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Upper limb test 7

Upper limb

QuestionAnswer
1. Know the markings of each bone in the upper limb.
upper limb consists of the arm (brachium), forearm (antebrachium), and hand (manus)
arm (brachium)
humerus is the sole bone of the arm
humerus It articulates with the scapula at the shoulder, and the radius and ulna at the elbow
humerus Major markings Proximal humerus includes the head, anatomical and surgical necks, greater and lesser tubercles, and the intertubercular groove
humerus Distal humerus includes the capitulum, trochlea, medial and lateral epicondyles, and the coronoid and olecranon fossae Medial portion includes the deltoid process
Forearm The bones of the forearm are the radius and ulna
Forearm They articulate proximally with the humerus and distally with the wrist bones
Forearm They also articulate with each other proximally and distally at small radioulnar joints Interosseous membrane connects the two bones along their entire length
Bones of the Forearm Ulna The ulna lies medially in the forearm and is slightly longer than the radius
Ulna Forms the major portion of the elbow joint with the humerus
Ulna Its major markings include the olecranon, coronoid process, trochlear notch, radial notch, and the styloid process
Radius The radius lies opposite (lateral to) the ulna
Radius The superior surface of the head articulates with the capitulum of the humerus
Radius Medially, the head articulates with the radial notch of the ulna
Radius Major markings include the radial tuberosity, ulnar notch, and styloid process
Hand Skeleton of the hand contains wrist bones (carpals), bones of the palm (metacarpals), and bones of the fingers (phalanges)
Carpus (Wrist) Consists of eight bones Scaphoid, lunate, triquetral, and pisiform proximally Trapezium, trapezoid, capitate, and hamate distally
Metacarpus (Palm) Five numbered (1-5) metacarpal bones radiate from the wrist to form the palm
Metacarpus (Palm) Their bases articulate with the carpals proximally, and with each other medially and laterally
Metacarpus (Palm) Heads articulate with the phalanges
Phalanges (Fingers) Each hand contains 14 miniature long bones called phalanges
Phalanges (Fingers) Fingers (digits) are numbered 1-5, beginning with the thumb (pollex)
Phalanges (Fingers) Each finger (except the thumb) has three phalanges – distal, middle, and proximal The thumb has no middle phalanx
Appendicular Skeleton The appendicular skeleton is made up of the bones of the limbs and their girdles Pectoral girdles attach the upper limbs to the body trunk Pelvic girdle secures the lower limbs
Pectoral Girdles (Shoulder Girdles) The pectoral girdles consist of the anterior clavicles and the posterior scapulae They attach the upper limbs to the axial skeleton in a manner that allows for maximum movement They provide attachment points for muscles that move the upper limbs
Clavicles (Collarbones) The clavicles are slender, doubly curved long bones lying across the superior thorax The acromial (lateral) end articulates with the scapula, and the sternal (medial) end articulates with the sternum
Scapulae (Shoulder Blades) The scapulae are triangular, flat bones lying on the dorsal surface of the rib cage, between the second and seventh ribs
Scapulae (Shoulder Blades) Scapulae have three borders and three angles Major markings include the scapular notch, the supraspinous and infraspinous fossae, the spine, the acromion, and the coracoid process
2. Where is the highest point of the shoulder? acromion
What is an extension of the scapular spine? acromion
3. Name the 8 carpal bones. Scaphoid, lunate, triquetral, and pisiform proximally Trapezium, trapezoid, capitate, and hamate distally
4. What is a Colle’s fracture? fracture of the distal end of the radius
Which is the most fractured carpal bone? scaphoid
5. Study the carpal tunnel and carpal tunnel syndrome. What nerve would be compressed and what symptoms would it cause?
Carpal Tunnel (canal): The concave space formed by: Floor: 4 carpal bones: pisiform and hamate (ulnar side) and scaphoid and trapezium (radial side). Roof: flexor retinaculum (deep fascia) Contents: long flexor tendons of the digits & median nerve.
Carpal tunnel syndrome: Excessive exercise, trauma, infection -> inflammation of the digital tendon sheaths -> compression of median nerve -> sensory changes over the lateral side of the hand & muscle weakness in the thenar eminence.
What nerve would be compressed and what symptoms would it cause? median nerve; cause tingling, numbness
6. What is the shoulder joint formed? What are the actions of the shoulder joint? Does it have more freedom of the movement than any joint of the body? What is the dislocated shoulder?
What is the shoulder joint formed? is a ball-and-socket joint formed by the head of the humerus and the glenoid cavity of the scapula. It also is referred to as the humeroscapular or glenohumeral joint.
