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Upper Limb Flashcards

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1
Q 
Origin
Insertion
Action
Nerve 
Special features
Pec Major
A

Clavicular head from medial 1/2 of clavicle. Sternocostal head from lateral manubrium and sternum, 6 upper costal cartilages and external oblique aponeurosis.

Lateral lip of bicipital groove of humerus and anterior lip of deltoid tuberosity

Clavicular: flexes and adducts arm
Sternal: adducts and medially rotates arm
Accessory muscle of respiration.

Medial pectoral nerve abd lateral pectoral nerve

Only muscle to be supplied by all 5 segments of brachial plexus. Folds on itself with clavicular fibres lowest and sternal fibres highest

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2
Q 
Origin
Insertion
Action
Nerve 
Special features
Pec Minor
A

Anterior aspect of 3,4, 5 ribs

Med and upper surface of coracoid process of scapula

Elevates ribs if scapula fixed, protraction of scapula

Medial pectoral nerve and lateral pectoral nerve (c6-8)

Pierced by medial pectoral nerve. Enclosed by clavipectoral fascia, landmark for axillary artery and cords of plexus

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3
Q 
Origin
Insertion
Action
Nerve 
Special features
Subclavius
A

Costochondral junction of first rib

Subclavian groove on middle 1/3 of clavicle

Depresses and steadies clavicle

Nerve to subclavius (C5,6, upper trunk)

Enclosed by clavipectoral fascia which forms costocoracoid ligament

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4
Q

Which four structures pierce the clavipectoral fascia?

A

Lymphatics
Cephalic vein
Lateral pectoral nerve
Thoracoacromial artery

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5
Q 
Origin
Insertion
Action
Nerve 
Special features
Trapezius
A

Med 1/3 sup nuchal line, ligamentum nuchae, spinous process and supraspinous ligs of all thoracic vertebrae

Upper fibres to lat 1/3 of post border of clavicle, med acromion and lat spine of scapula, lower fibres to med end of scapula spine as far as deltoid tub spine

Elevates and retracts scapula, rotates it during abduction of the arm. If scapula fixed extends and laterally flexes neck. Assists in raising arm above head

Spinal root of accessory nerve CNXI, proprioceptive C3 C4

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6
Q 
Origin
Insertion
Action
Nerve 
Special features
Latissimus dorsi
A

All thoracic spines and supraspinous ligs of lower 6 vertebrae, and L/S spines via lumbar fascia, post 1/3 iliac crest, lower 4 ribs (id w/ EOM)

Floor of bicipital groove of humerus after spiralling around teres major

Extends, adducts and medially rotates arm, costal also helps with deep inspiration

Thoracodorsal nerve from posterior cord C6-8

Glistening tendon
Highest fibres insert lowest into tendon
Only muscle of upper limb to have a pelvic attachment (via lumbar fascia)
Fibres from lowest 4 ribs interdigitate with external oblique

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7
Q 
Origin
Insertion
Action
Nerve 
Special features
Rhomboid major
A

Spines T2-T5 and supraspinous ligaments

Lower 1/2 of posteromedial border of scapula

Retracts scapula and rotates to rest position

Dorsal scapula nerve C5 from root

Test by pushing elbow back against resistance with hand on hip

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8
Q 
Origin
Insertion
Action
Nerve 
Special features
Rhomboid minor
A

Lower ligamentum nuchae, spines of C7/T1

Small area of posterior border of scapula at the level of the spine

Retracts scapula and rotates to rest position

Dorsal scapula nerve C5 from root

Test by pushing elbow back against resistance with hand on hip

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9
Q 
Origin
Insertion
Action
Nerve 
Special features
Levator scapulae
A

Post tubercle of transverse processes of C1-C4

Upper part of med border of scapula

Raises med border of scapula and laterally flex neck

Anterior rami of C3 and C4 and dorsal scapular nerves C5

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10
Q 
Origin
Insertion
Action
Nerve 
Special features
Serratus anterior
A

Upper 8 ribs, lowest 4 interdigitate with EOM

Inner med border of scapula; 1+2 upper angle, 3+4 costal margin, 5-8 inf angle

Laterally rotates upwards and protracts scapula, assists in raising arm above head

Long thoracic nerve from C5, C6, C7

Tested by pushing on a wall: winged scapula in paralysis
Nerve lies behind mid axillary line (usually protected in axillary operations)

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11
Q

What four ligaments make up the sternoclavicular joint?

