SM MSK Anatomy - Upper Limb: Axilla, Shoulder, Arm, Forearm, Hand Flashcards

SM 222a, Lab 2, Lab 3, Lab 4, Lab 5,

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1
Q

Which nerve might be injured by a fracture of the hook of the hamate?

Which functions would be compromised?

A

Ulnar nerve

  • Finger abduction, adduction would be lost
    • Interossei
  • Flexion of 3rd-5th MCP, extension of 3rd-5th PIP and DIP would be weakened
    • Lumbricals
  • Thumb adduction
    • Adductor pollicis
  • Sensation over the skin of the medial 1.5 fingers, palm, and dorsum
    • Cutaneous branches
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2
Q

Damage to which nerve would result in pain or sensory loss on the medial side of the forearm?

A

Medial cutaneous nerve

Note - if a cutaneous nerve is damaged, there will be no motor loss because it is a cutaneous nerve

(superficial branch of the ulnar nerve)

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3
Q

What structure is labeled by #8?

A

Long head of triceps brachii

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4
Q

This image shows the deepest layer of the anterior compartment of the arm

Which structure is labeled by #40?

A

Flexor digitorum profundus

(The only muscle that can flex the fingers at the DIP joints!)

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5
Q

Identify #1:

What muscle attaches to #1?

A

1: Greater tubercle of the humerus

Supraspinatus, infraspinatus, and teres minor attach here

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6
Q

What is the function of the lumbricals of the hand?

What is their innervation?

A

Radialy deviate the fingers, flex MCP, extend PIP and DIP

Median nerve for 1-2

Ulnar nerve for 3-4

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7
Q

Following a dog bite to the arm, a patient reports a loss of sensation over the 5th digit (pinkie). Cutaneous branches of which nerve may have been injured?

A

Cutaneous branches of the ulnar nerve

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8
Q

When the arm is abducted 180 degrees, _____ degrees occurs by rotation of the scapula and ______ degrees occurs by rotation of the humerus at the shoulder joint

A

When the arm is abducted 180 degrees, 60** degrees occurs by rotation of the scapula and **120 degrees occurs by rotation of the humerus at the shoulder joint

The scapula and the humerus move in a 1:2 ratio

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9
Q

What innervates adductor pollicis?

A

Ulnar nerve

If the median nerve (or recurrent branch of the median nerve) is damaged, the abductor pollicis brevis will no longer work; the thumb will be pressed against the hand by adductor policis

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10
Q

Which muscles protract the scapula?

A

Serratus anterior

Pectoralis minor

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11
Q

Describe the structure labeled by #3

  • Muscle:
  • Function:
  • Attachments:
  • Innervation:
A
  • Muscle: Brachioradialis
  • Function: Flex the elbow
  • Attachments: Humerus, distal radius
  • Innervation: Radial nerve
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12
Q

Which vein is labeled by #2?

A

Cephalic vein

(Empties into the axillary vein)

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13
Q

A man suffering from entrapment of the ulnar nerve at the medial epicondyle gets a medial condylar osteotomy. During the procedure the muscular attachments to the medial epicondyle are accidentally cut. Which of the following muscles may have been damaged?

A) Supinator

B) Flexor carpi radialis

C) Brachioradialis

D) Extensor carpi ulnaris

E) Flexor pollicis longus

A

B) Flexor carpi radialis

Muscles of the superficial layer of the anterior forearm:

  • Pronator teres (Creates the medial border of the cubital fossa)
  • Flexor carpi radialis
  • Palmaris longus
  • Flexor carpi ulnaris
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14
Q

Which structure is labeled by #11?

A

Ulnar nerve

Travels closely with the ulnar artery (17)

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15
Q

Which nerve supplies the structures in purple (labeled #4)?

A

Medial cutaneous nerve of the forearm

(A branch from the brachial plexus)

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16
Q

Which structure is labeled by #5?

A

Head of the ulna

Fig. 11.4 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Figs. 22.1A, 22.1B.

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17
Q

The vessels labeled by #4 most recently originated from which vessel?

A

Subscapular artery

(Posterior = circumflex scapular artery, anterior = thoracodorsal artery)

Fig. 16.2 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 24.1B.

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18
Q

Describe the muscle labeled by #6

  • Muscle:
  • Function:
  • Attachments:
  • Innervation:
A
  • Muscle: Supinator
  • Function: Supinate the forearm
  • Attachments: Lateral epicondyle of humerus, radius
  • Innervation: Radial nerve
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19
Q

Which structure is labeled by #1?

A

Surgical neck of the humerus

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20
Q

In the brachial plexus, the medial cord branches into the…

A

Ulnar and median nerves

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21
Q

Describe the deltoid muscle

  • Function:
  • Innervation:
  • Attachments
A

Deltoid

  • Function: Arm abduction, flexion, internal rotation
  • Innervation: Axiliary nerve (C5-C6)
  • Attachments: Clavicle, acromion, scapular spine, humerus
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22
Q

Together, the structures labeled #4 make up the…

A

Metacarpals

Fig. 11.5 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 23.2.

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23
Q

Which structure is labeled by #4?

A

Coracoacromial ligament

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24
Q

Which structure is labeled by #7?

A

Pronator quadratus

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25
Q

Which vein is labeled by #2?

How does it enter the deep venous system?

A

Basilic vein

Empties into the brachial vein just above the cubital fossa

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26
Q

Describe thumb flexion/extension

Describe thrumb abduction/adduction

Which muscles accomplish these movements?

A

Starting with the hand in anatomical position:

  • Flexion is moving the thumb across the palm
    • Flexor pollicis brevis (thenar compartment)
    • Flexor pollicis longus (anterior forearm)
  • Extension is the opposite of flexion
    • Extensor pollicis brevis (posterior forearm)
    • Extensor pollicis longus (posterior forearm)
  • Abduction is moving the thumb away from the palm
    • Abductor pollicis brevis (thenar compartment)
    • Abductor pollicis longus (posterior forearm)
  • Adduction is the opposite of abduction
    • Adductor pollicis (in the palm)
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27
Q

In the brachial plexus, the lateral cord branches into the…

A

Musculocutaneous and median nerves

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28
Q

Which bone is labeled by #7?

A

Radius (radial tuberosity)

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29
Q

Which structure is labeled by #6?

A

Medial head of triceps brachii

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30
Q

Which structure is labeled by #8?

A

Tendons of flexor digitorum superficialis

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31
Q

Which structure of the nervous system is labeled by #2?

A

Axillary nerve

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32
Q

Which actions are controlled by the musculocutaneous nerve?

A
  • Flexion
    • Shoulder
    • Elbow
  • Supination
    • Biceps brachii
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33
Q

Which structure is labeled by #9?

A

Long head of triceps brachii

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34
Q

Which muscle is labeled by #3?

Which nerve supplies it?

A

Biceps brachii, short head

Musculocutaneous nerve

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35
Q

Which joint in the body has the largest range of motion?

A

Glenohumeral joint

Ball and socket joint between the head of the humerus and the glenoid of the scapula

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36
Q

List the visible muscles of the thenar compartment

A
  • Abductor pollicis brevis (11)
  • Flexor pollicis brevis (13)
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37
Q

Which muscles attach to the coracoid process?

A

Short head of biceps brachii

Coracobrachialis

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38
Q

Which muscles function to extend the wrist?

Which nerve innervates these muscles?

A
  • Wrist extension only
    • Extensor carpi radialis
  • Wrist and digit extension
    • Extensor digitorum
    • Extensor pollicis

Radial nerve (posterior comartment of the forearm)

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39
Q

Which structure is labeled by #7?

What does it innervate?

A

Ulnar nerve

  • Anterior forearm
    • Flexor carpi ulnaris, flexor digitorum profundus
  • Hand
    • Intrinsic muscles of the hand
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40
Q

Why do most shoulder dislocations occur anteriorly?

A

The ligaments stabilizing the anterior part of the glenohumeral joint (SGHL, MGHL, IGHL) are very thin and lax - they don’t provide much stability

More stability is provided superiorly and posteriorly by the tendons of the rotator cuff muscles

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41
Q

Which structure is labeled by #4?

What is its innervation?

A

Triceps brachii (medial head)

Radial nerve

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42
Q

Describe teres major

  • Function:
  • Attachments:
  • Innervation:
A

Teres major

  • Function: Internally rotate, adduct, extend the arm
  • Attachments: Scapula, humerus (lesser tuberosity)
  • Innervation: Subscapular nerve
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43
Q

Which structure is labeled by #1?

A

Ulnar nerve

(Ulnar artery is next to it, but the pointer doesn’t quite reach)

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44
Q

If a patient cannot abduct their shoulder, which nerve is most likely injured?

A

Axillary nerve

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45
Q

Together, the structures labeled #3 make up the…

A

Proximal phalanges

Fig. 11.5 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 23.2.

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46
Q

Which structure is labeled by #3?

A

Subscapularis

Part of the rotator cuff of the shoulder

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47
Q

Which structures are labeled by #2?

  • Artery:
  • Nerve:
A
  • Artery: posterior humeral circumflex artery
  • Nerve: Axillary nerve
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48
Q

Describe the structure of synovial tendon sheaths.

