Morphology of the upper limb

Question 1

Pectoral girdle

Answer 1

Composed of the scapula and clavicle

Question 2

Features of the scapula

Answer 2

Coracoid process - Attachment of Pec. Minor, short head of biceps, coracobrachialis.

Spine- continuous with acromion.
Gives rise to origins: supraspinatus, infraspinatus.
- Attachment of Trapezius

Superior angle
- Attachment of levator scapulae

Inferior angle
- Attachment of teres major

Question 3

Features of the humerus [7]

Answer 3

Humeral head
- Forms glenohumeral joint with glenoid fossa of clavicle.

Necks- Surgical and anatomical

Tubercles- Greater and lesser
- Separated by the bicipital groove/ intertubercular sulcus

Deltoid tuberosity
- Attachment of deltoid

Epicondyle- Lateal and medial
- Attachment for flexors (medial) and extensors (lateral) of the wrists and digits

Condyles- Lateral and medial

Spiral groove
- Radial nerve and deep brachial artery run through

Question 4

Muscle attachments of the humerus
- Greater tubercle
- Lesser tubercle
- Bicipital groove
- Deltoid tuberosity
- Shaft

Answer 4

Greater tubercle
- Supraspinatus, infraspinatus, teres minor.

Lesser tubercle
- Subscapularis

Biciptal groove
- Pec major (lateral lip)
- Teres major (medial lip)
- Lattissimus dorsi (medial lip)

Delotid tuberosity
- Deltoid

Shaft
- Lateral head of triceps

Question 5

Radius features

Answer 5

Head
- Articulates with ulna and humerus

Neck

Radial tuberosity
- Insertion of biceps brachii tendon

Body/ Shaft

Styloid process
- Brachioradialis tendon

Interosseous membrance attaches to ulna

Question 6

Ulna features

Answer 6

Olecranon
- Forms bony point at flexed elbow
- Triceps insert at olecranon process

Ulna tuberosity
- Insertion of brachialis

Styloid process
- Attachment of ulnar collateral ligament of the wrist

Question 7

Bones of the wrist

Answer 7

Two rows of carpal bones (proximal and distal)
- 8 altogether

5 metacarpals

14 Phalanges

Question 8

Glenohumeral joint

Answer 8

Articulation of the head of humerus with glenoid cavity of scapula.

Ball and socket joint

Movements:
- Add/Abduction,
- Flex/Extension
- Internal/External rotation
- Circumduction.

Question 9

Radiocarpal joint

Answer 9

Radius articulates with proximal row of carpal bones

Movements:
-Add/Abduction (Radial/Ulnar deviation)
- Palmar Flex/Extension
- Supination/Pronation

Question 10

Joints of the wrist and hand

Answer 10

Midcarpal

Carpometacarpal

Metacarpophalangeal

Interphalangeal

Question 11

Pectoralis major
- Origin
- Innervation
- Insertion
- Function

Answer 11

Origin
-Clavicle
-Anterior surface of the sternum
-Costal cartilage 1-6.

Insertion
- Lateral lip of the bicipital groove of the humerus.

Innervation
- Medial and lateral nerve (Medial and lateral cord)

Function
- Medial rotation of humerus
- Flexion
- Adduction

Question 12

Pec. minor
- Origin
- Insertion
- Innervation
- Function

Answer 12

Origin
- Ribs 3-5

Insertion
- Coracoid process of scapula

Innervation
- Medial pectoral nerve (medial cord)

Action
- Stabilisation of scapula
- Raises ribs in inspiration

Question 13

Serratus anterior
- Origin
- Insertion
- Innervation
- Function

Answer 13

Origin
- upper 8/9 ribs

Insertion
- Medial margin of scapula

Innervation
- Long thoracic nerve (C5-7)

Function
- Protraction and stabilisation of scapula.

Question 14

Deltoid
- Origin
- Insertion
- Innervation
- Function

Answer 14

Origin
- Acromion
- Lateral third of clavicle
- Spine of scapula

Insertion
- Deltoid tuberosity of humerus

Innervation
- Axillary nerve (Posterior cord)

Function
- Abduction of arm (from 10-15 degrees)
- Flexion
- Extension

Question 15

Flexors of the arm
- At shoulder

Answer 15

Pec. major

Deltoid- anterior fibres

Coracobrachialis

Biceps brachii

Question 16

Flexors of the forearm
- At the elbow

Answer 16

Brachialis

Brachioradialis

Biceps brachii

Question 17

Extensors of the arm
- At shoulder

Answer 17

Lat. dorsi

Deltoid- posterior fibres

Teres major

Question 18

Extensors of the forearm
- At elbow

Answer 18

Triceps brachii

Question 19

Thenar eminence

Answer 19

Muscles on the palm, at the base of the thumb
- Supplied by median nerve
- Controls thumb movements

Question 20

Hypothenar eminence

Answer 20

Group of muscles in the palm
- Controls motion of little finger

Question 21

Dermatome

Answer 21

Individual area of skin innervated by a single spinal nerve.