A

Anterior and posterior sternoclavicular ligaments
Interclavicular ligament
Costoclavicular ligament

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12
Q

What is the key ligament in the acromioclavicular joint?

A

Coracoclavicular ligament
Attaches corocoid to clavicle
In 2 parts: conoid and trapezoid
Movements are all passive

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13
Q 
Origin
Insertion
Action
Nerve 
Special features
Subscapularis
A

Medial 2/3 of subscapular fossa of ant scapula

Lesser tubercle of humerus

Med rotates arm and stabilises shoulder joint

Upper and lower subscapular nerves C5,C6 from posterior cord

Subscap bursa communicates with shoulder joint

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14
Q 
Origin
Insertion
Action
Nerve 
Special features
Supraspinatus
A

Med 3/4 of supraspinous fossa of scapula

Greater tubercle of humerus, blends with shoulder joint capsule

Abducts arm and stabilises shoulder joint

Suprascapular nerve C5, C6 from superior trunk

Subacromial bursa lies above its tendon which forms part of rotator cuff. Test is abduction against resistance

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15
Q 
Origin
Insertion
Action
Nerve 
Special features
Infraspinatus
A

Med 3/4 of infraspinatous fossa of posterior scapula and deep infraspinous fascia

Middle facet of greater tubercle of humerus and capsule of shoulder joint

Laterally rotates arm and stabilises shoulder joint

Suprascapular nerve C5, C6 from superior trunk

Tested by keeping elbow flex and into side, then externally rotated forearm to the side. Bursa lies under its tendon. Covered by infraspinous fascia

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16
Q 
Origin
Insertion
Action
Nerve 
Special features
Teres minor
A

Middle 3rd of lat border of posterior scapula

Inf facet of greater tubercle of humerus andcapsule of shoulder joint

Lat rotates arm and stabilises shoulder joint

Axillary nerve (C5, 6) from posterior cord

Tendon forms part of rotator cuff, covered by infraspinatous fascia

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17
Q 
Origin
Insertion
Action
Nerve 
Special features
Teres major
A

Lower 1/3 of lateral side of inf angle of scapula

Medial lip/intertubular sulcus of ant humerus

Medially rotates and adducts arm, stabilises shoulder joint

Lower subscap nerve C6,C7 from posterior cord

Test is adduct arm against resistance. Lies in front of triceps and behind lat dorsi

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18
Q 
Origin
Insertion
Action
Nerve 
Special features
Deltoid
A

Lateral 1/3 of clavicle, acromion and spine of scapula

Deltoid tuberosity

Abducts arm, ant fibres flex and medial rotate, post fibres extend and laterally rotate

Axillary nerve (C5 and 6) from posterior cord

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19
Q

What are the three main vessels of the scapular anastomosis and what are their origins?

A

Transverse cervical artery/subclavian -> dorsal scapular artery

1st part of subclavian->Thyrocervical trunk -> transverse cervical->suprascapular artery

Axillary-> subscapular-> circumflex scapular branch

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20
Q

Where does the transverse humeral ligament lie?

A

Between the greater and lesser tubercles of humerus

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21
Q

Which muscular tendon is intracapsular with the shoulder joint?

A

Biceps brachii tendon, long head

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22
Q

Where do the 3 cords of the brachial plexus enter the axilla?

A

Formed behind the clavicle and enter axilla above the axillary artery

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23
Q

How does the axillary artery enter the axilla?

A

Passes over serratus anterior at the outer border of the first rib, behind the midpoint of the clavicle

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24
Q

Where does the axillary artery become the brachial artery?

A

At the lower border of teres major. Divided into 3 according to position in relation to pec minor; above, behind and below. The part that sits behind the muscle is surrounded by the 3 cord of the brachial plexus