What are the actions of the shoulder joint? The shoulder joint allows flexion, extension, hyperextension, abduction, adduction, medial rotation, lateral rotation, and circumduction of the arm
Does it have more freedom of the movement than any joint of the body? YES. p, 285
What is the shoulder joint formed? Ball-and-socket joint in which stability is sacrificed to obtain greater freedom of movement Head of humerus articulates with the glenoid fossa of the scapula
What is the dislocated shoulder? the most commonly dislocated joint; the head of the humerus becomes displaced inferiorly.
dislocated shoulder dislocated shoulder the head of the humerus becomes displaced inferiorly, where the articular capsule is least protected.
7. How is the wrist joint formed? Wrist (Radiocarpal) joint: a. Formed by: the distal end of the radius & lunate, scaphoid, and triquetrum.
8. Which 4 muscles make up the “rotator cuff”? supraspinatus, infraspinatus, teres minor, subscapularis tendons of these muscles encircle the joint (except for the inferior portion) and blends with the articular capsule.
9. Study the origin, insertion, and action of each muscle of the upper limb.
Ant. Thoracic Pectoralis minor Origin: 2 –5 or 3- 5 ribs Insertion:Coracoid process Action:Abducts scapula and rotates it downward
Ant. Thoracic Serratus anterior Origin:1-8 or 1-9 ribs Insertion:Vertebral border & inf. angle of scapula Action:Abducts scapula and rotates it upward; “boxer’s muscle”
Post. Thoracic Trapezius Origin:Occipital bone, ligamentum nuchae, spines of C7-T12 Insertion:Clavicle, acromion & spine of scapula Action:Elevates, adducts, depresses scapula; rotates scapula upward.
Post. Thoracic Levator scapulae Origin:Transverse processes of C1-4 Insertion:Superior vertebral border of scapula Action:Elevates scapula
Post. Thoracic Rhomboid major Origin:Spines of T2-T5 Insertion:Vertebral border of scapula inferior to spine Action:Elevates and adducts scapula and rotates it downward
Post. Thoracic Rhomboid minor Origin:Spines of C7-T1 Insertion:Vertebral border of scapula superior to spine Action:Elevates and adducts scapula and rotates it downward
Move the humerus Pectoralis major Origin:Clavicle, sternum, costal cartilages of 2-6 ribs Insertion:Greater tubercle & intertubercular sulcus of humerus Action:Adducts and medially rotates arm at shoulder; Flexes arm (part)
Move the humerus Latissimus dorsi Origin:Spine of T7-L5, thoracolumbar fascia, iliac rest, lower 4 ribs Insertion: Intertubercular sulcus of humerus Action:Adducts and medially rotates arm at shoulder; Extends arm; draws arm inferiorly and posteriorly
Move the humerus Deltoid Origin:Lateral third of clavicle, acromion & spine of scapula Insertion:Deltoid tuberosity of humerus Action:Abducts, flexes & medially rotates, extends & laterally rotates arm at shoulder
Move the humerus Subscapularis Origin:Subscapular fossa of scapula Insertion:Lesser tubercle of humerus Action:Medially rotates arm at shoulder only
Move the humerus Supraspinatus Origin:Supraspinous fossa of scapula Insertion:Greater tubercle of humerus Action:Abducts arm at shoulder only (assists deltoid m.)
Move the humerus Infraspinatus Origin:Infraspinous fossa of scapula Insertion:Greater tubercle of humerus Action:Laterally rotates and adducts arm at shoulder
Move the humerus Teres major Origin:Inferior angle of scapula Insertion:Intertubercular sulcus of humerus Action:Adducts and medially rotates arm at shoulder; Extends arm; draws arm inferiorly and posteriorly
Move the humerus Teres minor Origin:Lateral border of scapula Insertion:Greater tubercle of humerus Action:Laterally rotates and adducts arm at shoulder
Move the humerus Coracobrachialis Origin:Coracoid process of scapula Insertion:Middle of medial shaft of humerus Action:Flexes and adducts arm
Forearm Flexors Biceps brachii Origin:Supraglenoid tubercle of scapula (long head), coracoid process (short head) Insertion:Radial tuberosity & bicipital aponeurosis Action:Flexes forearm, supinates forearm, flexes arm
Forearm Flexors Brachialis Origin:Distal, ant. Surface of humerus Insertion:Ulna tuberosity & coronoid process Action:Major flexor of forearm
Forearm Flexors Brachioradialis Origin:Lateral border of distal humerus Insertion:Superior to styloid process of radius Action:Flexes forearm, supinates & pronates forearm to neutral position
Forearm Extensors Triceps brachii Origin:Infraglenoid tubercle of scapula, medial & lateral surfaces of humerus Insertion:Olecranon process Action:Extends forearm & arm
10. What muscles (4 of them) insert on the greater tubercle of the humerus? Pectoralis major Supraspinatus Infraspinatus Teres minor
11. What muscles (3 of them) origin or insert to the coracoid process of the scapula? Coracobrachialis, origin Biceps brachii, origin Brachialis, insertion
12. What muscles attach to or run in the intertubercular sulcus of the humerus? Pectoralis major, insertion Latissimus dorsi,insertion Teres major,insertion
How is the brachial plexus formed? Formed by the anterior rami of spinal nerves of C5-C8 and T1 Provides the entire nerve supply of the shoulder and upper limb
Name its subdivisions: rami (roots), ___, divisions, ______. Roots, Trunks, Divisions, Cords
There are four major branches of this plexus Roots – five ventral rami (C5-T1) Trunks – upper, middle, and lower, which form divisions Divisions – anterior and posterior serve the front and back of the limb Cords – lateral, medial, and posterior fiber bundles
14. Name the 3 cords and its nerves. - Lateral cord: musculocutaneous & part of median nerves. - Medial cord: part of median nerve & ulnar. - Posterior cord: axillary & radial.
