Tusom Anatomy Shelf: Upper Limb 2012 (Alixdixon)

Front 1

The first bone to begin ossification during fetal development and the last one to complete ossification

Back 1

Clavicle

Front 2

Most common fracture site of clavicle

Back 2

Middle third

Front 3

Where will the fragments go if the middle third of the clavicle is fractured?

Back 3

Upward displacement of proximal fragment by SCM and downward displacement of distal fragment by deltoid muscle and gravity

Front 4

What injuries can be associated with fracture of the clavicle?

Back 4

Injury to brachial plexus and may also cause fatal hemorrhage from the subclavien vein

Front 5

Classification of the superior transverse scapular ligament may cause....

Back 5

May trap or compress the suprascapular nerve as it passes through the scapular notch under the superior transverse scapular ligament, affecting functions of the supraspinatus and infraspinatus muscles

Front 6

Which muscles attach to the greater tuberosity of the humerus?

Back 6

Supraspinatus, infraspinatus and teres minor

Front 7

Which muscle attaches to the lesser tuberosity of the humerus?

Back 7

Subscapular

Front 8

What may a fracture of the surgical neck of the humerus damage?

Back 8

Axillary nerve and posterior humeral circumflex artery as they pass through the quadrangular space

Front 9

What could fracture of the humeral neck injure?

Back 9

The radial nerve and deep brachial artery in the spiral groove

Front 10

What could a supracondylar fracture injure?

Back 10

Median nerve. This is a fracture of the distal end of the humerus. It is common in children and occurs when the child FOOSH w/ elbow partially flexed.

Front 11

What could a fracture of the medial epicondyle of the humerus cause?

Back 11

Ulnar nerve, which runs in a groove behind the medial epicondyle

Front 12

Colles' Fracture

Back 12

Distal radius fracture in which the distal fragment is displaced dorsally and radially (posteriorly), producing a characteristic bump described as a dinner fork deformity

Front 13

Reverse Colles' Fracture

Back 13

Distal radius fracture in which the distal fragment is displaced anteriorly. This fracture may show styloid processes of the radius and ulna lie up on a radiograph

Front 14

Fracture of the scaphoid

Back 14

Occurs after FOOSH, shows a deep tenderness in the anatomical snuffbox, and damages the radial artery and causes avascular necrosis of the bone and degenerative joint disease of the wrist.

Front 15

Fracture of the hamate

Back 15

May injure the ulnar nerve and artery because they are near the hook of the hamate

Front 16

Bennett's Fracture

Back 16

Fracture of the base of the metacarpal of the thumb

Front 17

Boxer's Fracture

Back 17

Fracture of the necks of the second and third metacarpals, seen in professional boxers, and typically of the 5th metacarpal in unskilled boxers.

Front 18

Guyon's Canal Syndrome

Back 18

An entrapment of the ulnar nerve in the Guyon's canal, which causes pain, numbness, and tingling in the ring and little finger, followed by loss of sensation and motor weakness. Can be treated by surgical decompression of the nerve

Front 19

Guyon's Canal

Back 19

Formed by the pisiform, hook of the hamate, and pisohamate ligament, deep to the palmaris brevis and palmar carpal ligament. Transmits the ulnar nerve and artery.

Front 20

Which direction does the shoulder most often dislocate? And what could this injure?

Back 20

Anteroinferiorly because of the lack of support by tendons of the rotator cuff. This may damage the axillary nerve and the posterior humeral circumflex vessels.

Front 21

Referred pain to the shoulder most probably indicates involvement of which nerve?

Back 21

Phrenic. The supraclavicular nerve (C3-C4), which supplies sensory fibers over the shoulder, has the same origin as the phrenic nerve (C3-C5), which supplies the diaphragm.

Front 22

What are the rotator cuff muscles?

