins and needles in the cutaneous distribution of digital branches of median nerve e.g. tip of fingers etc
79
What nerve can be damaged in lunate dislocation
Median nerve (FOOSH) Lunate displaced anteriorly Similar symptoms to carpal tunnel syndrome
80
What does the palmar branch of the ulnar nerve supply
Medial palmar skin
81
What does the dorsal branch of the ulnar nerve supply
Lateral side of dorsum and lateral 1 ½ digits
82
What does the superficial branch of the ulnar nerve supply
Palmer surface of lateral 1 ½ digits | Palmaris brevis
83
What does the deep branch of the ulnar nerve supply
Hypothenar muscles, adductor pollicis, palmar and dorsal interossei and 4th + 5th lumbricals.
84
What symptoms does ulnar nerve compression/handlebar neuropathy cause
Sensory loss palmer surface of lateral 1 ½ digits Motor weakness in the intrinsic muscle of the hand (except thenar eminence and lateral 2 lumbricals) Hyperextension of metacarpophalangeal joints of digits 4 and 5 (extension is unopposed due to paralysis of lumbricals) = clawhand
85
What is the most common bone fractured in the wrist
Scaphoid | Causes tenderness in the anatomical snuffbox
86
Why can avascular necrosis occur after a scaphoid fracture
Blood enters the scaphoid distally, therefore, in the event of a fracture, blood supply to the proximal part may be disrupted
87
What is Colles fracture
Fracture of the distal end of the radius Most common in old people/ women due to osteoporosis Usually the result of FOOSH Often the ulnar styloid process is avulsed Dinnerfork deformity
88
How do the vertebral arteries become to basilar artery
Vertebral artery branches of subclavian artery Travel upwards through transverse foramina C6-C1 Passes through foramen magnum Unite to form basilar artery
89
What is subclavian steal syndrome
Occlusion of the subclavian artery proximal to the vertebral artery origin (atherosclerosis) causing reversed flow in the ipsilateral vertebral artery Blood is 'stolen' from the circular vertebrobasilar system to supply the distal territory of the occluded or stenosed artery
90
What arteries given off by the axillary artery are at risk of rupture when the surgical neck of the humerus is fracture
Anterior and posterior circumflex humeral arteries
91
Where does the axillary artery become the brachial artery
Inferior border of teres major
92
What are the 3 main branches given off the brachial artery
Profunda brachii artery Superior ulnar collateral artery Inferior ulnar collateral artery
93
Where does the brachial artery divide into the radial and ulnar arteries
Cubital fossa
94
What does the profunda brachii artery supply and where does it run
Posterior muscle compartment of the arm- triceps | Radial groove alongside the radial nerve- can be damaged in fracture of shaft of humerus
95
What are peri-articular anastamoses
Network of anastomoses of brachial and profunda brachii arteries in the arm with radial and ulnar arteries in the forearm. Ensures blood flow to the forearm even if elbow is fully flexed.
96
What are the arteries involved in the peri-articular anastamoses
Profunda brachii gives off radial collateral artery which anastamoses with radial recurrent artery Superior and inferior Ulnar collateral arteries anastamose with Anterior and posterior ulnar recurrent arteries
97
What does the radial artery supply
Supplies the anterolateral aspect of the forearm including flexors and extensors
98
What does the ulnar artery supply
Supplies the medial side of forearm – mainly flexors and pronators Gives off common interosseous artery which gives off anterior and posterior interosseous arteries which supply the middle of the flexor and extensor compartments respectively.
99
What does the cephalic vein drain and where does it run
Drains lateral side of dorsal venous arch Runs lateral side of arm into deltopectoral triangle and pierces clavipectoral fascia Drains into axillary artery
100
What does the basilic vein drain and where does it run
Drains medial side of dorsal arch and median cubital vein Runs medial side of arm Joins with deep arm veins/venae comitantes to form axillary vein

Medicine (7 decks)

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