What are the two ends of the clavicle referred to as
Sternal End and Acromial End
Which is more lateral, the acromion or the coracoid process
The acromion is more lateral and the coracoid process is more medial
Which is more medial, the lesser or greater tubercle of the humerus
The lesser tubercle is more medial
What is the supraspinous fossa
Look at superior margin of left scapula (It is the depression on the superior border of the posterior scapula)
What part of the humerus articulates with the scapula
The head of the humerus
Anatomical vs Surgical necks of Humerus
The anatomical neck is the part between the head and the tuberosities
The surgical neck is the part between the tuberosities and the shaft
What is the name of the space between the two tuberosities of the humerus
Intertubercular sulcus/bicipital groove
What is the suprascapular notch
A tiny groove between the superior border of the scapula and coracoid process
Subscapular Fossa
Infraspinous Fossa
On the posterior side of the scapula
Coronoid Fossa
Where is the deltoid tuberosity located
About halfway down the anterolateral surface of the humerus
Which protrudes more, the medial or lateral epicondyles?
Medial Epicondyle
What is the majority of the humerus referred to as
Shaft
Which is more medial, the trochlea or the capitulum
The trochlea is more medial
What articulates with the trochlea and what articulates with the capitulum
Trochlea - Ulna
Capitulum - Radius
What bone(s) articulates with the carpal bones
The Radius does articulate but the ulna does not
Bones at the base of the hand
Carpal Bones
What bones are directly distal to the bones at the base of the hand
Metacarpal bones
What group of bones (3) are the most distal of the hand
Phalanges (proximal, middle and distal)
What are the bones of the thumb referred to as
Proximal Phalanx and Distal Phalanx
Styloid process general meaning
A slender projection of bone
Where is the Glenoid Fossa
Lateral border of the scapula
Where is the supraglenoid tubercle located relative to the coracoid process
Posterior to the base
Where is the infraglenoid tubercle locates relative to the lateral border of the scapula
Inferior
Where do the two heads of the biceps brachii articulate
Short Head - Apex of Coracoid Process
Long Head - Supraglenoid Tubercle of scapula
Which is more medial - the long or short head of the biceps brachii
The short head is more medial
Describe the path of the musculocutaneous nerve relative to the flexor muscles
Superficial to the brachialis but deep to the biceps brachii
To which part of the upper limb does the musculocutaneous nerve provide sensory supply
Lateral aspect of the forearm
Three flexors of the arm from superficial to deep
Biceps Brachii
Brachialis
Coracobrachialis
(BBC)
What nerve provides motor innervation of the flexors of the arm
Musculocutaneous Nerve
Origin of coracobrachialis
Coracoid process of scapula (think of name)
Insertion of coracobrachialis
Anteromedial surface of humeral shaft
What is the axillary artery referred to as when it goes into the upper arm
Brachial Artery
What are the two main arteries of the forearm
Ulnar and Radial Arteries
Name the 3 heads of the triceps brachii
Medial Head
Lateral Head
Long Head
Origins of the triceps brachii heads
Long Head - Infraglenoid Tubercle of Scapula
Medial Head - Posterior surface of humerus (inferior to radial groove)
Lateral Head - Posterior surface of humerus (superior to radial groove)
Olecranon
Proximal Tip of Ulna
Insertion of triceps brachii
Olecranon of Ulna and Fascia of Forearm
Which nerve supplies the motor innervation of the triceps brachii
Radial Nerve
Teres Major
Origin of Teres Major
Inferior Angle of lateral border of scapula
Insertion point of teres major
Intertubercular sulcus of humerus
What nerve innervates the teres major and which cord does it come from
Lower subscapular nerve - from posterior cord of brachial plexus
Latissimus Dorsi
Where does the latissimus dorsi insert
