Upper Limb Flashcards

Question

Acromioclavicular joint - Ligaments - innervation - action

Answer 1

Similar to the sternoclavicular joint, the articulating surfaces covered by fibrocartilage Ligaments: - Coracoclavicular ligament (Conoid and trapezoid) - Acromioclavicular ligament Nerve supply - Lateral supraclavicular nerves (C4)

Answer 2

Quadrangular Space: Lies between the subscapularis and teres major Transmits the axillary nerve, with the posterior circumflex humeral artery and vein Triangular space: Below the teres major and between the humerus and long head of triceps Transmits the radial nerve and profunda brachii vessels

Answer 3

1. Subclavian artery 2. Axillary sheath 3. Teres Major

Answer 4

First part of the artery exposed by splitting clavicular head of pectoralis major and incising the clavipectoral fascia The rest of the artery is approached through the axilla, in the groove between coracobrachialis and long head of triceps

Answer 5

1. First part: Superior thoracic artery (supplies both pectoral muscles) 2. Second part: - Thoracoacromial artery (peirces clavipectoral fascia then seperates into clavicular, deltoid, acromial, pectoral branches) - Lateral thoracic artery (breast and pectoral muscles) 3. Third Part: Subscapular (largest branch, runs down posterior axillary wall giving off circumflex scapula artery) and anterior/posterior circumflex humeral arteries (circle humerus and supply shoulder region)

Answer 6

The five roots lie behind scalenus anterior muscle and emerge between it and scalenus medius to form the trunks which cross the lower part of the posterior triangle of the neck. Each of the three trunks divides into an anterior and a posterior division behind the clavicle. Here, at the outer border of the first rib, the upper two anterior divisions unite to form the lateral cord, the anterior division of the lower trunk runs on as the medial cord, while all three posterior divisions unite to form the posterior cord. These three cords enter the axilla above the first part of the artery, approach and embrace its second part, and give off their branches around its third part.

Answer 7

- Average number 35, may be over 50 i) Anterior (pectoral group) ii) Posterior (Subscapular group) iii) Lateral group iv) Central group v) Apical group

Answer 8

- Internal thoracic (mammary) artery - Lateral thoracic artery - Thoracoacromial artery

Answer 9

Lactiferous ducts

Answer 10

Suspensory ligaments of cooper. Function is to secure the breast to the dermis and underlying pectoral fascia seperate secretory lobules of the breast

Answer 11

Axillary nodes (75%) Parasternal nodes (20%) Posterior Intercostal nodes (5%)

Answer 12

Origin: Scapula (Acomion and crest of scapula spine), lateral 1/3 clavicle Attach: Deltoid tuberosity on lateral humerus Innervation: Axillary nerve Function: Anterior: flexion Posterior: extend Middle: Major abductor (Takes over from suprispinatus after 15 degrees)

Answer 13

The dorsal scapular and suprascapular arteries arise from the third and first parts of the subclavian, and the subscapular from the third part of the axillary artery. They and the circumflex scapular anastomose on both surfaces of the scapula.

Answer 14

Subclavian vein runs infront of anterior scalene Subclavian artery and roots of brachial plexus run behind anterior scalane and infront of middle scalene muscle

Answer 15

No accomanying artery Between anterior deltoid and pectoralis major then under pectoralis major joins other veins to become subclavien vein

Answer 16

Passes beneath pectoralis minor, over scalene anterior and under subclavius muscle and clavicle Joins Internal jugular vein to become braciocephalic vein

Answer 17

Synovial joint Between humeral head and glenooid fossa (4:1 ratio) Stabilised by the glenoid labrum Covered in a joint capsule (Surrounds glenoid labrum and surgical neck of humerus) Synovium covers attaches around the labrum and lines the capsule and humerus. It herniates through a hole to communicate with the subscapularis bursa and invests the long head of biceps tendon Ligaments: - Glenohumeral ligemnts - Coracohumeral ligament - Transverse humeral ligament - Coracoacromial ligament

Answer 18

Subacromial bursae: located inferiorly to the deltoid and acromion and superior to the suprispinatus tendon and joint capsule Subscapular bursae: located between subscapularis tendon and scapula Infraspinatus bursae Subdeltoid bursae Subcutaneous acromial bursa Coracobrachial bursa Subtendinous bursa of subscapularis

