Upper Limbs

Question 1

What are the 8 carpal bones (2 rows from lateral to medial)?

Answer 1

• 1st row: scaphoid, lunate, triquetrum, pisiform
• 2nd row: trapezium, trapezoid, capitate, hamate

Straight line to pinky, here comes the thumb

Question 2

What does the pectoralis major do, what is it innervated by and how do you test it?

Answer 2

• Adducts, flexes and medially rotates the humerus
• Innervation: medial and lateral pectoral nerve
• Adduct against resistance with elbow flexed

Question 3

What is the function of the pectoralis minor and what is it innervated by?

Answer 3

• Stabilise the scapula

* Innervation: medial pectoral nerve

Question 4

What is the function of the subclavius (part of the anterior chest wall)?

Answer 4

Stabilise and depress the clavicle

Question 5

What is the function of the serratus anterior, what is it innervated by and how do you test it?

Answer 5

• Laterally rotates the scapula and protracts the scapula against the ribcage
• Long thoracic nerve
• Ask the patient to push out their arm (medially against your hand) whilst you place your other hand on the posteriolateral aspect of their chest to feel the muscle

Question 6

What happens if the long thoracic nerve is damaged?

Answer 6

• Damaged nerve no longer allows the serratus anterior to hold the scapula in a protracted state against the ribcage
• Allows the scapula to protrude
• ‘Winged scapula’

Question 7

What do the extrinsic shoulder muscles comprise?

Answer 7

• Superficial: Latissimus dorsi, Trapezius

* Deep: Levator scapulae, Rhomboid major, Rhomboid minor

Question 8

What is the function of the latissimus dorsi and trapezius?

Answer 8

• Latissimus dorsi - Extend, adduct and medially rotate the upper limb
• Trapezius - elevate and rotate, retract and depress the scapula

Question 9

What nerves innervate the latissimus dorsi and trapezius?

Answer 9

• Latissimus dorsi - Long scapular nerve

* Trapezius - Accessory nerve (XI)

Question 10

What is the function of the levator scapulae, rhomboid major and rhomboid minor?

Answer 10

• Levator scapulae - elevation of the scapula
• Rhomboid major - retracts and medially rotates the scapula
• Rhomboid minor - retracts and medially rotates the scapula

Question 11

Which nerves innervate the levator scapulae, rhomboid major and rhomboid minor?

Answer 11

• Levator scapulae - Dorsal scapular nerve
• Rhomboid major - Dorsal scapular nerve
• Rhomboid minor - Dorsal scapular nerve

Question 12

What do the intrinsic shoulder muscles comprise (for the purpose of the OSPE)?

Answer 12

• Deltoid
• Teres major
• Rotator cuff muscles: 
- Subscapularis
- Supraspinatous
- Infraspinatous
- Teres minor

Question 13

What is the function of the deltoid and teres major?

Answer 13

• Deltoid - abducts the arm

* Teres major - adducts, retracts and medially rotates the humerus

Question 14

What are the functions of the rotator cuff muscles

Answer 14

• Subscapularis - medially rotates the arm
• Supraspinatous - abducts the humerus
• Infraspinatous - laterally rotates the arm
• Teres minor - laterally rotates the humerus

Question 15

Which nerves innervate the deltoid, teres major and rotator cuff muscles?

Answer 15

• Deltoid - axillary nerve
• Teres major - lower subscapular nerve
• Subscapularis - upper and lower subscapular nerves
• Supraspinatous - suprascapular nerve
• Infraspinatous - suprascapular nerve
• Teres minor - axillary nerve

Question 16

How do you test the supraspinatous, infraspinatous and teres minor simultaneously and what movement is this?

Answer 16

Lateral rotation and abduction

• Ask patient to put arms behind neck
• Apply resistance
• Palpate rotator cuff muscles

Question 17

How do you test the teres major and subscapularis simultaneously and what movement is this?