Back 22

Supraspinatus, Infraspinatus, Teres minor and Subscapular

Front 23

Rupture of the rotator cuff

Back 23

May occur by chronic wear and tear or an acute FOOSH and is manifested by severe limitation of shoulder joint motion, chiefly abduction.

Front 24

Subacromial bursa

Back 24

Lies between the coracoacromial arch and the supraspinatus muscle, usually communicates with the subdeltoid bursa, and protects supraspinatus tendon against friction with the acromion.

Front 25

Subdeltoid bursa

Back 25

Lies between deltiod muscle and shoulder joint capsule, usually communicates with the subacromial bursa, and facilitates the movement of the deltoid muscle over the joint capsule and the supraspinatus tendon.

Front 26

Breast cancer

Back 26

Occurs in the upper lateral quadrant most often (~60% of the time). Enlarges, attaches to Cooper's ligaments, and produces shortening of the ligaments, causing depression or dimpling of the overlying skin. Advanced sign = peu d'orange. Cancer may also attah to and shorten the lactiferous ducts, resulting in a retracted or inverted nipple.

Front 27

Radical mastectomy

Back 27

Extensive surgical removal of the breast and its related structures, including the pectoralis major and minor muscles, axillary lynph nodes and fascia, and part of the thoracic wall. It may injure the long thoracic and thoracodorsal nerves and may cause postop swelling of the upper limb as a result of lymphatic obstruction.

Front 28

Modified radical mastectomy

Back 28

Involves excision of the entire breast and axillary lymph nodes, w/ preservation of pectoralis major and minor muscles

Front 29

Lumpectomy

Back 29

Surgical excision of only the palpable mass in carcinoma of the breast

Front 30

Lymphatic drainage of breast

Back 30

Drains primarily to axillay nodes, more specifically to the pectoral nodes. Also follows perforating vessels through the pec major and thoracic wall to enter parasternal nodes, which may spread to other breast

Front 31

Pectoralis major

Back 31

I: lateral and medial pectoral
A: flexes, adducts and medially rotates arm

Front 32

Pectoralis minor

Back 32

I: Medial pectoral
A: Depresses scapula; elevates ribs

Front 33

Subclavius

Back 33

I: Nerve to subclavius
A: Depresses lateral part of clavicle

Front 34

Serratus anterior

Back 34

I: Long thoracic
A: Rotates scapula upward; abducts scapula w/ arm and elevates it above the horizontal

Front 35

Deltoid

Back 35

I: Axillary
A: Abducts, adducts, flexes, extends and rotates arm medially and laterally

Front 36

Supraspinatus

Back 36

I: Suprascapular
A: Abducts arm

Front 37

Infraspinatus

Back 37

I: Suprascapular
A: Rotates arm laterally

Front 38

Subscapularis

Back 38

I: Upper and lower subscapular
A: Adducts and rotates arm medially

Front 39

Teres major

Back 39

I: Lower subscapular
A: Adducts and rotates arm medially

Front 40

Teres minor

Back 40

I: Axillary
A: Rotates arm laterally

Front 41

Latissimus dorsi

Back 41

I: Thoracodorsal
A: Adducts, extends and rotates arm medially

Front 42

Quadrangular space

Back 42

Borders: Superior - teres minor and subscapularis; Inferior - teres major; Medial - long head of triceps; Lateral - surgical neck of humerus
Contents: Axillary nerve and posterior humeral circumflex vessels

Front 43

Triangular space (upper)

Back 43

Borders: Superior - teres minor; Inferior - teres major; Lateral - long head of triceps
Contents: Circumflex scapular vessels

Front 44

Triangular space (lower)

Back 44

Borders: Superior - teres major; Medial - long head of triceps; Lateral - medial head of triceps
Contents: Radial nerve and profunda brachii artery

Front 45

Triangle of auscultation

Back 45

Borders: Upper border of the latissimus dorsi, lateral border of trapezius and medial border of scapula.
Floor is formed by rhomboid major

Front 46

Cubital Fossa

Back 46

Borders: Lateral - brachioradialis; Medial - pronator teres; Superior - horizontal line connecting epicondyles of humerus w/ a floor formed by brachialis and supinator muscles
Contents (lateral to medial): radial nerve, biceps tendon, brachial artery and median nerve (Robin Beats Bat Man)
At lower end, brachial artery divides into radial and ulnar arteries.