Answer 19

long head of biceps (Supralenoid tubercle) loong head of triceps (Infraglenoid tubercle)

Answer 20

- Supraspinatus (15 degrees) - Middle deltoid

Answer 21

- Pectoralis major - Latissimus dorsi coracobrachialis

Answer 22

Clavicular head of pectoralis major Anterior deltoid Coracobrachialis Biceps

Answer 23

Latissimus dorsi Posterior deltois long head of triceps

Answer 24

Lateral: Infraspinatus, teres minor Medial: Subscapularis

Answer 25

Origin: Coracoid process Attach: Medial shaft humerus Innervation: Musculocutaneous nerve (actually passes through the muscle \*Care in surgical approach) Function: Weak Flexion and adduction of shoulder

Answer 26

Origin: Long head - Supraglenoid tubercle (emerges beneath the transverse ligament at the upper end of the intertubercular groove) Short head- Corocoid process (lateral to coracobrachialis) Attachment Posterior border of the tuberosity of the radius and fascia of the forearm via the bicepital aponeurosis Inntervation: Musculocutaneous nerve Function: Flexion of elbow and shoulder and supination of elbow (when elbow not in full extension)

Answer 27

Origin: from theanterior lower 2/3rds of humeral shaft and medial intermuscular septum Attachment: Ulna tuberosity and coronoid process Innervation: Musculocutaneous nerve (some of lateral part by radial nerve) Function: Flexion at elbow

Answer 28

Proximal: Profunda brachii (Leaves through lower triangular spave to run in the radial groove with the radial nerve). Supplies the triceps. Superior ulnar collareral artery (accompanies ulnar nerve) Inferior ulnar collateral artery Distal: Radial a. Ulnar a.

Answer 29

Superficial: Basilic vein - originates from dorsal venous network on hands. Ascends medially. At border of teres minor it travels deep. Combines with brachial vein to become axillary vein. Cephalic vein - arises from dorsal venous network on hands. Ascends antero-lateral. At the shoulder it travels between the deltoid and pectoralis major. Terminates by joining the axillary vein. At the elbow, the cephalic and basilic vein is connected by the median cubital vein Deep veins: (Beneath deep fascia) They are paired veins, each side of an artery (venae comitantes) Brachial veins (Each side of brachial artery) \*Perforating veins run between the deep and superficial veins

Answer 30

origin: - long head: Infraglenoid tubercle - Lateral head - Posterior humerus from surgical neck to deltoid insertion - Medial Head - Medial radial groove humerus and posterior humerus below Attach: Olecranon of ulna Innervation: Radial nerve (c7,8) Function: Extension elbow

Answer 31

Really Need Beer To Be At My Nicest Radial Nerve Bicep Tendon Brachial Artery Median Nerve

Answer 32

Path: - Continuation of posterior cord of brachial plexus - leaves shoulder through triangular area - Descends arm, in radial groove - Wraps around humerus laterally - enters the forearm anteriorly over the lateral epicondyle of humerus - divides into two branches in cubital fossa i) Deep - (motor) - Travels between brachialis and brachioradialis, then travels through supinators two heads to go deep. gives of posterior interosseous ii) Superficial (seonsory) - Between brachialis and brachioradialis then runs along lateral forearm, radial to radial artery giving off branches Motor function: - Triceps - Brachioradialis - extensor carpi radialis longus - Posterior forearm muscles

Answer 33

Radial collateral - Lateral epicondyle, blends with annular ligament Ulnar collateral - Medial condyle to coronoid process and olecronon Annular ligament - attaches to radial notch of ulna and its fibres encircle head and neck of radius, which is free to rotate within it. Superiorly it blends with capsule of joint

Answer 34

Lateral - Brachioradialis Medial - Pronator teres Superior border - Imaginary line between epicondyles Floor - Brachialis (proximal), Supinator (distal) Roof - skin, fascia, bicepital aponeurosis

Answer 35

Medially, on the biceptial aponeurosis - Median basilic vein - Medial cutaneous nerve of forearme medial to vein Laterally - Lateral cutaneous nerve of forearm and median cephalic vein