What is their function?

A
  • Structure
    • Visceral layer and parietal layer with synovial fluid in between
    • Mesotendons provide routes for blood vessles to get to tendons
  • Function
    • Reduce the friction between the tendon and the surrounding are as it moves
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49
Q

Which muscles are in the deep layer of the anterior compartment of the forearm?

A

Flexor digitorum profundus

Flexor pollicis longus

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50
Q

Which cord from the brachial plexus forms the axillary nerve?

A

Posterior cord

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51
Q

What structure is labeled by #9?

A

Latissimus dorsi

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52
Q

Which vessel is labeled by #2?

A

Axillary artery

  • Right subclavian -> Thoracoacromial (1) -> Axillary (2) -> Brachial (6)*
  • Fig. 16.2 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 24.1B.*
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53
Q

Which structure is labeled by #5?

A

Coracoacromial ligament

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54
Q

Which bone is labeled by #1?

A

Humerus

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55
Q

Which nerve supplies the structures in pink (labeled #3)?

A

Radial nerve (superficial branch)

Note - the superficial branch of the radial nerve only gives cutanous supply to the hand; loss of this nerve in the hand will result in loss of sensation on the dorsal surface and over the thenar compartment, but no functional deficits

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56
Q

Palmaris longus and flexor carpi ulnaris have been removed.

Which structure is labeled by #30?

What is its function?

Attachments?

Innervation?

A

Flexor digitorum superficialis

Flex the fingers at MCP and PIP

Medial epicondyle of the humerus, middle phalanges 1-4

Median nerve

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57
Q

Describe teres minor

  • Function:
  • Attachments:
  • Innervations:
A

Teres minor

  • Function: External rotation, weak adduction of the ar,
  • Attachments: Scapula, greater tuberosity of the humerus
  • Innervations: Axillary nerve

Part of the rotator cuff

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58
Q

Which structure is labeled by #10?

A

Radial artery

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59
Q

Which structure is labeled by #2?

What is its innervation?

A

Trapezius

Innervated by cranial nerve XI

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60
Q

Describe the posterior compartment of the forearm

  • Muscles:
  • Actions:
  • Nerve:
  • Atttachments:
A

Posterior component of the forearm

  • Muscles:
    • Wrist extensors - Extensor carpi radialis
    • Wrist and digital extensors - extensor digitorum, extensor pollicis
    • Forearm supinator - Supinator
    • Thumb abductor - Abductor pollicis longus
  • Actions: Extension of the wrist and/or digits, supination of the forearm, abduction of the thumb
  • Nerve: Radial nerve
  • Atttachments: Lateral epicondyle of the humerus
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61
Q

Which nerve supplies the structures in yellow (labeled #1)?

A

Median nerve

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62
Q

Which vein is labeled by #6?

A

Basilic vein

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63
Q

Which structure is labeled by #2?

A

Medial epicondyle of the humerus

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64
Q

Which ligament prevents the upward dislocation of the humerus?

A

Coracoacromial ligament

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65
Q

Which articulation connects the upper limb to the axial skeleton?

A

Sternoclavicular joint

The scapulothoracic articulation is free-floating; there are no attachments (not a true synovial joint)

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66
Q

Which structure is labeled by #1?

A

Supraspinatus

Part of the rotator cuff

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67
Q

Describe the structure labeled by #17

  • Muscle:
  • Function:
  • Attachments:
  • Innervation:
A
  • Muscle: Extensor pollicis longus
  • Function: Extend the thumb
  • Attachments: Ulna, distal phalanx of the thumb
  • Innervation: Radial nerve
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68
Q

What structure is labeled by #14?

A

Long head of biceps brachii?

(Short head = #13)

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69
Q

Which nerve innervates the compartment in blue?

Which muscles are in this compartment?

A

Ulnar nerve

Hypothenar muscles, medial two lumbricals, adductor pollicis

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70
Q

Which vessel is labeled by #6?

A

Brachial artery

  • Right subclavian -> Thoracoacromial (1) -> Axillary (2) -> Brachial (6)*
  • Fig. 16.2 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 24.1B.*
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71
Q

What structure is labeled by #10?

A

Teres major

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72
Q

A man falls and suffers a dislocation of the greater tubercle of the humerus. Which actions would be most affected?

A) Abduction and lateral rotation

B) Protraction of the scapula

C) Flexion of the shoulder

D) medial rotation of the shoulder

E) Retraction of the scapula

A

Abduction and lateral rotation

The greater tubercle is the attachment site of:

  • Supraspinatus (abductor)
  • Infraspinatus (lateral rotator)
  • Teres minor (lateral rotator)
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73
Q

What is the function of the palmar interossei muscles?

What is their innervation?

A

Adduct the fingers toward the middle finger

Ulnar nerve (deep branch)

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74
Q

What structure is labeled by #7?

A

Medial head of triceps brachii

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75
Q

Describe pectoralis major

  • Function:
  • Attachments:
  • Innervation:
A

Pectoralis major

  • Function: Shoulder adduction and flexion
  • Attachments: Clavicle, sternum, greater tuberosity of humerus
  • Innervation: Medial and lateral pectoral nerve
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76
Q

Which muscle supinates the forearm?

Which nerve innervates this muscle?

A

Supinator

Innervated by the radial nerve (posterior comartment of the forearm)

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77
Q

Which nerve innervates section 1 (red)?

A

Radial nerve (posterior cutaneous branch)

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78
Q

Which actions are controlled by the median nerve?

A
  • Flexion
    • Wrist
    • Digits
    • Thumb
    • Pronation
  • Thumb opposition, abduction
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79
Q

Together, structures #7 adn #8 are called….

A

7 = Trochlea (Articulates with the coronoid process of the ulna)

Condyle of the humerus

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80
Q

Which structure of the nervous system is labeled by #1?

A

Radial nerve

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81
Q

Which structure is labeled by #8?

What is its innervation?

A

Pectoralis minor

Medial pectoral nerve

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82
Q

Which muscle is labeled by #3?

A

Brachioradialis

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83
Q

Which muscles are forearm pronators?

Which nerve innervates these muscles?

A
  • Pronator teres
  • Pronator quadratus

Innervated by the median nerve (anterior compartment of the forearm)

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84
Q

Which structure is labeled by #11?

What is its innervation?

A

Deltoid

Axillary nerve

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85
Q

Which nerve innervates the deltoid and teres minor?

A

Axillary nerve

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86
Q

Which muscles are shown in this picture?

What is their function?

Attachments?

A

Lumbricals

  • Originate from the tendons of flexor digitorum profundus
  • Radially deviate the fingers
  • Innervation
    • Median nerve for the lateral two lumbricals
    • Ulnar nerve for the medial two lumbricals
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87
Q

Describe the structure labeled by #13

  • Muscle:
  • Function:
  • Attachments:
  • Innervation:
A
  • Muscle: Flexor pollicis brevis
  • Function: Flex the thumb
  • Attachments: Trapezium, flexor retinaculum, proximal phalanx of thumb
  • Innervation: Median nerve (recurrent branch)
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88
Q

Which nerves innervate the fingertips?

A

Median nerve (thumb -> ring finger)

Ulnar nerve (ring finger -> pinkie)

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89
Q

Which structure is labeled by #1?

A

Head of the radius

Articulates with the capitulum of the humerus

Fig. 11.4 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Figs. 22.1A, 22.1B.

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90
Q

Which muscle is labeled by #7?

A

Brachioradialis

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91
Q

Which nerves innervate the back of the arm?

A

Radial nerve - posterior cutaneous branch (red)

Musculocutaneous nerve (purple)

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92
Q

Which spinal nerves supply the brachial plexus?

A

C5-T1

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93
Q

Which structures are labeled by #1?

A

Anterior glenohumeral ligaments

(Superior, middle, and inferior)

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94
Q

Which nerve innervates the compartment in yellow?

Which muscles are in this compartment?

A

Median nerve

  • Thenar muscles
    • Abductor pollicis brevis, flexor pollicis brevis
  • Lateral two lumbricals
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95
Q

Which structure is labeled by #7?

A

Anular ligament of the radius

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96
Q

Which structure is labeled by #5?

A

Surgical neck of the humerus

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97
Q

What functional deficit(s) would you expect to see in this patient?

A

Deficits in…

  • Finger and wrist extension
  • Sensory loss on the dorsal aspect of the forearm and dorsolateral hand

These deficits would result from damage to the radial nerve, which sits in the radial groove (in the mid-shaft of the humerus)

Function of the triceps brachii is usually spared, because is innervation is proximal to the fracture

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98
Q

What separates the compartments within any section of the upper and lower limb?

A

Deep fascia

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99
Q

Which actions are controlled by the axillary nerve?

A
  • Shoulder abduction
  • Lateral rotation
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100
Q

Together, the structures labeled #1 make up the…

A

Distal phalanges

Fig. 11.5 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 23.2.

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101
Q

What structure is labeled by #1?

A

Biceps brachii

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102
Q

Which number labels teh radial artery?

A

8

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103
Q

Which number labels the radial nerve?

A

21

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104
Q

Which elbow flexor is in the posterior compartment of the forearm?

A

Brachioradialis

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105
Q

Which vessel is labeled by #5?

