Exam 5 - Upper Limb Part 1 - Oz First 100 slides Flashcards
(149 cards)
1
Q
Functions of the upper limb
Designed for?
A
Designed for extensive motion
- Manipulative appendage
- Operate devices
- Frequently injured because of its functions
2
Q
proximal segment of the limb that overlaps thorax and back of the trunk, plus lower lateral neck
A
Shoulder:
3
Q
first segment of the free upper limb
A
Arm:
4
Q
elbow to wrist
A
Forearm:
5
Q
composed of wrist, palm, dorsum of hand, and fingers
A
Hand:
6
Q
Pectoral girdles AKA
A
shoulder girdles
attach the bones of the upper limbs to the axial skeleton (the pectoral girdle is a component of the appendicular skeleton)
7
Q
Pectoral girdles (AKA shoulder girdles) attach the bones of the upper limbs to
A
the axial skeleton (the pectoral girdle is a component of the appendicular skeleton)
8
Q
Human body has two pectoral girdles, each comprising a (2 things)?
They are held in place by?
A
- Clavicle
- Scapula
Pectoral girdles are held in place by muscle attachments
9
Q
lies horizontally in the superior and anterior part of thorax superior to the first rib and articulates with the sternum and the scapula
A
The clavicle or collar bone
10
Q
one of the most frequently broken bones in the body, transmits mechanical force from the upper limb to the trunk.
A
The clavicle
11
Q
The clavicle transmits what?
A
mechanical force from the upper limb to the trunk.
12
Q
S-shaped bone with two curves
Extends from sternum to scapula above 1st rib
Fracture site is junction of curves
Ligaments attached to clavicle stabilize its position
A
Clavicle
13
Q
Clavicle
_-shaped bone with _ curves
Extends from _ to _ above 1st rib
Fracture site is…
_ attached to clavicle stabilize its position
A
S-shaped bone with two curves
Extends from sternum to scapula above 1st rib
Fracture site is junction of curves
Ligaments attached to clavicle stabilize its position
14
Q
Clavicle
The two ends are the….
A
….acromial extremity and the sternal extremity
slide 8
15
Q
Clavicle
The conoid tubercle is the site of attachment of the conoid portion of the _____ ligament, which is located between….
A
coracoclavicular
….the clavicle and the coracoid process of the scapula
slide 8
16
Q
Look at slide 9 for muscle attachments to the clavicle
A
I have faith that you did your duty to your nation, your fellow soldiers, your family, and yourself.
17
Q
The scapula or shoulder blade articulates with
A
the clavicle and the humerus
18
Q
The scapulae articulate with other bones anteriorly, but are held in place _____ only by complex shoulder and back musculature.
A
posteriorly
19
Q
The _____ is the lateral end of the spine, and is the high point of the shoulder.
(Tailors measure the length of the upper limb from this feature)
A
acromion
20
Q
The _____ accepts the head of the humerus to form the glenohumeral joint
A
glenoid cavity
21
Q
The thin edge of the scapula closer to the vertebral column is the ___ aka ____
A
medial border, AKA vertebral border
22
Q
Landmarks of the scapula
The thick edge closer to the arm is the ___ aka ____
A
lateral border, AKA axillary border
23
Q
Landmarks of the scapula
The medial and lateral borders join at the
A
inferior angle
24
Q
SLIDE 12 AND 13 HAVE A PRETTY PICTURE WITH COLORS
A
SLIDE 12 / 13
25
Landmarks of the scapula
The superior border joins the medial border at the
superior angle
SLIDE 13
26
Landmarks of the scapula
The scapular notch (suprascapular notch) is an indentation along the _____ border through which the ____ nerve passes
The scapular notch (suprascapular notch) is an indentation along the superior border through which the suprascapular nerve passes
27
Landmarks of the scapula
The coracoid process (like a crow’s beak) is a projection at the lateral end of the superior border to which tendons of muscles and ligaments attach... which ones?