Front 47

Corachobrachialis

Back 47

I: Musculocutaneous
A: Flexes and adducts arm

Front 48

Biceps brachii

Back 48

I: Musculocutaneous
A: Flexes arm and forearm, supinates forearm

Front 49

Brachialis

Back 49

I: Musculocutaneous
A: Flexes forearm

Front 50

Triceps

Back 50

I: Radial
A: Extends forearm

Front 51

Anconeus

Back 51

I: Radial
A: Extends forearm

Front 52

Pronator teres

Back 52

I: Median
A: Pronates and flexes forearm

Front 53

Flexor carpi radialis

Back 53

I: Median
A: Flexes forearm, flexes and abducts hand

Front 54

Palmaris longus

Back 54

I: Median
A: Flexes forearm and hand

Front 55

Flexor carpi ulnaris

Back 55

I: Ulnar
A: Flexes forearm; flexes and adducts hand

Front 56

Flexor digitorum superficialis

Back 56

I: Median
A: Flexes proximal interphalangeal joints, flexes hand and forearm

Front 57

Flexor digitorum profundus

Back 57

I: Ulnar and Median
A: Flees distal interphalangeal joints and heand

Front 58

Flexor pollicis longus

Back 58

I: Median
A: Flexes thumb

Front 59

Pronator quadratus

Back 59

I: Median
A: Pronates forearm

Front 60

Brachioradialis

Back 60

I: Radial
A: Flexes forearm

Front 61

Extensor carpi radialis longus

Back 61

I: Radial
A: Extends and abducts hand

Front 62

Extensor carpi radialis brevis

Back 62

I: Radial
A: Extends and abducts hand

Front 63

Extensor digitorum

Back 63

I: Radial
A: Extends fingers and hand

Front 64

Extensor digiti minimi

Back 64

I: Radial
A: Extends little finger

Front 65

Extensor carpi ulnaris

Back 65

I: Radial
A: Extends and adducts hand

Front 66

Supinator

Back 66

I: Radial
A: Supinates forearm

Front 67

Abductor polliis longus

Back 67

I: Radial
A: Abducts thumb and hand

Front 68

Extensor pollicis longus

Back 68

I: Radial
A: Extends distal phalanx of thumb and abducts hand

Front 69

Extensor pollicis brevis

Back 69

I: Radial
A: Extends proximal phalanx of thumb and abducts hand

Front 70

Extensor indicis

Back 70

I: Radial
A: Extends index finger

Front 71

Tennis elbow

Back 71

Lateral epicondylitis. Caused by a chronic inflammation or irritation of the origin of the extensor muscles of the forearm from the lateral epicondyle of the humerus as a result of unusual or repetitive strain

Front 72

Golfer's elbow

Back 72

Medial epicondylitis. Painful combination caused by a small tear or an inflammation or irritation in the origin of the flexor muscles of the forearm from the medial epicondyle.

Front 73

Cubital tunnel syndrome

Back 73

Results from compression on the ulnar nerve in the cubital tunnel behind the medial epicondyle, causing numbness and tingling in the ring and little fingers. The tunnel is formed by the medial epicondyle, ulnar collateral ligament, and two heads of the flexor carpi ulnaris muscle and transmits the ulnar nerve and superior ulnar collateral or posterior ulnar recurrent artery