Answer 36

\*FDP - Origin - medial surface of olecranon and upper 3/4 of medial/ anterior ulna + interosseous membrane (Tendon to index seperates in forearm, others in palm)

Answer 37

Flexor pollicis lonugs tendon receives fleshy fibres into its radial side to a point just above the wrist (FCR doesnt)

Answer 38

In front of the pronator quadratus and deep to the long flexor tendons of the fingers is a spave into which the proximal parts of the flexor synovial sheaths protrude Space becomes involved in proximal extension of synovial sheath infections

Answer 39

Path: Continuation of medial cord (C8, T1) Travels medial upper arm, through medial intermuscular septum Posterior to the medial epicondule in forearm, pierces the two heads of flexor carpi ulnaris and travels alongside ulnar Lies under flexor carpi ulnaris with ulnar artery on its radial side Motor: - Ant. Forearm (Flexor carpi ulnari, Half Flexor digitorum profundus) - Hand (Hypothenar, medial two lumbricals, adductor pollicus, interossei of hand, palmaris brevis) 3 Branches in the wrist/ hand: i) Palmar cutaneous branch ii) Dorsal cutaneous branch iii) Superficial branch (Supplies palmar brevis and finger tips)

Answer 40

Medial and lateral cords of brachial plexus (contains fibres from all 5 roots) Descends down arm initially laterally to brachial artey, halfway it crosses over to medial side of brachial artery. Enters forearm via cubital fossa (medial side) In forearm travels between flexor digitorum profundus and superficialis. Two major branches in forearm i) Anterior interosseous n. (Motor - ant. forearm) ii) Palmar cutaneous n. (Sensory - skin palm) Two branches in carpal tunnel i) Recurrent branch (Motor - Thenar muscles) ii) Palmar Digital cutaenous branch (Sensory + motor - two lumbircals and fingertips 3.5)

Answer 41

Right subclavian artery arises from Braciocephalic trunk Left subclavian artery from arch of aorta Once crosses 1st rib the subclavian artery becomes the axillary artery Axillary artery passes under pectoralis minor (in axillary sheath). Gives off branches (other card) Axillary artery reaches lower border of teres major and becomes brachial artery. Immediately distal to teres major the profunda brachii branch comes off (travels posterior arm) Brachial artery descends down the arm posterior to median nerve. As it corsses cubital fossa underneath brachialis it terminates into radial and ulnar arteries. Radial a. supplies posterior forearm. Passes over muscles of anterior forearm then disappears beneath tendons of abductor pollicis longus nad extensor pollicis brevis to corss anatomical snuff box. Ulna a. supplies anterior forearm. Passes deep to pronator teres. Cheif branch is the common interosseous a. The two arteries anastamose in the hand, forming the superficial palmar arch and deep palmar arch. Also anastaomse in the wrist through the posterior and and anterior carpal arch

Answer 42

Arises from lateral cord of brachial plexus leaves axilla and peirces coracobrachialis passes down arm anterior to brachialis and deep to bicep brachii (innervating both) continues into forearm as 'lateral and medial cutaneous nerve of forearm' (sensory lateral forearm as seen in pic)

Answer 43

Continuation of posterior cord Lies posterior to axillary artery Descends to inferior border of subscapularis and exists axilla through quadrangular space (Quad space: Superior [subscap, teres minor], inferior [teres major], lat. [humerus neck], med. [long head of triceps]) Terminates into two branches: Anterior terminal branch - innervates deltoids Posterior terminal branch - innervates teres minor and skin over inferior deltoid (continues as sensory n. - upper lateral cutaenous nerve of the arm) Which innervates skin over inferior deltoid

Answer 44

pronators: ponator teres, pronator quadratus (median n.) supinators: biceps, supinator (musculoc n. + radial n.)

