MSK upper limb 1 Flashcards
(120 cards)
1
Q
Complete the diagram
A
2
Q
Which ligament holds the ulnar in place?
Which ligament holds the head of the radius in place?
A
Ulnar collateral ligament
Annular ligament
3
Q
Which muscles cause flexion of the elbow joint
A
Biceps brachii, brachioradialis and brachialis
4
Q
Label this diagram
A
5
Q
Label
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6
Q
Label
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7
Q
Label
A
8
Q
Muscles involved insupination of the elbow
A
- Supinator
- Biceps brachii
9
Q
Muscles invovled in pronation of the elbow
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Pronator teres
Pronator quadratus
10
Q
Label diagram
A
11
Q
Label
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12
Q
Label
Insersion for pec minor
A
Coracoid process (Also biceps short head & coracobrachialis)
13
Q
Label
Name branches of brachial plexus & what cords they come from
A
Ulnar- Medial
Median- lateral & medial
Radial- posterior
Musculocutaneous- lateral
Axillary- posterior
14
Q
Insersion and origin for biceps brachi, two heads and deltoid
A
Biceps brachi
Long head: supraglenoid tubercle of scapula
Short head: coracoid process
Insersion: Tuberosity of radius
Deltoid
Insertion: Clavicle, acromion & spine of scapula
Origin: Deltoid tuberosity on the humerus
15
Q
What is the Common flexor origin & what muscles originate here
A
Medial epicondyle of the humerus
- Pronator teres
- Flexor carpi ulnaris
- Flexor digitorum superficialis
- Flexor carpi radialis
- Palmaris longus
16
Q
What is the Common extensor origin & what muscles originate here
A
Lateral epicondyle of the humerus
- Extensor digitorum
- Extensor digiti-minimi
- Extensor carpi ulnaris
- Extensor radialis brevis
17
Q
Biceps brachii insertion & origin
A
Origin: Long head:
LH: supraglenoid tubercle of scapula
SH: coracoid process
Insersion: tendon, into the radial tuberosity
18
Q
Brachioradialis insertion & origin
A
Humerus
inserts into Radial styloid process
19
Q
What attaches onto green & blue parts
A
Pec minor- green (the inserts onto coracoid process)
Serratus anterior- blue
20
Q
Green & blue attachments
A
Pec major
Origin= Clavicular & sternocostal heads
Insertion= intertubercular groove
Teres major
Origin= Inferior angle & lateral border of the scapula
Insertion= intertubercular groove
21
Q
Coracobrachilis insertion & origin
A
Origin= coracoid process
Insertion= mid shaft of humerus
22
Q
Deltoid attachments
A
Origin= Clavicle, acromion & spine of scapula
Insertion= Deltoid tuberosity
23
Q
What attaches onto the infra-glenoid tubercle of the scpula
A
Attachment of triceps brachii: long head
Insertion- Olecranon process of the ulna
24
Q
Label
A
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Label
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Label
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Label the image
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Complete diagram
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Label
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What does the radial nerve innervate & what are its nerve roots
Sensory – Innervates most of the skin of the posterior forearm, the lateral aspect of the dorsum of the hand, and the dorsal surface of the lateral three and a half digits.
Motor – Innervates the triceps brachii and the extensor muscles in the forearm.
nerve roots C5-T1
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Complete diagram
Note that the axillary artery turns into the brachial artery at the lower border of the pec major
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Label the contents of the axilla
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At what anatomical point does the axillary artery begin and end and from which artery?
***lateral margin of the first rib and then lower border of teres major***
***subclavian artery***
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Roots & cords of the brachial plexus
Ulnar- C8 & T1 Medial branch
Median- C6, 7, 8, T1 Lateral & medial branch
Radial- C5-T1 Posterior branch
Musculocutaneous- C5, 6 & 7 Lateral branch
Axillary- C5 & 6 Posterior branch
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What is Erb's palsy
Erb’s palsy refers to an injury to the upper roots of the brachial plexus (typically C5-6). It most commonly occurs as a result of a stretching injury during a difficult vaginal delivery.
