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Flashcards in Upper Limb Deck (178):
1

State the muscles and bones that make up the four borders of the axilla.

Anterior - pectoralis major/minor, subclavius
Medial - ribcage, intercostal muscles, serratus anterior
Posterior - latissimus dorsi, subscapularis, teres major, costal surface
Lateral - intertubecular groove of humerus

2

What forms the axillary sheath and what does it contain?

Fascia.
Contains major vessels and nerves

3

What are the two veins in the arm, and describe the changes as they pass through the axilla and over the first rib.

Cephic vein (follows deltoid, more lateral) and basilic vein (follows triceps, more medial). Merge to the axillary vein, then becomes the subclavian vein after passing over the first rib.

4

Describe the passage of the subclavian artery to the forearm.

Becomes the axillary artery in the anterior wall, passing the lateral border of the first rib.
Passes the inferior border of the teres major to become the brachial artery.
Then becomes the radial and ulnar arteries.

5

What are the nerve roots of the brachial plexus?

C5-8, T1

6

What muscle overlays the nerve roots of the brachial plexus?

Sternocleidomastoid

7

Where can the axillary nerve be found?

Deep behind the humerus, passes to the deltoid

8

Where can the radial nerve be found?

Passes down the radial groove

9

Where can the musculocutaneous nerve be found?

Passes between the biceps

10

Where can the ulnar nerve be found?

Posterior to the medial epicondyl of the humerus.

11

Where can the medial nerve be found?

Passes through the fossa.

12

What vein connects the basilic and cephalic veins in the cubital fossa?

Median cubital vein

13

Innervation of deltoid

Axillary nerve

14

Function of the deltoid

Abduction of the arm from 50 to 130 degrees

15

Function of the biceps brachii

Mainly for supination of the forearm, also for flexion.

16

Innervation of the biceps brachii

Musculocutaneous nerve

17

Attachments of the biceps brachii

Long head - tendon passes up intertubecular groove to attach to the supraglenoid tubercle

Short head - coracoid process

Fans to the bicipital aponeurosis and radial tuberosity.

18

Function of the brachialis

Flexion of the arm

19

Innervation of the brachialis

Musculocutaneous nerve

20

Function of the coracobrachialis

Flexion and adduction of the arm, stabilisation of the glenohumeral joint

21

Innervation of the coracobrachialis

Musculocutaneous nerve

22

What deep, posterior artery follows the course of the radial nerve?

Profunda brachii

23

What arteries wrap around the humeral head?

Posterior and anterior humeral circumflex artery

24

Function of the triceps brachii

Long - Aids in extention and adduction of the arm. Helps to stabalise the adducted glenohumeral joint.
Lateral - strongest. Primary muscle against resistance.
Medial - forearm extension, always active.

25

From lateral to medial, name the innervation and vasculature in the antecubital fossa.

Biceps tendon
Brachial artery
Medial nerve

26

Function of pronator teres

Pronation of the forearm

27

Innervation of the brachioradalis

Radial nerve

28

Give the muscle and innervation involved in extension at the elbow

Triceps
Radial nerve

29

Give the two joints that the shoulder articulates at.

Glenohumeral joint
Scapulothoracic joint

30

What is the glenoid labrum and what is it's function?

A fibrocartilage rim around the glenoid cavity which increases the surface for articulation, providing more stability.

31

Why is the glenohumeral joint inherently unstable?

Shallow
Disproportion of articular surfaces
Multiplanar movements
Lax capsule

32

What muscles are the most important in improving stability of the glenohumeral joint?

Rotator cuff muscles

33

Attachments of the glenohumeral capsule

Glenoid labrum
Glenoid cavity
Anatomical neck of the humerus
Bridges down intertubecular groove
Dips medially to the surgical neck

34

What is the function of the small anterior opening in the synovial membrane of the glenohumeral capsule?

So the joint can communicate with the subscapular bursa

35

Describe the synovial membrane of the glenohumeral joint

Lines the capsule and bone up to the edge of the articular surface. Secretes synovial fluid

36

Describe the three glenohumeral ligaments.