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25
How does the axillary artery divide?
1st/ above pec minor: superior thoracic artery (pec muscles) 2nd/ behind pec minor: thoracoacromial (splits into 4) and lateral thoracic (pecs and boobs) 3rd/below pec minor: subscapular, and 2 circumflex humeral arteries (anterior and posterior)
26
Which branch of the axillary artery runs with the axillary nerve?
Axillary artery->3rd part-> posterior circumflex artery Passes between subscapularis and teres major lateral to long head of triceps Supplies the deltoid Anastomses with anterior circumflex artery and profunda brachii artery
27
Describe the axillary vein
No sheath Medial to artery and nerve Becomes subclavian vein once over the first rib
28
What are the 5 nerve roots of the brachial plexus?
``` C5 (phrenic, dorsal scapular, long thoracic) C6 (long thoracic) C7 (long thoracic) C8 T1 (1st intercostal) Lie behind scalenus medius ```
29
What are the 3 trunks of the brachial plexus?
Superior (suprascapular nerve) Middle Inferior Cross the posterior triangle of the neck
30
Where are the divisions of the brachial plexus?
Behind the clavicle | All 3 trunks form an anterior and posterior division
31
How do the cords of the brachial plexus relate to the axillary artery?
They enter the axilla above the first part, then embrace the second part, and give off their branches around the third part
32
What are the 3 cords of the brachial plexus?
Lateral (lateral pectoral nerve) Posterior (upper subscapular, thoracodorsal, lower subscapular) Medial (medial pectoral nerve, medial cutaneous nerve of the arm, medial cutaneous nerve of the forearm)
33
What are the 5 terminal branches of the brachial plexus, which spinal nerves do they originate from and which cords do they come from?
``` Musculocutaneous C5-7 Lateral cord Axillary C5-6 Posterior cord Radial C5-T1 Posterior cord Median C5-T1 Lateral and medial cords Ulnar C7-T1 Medial cord ```
34
Describe the course of the axillary nerve
Passes between subscapularis and teres major, lateral to the long head of triceps (through quandrangular space) Lies in contact with surgical neck of humerus. Gives branches to shoulder joint and splits into anterior and posterior. Anterior supplies deltoid. Posterior supplies teres minor then becomes cutaneous as the upper lateral cutaneous nerve of the arm
35
Describe how the radial nerve gets to the arm
Crosses the lower border of posterior axillary wall, lies on top of glistening lat dorsi tendon, passes through triangular space- with profunda brachii (lower border of teres major, long head of triceps and humerus). Supplies long head of triceps and the extensor compartment of forearm Largest nerve in whole plexus
36
What is the blood and nerve supply to the breast? Which nerves are at risk of damage during mastectomy?
Lateral thoracic artery T4 to T6 intercostal nerve Long thoracic and thoracodorsal nerves
37
``` Origin Insertion Action Nerve Special features Triceps ```
Long head: infraglenoid tubercle of scapula Lat head: Upper half post. humerus Med head: lower half post. humerus Posterior part of upper olecrenon process and posterior capsule Extends elbow, stabilises shoulder and retracts capsule of elbow internally Radial nerve C7-8 4 branches
38
What is the key stabilising factor of the shoulder joint?
The 4 rotator cuff muscles (supraspinatus, infraspinatus, subscapularis and teres minor) all fuse with the lateral part of the capsule
39
``` Origin Insertion Action Nerve Special features Corocobrachialis ```
Corocoid process of scapula with biceps brachii Middle 3rd of medial border of humerus Flexes and weekly adducts arm Mscn N C5,-7 Musculocutanous nerve pierces
40
``` Origin Insertion Action Nerve Special features Biceps brachii ```
Long head from supraglenoid tubercle of scapula. Short head from coracoid process Posterior border of bicipital tuberosity of radius and bicipital aponeurosis to deep fascia Supinates forearm, flexes elbow, weakly flexes shoulder Mscn N No attachments to humerus
41
``` Origin Insertion Action Nerve Special features Brachialis ```
Ant lower 1/2 of humerus and med and lat IM septa Coronoid process and tuberosity of ulba Flexes elbow Mscn N and cheeky small supply radial nerve
42
Describe the origin and course of the brachial artery
Continuation of axillary artery Superficial, immediately deep to the deep fascia of the anteromedial aspect of the arm Median nerve laterally above, medial side below Ulnar nerve posterior above Artery splits into radial and ulnar arteries
43
Branches of brachial artery