Nerves affected – the peripheral nerves derived from C5-6 roots are most affected. This includes the musculocutaneous, axillary, suprascapular, and nerve to subclavius.
Muscles affected – supraspinatus, infraspinatus, subclavius, biceps brachii, brachialis, coracobrachialis, deltoid and teres minor.
Motor functions affected – abduction at shoulder, lateral rotation of arm, supination of forearm, and flexion at shoulder.
Sensory functions affected – sensation over the lateral aspect of upper limb (C5-6 dermatomes).
The affected limb hangs limply, medially rotated by the unopposed action of pectoralis major. The forearm is pronated due to the loss of biceps brachii. The wrist is weakly flexed due to the normal tone of the wrist flexors relative to the weakened wrist extensors. This is position is known as ‘waiter’s tip’ and is characteristic of Erb’s palsy
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What is Klumpke’s Palsy
Claw hand= Ulnar nerve
Injury of the lower roots of the brachial plexus (C8-T1).
Nerves affected – the peripheral nerves derived from T1 root are most affected; the ulnar and median nerves
Muscles affected – the intrinsic hand muscles
Sensory functions affected – sensation along medial side of upper limb (C8-T1 dermatomes).
The primary feature of Klumpke’s palsy is a clawed hand. This occurs due to paralysis of the lumbrical muscles, which normally act to flex the metacarpophalangeal joints (MCPJs) and extend the interphalangeal joints (IPJs). When paralysed, the fingers subsequently become extended at the MCPJs and flexed at the IPJs, producing a clawed appearance.
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Label
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Label
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Where does lymph from the medial & lateral part of the breast drain?
1. **Medial** part of the **breast** (close to sternum): **internal mammary nodes**
2. **Lateral** part of breast (close to axilla): **axillary lymph nodes**
The main lymph drainage of the breast is to **axillary nodes and to the parasternal nodes along the internal thoracic artery inside the thoracic cavity**. The lymphatics of the breast originate in the lymph capillaries of the mammary connective tissue, which surrounds the mammary structures, and drain through the deep substance of the breast.
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Orientating the clavicle:
The lateral aspect of a clavicle is **x** than the medial aspect
The superior surface is **x** than the inferior surface
The conoid tubercle is on the **x aspect of the x portion** of the clavicle
The lateral aspect of a clavicle is **flatter** than the medial aspect
The superior surface is **smoother** than the inferior surface
The conoid tubercle – attachment for the conoid ligament – is on the **inferior aspect of the lateral portion** of the clavicle
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How is the underside of the clavicle fixed to the coracoid process
Trapezoid ligament in front and conoid ligament behind
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label
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Label
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*What type of synovial joint are the acromioclavicular (AC) and sternoclavicular (SC) joints?*
***AC joint: Synovial Plane joint***
***SC joint: Saddle shaped synovial joint***
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What attachement is this showing
Long head of biceps brachi to the supraglenoid tubercle
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Label
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Label
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Where does the axillary nerve lie on the humerus
directly posterior, along humeral neck
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Label the two parts of the scapula
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Label
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Where does the triceps insert
Olecranon process of ulna
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Name therim of cartilage surrounding the socket of the shoulder joint
Glenoid labrum
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Label
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Label
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Function of Coracoacromial ligament
**prevents superior displacement** of the **humeral head.**
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Which part of the shoulder joint capsule is weakest, as it is not protected by muscles or ligaments?
