Upper limb anatomy Flashcards
(116 cards)
1
Q
Which root is sensory and which is motor
A
Dorsal = sensory Ventral = motor
2
Q
Root vs ramus
A
Root = 1-way (input OR output) Ramus = contains both sensory input + motor output
3
Q
Except for T2-T12, all ____ branch and make lateral connections just outside the spinal cord =
A
Ventral rami
Make NERVE PLEXUSES
4
Q
What is the important of a plexus?
A
Each muscle receives nerve supply from >1 spinal nerve –> damage to one doesn’t completely paralyze it
5
Q
Brachial plexus nerves + spinal levels
A
C5-C8 + T1 Axillary Musculocutaneous Median Ulnar Radial
6
Q
Socket of shoulder joint =
What helps make it deeper?
A
Glenoid cavity
Labrum
7
Q
a rounded protuberance at the end of some bones, forming an articulation with another bone
A
condyle
8
Q
What part of the ulna posteriorly fits into a fossa of the humerus?
A
Olecranon (fits into olecranon fossa between medial and lateral epicondyles of the humerus)
9
Q
ulna and radius each have a ___ process distally
A
styloid
10
Q
Name the carpal bones (2 rows lateral –> medial starting with proximal row)
A
Some Lovers Try Positions That They Cannot Handle
Scaphoid Lunate Triquetrum Pisiform
Trapezium Trapezoid Capitate Hamate
11
Q
Which carpal bones articulate with the radius?
A
Scaphoid + lunate
12
Q
Which 3 nerves of the brachial plexus go all the way into the hand?
A
Radial, median, ulnar
13
Q
5 branches (peripheral nerves) of the brachial plexus. Name the spinal levels and their targets: Axillary
A
C5-C6
Teres minor, deltoid
14
Q
5 branches (peripheral nerves) of the brachial plexus. Name the spinal levels and their targets: Radial
A
C5-T1
Posterior compartments
15
Q
5 branches (peripheral nerves) of the brachial plexus. Name the spinal levels and their targets: Musculocutaneous
A
C5-C7
Arm flexors
16
Q
5 branches (peripheral nerves) of the brachial plexus. Name the spinal levels and their targets: Median
A
C5-T1
Forearm flexors
17
Q
5 branches (peripheral nerves) of the brachial plexus. Name the spinal levels and their targets: Ulnar
A
C8-T1
Forearm flexors
18
Q
Extensor compartment nerves of upper limb
A
Axillary nerve + radial nerve
19
Q
WHAT ARE THE BRANCHES OF THE MF AORTA
A
Brachiocephalic (–> R subclavian + R common carotid)
L common carotid
L subclavian
20
Q
Vasculature of the R arm
A
Brachiocephalic –> Subclavian artery –> axillary –> brachial –> radial + ulnar –> palmar arches (deep goes R –> U, superficial goes U–>R)
21
Q
Blood samples often taken from what vein?
A
Median cubital vein
22
Q
veins of the arm empty into which main vein?
A
Subclavian (–> brachiocephalic –> SVC)
23
Q
Muscles acting on the shoulder: superficial layer (extrinsic back) (4)
A
Trapezius
Latissimus dorsi
Rhomboids (+/-)
Teres major
24
Q
Muscles acting on the shoulder:deep layer (4)
A
Supraspinatus Infraspinatus Teres minor Subscapularis "SITS"
25
Muscles acting on the shoulder: pectoral (3)
Serratus anterior
Pectoralis major
Pectoralis minor
26
Muscles acting on the shoulder: brachium
Deltoid
Long head of biceps
Long head of triceps
27
What back muscle extends, adducts, and medially rotates the humerus?
Latissimus dorsi
28
What muscle elevates/depresses/retracts the scapula?
Trapezius
29
Teres major does what movements of humerus?
Adduction + medial rotation (inserts on the lesser tubercle = anterior)
30
Which rotator cuff muscle inserts at the lesser tubercle of the humerus?
