Anatomy -Upper Limb- Chapter 3

Front 1

Golden Sentence:
The _______ innervates the posterior aspect of the arm.
The _______ innervates the posterior forearm

Back 1

The radial n. innervates the posterior aspect of the arm and the deep radial n. innervates the post. forearm

Front 2

Golden Sentence:
The ____________ innervates the brachialis m., biceps brachii, and coracobrachialis and then becomes the ____________.

Back 2

The musculocutaneous n. innervates the brachialis m., biceps brachii, and coracobrachialis and then becomes the lateral cutaneous antebrachial n (aka lateral cutaneous n of forearm).

Front 3

Golden Sentence:
The ________ innervates the anterior regions of the forearm EXCEPT the _______ and ______________

Back 3

The median n. innervates the anterior regions of the forearm EXCEPT the flexor carpi ulnaris and 2 tendons of the flexor digitorum profundus.

Front 4

What innervates the flexor carpi ulnaris and 2 tendons of the flexor digitorum profundus?

Back 4

The ulnar n.

Front 5

suprascauplar notch contents?

Back 5

nerve, artery, and vessels of the same name

Front 6

Clavicle Shape:
Medial 2/3 is _______ anteriorly and
lateral 1/3 is ________ anteriorly.

Back 6

S shaped
Medial 2/3 is convex anteriorly and
lateral 1/3 is concave anteriorly.

Front 7

cleidocranial dysostosis/dysplasia (CCD)?

Gene involved?

Back 7

fx of clavicel btwn middle 1/3 and lateral 1/3
rare autosomal disorder with defective ossification, delayed bone/tooth growth, and craniofacial abnormalities

RUNX2 (aka CBFA1)

Front 8

__________ of the clavicle is the weakest point because this is where ______________ ossification occurs here

Back 8

medial-lateral border is weakest point because this is where intramembranous ossification occurs here

Front 9

sternoclavicular joint is what type of joint?

Back 9

ball and socket synovial joint

Front 10

acromioclavicular joint is what type of joint?

Back 10

plane-type joint that permits sliding/gliding movements

Front 11

What type of ossification do the ends of the clavicle undergo?

Back 11

endochondral ossification in second decade of life

Front 12

Thirds of the clavicle?

Back 12

Front 13

type of ossification at ends of clavicle?

Back 13

endochondral ossification

Front 14

weakest part of clavicle?

Back 14

medial-lateral border is weakest point because this is where intramembranous ossification occurs here

Front 15

sternoclavicular joint is what type of joint?

Back 15

ball and socket synovial joint

Front 16

Acromioclavicular joint

Back 16

plane-type joint

Front 17

Movements of the shoulder joint?

Back 17

abduction, adduction, anteversion (flexion), retroversion (extension), lateral and medial rotation, and circumduction

Front 18

Fx of surgical neck of humorous = damage to what nerve?

Back 18

axillary n.

Front 19

Midshaft humerus injury = damage to what nerve?

Back 19

radial n.

Front 20

Fx of the medial epicondyle of humerus = damage to what nerve?

Back 20

ulnar n.

Front 21

Fx of distal end of humorous = damage to what nerve?

Back 21

median n.

Front 22

What passes through the spiral groove?

Back 22

radial nerve and deep brachial vessels

Front 23

Colles’ Fracture?

Back 23

Fracture of the distal end of the radius, posterior displacement. Falling on hand with extended arm (eg.: falling on ice).

Front 24

Colles Fx may be accompanied by?

Back 24

May be accompanied by avulsion of ulnar styloid process.

Front 25

most frequent bone to fracture among the carpal bones?

most dislocated carpal bone

Back 25

Scaphoid bone is the most frequent
bone to fracture among the carpal bones.

Lunate is the most dislocated carpal bone

Front 26

Ulnar collateral ligament injury may lead to?

Back 26

abnormal ABDuction of the forearm

Front 27

Radial collateral ligament injury may lead to?