(pectoralis minor, coracobrachialis, and biceps brachii) and ligaments (coracoacromial, conoid, and trapezoid) attach
28
is a projection at the lateral end of the superior border to which tendons of muscles (pectoralis minor, coracobrachialis, and biceps brachii) and ligaments (coracoacromial, conoid, and trapezoid) attach
The coracoid process (like a crow’s beak)
29
Landmarks of the scapula
The _____ is a surface for attachment of the supraspinatus muscle of the shoulder
supraspinous fossa
30
Landmarks of the scapula
The _____ is a surface for attachment of the infraspinatus muscle of the shoulder
infraspinous fossa
31
Landmarks of the scapula
The ______ on the ____ surface is a surface of attachment for the subscapularis muscle
subscapular fossa
anterior
32
The _____ traverses the scapular notch and converts it into a foramen
superior transverse scapular ligament
33
The ______ originates near the scapular notch, and frequently also extends to the superior transverse scapular ligament
omohyoid muscle
34
omohyoid muscle
FREQUENTLY EXTENDS TO?
superior transverse scapular ligament
35
The superior transverse scapular ligament traverses the _____ and converts it into a _____
scapular notch
foramen
LOOK AT SLIDE 18 FOR A CRIKEY OL PICTYA MATE
36
The superior transverse scapular ligament
On their way to the supraspinatus muscle, the _______ travels under the ligament, and the _______ goes over the ligament
suprascapular nerve
suprascapular artery
37
On their way to the _____, the suprascapular nerve travels under the ligament, and the suprascapular artery goes over the ligament
supraspinatus muscle
NERVE - UNDER
ARTERY - OVER
NAVY UNDER BRIDGE
ARMY OVER BRIDGE
38
The suprascapular nerve (under the tip of the probe) is seen passing under the ligament. It is sensory to the ____, and motor to the ___ AND ____.
It is sensory to the shoulder joint, and motor to the infraspinatus and supraspinatus muscles.
39
A navy travels under a bridge, and an army travels over a bridge.
The suprascapular nerve travels under the bridge, and the suprascapular artery travels over the bridge.
40
Suprascapular Neuritis
A form of entrapment neuropathy commonly caused by...
...compression of the suprascapular nerve at the back of the shoulder.
41
Suprascapular Neuritis
The suprascapular nerve is liable to injury as it travels through the ___ AND IS SPANNED BY
The nerve is liable to injury as it travels through the suprascapular notch where it is spanned by the transverse ligament
42
Suprascapular Neuritis
Types of injuries include
overuse of the arm and excessive traction.
43
Suprascapular Neuritis
Clinical Findings
Direct pressure over the nerve in the notch with the examining finger can....
Prolonged entrapment of the nerve leads to visible wasting of the ____ AND ____ MUSCLES.
....reproduce the local and referred pain down the arm
supraspinatus and infraspinatus muscles
44
Suprascapular Neuritis
Clinical Findings
Direct pressure over the nerve in the notch with the examining finger can....
Prolonged entrapment of the nerve leads to visible wasting of the ____ AND ____ MUSCLES.
....reproduce the local and referred pain down the arm
supraspinatus and infraspinatus muscles
45
Articulations of the pectoral girdle
Clavicle articulates with the ____ of the sternum at the _____
manubrium
sternoclavicular joint
46
Articulations of the pectoral girdle
Scapula
Articulates with the clavicle at the ______ joint
Articulates with the humerus at the....
acromioclavicular
....glenohumeral joint
47
Articulations of the pectoral girdle
Pectoral girdles do not articulate with the...
Pectoral girdles are held in place by ____
...vertebral column
muscle attachments
48
Sternoclavicular joint
Articulation between sternal end of clavicle with ____ of sternum and....
manubrium
...first costal cartilage
good pic on side 26
49
Sternoclavicular joint
IS WHAT TYPE OF JOINT?
THE ONLY TRUE ___ THAT CONNECTS PECTORAL GIRDLE WITH RIBCAGE
Synovial joint (it is a saddle joint)
The only true synovial joint that connects the pectoral girdle with the ribcage
good pic on side 26
50
Where the lateral (acromial) end of the clavicle articulates with the acromion process of the scapula
ACROMIOCLAVICULAR JOINT
51
ACROMIOCLAVICULAR JOINT
What articulates?
Where the lateral (acromial) end of the clavicle articulates with the acromion process of the scapula
52
Generally considered a joint of the upper limb
Synovial joint (a small synovial joint)
Site of shoulder separations
ACROMIOCLAVICULAR JOINT
good pic on side 28
53
ACROMIOCLAVICULAR JOINT
Stabilizing ligaments?
