1
Q
what is the only bony articulation b/ upper limb and rest of skeleton?
A
sternoclavicular joint
2
Q
what is the acromioclavicular joint?
A
- synovial joint
- articulation b/ acromion and clavicle
3
Q
what stabilises the acromioclavicular joint?
A
acromioclavicualr, conoid, trapezoid ligaments
4
Q
what is protraction of the scapula?
A
scapula moves anteriorly and laterally
5
Q
what is retraction of the scapula?
A
scapula moves posteriorly and medially
6
Q
what is medial rotation of the scapula?
A
results in medial rotation of upper limb (from the arm)
7
Q
what is the glenohumeral joint?
A
- ball and socket
- synovial joint
- head of humerus and glenoid cavity
- one of the most highly mobile joints in body (at cost of joint stability)
8
Q
describe the elbow joint
A
- synovial joint
- motion in only one plane
- trochlea of humerus with trochlear notch of ulna
- capitulum of humerus with head of radius
9
Q
what movements does the elbow allow?
A
- flexion
- extension
10
Q
what is the difference between pronation and supination?
A
Pronation - palm towards Pavement
Supination - turning palm towards Sky
11
Q
where do the radius and ulna articulate with each other?
A
- proximal radio-ulnar joint
- distal radio-ulnar joint
12
Q
describe the proximal radio-ulnar joint
A
- head of radius
- radial notch of ulna
- not part of elbow joint but shares same articular capsule
13
Q
describe the distal radio-ulnar joint
A
- head of ulna
- ulnar notch of radius
- has an articular disc (stabilises joint when radius pivots round ulna)
14
Q
why is the wrist joint known as the radiocarpal joint?
A
- ulna not part of wrist joint
- separated by articular disc
- only articulates with ulnar notch of radius distally
15
Q
why is the pisiform a sesamoid bone?
A
- embedded in the tendon of the flexor carpi ulnaris
- does not take part in formation of wrist joint
16
Q
what goes through the carpal tunnel?
A
- 4 tendons of flexor digitorum profundus
- 4 tendons of flexor digitorum superficialis
- tendon of flexor pollicis longus
- median nerve
17
Q
what forms the carpal tunnel?
A
- carpal bones
- flexor retinaculum (strong fibrous band)
18
Q
where does the flexor retinaculum attach?
A
- scaphoid and trapezium bones on radial side
- pisiform and hook of Hamate on ulnar side
19
Q
what is carpal tunnel syndrome?
A
- 1 or more of the flexor tendons swells
- further narrows canal
- entrapment and compression of median nerve
20
Q
what does pec major do?
A
adducts, flexes, medially rotates humerus
21
Q
where does pec major arise?
A
- medial half of clavicle
- superior sixth CC
- aponeurosis of external oblique
22
Q
where does pec major insert?
A
into lateral lip of intertubercular sulcus
23
Q
what is pec major innervated by?
A
medial and lateral pectoral nerve
24
Q
how do you test the pec major?
A
- ask pt to adduct their arm while their elbow is flexed against resistance
- feel the action of pec major by placing your hand on the chest
25
what innervates pec minor?
medial pectoral nerve
26
what does pec minor do?
stabilises the scapula
27
where does pec minor originate?
anterior surface of ribs 3-5
28
where does pec minor insert?
coracoid process of scapula
29
where does the subclavius arise?
first costochondral joint
30
where does the subclavius insert?
middle third of clavicle
31
what does the subclavius do?
stabilises and depresses clavicle
32
where does the serratus anterior arise from?
lateral aspects of ribs 1-8
33
where does the serratus anterior insert?
medial border of scapula
34
what does the serratus anterior do?
- laterally rotates scapula
| - protracts the scapula against ribcage
35
what is the serratus anterior innervated by?
long thoracic nerve
36
what happens when the long thoracic nerve is damaged?
- serratus anterior can't hold scapula in protracted state against ribcage
- it protrudes
- winging of scapula
37
how do test the serratus anterior?
- ask pt to push their arm out
- feel action of serratus anterior
- place hand on posterolateral side of chest and resist them pushing their arm out
38
where does latissimus dorsi insert?
intertubercular groove of humerus (between pec major and teres major)
39
where does latissimus dorsi originate?
- vertebrae T7-T12
- iliac crest
- ribs 9-12
- inferior angle of scapula
40
what innervates the latissimus dorsi?
long scapular nerve
41
what are the function of the latissimus dorsi?
extend, adduct, medially rotate upper limb
42
how do you test the latissimus dorsi?
