Clinical Anatomy of the Upper Limb

Question 1

What makes up the shoulder girdle?

Answer 1

Clavicle/scapula, sternoclavicular joint, acromioclavicular joint, glenohumeral joint

Question 2

What are the bones of the upper limb?

Answer 2

Shoulder girdle, humerus, elbow joint, radius/ulna, wrist (radio-carpal joint), carpus, MCPs, MCs, IPs

Question 3

What muscle group move the shoulder girdle?

Answer 3

Superficial muscles of the back (e.g trapezius)

Question 4

What is the origin and insertion of trapezius?

Answer 4

Origin = T12 spinous process
Insertion = occiput and scapular spine

Question 5

What innervates trapezius?

Answer 5

Accessory nerve (CN XI)

Question 6

What are the functions of trapezius?

Answer 6

Elevates and depresses scapula

Retracts scapula

Question 7

What are some pathologies that can affects the glenohumeral joint?

Answer 7

OA/RA, dislocation, adhesive capsulitis

Question 8

What is the function of the labrum of the shoulder?

Answer 8

Increases capture of humeral head - increases stability

Question 9

What do the rotator cuff muscles do as a whole?

Answer 9

Stabilise the shoulder girdle and move the arm

Question 10

What are the four rotator cuff muscles?

Answer 10

Supraspinatus, infraspinatus, teres minor, subscapularis

Question 11

What are some features of supraspinatus?

Answer 11

Originates from supraspinous fossa
Innervated by suprascapular nerve (C5/6)
Abducts arm

Question 12

What are some features of infraspinatus?

Answer 12

Originates from infraspinous fossa
Innervated by suprascapular nerve (C5/6)
Externally rotates arm

Question 13

What are some features of teres minor?

Answer 13

Originates from dorsal surface of lateral scapular border
Innervated by axillary nerve
Externally rotates the arm

Question 14

What are some features of subscapularis?

Answer 14

Originates at anterior surface of scapula (scapular fossa)
Innervated by upper and lower subscapular nerves (C5/6)
Internally rotates the arm

Question 15

Where are the insertions of the rotator cuff muscles?

Answer 15

Greater tuberosity of humerus = supraspinatus, infraspinatus and teres minor
Lesser tuberosity of humerus /shoulder capsule = subscapularis

Question 16

What pathology may affects the rotator cuff muscles?

Answer 16

Susceptible to tears and impingement

Question 17

What are the origins of the deltoid muscle?

Answer 17

Clavicle, acromion and scapular spine

Question 18

Where does the deltoid insert, and what action does it perform?

Answer 18

Inserts at deltoid tuberosity on lateral aspect of humerus

Abducts the arm

Question 19

What innervates the deltoid muscle?

Answer 19

Axillary nerve (C5/6)

Question 20

What are the origins and insertion of the biceps brachii?

Answer 20

Origins = coracoid process (short head) and labrum/glenoid (long head)
Insertion = tuberosity of radius

Question 21

What innervates the biceps brachii, and what action does the muscle perform?

Answer 21

Innervated by musculocutaneous nerve (C5/6)

Flexes elbow and supinates forearm

Question 22

What is the biceps brachii susceptible to?

Answer 22

Tendonitis

Question 23

What are some pathologies that affect the elbow joint?

Answer 23

Fracture = radial neck/shaft, supracondylar process (especially children), olecranon
Bursitis = olecranon bursa
OA/RA and dislocation
Ligament tears or strains

Question 24

What ligaments are present at the elbow joint?

Answer 24

Medial collateral, lateral collateral, annular

Question 25

Where is the site of insertion for all the extensor muscles of the forearm?

Answer 25

Lateral epicondyle of humerus

Question 26

What compartment of the forearm is the extensor compartment?

Answer 26

Dorsal compartment

Question 27

Where is the site of insertion for all the flexor muscles of the forearm?

Answer 27

Medial epicondyle of the humerus

Question 28

What compartment of the forearm is the flexor compartment?

Answer 28

Volar compartment

Question 29

What bony features of the forearm are visible in supination?

Answer 29

Radial head, radial shaft, radial tuberosity, interosseous membrane, radial styloid, ulna styloid

Question 30

What bony features of the forearm are visible in pronation?

Answer 30

Olecranon fossa, coranoid process, ulna shaft

Question 31

What pathologies may affect the wrist?

Answer 31

OA/RA, dislocation, fractures (distal radius, scaphoid)

Question 32

What are the to groups of muscles that act on the hand?

Answer 32

``` Intrinsic = located in hand, responsible for fine motor functions of hand Extrinsic = located in anterior and posterior forearm, control finger flexion/extension and wrist movement ```

Question 33

What are the intrinsic muscles of the hand?

Answer 33

Thenar muscles, hypothenar muscles, interossei muscles, lumbrical muscles

Question 34

What muscles make up the thenar muscles?

Answer 34

Opponens pollicis, flexor pollicis brevis, abductor pollicis brevis

Question 35

What function do the thenar muscles have, and what innervates them?

Answer 35

Move the thumb | Innervated by median nerve

Question 36

What muscles make up the hypothenar muscles?

Answer 36

Abductor digiti minimi (main one) and flexor digiti minimi brevis

Question 37

What movements do the interossei muscles carry out?

Answer 37

``` All flex at MCP joints and extend at IP joints Dorsal interossei (x4) = abduct fingers at MCP joints Palmar interossei (x4) = adduct fingers at MCP joints ```

Question 38

What nerve innervates the interossei muscles?

