Upper Limb Flashcards
1
Q
Muscles forming the ANTERIOR WALL of the AXILLA
A
PECTORALS MAJOR & PECTORALIS MINOR
2
Q
Muscles forming the POSTERIOR WALL of the AXILLA
A
SCAPULA, SUBSCAPULARIS, TERES MAJOR & LATISSIMUS DORSI
3
Q
Muscles forming the MEDIAL WALL of the AXILLA
A
THORACIC WALL & SERRATUS ANTERIOR
4
Q
Muscles forming the LATERAL WALL of the AXILLA
A
INTERTUBERCULAR SULCUS OF HUMERUS
5
Q
Contents of the axilla
A
Axillary artery, Axillary vein, Brachial plexus, Tendons of Biceps Brachii + Coracobrachialis & Axillary lymph nodes
6
Q
Brachial plexus values
A
Formed by the ANTERIOR (ventral) RAMI of C5-T1
7
Q
What root(s) of the brachial plexus give the superior trunk?
A
C5 + C6 roots
8
Q
What root(s) of the brachial plexus give the middle trunk?
A
C7 root
9
Q
What root(s) of the brachial plexus give the inferior trunk?
A
C8 + T1 roots
10
Q
Which nerve root(s) are affected in Erb’s palsy?
A
C5 + C6 roots
11
Q
What is Erb’s palsy?
A
Injury to UPPER trunk giving a MEDIALLY ROTATED UPPER TRUNK WITH FLEXED WRIST
12
Q
What causes Erb’s palsy?
A
HYPEREXTENSION of the HEAD from the SHOULDER
13
Q
Which muscles are affected in Erb’s palsy?
A
SUPRASPINATUS, INFRASPINATUS, SUBCLAVIAS, BICEPS BRACHII, BRACHIALIS, CORACOBRACHIALIS, DELTOID & TERES MINOR
14
Q
What is Klumpke’s palsy?
A
Injury to LOWER trunk giving a loss of grasp reflex with a supinated hand, extended wrist and fingers clawed
15
Q
Which nerve root(s) are affected in Klumpke’s palsy?
A
C8 + T1 roots
16
Q
What causes Klumpke’s palsy?
A
Undue ABDUCTION of the ARM
17
Q
Which muscles are affected in Klumpke’s palsy?
A
INTRINSIC MUSCLES OF THE HAND + ULNAR FLEXORS OF WRIST & FINGERS AFFECTED
18
Q
What are the cords of the brachial plexus?
A
Lateral, posterior and medial **
19
Q
What are the branches of the LATERAL CORD?
A
MUSCULOCUTANEOUS nerve (+ lateral pectoral and lateral root of median nerves)
20
Q
What are the branches of POSTERIOR CORD?
A
AXILLARY & RADIAL nerves (+ thorascodorsal, upper subscapular and lower sub scapular nerves)
21
Q
What are the branches of MEDIAL CORD?
A
ULNAR nerve (+medial pectoral, median root of median nerve, medial cutaneous nerves of arm and forearm)
22
Q
Arterial supply of the Upper Limb
A
Brachiocephalic–>Subclavian–>Axillary–>Brachial–>Radial/Ulnar–>Deep palmar arch–> Superficial palmar arch
23
Q
Name the superficial veins of the Upper Limb
A
Cephalic vein, Median cubital vein & Basilic veins
24
Q
Which of the veins of the upper limb is most lateral?
A
Cephalic vein
25
Which of the veins of the upper limb is most medial?
Basilic vein
26
Which of the veins of the upper limb shunts blood from one of the other veins to another? From which to which?
Median Cubital vein shunts blood from Cephalic to Basilic
27
Area supplied by C3 dermatome
Tip of shoulder
28
Area supplied by C4 dermatome
Top half of shoulder
29
Area supplied by C5 dermatome
Lateral aspect of arm
30
Area supplied by C6 dermatome
Lateral aspect of forearm and thumb
31
Area supplied by C7 dermatome
Middle 3 fingers
32
Area supplied by C8 dermatome
Little finger
33
Area supplied by T1 dermatome
Medial aspect of elbow
34
Area supplied by T2 dermatome
Medial aspect of arm
35
What are the 5 groups of AXILLARY LYMPH NODES?