Stabilizing ligaments
Acromioclavicular ligament
Coracoclavicular ligaments:
- ----Trapezoid ligament
- ----Conoid ligament
good pic on side 28
54
Acromioclavicular joint
*The ___ ligament and the ____ ligament comprise the coracoclavicular ligament, which attaches to the ___ and ____ process of the scapula, providing stability to the acromioclavicular joint
*The conoid ligament and the trapezoid ligament comprise the coracoclavicular ligament, which attaches to the clavicle and the coracoid process of the scapula, providing stability to the acromioclavicular joint
55
*The conoid ligament and the trapezoid ligament comprise the
coracoclavicular ligament
56
coracoclavicular ligament
which attaches to the clavicle and the coracoid process of the scapula, providing stability to the....
acromioclavicular joint
57
coracoclavicular ligament
provides stability to ?
acromioclavicular joint
coraco = coracoid process
clavicular = clavicle
58
Upper Extremity
Each free upper limb comprises ___ bones
30 bones
59
Each free upper limb comprises 30 bones
which ones?
humerus within the arm
ulna & radius within the forearm
carpal bones within the wrist
metacarpal bones within the palm
phalanges in the fingers
60
Upper Extremity:
Joints (which ones)?
shoulder (glenohumeral)
elbow
wrist
metacarpophalangeal
interphalangeal
61
is the longest and largest bone of the upper limb
Humerus
62
It articulates proximally with the scapula and distally at the elbow with both the radius and ulna
Humerus
63
Humerus
It articulates ____ with the scapula and ___ at the elbow with both the....
Humerus articulates
proximally with the scapula
distally at the elbow
(with both the radius and ulna)
64
Humerus --- Proximal End
The head of the humerus articulates with the glenoid cavity of the ___ at the ___
The head of the humerus articulates with the glenoid cavity of the scapula at the glenohumeral, or shoulder, joint
65
The head of the humerus articulates with the _____ of the scapula at the glenohumeral, or shoulder, joint
glenoid cavity
66
Humerus --- Proximal End
are sites of insertion for some of the muscles that move the humerus at the shoulder joint?
Greater and lesser tubercles
67
The anatomical neck is located between the....
tubercles and the head
68
is the site of attachment of the articular capsule?
anatomical neck
69
contains the long head of the biceps brachii muscle
Intertubercular sulcus (bicipital groove, also intertubercular groove)
70
Surgical neck is distal to the ____, where the humerus is....
tubercles
...frequently broken
71
Humerus --- Proximal End
_______ in the middle of the shaft is the site of attachment of the deltoid muscle
Deltoid tuberosity
72
is the site of attachment of the deltoid muscle
Deltoid tuberosity
73
Humerus --- Distal End
The distal end of the humerus is where projections of the humerus articulate with____.... to form what?
forearm bones to form the elbow joint
slides 37-41 for pics
74
Humerus --- Distal End
On the anterior surface is the sharp ______ on the shaft of the bone that ends in the lateral epicondyle
lateral supracondylar ridge
slides 37-41 for pics
75
Humerus --- Distal End
lateral supracondylar ridge:
is on what surface side?
ends in?
anterior surface
ends in the lateral epicondyle
slides 37-41 for pics
76
Humerus --- Distal End
The larger medial epicondyle is the termination of the
medial supracondylar ridge
slides 37-41 for pics
77
medial supracondylar ridge what marks its termination or end?
medial epicondyle
slides 37-41 for pics
78
Humerus --- Distal End
The rounded capitulum is near the
lateral epicondyle
79
Humerus --- Distal End
The trochlea, with its indentation, is more ____ in position
medial
80
Humerus --- Distal End
Two anterior depressions in the bone receive parts of the radius and the ulna when the forearm is flexed at the elbow:
The shallow radial fossa lies above the capitulum, and contains part of the radius during flexion
The deep coronoid fossa located above the trochlea receives the ulnar coronoid process
81
Humerus --- Distal End
Two anterior depressions in the bone receive parts of the radius and the ulna when the forearm is flexed at the elbow:
shallow radial fossa
deep coronoid fossa
82
Humerus --- Distal End
The _____located above the trochlea receives the ulnar coronoid process
deep coronoid fossa
83
Humerus --- Distal End
The ______ lies above the capitulum, and contains part of the radius during flexion
shallow radial fossa
84
Humerus --- Distal End
The _____ is a large depression of the posterior humerus that receives the olecranon process of the ulna when the forearm is extended (straightened)
olecranon fossa
85
olecranon fossa is anterior or posterior of humerus?