Answer 45

Proximal radioulnar joint: - Quadrate ligament - between neck of radius, procimal to tuberosity and upper part of supinator fossa of ulna Distal radioulnar joint: Closed distally by triangular fibrocartilage. Attached to base of ulna notch of radius and ulnar styloid This joints are responsible for supination and pronation

Answer 46

If thumb is extended (drawing up extensor tendons) it created a cavity Medial - extensor pollicis longus tendon Lateral - abductor pollicis longus/ extendor pollicis brevis Proximal - styloid process of radius roof- skin - floow - carpal bones (Scaphoid, trapezium) Significance: The (superficial) cutaneous branches othe radial nerve cross the tendons The cephalic vein begins in the snuffbox from the dorsal vneous network the radial artery lies on the floor

Answer 47

Above styloid process of radius attached to pisiform and triquetral bones

Answer 48

Borders: - flexor retinaculum - deep carpal arch: scaphoid, trapezium,hamate, pisiform Contents: 9 tendons: Flexor digitorum profundus (4), Flexor digitorum superficialis (4), flexor pollicis longus (1) FDS and FDP share same sheath. FPL own sheath. Median nerve

Answer 49

Synovial Joint. \*Ulna is not part of the joint, it articulates with the radius, just proximal to the wrist joint Between radius with scaphoid, lunate, triquetral bones A simple capsule surrounds the joint Ligaments: - Palmar radiocarpal - Dorsal radiocarpal - Ulnar collateral (Ulnar styloid to triquetrum and pisiform) - Radial colateral (Styloid process to scaphoid and trapeium) Nerve supply - posterior interosseous (radial) and anterior interosseous (median) Adduction: flexor and extensor carpi ulnaris Abduction: abductor pollicis longus, flexor carpi radialis

Answer 50

Degenerated tendon of palmaris longus Extends from flexor retinaculum where it fans out towards the bases of the fingers (proximal phalanges) Thinnest over hypothenar region Function is mechanical (attaches to skin of hand to improve grip)

Answer 51

Strong band attached from Scaphoid and trapezium laterally to pisiform and hamate medially \*Pisiform only bone that gives rise to both flexor and extensor retinaculum Th ulnar nerve lies on the retinaculum alongside the pisiform bone, with the ulnar artery on its radial side. (known as Canal of Guyon) Nerve then divides into a superficial and deep branch at distal border of retinaculum

Answer 52

it is the artery that is the continuation of the ulnar artery in the palm gives off palmar fidital arteries that supply the fingers

Answer 53

Lying immediately deep to the superficial palmar arch are the common palmar digital nerves they pass distally to the webs, between the slips of the palmar aponeurosis and divide like the arteries into proper palmar digital nerves

Answer 54

Caused by continual swelling in the synovial sheaths symptoms: - Wasting and weakness of thenar muscles (loss of opposition of thumb) - Anaesthesia over three and a half digits on the thumb side of the hand - Note there is NO Anaesthesia over the thenar eminence (supplied by palmar branch of median nerve which doesnt pass through carpal tunnel) Sugical division of the retinaculum relieves pressure and symptoms \*Note must be differentiated from median nerve damage higher up which would cause damage to the palmar cutaenous branch resulting in weakness of the relevant flexor muscles in the forearm (flexor pollicis longus) - in carpal tunel syndrome the terminal phalanx of the thumb can be flexed with normal power, but with higher lesions this power is lost

Answer 55

\*Note ontop of abduction and adduction they have same function as lumbricals - flexion of MCP and extention of prox interphalangeal joint

Answer 56

Leaves lower end of radius and slopes across snuffbox over trapezium passes into hand between two heads of first dorsal interosseous muscle Branches i) arteria radialis indicis (radial side of index finger) ii) princeps pollicis - either side of thumb The main trunk of radial artery then forms the deep palamr arch (anastomosing with deep branch of ulnar artery)

Answer 57

Oval shaped - Medial wall - medial epicondyle of humerus - Lateral wall - olecranon of ulna - Floor - elbow joint capsule and medial collateral ligament of elbow - Roof - ligament spanning between medial epicodyle and olegranon (cubital tunnel retinaculum) Contents - ulnar nerve

Answer 58

Extends from proximal pisoform to origin of hypothenar muscles at hook of hamate Borders: Medial (ulnar) - Pisiform, flexor carpi ulnaris tendon, abductor digiti minimi Lateral - hook of hamate Roof - palmar carpal ligament Floor - retinaculum, psiohamate ligament, hypothenar muscles Contents: - ulnar nerve - bifurcates in canal to superficial (sensory) and deep (motor) branches - ulnar artery (lateral to nerve) - venae comitanted of ulnar artery - lymphatic vessels