A

Profunda brachii artery

(Deep brachial artery)

Fig. 16.2 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 24.1B.

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106
Q

Which numbers label the basilic vein?

Where does it enter the deep venous system?

A

Basilic vein = 6, 5, 2

Empties into the brachial vein just above the cubital fossa

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107
Q

Which structure is labeled by #8?

A

Capitellum of the humerus

Articulates with the head of the radius

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108
Q

Which structure is labeled by #6?

A

Greater tuberosity of the left humerus

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109
Q

Which structure is labeled by #2?

A

Olecranon process of the ulna

(The other side contains the trochlear notch, which articulates with the trochlea of the humerus)

Fig. 11.4 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Figs. 22.1A, 22.1B.

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110
Q

What structure is labeled by #6?

A

Brachialis

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111
Q

If the median nerve is damaged, which digits can still be flexed?

A

4th and 5th digits

Ulnar nerve supplies medial tendons of flexor digitorum profundus

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112
Q

What structure is labeled by #3?

A

Acromion of the scapula

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113
Q

Which vein is labeled by #5?

A

Basilic vein

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114
Q

Which nerves innervate latissimus dorsi, teres major, and subscapularis?

A

Subscapular nerves

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115
Q

Which structure of the nervous system is labeled by #4?

A

Musculocutaneous nerve

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116
Q

Describe the structure of fibrous tendon sheaths

What is their function?

A

Connective tissue that wratp the synovial tendon sheaths against the bone

Act as pullies that hold the tendons against the bone

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117
Q

Which muscle is labeled by #1?

A

Latissimus dorsi

(The only spinal muscle that attaches to the humerus)

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118
Q

Which muscles are shown in this picture?

What is their function?

What is their innervation?

A

Dorsal interossei

Abduct the fingers away from the middle finger

Ulnar nerve (deep branch)

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119
Q

Which bone is labeled by #3?

A

Clavicle

Fig. 11.6 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 20.2A.

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120
Q

What is the purpose of the acromioclavicular joint?

What type of joint is it?

A

The achromioclavicular joint (AC) anchors the clavicle to the scapula

Synovial joint - allows only small slidign movements between the acromion of the scapula and the distal end of the clavicle

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121
Q

Which muscles act to supinate the forearm

What are their innervations?

A

Supinator (posterior forearm, radial nerve)

Biceps brachii long head (anterior arm, musculocutaneous nerve)

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122
Q

Damage to which nerve results in “Ape hand”: adducted thumb with supinated, extended wrist and extended 1st and 2nd digits?

A

Damage to the median nerve

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123
Q

Describe the path of the radial nerve after it leaves the brachial plexus

A

Radial nerve (C5-6)

  • Innervates the posterior arm
  • Descends within the spiral radial groove in the humerus
  • Passes anteriorly
    • -> Superficial branch: cutaneous innervtion to the lateral dorsum of the hand
    • -> Deep branch: Motor innervation to the posterior forearm
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124
Q

Which structure is labeled by #6?

A

Medial epicondyle of the humerus

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125
Q

Which vessel is labeled by #15?

A

Superficial palmar arch

(Gets most of its supply from the ulnar artery)

Fig. 16.2 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 24.1B.

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126
Q

Which structure is labeled by #3?

A

Subscapular artery

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127
Q

Which structure is labeled by #4?

Which muscles attach here?

A

Medial epicondyle

Some wrist and digial flexors

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128
Q

Which nerve supplies the structures in green (labeled #5)?

A

Musculocutanous nerve

Via the lateral cutaneous nerve of the forearm; supplies the lateral half of the anterior suface of the forearm

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129
Q

Which nerves arise from the posterior cord of the brachial plexus?

What do they innervate?

A

Axillary nerve innervates the deltoid and teres minor

Radial nerve innervates the posterior compartments of the arm and forearm

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130
Q

Which muscles work to pronate the forearm?

Where are they located?

A
  • Pronator teres
  • Pronator quadratus

Both are in the flexor (anterior) compartment

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131
Q

Which vessel is labeled by #13?

A

Ulnar artery

Fig. 16.2 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 24.1B.

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132
Q

Which nerve supplies the structures in blue (labeled #2)?

A

Ulnar nerve

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133
Q

Which muscle is labele by #6?

A

Biceps brachii

Fig. 11.6 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 20.2A.

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134
Q

What is the flexor retinaculum?

Where does it attach?

A

The flexor retinaculum forms the anterior wall (“roof”) of the carpal tunnel

Hook of the hamate, pisiform, tubercle of the scaphoid, tubercle of the trapezoid

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135
Q

Which structure is labeled by #18?

A

Pronator teres

Most superficial muscle of the flexor goup, on the medial side of the forearm

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136
Q

Which arteries encircle the surgical neck of the humerus?

A

Anterior and posterior circumflex arteries

Branches from the brachial artery

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137
Q

Which vein is labeled by #5?

A

Median cubital vein

Connects the cephalic (lateral) and basilic (medial) veins

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138
Q

Which structure is labeled by #3?

What is its innervation?

A

Infraspinatus

Suprascapular nerve

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139
Q

Which vein is commonly used for blood draws and IV line placement?

A

Median cubital vein - #3

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140
Q

Which boney structure is labeled by #5?

A

Olecranon of the ulna

Fig. 11.6 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 20.2A.

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141
Q

List the muscles of the hypothenar compartment

What innervates them?

A
  • Abductor digiti minimi (35)
  • Flexor digiti minimi brevis (36)

Ulnar nerve (deep branch)

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142
Q

If a patient cannot pronate their hand, which nerve is most likey injured?

A

Median nerve

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143
Q

Which muscle is labeled by #5?

Which nerve supplies it?

A

Brachialis

Musculocutaneous nerve

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144
Q

Which vessel is labeled by #7?

A

Lateral thoracic artery

Fig. 16.2 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 24.1B.

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145
Q

If a patient cannot flex their ring or pinkie finger, which nerve is most likely damaged?

A

Ulnar nerve

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146
Q

Whihc structure is labeled by #10?

A

Radial nerve

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147
Q

Describe triceps brachii

  • Function:
  • Attachments:
  • Innervation:
A

Triceps Brachii

  • Function: Extend shoulder and forearm
  • Attachments:
    • Long head: Scapula, olecranon process of the ulna
    • Lateral head: Humerus, olecranon process of the ulna
    • Medial head: Humerus, olecranon process of the ulna
  • Innervation:
    • Radial nerve (C6 to C8)
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148
Q

Which articulation is labeled by #5?

A

Scapulothoracic “joint” (free floating, no attachment)

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149
Q

Which boney structure is labeled by #4?

A

Medial epicondyle of the humerus

Fig. 11.6 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 20.2A.

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150
Q

Which structure is labeled by #4?

A

Coronoid process of the ulna

Fig. 11.4 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Figs. 22.1A, 22.1B.

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151
Q

Which structure is labeled by #6?

A

Styloid process of the ulna

Fig. 11.4 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Figs. 22.1A, 22.1B.

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152
Q

Which muscles functions to abduct the thumb?

Which nerve innervates these mucles?

A
  • Abductor policis longus
    • Radial nerve (posterior comartment of the forearm)
  • Abductor pollicis brevis
    • Recurrent branch of the median nerve (thenar compartment)
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153
Q

Which structure is labeled by #8?

A

Glenohumeral joint

(Glenoid fossa of the scapula + head of humerus)

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154
Q

Which structure is labeled by #2?

A

Infraspinatus

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155
Q

Which muscle is labeled by #4?

Which nerve supplies it?

A

Biceps brachii, long head

Musculocutaneous nerve

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156
Q

Which structure is labeled by #10?

What innervates it?

A

Triceps brachii

Radial nerve

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157
Q

Which structure is labeled by #10?

A

Flexor retinaculum

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158
Q

Describe the subscapularis

  • Function:
  • Attachments:
  • Innervation:
A

Subscapularis (anterior part of the rotator cuff)

  • Function: Internally rotate the arm at the shoulder joint
  • Attachments: Scapula, humerus (lesser tuberosity)
  • Innervation: Subscapular nerve
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159
Q

Which structure is labeled by #13?

A

Brachial artery

Splits into the radial (10) and ulnar (17) arteries

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160
Q

Which structure is labeled by #9?

A

Axillary artery and vein

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161
Q

Which structure is labeled by #6?

A

Radial artery

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162
Q

Which number labels the median nerve?

Normally, which muscles is it deep to? Superficial to?

A

7

Deep to flexor digitorum superficialis

Superficial to flexor digitorum profundus

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163
Q

Which structure is labeled by #17?

A

Ulnar artery

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164
Q

Which structure is labeled by #11?

What does it innervate?

A

Ulnar nerve

  • Anterior forearm
    • Flexor carpi ulnaris, flexor digitorum profundus
  • Hand
    • Intrinsic muscles of the hand
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165
Q

Which structure is labeled by #6?

A

Acromioclavicular joint

(covered by the acromioclavicular ligament)

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166
Q

Describe pectoralis minor

  • Function:
  • Attachments:
  • Innervation:
A

Pectoralis minor

  • Function: Stabilize scapula against the body wall
  • Attachments: Coracoid process, ribs 3-5
  • Innervation: Medial pectoral nerve
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167
Q

Loss of extension in the digits and wrist is most likely the result of damage to which nerve?