Back 27

abnormal ADDuction of the forearm

Front 28

What is Smith's Fracture?

Back 28

reverse Colles fx.

Front 29

What is a pulled elbow?

Back 29

aka Nursemaid's elbow, babysitter's elbow

small kids are abruptly pulled up by their arm; causes immature head of radius to dislocate from annular ligament resulting in painful pronation

Front 30

most frequently fractured carpal row?

most frequently and second most freq fractured carpal bone?

Back 30

the proximal row

scaphoid followed by triquetral

Front 31

Carpal bones articulate together to form a unit known as

Back 31

the carpal groove

Front 32

The carpal groove is covered by the ______ forming the ______

Back 32

flexor retinaculum forming the carpal tunnel

Front 33

Points of insertion of flexor retinaculum?

Back 33

Tubercle of scaphoid, pisiform, tubercle of
Trapezium and hook of Hamate.

Front 34

pathology of carpal tunnel syndrome?

Back 34

compression of median nerve

Front 35

causes of carpal tunnel syndrome?

Back 35

-pregnancy = increased progesterone = increased fluid
-amyloidosis = amyloid not eliminated = accumlation
-hypothyroid = low metabolism = accumulation of fluid/fat
-rheumatoid arthritis

Front 36

elbow joint is what type of joint? how many total joints at elbow?

Back 36

synovial; 3 joints:
humeroulnar
humeroradial
proximal radioulnar

Front 37

wrist joint aka? type of joint?

Back 37

aka radiocarpal joint

ellipsoid-type synovial joint

Front 38

Movement of the carpal joints by row?

Back 38

first (proximal) row has some movement

second row has no movement

Front 39

First carpometacarpal joint type?

Back 39

saddle joint: abduction, adduction, opposition, reposition, and circumduction

Front 40

metacarpophalangeal joint type?

Back 40

ball-and-socket synovial

restricted movement

Front 41

Fxn & Innervation:
Deltoid

Back 41

NN: Axillary N. (C5- C6).

Function: Most important abductor of the arm up to 90 degree.

Front 42

Fxn & Innervation:
Supraspinatus

Back 42

Abductor of the arm, belongs to the rotator cuff muscle group.
NN: Suprascapular N. (C4-C6)

Front 43

Fxn & Innervation:
Infraspinatus

Back 43

Lateral rotator of the arm
belongs to the rotator cuff muscle group.
NN: Suprascapular N. (C5-C6)

Front 44

Fxn & Innervation:
Teres minor

Back 44

Lateral rotator of the arm,
Rotator cuff group, NN: Axillary (circumflex) N. C5-C6

Front 45

Fxn & Innervation:
Teres major

Back 45

adduction and medial rotator of arm

lower sub scapular n. (C6-C7)

Front 46

Fxn & Innervation:
Latissimus Dorsi

Back 46

medial rotation, extension, and adduction of arm; also coughing

thoracodorsal n. (C6-8)

Front 47

Fxn & Innervation:
subscapularis muscle

Back 47

aids in arm adduction and medial rotation

subscapular n. (C5-7)

Front 48

Rotator cuff muscles?

Back 48

supraspinatus, infraspinatus, teres minor, and subscapularis

Front 49

Notable rotator cuff injury?

Back 49

tendinopathy of the supraspinatus, calcification, pain, avulsion of greater tubercle

Front 50

Fxn & Innervation:
Coracobrachialis M

Back 50

Flexion (anteversion) and adduction of arm,
Musculocutaneous N. (C5,C6,C7).

Front 51

Fxn & Innervation:
Serratus Anterior

Back 51

elavation of arm over 90deg; protracts scapula; respiratory muscle

long thoracic nerve (C5-C7)

Front 52

Winged scapula differential?

Back 52

can lift arm above 90deg = damage to dorsal scapular n. (rhomboids)

CANT lift arm above 90deg = damage to long thoracic n. (serratus ant.)