- pt adduct arm while elbow is flexed against resistance
| - stand behind pt and feel action
43
what are the 3 parts of the trapezius?
- descending
- transverse
- ascending
44
where does the trapezius originate?
- occipital bone
- nuchal ligament
- spinoud processes of C7-T12
45
where does trapezius insert?
- clavicle
- acromion
- scapular spine
46
what is the function of the trapezius?
- elevate and rotate scapula
- retract scapula
- depress scapula
47
what innervates the trapezius?
accessory nerve
48
how do you test the trapezius?
raise shoulders against resistance
49
where does levator scapulae originate?
transverse processes of C1-C4
50
where does levator scapulae attach?
medial border of scapula
51
what innervates the levator scapulae?
dorsal scapular nerve
52
what is the function of levator scapulae?
helps elevation of scapula
53
where does rhomboid major originate?
- spinous processes of T2-T5
| - attaches to medial border of scapula
54
what innervates the rhomboid major?
dorsal scapular nerve
55
what does the rhomboid major do?
retracts and medially rotates scapula
56
where does the rhomboid minor originate?
- spinous processes of C7-T1
57
where does the rhomboid minor attach?
medial border of scapula
58
what does the rhomboid minor do?
retraction and medial rotation of scapula
59
what innervates rhomboid minor?
dorsal scapular nerve
60
what are the intrinsic shoulder muscles?
- deltoid
- teres major
- rotator cuff muscles
61
in general where do the intrinsic shoulder muscles originate and attach to?
originate from scapula/clavicle
| attach to humerus
62
where does the deltoid originate?
- acromion
- spine of scapula
- lateral third of clavicle
63
what does the deltoid do?
main abductor of arm
64
what innervates deltoid?
axillary nerve
65
where does the deltoid insert?
deltoid tuberosity
66
how do you test the function of the deltoid?
- pt needs to flex elbow and raise their arm to the side
| - resist abduction of arm and feel deltoid
67
where does teres major originate?
lateral aspect of inferior angle of scapula
68
where does teres major insert?
medial lip of intertubercular sulcus
69
what are the functions of the teres major?
adduct, retract, medially rotate humerus
70
what innervates the teres major?
lower subscapular nevre
71
where do all the rotator cuff muscles (RCM) attach?
to the tubercles of the humerus to stabilise glenohumeral joint
72
what is different about the subscapularis?
- only RCM to originate anteriorly to scapula at subscapular fossa
- only RCM to attach to lesser tubercle of humerus
73
what does the subscapularis do?
medially rotates the arm
74
what innervates the subscapularis?
upper and lower subscapular nerves
75
where does the supraspinatous originate? what innervates it?
- supraspinous fossa of scapula
| - suprascapular nerve
76
what is the function of the supraspinatous?
main abductor of humerus for first 15 degrees
77
where does the infraspinatous originate? what innervates it?
- infraspinous fossa of scapula
| - suprascapular nerve
78
what is the function of infraspinatous?
laterally rotate arm
79
where does the teres minor originate and insert?
- originate: lateral border of scapula
| - insert: greater tubercle
80
what innervates the teres minor?
axillary nerve
81
what is the function of the teres minor?
laterally rotate humerus
82
what muscles are the anterior muscles of the arm?
- biceps brachii
- brachialis
- coracobrachialis
83
what are the anterior muscles of the arm innervated by and supplied by?
musculocutaneous nerve
| brachial artery
84
what does the biceps brachii do?
- superficial flexor
| - mian supinator of forearm
85
where does the short head originate from?
coracoid process of scapula
86
where does the long head orignate from?
- supraglenoid tubercle of scapula
- descends down humerus through intertubercular groove
- merges with short head
87
where does the biceps brachii attach?
radial tuberosity
88
how do you test the function of the biceps brachii?
- flex elbow against resistance
| - stabilise elbow joint
89
what are the intrinsic shoulder muscles?
- deltoid
- teres major
- rotator cuff muscles
90
where does brachialis attach?
distally to ulnar tuberosity
91
where does the deltoid originate?
- acromion
- spine of scapula
- lateral third of clavicle
92
what does the deltoid do?
main abductor of arm
93
what innervates deltoid?
axillary nerve
94
where does the deltoid insert?
deltoid tuberosity
95
how do you test the function of the deltoid?
- pt needs to flex elbow and raise their arm to the side
| - resist abduction of arm and feel deltoid
96
where does teres major originate?
lateral aspect of inferior angle of scapula
97
where does teres major insert?
medial lip of intertubercular sulcus
98
what are the functions of the teres major?
adduct, retract, medially rotate humerus
99
what innervates the teres major?
lower subscapular nevre
100
where do all the rotator cuff muscles (RCM) attach?
to the tubercles of the humerus to stabilise glenohumeral joint
101
what is different about the subscapularis?
