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Medicine Phase 1 > Musculoskeletal (Upper limbs) ANATOMY > Flashcards

Musculoskeletal (Upper limbs) ANATOMY Flashcards

1
Q

Name the 5 superficial back muscles.

A
  1. Trapezius
  2. Latissimus dorsi
  3. Leavator scapuli superioris
  4. Rhomboid minor
  5. Rhomboid major
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2
Q

What is the innervation of trapezius?

A

Cn 11 - accessory

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3
Q

What is the action of trapezius?

A

Elevates the scapula and rotates it during abduction of the arm.

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4
Q

Which rhomboid muscle lies most superiorly?

A

Rhomboid minor lies superior to major.

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5
Q

Name the 4 rotator cuff muscles.

A
  1. Supraspinatus
  2. Infraspinatus
  3. Subscapularis
  4. Teres minor
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6
Q

What is the function of the rotator cuff muscles?

A

To stabilise the shoulder joint.

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7
Q

Where do the rotator cuff muscles originate from and insert?

A

Origin: scapula, insertion: humeral head.

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8
Q

Why can posterior dislocation of the shoulder result in deltoid weakness and numb skin above the deltoid tendon?

A

Because it can stretch the axillary nerve.

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9
Q

What is the insertion of deltoid muscle?

A

Deltoid tuberosity of the humerus.

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10
Q

What is the function of deltoid?

A

To abduct, flex and extend the arm.

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11
Q

What are the 3 heads of the triceps?

A
  1. Long head (most medial).
  2. Lateral head.
  3. Medial head.
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12
Q

Which head of the triceps lies deepest?

A

The medial head - cannot be seen unless the lateral and long are dissected away.

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13
Q

What is the insertion of triceps?

A

Olecranon of the ulna.

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14
Q

What is the innervation of triceps?

A

The radial nerve.

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15
Q

Which rotator cuff muscle is most likely to be affected in rotator cuff tendinitis?

A

Supraspinatus - tendon passes through a tight gap between the humerus and acromium of the scapula and so is prone to inflammation. ‘Painful arc’.

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16
Q

What is the action of supraspinatus?

A

Abduction.

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17
Q

What is the action of infraspinatus?

A

External rotation.

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18
Q

What is the action of teres minor?

A

External rotation.

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19
Q

What is the action of subscapularis?

A

Internal rotation.

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20
Q

What is the innervation of the deltoid muscle?

A

Axillary nerve.

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21
Q

What is the action of deltoid?

A

Abduction of the arm!

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22
Q

What type of muscles fibres make up deltoid?

A

Multi-pennate fibres - these fibres are powerful.

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23
Q

What is the function of latissiums dorsi?

A

Adduction!

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24
Q

What is the action of triceps?

A

Extension of the forearm.

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25
Q

What is the axilla?

A

An area underneath the shoulder joint at the junction between the upper limb and thorax.

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26
Q

An area underneath the shoulder joint at the junction between the upper limb and thorax.

A

The first rib, clavicle and scapula.

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27
Q

What structures form the medial wall of the axilla?

A

Serratus anterior, ribs and intercostal spaces.

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28
Q

What structures form the lateral wall of the axilla?

A

Upper humerus, biceps brachii and coracobrachialis muscle.

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29
Q

What structures form the anterior wall of the axilla?

A

Pectoralis major and minor.

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30
Q

What structures form the posterior wall of the axilla?

A

Latissimus dorsi, teres major and subscapularis.

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31
Q

What structures form the base of the axilla?

A

Skin and deep fascia.

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32
Q

Name 5 things contained wihin the axilla.

A
  1. Fat.
  2. Lymph nodes.
  3. Axillary artery.
  4. Axillary vein.
  5. Brachial plexus.
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33
Q

What spinal nerve roots form the brachial plexus?

A

C5 - T1.

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34
Q

What are divisions of the brachial plexus?

A

Roots -> Trunk -> Divisions (anterior and posterior) -> Cords -> Branches.

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35
Q

What are the 5 main branches of the brachial plexus?

A
  1. Musculocutaneous.
  2. Axillary.
  3. Median.
  4. Radial.
  5. Ulnar.
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36
Q

What are the nerve roots for the musculocutaneous branch?

A

C5, 6, 7.