Front 53

What are the causes/signs/symptoms of axillary nerve injury?

Back 53

fx to proximal humerus

limited arm abduction and damaged skin sensation

Front 54

Fxn & Innervation:
Biceps Brachii

Back 54

Long head): abductor and medial rotator
of the arm
Short head: adductor of the arm
Both heads flex (anteroversion) shoulder joint

On elbow joint: flexor and strong supinator of
the forearm.

NN: Musculocutaneous N. (C5- C6)

Front 55

Biceps Jerk?

Back 55

Reflex that tests patency of Musculocutaneous nerve: C5-C6

part of brachial plexus

Front 56

hyperreflexia? indicative of?

Back 56

exaggeration of reflexes

indicates possible upper motor neuron problem

Front 57

hyporeflexia? indicative of?

Back 57

lack of reflex (little to none)

lower motor neuron disease

Front 58

Knee reflex root nerves?

Back 58

L3-L4

Front 59

Fxn & Innervation:
Brachialis

notable feature?

Back 59

Powerful flexor of the elbow joint

NN: Musculocutaneous N. (C5- C6)
and radial nerve to some of its lateral part

HYBRID muscle

Front 60

Fxn & Innervation:
Triceps

Triceps Jerk?

Back 60

Function: Chief extensor of elbow joint
Long head acts on 2 joints:
Retroversion and adduction of the arm

Radial N. (C6- C7- C8)

Triceps Jerk: C7- C8

Front 61

Fxn & Innervation:
Anconeus M:

Back 61

assists (extension of the elbow) triceps.

Innervation: Radial N.(C7- C8)

Front 62

common head of forearm flexors?

Back 62

medial epicondyle of the humerus

Front 63

common head for forearm extensors?

Back 63

dorsal lateral epicondyle

Front 64

Upper brachial plexus lesion aka? causes?

Back 64

Erb-Duchenne paralysis (C5-C6): Traction on the arm at birth or falling on the shoulder may damage the upper part of the plexus (roots may be pulled out of spinal cord)

Front 65

Signs of Erb Duchenne?

Back 65

Signs: Deltoid and supraspinatus are paralyzed (no arm abduction)
Infraspinatus paralysis leads to medial rotation of the arm.
Biceps and Brachialis are also paralyzed (no elbow flexion) .

Front 66

Lower brachial plexus lesion

Back 66

Klumpke’s paralysis (C8-T1)

Front 67

Klumpke’s paralysis (C8-T1)

Back 67

Claw hand

Signs: Atrophic paralysis of the forearm and small muscles of hand (Claw hand) and often a sympathetic palsy: eg: a Horner’s syndrome

Front 68

Fxn & Innervation:
Palmaris longus

Back 68

Flexes the hand toward the palm,
tenses the palmar aponeurosis,

NN: Median N. (C7-T1)

Front 69

Fxn & Innervation:
Pronator Teres

Back 69

Function: pronation of forearm and flexion at elbow

NN: Median N. (C6- C7)

Front 70

Fxn & Innervation:
Flexor carpi radialis

Back 70

F: Palmar flexion and Radial abduction of hand

NN: Median N. (C6- C7)

Front 71

Fxn & Innervation:
Flexor digitorum superficialis

Back 71

Strong flexors of the finger (4 medial) joints;
also flexes the wrist , Runs in the carpal tunnel

NN: Median N. (C7, C8, T1)

Front 72

Fxn & Innervation:
Flexor carpi ulnaris

Back 72

F: Hand (palmar) flexion and adduction
Runs outside of carpal tunnel.