Front 74

Abductor pollicis brevis

Back 74

I: Median
A: Abducts thumb

Front 75

Flexor pollicis brevis

Back 75

I: Median
A: Flexes thumb

Front 76

Opponens pollicis

Back 76

I: Median
A: Opposes thumb to other digits

Front 77

Adductor pollicis

Back 77

I: Ulnar
A: Adducts thumb

Front 78

Palmaris brevis

Back 78

I: Ulnar
A: Wrinkles skin on medial side of palm

Front 79

Abductor digiti minimi

Back 79

I: Ulnar
A: Abducts little finger

Front 80

Flexor digiti minimi brevis

Back 80

I: Ulnar
A: Flexes proximal phalanx of little finger

Front 81

Opponens digiti minimi

Back 81

I: Ulnar
A: Opposes little finger

Front 82

Lumbricals

Back 82

I: Median (2 lateral) and ulnar (2 medial)
A: Flex metacarpophalangeal joints and extend interphalangeal joints

Front 83

Dorsal interossei

Back 83

I: Ulnar
A: Abduct fingers; flex metacarphophalangeal joints; extend interphalangeal joints

Front 84

Palmar interossei

Back 84

I: Ulnar
A: Adduct fingers; flex metacarpophalangeal joints; extend interphalangeal joints

Front 85

What crosses superficially to the flexor retinaculum?

Back 85

Superficial branch of the radial nerve, ulnar nerve, ulnar artery, palmaris longus tendon and palmar cutaneous branch of the median nerve.

Front 86

Dupuytren's Contracture

Back 86

A progressive thickening, shortening, and fibrosis of the palmar fascia, especially the palmar aponeurosis, producing a flexion deformity of fingers in which the fingers are pulled toward the palm, especially the third and fourth fingers

Front 87

Volkmann's Contracture

Back 87

An ischemic muscular contracture (flexion deformity) of the fingers and sometimes of the wrist, resulting from ischemic necrosis of the forearm flexor muscles, caused by a pressure injury, such as compartment syndrome. The muscles are replaced by fibrous tissue, which contracts, producing the deformity.

Front 88

Carpal tunnel

Back 88

Formed anteriorly by the flexor retinaculum and posteriorly by the carpal bones. Transmits the median nerve and the tendons of flexor pollicis longus, flexor digitorum profundus, and flexor digitorum superficialis muscles.

Front 89

Carpal tunnel syndrome

Back 89

Caused by compression of the median nerve d/t reduced size of carpa tunnel. Leads to pain and parasthesia in the hand in the area supplied by the median nerve and may also cause atrophy of the thenar muscles. No parasthesia occurs over the thenar eminence of skin b/c this area is supplied by the palmar cutaneous branch of the median nerve.

Front 90

Tenosynovitis

Back 90

Inflammation of the tendon and synovial sheath, and puncture injuries cause infection of the synovial sheaths of the digits. The tendons of the 2nd, 3rd and 4th digits have separate synovial sheaths so that the infection is confined to the infected digit, but rupture of the proximal ends of these sheaths allows the infection to spread to the midpalmar space. The synovial sheath of the little finger is usually continuous with the common synovial sheath (ulnar bursa), and thus, tenosynovitis may spread to the common sheath and thus through the palm and carpal tunnel to the forearm. Likewise, tenosynovitis in the thumb may spread through the synovial sheath of the flexor pollicis longus (radial bursa)

Front 91

Trigger finger

Back 91

Results from stenosing tenosynovitis or occurs when the flexor tendon develops a nodule or swelling that interferes w/ it s gliding through the pulley, causing and audible clicking or snapping. Sxs are pain at the joints and a clicking when extending or flexing the joints. May be caused by RA, DM, repetitive trauma, and wear and tear of aging.

Front 92

Mallet finger

Back 92

Finger w/ permanent flexion of the distal phalanx d/t an avulsion of the lateral bands of the extensor tendon to the distal phalanx.