Subscapularis
31
Rotator cuff: teres minor and infraspinatus insert at the ___ and therefore rotate the humerus ___
Greater tubercle of the humerus
| laterally
32
Pectoralis minor moves the ____
| Pectoralis major moves the _____
Minor --> scapula (protraction)
| Major --> humerus (arm flexion/adduction
33
Winged scapula = lesion of ____ resulting in what?
Long thoracic nerve
| Inactive serratus anterior (so pec minor pulls scapula forward)
34
Deltoid is innervated by ___ nerve and responsible for what movements?
Axillary nerve
| Flexion, extension, abduction
35
Abduction of shoulder involves what 4 muscles in what order to get from 0 --> 180 degrees?
(note - supplied by 4 diff nerves!)
Supraspinatus --> deltoid --> trapezius --> serratus anterior
36
Up to 30o arm abduction, what joint? a
| After 30o, what joint?
First just glenohumeral
| then glenohumeral + scapulothoracic
37
Which arm flexor is also innervated by the radial nerve?
Brachialis
38
3 arm flexors
Biceps (supination)
Coracobrachialis (shoulder flexion)
Brachialis (elbox flexion)
39
Popeye sign =
Rupture of biceps tendon (long-head)
| *generally not surgically repaired, brachialis does most of the work
40
Which heads of the triceps extend the arm? Which extend the forearm?
All extend forarm (insert in ulna via triceps brachii tendon)
Only long head extends arm because it originates on scapula, medial/lateral originate on humerus)
41
common origin of the flexor compartment (forearm)
Medial epicondyle
42
Common origin of the extensor compartment (forearm)
Lateral epicondyle
43
Forearm flexor innervated by radial nerve
Brachioradialis
44
Name 5 SUPERFICIAL forearm flexors from lat to med
Brachioradialis then Pass Fail Pass Fail
Pronator teres (pronation)
Flexor carpi radialis (abduction +flexion of hand)
Palmis longus (flexion at wrist, weak elbow flexion)
Flexor carpi ulnaris (adduction/flexion of hand)
45
Middle + Deep forearm flexors (3)
Flexor digitorum superficialis
Flexor digitorum profundus
Pronator quadratus
46
Thick fibrous band across base of wrist (anterior) to protect/hold tendons =
Flexor retinaculum
47
Flexor digitorum superficialis does what? Innervation?
Flexes phalanges @ PIP
| Medial nerve
48
Flexor digitorum profundus does what? Innervation?
Flexes wrist, metacarpophalangeal, PIP and DIP joints of 2nd-5th digits
Median + ulnar nerve
49
Holding tendons in place at back of wrist =
Extensor retinaculum
50
Forearm extensors (lateral --> medial)
Extensor carpi radialis (longus + brevis) - abduct hand
Extensor digitorum
Extensor digiti minimi
Extensor carpi ulnaris
51
Deep lateral forearm extensor that supinates arm
Supinator
52
2 types of epicondylitis
Medial collateral ligament (flexors) = golfer's elbow (overuse flexion)
Lateral collateral ligament (extensors) = tennis elbow (overuse extension)
53
Outcropping muscles of forearm (4)
```
Abductor pollicus longus
Extensor pollicus longus
Extensor pollicus brevis
Extensor indicis (2nd digit)
```
54
What is the action of the 4 lumbricals of the hand?
Flex the metacarpophalangeal joints
Extend the PIP & DIP joints
(N= median for 1-2, ulnar for 3-4)
55
intrinsic muscle sets of the hand (5)
```
Lumbricals (1-4)
Dorsal interossei (1-4)
Palmar interossei (1-3)
Thenar group
Hypothenar group
```
56
What do the dorsal interossei do?
Abduct digits from axial line
| N = ulnar
57
What do the palmar interossei do? N =
Adduct digits toward axial line
| N = ulnar
58
What muscle does all the fancy thumb motions (flexion, extension, opposition, adduction, abduction)
Thenar muscles (N = median & ulnar)
59
4 joints of the pectoral girdle
Glenohumeral
Sternoclavicular
Acromioclavicular
Scapulothoracic (not a true joint)
60
Important prominences of the scapula
Spine (posterior)
Acromion (lateral)
Coracoid (anterolateral)
61
Ligaments of the AC joint
Acromioclavicular ligament
| Coracoclavicular ligaments
62
"shoulder dislocation" occurs at what joint?