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37
Q

What muscle does the musculocutaneous nerve enter?

A

Coracobrachialis.

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38
Q

What are the nerve roots for the axillary branch?

A

C5, 6.

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39
Q

What are the nerve roots for the median branch?

A

C6, 7, 8, T1.

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40
Q

What are the nerve roots for the radial branch?

A

C5, 6, 7, 8, T1.

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41
Q

What are the nerve roots for the ulnar branch?

A

C8, T1.

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42
Q

What are the names of the 3 trunks of the brachial plexus?

A
  1. Superior trunk.
  2. Middle trunk.
  3. Inferior trunk.
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43
Q

What nerve roots contribute to the superior trunk?

A

C5, C6.

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44
Q

What nerve roots contribute to the middle trunk?

A

C7.

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45
Q

What nerve roots contribute to the inferior trunk?

A

C8, T1.

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46
Q

What divisions form the lateral cord?

A

The anterior divisions of the superior and middle trunks.

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47
Q

What divisions form the posterior cord?

A

The posterior divisions of the superior, middle and inferior trunks.

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48
Q

What divisions form the medial cord?

A

The anterior division of the inferior trunk.

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49
Q

What are the names of the 3 cords of the brachial plexus?

A
  1. Lateral cord.
  2. Posterior cord.
  3. Medial cord.
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50
Q

What does the musculocutaneous nerve give motor innervation to?

A

Anterior flexors - brachialis, biceps brachii and coracobrachialis - BBC.

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51
Q

What does the musculocutaneous nerve give sensory innervation to?

A

Lateral forearm.

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52
Q

What would be the effect of damage to the musculocutaneous nerve?

A

Flexion at the shoulder and elbow would be affected. Loss of sensation to the lateral forearms.

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53
Q

What does the axillary nerve give motor innervation to?

A

Abductors of the arm at the shoulder - teres minor, long head of triceps and deltoid.

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54
Q

What does the axillary nerve give sensory innervation to?

A

Innervates the skin over the lower deltoid.

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55
Q

What would be the effect of damage to the axillary nerve?

A

Unable to abduct the arm 15-90 degrees. Loss of sensation over the lower deltoid region.

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56
Q

What does the median nerve give sensory innervation to?

A

Lateral palm of the hand and the lateral 3.5 fingers.

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57
Q

What does the median nerve give motor innervation to?

A

Flexors in the anterior forearm, the thenar muscles and the lateral two lumbricals in the hand.

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58
Q

What would be the effect of damage to the median nerve?

A

Flexion of the forearm would be weakened, thenar muscle atrophy, unable to make a fist with their hands - only the little and ring fingers can flex completely. Loss of sensation over the lateral palm and lateral 3.5 fingers.

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59
Q

What does the radial nerve give motor innervation to?

A

Triceps brachii, responsible for extension at the elbow. It also innervates extensor muscles in the posterior compartment of the forearm.

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60
Q

What does the radial nerve give sensory innervation to?

A

Skin on the posterior side of the forearm and the posterior aspect of the hand.

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61
Q

What would be the effect of damage to the radial nerve?

A

Unable to extend the forearm, wrist and fingers. Unopposed flexion of the wrist: ‘wrist drop’. Loss of sensation over the posterior forearm and hand.

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62
Q

What would be the effect of damage to the ulnar nerve?

A

Unable to abduct and adduct the fingers. Movement of the little and ring fingers is reduced. A hand deformity called ‘ulnar claw’ will develop long term. Loss of sensation to the medial 1.5 fingers and medial palm.

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63
Q

What does the ulnar nerve give sensory innervation to?

A

Medial 1.5 fingers and the medial palm.

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64
Q

What does the ulnar nerve give motor innervation to?

A

Muscles of the hand, flexor carpi ulnaris (flexes and adducts the hand at the wrist) and medial half of the flexor digitorum profundus (flexes the fingers).

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65
Q

What is the cubital fossa?

A

An area of transition between the arm and forearm.

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66
Q

What muscle forms the medial border of the cubital fossa?

A

Pronator teres muscle.

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67
Q

What muscle forms the lateral border of the cubital fossa?

A

Brachioradialis muscle.

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68
Q

What are the contents of the cubital fossa lateral to medial?