A

Radial nerve

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168
Q

Which nerve follows the radial artery?

A

Superficial branch of the radial nerve (23)

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169
Q

In the upper arm…

  • The coracobrachialis works on the ______ joint
  • The brachialis works on the ____ joint
  • The biceps brachii works on the _____ joint
A

In the upper arm…

  • The coracobrachialis works on the shoulder joint
  • The brachialis works on the elbow joint
  • The biceps brachii works on the shoulder and elbow joint
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170
Q

List the muscles in the deep posterior forearm

A
  • Extensor indicis (19)
  • Extensor pollicis longus (17)
  • Extensor pollicis brevis (18)
  • Abductor pollicis longus (16)
  • Supinator (6)
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171
Q

Which structure is labeled by #3?

A

Flexor pollicis longus

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172
Q

List the muscles of the rotator cuff and their actions

A
  • Supraspinous - abduction
  • Subcapsularis - medial rotation
  • Infraspinatus - lateral rotation
  • Teres minor - lateral rotation
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173
Q

What is a “sprain”?

A

Damage to a ligament

Graded based on the degree of the tear and resulting joint instability

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174
Q

Which structure is labeled by #8?

(Not the ligements, but what they are attaching to)

A

Glenoid labrum

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175
Q

List the medial rotators of the shoulder joint

What innervates them?

A
  • Teres major - Subscapular nerve
  • Subscapularis - Subscapular nerve
    • Part of the rotator cuff
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176
Q

Damage to which nerve results in loss of thumb function and thenar atrophy?

A

Median nerve (recurrent branch)

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177
Q

Which vessel is labeled by #11?

A

Radial artery

Fig. 16.2 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 24.1B.

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178
Q

What muscle is labeled by #3?

A

Teres minor

(part of rotator cuff)

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179
Q

Which structure is labeled by #7?

A

Coracoclavicular joint

(Made up of the coracoclavicular ligaments)

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180
Q

Identify the scaphoid

A

Fig. 11.5 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 23.2.

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181
Q

The structures highlighted in green are the attachment points for which other structure?

List the names of the attachment points

A

Attachments for the flexor retinaculum (the roof of the carpal tunnel)

  1. Hook of the hamate
  2. Pisiform
  3. Tubercle of the trapezium
  4. Tubercle of the scaphoid
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182
Q

Describe infraspinatus

  • Function:
  • Attachments:
  • Innervations:
A

Infraspinatus

  • Function: Externally rotate the arm
  • Attachments: Scapula, greater tuberosity
  • Innervations: Suprascapular nerve

Part of the rotator cuff

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183
Q

Which structure of the nervous system is labeled by #3?

A

Median nerve

(Lateral and Medial cord join together)

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184
Q

Which vein is labeled by #4?

A

Cephalic vein

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185
Q

Which structure is labeled by #7?

What is its innervation?

A

Pectoralis major

Medial and lateral pectoral nerves

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186
Q

Which structure is labeled by #1?

A

Glenoid cavity of the scapula

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187
Q

Which joint in the body is most commonly dislocated?

A

Glenohumeral

Ball and socket joint of the shoulder, between the head of the humerus and the glenoid of the scapula

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188
Q

Which structure is labeled by #18?

A

Palmaris longus

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189
Q

Ligaments attach _______ to ________

A

Ligaments attach bone** to **bone

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190
Q

Which structure is labeled by #1?

Which muscles attach here?

A

Greater tubercle of the humerus

Supraspinatus, infraspinatus, teres minor (all rotator cuff muscles except subscapularis, which inserts on the lesser tubercle)

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191
Q

Which structure is labeled by #5?

A

Subclavian artery and vein

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192
Q

Which structure is labeled by #3?

A

Sternoclavicular joint

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193
Q

What muscle tendon is the examiner testing?

A) Triceps brachii

B) Coracobrachialis

C) Deltoid

D) Biceps brachii

E) Teres major

A

D) Biceps brachii

Supplied by the musculocutaneous nerve, C5-C7

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194
Q

Which structure is labeled by #6?

Which bone articulates with this structure?

A

Trochlea

Trochlear notch of the ulna

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195
Q

Which cord from the brachial plexus forms the radial nerve?

A

Posterior cord

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196
Q

Which numbers label the cephalic vein?

Where does it enter the deep venous system?

A

Cephalic vein = 7, 4, 1

Empties into the axillary vein at the deltopectoral triangle

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197
Q

A neoplasm of the acromion process completely compresses the axillary artery. Yet the patient has a normal radial pulse. What anastomosis explains this finding?

  1. Anterior and posterior humeral circumflex arteries
  2. Subscapular and brachial arteries
  3. Subscapular and posterior humeral circumflex arteries
  4. Suprascapular and subscapular arteries
  5. Thoracoacromial and subclavian arteries
A

d. Suprascapular and subscapular arteries

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198
Q

Which muscle is labeled by #18?

Perspective: imagine the elbow is coming out of the screen and the shoulder is going into the screen

A

Triceps brachii

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199
Q

Which nerve innervates section 5 (blue)?

A

Ulnar nerve

200
Q

Together, the structures labeled #2 make up the…

A

Middle phalanges

Fig. 11.5 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 23.2.

201
Q

Which structure is labeled by #1?

A

Greater tubercle of the humerus

202
Q

Which structure is labeled by #2?

A

Coracohumeral ligament

203
Q

What structure is labeled by #12?

A

Subscapularis

204
Q

What is the examiner doing here?

A. Testing the brachial pulse

B. Testing the femoral pulse

C. Testing the radial pulse

D. Testing the ulnar pulse

E. Testing the axillary pulse

A

C. Testing the radial pulse

205
Q

Which vessel is labeled by #8?

A

Superior and inferior ulnar collateral arteries

Fig. 16.2 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 24.1B.

206
Q

Which articulations anchor the scapula to the clavicle?

A

Acromioclavicular (AC) - synovial joint

Coracoclavicular (CC) - fibrous joint

207
Q

Which non-bone structures may be damaged due to a clavicle fracture?

A

Brachial plexus

Subclavian artery/vein

Axiallary artery

208
Q

Which nerves are involved in pronation of the elbow?

Which compartment is this?

A

Median nerve

Anterior compartment of the forearm

  • Forearm pronators – pronator teres, pronator quadratus
209
Q

If a patient cannot flex their elbow, which nerve is most likely injured?

A

Musculocutaneous nerve

210
Q

Which structure is labeled by #16?

Which muscles originate here?

Where do they attach?

A

Medial epicondyle of the humerus

  • Flexor carpi radialis (4) -> 2nd and 3rd Metacarpals
  • Flexor digitorum superficialis (6?) -> Middle phalanges 1-4
    • Underneath palmaris longus and flexor carpi ulnaris
  • Flexor carpi ulnaris (19) -> pisiform, hook of hamate
  • Pronator teres (17) -> Radius
  • Palmaris longus (18) -> Palmar aponeurosis
    • not everyone has this!
211
Q

Which number labels the infraspinatus?

A

3

212
Q

Which number labels the long head of triceps brachii?

A

10

213
Q

Which structure is labeled by #7?

What is its innervation?

A

Teres major

Lower subscapular nerve

214
Q

Which muscles retract the scapula?

A

Middle trapezius

Rhomboids

215
Q

Which muscle of the forearm is technically in the extensor compartment, but acts as a flexor of the elbow?

A

Brachioradialis

216
Q

Which muscle is labeled by #2?

Which nerve supplies it?

A

Latissimus dorsi

Ventral rami of a spinal nerve

(Latissimus dorsi is an extrinsic back muscle)

217
Q

Which structure is labeled by 9?

Which structure is labeled by 23?

What do they innervate?

A

9 - superficial branch of the radial nerve; cutaneous innervation to the lateral dorsum of the hand

23 - deep branch of the radial nerve; supplies the muscles of the posterior forearm (extensors)

218
Q

Which structure is labeled by #2?

A

Radial tuberosity

Fig. 11.4 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Figs. 22.1A, 22.1B.

219
Q

Which structure is labeled by #20?

A

Ulnar artery

220
Q

Why doesn’t the middle finger have a palmar interosseus muscle?

A

Movement in either direction is accomplished by the dorsal interosseus muscles of the middle finger

221
Q

Which vein empties into the axillary vein?

A

Cephalic vein (#7, 4, 1)

222
Q

Describe the anterior compartment of the arm

  • Muscles:
  • Actions:
  • Nerve:
  • Atttachments:
A

Anterior component of the arm

  • Muscles: Biceps brachii, coracobrachialis, brachialis
  • Actions: Flexion of the shoulder and elbow joints
  • Nerve: Musculocutaneous
  • Atttachments:
    • Biceps Brachii:
      Long: Supraglenoid tubercle, radial tuberosity
      Short: Coracoid process, radial tuberosity
    • Coracobrachialis: Coracoid process of the scapula, humerus
    • Brachialis: Humerus, ulnar tuberosity
223
Q

Which structure is labeled by #17?

A

Pronator teres

224
Q

Which structure is labeled by #7?