Anterior (pectoral), Posterior (subscapular), Apical, Central and Lateral groups
36
Pectoral girdle
Set of bones connecting the upper limb to the axial skeleton
37
Sterno-clavicular joint
Small, double plane synovial joint articulating entire upper limb and pectoral girdle
38
Acromio-clavicular joint
Plane synovial joint connecting acrimion of scapula and lacrimal end of clavicle
39
What causes movement of pectoral girdle?
Sterno-clavicular, acromio-clavicular and shoulder joints all moving simultaneously
40
Scapulohumeral rhythm
When considering abduction of arm from anatomical position- initially all movement at glenohumeral joint BUT beyond first 30 degrees, for every 3 degrees of abduction, 2 degrees is occurring at the shoulder joint and 1 degree is occurring at scapulothoracic joint (2:1 ratio)
41
Muscles ELEVATING scapula
LEVATOR SCAPULAE & UPPER TRAPEZIUS FIBRES
42
Muscles DEPRESSING scapula
PECTORALIS MINOR, LOWER TRAPEZIUS FIBRES, LATISSMUS DORSI & SUBCLAVUS
43
Muscles PROTRACTING scapula
SERRATUS ANTERIOR
44
Muscles RETRACTING scapula
MIDDLE TRAPEZIUS FIBRES & RHOMBOIDS
45
Muscles UPWARDLY ROTATING scapula
UPPER & MIDDLE TRAPEZIUS FIBRES
46
Muscles DOWNWARDLY ROTATING scapula
INFERIOR TRAPEZIUS, INFERIOR SERRATUS ANTERIOR & RHOMBOIDS
47
What type of joint is the shoulder?
Synovial ball and socket joint
48
What makes up the ball of the shoulder joint?
Head of humerus
49
What makes up the socket of the shoulder joint?
Glenoid cavity
50
What surrounds the socket of the shoulder joint? What's it role?
Glenoid labrum (fibrocartilaginous cartilage) which deepens articular cavity and protects edges of the bones
51
Name the ligaments of the shoulder joint
CORACOHUMERAL LIGAMENT, CORACOACROMIAL ARCH & GLENOHUMERAL LIGAMENT
52
What is the role of the Coracohumeral Ligament?
Strengthens superior aspect of joint
53
What is the role of the Coracoacromial Arch?
Prevents upward displacement of the humeral head
54
What is the role of the Glenohumeral Ligament?
Strengthens anterior aspect of joint
55
What is the role of BURSAE around the shoulder joint?
Provide cushioning around joints, via fluid filled centre
56
What is a Bursae?
Small fluid-filled sac lined by synovial membrane with an inner capillary layer of viscous fluid
57
Name the bursa around the shoulder joint?
Subacromial bursa & Subscapular bursa
58
What is the role of the Rotator Cuff muscles?
Allow shoulder movement and gives support, preventing dislocation
59
What are the Rotator Cuff muscles?
SUBSCAPULARIS, SUPRASPINATUS, INFRASPINATUS & TERES MINOR
60
What movements do the Rotator Cuff muscles carry out on Glenohumeral joint?
FLEXION, EXTENSION, ADDUCTION, ABDUCTION, MEDIAL/LATERAL ROTATION & CIRCUMDUCTION
61
What are the other muscles of the Shoulder joint?
DELTOID, PECTORALIS MAJOR, PECTORALIS MINOR, SERRATUS ANTERIOR, TRAPEZIUS, TERES MAJOR & LATISSIMUS DORSI
62
What are the action(s) of the ANTERIOR FIBRES of DELTOID?
FLEX & MEDIALLY ROTATE SHOULDER
63
What are the action(s) of the MIDDLE FIBRES of DELTOID?
ABDUCT SHOULDER
64
What are the action(s) of the POSTERIOR FIBRES of DELTOID?
EXTEND & LATERALLY ROTATE SHOULDER
65
Which nerve innervates the Deltoid muscle?
AXILLARY NERVE (C5 + C6)
66
What are the action(s) of the PECTORALS MAJOR?