Answer 59

On the tendon of flexor pollicis longus the sheath extends from above the flexor retinaculum to the insertion of the tendon into the terminal phalanx of the thumb. The tendons of the superficial and deep flexors are together invested with a common synovial sheath that is incomplete on the radial side (FDS, FDP). From the metacarpal heads to the distal phalanges FPL, FDS and FDP are enveloped in a fibrous flexor sheath

Answer 60

Superficial transverse metacarpal ligament: Lies beneath palmar skin The ligament supports the fold of skin at the web Digital vessels and nerves lie immediately deep to ligament Deep transverse metacarpal ligament joins the palmar ligaments of the metacarpal phalangeal joints

Answer 61

Palmar radiocarpal - anterior hand. form radius to both rows of carpal bones Dorsal radiocarpal - poserior. Radius to both rows of carpal bones ulnar collateral - ulnar styloid process to triquetrum and pisiform radial collateral - radial stylois to scaphor and trapezium

Answer 62

A grey ramus communicans joins each root of the brachial plexus and these sympathetic fibres hitch-hike through the plexus and its branches and remains in the nerves until very near their area of supply

Answer 63

Whole limb immobile and anaesthetic If serratus anterior and rhomboids are in action, damage is distal to the roots of origin If supraspinatus and infraspinatus espace, the damage is distal to the upper trunk Commonest traction injury to the plexus is at C5,6 (Erb's Paralysis) which can be caused at birth (Erb-Duchenne paralysis). The supinators are paralysed so that the arm hangs by the side, medially rotated, extended at the elbow and pronated with loss of sensation on lateral arm and forearm (Musculocutaneous n., axillary n.) Damage to the lowest roots (C8,T1) results in small muscles of the hand being effected leading to a claw hand and inability to extend the fingers, with sensory loss on the ulnar side of the forearm.

Answer 64

Damaged in 5% of dislocations of the shoulder, fractures of proximal humerus or iatrogenic Results in paralysis of the deltoids and and egg-shaped anaesthesia over the outer side of the upper arm below the acromion

Answer 65

Injured my fractures of shaft of humerus Transient presentations from crutches or saturday night palsy \*Note Branches for triceps leave before nerve reaches the humerus (so a mid shaft fracture won't effect elbow extension) but may be effected in higher lesions Motor: Wrist drop (Thus loss of grip stregnth) Sensory: loss is minimal, usually a coin-shaped area overlying first dorsal interosseous (Apparently there is a fair bit of overlap from ular and median n.)

Answer 66

Most common at elbow or wrist Wrist: Motor - Claw hand from paralysis of lumbricals and interossei (Hyperextension of MCP joint and Flexion of Interphalangeal joints of ring and little finger. THa claw is brought about by unopposed action of the extensors and flexor digitorum Wasting of the interossei becomes evident on dorsum of hand. Sensory: ulnar side of hand (medial 1.5 fingers) (Test for abduction to prove this) Injury at the elbow: Motor: Gives straighter fingers as the ulnar half of the flexor digitorum profundus is out of action and cant fles the distal interphalangeal joints (test for distal Interphalangeal joint flexion to prove this)

Answer 67

Injury at wrist: Motor: Wasting of the thenar eminence (do note the flexor pollicis brevis can sometimes be innervated by ulnar nerve, so the most obvious wasting is the abductor pollicis brevis which is always innervated by median n.) (if testing, do not test flexor pollicis brevis, test abduction of thumb) Sensory: - Anaesthesia over three and a half digits on the thumb side of the hand - Note there is NO Anaesthesia over the thenar eminence (supplied by palmar branch of median nerve which doesnt pass through carpal tunnel) Lesion below anterior interosseous nerve: Recurrent branch of median nerve * Innervates muscles of the thenar eminence * Damaged with lacerations of the radial-sided wrist and proximal palm * Results in loss of thumb flexion, opposition, and abduction without sensory or other motor deficits Median claw: Distal median nerve injury causes palsy of the lumbricals I and II with preserved function of extrinsic flexors. This imbalance leads to permanent flexion of the index finger and the middle finger (aggravated when trying to extend the fingers). Ape hand: inability to oppose and abduct the thumb due to injury of the proximal or distal median nerves impairing the thenar muscles' functions Palmar cutaneous nerve * Purely sensory nerve arising from median nerve proximal to the carpal tunnel * Provides sensation to the palm Lesion above anterior interosseous nerve: Wasting of the front of the forearm because of the long flexors (Excepts flexor carpi ulnaris and 1/2 FDP) and the pronators are paralysed Hand of benediction: when asked to make a fist, the patient can only flex the ring finger and the little finger due to * Loss of thumb opposition and abduction * Loss of index and middle finger flexion Impaired wrist pronation and flexion Thenar muscle atrophy (chronic injury)