``` Ulnar Radial Profunda brachii (supplies triceps and splits into radial collateral and medial collateral) Superior ulnar collateral Inferior ulnar collateral ```
44
Veins of the arm?
Cephalic (lateral) -lies in groove between deltoid and pec major Basilic (medial)->axillary vein
45
Course of median nerve
Commences lateral to axillary artery | Lies in front and medial to brachial artery at elbow
46
Course of the musculocutaneous nerve
Pierces coracobrachialis and lies between biceps and brachialis Supplies flexor compartment of the arm
47
Course of ulnar nerve
Gives no branches in the arm Branch to elbow joint comes off as it lies on the groove behind medial epicondyle of humerus where it is palpable Disappears into forearm between the heads of flexi carpi ulnaris
48
Course of medial cutaneous nerve of the forearm
Commences between axillary artery and vein Divides into anterior and posterior branches Anterior branch passes over the median cubital vein Supplies skin to lower part of the arm and over medial forearm
49
What does the intercostobrachial nerve supply?
A branch of the second intercostal nerve | Supplies skin of axilla and medial upper arm and communicates with medial cutaneous nerve of the arm
50
Describe the course of the radial artery within the arm
Enters through triangular space with profunda brachii Runs between brachialis and brachioradialis Supplies elbow joint Gives lower lateral cutaneous nerve of the arm and posterior cutaneous nerve of the forearm. Gives branches to brachioradialis, extensor carpi radialis longus and the lateral part of brachialis Terminates into superficial branch and posterior interosseous nerve at lateral epicondyle
51
Which parts of the ulna and radius articulate with the trochlea and capitulum of the humerus?
Ulna: olecrenon, trochlear notch, coronoid process Radius: head
52
What is the difference between the radial collateral ligament and the ulnar collateral ligament?
Both triangular Ulnar collateral has 3 parts Radial has 2 parts
53
Where is the annular ligament attached?
The radial notch of the ulna | Nil attachment to the radius itself
54
How does the valgus angle of the elbow differ between men and women?
Obliquity of the ulna is more pronounced in women
55
``` Origin Insertion Action Nerve Special features Pronator teres ```
Superficial head: medial epicondyle, med supracondylar ridge. Deep head: med border of coronoid process Lateral convexity of radius Pronates forearm and flexes elbow Median N (C6,7) Median nerve passes between two heads. Ulnar artery passes deep to deep head Forms medial border of cubital fossa
56
``` Origin Insertion Action Nerve Special features Flexor carpi radialis ```
Common flexor origin Bases of 2nd and 3rd MC via groove in trapezium Flexes and abducts wrist Median N (C6,7) Own compartment in carpal tunnel At level of the wrist-median nerve medial to tendon and radial artery lateral to it
57
``` Origin Insertion Action Nerve Special features Flexor digitorum superficialis ```
Humeral head:Common flexor origin Ulnar head: Sublime tubercle and fibrous arch Radial head: whole length of oblique line Middle phalanges of medial 4 fingers Flexes prox IP joints and MCP/wrist Median N (C7, 8,T1) Median nerve is applied to under surface of muscle. At wrist, tendons of middle and ring fingers lie superficial to index and little finger
58
``` Origin Insertion Action Nerve Special features Palmaris longus ```
Common flexor origin Flexor retinaculum and palmar aponeurosis Flexes wrist and anchors skin and fascia against shearing forces Median N (C7,8) Absent in 13% of people Lies in front of median nerve at wrist.
59
``` Origin Insertion Action Nerve Special features Flexor carpi ulnaris ```
Humeral head: CFO Ulnar head: aponeurosis from med olecrenon and upper 2/3 ulna Pisiform, hook of hamate, base of 5th MC via pisometacarpal and pisohamate ligs Flexes and adducts wrist. Fixes pisiform during action of hypothenar muscles Ulnar nerve C7,C8 Ulnar nerve passes between the two heads
60
``` Origin Insertion Action Nerve Special features Flexor digitorum profundus ```
Upper 3/4 anterior and medial surfaces of the ulna including subcutaneous border and IO membrane Distal phalanges of medial 4 fingers Flexes distal IP joints then then rolls the fingers and wrist into flexion Anterior interosseous branch of median nerve and ulnar nerve (C8, T1). 2:2 (60%), 3:1, 1:3. Each lumbrical supplied by the same nerve which innervates the belly of parent tendon Tendon for index finger separates in forearm, other 3 don't detach until palm
61
Borders of cubital fossa