ADDUCTS & MEDIALLY ROTATES HUMERUS
67
Which nerve(s) innervates the Pectoralis Major muscle?
LATERAL & MEDIAL PECTORAL NERVES
68
What are the action(s) of the SERRATUS ANTERIOR?
PROTRACTS SCAPULAE
69
Which nerve innervates the SERRATUS ANTERIOR?
LONG THORACIC NERVE (C5, C6 + C7)
70
What are the action(s) of the SUPERIOR FIBRES of TRAPEZIUS?
ELEVATES SCAPULA
71
What are the action(s) of the MIDDLE FIBRES of TRAPEZIUS?
RETRACTS SCAPULA
72
What are the action(s) of the INFERIOR FIBRES of TRAPEZIUS?
DEPRESS SCAPULA
73
Which nerve innervates the TRAPEZIUS?
ACCESSORY NERVE (CN XI)
74
What are the action(s) of TERES MAJOR?
DEPRESS SHOULDER + ADDUCTS & MEDIALLY ROTATES HUMERUS
75
What are are the action(s) of LATISSIMUS DORSI?
INTERNAL ROTATION OF SHOULDER + EXTENSION
76
What are the compartments of the arm?
ANTERIOR (flexor) + POSTERIOR (extensor)
77
How many muscles are in the anterior compartment of the arm? What are they?
3- BICEPS BRACHII, CORACOBRACHIALIS & BRACHIALIS
78
Which is the most superficial muscle of the arm?
Biceps Brachii
79
Which is the middle muscle of the arm?
Coracobrachialis
80
Which is the deepest muscle of the arm?
Brachialis
81
Biceps Brachii
Arises from scapula to form 2 heads LONG (lateral) AND SHORT (medial) heads which unite at distal 1/3 of upper arm to form a tendon
82
Where does the long head of the Biceps Brachii arise from?
Supra-glenoid tubercle
83
Where does the short head of the Biceps Brachii arise from?
Coracoid process
84
Which head of the Biceps Brachii is most lateral? And which most medial?
Lateral - long head & medial - short head
85
What is the action of the BICEPS BRACHII?
FLEXION (at shoulder and elbow joint) & SUPINATION (at radio-ulnar joint)
86
Which nerve innervates Biceps Brachii?
MUSCULOCUTANEOUS NERVE (C5 &C6)
87
Coracobrachialis
Arises from tip of coracoid process and inserts into medial margin of humerus
88
What is the action of the CORACOBRACHIALIS?
FLEXION + ABDUCTION of arm (& resists dislocation of shoulder)
89
Which nerve innervates Coracobrachialis?
MUSCULOCUTANEOUS NERVE (C5, C6, C7)
90
Brachialis
Arises from front of distal half of shaft of humerus and inserts into coronoid process of ulna
91
What is the action of the BRACHIALIS?
FLEXION of elbow joint
92
Which nerve innervates Coracobrachialis?
MUSCULOCUTANEOUS NERVE (C5, C6)
93
Which cord of the brachial plexus does the MUSCULOCUTANEOUS NERVE arise from?
Lateral cord
94
Which compartment of the arm does the Musculocutaneous nerve innervate?
Anterior compartment (BBC muscles)
95
What is the path of the Muculocutaneous nerve?
Enters arm through coerce-brachialis and descend between biceps brachii and brachialis
96
Once it supplies the muscles of the arm, what does the Musculocutaneous nerve continue on to be?
Lateral Cutaneous of the forearm
97
What are the root value of the Musculocutaneous nerve?
C5, C6, C7
98
Root of the Brachial Artery
Direct continuation of Axillary artery; begins at lower border of the Teres Major muscles and ends in the cubital fossa
99
What is the name of the deep artery of the arm branching from brachial artery?
Profunda Brachii Artery
100
Root of the Median Nerve
Descends along lateral side of axillary artery and upper part of brachial artery, crossing to the medial side of the brachial artery and entering the cubital fossa
101
What muscles in the arm does the Median Nerve supply?
NONE
102
Which cord of the brachial plexus does the MEDIAN NERVE arise from?
Medial and Lateral cords
103
Which cord of the brachial plexus does the ULNAR NERVE arise from?