Intertubercular sulcus between pec major and teres major muscles
** Lady between two majors
What nerve innervates the Lattisimus Dorsi and which cord does it come from
Thoracodorsal Nerve - from posterior cord of brachial plexus
Radial Groove
Broad shallow depression on posterior humeral shaft for the radial nerve and deep brchial artery
Anconeus
Small triangular muscle of tarm located at posterior aspect of elbow
Origin of anconeus
Lateral Epicondyle
Insertion point of anconeus
Lateral surface of olecranon
Insertion point of anconeus
Lateral surface of olecranon
Innervation of Anconeus muscle
Radial Nerve
Relation of ulnar nerve to medial epicondyle
Superficial (this nerve is the ‘funny bone’)
Which flexor of the arm provides the greatest amount of flexion force
Brachialis
What do the biceps and brachialis do that the coracobrachialis does not
The coracobrachialis will flex & adduct the arm but not the forearm, unlike the other two muscles I think
When is the biceps more powerful
When the elbow approaches 90 degrees
Boundaries of Cubital Fossa
Superior - Imaginary line between medial and lateral epicondyles
Medial - Pronator Teres Muscle
Lateral - Brachioradialis Muscle
Clinical Significance of Cubital Fossa Surface Anatomy
Blood transfusion from median cubital vein
Arteriovenous fistula for haemodialysis
Order of preference
Radial Artery - Cephalic Vein
Brachiocephalic Insertions
Brachiobasilic Insertions
Contents of Cubital Fossa
Terminal part of brachial artery
Start of radial & Ulnar Arteries
Meduan & Radial Nerves - both superficial and superficial branches
Superficial Wrist Muscles of Anterior compartment of forearm
Flexor Carpi Ulnaris (FCU)
Flexor Carpi Radialis (FCR)
Superficial Extrinsic Hand Muscles of Anterior compartment of forearm
Palmaris Longus
Flexor Digitalis Superficialis (FDS)
Superficial Forearm Rotator Muscles of Anterior compartment of forearm
Only Pronator Teres
Deep Extrinsic Hand Muscles of Anterior compartment of forearm
Flexor Digitalis Profundus (FDP)
Flexor Pollicis Longus (FPL)
Deep Forearm Rotator Muscles of Anterior compartment of forearm
Only pronator quadratus
Elbow Joint Muscles of Lateral Compartment of Forearm
Brachioradialis
Wrist Muscles of Lateral Compartment of Forearm
Extensor Carpi Radialis Longus (ECRL)
Extensor Carpi Radialis Brevis (ECRB)
Superficial Wrist Muscles of Dorsal Compartment of Forearm
Only Extensor Carpi Ulnaris (ECU)
Superficial Elbow Joint Muscles of Dorsal Compartment of Forearm
Only Anconeus
Superficial Extrinsic Hand Muscles of Dorsal Compartment of Forearm
Extensor Digitorum Communis (EDC)
Extensor Digiti Minimi (EDM)
Deep Forearm Rotator Muscles of Dorsal Compartment of Forearm
Only Supinator
Deep Extrinsic Hand Muscles of Dorsal Compartment of Forearm
Thumb Extenders/Abductors:
Extensor Pollicis Longus (EPL)
Extensor Pollicis Brevis (EPB)
Abductor Pollicis Longus (APL)
Extensor indices proprius (EIP)
Which muscles mostly originate from the medial and which from the lateral epicondyle
Lateral Epicondyle - Extensors & Supinator
Medial Epicondyle - Flexors & Pronator Teres
**THINK MEDIAL - FLEXOR (MOTHER FUCKER)
What causes tenderness & pain at an epicondyle
Overuse of the specific muscle group (e.g. extensors at lateral epicondyles)
Chronically this gives epicondylitis and diseases like tennis elbow & golfers elbow
Most Commonly Affected Flexor Muscle Attachements by Epicondylitis
Pronator Teres (Humeral Head) Flexor Carpi Radialis
**I THINK
Most Commonly Affected Extensor Muscle Attachements by Epicondylitis
Extensor Carpi Radialis Brevis
**I THINK
Superficial Layer Flexor Muscles of the Forearm
Pronator Teres
Flexor Carpi Radialis
Palmaris Longus
Flexor Carpi Ulnaris
Intermediate Layer Flexor Muscles of the Forearm
Flexor Digitorum Superficialis
Deep Layer Flexor Muscles of the Forearm
Flexor Digitorum Profundus
Flexor Pollicis Longus
Pronator Quadatus
Extensor muscles of forearm
Refer to other lecture
Compartments of the forearm