NN: Ulnar N. (C7- C8)

Front 73

Fxn & Innervation:
Flexor digitorum Profundus

Back 73

Runs through the carpal tunnel
Function: it is a flexor of the wrist, midcarpal,
metacarpophalangeal and phalangeal joints

NN: Median N. (ant. Interosseous branch) laterally
(C8 and T1), Ulnar N. medially (C8- T1)

Front 74

Fxn & Innervation:
Flexor pollicis longus

Back 74

Runs through the carpal tunnel
Has it’s own tendon sheath
Flexor of the terminal phalanx (thumb)

NN: Median N. (ant. Interosseous branch) C8- T1

Front 75

Fxn & Innervation:
Pronator quadratus

Back 75

Pronates the forearm (with Pronator Teres)

Median N. (ant. Interosseous branch) C8- T1

Front 76

Structures passing into the tunnel?

Back 76

Flexor digitorum superficialis and profundus,
Flexor pollicis longus and Median nerve.
Flexor carpi radialis has its own canal in the
groove of trapezium.

Front 77

Palmarcarpal tendon sheeths fxn?

Back 77

prevent friction between tendons in carpal tunnel

Front 78

Fxn & Innervation:
Brachioradialis (beer drinking M.)

Back 78

It brings the forearm into midposition between
pronation and supination; in this position it acts
as a flexor (forearm flexor)

NN: Radial N. (C5- C6 and C7)

Front 79

Fxn & Innervation:
Extensor carpi radialis longus

Back 79

Extensor and abductor of hand at wrist joint
NN: Radial N. (C6- C7)

Front 80

Fxn & Innervation:
Extensor carpi radialis brevis

Back 80

Extensor and abductor of the hand at wrist joint
NN: Radial N. (deep branch) (C7- C8)

Front 81

Golfer elbow?

Back 81

periostitits = inflammation of medial epicondyle

Front 82

Tennis elbow?

Back 82

back hand hitting = lateral epicondyle periostits
Tennis players can have both but usual lateral

Front 83

Extensor retinaculum?

Back 83

Covers the carpal bones dorsally and has
septae which produce 6 tendon
compartments through which tendon of
the extensor muscles and the abductor
pollicis longus pass.

Front 84

1st compartment?

Back 84

abductor pollicis longus
extensor pollicis brevis

Front 85

2nd compartment?

Back 85

extensor carpi radialis longus and brevis

Front 86

Compartment 3?

Back 86

Extensor pollicis longus

Front 87

Compartment 4?

Back 87

Extensor digitorum and extensor indicis

Front 88

Compartment 5?

Back 88

extensor digiti minimi

Front 89

Compartment 6?

Back 89

extensor carpi ulnaris

Front 90

Thenar muscles? innervated by?

Back 90

All by median n except adductor pollicis

Abductor polloicis brevis
Flexor pollicis brevis
Adductor Pollicis - deep branch of ulnar n.
Opponens pollicis

Front 91

Hypothenar muscles? innervation?

Back 91

All innervated by: deep branch of ulnar N. C8- T1:
Abductor digiti minimi
Flexor digiti minimi
Opponens digiti minimi

Front 92

Fxn & Innervation:
Palmar interossei: 3 muscles

Back 92

Function: Adduction of digits, assist lumbricals
Ulnar N. deep branch (C8-T1)

Front 93

Fxn & Innervation:
Dorsal Interossei: 4 muscles

Back 93

Function: Abduction of digits
Ulnar N. (deep branch) C8- T1

Front 94

Fxn & Innervation:
Lumbricals: 4 muscles

Back 94

2 lateral ones innervated by Median N. C8-T1
2 medial ones innervated by Ulnar N. C8-T1

Front 95

Dupuytren’s contracture

Back 95

progressive fibrosis, thickening and shortening of the palmar aponeurosis leads to partial flexion of the ring and small finger (dupuytren's contracture).

mimics claw hand but NO nerve damage

Front 96

Radial n injury at proximal origin of Triceps

Back 96

Flexed elbow and wrist drop with flexed/adducted thumb

Front 97

Sensory loss occurs where with proximal radial n injury?

Back 97

dorsolateral lower brachial region
posterior forearm
dorsal hand
radial side of the proximal phalanges

Front 98

injury at the radial groove
what nerve?