Superior, middle and inferior.
Extend between the glenoid labrum and humerus.
Part of the fibrous capsule and reinforces the capsule anteriorly.
Can only be seen from inside the capsule.

37

Describe the extracapsular ligaments.

Coracromial ligament - most important. Between the acromion and coracoid process. Supports and stabilises the shoulder joint.

Coracohumeral ligament - from the base of the coracoid process to the anterior part of the greater tubercle. Strengthens the upper part of the capsule of the shoulder joint.

Transverse humeral ligament - holds the tendon of the long head of the biceps in place during shoulder movement. Inserts into the intertubecular groove.

All together forms the coracoacromial arch, a strong osseoligamentous structure which overlies the humeral head. This prevents the upper displacement of the humerus.

38

State the four muscles which make up the rotator cuff.

Supraspinatus, infraspinatus, teres minor and subscapular

39

Function of the supraspinatus

Initiation and first 15 degrees of abduction of the arm

40

Innervation of the supraspinatus

Suprascapular nerve (C5/6)

41

Function of the infraspinatus

Lateral rotation of the arm

42

Innervation of the infraspinatus

Suprascapular nerve (C5/6)

43

Function of the teres minor

Lateral rotation
Weak adductor

44

Innervation of the teres minor

Axillary nerve

45

Function of the subscapular muscle

Medial rotation of the arm

46

Innervation of the subscapular muscle

Upper and lower subscapular nerve

47

Describe the tendinous cuff of the glenohumeral joint

Tendons blend together to form a cuff.
Fuses with the capsule and strengthens it.
Tone in the muscles holds the head close to the glenoid cavity.

48

What separates the supraspinatous tendon from the arch?

Subacromial bursa

49

What movement of the arm risks impingement of soft tissue?

Abduction

50

Describe the function of the subscapular bursa

Facilitates movement of the tendon of subscapularis muscle over the scapula and communicates with the joint cavity.

51

Describe the function of the subacromial bursa.

Facilitates movement of the supraspinatus tendon under the coracoacromial arch and deltoid muscle over the capsule and greater tubercle of the humerus.

52

What is the function of the suprascapular artery?

Supplies the skin over the acromion and upper part of the chest.
Has a small role in supplying the sternocleidomastoid and subscapularis.

53

What is the origin of the suprascapular nerve?

Upper trunk of the brachial plexus

54

What is the function of the suprascapular nerve?

Innervates the supraspinatus and infraspinatous muscle.
Sensory for the acromioclavicular and glenohumeral joints

55

What is the origin of the axillary nerve?

Posterior cord of the brachial plexus

56

What is the function of the axillary nerve?

Innervates the deltoid, teres minor and long head of the triceps brachii.
Sensory from the shoulder joint and regimental badge area.

57

Where does the lateral pectoral nerve penetrate?

Deep surface of the pectoralis major

58

What are the axillary nerve and posterior circumflex artery vulnerable to at the front of the humerus?

Intramuscular injection of the deltoid muscle

59

What are the axillary nerve and posterior circumflex artery vulnerable to at the back of the humerus?

Injury during shoulder joint dislocation and surgical neck fractures

60

Function of the aconeus

Abduction of the ulna, accessory extensor at the elbow.

61

Innervation of extensor carpi radialis longus

Radial nerve

62

Function of extensor carpi radialis longus

Extension and abduction of the wrist

63

Innervation of the extensor carpi radialis brevis

Deep branch of radial nerve

64

Function of extensor carpi radialis brevis

Extension and abduction of the wrist

65

Innervation of the supinator

Posterior interosseus nerve

66

Function of the supinator

Supination

67

Innervation of abductor pollicus longus

Posterior interosseus nerve

68

Function of abductor pollicus longus.

Accessory extensor of the thumb

69

Innervation of extensor pollicus brevis

Posterior interosseus nerve

70

Function of the extensor pollicus brevis

Extends metacarpophalangeal and carpometacarpal joint.