Inferior aspect
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Name the two main bursae of the shoulder joint
Subacromial and subscapular bursae
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Label two main bursae of shoulder
a) subacromial bursae
b) subscapular bursae
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*Which bursa communicates with the joint cavity?*
The **subscapular bursae** communicates with the glenohumeral joint between the superior & middle glenohumeral ligaments
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*What is the role of subacromial bursa?*
The **subacromial bursa** **protects the underlying supraspinatus muscle** from attrition wear between the humeral head and the acromion
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What common sporting injury damages the **subacromial bursa?**
* Rotator cuff pinching and tendinitis; often in sports requiring **arms to be moved over the head repeatedly** e.g. baseball pitching, serving in tennis, swimming
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Name the 4 rotator cuff muscles & identify their main action
· S – Supraspinatus – abducts the arm
· I – Infraspinatus – externally rotates the arm
· T – Teres minor – externally rotates the arm
· S – Subscapularis – internally rotates the arm
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DIstal attachement for the 4 rotator cuff muscles
Subscapularis- lesser tubercle
infraspinatus, teres minor & supraspinatous= greater tubercle
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Function of the anterior, posterior and middle deltoid fibers
what is its nerve supply
**Anterior fibres** of deltoid **flexion** and **medial rotation** at the shoulder joint
**Middle fibres** **abduction** of the arm at the shoulder joint
**Posterior fibres** **Extension** and **lateral rotation** at the shoulder joint
nerve supply = axilliary nerve
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what nerve causes winging of the scapula
Damage to the long thoracic nerve
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Distil attachment & action of the pectoralis major muscle
The distal attachment of this muscle is to the **lateral lip of the intertuburcular groove of the humerus**
Its action on the shoulder joint is to **adduct the shoulder** and **internally rotate the humerus** at the glenohumeral joint.
Muscle used to throw a ball/in arm wrestle
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complete
1. Trapezius
2. Latissimus dorsi
3. teres major
4. Deltoid
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Action of the superior, middle and inferior trapezius fibers
Innervation?
**Superior fibres** of trapezius elevation & rotation during abduction of the scapula
**Middle fibres** of trapezius adduction/retraction of the scapula (move it back on the thorax)
**Inferior fibres** of trapezius depress the scapula
Innervation = spinala accessory nerve
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What muscles flex the shoulder
1. Anterior deltoid muscle
2. Pectoralis major (upper)
3. Coracobrachials
4. Biceps brachii
All at the front; pull the shoulder fowards
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`what muscles extend the shoulder
1. Deltoid (posterior fibers)
2. Latissimus dorsi
3. Teres major
All at the back; pull the shoulder back
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What muscles adduct the shoulder
**1. Pectoralis major**
**2. Latissimus dorsi**
**3. Teres major**
**4. Teres minor**
**- all pull inwards; imagine them forming a triangular pulley**
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What muscles abduct the shoulder from 0-90 degrees
Supraspinatous & deltoid (middle fibers)
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What muscles abduct the shoulder from 90-180 degrees
Trapezius & serratus anterior
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What muscles internally rotate the shoulder
1. Subscapularis
2. Latissimus dorsi
3. Pectoralis major
4. Teres major
5. Deltoid (anterior)
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What muscles externally rotate the shoulder
1. infraspinatus
2. teres minor
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Action of biceps brachii and location of insertion
Action- flexion of elbow & shoulder
supination of elbow
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Where does the brachial artery bifurcate into the radial and ulnar artery?
cubital fossa at the level of the radial neck, below the bicipital aponeurosis
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Label this
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Complete the diagram
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Complete the diagram
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Complete
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What artery forms the deep vs superficial palmar arch
Deep= radial artery
Superficial = ulnar artery
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Complete
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Fill in the diagram
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Complete
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Complete
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Describe consequence of an injury to the axillary nerve & the usual location of injury to this nerve
Humeral neck fracture/dislocation
Erb's palsy- waiters tip: hyperextension injury to the shoulder
Injury to upper trunk: They are supplied by the nerve roots C5 –C6 …Deltoid, bicepps brachi and brachialis, infraspinatus, supraspinatus and serratus anterior muscles…
As a result of injuries to the superior parts of the bra- chial plexus (Erb-Duchenne palsy), paralysis of the muscles of the shoulder and arm supplied by the C5 and C6 spinal nerves occurs: deltoid, biceps, and brachialis. The usual clinical appearance is an upper limb with an adducted shoul- der, medially rotated arm, and extended elbow. The lateral aspect of the forearm also experiences some loss of sensation.