A
  1. Biceps tendon.
  2. Brachial artery.
  3. Median nerve.
    (TAN)
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69
Q

Does the median nerve lie lateral or medial to the brachial artery in the upper arm?

A

Laterally. It crosses to the medial side as it descends through the arm.

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70
Q

What is the origin of brachialis?

A

Lower half of the anterior humerus.

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71
Q

What is the insertion of brachialis?

A

Coronoid process of the ulna.

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72
Q

What is the action of brachialis?

A

Flexion of the elbow joint.

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73
Q

What muscle does brachialis lie deep to?

A

Biceps brachii.

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74
Q

Biceps brachii: what is the origin of the long head?

A

Supraglenoid tubercle of the scapula.

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75
Q

Biceps brachii: what is the origin of the short head?

A

Coracoid process of the scapula.

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76
Q

Where does the biceps tendon insert?

A

The tuberosity of the radius.

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77
Q

What is the action of biceps?

A

Flexion of the elbow joint and supination of the forearm.

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78
Q

What nerve lies on the superficial surface of serratus anterior?

A

Long thoracic nerve.

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79
Q

What is the origin of deltoid?

A

Clavicle, acromion of scapula, spine of scapula.

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80
Q

Name 3 nerves closely related to the humerus.

A
  1. Radius.
  2. Ulnar.
  3. Axillary.
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81
Q

Transection of which cord of the brachial plexus produces paralysis of the biceps, brachialis and coracobrachialis?

A

Lateral cord.

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82
Q

What is the main muscle to abduct the shoulder 0-15 degrees?

A

Supraspinatus.

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83
Q

What is the main muscle to abduct the shoulder 15-90 degrees?

A

Deltoid.

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84
Q

What are the main muscle(s) that abduct the shoulder greater than 90 degrees?

A

Trapezius and serratus anterior.

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85
Q

Name 4 superficial muscles in the anterior compartment of the forearm?

A
  1. Pronator teres.
  2. Flexor carpi radialis.
  3. Palmaris longus.
  4. Flexor carpi ulnaris.
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86
Q

Where do the superficial muscles in the anterior compartment of the forearm originate from?

A

The common tendon which arises from the medial epicondyle of the humerus.

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87
Q

What nerve innervates flexor carpi ulnaris?

A

Ulnar nerve (C8-T1).

88
Q

What is the action of flexor carpi ulnaris?

A

Flexion and adduction at the wrist.

89
Q

What nerve innervates palmaris longus?

A

Median nerve (C6-T1).

90
Q

What is the action of palmaris longus?

A

Flexion at the wrist.

91
Q

What nerve innervates flexor carpi radialis?

A

Median nerve (C6-T1).

92
Q

What is the action of flexor carpi radialis?

A

Flexion and abduction at the wrist.

93
Q

What nerve innervates pronator teres?

A

Median nerve (C6-T1).

94
Q

What is the action of pronator teres?

A

Pronation of the forearm.

95
Q

What nerve innervates brachioradialis?

A

Radial nerve (C5-T1).

96
Q

What is the action of brachioradialis?

A

Flexion of the elbow.

97
Q

What artery is the brachial artery a continuation of?

A

The axillary artery.

98
Q

What arteries does the brachial artery branch into?

A

The radial and ulnar arteries.

99
Q

Name 3 deep muscles in the anterior compartment of the forearm.

A
  1. Flexor digitorum profundus.
  2. Flexor pollicis longus.
  3. Pronator quadratus.
100
Q

What bone does flexor digitorum profundus originate from?

A

The ulna bone.

101
Q

What is the innervation to flexor digitorum profundus?

A
  • Medial half (little and ring fingers) - ulnar nerve.
  • Lateral half (middle and index fingers) - median nerve.
102
Q

What is the action of flexor digitorum profundus?

A

It flexes the interphalangeal joints and the metacarphophalangeal joints.

103
Q

What bone does flexor pollicis longus originate from?

A

The anterius radius.

104
Q

What is the insertion of flexor pollicis longus?

A

The thumb.

105
Q

What is the innervation of flexor pollicis longus?

A

Median nerve.

106
Q

What is the action of flexor pollicis longus?

A

It flexes the interphalangeal joints and the metacarphophalangeal joints of the thumb.

107
Q

What is the action of pronator quadratus?

A

It pronates the forearm.