71

Innervation of extensor indices

Posterior interosseus nerve

72

Function of extensor indicies

Extends the index finger

73

Innervation of extensor pollicus longus

Posterior interosseus nerve

74

Innervation of extensor carpi ulnaris

Posterior interosseus nerve

74

Function of extensor carpi ulnaris

Extends and adducts the wrist

74

Innervation of extensor digiti minimi

Posterior interosseus nerve

74

Function of extensor digiti minimi

Extends the little finger

74

Innervation of extensor digitorum

Posterior interosseus nerve

74

Function of extensor digitorum

Extends the four fingers and wrist

74

Innervation of the aconeus

Radial nerve

80

Function of extensor pollicus longus

Extends all joints of the thumb

81

What muscles produce the hinge movement in the forearm?

Biceps brachii
Triceps brachii
Brachioradialis

82

What part of the humerus articulates with the ulna?

Trochlea

83

What part of the humerus articulates with the radius?

Capitulum

84

What type of joint is the elbow?

Synovial hinge joint

85

What is the maximum extension with the ulna at the elbow?

170 degrees

86

What ligaments strengthen the elbow laterally and medially?

Laterally - Radial collateral ligament
Medially - Ulnar collateral ligament

87

What joint shares a capsule with the elbow?

Proximal radioulnar joint

88

Describe the ulnar collateral ligament

3 bands
Anterior - large, stiff and rigid. Attaches the distal humerus to the coronoid process
Posterior - fan like. Attaches the humerus to the ulna.
Oblique - deeper socket for the trochlea of the humerus in the trochlear notch

89

Describe the radial collateral ligament

Fan-like band passing from the humerus to radius. Blends with the annular ligament.

90

What two bursae are important in the elbow and where are they found?

Subcutaneous olecranon bursa - superficial, over the olecranon process. Posterior.

Subtendinous olecranon bursa - beneath the triceps tendon over the olecranon process.

91

Describe the inbuilt redundancy of vasculature in the elbow.

Recurrent branches of the radial and ulnar arteries pass around the elbow and anastamose with others.

92

Describe the proximal radioulnar joint

Pivot joint.
The head of the radius is sat in the radial notch. Annular ligament wraps around the radial head, forming a ligamentous collar which prevents subluxation of the radius.

93

Describe a pulled elbow.

Common in children.
Caused by traction in the forearm which causes subluxation of the radius which can lead to dislocation.
Most common in children because the annular ligament isn't fully descended and the ligaments aren't as strong. The radial head is also not fully developed.

94

Describe the difference between subluxation and dislocation

Subluxation is partial dislocation, so the bone may be misaligned but is still in contact.
In dislocation there is complete loss of contact of the joint surfaces.

95

Describe the muscles that allow pronation of the forearm.

Pronator quadratus - deep and distal
Pronator teres - superficial and proximal

96

What muscles are involved in supination of the forearm?

Supinator - proximal
Biceps brachii

97

Describe articulation of the radius with the humerus on supination.

Head of the radius rotates at the capitulum of the humerus - mini ball and socket joint.

98

Describe the interosseus membrane

Fibrous joint which runs inferomedially. Allows distribution of force from the radius to the ulna.

99

Describe the distal radioulnar joint.

The distal head of the ulna articulates with the ulnar notch of the radius.
Has the articular disc which is a specialisation of ligaments.
Clear separation between the distal joint and wrist.
No true pivoting, but the articular disc allows stretching.
Has the sacciform recess - specialisation of the synovial membrane which allows twisting of the capsule.

100

What bones articulate at the wrist joint?