Answer 38

The ulnar nerve

Question 39

How many lumbricals are there?

Answer 39

Four = one for each finger

Question 40

Where do the lumbricals allow movement of?

Answer 40

Crucial for finger movement = link flexor and extensor tendons

Question 41

What is the innervation of the lumbricals?

Answer 41

Median nerve = lateral two | Ulnar nerve = median two

Question 42

What are the extrinsic muscles of the hand?

Answer 42

``` Flexor tendons (flexor digitorum profundus) Flexor pulleys = annular ligaments, cruciate pulleys ```

Question 43

What action does the flexor digitorum profundus perform?

Answer 43

Extensor flexor muscle of the fingers = flexes fingers at DIPs

Question 44

What nerves innervate the flexor digitorum profundus?

Answer 44

``` Anterior interosseous nerve (branch of median nerve - C8,T1) = second and third digits Ulnar nerve (C8,T1) = fourth and fifth digits ```

Question 45

Where does the flexor digitorum profundus pass?

Answer 45

Through carpal tunnel, trained to metacarpals/phalanges by a pulley system

Question 46

What are the two most biochemically important annular ligaments?

Answer 46

A2 and A4 = critical to preventing bowstringing

Question 47

What structures do some of the annular ligaments overlie?

Answer 47

``` A1 = MP joint A3 = PIP joint A5 = DIP joint ```

Question 48

What annular ligament is most commonly involved in trigger finger?

Answer 48

A1

Question 49

What is the function of the cruciate pulleys?

Answer 49

Function to prevent sheath collapse and expansion during digital motion

Question 50

How many cruciate pulleys are there at the level of the joints?

Answer 50

3

Question 51

What is the function of the palmar fascia?

Answer 51

Separates the palmar muscle bellies and flexor tendons from the skin

Question 52

What is the palmar fascia susceptible to?

Answer 52

Hypertrophy and fibrosis (Dupuytren's contracture)

Question 53

What forms the deep and superficial palmar arches in the hand?

Answer 53

The radial and ulnar arteries

Question 54

What does the superficial palmar arch give rise to?

Answer 54

The common digital arteries

Question 55

How are the radial and ulnar digital arteries named?

Answer 55

Named after the side of the digit they are on (not the artery they originate from)

Question 56

What are the three peripheral nerves that supply the hand?

Answer 56

Median, ulnar and radial nerves

Question 57

Where does the muscular aspect of the median nerve supply?

Answer 57

Flexors of forearm and LOAF muscles | Tested at abductor pollicis brevis

Question 58

Where does the median nerve supply cutaneous sensation to?

Answer 58

Radial 3 and a half digits | Tested at tip of index finger and base of thenar muscles

Question 59

Where does the muscular aspect of the ulnar nerve supply?

Answer 59

Small intrinsic muscles of the hand | Tested at abductor digiti minimi

Question 60

Where does the ulnar nerve provide cutaneous sensation to?

Answer 60

Ulnar 1 and a half digits | Tested at dorsum and volar aspects of little finger

Question 61

Where does the muscular part of the radial nerve supply?

Answer 61

Extensors of forearm | Tested at extensor digitorum communis (extensor indicis)

Question 62

Where does the radial nerve supply cutaneous sensation to?

Answer 62

Variable portion dorsum of hand | Tested at dorsum of first webspace

Question 63

What forms the cubital tunnel?

Answer 63

Formed by two heads of flexor carpi ulnaris muscle

Question 64

Where does the ulnar nerve pass?

Answer 64

Posterior to medial epicondyle, then enters cubital tunnel and goes underneath arcuate ligament

Question 65

What causes cubital tunnel syndrome?

Answer 65

Compression of the ulnar nerve

Question 66

Where does the median nerve pass through the carpal tunnel?

Answer 66

At the level of the wrist

Question 67

What are the boundaries of the carpal tunnel?

Answer 67

Carpal bones = dorsal, medial and lateral constraints | Flexor retinaculum/transverse carpal ligament

Question 68

What causes carpal tunnel syndrome?

Answer 68

Compression of the median nerve

Question 69

What forms the brachial plexus?

Answer 69

Ventral rami of C5-8 and T1 nerve roots

Question 70

Where does the brachial plexus pass?

Answer 70

Proceeds through neck, then the axilla and into the arm

Question 71

What does the brachial plexus give rise to?

Answer 71

Peripheral nerves of the entire upper limb

Question 72

What is the order of structures in the brachial plexus?

Answer 72

Roots, trunks, divisions, cords, branches