Medial cord
104
What muscles in the arm does the Ulnar Nerve supply?
NONE
105
When hitting the 'funny bone', which nerve is impacted?
Ulnar Nerve
106
Root of the Ulnar Nerve
Descends along medial side of brachial artery entering the posterior compartment and running along the medial head of the triceps and to the BACK OF THE MEDIAL EPICONDYLE
107
Which nerve could be damaged with an injury at the Radial Groove?
Radial Nerve
108
Which nerve could be damaged with an injury at the Medial Epicondyle?
Ulnar Nerve
109
Which nerve could be damaged with an injury at the Surgical Neck of the humerus?
Axillary Nerve
110
What is the cubital fossa?
Triangular depression/hollow in front of the elbow
111
Which artery can be palpated medial to the tendon of the Biceps Brachii in cubital fossa?
Brachial Artery
112
What makes up the base of the cubital fossa boundary?
Imaginary line between 2 epicondlyes
113
What makes up the medial border of the cubital fossa boundary?
Brachioradialis muscle
114
What makes up the lateral border of the cubital fossa boundary?
Pronator teres muscle
115
What does the cubital fossa contain?
BRACHIAL, RADIAL & ULNAR ARTERIES, DEEP ACCOMPANYING VEINS, BICEPS BRACHII TENDON, MEDIAN & RADIAL NERVE
116
What is the median cubital vein often used for?
IV injection
117
Which artery is used to auscultate when measuring blood pressure?
Brachial artery
118
How many muscles are in the posterior compartment of the arm? What are they?
1- TRICEPS BRACHII
119
Why is biceps called biceps?
2 heads
120
Why is triceps called triceps?
3 heads
121
Triceps Brachii
Arises from long head from the scapula & by shorter heads (medial and lateral) from the humerus, continuing to common tendon of triceps which is inserted into Olecranon process of ulna
122
What is the action of the TRICEPS BRACHII?
EXTENSION of elbow
123
Anconeus muscles
Helps the triceps extend the forearm + abducts the ulna during pronation of the forearm
124
Which nerve innervates Triceps Brachii?
RADIAL NERVE (C7, C8, T1)
125
Which cord of the brachial plexus does the RADIAL NERVE arise from?
Posterior cord
126
Radial Nerve
Nerve of the extensor compartment of arm and forearm (innervates all the extensor muscles of elbow and wrist joint)
127
Root of Radial Nerve
Enters the arm anterior to the long head of triceps, runs along profunda artery and curves around mid shaft region of humerus in the radial groove
128
What are the root values of the radial nerve?
C5, C6, C7, C8, T1
129
What would cause a radial nerve injury and what is it most likely to affect and cause?
Radial groove injury by fracture of the humerus is most likely to affect Triceps Brachii and Biceps Brachii and cause a wrist drop
130
What type of joint is the elbow joint?
Synovial hinge joint
131
What are the 2 articulations of the elbow joint?
Trochlear notch of ulna and humerus & head of radius and capitulum of humerus
132
What actions occur at the elbow joint?
Flexion and extension
133
What muscles perform FLEXION at the elbow joint?
Brachialis, Biceps Brachii and Brachioradialis
134
What muscles perform EXTENSION at the elbow joint?
Triceps Brachii and Anconeus
135
Name the ligaments of the elbow
Ulnar Collateral, Radial Collateral and Anular Ligaments
136
How many radio-ulnar joints are there?
2 (proximal and distal)
137
What type of joints are the radio ulnar joints?
Pivot type synovial type joints
138
What actions do the RADIO-ULNAR JOINTS carry out?
SUPINATION AND PRONATION
139
Which muscles are involved in SUPINATION of arm/forearm?
Supinator and Biceps Brachii
140
Which muscles are involved in PRONATION of arm/forearm?
Pronator teres and Pronator Quadratus
141
How many layers are there to the Anterior Forearm? What are they?
3- Superficial, Deep & Intermediate
142
What action do the muscles in the Anterior Forearm perform?
FLEXORS of the wrist/digits & PRONATORS of the forearm
143
How many muscles are in the Superficial Group of the Anterior Forearm? What are they?