Front 93

Boutonniere deformity

Back 93

Finger w/ abnormal flexion of the middle phalanx and hyperextension of the distal phalanx d/tan avulsion of the central band of the extensor tendon to the middle phalanx or RA

Front 94

Anatomic Snuffbox

Back 94

Bounded medially by the tendon of the extensor pollicis longus muscle and laterally by the tendons of the extensor pollicis brevis and abductor pollicis longus muscles. Contains scaphoid and radial artery.

Front 95

Dorsal scapular nerve

Back 95

C5. Innervates rhomboids and frequently levator scapulae muscles

Front 96

Long thoracic nerve

Back 96

C5-C7. Innervates serratus anterior muscle

Front 97

Injury to long thoracic nerve

Back 97

Results in paralysis of serratus anterior muscle and inability to elevate the arm above the horizontal. Will produce a winged scapula.

Front 98

Suprascapular nerve

Back 98

C5-C6. Passes through scapular notch under superior transvers scapular ligament. Supplies supraspinatus and infraspinatus muscles.

Front 99

Nerve to subclavius

Back 99

C5. Innervates subclavius. Usually branches to accessory phrenic nerve, which enters thorax to join phrenic

Front 100

Lateral pectoral nerve

Back 100

C5-C7. Innervates pectoralis major primarily

Front 101

Musculocutaneous Nerve

Back 101

C5-C7. Innervates corachobrachilis, biceps brachii and brachialis muscles. Innervates all flexor muscles in the anterior compartment of the arm. Continues into forearm as lateral antebrachial cutaneous nerve.

Front 102

Medial pectoral nerve

Back 102

C8-T1. Innervates pectoralis minor and pectoralis major

Front 103

Medial brachial cutaneous nerve

Back 103

C8-T1. Innervates skin on medial side of arm

Front 104

Medial antebrachial cutaneous nerve

Back 104

C8-T1. Innervates skin on medial side of forearm

Front 105

Ulnar nerve

Back 105

C7-T1. Runs down medial aspect of arm. Innervates flexor carpi ulnaris and flexor digitorum profundus muscles. enters hand superificial to flexor retinaculum and lateral to pisiform bone. Innervates all interossei, adductor pollicis and 2 medial lumbricals

Front 106

Median nerve

Back 106

C5-T1. Formed by heads of both medial and lateral cords. Runs down anteromedial aspect of arm. Innervates all anterior muscles of the forearm except flexor carpi ulnaris and ulnar half of flexor digitorum profundus. Enters palm of hand through carpal tunnel deep to flexor retinaculum; gives off recurrent branch to thenar muscles. Innervates abductor pollicis brevis, opponens pollicis and 2 lateral lumbricals

Front 107

Upper subscapular nerve

Back 107

C5-C6. Innervates upper portion of subscapularis

Front 108

Thoracodorsal nerve

Back 108

C7-C8. Innervates latissimus dorsi

Front 109

Injury to posterior cord

Back 109

Caused by pressure of the crosspiece of a crutch, resulting in paralysis of the arm called crutch palsy. It results in loss in function of the extensors of the arm, forearm and hand, and produces a wrist drop

Front 110

Lower subscapular nerve

Back 110

C5-C6. Innervates lower part of subscapularis and teres major.

Front 111

Axillary nerve

Back 111

C5-C6. Innervates deltoid and teres minor, and gives rise to lateral brachial cutaneous nerve. Passes posteriorly through quadrangular space accompanied by the posterior circumflex humeral artery and winds around surgical head of humerus

Front 112

Injury to axillary nerve

Back 112

Cause by fx of surgical neck of humerus or inferior dislocation of the humerus. It results in weakness of lateral rotation and abduction of the arm.

Front 113

Radial nerve

Back 113

C5-T1. Occupies musculospiral groove on back of the humerus with the profunda brachii artery. Deep branch: innervates extensor muscles of forearm. Superficial branch: Innervates skin of radial side of hand

Front 114

Injury to radial nerve

Back 114

Caused by fx of the midshaft of the humerus. Results in loss of function in the extensors of the forearm, hand, metacarpals and phalanges. It also results in loss of wrist extension, leading to wrist drop.