A

Olecranon fossa of the humerus

The olecranon process of the ulna sits in here

225
Q

Which structure is labeled by #7?

A

Radial groove of the humerus

Radial nerve sits in here

This is why humeral shaft fractures can cause damage to the radial nerve

226
Q

The musculocutaneous nerve innervates which muscles?

A

The muscles of the anderior compartment of the arm:

  • Biceps bracii
  • Coacobrachialis
  • Brachialis
227
Q

After a stab wound to the neck a man’s shoulder droops and he is unable to abduct his arm without some assistance, yet the deltoid muscles is of normal strength. You suspect damage to which of the nerve?

A) Subscapular

B) Spinal accessory

C) Long thoracic

D) Dorsal scapular

E) Axillary

A

B) Spinal accessory

The spinal acessory nerve (cranial nerve XI) innervates trapezius. Trapezius controls many actions of the scapula, including rotation

Rotation of the acrominon -> abduction of the arm

228
Q

Which nerve innervates the intrinsic muscles of the hand?

What are the consequences if this nerve is damaged?

A

Ulnar nerve (deep branch)

Loss of interossei (dorsal and palmar) results in loss of extension at PIP and DIP, loss of flexion at MCP

The result flexion at PIP and DIP, extension at MCP

(Extensor digitorum is till intact)

229
Q

Which structure is labeled by #7?

A

Lesser tuberosity of the left humerus

230
Q

Which cords of the brachial plexus form the median nerve?

A

Lateral and medial cords

231
Q

Which structure of the nervous system is labeled by #5?

A

Posterior cord

232
Q

During insertion of an IV cannula in the median cubital vein, the patient suddenly lost feeling on the radial side of the forearm. What nerve may have been injured?

A. Lateral cutaneous nerve of the forearm

B. Medial cutaneous nerve of the forearm

C. Median nerve

D. Posterior cutaneous nerve of the forearm

E. Superficial radial nerve

A

A. Lateral cutaneous nerve of the forearm

233
Q

Which articulation is labeled by #1?

A

Acromioclavicular joint

234
Q

Which structure is labeled by #2?

A

Acromion of the scapula

235
Q

What is the function of the “girdles” of the forelimb and hindlimb

A

Attach the limb to the axial skeleton

Scapula in the forelimb

Pelvis in the hindlimb

236
Q

Which structure is labeled by #5?

A

Coracoid process of the left scapula

237
Q

Which actions are controlled by the radial nerve?

A
  • Extension
    • Shoulder
    • Elbow
    • Wrist
    • Digits
  • Supination
    • Supinator
238
Q

Which structure is labeled by #3?

A

Head of the humerus

239
Q

List the extensors of the shoulder joint

What innervates them?

A
  • Triceps brachii - Radial nerve
    • Main extensor
  • Latissimus dorsi - Ventral rami of spinal nerve (subscapular)
  • Deltoid - Axillary nerve
240
Q

What kinds of nerve fibers are carried in the nerves of the brachial plexus?

A
  • Somatic motor
  • Somatic sensory
  • Postganglionic sympathetic

No parasympathetic fibers - limbs are part of the body wall, no parasympathetic activity

241
Q

If the median nerve is damaged, will the thumb be adducted or abducted?

A

Adducted

Abductor pollicis brevis will not function, but adductor pollicis will (ulnar nerve)

242
Q

Following a stab wound to the shoulder, the musculocutaneous nerve was severed. What functional deficits would you expect to see?

A

Diminished elbow flexion and shoulder flexion

Note: note completely lost since some of the muscles of the anterior forearm can flex the elbow, and deltoid and pec. major can flex the shoulder

243
Q

Which muscle is outlined in blue?

What is its function?

Innervation?

Attachments?

A

Flexor digiorum profundus

Flex fingers at MCP, PIP, and DIP

Median nerve (lateral 1/2), Ulnar nerve (medial 1/2)

Ulna, distal phalanges 1-4

244
Q

Which joint is involved in flexion and extension of the elbow?

A

Ulnotrochlear joint

Coronoid process and trochlear notch of ulna + trochlea of humerus

245
Q

Which structure is labeled by #1?

A

Coracoclavicular joint

Conoid ligament (left) + Trapezoid ligament (right)

246
Q

Which structure is labeled by #7?

A

Median nerve

247
Q

Which compartment is shown in this picture?

What are its primary actions?

What is its innervation?

A

Anterior compartment of the forearm

Wrist flexion, finger flextion, forearm pronation

Median nerve

248
Q

Which vessel is labeled by #5?

A

Median cubital vein

Fig. 11.6 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 20.2A.

249
Q

Which structure is labeled by #1?

A

Supraspinatus

250
Q

Which boney structure is labeled by #2?

A

Coracoid process of the scapula

Fig. 11.6 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 20.2A.

251
Q

The medial cutaneous nerve of the forearm is a terminal branch off which cord of the brachial plexus

A

Medial cord

252
Q

Which structure is labeled by #7?

A

Trochlea of the humerus

Articulates with the coronoid process of the ulna

253
Q

Which nerve is compressed in carpal tunnel syndrome?

What are the consequences?

A

The median nerve is compressed

Usually compression is due to repetitive use of the fingers; the tendons of flexor digitorum superficialis and flexor digitorum profundus run through the carpal tunnel. Overuse results in increased serous fluid, which leads to compression of the median nerve

  • Loss/reduction of thumb function
    • The thenar compartment is innervated by the recurrent branch of the medial nerve, which branches right after the nerve emerges from the carpal tunnel
  • Pain in the cutaneous distribution of the median nerve
    • Lateral palm of the hand
254
Q

Which structure is labeled by #10?

A

Lateral head of triceps brachii

255
Q

Which structure is labeled by #2?

A

Acromioclavicular joint

(Covered by the acromioclavicular ligament)

Note: This is the left scapula, anterior view

256
Q

Which structure is labeled by #4

A

Greater tubercle of the humerus

257
Q

Which nerve innervates section 4 (orange)?

A

Median nerve

258
Q

Which strucutre is labeled #6?

A

Radius

Fig. 11.5 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 23.2.

259
Q

Which structure is labeled by #1?

A

Brachial artery

260
Q

Which structure is labeled by #1?

What is its innervation?

A

Supraspinatus

Suprascapular nerve

261
Q

Which structure is labeled by #14?

A

Median nerve

262
Q

Describe biceps brachii

  • Function:
  • Attachments:
  • Innervation:
A

Biceps brachii

  • Function: Shoulder flexion, elbow fexion, supination
  • Attachments:
    • Short head: Coracoid process, radial tuberosity
    • Long head: Supraglenoid tubercle, radial tuberosity
  • Innervation: Musculocutaneous nerve
    • Same as all muscles of the anterior compartment of the arm
263
Q

Which structure is labeled by #4?

A

Radial tuberosity

Fig. 11.4 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Figs. 22.1A, 22.1B.

264
Q

Which structure of the nervous system is labeled by #6?

A

Medial cord

265
Q

This image shows the deepest layer of the anterior compartment of the arm

Which structure is labeled by #14?

A

Tendon of flexor pollicis longus

(Muscle is 37)

266
Q

Which structure is labeled by #5?

A

Abductor pollicis longus

267
Q

Which vessel is labeled by #14?

A

Deep palmar arch

Gets most of its supply from the radial artery

Fig. 16.2 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 24.1B.

268
Q

List the lateral rotators of the shoulder joint

What innervates them?

A
  • Infraspinatus - Suprascapular nerve
  • Teres minor - Axillary nerve
269
Q

Which nerve is labeled by #7?

A

Median nerve

Will go on to innervate most of the anterior compartment of the forearm

270
Q

Which nerves innervate the body wall?

A

Spinal nerves

  • Ventral ramus
    • Extrinsic back muscles
    • Intercostal muscles
    • Limbs (extensions of the body wall) via plexi
    • Anterior and lateral cutaneous nerves
      • Skin and superficial fascia
  • Dorsal ramus
    • Intrinsic back muscles
    • Posterior cutaneous nerves
      • Skin and superficial fascia
271
Q

Loss of senasation in the pinkie finger indicates injury to which nerve?

A

Ulnar

272
Q

List the pathway of the vein on the radial side of the upper limb, from its most proximal point to its entry into the deep venous system

A
  • Doral Arch
  • Cerphalic Vein
  • Axillary vein (part of deep venous system)
273
Q

Which structures are labeled by #4?

  • Artery:
  • Nerve:
A
  • Artery: Profunda brachii (Deep brachial artery)
  • Nerve: Radial
274
Q

Which muscles function to extend the wrist and digits?

Which nerve innervates these muscles?

A
  • Extensor digitorum
  • Extensor pollicis

Innervated by the radial nerve (posterior comartment of the forearm)

275
Q

Which structure is labeled by #3?

A

Brachioradialis

276
Q

Damage to which nerve would result in pain or sensory loss on the lateral side of the forearm?

A

Lateral cutaneous nerve

Note - if a cutaneous nerve is damaged, there will be no motor loss because it is a cutaneous nerve

(superficial branch of the musculocutaneous nerve)

277
Q

What part of the shoulder is injured in a separated shoulder?