108
Q

Name 3 forearm muscles that are not supplied the median nerve.

A
  1. Flexor carpi ulnaris.
  2. The medial half of flexor digitorum profundus.
  3. Brachioradialis.
109
Q

What are the 3 main groups of bones in the hand?

A
  1. Carpal bones.
  2. Metacarpals.
  3. Phalanges.
110
Q

How many phalanges does each finger have?

A

3.

111
Q

How many phalanges does the thumb have?

A

2.

112
Q

How many carpel bones are there?

A

8.

113
Q

Why is the skin of the palm adherent to the underlying connective tissue?

A

To prevent the skin from slipping off the hand whilst gripping.

114
Q

What is the carpal tunnel?

A

A space between the flexor retinaculum and the carpal bones.

115
Q

What structures pass through the carpal tunnel?

A

Flexor tendons entering the hand and the median nerve.

116
Q

What is the cause of carpal tunnel syndrome?

A

Swelling of the tendons increases the pressure in the tunnel and compresses on the median nerve.

117
Q

What are the symptoms of carpal tunnel syndrome?

A

Pain, diminished sensation the hand and weakness of the thenar muscles.

118
Q

What arteries form the superficial palmar arch?

A

The ulnar artery and a small contribution from the radial artery.

119
Q

What is the superficial palmar arch?

A

An arterial arcade formed mainly by the ulnar artery that gives off 4 digital branches to the fingers.

120
Q

What nerve branch arises from the median nerve in the forearm?

A

Palmar cutaneous nerve.

121
Q

What does the palmar cutaneous branch of the median nerve innervate?

A

The skin of the lateral palm.

122
Q

What are the two terminal branches of the median nerve?

A
  1. Recurrent branch.
  2. Palmar digital branch.
123
Q

What does the palmar digital branch of the median nerve innervate?

A

The palmar surface and fingertips of the lateral 3.5 digits. It also gives motor innervation to the lateral 2 lumbricles.

124
Q

What are the 3 main nerve branches of the ulnar nerve?

A
  1. Palmar cutaneous branch.
  2. Dorsal cutaneous branch.
  3. Superficial branch.
125
Q

What does the palmar cutaneous branch of the ulnar nerve innervate?

A

The skin on the medial half of the palm.

126
Q

What does the dorsal cutaneous branch of the ulnar nerve innervate?

A

Skin of the medial 1.5 digits and the associated dorsal hand area.

127
Q

What does the superficial branch of the ulnar nerve innervate?

A

The palmar surface of the medial 1.5 fingers.

128
Q

What nerve and artery lie superficial to the flexor retinaculum?

A

The ulnar nerve and artery.

129
Q

True or false: the ulnar nerve and artery pass through the carpal tunnel.

A

False. They lies superficial to the flexor retinaculum and so outside of the carpal tunnel.

130
Q

What intrinsic hand muscles are innervated by the median nerve?

A

The 3 thenar muscles and the lateral 2 lumbricles.

131
Q

Where are the thenar muscles located?

A

At the base of the thumb.

132
Q

What is the action of the thenar muscles?

A

Fine movements of the thumb.

133
Q

Name the 3 thenar muscles.

A
  1. Abductors pollicis brevis.
  2. Flexor pollicis brevis.
  3. Opponens pollicis.
134
Q

Where do the abductors pollicis brevis and flexor pollicis brevis insert?

A

The lateral aspect of the 1st phalanx of the thumb.

135
Q

What is the action of opponens pollicis?

A

It opposes the thumb by medially rotating and flexing the metacarpal.

136
Q

Where are the hypothenar muscles attached?

A

The little finger. They are mirror images of the thenar muscles.

137
Q

What nerve innervates the hypothenar muscles?

A

The deep branch of the ulnar nerve.

138
Q

Name the 3 hypothenar muscles.

A
  1. Abductor digiti minimi.
  2. Flexor digiti minimi.
  3. Opponens digiti minimi.
139
Q

How many lumbrical muscles are there in each hand?

A

4 - each associated with a finger.

140
Q

What is the innervation to the lumbrical muscles.

A
  • The medial 2 = deep branch of ulnar nerve.
  • The lateral 2 = median nerve.
141
Q

What is the origin of the lumbricals?

A

The flexor digitorum profundus tendon.