4- PRONATOR TERES, FLEXOR CARPI RADIALIS, PALMARIS LONGUS & FLEXOR CARPI ULNARIS
144
PRONATOR TERES ~ action and innervation
PRONATES & FLEXES FOREARM AT ELBOW and INNERVATED BY MEDIAN NERVE
145
FLEXOR CARPI RADIALIS ~ action and innervation
FLEXES & ABDUCTS HAND AT WRIST and INNERVATED BY MEDIAN NERVE
146
PALMARIS LONGUS ~ action and innervation
FLEXES HAND AT WRIST and INNERVATED BY MEDIAN NERVE
147
FLEXOR CARPI ULNARIS ~ action and innervation
FLEXES & ADDUCTS HAND AT WRIST and INNERVATED BY ULNAR NERVE
148
What are the superficial muscles of the anterior forearm attached to?
Attached by a common flexor tendon to the medial epicondyle of the humerus
149
BRACHIORADIALIS ~ action, innervation and exception
FLEXES FOREARM AT THE ELBOW JOINT and INNERVATED BY RADIAL NERVE (Belongs to the extensor compartment but functionally is a flexor of the forearm)
150
How many muscles are in the Intermediate Group of the Anterior Forearm? What are they?
1- FLEXOR DIGITORUM SUPERFICIALIS
151
FLEXOR DIGITORUM SUPERFICIALIS ~ action and innervation
FLEXES WRIST, METACARPO-PHALANGEAL + INTERPHALANGEAL JOINTS) and INNERVATED BY MEDIAN NERVE (Gives rise to 4 tendons which attach to the medial four digits)
152
How many muscles are in the Deep Group of the Anterior Forearm? What are they?
3- FLEXOR DIGITORUM PROFUNDUS, FLEXOR POLLICUS LONGUS & PRONATOR QUADRATUS
153
FLEXOR DIGITORUM PROFUNDUS ~ action and innervation
FLEXES WRIST & FINGER JOINTS with dual nerve supply --> MEDIAL PART (digits 4 + 5) supplied by ULNAR NERVE and LATERAL PART (digits 2 + 3) supplied by MEDIAN NERVE
154
FLEXOR POLLICIS LONGUS ~ action and innervation
LONG FLEOX OF THUMN and INNERVATED BY MEDIAN NERVE
155
PRONATOR QUADRATUS ~ action and innervation
PRONATES FOREARM and INNERVATED BY MEDIAN NERVE
156
What is the main nerve of the anterior compartment of the forearm?
MEDIAN NERVE
157
Which muscles does the Median Nerve not supply in the forearm?
FLEXOR CARPI ULNARIS & Medial Half of FLEXOR DIGITORUM PROFUNDUS
158
What is the Median Nerve medial to?
Brachial Artery
159
Which nerve supplies the muscles that the Median Nerve doesn't supply in the forearm (FLEXOR CARPI ULNARIS & Medial Half of FLEXOR DIGITORUM PROFUNDUS)?
Ulnar Nerve
160
How many terminal branches does the Brachial Artery have? What are they?
2- ULNAR & RADIAL ARTERIES
161
Where is the Carpal Tunnel?
Deep to the flexor retunaculum between the scaphoid and the trapezium on the lateral side + pisiform and hamate bone on the medial side
162
What is the Fibrous Retinaculum?
Strong fibrous band which converts the concavity of the palmar surface of the carpal bones and converts it into the carpal tunnel
163
What does the Carpal Tunnel contain?
MEDIAN NERVE, 4 TENDONS OF FDP, 4 TENDONS OF FDS & 1 TENDON OF FPL
164
Which nerve is affected in Carpal Tunnel Syndrome?
Median Nerve
165
How is Carpal Tunnel Syndrome treated?
By cutting the Flexor Retinaculum
166
How many compartments do the Intrinsic Muscles of the Hand have? What are they?
