EXAM 3 Upper Limb

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EXAM 3 Upper Limb
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2010-10-25 16:08:50
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EXAM 3 Upper Limb
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  1. Identify the bones, muscles and/or tendons that form the pectoral girdle.
    The pectoral (shoulder) girdle is a bony ring. It is incomplete posteriorly. Formed by the scapulae and clavicles and completed anteriorly by the manubrium of the sternum.


    • q. Figure 6.3 on page 405.
    • b. Figure 6.29 on page 471
    • c. Figure 6.31 on page 474
    • d. Figure 6.32D on page 475
  2. Sternum articulates with
    the ribs via costal cartilage & the blunt end of clavicle
  3. Clavicle articulates with
    the manubrium of the sternum (blunt end) & with the acromion of the scapula (rounded end)
  4. Scapula articulates with
    the rounded end of the clavicle and with the head of the humerus in the glenoid fossa of the scapula
  5. The remaining divisions of the scapula are:
  6. 1.) Acromion
    • 2.) Coracoid Process
    • 3.) Glenoid Cavity,
    • 4.) Infraspinous Fossa,
    • 5.) Spine of Scapula,
    • 6.) Subscapular Fossa,
    • 7.) Suprascapular Notch
    • 8.) Supraspinous Fossa.
  7. Radius articulates with
    its head (capitulum) to the lateral epicondyle of the humerus
  8. The trochlear (semilunar) notch (of ulna) articulates with
    the trochlea of the humerus
  9. the olecranon process articulates with
    the olecranon fossa.
  10. coronoid fossa articulates with the
    coronoid process
  11. Radius articulates with
    humerus (head to capitulum) & with carpals (scaphoid, lunate)
  12. Ulna articulates with
  13. the humerus (trochlear notch with trochlea, olecranon fossa with olecranon process, coronoid fossa with coronoid process) & articular disc, ulnar collateral ligaments for carpal
  14. What limits movements of the wrist?
    • Ligaments (radiocarpal, joint capsule, radial and ulnar collateral) and bony appositions
    • (styloid process of both radius and ulna, carpal bones)
  15. Where is the weakest part of the clavicle?
    Junction of middle and lateral 3rds
  16. What is the most common fracture of the forearm?
    Colles Fracture: distal end of the radius broken
  17. If a fall occurs and the palm of the hand is in an abducted position which bone is commonly fractured?
    MOST common: scaphoid (carpal)
  18. Which bones of the upper limb are palpable?
    Humerus, Radius, Ulna, Pisiform, Trapezium (tubercle), Hamate (hook), Capitate, Metacarpals, Phalanges
  19. What is subluxation of a joint? What type of movement is limited?
  20. Subluxation: incomplete temporary dislocation. In the upper limb subluxation of the head of the radius (pulled elbow) limits the limb: elbow flexed, forearm pronated
  21. What is the anatomical and/or clinical significance of the following structures?
    Intertubercular groove
  22. Long Head of the Biceps Brachii passes through
  23. What is the anatomical and/or clinical significance of the following structures?
    Deltoid tuberosity
  24. Attachment for Deltoid, relationship to radial groove for radial nerve to pass
  25. Styloid process of radius
  26. Bony apposition, larger: can be palpated: radial artery winds around lateral aspect, cephalic vein relationship, radial artery
  27. Olecranon process with the ulnar nerve
    The ulnar nerve is superficial (medial) to the olecranon process
  28. Rotator cuff muscles
    S.I.T.S.: Supraspinatus, Infraspinatus, Teres Minor, Subscapularis. The supraspinatus tendon tears most often causing degenerative tendonitis of the rotator cuff.
  29. What muscles form the rotator cuff (SITS)?
    S.I.T.S.: Supraspinatus, Infraspinatus, Teres Minor, Subscapularis.
  30. If there were a rotator cuff tear of a tendon where would a surgical incision be made?
  31. Rotator cuff repairs are done in many fashions. The most common surgical incision is at an oblique angle at the acromion (lateral) to avoid damaging the deltoid muscle, then deep to the subacromial bursa the tendon of the supraspinatus then is attached to the superior facet of the greater tubercle of the humerus.