88
What nerve roots make up the brachial plexus
Which roots form the upper, middle and lower trunks
Ventral rami of C5-T1
Upper trunk: C5&6
Middle trunk: C7
Lower trunk: C8&T1
89
Describe consequence to an injury to lower trunk
ulnar nerve
what locaiton is the injury
Claw hand/Klumpke’s Palsy
- Ulnar nerve
medial epicondyl fracture
Both injuries are most commonly caused by shoulder dystocia at birth or following traumatic injury (e.g. motor vehicle accident)
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Describe consequence of injury to radial nerve & how this can occur
Wrist drop
Humeral midshaft facture
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Describe consequence of injury to median nerve & how this can occur
Wrist lesion- carpal tunnel syndrom
Hand of benediction
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Describe consequence of injury to long thoracic n and how this can occur
Often during sport, blow to ribs + masectomy
- winging of scapula
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Note that the entire upper limb and pectoral girdle articulate at one small joint only - which is this?
Sternoclavicular joint
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Describe the base, apex, walls of the axilla
Base:
Apex: lateral border of the first rib, superior border of scapula, and the posterior border of the clavicle.
Lateral border: intertubercular groove of the humerus.
Medial border: Seratus anterior & thoracic wall (ribs & intercostal muscles)
Anterior wall: Pec major, pec minor & underlying subclavius muscle
Posterior wall: Subscapularis, teres major & lattismus dorsi
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Describe the contents of the axilla
Axillary artery, axillary vein, brachial plexus, axillary lymph nodes, biceps brachi (short head) & coracobrachialis tendon
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Label the extensor expansion diagram
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What is the function of the lumbricals
FLexion of the metacarpalphalangeal joint & extension of the interphalangeal joint
- flex a straightened finger
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What type of fracture can cause a radial nerve injury
Fracture to the spiral groove of the humerus
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Which vein lies anterior to the roof of the antecubital fossa?
Median cubital vein
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Describe "students elbow"
Olecranon bursitis
The subcutaneous olecranon bursa is one of these structures and can be damaged through repeated excessive pressure and friction
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Tennis elbow
Repetitive overuse of the muscles in the forearm causes inflammation of the muscle tendons attached to the lateral epicondyle of the elbow – this is lateral epicondylitis.
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Golfers elbow- what is it
Repetitive overuse of the muscles in the forearm causes inflammation of the muscle tendons attached to the medial epicondyle of the elbow – this is medial epicondylitis.
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What type of joint is the elbow & the proximal and ditsil radioulnar joint?
Elbow= synovial hinge
Proximal & distil tibiofibular= pivot type synovial joints
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What type of joint is the
sternoclavicular
acromioclavicular
glenohumeral
elbow
radioulnar
wrist (radiocarpal)
carpometacarpal
thumb
metacarpopharyngeal
proximal & distil interphalangeal
Sternoclavicular – Saddle
Acromioclavicular – Plane
Glenohumeral – Ball and socket
Elbow – Hinge
Proximal and Distal Radio-ulnar – Pivot
Wrist (Radiocarpal) – Condyloid
Carpometacarpal – Plane except CMC joint of thumb is saddle
Metacarpophalangeal – Condyloid
Proximal and Distal interphalangeal – Hinge
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Hip –
Knee –
Proximal tibiofibular –
Distal tibiofibular –
Ankle –
Subtalar (Talocalcaneal) -
– Talonavicular
Hip – Ball and socket
Knee – Hinge
Proximal tibiofibular – Plane
Distal tibiofibular – Fibrous: syndesmosis
Ankle – Hinge
Subtalar (Talocalcaneal) – Plane (gliding motion)
Talonavicular – Ball and socket (pivot from side to side)
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What type of joint is the wrist
Condyloid joint
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What type of joint are the carpometacarpal joints
plane, except from the thumb which is a saddle
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What type of joint is the metacarpalpharyngeal
Condyloid
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What type of joint is the proximal and distal interphalangeal
Synovial hinge
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