Back 98

radial n injury (humerus fx)
triceps is working (already innervated) = elbow movement
wrist drop present
sensory loss in dorsolateral arm/hand

Front 99

forearm radial nerve injury

Back 99

deep radial nerve is damaged
wrist drop
no sensory loss

Front 100

Median Nerve injury
Above the elbow?

Back 100

Muscles in the arm are not affected
Forearm and hand muscles are affected
Flexors are mainly affected
HAND OF PAPAL BENEDICTION
Pronation of forearm paralyzed and sensory loss over
the median N. area

Front 101

Median Nerve injury
Injury at wrist Joint

Back 101

APE Hand
(suicide or injury e.g.: hand out of car’s window)
Short muscles of the thumb paralyzed, not adductor.
Thenar muscles atrophy (flattened, APE HAND)
Flexor pollicis longus functioning
Sensory loss over Medial N. area

Front 102

Ulnar nerve injury
At wrist

Back 102

Claw hand
flexion of the ring and little finger
is not possible at distal phalangeal joints
Small muscles of the little finger are paralyzed
Abduction and Adduction of the fingers are impaired
( paralysis of interossei MM, piano playing,
writing.. Impaired)
Sensory loss over ulnar innervating area.

Front 103

Ulnar nerve injury at elbow?

Back 103

Injury at elbow:
Paralysis of flexor carpi ulnaris and medial portion of Flexor digitorum profundus
hand is abducted and extended
claw hand

Front 104

logic statement for papal benediction and ape hand?

Back 104

any time you have papl benediction you have ape hand but when you have ape hand you don’t always have papal benediction

Front 105

Upper limb blood supply start to radial/ulnar a.

Back 105

Aorta > Subclavian > passes through scalene gap/below clavicle > axillary artery (6 branches) > passes margin or teres/lat dorsi > brachial artery (deep brachial a. branches posteriorly) > divides in elbow region into radial and ulnar

Front 106

blood supply of upper limb from radial and ulnar

Back 106

ulnar artery > interosseous artery

radial and ulnar artery join to form deep palmar arch and superficial palmar arches > palmar arteries

Front 107

6 Branches of the axillary a.?

Back 107

SLAP STuff:
Superior Thoracic a.
Lateral Thoracic a.
Anterior Circumflex a.
Posterior Circumflex a.
Subscapular a.
Thoracoacromial a.

Front 108

Breast Cancers may
give metastasis to the _____

Back 108

axillary lymph node

Front 109

Quaderangular space
Contents?
Borders?

Back 109

Contents:
Axilary nerve Post. Circumflex humeral artery

Borders:
Teres Minor
Teres Major
Humerus
Long head of Triceps

Front 110

Guyons canal?

Back 110

ulnar nerve and vessels pass through between the two layers of the retinaculum (fig 6-40 pg 367)

located anteriorly

Front 111

Snuffbox: borders:

Back 111

Tendon of extensor pollicis longus (superior)
tendons of the ext. pollicis brevis and
abductor pollicis longus (inferiorly).

Front 112

Contents of snuffbox:

Back 112

Radial artery
Superficial radial N.

Front 113

Snuff box picture

Back 113

Front 114

What goes through the carpal tunnel

Back 114

flexor digitorum superficialis
flexor digitorum profundus
flexor pollicis longus
median n

Front 115

The flexor pollicis brevis is innervated by ?

Back 115

median n. (superficial) and ulnar n. (deep)

hybrid

Front 116

Deep Radial n. runs between two heads of ____

Back 116

supinator m

Front 117

3 muscles that insert on coracoid process?

Back 117

short head of biceps brachii
coracobrachialis
pectoralis minor

Front 118

Volkmann's contracture?

Back 118

ischemic contracture when brachial artery is lacerated or completely compressed for too long.

Causes loss of finger contraction & wrist flexion