**Volar is split into superficial and deep
What fascia encloses the muscles of the arm
Circumferential Fascia
Movements at wrist
Flexion
Extention
Radial/Ulnar Deviation
Pronation/Supination
Wrist Flexors
Flexor Carpi Radialis
Flexor Carpi Ulnaris
*ALSO DOES DEVIATION
Wrist Extendors
Extensor Carpi Radialis Longus & Brevis
ECU
Muscles involved in wrist pronation/supination
Pronator Teres
Pronator Quadratus
Supinator
Biceps Brachii
Describe the movement of the ulna and radius during pronation
The ulna is kept in place by the annular ligament which circles the radius while not touching it. This allows the radius to freely move over/around the ulna which is kept still as an axis
3 Joints at the elbow joint complex
Humeroradial Joint
Proximal Radioulnar Joint
Humeroulnar Joint
What type of joint is the humeroradial joint
Shadow ball & Socket aka hinge/pivot joint
What bone anatomy is relevant at the humeroradial joint
Capitulum of Humerus
Radius Head
What type of joint is the humeroulnar joint
Hinge Joint
What bone anatomy is relevant at the humeroulnar joint
Trochlea of Humerus
Trochlear Notch of Ulna
What type of joint is the proximal radioulnar joint
Pivot Joint
What bone anatomy is relevant at the proximal radioulnar joint
Radius Head
Radial Notch of Ulna
Which elbow joints are responsible for pro-/supination movements and which for flexion/extension movements
FOOSH Injury
Fall on Out-Stretched Hand
Most significant cause of upper extremity injury
3 Most Common Shoulder Problems
Dislocation
Rotator Cuff Injury
Frozen Shoulder
Frozen Shoulder
The normally flexible elastic joint capsule becomes inflamed and eventually contracted
Severely painful & restrictive
Which nerve is most commonly injured by shoulder dislocation
Axillary Nerve
think logically; proximity to axilla
Simply describe the size relationship between the humeral head (ball) and glenoid fossa (socket) to which it articulates
Head 4x> Socket
**HUMERAL HEAD IS MUCH BIGGER THAN GLENOID FOSSA
Vaguely state the stability of the elbow joint
It is a very stable joint
What type of injury usually causes elbow dislocation
FOOSH Injuries
What are the three main mechanisms of injury to the elbow
Valgus force (movement of distal forearm/hand laterally) Posterior Translation Posterolateral Rotation (i have no clue)
When are elbow joint dislocations the most common type of dislocation
Most common dislocation in children but it is the second most common in adults (after shoulder dislocation)
What is the most common type of elbow dislocation
Posterior dislocation (Past the trochlea)
Most common upper-extremity injury in children
Pulled Elbow/Radial Head Subluxation (Partial dislocation)
Typically results from a quick pull on a child’s arm when the adult lifts the child by the arm or tries to prevent a fall
Sail Sign on X-rays
Joint swelling distending the capsule will lift fat pads and create sail signs
Suggests a fracture in one or more of the bones at the elbow
Bursae
Closed fluid filled sacs (Like a water balloon) that works as a cushion and gliding surface to reduce friction between tissues
Located next to tendons of large joints like the elbows and shoulders
Nerves of the upper limb
Brachial Plexus Terminal Branches
Dorsal Scapular
Long Thoracic
Suprascapular
Subclavius
Lateral & Medial Pectoral
Superior & Inferior subscapular
Thoracodorsal
What muscles does the axillary nerve innervate
Teres Minor
Deltoid
What muscles does the musculocutaneous nerve innervate
BBC (biceps brachii, brachialis, coracobrachialis)
What does the radial nerve innervate
Posterior Arm
Posterior Forearm
Lateral Forearm
What does the Median nerve innervate
Anterior Forearm
Thenar Muscles
Lateral 2 Lumbricals
What does the ulnar nerve innervate
Hypothenar
Central Hand
Main injury on median nerve
Pronator Syndrome
Carpal Tunnel Syndrome
Main injury on ulnar nerve
Ulnar neuropathy at elbow
Distal Ulnar neuropathy at Guyon’s canal
Main injury on radial nerve
Radial Tunnel Syndrome
Wartenberg Syndrome
Humerus Fracture on Shaft