Pronator teres Brachioradialis Line between humeral epicondyles
62
Contents of cubital fossa
Median nerve Brachial artery Tendon of biceps Radial nerve and posterior interosseous branch
63
``` Origin Insertion Action Nerve Special features Flexor pollicis longus ```
Ant surface of radius below ant oblique line and adjacent IO membrane Base of distal phalynx and thumb Flexes distal phLnx of thumb Ant IO (C7-C8) branch of median nerve Unipennate fleshy fibres on radial side. Deep to FCR in carpal tunnel. Only flexor of thumb
64
``` Origin Insertion Action Nerve Special features Pronator quadratus ```
Antmed distal ulna Ant surface of lower 1/4 radius Pronates forearm and holds radius and ulna together Ant IO (C7-8)
65
Three nerves which supply forearm and the muscle who's two heads they pass through
Median- pronator teres Ulnar- flexi carpi ulnaris Posterior interosseus branch of radial- supinator
66
In which plane of the forearm does the radial artery lie?
over supinator and pronator teres but underneath brahcioradialis
67
What are the branches of the ulnar artery in the forearm?
Common interosseous-> anterior +posterior interosseous
68
Describe the cutaneous distribution of the radial nerve
Posterior arm with a strip down dorsal forearm to the wrist plus dorsal side of lateral 2 fingers excluding finger tips
69
Describe the cutaneous distribution of the median nerve
Palmer surface of lateral 3 and a half fingers plus finger tips on dorsal side of the same fingers
70
Which nerve supplies the elbow?
The median nerve
71
Describe the course of the ulnar nerve in the forearm
Enters by passing humeral and ulnar heads of flexor carpi ulnaris Lies under aponeurosis of flexor carpi ulnaris, with the ulnar artery lying just laterally to it along the distal 2/3 of the forearm
72
``` Origin Insertion Action Nerve Special features Brachioradialis ```
Upper 2/3 lateral supracondylar ridge of humerus Base of styloid process of radius Flexes elbow joint- strongest when semipronated Radial nerve Lies beneath abductor pollicis longus and extensor pollicis brevis Lies on top of radial nerve and artery
73
``` Origin Insertion Action Nerve Special features Extensor carpi radialis longus ```
Lower 2/3 lateral sypracondylar ridge of humerus Base of second metacarpal Extends and abducts the wrist Radial nerve (C6,7) Making a fist. Runs with brachioradialis
74
``` Origin Insertion Action Nerve Special features Extensor carpi radialis brevis ```
CEO Posterior base of 3rd MC Extends and abducts the hand at the wrist posterior interosseous nerve Lies under ECRL
75
Where is the common extensor origin?
Anterior lateral epicondyle of the humerus
76
``` Origin Insertion Action Nerve Special features Extensor digitorum ```
CEO Extensor expansion of all 4 fingers, with 3rd and 4th fused, little finger gets a tendon via tendinous band Extends all joints of fingers and wrist Posterior interosseous nerve Separated from above 3 muscles by emergence of thumb muscles
77
``` Origin Insertion Action Nerve Special features Extensor digiti minimi ```
CEO Extensor expansion of little finger, usually 2 tendons joined by extensor digitorum Extends little finger and wrist Posterior interosseous nerve (C7,8)
78
``` Origin Insertion Action Nerve Special features Extensor carpi ulnaris ```
CEO and aponeurotic sheath (ulnar origin) Base of 5th MC via groove by ulnar styloid Extends and adducts the hand at the wrist PIN Making a fist Ulnar common origin
79
``` Origin Insertion Action Nerve Special features Anconeus ```
Smooth surface at lower extremity of posterior aspect of lateral epicondyle of humerus Lateral olecranon Small amount of posterolateral movement during pronation Radial (C7,8)
80
``` Origin Insertion Action Nerve Special features Supinator ```
Deep part from the supinator crest and fossa of the ulna Superficial part from the lateral epicondyle and lateral ligament of the elbow and annular ligament Neck and shaft of radius Fixes the forearm in supination. Only acts alone when elbow is extended PIN PIN passes between its 2 heads, prime supinator when elbow extended
81
``` Origin Insertion Action Nerve Special features Abductor pollicis longus ```
Posterior ulnar and radius and interosseous membrane Inserts over radial extensor tendons and brachioradialis to base of 1st MC and trapezium Extends thumb at CMC joint and abducts wrist PIN Forms radial side of the snuff box. Crosses BR and ECRL superficially
82
``` Origin Insertion Action Nerve Special features Extensor pollicis brevis ```