A

The ligaments of the acromioclavicular (AC) and/or coracoclavicular (CC) joints

Severity of the injury depends on whether they are stretched or torn

278
Q

If the ulnar nerve is damaged, which fingers will maintain the ability to flex?

A

Thumb, 1st digit, 2nd digit

279
Q

Which muscle is labeled by #3?

A

Lateral head of triceps brachii

Fig. 11.6 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 20.2A.

280
Q

If the ulnar nerve is damaged, will the thumb be adducted or abducted?

A

Abducted

Ulnar nerve innervates adductor pollicis

Median nerve (recurrent branch) innervates abductor pollicis brevis

281
Q

Which nerve supplies the thenar compartment of the hand?

A

Recurrent branch of the median nerve

282
Q

Which cord from the brachial plexus forms the ulnar nerve?

A

Medial cord

283
Q

Which structure is labeled by #20?

A

Ulnar artery

284
Q

Which cord from the brachial plexus forms the musculocutaneous nerve?

A

Lateral cord

285
Q

Which number labels the axillary nerve?

A

9

286
Q

Which muscles are shown in this picture?

What is their function?

What is their innervation?

A

Palmar interossei (deep to the lumbricals)

Adduct the fingers toward the middle finger

Ulnar nerve (deep branch)

287
Q

Which artery follows the superficial branch of the radial nerve?

A

Radial artery

288
Q

Which vessel is labeled by #10?

A

Posterior interosseous artery

Fig. 16.2 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 24.1B.

289
Q

Which nerve is labeled by #4?

It is a continuation of which nerve?

A

Lateral cutaneous nerve of the arm

Continuation of the musculocutaneous nerve

290
Q

A girl falls on her outstretched hand. She experiences wrist pain and points to area between the extensor pollicis longus and abductor pollicis longus tendons.

Which bone is most likely broken?

What is a possible complication of this injury?

A

Scaphoid

Blood supply to the scapoid is through the distal side; a break in the scaphoid could cut off blood supply to the proximal scaphoid, resulting in avascular necrosis

291
Q

Which vein is labeled by #3?

A

Basilic vein

(Empties into the brachial vein)

292
Q

Which boney structure is labeled by #6?

A

Styloid process of the radius

Fig. 11.6 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 20.2A.

293
Q

List the pathway of the vein on the ulnar side of the upper limb, from its most proximal point to its entry into the deep venous system

A
  • Dorsal arch
  • Basilic vein
  • Brachial vein (part of the deep venous system)
294
Q

Describe the serratus anterior

  • Function:
  • Attachments:
  • Innervation:
A

Serratus anterior

  • Function: Protract the scapula, lower a raised arm, rotate the scapula laterally
  • Attachments: Scapula, ribs
  • Innervation: Long thoracic nerve
295
Q

Describe the structure labeled by #36

  • Muscle:
  • Function:
  • Attachments:
  • Innervation
A
  • Muscle: Flexor digiti minimi brevis
  • Function: Flex the 5th digit
  • Attachments: Hook of hamate, proximal phalanx
  • Innervation: Ulnar nerve (deep branch)
296
Q

Which articulation is labeled by #3?

A

Glenohumeral joint

297
Q

Which nerve innervates section 2 (purple)?

A

Musculocutaneous nerve

298
Q

Which number labels flexor digitorum superficialis?

A

30

299
Q

Which structure is labeled by #6?

What is it innervated by?

A

Subscapularis

Subscapular nerve

300
Q

Which structure is labeled by #3?

A

Extensor carpi radialis

301
Q

Which structure is labeled by #21?

A

Common interosseous artery

It branches into the anterior (23) and posterior interosseous arteries

302
Q

Which vein is labeled by #3?

A

Median cubital vein

Connects the cephalic and basilic veins

Median cubital vein is often used for blood draws and IV line placement

303
Q

Which structure is labeled by #4?

A

Teres major

304
Q

Which structure is labeled by #2?

A

Coracoacromial ligament

305
Q

Which structure is labeled by #8?

A

Flexor retinaculum

(Roof of the carpal tunnel)

306
Q

Which structure is labeled by #5?

Which bone articulates with this structure?

A

Capitellum

Head of the radius

307
Q

Which number labels the ulnar nerve?

Which muscles of the anterior compartment does it supply?

A

13, 27

Flexor digitorum profundus (medial 1/2)

Flexor carpi ulnaris

Note: does not pass under the flexor retinaculum => it is vulnerable to cuts of the wrist

308
Q

Which vessels are labeled by #3?

A

Anterior and posterior humeral circumflex arteries

Fig. 16.2 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 24.1B.

309
Q

Which structure is labeled by #4?

A

Brachial artery

310
Q

Which structure is labeled by #3?

A

Coracoid process of the right scapula

311
Q

Injury to which nerve results in “Wrist drop”: wrist flexed, forearm pronated?

A

Radial nerve

312
Q

In the brachial plexus, the posterior cord branches into the…

A

Axillary and radial nerves

313
Q

What structure is labeled by #15?

A

Supraspinatus?

314
Q

Which muscle is labeled by #7?

Which nerve supplies it?

A

Subscapularis

Subscapular nerve

315
Q

Which vein is labeled by #7?

A

Cephalic vein

316
Q

Which vein is labeled by #1?

How does it enter the deep venous system?

A

Cephalic vein

Empties into the axillary vein at the deltopectoral triangle

317
Q

What is the purpose of the coracoclavicular joint?

What type of joint is it?

A

The coracoclavicular joint (CC) anchors the clavicle to the scapula

Fibrous joint

318
Q

Which structure is labeled by #2?

A

Median nerve

319
Q

Which structure is labeled by #2?

A

Lesser tubercle of the humerus

320
Q

Which structures are supplied by the suprascapular nerve?

A

Supraspinatus

Infraspinatus

(Muscles of the rotator cuff)

321
Q

Which structure is labeled by #6?

A

Radial collateral ligament

322
Q

Which number labels the deep brachial artery?

A

20

323
Q

Which structure is labeled by #9?

A

Radial artery

324
Q

If a patient cannot extend their elbow or wrist, which nerve is most likely injured?

A

Radial nerve

325
Q

Which vessel is labeled by #24?

Perspective: imagine the elbow is coming out of the screen and the shoulder is going into the screen

A

Brachial artery

326
Q

Which structure is labeled by #4?

A

Teres minor

Part of the rotator cuff of the shoulder

327
Q

Which structure is labeled by #5?

A

Lateral epicondyle of the humerus

328
Q

Describe the anterior compartment of the forearm

  • Muscles:
  • Actions:
  • Nerve:
  • Atttachments:
A

Anterior component of the forearm

  • Muscles:
    • Wrist flexors - Flexor carpi radialis
    • Wrist and digital flexors - Flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus
    • Forearm pronators - Pronator teres, pronator quadratus
  • Actions: Flexion of the wrist and/or digits, pronate the forearm
  • Nerve: Median nerve
    • Ulnar nerve for flexor digitorum profundus and flexor carpi ularis only
  • Atttachments: medial epicondyle of the humerus
329
Q

Which structure is labeled by #2?

A

Anatomical neck of the humerus

330
Q

What structure is labeled by #4?

A

Brachial artery

331
Q

Which structure is labeled by #5?

A

Infraspinatus

Part of the rotator cuff of the shoulder

332
Q

Describe the structure labeled by #14

  • Muscle:
  • Function:
  • Attachments:
  • Innervation:
A
  • Muscle: Extensor carpi radialis longus (Brevis is 15)
  • Function: Extend the wrist
  • Attachments: Lateral condyle of the humerus, 2nd metacarpal
  • Innervation: Radial nerve
333
Q

Which muscles are wrist and digital felxors?

Which nerve innervates these muscles?

A
  • Wrist and digital flexors
    • Flexor digitorum superficialis (Median nerve)
    • Flexor digitorum profundus (Ulnar nerve)
    • Flexor pollicis longus ​(Median nerve)

All are part of the anterior component of the forearm

334
Q

Describe coracobrachialis

  • Function:
  • Attachments:
  • Innervation:
A

Coracobrachialis

  • Function: Shoulder flexion, adduction, internal rotation
  • Attachments: Coracoid process, humerus
  • Innervation: Musculocutaneous nerve
    • Same as all muscles of the anterior compartment of the arm
335
Q

Which muscle is labeled by #1?

A

Deltoid

Fig. 11.6 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 20.2A.

336
Q

Describe supraspinatus

  • Function:
  • Attachments:
  • Innervations:
A

Supraspinatus

  • Function: Abduct the arm
  • Attachments: Scapula, greater tuberosity
  • Innervations: Suprascapular nerve

Part of the rotator cuff

337
Q

Which nerve innervates section 3 (pink)?

A

Radial nerve (superficial branch)

338
Q

List the abductors of the shoulder joint

What innervates them?

A
  • Deltoid - Axillary nerve
  • Supraspinatus - Suprascapular nerve
    • Part of rotator cuff
339
Q

What structure is labeled by #5?

A

Ulnar nerve

340
Q

Which structure is labeled by #4?

A

Acromion of the right scapula

341
Q

Which nerve is labeled by #7?

What does it innervate?