Cutaneous sensory changes indicate nerve damage at a segmental level.

Question 22

Function of vertebral column curvatures

Answer 22

• Shock absorption
• Flexibility

Question 23

Primary curvatures of the vertebral column
- Description
- Function
- Pathology

Answer 23

Kyphoses
- Important for the curved position of a fetus.

• Thoracic
• Sacral

Pathology
- Excess curvature (thoracic)= Hyperkyphosis (hunchback)

Question 24

Secondary curvatures of the vertebral column
- Description
- Function
- Pathology

Answer 24

Lordoses
- Important for the transition from crawling to walking.

• Cervical
• Lumbar

Pathology
- Excess curvature
(lumbar)= Hyperlordosis (C-shaped lower back)

Question 25

Intervertebral joints

Answer 25

Between vertebral bodies - Fibrocartilaginous joint due to intervertebral discs Function: Weight bearing and strength

Question 26

Intervertebral discs - Structure - Function - Pathology

Answer 26

Composed of - Outer, strong layer, Annulus fibrosus - Inner, semi fluid Nucleus pulposus Thickness increases down the column. Function - Holds vertebrae together - Shock absorber. Pathology - Disc herniation/ Protrusion--> Impingement of nerves in vertebral canal

Question 27

Ligaments of the vertebral column - Overal function - Specific ligaments - Pathology

Answer 27

Overall function -Reinforces/ stabilizes joints -Limits range of movement Ligaments that resists hyperextension -Anterior longitudinal ligament - Damaged in whiplash traumas. Ligaments that resists hyperflexion - Posterior longitudinal ligament - Ligamentum flava

Question 28

Extrinsic back muscles

Answer 28

Move limbs and ribs Composed of superficial and intermediate muscles. Superficial - Trapezius - Latissimus dorsi - Levator scapulae - Rhomboids Intermediate - Serratus posterior, superior and inferior

Question 29

Trapezius - Origin - Insertion - Innervation - Function

Answer 29

Origin -Ligamentum nuchae -External occipital protuberance -Spinal processes C7-T12. Insertion: -Spine of scapula -Acromion process -Lateral, posterior 1/3 of clavicle Innervation - CN 11 - Cervical spinal nerve C3-4. Action - Rotation of scapula - Retraction, depression and elevation of scapula

Question 30

Latissimus dorsi - Origin [4] - Insertion - Innervation - Function

Answer 30

Origin - Spinous processes T7-L5 -Iliac crest -Inferior angle of scapula -Inferior 3 or 4 ribs. Insertion - Bicipital groove (medial lip) Innervation - Thoracodorsal nerve (Posterior cord) Function - Adduction - Extension - Internal rotation - Rotation of trunk

Question 31

Levator scapulae - Insertion - Innervation - Function

Answer 31

Insertion - Medial border of scapula Innervation- vental rami - Dorsal scapular nerve (C5) - C3,C4 (cervical nerve) Function - Elevates scapula, as seen in adduction

Question 32

Rhomboids - Origin - Insertion - Innervation - Function

Answer 32

Origin - Spinous processes C7-T5 Insertion - Medial border of scapula Innervation - Dorsal scapular nerve (C5, ventral rami) Action - Retracts scapula--> adduction

Question 33

Deep back muscles - Features - Innervation

Answer 33

Composed of Splenus- neck Erector spinae muscles Multifidus Innervation - Posterior primary ramus of spinal nerve

Question 34

Erector spinae muscles - Function - Origin - Muscle insertions

Answer 34

Allows movement of the vertebral column - Extensor - Lateral flexion - Rotation Origin - Erector spinae aponeurosis Insertions - Iliocostalis to ribs - Longissimus to transverse processes - Spinales to spinous processes

Question 35

Multifidus - Function - Origin - Insertions - Innervation

Answer 35

Movement of vertebral column - Extend - Rotation - Stabilisation Origin - Sacrum - Erector spinae aponeurosis Insertion - Spinous process