receives the ___ when the forearm is extended (straightened)
posterior
olecranon process
86
FRACTURES OF THE HUMERUS
Most fractures of the proximal end of the humerus are fractures of the
surgical neck
87
FRACTURES OF THE HUMERUS
One fragment is driven into the spongy bone of the other fragment
Tend to be stable, due to the impaction
Arm passively moveable with little pain
Impact fractures
88
FRACTURES OF THE HUMERUS
Transverse fractures:
Transverse fractures to the body of the humerus frequently result from....
The pull of the ____ muscles carries the proximal fragment of the fractured humerus ____
....a direct blow to the arm
deltoid
laterally
89
Impact fractures
(FRACTURES OF THE HUMERUS)
describe features / characteristics...
One fragment is driven into the spongy bone of the other fragment
Tend to be stable, due to the impaction
Arm passively moveable with little pain
90
FRACTURES OF THE HUMERUS
An _____ occurs when a ligament or tendon attached to a bone pulls away part of the bone (at any location—not just the humerus)
avulsion fracture
91
FRACTURES OF THE HUMERUS
Avulsion fractures of the greater tubercle of the humerus cause ...
...the tubercle to be pulled away
92
FRACTURES OF THE HUMERUS
These are relatively common, and usually result from a fall either onto the ___ IN WHICH AGE GROUP?
point of the shoulder—the acromion—in middle aged and elderly, or the hand in younger people
93
FRACTURES OF THE HUMERUS
Avulsion fractures (anywhere) are typically repaired by?
open reduction and fixation with a screw (or screws)
94
Fractures of humerus at different locations may be associated with damage to particular nerves because the humerus is in direct contact with specific nerves at those locations.
Surgical neck :: ?
Shaft (radial groove) :: ?
Distal end :: ?
Medial epicondyle :: ?
Surgical neck :: axillary nerve
Shaft (radial groove) :: radial nerve
Distal end :: median nerve
Medial epicondyle :: ulnar nerve
95
FX LOCATION :: ASSOCIATED NERVE?
Surgical neck :: ?
Shaft (radial groove) :: ?
Distal end :: ?
Medial epicondyle :: ?
Surgical neck :: axillary nerve
Shaft (radial groove) :: radial nerve
Distal end :: median nerve
Medial epicondyle :: ulnar nerve
96
Forms medial border of forearm (little finger side)
Stabilizing forearm bone
Ulna
97
Forms lateral border of forearm (thumb side)
Shorter, moveable forearm bone
Radius
98
FUNNY BONE = WHICH NERVE?
ULNAR NERVE OF MEDIAL EPICONDYLE
99
Ulna
Together, the olecranon and the coronoid process receive the...
They contribute to the formation of the _____, which is a large curved area that forms part of the elbow joint
...trochlea of the humerus
trochlear notch
100
Ulna
On the lateral side of the ______ is the radial notch, which is a depression that receives the head of the radius
coronoid process
101
Ulna
Just inferior to the coronoid process is the ulnar tuberosity, to which the
____ muscle attaches
brachialis muscle attaches
102
Ulna
The head of the ulna is at its ____ end
A disc of fibrocartilage separates the wrist from the...
distal
...head of the ulna
103
Ulna
A styloid process on the distal end is an attachment point for the ?
ulnar collateral ligament to the wrist
104
Radius
The proximal end of the
radius has a disc-shaped head that articulates with both the _____ of the humerus and the ____ of the ulna
Inferior to the head is the constricted neck
capitulum
radial notch
105
Radius
The _____ is a roughened area inferior to the neck that serves as a point of attachment for tendons of the biceps brachii muscle
radial tuberosity
106
Radius
The radial styloid process is on the lateral side, and can be felt proximal to the thumb. It provides attachment for the _____ muscle in the vicinity, and the _____ ligament to the wrist
brachioradialis
radial collateral
107
Radius
The ______is a broad, flat, fibrous connective tissue that joins the shafts of the radius and ulna
It also provides a site of attachment for...