Lower 1/3 of posterior radius and IOM Over tendons of radial extensors and BR to base of proximal phalanx Extends thumb and prevents flexion of MCP joint when thumb and index finger pinched PIN Forms radial side of the snuff box. Crosses BR and ECRL superficially
83
``` Origin Insertion Action Nerve Special features Extensor pollicis longus ```
Middle 1/3 of posterior ulnar and ION Base of distal phalanx and thumb Extends IP and MCP joints of the thumb PIN Forms ulnar side of snuffbox Crosses dorsal tubercle of radius
84
What is hammer thumb?
Colles fracture causes occlusion of branches of anterior interosseous artery surrounding radius These becomes necrosed and EPL tendon ruptures This produces a flexion deformity of the distal phalanx
85
``` Origin Insertion Action Nerve Special features Extensor indicis ```
Lower posterior shaft of ulna and IOM Extensor expansion of index finger Extends index finger PIN Covered by tendons of extensor digitorum
86
``` Origin Insertion Action Nerve Special features Abductor pollicis brevis ```
Flexor retinaculum and scaphoid tubercle Radial side of proximal phalanx and EPL tendon Abducts thumb – moving in plane at right angles to palm, assist in extension Muscular branch of medial (C8, T1)
87
What are the borders of the anatomical snuff box?
Extensor pollicis longus tendon (ulnar side) Extensor pollicis brevis and abductor pollicis brevis on the radial side Cephalic vein begins at the roof of the snuffbox Radial artery (deep to all 3 tendons) lies on the floor
88
What are the attachments of the extensor retinaculum?
Proximally to the anterolateral border of the radius and distally to the pisiform and triquetral bones
89
What are the three most proximal bones of the hand?
Scaphoid, lunate and triquetral
90
Which vessels form the dorsal carpal arch?
Radial, ulnar and anterior interosseous arteries
91
Describe the palmar aponeurosis
Made up of longitudinal and deeper transverse fibres | Localised thickening of palmar aponeurosis occurs in Dupuytren's contracture
92
Where does the flexor retinaculum run?
Hamate and pisiform medially Scaphoid and trapezium laterally Between it and the bones of the wrist is the carpal tunnel
93
What lies in the carpal tunnel?
The four tendons of flexor digitorum superficialis (superfically) Median nerve Flexor pollicis longus tendon (radial side)-has its own sheath Four tendons of flexor digitorum profundus (deep)-only index finger tendon separate
94
What are the three muscles of the thenar eminence?
Abductor pollicis brevis Flexor pollicis brevis Opponens pollicis
95
``` Origin Insertion Action Nerve Special features Flexor pollicis brevis ```
Superficial head: flexor retinaculum and trapezium. Deep: trapezoid and capitate Radial sesamoid of thumb and radial side base of proximal phalanx Draws thumb across the palm Muscular branch of medial (T1 +C8)- muscle with most variable nerve supply in the body
96
``` Origin Insertion Action Nerve Special features Opponens pollicis ```
Flexor retinaculum and trapezium Radial border of thumb MC Opposition of thumb Muscular branch of medial T1 and C8 Deepest thenar muscle
97
Which muscles make up the hypothenar eminence?
Abductor digiti minimi Flexor digiti minimi brevis Opponens digiti minimi
98
``` Origin Insertion Action Nerve Special features Abductor digiti minimi ```
Pisiform, tendon of FCU Base of proximal phalanx and extensor expansion Cup the palm and grip large objects Deep branch ulnar nerve C8,T1 Most medial of thenar muscles. Sesamoid bone common in tendon
99
``` Origin Insertion Action Nerve Special features Flexor digiti minimi brevis ```
FR, hook of hamate Ulnar side of base of proximal phalanx Cup the palm and grip large objects Deep branch ulnar nerve C8,T1
100
``` Origin Insertion Action Nerve Special features Opponens digiti minimi ```
FR, hook of hamate Ulnar side of base of proximal phalanx Cup the palm and grip large objects Deep branch ulnar nerve C8,T1 Deepest hypothenar muscle
101
``` Origin Insertion Action Nerve Special features Palmaris brevis ```
Over hypothenar side of the hand attached to palmar aponeurosis Ulnar nerve (superficial)- only muscle supplied by this nerve
102
``` Origin Insertion Action Nerve Special features Lumbricals ```
FDP tendons Extensor expansions of dorsum of proximal phalanges Extension of both interpharangeal joints- required for pinching 2 ulnar lumbricals by ulnar n, 2 radial lumbricals by median n U/M distribution follows that of parent bellies of tendons in forearm Ulnar supplied – bicipital, from adjacent profundus tendons Median supplied – unicipital, arise from one tendon only (muscle arises from radial side of tendon)