A

Superficial branch of the radial nerve

Sensory nerve that innervates the lateral half of the back of the hand (not including the fingertips)

342
Q

Humerus fractures often occur at the _________ and can result in a lesion of the _________.

Which actions will be compromised?

A

Humerus fractures often occur at the surgical neck** and can result in a lesion of the **axillary nerve.

Shoulder abduction and external rotation will be compromised

343
Q

Which number labels the common interosseous artery?

A

21

Comes from the ulnar artery (17)

Branches into the anterior (23) and posterior interosseous arteries

Note: #14 is the median nerve

344
Q

Which structure is labeled by #3?

A

Teres minor

345
Q

Which nerves are involved in flexion of the wrist and fingers?

Which compartment is this?

A

Median and ulnar nerves

Anterior compartment of the forearm

  • Wrist flexorsFlexor carpi radialis, flexor carpi ulnaris
  • Wrist and digital flexors – Flexor digitorum superficialis, flexor digitorum profundus (ulnar), flexor pollicis longus
346
Q

Describe the posterior compartment of the arm

  • Muscles:
  • Actions:
  • Nerve:
  • Atttachments:
A

Posterior component of the arm

  • Muscles: Triceps brachi
  • Actions: Extension of the shoulder and elbow joints
  • Nerve: Radial
  • Atttachments: Infraglenoid tubercle, olecranon process of the ulna
347
Q

Describe brachialis

  • Function:
  • Attachments:
  • Innervation:
A

Brachialis

  • Function: Elbow flexion
  • Attachments: Humerus, ulnar tuberosity
  • Innervation: Musculocutaneous nerve
    • Same as all muscles of the anterior compartment of the arm
348
Q

Which structure is labeled by #5?

What does it innervate?

A

Musculocutaneous nerve

Innervates the anterior compartment of the arm (biceps brachii, coracobrachialis, brachialis)

349
Q

Which structure is labeled by #3?

A

Head of the radius

Fig. 11.4 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Figs. 22.1A, 22.1B.

350
Q

What do muscles within the same compartment generally have in common?

A

Embryological origin

Nerve and blood supply

Attachment points

Function

351
Q

Which structure is labeled by #11?

A

Deltoid

352
Q

Which structure is labeled by #5?

What is its innervation?

A

Triceps brachii (Lateral head)

Radial nerve

353
Q

Which nerve is responsible for extension of the shoulder, elbow, wrist, and fingers?

Which compartments are involved?

A

Radial nerve

Posterior arm, posterior forearm

354
Q

An infection in which synovial digital sheath could result in the most serious complication?

A

Synovial digital sheath of the 5th digit

This sheath is continuous with the common flexor synovial sheath, which contains the tendons of the wrist; the infection could spread far

355
Q

Which vessel is labeled by #12?

A

Anterior interosseous artery

Fig. 16.2 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 24.1B.

356
Q

If a patient cannot hold paper between their fingers, which nerve is most likely damaged?

A

Ulnar nerve

Innervates the palmar interossei, which adduct the fingers toward the middle finger

(Ulnar nerve also supplies the dorsal interossei, which abduct the fingers away from the middle finger)

357
Q

Which structure is labeled by #6?

A

Ulnar artery and nerve

358
Q

Which structure is labeled by #7?

A

Medial epicondyle of the humerus

359
Q

What structure is labeled by #4?

A

Glenoid cavity of the scapula

360
Q

The head of the humerus articulates with the
_____ of the _____

A

The head of the humerus articulates with the
glenoid** of the **scapula

361
Q

What is cubital tunnel syndrome?

A

Irritation of the ulnar nerve as it crosses the medial epicondyle, passing through the two heads of flexor carpi ulnaris (the cubital tunnel)

This leads to sensation similar to hitting your funny bone

362
Q

Label the indicated components of the medial plexus

            1. 7.
A
  1. Lateral cord
  2. Musculocutaneous nerve
  3. Lateral cord’s contribution to the median nerve
  4. Median nerve
  5. Ulnar nerve
  6. Medial cord’s contribution to the median nerve
  7. Medial cord

Not pictured: Posterior cord, which gives rise to the axillary nerve and radial nerve

363
Q

If a patient cannot supinate their hand, which nerve is most likey injured?

A

Radial nerve

364
Q

Which structure is labeled by #3?

A

Coracoid process of the scapula

365
Q

Describe the structure labeled by #16

  • Muscle:
  • Function:
  • Attachments:
  • Innervation:
A
  • Muscle: Abductor pollicis longus
  • Function: Abduct the thumb
  • Attachments: Ulna, radius, interosseus membrane, 1st metacarpal
  • Innervation: Radial nerve
366
Q

Which structure is labeled by #8?

A

Medial epicondyle of the humerus

367
Q

Which muscles control thumb movement?

What are their nerve supplies?

A
  • Ulnar
    • Adductor pollicis
  • Median - Thenar compartment
    • Abductor pollicis brevis
    • Flexor pollicis brevis
    • Opponens pollicis
  • Median - Anterior forearm
    • Flexor pollicis longus
  • Radial - Posterior forearm
    • Extensor pollicis longus
    • Extensor pollicis brevis
368
Q

Which arteries supply the common digital arteries?

A

The superficial and deep palmar arches both contribute to each common digital artery

  • Ulnar and radial arteries meet to from the superficial and deep palmar arches
  • The superficial palmar arch, supplied primarily by the ulnar artery, is a larger source of blood than the deep
  • The radial artery contributes more blood to the deep palmar arch

Therefore, the ulnar artery is the largest source of blood for the common digital arteries

369
Q

Which structure is labeled by #10?

A

Cephalic vein

(Joins the deep venous system via the axillary vein)

370
Q

Which vein is labeled by #19?

Perspective: imagine the elbow is coming out of the screen and the shoulder is going into the screen

A

Cephalic vein

371
Q

Which two muscles are antagonists to supination of the forearm?

A

Pronator teres

Pronator quadratus

372
Q

Which injury is showin in both Picture A and Picture B?

Which structures are compromised in each picture?

A

Both: Separated shoulder

Separation of the clavicle from the scapula

  • A: Dislocation of acromioclavicular joint
  • B: Dislocation of acromioclavicular joint with rupture of the coracoclavicular ligament
373
Q

Which structure is labeled by #1?

A

Axillary artery

374
Q

Which structure is labeled by #4?

A

Flexor digitorum profundus

375
Q

Which structures are found in the carpal tunnel?

A
  • Median nerve
  • Flexor digitorum superficialis
  • Flexor digitorum profundus
  • Flexor pollicis longus
376
Q

Loss of sensation in the tips of the thumb, index, and ring fingers indicates injury to which nerve?

A

Median

377
Q

Which structure is labeled by #7?

A

Head of the ulna

Fig. 11.4 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Figs. 22.1A, 22.1B.

378
Q

Which muscle of the rotator cuff stabilizes the shoulder anteriorly?

A

Subscapularis

379
Q

Describe the structure labeled by #27

  • Muscle:
  • Function:
  • Attachments:
  • Innervation:
A
  • Muscle: Adductor pollicis longus transverse head
    • Oblique head is #26)
  • Function: Adduct the thumb
  • Attachments: Third metacarpal, proximal phalanx of thumb
  • Innervation: Ulnar nerve (C8-T1)
380
Q

Identify the labeled structures

  • A:
  • B:
  • C:
  • D:
A
  • A: Deltoid muscle
  • B: Head of the Humerus
  • C: Supraspinatus muscle
  • D: Glenoid of the scapula
381
Q

Which structure is labeled by #6?

A

Radial artery

382
Q

Which muscles flex the wrist?

Which nerve innervates these muscles?

A
  • Wrist only flexors
    • Flexor carpi radialis (Median nerve)
    • Flexor carpi ulnaris (Ulnar nerve)
  • Wrist and digital flexors
    • Flexor digitorum superficialis (Median nerve)
    • Flexor digitorum profundus (Median nerve + Ulnar nerve)
    • Flexor pollicis longus ​(Median nerve)

All are part of the anterior component of the forearm

383
Q

Which structure is labeled by #3?

A

Head of the humerus

384
Q

Describe the structure labeled by #7

  • Muscle:
  • Function:
  • Attachments:
  • Innervation:
A
  • Muscle: Extensor digitorum
  • Function: Extend the wrists and digits
  • Attachments: Lateral epicondyle of the humerus, middle and distal phalanges
  • Innervation: Radial nerve
385
Q

What structure is labeled by #1?

A

Scapular spine

386
Q

Which muscle is labeled by #9?

Which nerve supplies it?

A

Supraspinatus

Suprascapular nerve

387
Q

Which structures may be damaged by an anterior shoulder dislocation?

A

Glenohumeral ligaments

Glenoid labrum

Glenohumeral joint capsule

Axillary nerve

388
Q

A boy suffers a severe laceration of the forearm. To check the ulnar pulse near the wrist the examiner would palpate which of the following locations?

A) lateral to the tendon of the flexor carpi ulnaris

B) lateral to the tendon of the flexor digitorum superficialis

C) lateral to the tendon of the palmaris longus

D) medial to the tendon of the flexor carpi ulnaris

A

A) lateral to the tendon of the flexor carpi ulnaris

389
Q

Which numbers together make up the biceps muscle?