Glenohumeral joint
63
"shoulder separation" occurs at what joints?
Acromioclavicular and sternoclavicular
64
3 joints of elbow
Radiocapitellar (capitulum of humerus)
Ulnotrochlear
- radiocapitellar + ulnotrochlear --> hinge joint of elbow
Proximal radioulnar (pronation/supination)
65
3 important ligaments of elbow
Ulnar collateral ligament
Radial collateral ligament
Annular ligament of radius
66
Name the 6 main forearm flexors
```
Brachioradialis
Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris
Flexor digitorum superficialis
```
67
Name the 5 main forearm extensors
```
Supinator
Extensor carpi radialis (longus + brevis)
Extensor digitorum
Extensor digiti minimi
Extensor carpi radialis
```
68
Which carpal one is only visible on palmar aspect of hand
Pisiform (p = palm)
69
Which carpal bones form the anatomical snuff box of the hand? Tendons of which muscles?
Scaphoid + trapezium
| EPB/APL + EPL
70
Which carpal bone is most commonly fractured
Scaphoid
71
Each interphalangeal joint of hand is a ___ joint with it's own ___ and _____
Synovial
Capsule
Lateral/collateral ligaments
72
The thumb is a ___ joint
Saddle
73
___ joint is what we typically think of as the "wrist". Important ligaments? (4)
```
Radiocarpal joint
Ulnar carpal collateral ligament
Radial carpal collateral ligament
Dorsal/palmar radiocarpal ligaments
Dorsa/palmar radioulnar ligament
Palmar ulnocarpal ligament
```
74
What is a colle's fracture? What usually causes it? Sign on x-ray?
Fracture of radius where styloid process pushed posteriorly
usually FOOSH
Dinnerfork deformity
75
What is thoracic outlet syndrome? What 3 areas can this occur?
Compression of brachial plexus/subclavian vessels
| 3 areas: interscalene triangle, costoclavicular space, pectoralis minor space
76
What is the test for thoracic outlet syndrome?
Wright's test (hyperabduction)
| Arm into external rotation + abduction --> check for radial pulse ablation
77
What nerve goes through the carpal tunnel? What bounds it? How many tendons go through?
Median nerve
Floor = carpal bones
Root = flexor retinaculum
9 (2 per digit + one for thumb)
78
Implications of carpal tunnel syndrome?
Thenar muscle weakness + skin paresthesia
79
Shoulder is most prone to dislocation ____
Infero-anteriorly (least stabilizing structures/ligaments)
80
What is the most common site of bursitis in the rotator cuff?
Subacromial bursa (between acromion and supraspinatus)
81
What is subacromial impingement syndrome?
inflammation and irritation of the rotator cuff tendons as they pass through the subacromial space, resulting in pain, weakness, and reduced range of motion within the shoulder
82
2 possible pathologies that can cause SIS?
Rotator cuff tendinosis
Subacromial bursitis
(chicken & egg situation)
83
THe proximal radioulnar joint is what kind of joint?
Pivot joint (facilitates supination/ pronation, annular ligament of radius loops around)
84
The main large bursa of the elbow
Olecranon bursa
85
What nerve can become entrapped in the cubital tunnel?
Ulnar nerve
86
Where can the ulnar nerve be found on elbow palpation?
Medial para-olecranon groove just behind medial epicondyle
87
What is the carrying angle?
Valgus physiological deviation of upper limb (up to 10 degrees in men, 20 in women); allows us to swing arms and carry stuff without abducting shoulders
88
Difference between smith fracture and colle's fracture?
```
Smith = distal radius anteriorly displaced
Colles = posteriorly displaced (dinner fork sign)
```
89
How do you differentiate between Dupuytren's contracture (thickened palmar fascia) vs torn tendon?
Name 4 conditions DC is associated with
Passive movement. DC will be rigid
| Diabetes, epilepsy, alcoholism, liver disease/cirrhosis
90
What are osteophytes? Most common cause
Bone spurs caused by joint damage
| Osteoarthritis
91
What are bouchard's nodes and heberden's nodes? What else might you see in the same disease?