  32. Identify the Location and Main Action of the muscle groups (flexors, extensors, abductors, adductors) of the arm, forearm, and hand. A&M pg 442-451
    See Table 6.6: Muscles of Arm, page 437
    See Table 6.7: Muscles of the Anterior Compartment of the Forearm, page 446-447
    See Table 6.8: Muscles of the Posterior Compartment of the Forearm, page 450-451
    See Table 6.11: Intrinsic Muscles of the Hand, page 460-461
  33. Flexor muscles of the forearm originate from what bony marking?
    Common Flexor Tendon on the Medial Epicondyle of the Humerus
  34. Extensor muscles of the forearm originate from what bony marking?
    Common Extensor Tendon on the Lateral Epicondyle of the Humerus
  35. Identify the boundaries of the Axilla
    • The axilla provides a passageway for vessels and nerves going to and from the upper limb.
    • The axilla has an apex, base, and four walls, three of which are muscular: The apex of the axilla is the cervicoaxillary canal,
    • -The base of the axilla is formed by the concave skin, subcutaneous tissue, and axillary (deep) fascia extending from the arm to the thoracic wall forming the axillary fossa (armpit).
    • -The anterior wall of the axilla is formed by the pectoralis major and minor and the pectoral and clavipectoral fascia associated with them. The anterior axillary fold is the inferiormost part of the anterior wall.
    • -The posterior wall of the axilla is formed chiefly by the scapula and subscapularis on its anterior surface and inferiorly by the teres major and latissimus dorsi. The posterior axillary fold is the inferiormost part of the posterior wall that may be grasped.
    • -The medial wall of the axilla is formed by the:
    • Thoracic wall - 1st to 4th rib and the intercostal muscles plus the overlying serratus anterior muscle.
    • -The lateral wall of the axilla is the narrow bony wall formed by the
    • intertubercular groove in the humerus.
  36. Cubital fossa boundaries plus clinical importance
    • It's the shallow triangular depression on the anterior surface of the elbow. Boundaries of the cubital fossa are:
    • -Superiorly, an imaginary line connecting the medial and lateral epicondyles.
    • -Medially, the pronator teres muscle.
    • -Laterally, the brachioradialis muscle.
    • -The floor of the cubital fossa is formed by the brachialis and supinator muscles. The roof of the cubital fossa is formed by the continuity of brachial and antebrachial (deep) fascia, reinforced by the bicipital aponeurosis, subcutaneous tissue, and skin.
  37. The contents of the cubital fossa are:
    • Terminal part of the brachial artery and the commencement of its terminal branches, the radial and ulnar arteries; the brachial artery lies between the biceps tendon and the median nerve.
    • (Deep) accompanying veins of the arteries.
    • Biceps brachii tendon.
    • Median nerve.
    • Radial nerve, dividing into its superficial and deep branches.
  38. In the subcutaneous tissue overlying the cubital fossa are the median cubital vein, lying anterior to the brachial artery, and the medial and lateral cutaneous nerves of the forearm, related to the basilic and cephalic veins
  39. Anatomical snuffbox
  40. The tendons of the APL and EPB bound the triangular anatomical snuff box laterally, and the tendon of the EPL bounds it medially . The snuff box is visible as a hollow on the lateral aspect of the wrist when the thumb is extended fully; this draws the APL, EPB, and EPL tendons up and produces a concavity between them. Observe that the:
    • -Radial artery lies on the floor of the snuff box.
    • -Radial styloid process can be palpated proximally and the base of the 1st metacarpal can be palpated distally in the snuff box.
    • -Scaphoid and trapezium can be felt in the floor of the snuff box between the radial styloid process and the 1st metacarpal
  41. What are the boundaries of the following potential spaces of the hand?
    Between the flexor tendons and the fascia covering the deep palmar muscles are two potential spaces: the thenar space and the midpalmar space. These spaces are bounded by fibrous septa passing from the edges of the palmar aponeurosis to the metacarpals. Between the two spaces is the especially strong lateral fibrous septum, which is attached to the 3rd metacarpal. The midpalmar space is continuous with the anterior compartment of the forearm via the carpal tunnel.
  42. Thenar: Thenar muscles in the thenar compartment:
    abductor pollicis brevis, flexor pollicis brevis, and opponens pollicis
  43. Hypothenar: Hypothenar muscles in the hypothenar compartment:
    abductor digiti minimi, flexor digiti minimi brevis, and opponens digiti minimi
  44. Mid-palmar: The interossei in separate interosseous compartments between the
    metacarpals, The short muscles of the hand, the lumbricals, in the central compartment with the long flexor tendons.