interosseous membrane
...some tendons of deep skeletal muscles of the forearm
108
Radius
Articulation of the head of the radius with the ulna’s radial notch is the
proximal radioulnar joint
109
Radioulnar articulations
Distally, the head of the ulna articulates with the ulnar notch of the radius at the
distal radioulnar joint
110
Dorsal tubercle of radius
The dorsal tubercle of the radius is a small prominence on the dorsal aspect of the distal end of the radius, lateral to the groove for the
extensor pollicis longus tendon
111
Dorsal tubercle of radius
It serves as a trochlea (pulley) for the tendon
AKA
Lister’s tubercle
112
Carpals, Metacarpals, and Phalanges
BONES OF THE HAND
113
Carpals, Metacarpals, and Phalanges
Eight ____ bones bound together by ligaments comprise the wrist
Five ______ bones are contained in the palm of each hand
Each hand contains 14 _______:
- Three in each finger
- Two in each thumb
Eight carpal bones bound together by ligaments comprise the wrist
Five metacarpal bones are contained in the palm of each hand
Each hand contains 14 phalanges:
- Three in each finger
- Two in each thumb
114
8 Carpal Bones (wrist)
```
Proximal row, lateral to medial
scaphoid - boat shaped
lunate - moon shaped
triquetrum - 3 corners
pisiform - pea shaped
Distal row, lateral to medial
trapezium - four sided
trapezoid - four sided
capitate - large head
hamate - hooked process
```
WELL DONE NERD
115
Note that the ulna does not participate in the wrist joint.
The distal end of the radius and the articular disc of the distal radioulnar joint articulate with the proximal row of carpal bones, except for the ____.
pisiform
The pisiform acts primarily as a sesamoid bone, increasing the leverage of the flexor carpi ulnaris, and articulates with only the triquetrum.
116
8 Carpal Bones (wrist)
LIST THEM ALL AND DESCRIBE THEIR SHAPES
```
Proximal row, lateral to medial
scaphoid - boat shaped
lunate - moon shaped
triquetrum - 3 corners
pisiform - pea shaped
Distal row, lateral to medial
trapezium - four sided
trapezoid - four sided
capitate - large head
hamate - hooked process
```
117
The pisiform acts primarily as a sesamoid bone, increasing the leverage of the ______, and articulates with only the _____.
The pisiform acts primarily as a sesamoid bone, increasing the leverage of the flexor carpi ulnaris, and articulates with only the triquetrum.
118
Some
Lovers
Try
Positions
That
They
Can't
Handle
Yes I'm talking about you!
But really the carpal bones of the hand
119
5 total
Numbering: #1 proximal to thumb
Base, shaft, head
Knuckles (metacarpophalangeal joints)
Metacarpals
120
14 total: each is called phalanx
Proximal, middle, distal on each finger, except thumb
Base, shaft, head
Phalanges
121
The vertebral borders of the scapulae lie lateral to the
vertebral furrow
122
The ____ is a large triangular shaped muscle of the upper and middle back
trapezius
123
Another superficial muscle is the latissimus dorsi, which is inferior to the
trapezius
124
The ______ is formed from the lateral border of the latissimus dorsi as its fibers travel toward its insertion on the arm
posterior axillary fold
125
Another muscle that contributes to the posterior axillary fold and also inserts into the arm is the....
located where?
...teres major.
It is located near the inferior angle of the scapula
126
____ muscle contributes to the rounded shape of the shoulder.
deltoid
127
The _______ is the site of articulation of the clavicle with the acromion of the scapula
acromioclavicular articulation
128
The _____ is the depression between the two sternal ends of the clavicles
jugular notch
129
The _____ is the most superficial muscle of the anterior thoracic wall. It has a broad origin from the clavicle and sternum
The border of the pectoralis major forms the....
pectoralis major
....anterior axillary fold
130
The serratus anterior muscle is on the _____ side of the thorax
anterolateral
131
The ____ is the site where the limb joins the trunk
axilla
132
The biceps brachii and triceps brachii are easily seen
OK... except on you fellas!
133
The olecranon process in the elbow is the insertion site for...