Osteophytes formed at PIPs and DIPS respectively in osteoarthritis
Also see squaring of the wrist due to osteophytes at the first CMC joint
92
"sausage digits"
Dactylitis (can be seen in psoriatic arthritis)
93
What are you looking for if you get the pt to do the "Prayer Sign"?
Swan neck deformities (extend PIP, flex DIP)
Boutonnier's deformities (PIP flex, extend DIP - like pushing button)
^signs of RA
94
In RA the ___ are typically spared from swelling
DIP
95
What 2 hand bumps do you easily feel (right beside the wrist)
Pisiform (medial by pinky)
| Scaphoid (lateral by thumb)
96
Shoulder Physical Exam: Inspection
| Asymmetrical height of shoulders could indicate what?
Scoliosis
| Sprengel's deformity (high-riding scapula)
97
Test to check for internal rotation of the scapula
Apley scratch test
98
Main pathologies you're looking for in shoulder special tests (5)
1) Supraspinatus tear
2) Subacromial impingement syndrome
3) Bicipital tendinitis
4) Acromioclavicular joint pathology (e.g. OA)
5) Instability
99
Special test for supraspinatus tear
Drop arm test
100
Special tests for SIS (4)
1) Painful arc (abduction)
2) Neer's test (passive full flexion)
3) Hawkins-Kennedy Test (hold hawk, push down)
4) Empty can test (push down)
101
Special tests for bicipital tendinitis (2)
1) Speed's test (push down)
| 2) Yergason's test (thumbs up, you try to pronate them, they resist)
102
Special tests for acromioclavicular joint pathology (2)
```
Scarf test (wrap hand like scarf, push while stabilizing ipsilateral shoulder)
AC Joint distraction test (adduction behind back)
```
103
Test for inferior shoulder instability
Pull down on arm --> SULCUS sign
104
Test for recurrent anterior subluxation/anterior shoulder instability)?
Apprehension test
Relocation test
Anterior release sign
105
Name 6 special tests for the elbow
MCL/LCL stability (vagus/varus with arm at 30 degrees)
Anterio-posterior stability (arm at 90, try to move humerus)
Tennis elbow (start with arm out wrist extended)
Golfer's elbow (same but wrist flexed)
Tinel's sign (tap ulnar nerve) - cubital tunnel syndrome
Elbow flexion test (60 seconds CTS)
106
What is quervain's tenosynovitis
inflammation of tendons of lateral snuffbox (extensor pollicis brevus/abductor pollicis longus)
107
Tests for carpal tunnel syndrome
Tinel's sign (same as cubital but in this case tap median nerve)
Phalen's sign (hold dorsal hands together 60 seconds)
108
How can you test for DeQuervain's tenosynovitis?
Finkelstein's test (thumb in fist, ulnar deviation)
109
Name 4 stability tests in the hand exam
1) Wrist stability (sublux up & down)
2) Piano key sign (push down in ulnar head) - distal radioulnar ligament stability, RA can impact
3) MCP stability (flexed!) - like ant-post drawer test, also valgus/varus
4) IP stability (varus/valgus)
110
Median nerve motor and sensory testing
```
Motor = "okay" sign
Sensory = palmar pad of index finger
```
111
Radial nerve motor and sensory testing
```
Motor = thumbs up
Sensory = dorsal 1st web space
```
112
Ulnar nerve motor and sensory testing
```
Motor = finger abduction
Sensory = palmar pad of pinky finger
```
113
Heads of humerus, radius, ulna (proximal vs distal)
```
Humerus = proximal
Radius = proximal
Ulna = distal (by styloid)
```
114
Subacromial bursitis =
```
Supraspinatus tendonitis
(chicken and egg, they come together)
```
115
4 compartments of the forearm
```
Superficial volar (flexor carpi U/R, pronator teres, flexor digitorum superficialis)
Deep volar (FDP, FPL)
Dorsal (supinator, extensors)
Lateral Mobile Wad of Henry (brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis)
```
116
Compartments of the arm
Anterior: biceps brachii, brachialis, coracobrachialis
Posterior: triceps brachii
Deltoid