  45. What muscle aids in protecting the subclavian vessels and the superior trunk of the brachial plexus if the clavicle fractures? Not a major muscle.
    Subclavius
  46. The thumb movement(s) is the most complex. Be able to identify each of these movements.
    Opposition
  47. Superficial posterior axioappendicular (extrinsic shoulder) muscles:
    trapezius and latissimus dorsi.
  48. Deep posterior axioappendicular (extrinsic shoulder) muscles:
    levator scapulae and rhomboid
  49. Scapulohumeral
  50. Intrinsic shoulder muscles: deltoid, teres major, and the four rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis)
  51. If the following vessels were interrupted (tied off) how would the upper limb receive blood? Right subclavian artery
  52. If the RSC were interrupted before the Thyrocervical Trunk, no blood would get to upper limb, if after: then the Thyrocervical Trunk
  53. If the following vessels were interrupted (tied off) how would the upper limb receive blood? Axillary artery
    If the AA was interrupted, back to the Thyrocervical Trunk: a branch of this Supscapular Artery
  54. If the following vessels were interrupted (tied off) how would the upper limb receive blood? brachial artery
    If the BA is interrupted then the Deep Artery of the Arm and/or the Ulnar Collateral Arteries (superior & Inferior)
  55. If the following vessels were interrupted (tied off) how would the upper limb receive blood? Radial artery
  56. Depends on interruption height: Superficial Palmer branch of Radial Artery or the Interosseous Arteries (Posterior and Anterior)
  57. If the following vessels were interrupted (tied off) how would the upper limb receive blood? Ulnar artery
    • Depends on interruption height: Palmer Carpal branch of Ulnar Artery or the
    • Interosseous Arteries (Posterior and Anterior).
  58. Where in the upper limb can a pulse be taken? Identify the vessel and the location.
    Brachial Artery (arm, medial), Radial Artery (forearm, lateral)
  59. Of the blood vessels branching from the aortic arch what is the blood supply to the right and the left upper limb? How do they differ?
    Aortic Arch: Brachiocephalic truck will give rise to the Right Common Carotid Artery as well as the Right Subclavian; the Aortic Arch then gives rise to the Left Common Carotid Artery and Left Subclavian Artery
  60. The deep veins run in pairs and are called what?
    Vena Comitantes
  61. Be able to identify and trace the superficial blood drainage of the upper limb back to the heart.
    Digital Veins—Dorsal Venous Network/Superficial Venous Palmar Arch- Cephalic Vein/Basilic Vein (forearm)—Medial Cubital Vein—Cephalic Vein/Basilic Vein (arm)—Axillary Vein—Subclavian Vein—Brachiocephalic Vein
  62. Which artery in the arm is compressed when taking a blood pressure?
  63. Brachial Artery is compressed, while a stethoscope is placed over the cubital fossa
  64. Where would you place a tourniquet to obtain a bloodless surgical field to treat an extensive hand injury? Remember collateral circulation!
    Band the wrist or higher on the forearm
  65. In a fracture of the hand which of the carpal bones or part of a carpal bone has a poor blood supply and may not heal but becomes necrotic and dies?
  66. Scaphoid
  67. Be able to identify the following structures of the brachial plexus:Roots:
    The brachial plexus is formed by the union of the anterior rami of the C5–T1 nerves, which constitute the roots of brachial plexus
  68. Be able to identify the following structures of the brachial plexus: trunk:
    • A superior trunk, from the union of the C5 and C6 roots. A middle trunk, which is a continuation of the C7 root.
    • An inferior trunk, from the union of the C8 and T1 roots.
  69. Be able to identify the following structures of the brachial plexus:Divisions:
    Each trunk of the brachial plexus divides into anterior and posterior divisions as the plexus passes through the cervicoaxillary canal posterior to the clavicle.
  70. Be able to identify the following structures of the brachial plexus:Cords:
    The divisions of the trunks form three cords of the brachial plexus, within the axilla: Lateral, Medial and Posterior Cords
  71. Terminal branches – Identify what area of upper limb that each supplies. Musculocutaneous:
    muscles of anterior compartment of arm, skin lateral aspect.