Answer 68

esenchyme chondrifies at the sixth week, when the whole scapula becomes cartilaginous. A bony centre appears in the eighth week at the thick part of the lateral angle and gradually enlarges. At birth the blade and spine are ossified, but the acromion, coracoid process, medial border and inferior angle are still composed of hyaline cartilage. Secondary centres appear in these places, and around the lower margin of the glenoid cavity, at about puberty, and all are fused by 25 years. The centre at the base of the coracoid process ossifies at 10 years and fuses, across the glenoid cavity, soon after puberty.

Answer 69

The whole is cartilaginous at the sixth week. A primary centre appears in the centre of the shaft at the eighth week. Upper and lower ends are cartilaginous at birth. Secondary centres appear at both ends. For the upper end they are in the head during the first year, greater tuberosity at the third and lesser tuberosity at the fifth year. These three fuse by the seventh year into a single bony epiphysis, hollowed to fit a conical projection of the bony shaft. The epiphyseal line skirts the bone across the lowest margin of the articular surface, cutting across the tuberosities. This is the growing end of the bone; fusion occurs at about 20 years. At the lower end four centres appear. There is one for the capitulum and lateral ridge of the trochlea at the second year, one for the medial epicondyle at the fifth year, the remainder of the trochlea at the twelfth and the lateral epicondyle at the thirteenth year. The medial epicondyle remains a separate centre, separated by a downward projection of the shaft (in contact with the ulnar nerve) from the other three, which fuse together. Union with the shaft occurs at about 18 years.

Answer 70

The whole appears in cartilage at the sixth week, and a centre appears in the middle of the shaft at the eighth week. At birth both ends are carti laginous; the lower is the growing end. A centre appears in the lower end at the end of the first year, and fuses at 20 years. This epiphyseal line is extracapsular; it runs transversely through the base of the styloid process and lies above the ulnar notch. The centre for the head appears at 4 years and fuses at 12; the epiphyseal line is at the junction of head and neck.

Answer 71

Cartilage at the sixth week, a centre for the shaft appears at the eighth week. The head is not ossified until the sixth year. This is the growing end and does not fuse with the shaft until 20 years. The upper end is curious in that it shows only a small epiphysis at the proximal surface of the olecranon; this appears at about the tenth year and fuses at 18 years or earlier. The massive upper end of the ulna grows in size and adapts its shape to the trochlea as one mass of bone, unaided by growth and adjustment at an epiphyseal line.

Answer 72

Unlike the tarsus the carpus is all cartilaginous at birth.Each carpal bone ossifies from one centre. The largest bone, the capitate, ossifies first (first year) and the smallest, the pisiform, ossifies last (tenth year). The others ossify in sequence, according to their size, at approximately yearly intervals (hamate, triquetral, lunate, trapezium, scaphoid, trapezoid), so the whole carpus, except the sesamoid pisiform bone, is ossified by the seventh year. The shafts of all the metacarpals and phalanges ossify in utero, so that at birth there is a cartilaginous epiphysis at the base of every bone except the metacarpals of the palm (second, third, fourth and fifth), where the epiphysis is at the head. Note that the thumb metacarpal ossifies like a phalanx. The cartilagi nous epiphyses ossify at the second to third year and fuse at 20 years. The tuberosity of each terminal phalanx ossifies in membrane.

Answer 73

Shoulder: Abduction C5 Adduction C6,7,8 Elbow Flexion C5,6 Extension C7,8 Forearm Supinate C6 Pronate C7,8 Wrist Flexion C6,7 Extension C6,7 Fingers and thumb (long tension) Flex C7,8 Ext C7,8 Intrinsic muscles of Hand T1

Upper Limb Flashcards

(108 cards)