Scaphoid
Lunate
Triquetrium
Radius

101

Function of opponens pollicis

Opposes the thumb by medially rotating and flexing the metacarpophalangeal

102

Innervation of opponens pollicis

Median nerve

103

Function of abductor pollicis brevis

Abducts the thumb

104

Innervation abductor pollicis brevis

Median nerve

105

Function of flexor pollicis brevis

Flexes the metacarpophalangeal joint of the thumb

106

Innervation of flexor pollicis brevis

Median nerve

107

Function of abductor digiti minimi

Abducts the little finger

108

Innervation of abductor digiti minimi

Ulnar nerve

109

Function of opponens digiti minimi

Rotates the metacarpal of the little finger towards the palm, producing opposition

110

Innervation of opponens digiti minimi

Ulnar nerve

111

Function of flexor digiti minimi brevis

Flexes the metacarpophalangeal joint of the little finger

112

Innervation of flexor digiti minimi brevis

Ulnar nerve

113

Function of the lumbricles of the hand

Link extensor tendons to flexor tendons
Flexion of the metacarpophalangeal joint of the four fingers
Extension of the interphalangeal joints of the four fingers

114

Innervation of the lumbricles of the hand

I and II - median nerve
III and IV - ulnar nerve

115

How many interossei are there on the dorsal and palmar surfaces?

Dorsal - 4
Palmar -

116

Innervation of the interossei of the hand

Ulnar nerve

117

Innervation of adductor pollicis

Ulnar nerve

118

Innervation of palmaris brevis

Ulnar nerve

119

Function of the dorsal interossei

Abducts in index, middle and ring fingers and assists in flexion of the metacarpophalangeal joints and extension at the interphalangeal joints.

120

Function of the palmar interossei

Adduct the fingers
Assists in flexion of the metacarpophalangeal joints and extension at the interphalangeal joints.

121

Function of adductor pollicis

Adducts the thumb

122

Function of palmaris brevis

Tenses the skin of the palm on the ulnar side during gripping.

123

Function of flexor carpi ulnaris

Flexion and adduction at the wrist.

124

Innervation of flexor carpi ulnaris

Ulnar nerve

125

Function of palmaris longus

Causes flexion at the wrist

126

Innervation of palmaris longus

Median nerve

127

Function of flexor carpi radialis

Flexion and abduction at the wrist

128

Innervation of flexor carpi radialis

Median nerve

129

Function of pronator teres

Forms the medial border of the cubital fossa
Pronation of the forearm

130

Innervation of pronator teres

Median nerve

131

Function of flexor digitorum superficialis

Flexes the metacarpophalangeal joints and proximal interphalangeal joints of the four fingers.
Flexes at the wrist.

132

Innervation of flexor digitorum superficialis

Median nerve

133

Function of flexor digitalis profundus

Flexes distal interphalangeal joints and the wrist

134

Innervation of flexor digitalis profundus

Median nerve and ulnar nerve

135

Function of flexor pollicis longus

Flexor of the phalanges of the thumb and assists in flexing the wrist when the thumb is fixed

136

Innervation of flexor pollicis longus

Median nerve

137

Function of pronator quadratus

Pronates the forearm

138

Innervation of pronator quadratus

Median nerve

139

Where does the common extensor tendon of the forearm attach?

Lateral epicondyle

140

Where does the common flexor tendon of the forearm attach?

Medial epicondyle

141

Describe the pathology of lateral epicondylitis (tennis elbow)

Inflammation of the periosteum of the lateral epicondyle.
Caused by repeated use of the superficial extensor muscles which strains their common tendinous attachment to the lateral epicondyle.

142

Describe the potential causes of wrist drop and explain the pathology behind it.

Axilla - humeral dislocation or fracture of the proximal humerus
Radial groove - mid-shaft fracture of the humerus.

It's a sign of radial nerve injury proximal to the elbow.

All extensor muscles are paralysed so the tone of flexor muscles causes unopposed flexion.

143

Give all the superior muscles in the anterior compartment of the forearm from lateral to medial

Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris

144

Give the intermediate muscle of the anterior compartment of the forearm

Flexor digitorum superficialis.

145

Give the deep muscles of the anterior compartment of the forearm.

Flexor digitalis profundus
Flexor pollicis longus
Pronator quadratus

146

The majority of muscles in the anterior compartment of the forearm have the same innervation.
What nerve is this, and state the exceptions.

Median nerve.
Exceptions are flexor carpi ulnaris (ulnar nerve) and flexor digitalis profundus (medial - ulnar nerve, lateral - median nerve)

147

Give the superficial muscles of the posterior compartment of the forearm from lateral to medial.