  72. Terminal branches – Identify what area of upper limb that each supplies.Median:
    Muscles of anterior forearm compartment (except for FCU and Ulnar half of FDP), palmer skin and 5 intrinsic muscles of the thenar ½ of palm.
  73. Terminal branches – Identify what area of upper limb that each supplies. Ulnar:
    FCU and the ulnar ½ of the FDP, most intrinsic muscles of the hand, skin of hand (medial to axial line of digit 4).
  74. Terminal branches – Identify what area of upper limb that each supplies. Axillary:
    Glenohumeral joint, teres minor, deltoid, skin of superolateral arm (over inferior part of deltoid).
  75. Terminal branches – Identify what area of upper limb that each supplies. Radial:
    All muscles of posterior compartments of arm and forearm, skin of posterior and infrolateral arm/posterior forarm/dorsum of hand (lateral to axial line of digit 4).
  76. Define a dermatome. What is the significance of the dermatome?
  77. Dermatome: unilateral area of skin innervated by the general sensory fibers of a single spinal nerve.
    Significant due to dermatome mapping, understanding embryological development and overlapping of sensory and motor.
  78. What would be the problem with the upper limb if the following nerves were damaged? Take each nerve independently. Give motor only.

    Radial:
    Wrist Drop
  79. What would be the problem with the upper limb if the following nerves were damaged? Take each nerve independently. Give motor only. Ulnar:
    Claw Hand
  80. What would be the problem with the upper limb if the following nerves were damaged? Take each nerve independently. Give motor only.
    Musculocutaneous:
    Reduces flexion of the elbow and supination of forearm
  81. What would be the problem with the upper limb if the following nerves were damaged? Take each nerve independently. Give motor only.
    Axillary:
  82. Axillary Nerve Atrophy of the deltoid occurs when the axillary nerve (C5 and C6) is severely damaged (e.g., as might occur when the surgical neck of the humerus is fractured). As the deltoid atrophies, the rounded contour of the shoulder disappears. This gives the shoulder a flattened appearance and produces a slight hollow inferior to the acromion. A loss of sensation may occur over the lateral side of the proximal part of the arm, the area supplied by the superior lateral cutaneous nerve of the arm. To test the deltoid (or the function of the axillary nerve) the arm is abducted, against resistance, starting from approximately 15°.
  83. What would be the problem with the upper limb if the following nerves were damaged? Take each nerve independently. Give motor only.
    Suprascapular:
    2 points of fixation of nerve are at its origin from upper trunk & at suprascapular notch, where it is susceptible to traction injury. It is fixed at its origin from C-5 or upper trunk of brachial plexus and at its termination in infraspinatus;
  84. What would be the problem with the upper limb if the following nerves were damaged? Take each nerve independently. Give motor only.
    Compression at the notch:
    may be compressed by either the suprascapular ligament or a cyst (arising from the shoulder joint) which results in paralysis of supraspinatus and infraspinatus; following blunt trauma, the ligament may calcify (causing compression); compression at the level of the supraspinatus notch would be expected to affect both the supraspinatus and infraspinatus;
  85. Where would you apply pressure to the upper limb to disable each of the five branches of the brachial plexus?
  86. Brachial Plexus Block: axillary. Other possible approaches: interscalene, supraclavicular
  87. Define and give an example of: Anesthesia:
    loss of cutaneous sensation
  88. Define and give an example of: Paralysis:
  89. 1.) Complete: non movement detected
    2.) Incomplete: not all muscles are paralyzed, person can move, but movements are weak.
  90. The median nerve lies in what position to the axillary artery?
    The median nerve is lateral to the axillary artery
  91. What is carpal tunnel syndrome? What movement(s) is (are) limited in carpal tunnel syndrome?
    The carpal tunnel becomes inflamed due to lesion or over use. The median nerve is the most sensitive structure in the carpal tunnel. Carpal Tunnel sufferers are unable to oppose the thumb.
  92. What is the characteristic clinical sign of radial nerve injury?
  93. Wrist Drop
  94. Know how lymph channels (also called: Lymphatic vessles or Lymphatics) travel in the upper limb.
  95. Know what palmer aponeurosis, ligaments, tendons and soft tissue are for in
  96. Support: keeps tendons in place.

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