Front 115

Injury to musculocutaneous nerve

Back 115

Results in weakness of supination (biceps) and flexion (biceps and brachialis) of forearm and loss of sensation on the lateral side of the forearm.

Front 116

Injury to median nerve

Back 116

May be caused by supracondylar fx of the humerus or a compression in the carpal tunnel. Results in loss of pronation, opposition of the thumb, and flexion of the lateral 2 interphalangeal joints and impairment of medial two interphalangeal joints. Also produces characteristic flattening of thenar eminence: ape hand

Front 117

Injury to ulnar nerve

Back 117

Caused by fx of medial epicondyle and results in claw hand, in which ring and little fingers are hyperextended at metacarpophalangeal joints and flexed at interphalangeal joints. Results in loss of abduction and adduction of fingers and flexion of metacarpophalangeal joints because of the paralysis of the palmar and dorsal interossei muscles and medial two lumbricals. Also produces a wasted hypothenar eminence and palm and also leads to loss of adduction of the thumb because of the paralysis of the adductor pollicis muscle.

Front 118

Upper trunk injury

Back 118

Erb-Duchenne paralysis. Caused by birth injury during a breech delivery or a violent displacement of the head from the shoulder such as might result from a fall. Results in loss of abduction, flexion, and lateral rotation of the arm, producing a waiter's tip hand in which the arm tends to lie in medial rotation resulting from paralysis of lateral rotator muscles.

Front 119

Lower trunk injury

Back 119

Klumpke's paralysis. May be caused by difficult breech delivery, by a cervical rib, or by abnormal insertion or spasm of the anterior and middle scalene muscles. Causes claw hand.

Front 120

Ligation of axillary artery between thryocervical trunk and subscapular artery

Back 120

Blood from anastomoses in the scapular region arrives at the subscapular artery in which the blood flow is reversed to reach the axillary artery distal to the ligature. The axillary artery may be compressed or felt for the pulse in front of the teres major or against the humerus in the lateral wall of the axilla.

Front 121

What may happen if the ulnar artery arises high from the brachial artery?

Back 121

It may run superficially to the flexor muscles, then when injecting, the artery mau be mistaken for a vein for certain drugs, resulting in disastrous gangrene w/ subsequent partial or total loss of the hand

Front 122

Where can the ulnar pulse be felt?

Back 122

On the anterior aspect of the flexor retinaculum on the lateral side of the pisiform bone.

Front 123

Allen Test

Back 123

A test for occlusion of the radial or ulnar artery; either the radial or ulnar artery is digitally compressed by the examiner after blood has been forced out of the hand by making a tight fist; failure of the blood to return to the palm and fingers on opening indicates that the uncompressed artery is occluded

Front 124

Venipuncture of upper limb

Back 124

May be performed on axillary vein to locate central ine, on median cubital vein for drawing blood, an don dorsal venous network or cephalic and basilic veins at their origin for long-term introduction of fluids or IV feeding

Front 125

Branches of axillary artery

Back 125

She Tastes Like Substandard Apple Pie
Superior thoracic
Thoracoacromial
Lateral thoracic
Subscapular
Anterior humeral circumflex
Posterior humeral circumflex

Front 126

Branches of thoracoacromial trunk

Back 126

Pectoral, clavicular, acromial and deltoid

Front 127

The ulnar bursa contains

Back 127

The tendons of both the flexor digitorum superficialis and profundus muscles.

Front 128

The radial bursa contains

Back 128

The tendon of the flexor pollicis longus

Front 129

What forms the floor of the cubital fossa?

Back 129

Brachialis and supinator muscles

Front 130

What does the anterior interosseous nerve innervate?

Back 130

Branch of median nerve. Supplies flexor pollicis longus, half of the flexor digitorum profundus, and the pronator quadratus.