Five important nerves arise from the brachial plexus: musculocutaneous & part of median nerves part of median nerve & ulnar axillary & radial
15. Study the table on p.78. Know the name of each nerve, its distribution and injury.
nerve Axillary Origin: C5-C6 Distribution: Deltoid, teres minor muscles; skin over deltoid and superior posterior aspect injury:can be caused by improperly administered intramuscular injections into the deltoid muscle of arm
nerve Musculocutaneous Origin: C5-C7 Distribution: Flexors: coracobrachialis, biceps brachii, & brachialis injury:
nerve Radial Origin: C5-C8, T1 Distribution:Essentially all extensor muscles, Triceps brachii, anconeus, and extensor muscles of forearm; skin of posterior arm and forearm, lateral two-thirds of dorsum of hand, and fingers over proximal and middle phalanges
nerve Radial injury:wrist drop, the inability to extend the wrist and finger
nerve Median Origin:C5-C8, T1 Distribution:Flexors of forearm except flexor carpi ulnaris and ulnar half of flexor digitorum profundus
nerve Median injury:Median nerve palsy: numbness, tingling, pain in palm and fingers; inability to pronate the forearm and flex the proximal interphalangeal joint
nerve Ulnar Origin:C8-T1 Distribution:Flexor carpi ulnaris & part of the flexor digitorum profundus; most of the hand muscles
nerve Ulnar injury:Clawhand: inability to adduct or abduct the four fingers (not the thumb), loss of sensation of the little finger
nerve Dorsal scapular Origin:C5 Distribution:Levator scapula, rhomboid major & minor injury:
nerve Long thoracic Origin:C5–C7 Distribution:Anterior serratus injury:Winged scapula: paralysis of the serratus anterior
nerve Suprascapular Origin:C5–C6 Distribution:Supraspinatus & infraspinatus injury:
nerve Thoracodorsal Origin:C6–C8 Distribution:Latissimus dorsi injury:
nerve Upper subscapular Origin:C5–C6 Distribution:Subscapularis injury:
nerve Lower subscapular Origin:C5–C6 Distribution:Subscapularis, teres major injury:
nerve Lateral pectoral Origin:C5–C7 Distribution:Pectoralis major injury:
nerve Medial pectoral Origin:C8–T1 Distribution:Pectoralis major, minor injury:
16. What nerve supplies the deltoid and teres minor muscles? Axillary
17. What nerve supplies supplies most of hand muscles? Ulnar
18. What nerve supplies supplies lattisimus dorsi? Thoracodorsal
19. What nerve supplies supplies supraspinatus and infraspinatus? Suprascapular
20. What nerve supplies Biceps brachii and brachialis? Musculocutaneous
21. What is the condition called winged scapula? What nerve is injured and what muscle is paralyzed? Winged scapula: paralysis of the serratus anterior Long thoracic nerve; Anterior serratus
22. Which nerve injury would lead to wrist drop? Radial nerve
23. What muscles does the axillary nerve supply? Deltoid and teres minor muscles; skin over deltoid and superior posterior aspect of arm
What is the consequence with the axillary nerve injury? axillary nerve palsy
What is the consequence with the axillary nerve injury? Paralysis of the teres minor muscle and deltoid muscle, resulting in loss of abduction of arm (from 15-90 degrees), weak flexion, extension, and rotation of shoulder. Paralysis of deltoid & teres minor results in Flat shoulder deformity.
What is the consequence with the axillary nerve injury? Loss of sensation in the skin over a small part of the lateral upper arm.
What is the consequence with the axillary nerve injury?
Created by: nely.nieto