Upper Limb

Question 1

Where does scapula extend from?

Answer 1

Ribs 2-7 when arm by side

Question 2

Why is rotation of the scapula required

Answer 2

For full abduction

Question 3

Describe osteology of clavicle

Answer 3

Medial 2/3 convex anteriorly and circular cross-section
Lateral 1/3 convex posteriorly and flat cross-section

Question 4

Costoclavicular ligament?

Answer 4

Attaches clavicle to 1st costal cartilage

Question 5

First bone to ossify in foetus?

Answer 5

Clavicle - only long bone which develops in a membrane

Question 6

Function of clavicle?

Answer 6

Transmit force from upper limb to axial skeleton
Acts as a strut to hold arm free from trunk

Question 7

What may pierce the clavicle?

Answer 7

Supraclavicular nerves

Question 8

Most commonly frac bone?

Answer 8

Clavicle - usually at junction between middle and lateral 1/3

Question 9

Describe the humeral head

Answer 9

1/3 of a sphere facing upwards and backwards

Question 10

What separates greater and lesser tubercle of humerus?

Answer 10

Bicipital groove - containing long head of biceps tendon

Question 11

What passes medially and wraps round surgical neck of humerus?

Answer 11

Axillary nerve
Posterior circumflex humeral artery and vein

Question 12

Radial nerve path around humerus?

Answer 12

Sits in spiral groove which lies posteriorly on the shaft and winds around - between the medial and lateral heads of triceps

Question 13

Osteology of distal humerus

Answer 13

Rounded capitulum laterally - for articulation with radial head
Trochlea medially - for articulation with trochlear notch of ulna
Medial and lateral epicondyles - these are extracapsular

Question 14

Where does the ulnar nerve lie relative to the distal humerus?

Answer 14

In the groove on the posterior aspect of the medial epicondyle

Question 15

Osteology of radius and ulna

Answer 15

Radius consists of head, neck, radial tuberosity shaft and expanded distal end

Ulna contains olecranon, trochlear fossa, coronoid process with its radial notch for articulation with radial head, shaft and small distal head

Both have a distal styloid process

Question 16

Carpal bones?

Answer 16

Lateral to medial:

Scaphoid lunate triquetral pisiform
Trapezium trapezoid capitate hamate

Question 17

Shape of carpal bones overall?
How is this shape maintained?

Answer 17

Arched transversely with plamar aspect being concave

Maintained by individual bones, which are broader posteriorly than anteriorly

Also by flexor retinaculum passing from scaphoid/trapezium laterally to pisiform and hook of hamate medially

Question 18

What surface of the triquetrum does pisiform sit on?
What sits next to it distally?

Answer 18

Palmar surface

Hook of hamate

Question 19

Shoulder flexors? (3)

Answer 19

Anterior delt
Pec major
Coracobrachialis

Question 20

Shoulder extensors? (3)

Answer 20

Lat dorsi
Teres major
Posterior delt

Question 21

Internal rotators of shoulder? (4)

Answer 21

Pec major
Lat dorsi
Subscapularis
Anterior delt

Question 22

External rotators of shoulder? (3)

Answer 22

Infraspinatus
Teres minor
Posterior delt

Question 23

Articular surfaces of sternoclavicular joint?
Ligament? Function?

Answer 23

Medial end of clavicle and manubrium of sternum with an intra-articular disc

Costoclavicuar cartilage - attaches medial clavicle to first costal cartilage
Acts as a fulcrum so when lateral clavicle is raised (e.g. shrugging), medial is depressed

Question 24

Articular surfaces of ACJ?
Nearby ligaments?
How is movement induced?

Answer 24

Lateral clavicle with acromion process - has an incomplete articular disc, surrounded by capsule

Coracoclavicular ( lateral clavicle *coracoid process - conoid is more medial than trapezoid ligament)

Passively with scapular movement

Question 25

Which aspect of glenohumeral joint is not covered by rotator cuff?