5; THENAR, HYPOTHENAR, ADDUCTOR, CENTRAL COMPARTMENT & INTEROSSEI
167
THENAR COMPARTMENT (muscles, action and innervation)- lateral part of hand
ABDUCTOR POLLICIS BREVIS, FLEXOR POLLICIS BREVIS AND OPPONENS POLLICIS
APPOSITION OF THE THUMB
INNERVATED BY MEDIAN NERVE
168
HYPOTHENAR COMPARTMENT (muscles, action and innervation)- medial part of hand
ABDUCTOR DIGITI MINIMI, FLEXOR DIGITI MINIMI AND OPPONENS DIGITI MINIMI
ABDUCT, FLEX AND OPPOSE
INNERVATED BY ULNAR NERVE
169
ADDUCTOR COMPARTMENT (muscles, action and innervation)
ADDUCTOR POLLICIS (oblique and transverse heads)
ADDUCTION OF THUMB
INNERVATED BY ULNAR NERVE
170
CENTRAL COMPARTMENT (muscles, action and innervation)
4 earth worm like muscles called LUMBRICALS which originate from FLEXOR DIGITORUM PROFUNDUS
FLEX fingers at MCP joint AND SIMULTANEOUSLY EXTEND ICP joint of 2-5 digits
Medial 2 innervated by ULNAR NERVE
Lateral 2 innervated by MEDIAN NERVE
171
INTEROSSEI COMPARTMENT (muscles, action and innervation)
Muscles between metacarpal bones
4 DORSAL INTEROSSEI ABDUCT THE FINGERS (DAB)
3 PALMAR INTEROSSEI ADDUCT THE FINGERS (PAD)
INNERVATE BY ULNAR NERVE
172
What type of joint is the Wrist Joint?
Synovial condylar joint - also known as radiocarpal joint
173
What forms the distal and proximal ends of this joint?
Distal end of radius from the proximal part of the joint
Proximal row of carpal bones from the distal articular part of the joint
174
Name the carpal bones
Schaphoid, Lunate, Triquetrum, Pisiform, Hamat, Capitate, Trapezios, Trapezium
175
What are the actions of the wrist joint?
Flex, Extend, Circumduct, Adduct and Abduct
176
How many groups of muscles are there to the Posterior Forearm? What are they?
3 functional groups;
1. Muscles that extend and abduct/adduct the hand
2. Muscles that extend the medial 4 digits
3. Muscles that extend or abduct the thumb
177
What action do the muscles in the Posterior Forearm perform?
EXTENSORS of the wrist/digits, ABDUCT/ADDUCTORS of the wrist + SUPINATORS of the thumb
178
Which muscles are in group 1 (muscles that extend and abduct/adduct the hand)?
EXTENSOR CARPI RADIALIS LONGUS
EXTENSOR CARPI RADIALIS BREVIS
EXTENSOR CARPI ULNARIS
179
Which muscles are in group 2 (muscles that extend the medial 4 digits)?
EXTENSOR DIGITORUM
EXTENSOR INDICUS
EXTENSOR DIGITI MINIMI
180
Which muscles are in group 3 (muscles that extend or abduct the thumb)?
ABDUCTOR POLLICIS LONGUS
EXTENSOR POLLICIS BREVIS
EXTENSOR POLLICIS LONGUS
181
Which nerve innervates all the muscles in the posterior compartment of the forearm?
Radial nerve
182
Supinator (action and innervation)
```
Supinates forearm (rotates radius)
Supplied by Deep Branch of Radial Nerve
```
183
What is the main superficial vein of the hand?
Dorsal venous arch
184
Where does the Radial Nerve divide? Into what?
Cubital fossa it divides into superficial and deep branches (deep branch/posterior interosseous nerve)
185
What are the Deep Muscles of the Forearm? What part of the arm do they act on?
Group 3
ABDUCTOR POLLICIS LONGUS
EXTENSOR POLLICIS BREVIS
EXTENSOR POLLICIS LONGUS
All acting on the thumb
186
Which tendon(s) bind the anatomical snuff box laterally?
Tendon of APL + EPB
187
Which tendon(s) bind the anatomical snuff box medially?
Tendon of EPL
188
Which 2 carpal bones can be felt in the snuff box?
Scaphoid + Trapezium
189
Which artery can be palpated in anatomical snuff box?
Radial artery
190
Fracture of which bone can be fatal for the anatomical snuff box artery?
Scaphoid bone