Brachioradialis
Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor digitorum
Extensor digiti minimi
Extensor carpi ulnaris
Aconeus

148

Give the deep muscles of the posterior compartment of the forearm from lateral to medial.

Supinator
Abductor pollicis longus
Extensor pollicis brevis
Extensor pollicis longus
Extensor indices

149

Give the function of the trapezius

Upper - elevates and rotates the scapula during abduction of the arm
Middle - retracts the scapula
Lower - pulls the scapula inferiorly

150

Innervation of the trapezius

Accessory nerve

151

How would you check for damage of the accessory nerve?

Shrug the shoulders against resistance

152

Function of levator scapulae

Elevates the scapula

153

Innervation of levator scapulae

Dorsal scapular nerve

154

Function of rhomboid major and minor

Retracts and rotates the scapula

155

Innervation of rhomboid major and minor

Dorsal scapular nerve

156

Nerves originating from the lateral cord of the brachial plexus

Musculocutaneous
Median (part)

157

Nerves originating from the posterior cord of the brachial plexus

Radial nerve
Axillary nerve

158

Nerves originating from the medial cord of the brachial plexus

Ulnar nerve
Median nerve (part)

159

Root origin of the musculocutaneous nerve

C5
C6

160

Root origin of the median nerve

C5
C6
C8
T1

161

Root origin of the radial nerve

C7

162

Roor origin of the ulnar nerve

C8
T1

163

Describe the cause and symptoms of Erb's palsy

Upper brachial plexus injury generally caused during delivery of the neonate
Nerves with C5/C6 nerve roots damaged - Musculocutaneous, median, nerve to subclavius and suprascapular
Loss of shoulder abduction, lateral rotation, supination and flexion.
Causes 'waiter's tip'

164

Describe the cause and symptoms of Klumpke palsy

Upper brachial plexus injury caused by excessive abduction of the arm.
Damages T1 so the ulnar and median nerves are affected.
All the small muscles of the hand are affected and there is loss of sensation along the medial arm

No flexor muscles are affected as they are innervated by a different nerve root.

165

Give the three bursa that can be found around the shoulder joint.

Subcoracoid bursa
Subscapular bursa
Subacromial bursa

166

Describe the glenohumeral ligament and give its function

Stabilises the anterior aspect of the joint.

Three bands run with the joint capsule from the glenoid fossa to the anatomical neck of the humerus.

167

Describe the coracohumeral ligament and give its function

Supports the superior part of the joint capsule

Base of the coracoid process to the greater tubercle of the humerus

168

Describe the transverse humeral ligament and give its function

Holds the tendon of the long head of the biceps in the intertubecular groove

Spans the distance between the two tubercles of the humerus

169

Describe the coracoacromial ligament and it's function

Overlies the shoulder joint, preventing superior displacement of the humeral head

Runs between the acromion and coracoid process to form the coraco-acromial arch

170

What arteries supply the glenohumeral joint?

Posterior circumflex humeral artery
Suprascapular artery
Branches of these then anastamose around the joint.

171

What nerves supply the shoulder joint?

Axillary
Suprascapular
Lateral pectoral
(all from roots C5/C6)

172

What type of joint is the shoulder?

Ball and socket synovial joint

173

What muscles allow extension at the shoulder?

Posterior deltoid
Latissimus dorsi
Teres major

174

What muscles allow flexion at the shoulder?

Biceps brachii (both heads)
Pectoralis major
Anterior deltoid
Coracobrachialis

175

What muscles allow medial rotation at the shoulder?

Subscapularis
Pectoralis major
Latissimus dorsi
Teres major
Anterior deltoid

176

What muscles allow lateral rotation at the shoulder?

Infraspinatus
Teres minor

177

Describe painful arc in the shoulder

Pain in the middle of abduction caused by rotator cuff tendonitis.
Inflammation of the muscle tendons, usually caused by overuse.
Causes degenerative changes in the subacromial bursa, and the supraspinatous tendon, which increases friction between the structures of the joint.