The ______ of the humerus can be easily palpated
...all three heads of the triceps
lateral epicondyle
134
The _______vein is commonly used for normal venipuncture
median cubital
135
Elevation Depression
Retraction Protraction
UPward rotation
Movements of the scapula produced by muscles of the superficial layers of the back
starting on slide 76
136
OVERVIEW OF UPPER LIMB MUSCLE ATTACHMENTS
Look at slides 80 through 83 for reference... he said he would not test on these pictures, but we need to be familiar with this stuff
Please do it!
137
Look at slides 85 - 87 for pictures of arterial and venous distribution
DO IT or you are a bad apple!
138
These are upper limb muscles that attach to the thoracic cage
Anteriorly (4) ?
Posteriorly (1) ?
```
Comprise
Anteriorly…
Pectoralis major
Pectoralis minor
Serratus anterior
Subclavius
Posteriorly: latissimus dorsi
```
139
Pectoralis Major
Origion
Insertion
Action
Innervation
Origin: clavicle, sternum, and costal cartilages of ribs 2 – 5, or 2 – 6 (sometimes 1 – 7)
Insertion: intertubercular sulcus (AKA intertubercular groove) of humerus
Action: adducts and medially rotates humerus at the shoulder joint
Innervation: lateral and medial pectoral nerves
140
Pectoralis Minor
Origion
Insertion
Action
Innervation
Origin: Ribs 2 – 5, or 3 – 5, or 2 - 4
Insertion: coracoid process (of scapula)
Action: abducts (protracts) scapula and rotates it downward; elevates ribs during forced inhalation when scapula is fixed
Innervation: medial pectoral nerve
141
Serratus anterior
Origion
Insertion
Action
Innervation
Origin: superior eight or nine ribs
Insertion: vertebral border and inferior angle of scapula
Action: abducts scapula and rotates it upward; elevates ribs when scapula is fixed. Termed “boxer’s muscle” because it is important in horizontal arm movements such as punching and pushing
Innervation: long thoracic nerve
142
Injury to the long thoracic nerve results in paralysis of the
serratus anterior muscle.
| winged scapular
143
When the arm is raised, the vertebral border and inferior angle of the scapula pull away from the thoracic wall and protrude outward, causing the medial border of the scapula to protrude. The arm can not be abducted beyond the horizontal position.
Because the scapula looks like a wing, this condition is called a winged scapula.
Long thoracic nerve injury
144
Subclavius muscle
Origion
Insertion
Action
Innervation
Origin: first rib
Insertion: clavicle
Action: Depresses clavicle and moves it anteriorly. Helps stabilize pectoral girdle
Innervation: subclavian nerve (AKA nerve to the subclavius)
145
Muscles of the back are arranged in several layers
_____ connect the upper limb to the vertebral column the intermediate layer is composed of muscles that are involved in respiration (sometimes called extrinsic muscles of the upper limb)
The deepest layers are muscles that....
Superficial layers
....extend the head and vertebral column, and produce rotation and lateral bending of the head, neck, and back
146
Components
Trapezius
Latissimus dorsi
Levator scapulae
Rhomboids (major and minor)
Act on the upper limb, even though they are located in the back
Generally receive their nerve supply from...
except for the...
Superficial back muscles
ventral rami of cervical nerves (except the trapezius receives its motor fibers from a cranial nerve (CN XI, the accessory nerve))
147
Trapezius
Origion
Insertion
Action
Innervation
Origin: external occipital protuberance, superior nuchal line (of occipital bone), nuchal ligament (ligamentum nuchae), and spinous processes of C7 - T12
Insertion: clavicle, acromion and spine of scapula
Action: superior fibers elevate scapula and extend head, middle fibers adduct (retract) scapula, inferior fibers depress scapula
Innervation: accessory nerve (CN XI)
148
Latissimus Dorsi
Origion
Insertion
Action
Innervation
Origin: spinous processes of inferior 6 thoracic vertebrae, lumbar vertebrae (T7 – L5), crests of sacrum and ilium
Insertion: intertubercular sulcus (AKA intertubercular groove) of humerus
Action: extends, adducts, and medially rotates humerus at shoulder joint, draws arm inferiorly and posteriorly, raises body toward arms during climbing
Innervation: thoracodorsal nerve
149
Where does the trapezius receive its motor fibers from?
CN XI, the accessory nerve
(unlike the other superficial back muscles i.e. Lats, levator scapulae, and rhomboids