A

3 and 4

390
Q

Which structure is labeled by #36?

A

Flexor digitorum profundus

(Sections in the forearm are more distict than FDS)

391
Q

Which structure is labeled by #17?

A

Ulnar artery

Relevant branches:

  • Common interosseous (21)
  • Will go on to supply the majority of the blood for the superficial palmar arch
392
Q

A child suffers a deep cut wound on the palmar aspect of the index finger. What movement of the index finger would show the emergency room doctor that function of the flexor digitorum profundus was preserved?

A

Flexion of the distal interphalangeal joint (DIP)

Flexor digitorum profundus is the only muslle that can flex the fingers at the DIP joint

The PIP joint can be flexed by flexor digitorum profundus or flexor digitorum superficialis

393
Q

List the three types of synovial joints from most to least mobile

A
  • Ball and socket
    • Permit movement on several axes
  • Condylar joints
    • Permit movement in one major and one minor direction
  • Hinge joints
    • Permit motion in one direction
394
Q

Which structure of the nervous system is labeled by #7?

A

Ulnar nerve

395
Q

Which structure is labeled by #3?

A

Brachioradialis

Most superficial extensor; on the lateral side of the anterior forearm

396
Q

Which structure is labeled by #1?

A

Deltoid

397
Q

Which vessel is labeled by #29?

Perspective: imagine the elbow is coming out of the screen and the shoulder is going into the screen

A

Basilic vein

398
Q

Which structure is labeled by #2?

A

Brachialis

Part of anterior compartment of the arm (musculocutaneous nerve)

399
Q

Describe latissimus dorsi

  • Function:
  • Attachments:
  • Innervation:
A

Subscapularis (anterior part of the rotator cuff)

  • Function: Adduct, internally rotate, extend teh arm
  • Attachments: Vertebrae, Scapula, Humerus, Iliac crest
  • Innervation: Ventral ramus of spinal nerve
400
Q

Identify the labeled structures

  • A:
  • B:
  • C: (a joint)
  • D:
A
  • A: Clavicle
  • B: Coracoid process of the scapula
  • C: Acromioclavicular joint
  • D: Head of the humerus
401
Q

Together, the structures labeled #5 make up the…

A

Carpals

Fig. 11.5 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 23.2.

402
Q

Which bone is labeled by #3?

A

Ulnar collateral ligament

403
Q

A 74 year old man complains of pain in his right hand and fingers when he works with his hands for a while. Thorough testing reveals insufficient blood flow into the deep palmar arch.

Occlusion of which artery is the most likely cause of this condition?

A

Radial artery

404
Q

Which vessel is labeled by #16?

A

Common palmar digital arteries

(Will separate into palmar digital arteries)

Fig. 16.2 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 24.1B.

405
Q

Which structure is labeled by #6?

A

Styloid process of the ulna

Fig. 11.4 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Figs. 22.1A, 22.1B.

406
Q

What muscle is labeled by #1?

A

Supraspinatus

(Part of the rotator cuff)

407
Q

Which muscle is labeled by #20?

Perspective: imagine the elbow is coming out of the screen and the shoulder is going into the screen

A

Biceps brachii

408
Q

Which vessel is labeled by #8?

A

Axillary artery

409
Q

Which structure is labeled by #1?

A

Coronoid process of the ulna

Fig. 11.4 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Figs. 22.1A, 22.1B.

410
Q

Which nerve is involved in flexion of the shoulder and elbow?

Which compartment is this?

A

Musculocutaneous nerve

Anterior compartmetn of the arm

(Biceps brachii, coracobrachialis, brachialis)

411
Q

Which structure is labeled by #6?

What is its innervation?

A

Triceps bracii (long head)

Radial nerve

412
Q

Which muscle is labeled by #1?

Which nerve supplies it?

A

Coracobrachialis

Musculocutaneous nerve

413
Q

Which structure is labeled by #7?

A

Styloid process of the radius

Fig. 11.4 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Figs. 22.1A, 22.1B.

414
Q

Describe the structure labeled by #11

  • Muscle:
  • Function:
  • Attachments:
  • Innervation:
A
  • Muscle: Abductor pollicis brevis
  • Function: Abduct the thumb
  • Attachments: Tubercles of the scaphoid and trapezium, proximal phalanx of thumb
  • Innervation: Median nerve; recurrent branch
415
Q

Which structure is labeled by #2?

What is its innervation?

A

Teres minor

Axillary nerve

416
Q

Which vessel is labeled by #1?

A

Thoracoacromial artery

  • Right subclavian -> Thoracoacromial (1) -> Axillary (2) -> Brachial (6)*
  • Fig. 16.2 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Fig. 24.1B.*
417
Q

This image shows the deepest layer of the anterior compartment of the arm

Which structure is labeled by #37?

What is its function?

Attachments?

Innervation?

A

Flexor pollicis longus (continues as #14)

Flex the thumb (from resting -> across the palm)

Radius, palmar aspect of distal phalanx of the thumb

Median nerve

418
Q

Which bone is broken?

Which artery and nerve are most at risk?

What deficit would result?

A

Humerus

Deep brachial artery and radial nerve

Deficit in wrist extension -> wrist drop

419
Q

Which structure is labeled by #16?

A

Brachial artery

WIll split into the radial (6) and ulnar (20) arteries

420
Q

Which artery supplies most of the blood to the hand?

A

Ulnar artery via superficial palmar arch

(Superficial palmar arch is a larger source of blood than the deep palmar arch)

421
Q

Which muscles depress the scapula?

A

Inferior trapezius

Serratus anterior

422
Q

Which articulation is labeled by #2?

A

Coracoclavicular joint

423
Q

Which nerves innervate the palm?

A

Median nerve (orange)

Ulnar nerve (blue)

424
Q

List the adductors of the shoulder joint

What innervates them?

A
  • Latissimus dorsi - Ventral rami of spinal nerve (subscapular)
  • Teres major - Subscapular nerve
  • Pectoralis major - Lateral pectoral nerve
425
Q

Which structure is labeled by #8?

A

Extensor digiti minimi

426
Q

Which structure is labeled by #9?

What innervates it?

A

Lattisimus dorsi

Ventral rami of a spinal nerve

427
Q

The lateral cutaneous nerve of the forearm is a terminal branch off which major nerve of the brachial plexus?

A

Musculocutaneous nerve

(From the lateral cord)

428
Q

Which structure is labeled by #2?

Which muscles attach here?

A

Lesser tubercle of the humerus

Subscapularis

(The only muscle of the rotator cuff that doesn’t attach to the greater tubercle)

429
Q

What structure is labeled by #2?

A

Coracoid process of the scapula

430
Q

Which three nerves might be injured due to venipuncture in the median cubital fossa?

How can you tell which nerve is injured?

A
  • Lateral cutaneous nerve
    • Cutaneous branch of the musculocutaneous nerve
    • Supplies the skin on the lateral side of the forearm
  • Medial cutaneous nerve
    • Branch of the ulnar nerve
    • Supplies the skin on the medial side of the forearm
  • Median nerve
    • Usually due to deeper puncture
    • Supplies the skin on the palmar side of the lateral 3.5 digits
431
Q

Which structure is labeled by #3?

What does it innervate?

A

Median nerve

Innervates most of the muscles in the anterior compartment of the forearm

  • Flexors of the wrist and fingers
    • Flexor carpi radialis
    • Palmaris longus
    • Flexor digitorum superficialis
  • Pronators
    • Pronator teres
    • Pronator quadratus
432
Q

Which structure is labeled by #3?

A

Acromion of the left scapula

433
Q

Which muscles elevate the scapula?

A

Superior trapezius

Levator scapulae

Rhomboids

434
Q

Which structure is labeled by #3?

A

Trochlear notch of the ulna

(This is the part of the olecranon that articulates with the trochlea of the humerus)

Fig. 11.4 Adapted from Gilroy et al. Atlas of Anatomy, second edition, Figs. 22.1A, 22.1B.

435
Q

Which structure is labeled by #3?

Which muscles attach here?

A

Lateral epicondyle

Some wrist extensors

436
Q

List the flexors of the shoulder joint

What innervates them?

A
  • Biceps brachii - Musculocutaneous nerve
    • Main flexor of the shoulder joint
  • Deltoid - Axillary nerve
  • Pectoralis major - Lateral pectoral nerve
437
Q

Which structures bound the anatomical snuffbox? Which artery passes through?

A

Extensor pollicis longus, extensor pollicis brevis, adductor pollicis longus are the edges

Scaphoid is the floor

Radial artery

438
Q

Which structure is labeled by #4?

A

Flexor carpi radialis

439
Q

The subscapular nerves arise from which cord of the brachial plexus?

A

Posterior cord

440
Q

Together, the structures highlighted in yellow are called the…

A

Rotator cuff

441
Q

What structure is labeled by #11?

A

Coracobrachialis

442
Q

Which articulation is labeled by #4?

A

Sternoclavicular joint

443
Q

What structure is labeled by #13?

A

Short head of biceps brachii

(Long head is #14)

444
Q

What muscle is labeled by #4?

A

Subscapularis

(Part of rotator cuff)

445
Q

What structure is labeled by #3?

A