- only RCM to originate anteriorly to scapula at subscapular fossa
- only RCM to attach to lesser tubercle of humerus
102
what does the subscapularis do?
medially rotates the arm
103
what innervates the subscapularis?
upper and lower subscapular nerves
104
where does the pronator teres attach?
pronator tuberosity on lateral spect of shaft of radius
105
what is the function of the supraspinatous?
main abductor of humerus for first 15 degrees
106
where does the infraspinatous originate? what innervates it?
- infraspinous fossa of scapula
| - suprascapular nerve
107
what is the function of infraspinatous?
laterally rotate arm
108
what does FCR do?
flexion, abduction of wrist
109
what innervates the teres minor?
axillary nerve
110
what is the function of the teres minor?
laterally rotate humerus
111
what muscles are the anterior muscles of the arm?
- biceps brachii
- brachialis
- coracobrachialis
112
what are the anterior muscles of the arm innervated by and supplied by?
musculocutaneous nerve
| brachial artery
113
what does the biceps brachii do?
- superficial flexor
| - mian supinator of forearm
114
where does the short head originate from?
coracoid process of scapula
115
where does the long head orignate from?
- supraglenoid tubercle of scapula
- descends down humerus through intertubercular groove
- merges with short head
116
where does the biceps brachii attach?
radial tuberosity
117
how do you test the function of the biceps brachii?
- flex elbow against resistance
| - stabilise elbow joint
118
what is the origin of the brachialis?
middle of humeral shaft
119
where does brachialis attach?
distally to ulnar tuberosity
120
what is the function of the brachialis?
main flexor of forearm
121
what is the relationship b/brachialis and cubital fossa?
brachialis is the floor of the cubital fossa
122
where do the brachialis and coracobrachialis lie compared to the biceps brachii?
deep
123
where does the coracobrachialis originate?
coracoid process of scapula
124
what does the coracobrachialis do?
assist in flexion and adduction of humerus
125
what is the only muscle in the posterior compartment?
triceps brachii
126
what is the triceps brachii made up of?
3 heads that converge together to form a common tendon
| common tendon inserts distally at olecranon of ulna
127
where do the 3 heads originate?
Long head: infraglenoid tubercle
| Medial and lateral head: posterior surface of humerus
128
what does the triceps do?
extension of forearm
129
what is the triceps innervated by?
- radial nerve
130
how do you test the triceps?
Pt to extend elbow whilst resisting movement
| stabilise elbow joint
131
what are the superficial muscles of the anterior compartment of the forearm?
- pronator teres
- flexor carpi radialis
- palmaris longus
- felxor carpi ulnaris
132
where does the pronator teres originate?
common flexor tendon at medial epicondyle of humerus
| ** point of origin for all superficial and intermediate flexors of forearm
133
what does the pronator teres do?
pronate radius about ulna
134
what is pronator teres innervated by?
median nerve
135
where does FCR insert?
base of second and third metacarpal
136
what does FCR do?
flexion, abduction of wrist
137
where does palmaris longus attach? what does it do?
- flexor retinaculum and palmar aponeurosis
| - assist in flexion of wrist joint
138
where does the FCU attach?
- pisiform
- hamate
- base of 5th metacarpal (little finger)
139
what is special about the innervation of FCU?
only superficial muscle that is not innervated by median nerve
innervated by ULNAR nerve
140
what does FCU do?
flexion, ulnar deviation of wrist
141
how do you test the superficial flexors of anterior forearm?
- pt makes arms like a boxer and bend elbows in front of them
- pt turns their wrists around and push down against resistance
- must stabilise wrist
142
what is in the intermediate layer of muscle within the anterior forearm?
only flexor digitorum superficialis
143
where does the FDS originate?
2 heads which originate form common flexor tendon and radius
144
what passes between the 2 heads of the FDS?
median nerve
| ulnar artery
145
what then happens when the FDS travels distally?
- gives off 4 tendons at the wrist
- these travel through carpal tunnel in common flexor sheath
- attach to four intermediate phalanges of hand
146
what does the FDS do?
- flexion of wrist
| - flexes metacarpophalangeal joints and proximal interphalangeal joints of last 4 digits
147
what innervates the FDS?
median nerve
148
how do you test the FDS?