Answer 17

Medial rotation, adduction and retraction of the upper arm

• Ask patient to put hands as far up behind their back as possible
• Apply resistance
• Palpate rotator cuff muscles

Question 18

What are the anterior muscles of the arm and their functions?

Answer 18

• Biceps brachii - superficial flexor and main supinator of forearm
• Brachialis - main flexor of the forearm
• Coracobrachialis - assists in flexion and adduction of humerus

Question 19

Which nerves innervate the anterior muscles of the arm (and what is the main artery)?

Answer 19

• All innervated by the musculocutaneous nerve (C5, 6, 7)
• Brachialis has some innervation from the radial nerve (C5-T1)
• Brachial artery

Question 20

What is the posterior muscle of the arm and its function?

Answer 20

Triceps brachii - extension of the forearm

Question 21

Which nerves innervate the superficial muscles of the anterior compartment of the forearm?

Answer 21

All median nerve, except FCU - ulnar nerve

Question 22

Which nerve innervates the intermediate layer of muscle of the anterior forearm (flexor digitorum superficialis)?

Answer 22

Median nerve

Question 23

Which nerves innervate the deep muscles of the anterior compartment of the forearm?

Answer 23

• FPL - median nerve
• FDP - ulnar nerve (medial 2 tendons) + median nerve (lateral 2 tendon)
• PQ - median nerve

Question 24

What are the superficial, intermediate and deep muscles of the anterior compartment of the forearm?

Answer 24

• Pronator teres
• FCR
• FCU
• Palmaris longus

• Flexor digitorum superficialis

• Flexor pollicis longus
• Flexor digitorum profundus
• Pronator quadratus

Question 25

What are the borders of the anatomical snuffbox?

Answer 25

* Medial - tendon of 'Extensor pollicis longus' * Lateral - tendons of 'Extensor pollicis brevis' and 'Abductor pollicis longus' * Floor - scaphoid and trapezium bone

Question 26

What are the superficial muscles of the posterior compartment of the forearm (beginning laterally)?

Answer 26

* Brachioradialis * Extensor carpi radialis longus * Extensor carpi radialis brevis * Extensor digitorum * Extensor digiti minimi * Extensor carpi ulnaris * Anconeus

Question 27

What are the deep muscles of the posterior compartment of the forearm (beginning laterally)?

Answer 27

* Supinator * Abductor pollicis longus * Extensor pollicis brevis * Extensor pollicis longus * Extensor indicis

Question 28

Which nerve innervates the posterior muscles of the forearm?

Answer 28

Radial nerve

Question 29

What are the intrinsic muscles of the hand and what are they innervated by?

Answer 29

* Interossei (flex MCP, extend IP) - ulnar nerve * Lumbricals (flex MCP, extend IP) - median nerve (2 + 3) and ulnar nerve (4 + 5) * Thenar muscles (flexor pollicis brevis, abductor pollicis brevis, opponens pollicis) - median nerve (recurrent branch) * Hypothenar muscles (flexor digiti minimi brevis, abductor digiti minimi, opponens digiti minimi) - ulnar nerve (deep branch) * Adductor pollicis - ulnar nerve

Question 30

Which nerve innervates the SCM?

Answer 30

Accessory nerve (XI)

Question 31

If there is damage of the ulnar nerve at the wrist, you get 'ulnar claw'. What is this and why does this occur?

Answer 31

• Loss of interossei muscles (normally flex MCP and extend IP joints) => hyperextension of MCP joints => flexion of IP joints • Intact lumbricals of 2+3 (median) - extension maintained • Lost lumbricals of 4+5 (normally flex MCP and extend IP joints) => extension lost in 4+5 => greater flexion in 4+5 by flexor digitorum profundus possible

Question 32

The biceps reflex tests which nerve segments?

Answer 32

C5, C6 (musculocutaneous)

Question 33

Which artery supplies the posterior compartment of the arm?

Answer 33

Profunda brachii artery (branch of brachial artery)

Question 34

The triceps reflex tests which nerve segments?

Answer 34

C7, 8 (radial nerve)