103
``` Origin Insertion Action Nerve Special features Adductor pollicis ```
Transverse head: palmar border of 3rd MC. Oblique head: base of 2nd and 3rd MC Ulnar sesamoid of thumb Approximate thumb to index finger Deep branch of ulnar nerve (C8, T1) Radial artery passes between 2 heads to form deep palmar arch
104
``` Origin Insertion Action Nerve Special features Palmar interosseous ```
Ulnar side of MC 2, radial side of MC 4 and 5 Extensor expansion, on side of the finger towards the middle finger. Middle finger has no PI Adduct fingers relative to the 3rd MC. Assist dorsal interossei with flexion and MCPJ and extension and PIPJ Deep branch of ulnar nerve (c8, T1)- claw hand in paralysis Small- only visible from palmar side
105
``` Origin Insertion Action Nerve Special features Dorsal interosseous ```
Both adjacent MC (2 heads) Extensor expansion on the side of the finger away from the middle finger. Middle finger has DI on both sides. Abduct fingers relative to the axis (middle) of palm. Assists palmar in the flexion at mCPJ and extension at PIPJ Deep branch of ulnar nerve (c8, T1)- claw hand in paralysis Large muscles, can be seen from dorsal and palmar sides
106
Which nerves supply the fingers?
Common palmar digital nerves-> proper palmar digital nerves In the palm the arteries are superficial to the nerves but in the fingers the nerves are are superior to the arteries
107
How does the median nerve supply the palm?
Enters beneath flexor retinaculum Splits into 3, medial, lateral and muscular (recurrent) Muscular recurrent supplies thenar muscles by passing over tenson of flexor pollicis longus- at risk during incision
108
Why is their no anaesthesia over the thenar eminence in carpal tunnel syndrome?
Skin is supplied by palmar branch of median nerve which travels superficially to the FR, so escapes compression If median nerve damaged at a higher level, will be weakness of thumb flexion and palmar cutaneous loss
109
Which arteries make up the deep palmar arch?
Deep ulnar artery and radial artery
110
What is a vincula?
A vascular synovial fold Each tendon has two Flexor digitorum profundus tendon long vincula passes from the tendon between the two halves of the superficialis tendon
111
What are the branches of the lateral cord of the brachial plexus?
Lateral pectoral Musculocutaneous (lateral cutaneous nerve of forearm) Lateral root of median nerve
112
What are the branches of the medial cord?
``` Medial pectoral Medial root of the medial nerve Medial cutaneous nerve of arm Medial cutaneous nerve of the forearm Ulnar ```
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What are the branches of the posterior cord?
``` Upper subscapular Thoracodorsal Lower subscapular Axillary Radial ```
114
What is the most common traction injury to the brachial plexus?
Erb's paralysis, damage to C5 and C6 nerve roots Arm hangs by side, medially rotated, extended at the elbow and pronated with loss of sensation of the lateral arm and forearm
115
Which muscle is the only one supplied by all five nerve roots of the brachial plexus?
Pectoralis major
116
How is the axillary nerve damaged?
In 5% of shoulder dislocations | Shoulder abduction is weak and there is a small area with loss of sensation over the deltoid
117
How do you test if musculocutaneous nerve is intact?
Nerve is rarely injured | Flex biceps and palpate tendon
118
How do you differentiate humeral fracture from Saturday night palsy?
Fractures of the humeral shaft damage radial nerve Results in wrist drop Saturday night palsy is a higher up compression of the nerve so also results in loss of elbow extension
119
How to test for ulnar nerve injury?
Claw hand | Abduction of index finger
120
What position is a hand with a medial nerve injury in?
Pointing index finger position
121
What is the order of ossification of upper limb bones?
1. Clavicle-starts week 5 as a fetus, completely fused by late teens 2. Scapula- week 8 as a fetus, finished age 20 3. Humerus- week 8 as a fetus (primary centre), 3 secondary centres (toddler), lateral epicondyle fuses age 15, medial epicondyle fuses age 20 4. Radius- week 8 as a fetus, upper epiphyses fuses at 15, lower at 20 5. Ulnar- week 8 as a fetus, olecrenon fuses at 16, head fuses at 18 6. Carpal bones ossify in sequence from largest( capitate) to smallest (pisiform)
122
List the bones of the hand distal to proximal and radial to ulnar
Scaphoid, lunate, triquestral, pisiform, | trapezium, trapezoid, capitate, hamate

Anatomy (6 decks)

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