142
Q

What is the action of the lumbricals?

A

Flexion of the metacarphophalangeal joint and extension of the interphalangeal joints.

143
Q

What covers the flexor tendons?

A

A fibrous flexor sheet that fans out into synovial sheaths.

144
Q

What is the importance of the synovial sheath that covers the flexor tendons?

A

It reduces friction in flexion and extension.

145
Q

What is the innervation to the interossei muscles?

A

The deep branch of the ulnar nerve.

146
Q

What is the action of the dorsal interossei muscles?

A

Abduction.

147
Q

What is the action of the palmar interossei muscles?

A

Adduction.

148
Q

What carpal bones are most prone to injury?

A

The scaphoid is most prone to fracture and the lunate is most prone to dislocation.

149
Q

What is the complication of a scaphoid fracture?

A

The artery supplying the scaphoid bone is often affected and so the bone can be without blood supply: avascular necrosis.

150
Q

The ulnar artery and nerve lie superficially to the flexor retinaculum. Which lies medially?

A

The ulnar nerve lies medial and the artery lateral.

151
Q

What is the cutaneous distribution of the median nerve?

A

The lateral palm of the hand and the palmar surface of the lateral 3.5 digits.

152
Q

What is the cutaneous distribution of the ulnar nerve?

A

The medial palm of the hand and the palmar and dorsal surfaces of the medial 1.5 digits.

153
Q

List the hand muscles supplied by the deep branch of the ulnar nerve.

A
  1. Hypothenar muscles.
  2. Medial 2 lumbricles.
  3. Interossei muscles.
154
Q

What are the 2 location where the ulnar nerve is often damaged?

A

At the elbow and at the wrist.

155
Q

What is the termination of the cephalic vein?

A

Terminates with the axillary vein.

156
Q

What is the common flexor origin?

A

Medial epicondyle of the humerus. Where the superficial anterior forearm muscles originate.

157
Q

Which muscles in the forearm are supplied by the ulnar nerve?

A
  • Flexor carpi ulnaris.
  • Medial flexor digitorum profundus.
158
Q

Define pronation.

A

Turning the hand so the palm is facing down.

159
Q

Define supination.

A

Turning the hand so the palm is facing up.

160
Q

Which muscles are responsible for pronation?

A

Pronator teres and pronator quadratus.

161
Q

What artery are the cords of the brachial plexus in relation to?

A

The axillary artery.

162
Q

What artery are the trunks of the brachial plexus in relation to?

A

The subclavian artery.

163
Q

What are the nerve roots for the long thoracic nerve?

A

C5-7.

164
Q

What is the function of the pericardium?

A

It provides a friction free surface to accommodate the heart’s sliding movements.

165
Q

What nerve innervates the muscles of the posterior compartment of the forearm?

A

The radial nerve.

166
Q

What are muscles of the posterior compartment of the forearm commonly known as?

A

Extensors - their general function is to produce extension at the wrist and fingers.

167
Q

Which muscles of the posterior compartment of the forearm originate from the lateral epicondyle?

A
  1. Extensor carpi radialis brevis.
  2. Extensor carpi ulnaris.
  3. Extensor digiti minimi.
  4. Extensor digitorum.
168
Q

Name the superficial muscles of the posterior compartment of the forearm.

A
  1. Extensor carpi radialis brevis.
  2. Extensor carpi radialis longus.
  3. Extensor carpi ulnaris.
  4. Extensor digiti minimi.
  5. Extensor digitorum.
  6. Brachioradialis - flexor but has all the characteristics of an extensor.
169
Q

What is the action of brachioradialis?

A

Flexion at the elbow.

170
Q

Where do the tendons of extensor carpi radialis longus and brevis insert?

A

The metacarpal bones 2 and 3.

171
Q

What is the action of extensor carpi radialis longus and brevis?

A

Extension and abduction of the wrist.

172
Q

What is the origin of extensor digitorum?

A

Lateral epicondyle of the humerus.

173
Q

What is the action of extensor digitorum?

A

Extension of the medial four fingers at the MCP and IP joints.

174
Q

What is the action of extensor digiti minimi?

A

Extension of the little finger.

175
Q

What is the origin of extensor carpi ulnaris?

A

Lateral epicondyle of the humerus.