Answer 25

Inferior

Question 26

Insertion of rotator cuff tendons?

Answer 26

Supra/Infra-spinatus and teres minor to greater tuberosity of humerus Subscapularis to lesser tuberosity

Question 27

Path of supraspinatus?

Answer 27

Passes over apex of shoulder, beneath acromion and coracoacromial ligament, from which it is separated by the subacromial bursa, then to greater tuberosity

Question 28

Relationship between joints in the shoulder girdle and shoulder movement?

Answer 28

All but very slight glenohumeral movements are always accompanied by movements of the scapula on the clavicle and clavicle on manubrium.

Question 29

Muscles involved in full abduction?

Answer 29

Supraspinatus initiates to 15 degrees Deltoid takes over to 90 degrees 90-180 degrees is by rotation of the scapula by trapezius and serratus anterior

Question 30

Relationship between glenohumeral, scapular and sternoclavicular movements?

Answer 30

As soon as abduction commences rotation of scapula begins Movements of scapula occur with reciprocal movements of sternoclavicular joint eg elevate the shoulder and sternoclavicular joint is depressed - move shoulder forwards and the joint moves backwards

Question 31

What muscles elevate the shoulder?

Answer 31

Trapezius and elevator scapulae

Question 32

What depresses the shoulder?

Answer 32

Gravity, pec major and pec munor

Question 33

What protracts the scapula?

Answer 33

Serratus anterior and pec minor

Question 34

What retracts the scapula?

Answer 34

Rhomboids and middle fibres of trapezius

Question 35

What muscles rotate the scapula?

Answer 35

Trapezius and serratus anterior

Question 36

How will fragments of clavicle move in a fracture?

Answer 36

Trapezius unable to support weight of arm Lateral fragment is depressed down and drawn medially by shoulder adductors and broken ends overlap. Slight elevation of medial fragment due to sternocleidomastoid

Question 37

How can someone adduct arm in supraspinatus tendon rupture?

Answer 37

Tilt body to injured side so gravity pulls limb away from trunk and deltoid activates

Question 38

Which nerve supplies the serratus anterior? Roots? How is it commonly damaged?

Answer 38

Long thoracic nerve C5-7 Neck, breast or axillary surgery ( = winging of scapula)

Question 39

Describe articulations of elbow joint

Answer 39

3 articulations within 1 synovial cavity Humeroulnar - trochlea of humerus and trochlear notch of ulna (hinge joint) Humeroradial - capitulum and radial head (ball and socket joint) Proximal radioulnar - head of radius and radial notch of ulna (pivot joint)

Question 40

Describe structure of elbow joint capsule What structures are extracapsular?

Answer 40

Thin and lax anteriorly and posteriorly Thickened at sides to form medial and lateral collateral ligaments Lateral ligament is attached to annular ligament, which holds the radial head in place Medial and lateral epicondyles are extra capsular

Question 41

Elbow flexors?

Answer 41

Biceps, brachial, brachioradialis, forearm flexors

Question 42

Elbow extenders?

Answer 42

Triceps Aconeus

Question 43

Elbow pronators

Answer 43

Pronator teres Pronator quadratus

Question 44

Elbow supinators

Answer 44

Biceps Supinator

Question 45

What are the articular surfaces of the wrist?

Answer 45

Distal radius and head of ulna Proximal scaphoid, lunate, triquetral Head of ulna separated from carpus by articular disc

Question 46

What type of joint is wrist?

Answer 46

Condyloid joint Allows flexion, extension, abduction and adduction

Question 47

Wrist adductors?

Answer 47

Flexor carpi ulnaris Extensor carpi ulnaris

Question 48

Wrist abductors?

Answer 48

Flexor carpi radialis Extensor carpi radialis longus Extensor pollicis longus Abductor pollicis longus

Question 49

What type of joint is thumb CMC?

Answer 49

Saddle joint Allows flexion, extension, abduction, adduction and opposition Other CMC joints have only limited gliding movement