- pt flexes last 4 digits at interphalangeal joint against resistance
- stabilise the medial four proximal interphalangeal joint
- stabilise other digits
149
where does the FPL originate?
shaft of radius and surrounding interosseous membrane
150
where does the FPL attach?
base of distal phalanx of thumb
151
what is the function of the FPL?
works in flexion of thumb interphalangeal joint
152
where does the FDP originate?
ulna and associated interosseous membrane
153
where does the FDP attach?
distal phalanges of last 4 digits
154
what does the FDP function in?
flexion of distal interphalangeal joints, flexion of metacarpophalangeal joints
155
what is FDP innervated by?
- ulnar nerve (medial 2 tendons)
| - median nerve (lateral 2 tendons)
156
how do you test the FDP?
ask patient to flex their last 4 digits at distal interphalangeal joints against resistance
157
where does the pronator quadratus originate?
distal aspect of ulnar shaft
158
where does the pronator quadratus insert?
adjacent area of radial shaft
159
what is the funciton of pronator quadratus
pronation of radius
160
how do you test the pronator quadratus?
pronate forearm against resistance
161
what are the superficial muscles of the posterior compartment of the forearm?
- brachioradialis
- extensor carpi radialis longus
- extensor carpi radialis brevis
- extensor digitorum
- extensor digiti minimi
- extensor carpi ulnaris
- anconeus
162
what is the main role of muscles in the posterior compartment of the forearm?
extensors of the wrist joint and joints of hand
| all innervated by radial nerve
163
why is the brachioradialis an anomaly in the posterior compartment?
it works to flex the elbow
164
what is the anconeus? Where does it originate?
small triangle shaped muscle
| originates from lateral epicondyle of humerus
165
where does the anconeus insert?
into olecranon and posterior surface of ulna
166
what are the muscles in the deep compartment of the forearm?
- supinator
- abductor pollicis longus
- extensor pollicis brevis
- extensor pollicis longus
- extensor indicis
167
what are the 2 tests for posterior compartment of the forearm?
1. Extensors of wrist: pt flatten hand and extend wrist back against resistance
2. Extensors of digits: pt places hands flat on table and raise fingers up
168
what are the intrinsic muscles of the hand?
- interossei
- lumbricals
- thenar muscles
- hypothenar muscles
- adductor pollicis
169
where are the interossei muscles? What innervates them?
located between metacarpal bones
| innervated by ulnar nerve
170
where do the interossei originate and insert?
Originate: metacarpals
Insert: proximal phalanges of digit upon which they function
171
what do the interossei do?
palmar interossei: deep on palmar side of hand, function to adduct digits at metacarpophalangeal
dorsal interossei: superficially on dorsal surface, abduct digits at metacarpophalangeal
172
how do you test the palmar interossei?
place a piece of paper b/ each of the four medial digits and ask them to adduct digits and stop you pulling piece of paper b/ fingers
173
how do you test the dorsal interossei?
ask pt to adduct each digit one by one while you provide resistance and stabilise metacarpophalangeal joint
174
Where do the 4 lumbricals originate?
radial side of FDP tendons
175
what is the function of the lumbricals?
- flex metacarpophalangeal joints
| - extend interphalangeal joint
176
what innervates the lumbricals?
- 2nd/3rd digits = median nerve
| - 4th/5th digits = ulnar nerve
177
what causes ulnar claw?
- paralysis of medial 2 lumbricals due to ulnar neuropathy
178
what are the thenar muscles?
located at base of thumb, produces a bulge = thenar eminence
179
what do the thenar muscles do?
responsible for fine movements of thumb
180
what innervates thenar muscles?
median nerve
181
what are the 3 hypothenar muscles?
- abductor digiti minimi
- flexor digiti brevis
- opponens digiti minimi
182
what do the hypothenar muscles do?
fine control of little finger
183
what forms the hypothenar eminence?
hypothenar muscles produce a bulge proximally and medially under little finger
184
how do you test the thenar and hypothenar muscles?
tested together
ask pt to touch their thumb to their little finger as hard as they can
examiner try and disconnect thumb and finger
185
where does the SCM originate?
- sternal manubrium
| - medial 1/3 of clavicle
186
where does the SCM attach?
mastoid process of temporal bone
187
what does the SCM do?
functoins to rotate head
188
what does contraction of both SCMs result in?
- flexion of neck
| - extension of head at atlanto-occipital joint
189
what innervates the SCM?
accessory nerve
190
how do you test the function of the SCM?
place dorsal aspect of hand on pt cheek
ask pt ti run head to side of hand against resistance
palpate SCM at same time
191
what are the 5 parts of the brachial plexus?
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roots
trunks
divisions
cords
branches
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OSPE
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