176
Q

What is the insertion of extensor carpi ulnaris?

A

Base of metacarpal 5.

177
Q

What is the action of extensor carpi ulnaris?

A

Extension and adduction of the wrist.

178
Q

Where do extensors of the carpus insert?

A

Metacarpal bones.

179
Q

What is wrist drop?

A

When the extensor of the wrist are paralysed due to paralysis of the radial nerve above the elbow. The flexors are unopposed and so you get wrist drop.

180
Q

Name the deep muscles of the posterior compartment of the forearm.

A
  1. Supinator.
  2. Abductor pollicis longus.
  3. Extensor pollicis longus.
  4. Extensor pollicis brevis.
  5. Extensor indicis.
181
Q

What are the origins of the 2 heads of supinator?

A
  1. Lateral epicondyle of humerus.
  2. Posterior surface of the ulna.
182
Q

What is the action of supinator?

A

Supinates the forearm.

183
Q

What tendons forms the lateral wall of the anatomical snuffbox?

A
  1. Extensor pollicis brevis.
  2. Abductor pollicis longus
184
Q

What tendons forms the lateral wall of the anatomical snuffbox?

A

Extensor pollicis longus.

185
Q

What is the action of extensor pollicis brevis?

A

Extension at the metacarpophalangeal and interphalangeal joints of the thumb.

186
Q

What is the action of extensor pollicis longus?

A

Extends all the joints of the thumb.

187
Q

What is the action of extensor indicis?

A

It allows the index finger to be independent of the other fingers in extension.

188
Q

What tendon does the tendon of extensor indicis join?

A

The extensor digitorum tendon.

189
Q

What bone forms the floor of the anatomical snuffbox?

A

Scaphoid.

190
Q

What might tenderness in the snuffbox region suggest?

A

Fracture of the scaphoid.

191
Q

What artery, nerve and vein lie in the anatomical snuffbox?

A
  • Radial artery.
  • Branch of the radial nerve.
  • Cephalic vein.
192
Q

What are the two articulating surfaces of the elbow joint?

A
  1. Trochlear notch of the ulna and trochlea of the humerus.
  2. Head of the radius and capitulum of the humerus.
193
Q

What are the movements of the elbow joint?

A
  1. Extension of triceps brachii.
  2. Flexion of brachialis, biceps brachii and brachioradialis.
194
Q

What do the medial and lateral collateral ligaments of the elbow attach to?

A

The annular ligament.

195
Q

What type of joints are the radioulnar joints?

A

Pivot joints.

196
Q

What structures articulate at the proximal radioulnar joint?

A

The head of the radius and the radial notch of the ulnar.

197
Q

What are the movements of the radioulnar joints?

A

Pronation and supination.

198
Q

Name 2 muscles responsible for pronation.

A
  1. Pronator teres.
  2. Pronator quadratus.
199
Q

Name 2 muscles responsible for supination.

A
  1. Supinator.
  2. Biceps brachii.
200
Q

What is the dermatome of the thumb?

A

C6.

201
Q

What is the dermatome of the middle and index fingers?

A

C7.

202
Q

What is the dermatome of the ring and little fingers?

A

C8.

203
Q

What are the dermatomes of the anterior aspect of the arm?

A

C5 and T1 centrally. C6 laterally and C8 medially.

204
Q

What separates the wrist joint from the inferior radio-ulnar joint?

A

Triangular fibrocartilage.

205
Q

What does the head of the radius articulate with?

A

The capitulum of the humerus.

206
Q

What does the trochlea of the humerus articulate with?

A

Trochlear notch of the ulna.

207
Q

Contraction of the triceps will result in what action at the elbow?

A

Extension.

208
Q

What 3 carpal bones form the wrist joint with the distal radius?

A

Scaphoid, lunate and triquetral bones.

209
Q

What nerve innervates adductor pollicis?

A

Ulnar.

210
Q

What is the dermatome of the clavicle?

A

C4.

211
Q

What is the myotome of the deltoid?

A

C5.

212
Q

What is the myotome of the biceps?

A

C6.

213
Q

What is the myotome of the triceps?

A

C7.

214
Q

What is the spinal reflex for the biceps?

A

C5/6.

215
Q

What is the spinal reflex for the triceps?

A

C7/8.

Medicine Phase 1 (16 decks)

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