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VW Eliot UL Anatomy
IS-B1-Eliot Upper Limb Anatomy
| Question | Answer |
|---|---|
| What point moves laterally during lateral rotation (external rotation) of the scapula? | Inferior angle |
| Does lateral rotation of the scapula make the surface of the glenoid fossa point more superiorly or more inferiorly? | More superiorly |
| Name two movements of the arm at the shoulder that is accompanied by glenoid-up rotation of the scapula. | Flexion or abduction |
| In what direction does the anterior surface of the arm move during medial rotation of the arm? During lateral rotation of the arm? | Medially. Laterally |
| What two opposites are the principal movements of the forearm at elbow? | Flexion, extension |
| Is adduction ulnar deviation or is it radial deviation? Is adduction medial deviation or is it lateral deviation? | Ulnar deviation. Medial deviation |
| Using the standard anatomical position as a reference, is the surface of the palm in the sagittal plane or in the coronal plane? | Coronal Plane |
| Does flexion and extension of the fingers (second through fifth digits) occur in the sagittal plane or in the coronal plane? | Sagittal Plane |
| Does flexion and extension of the thumb occur in the sagittal plane or in the coronal plane? | Coronal plane |
| Does abduction and adduction of the fingers occur in the sagittal plane or in the coronal plane? | Coronal plane |
| At which joint does most abduction and adduction occur? | Metacarpophalangeal joint |
| Does abduction and adduction of the thumb occur in the sagittal plane or in the coronal plane? | Sagittal plane |
| Can the thumb be opposed to the fifth digit without adducting the thumb? Can the thumb be opposed without flexing the interphalangeal joint of the thumb? | Yes to both |
| Can the thumb be opposed without flexing the carpometacarpal joint of the thumb? | No |
| What one muscle lies superficial to at least part of each of the four rotator cuff muscles? | Deltoid Muscle |
| Which two layers of the trilaminar embryonic disc provide source tissue for the limbs? (Endoderm, mesoderm or ectoderm.) | Ectoderm, mesoderm |
| What specific tissue in the limbs comes directly from the more superficial of those layers? (Yes, we know neurons and Schwann cells come from that same layer, but not so directly.) | Epidermis (also sweat glands and nails) |
| What tissues come for the other, deeper layer of the embryonic disc? | Bones, vessels, fascia |
| Which embryonic week is the critical period for limb development? | Fourth Week |
| What starts to develop first, the proximal part of a limb, or the distal part? | Proximal |
| What starts to develop first, the forelimb (upper limb) or hindlimb (lower limb)? | Upper limb |
| So, in the range from the shoulder to the fingernails and the hip to the toenails, what starts to develop first, and what is the last part to begin development? | Shoulder first, toenails last, approximately |
| What is phocomelia? What was its common environmental (non-genetic) cause? | Severe congenital dysgenesis of the limbs. Thalidomide, an anti-nausea drug that was administered to pregnant women in North America and Europe in the 1950s, was associated |
| How do the limb malformations of phocomelia give evidence of the timing of limb development? | The hands or feet are often more normally developed than the more proximal parts of the limb. The fingernails or toenails may develop normally. This indicates that the disturbance occurred relatively early in limb development |
| Which three of the four rotator cuff muscles are the S-I-T muscles? | Supraspinatus, infraspinatus, teres minor |
| What do three of the four rotator cuff muscles have in common? | Insertion on greater tubercle (synonymous with tuberosity) of humerus |
| What muscle is added to make the S-I-T-S muscles? | Subscapularis muscle |
| Which rotator cuff muscle(s) is/are located superiorly? | Supraspinatus muscle |
| Which rotator cuff muscle(s) is/are located posteriorly? | Infraspinatus, teres minor muscles |
| Which rotator cuff muscle(s) is/are located anteriorly? | Subscapularis muscle |
| What is the principal anatomical action of the Subscapularis muscle? | Internal rotation of the arm at the shoulder |
| What is the principle action of the supraspinatus muscle? | Abduction of the arm at the shoulder |
| What is the principle action of the infraspinatus and teres minor muscles? | External rotation of the arm at the shoulder |
| Which two rotator cuff muscles have the most distal insertions on the humerus? What action does that give those two muscles? | Teres minor and subscapularis muscles Adduction of the arm at the shoulder |
| Name a muscle that is not a rotator cuff muscle that also internally rotates the arm at the shoulder. | Pectoralis major muscle! |
| Osteophytes on the acromioclavicular joint can irritate the supraspinatus tendon. Where around the circumference of the AC joint must those abrasive osteophytes be located, if they have that effect? | Inferior surface: calcific deposits in the tendon itself can irritate the bursa and the tendon |
| Relative to the supraspinatus tendon, where is the subacromial bursa located? | Superior |
| What branch of the thyrocervical trunk artery supplies blood to the supraspinatus tendon? | Suprascapular artery |
| Name a branch of the axillary artery that supplies blood to the supraspinatus tendon. | Posterior humeral circumflex |
| What is the principal cell type in adult tendon, fibrocyte or fibroblast? | Fibrocyte |
| So, in general, is tendon a highly metabolically active tissue that requires much blood supply? | No |
| So is healing of a supraspinatus injury rapid and effective or is it slow? | Slow |
| Which brachial plexus compartment has the muscles that the musculocutaneous nerve innervates? | Anterior arm |
| Which compartments have the muscles that the median nerve innervates? | Anteromedial forearm, thenar, palm |
| Which compartments have the muscles that the ulnar nerve innervates? | Anteromedial forearm, hypothenar, palm |
| The median nerve and ulnar nerve share a forearm compartment and also the palm. In which one does the median nerve dominate? In which one does the ulnar nerve dominate? | Anteromedial forearm. Palm |
| What two muscles does the axillary nerve innervate? | Deltoid muscle, teres minor muscle |
| Which compartments have the muscles that the radial nerve innervates? | Posterior arm, posterolateral forearm |
| Are dermatome surfaces the same as “skin surfaces that are innervated by cutaneous branches” of nerves? | No |
| Hartwig emphasizes the innervations of the tips and hyponychia of the four fingers. (Hyponychium is the sensitive skin under the edge of a fingernail.) What nerve for the second digit? | Median nerve |
| What nerve for the tip and nailbed of the third digit? What nerve for the tip and nailbed of the fifth digit? | Median Nerve Ulnar Nerve |
| focus on C7 for the middle digit. Working from there, what dermatome includes the thumb and lateral aspect of the forearm? | C6 |
| Working from C7, what dermatome includes the fifth digit and medial aspect of the forearm? | C8 |
| What muscle inserts on the radial tuberosity of the radius? Name its partner, which attaches to the coronoid process of the ulna. | Biceps brachii muscle Brachialis muscle |
| What action do the biceps brachii and brachialis muscle share? | Flexion of the forearm at the elbow |
| What action does the biceps brachii get by attaching to the radius and not the ulna? | Supination of the radius relative to the ulna |
| What is brachialis muscles only significant anatomical action on the forearm at the elbow? | Flexion of the forearm at the elbow |
| The name of the pronator teres muscle makes one of its actions obvious. What is its other anatomical action on the forearm at the elbow? | Flexion of the forearm at the elbow |
| The ulnae of some mammals (e.g., sea lion) have very large olecranon processes. What muscle attaches there? What movement is performed forcefully with the leverage of a large olecranon process? | Triceps brachii muscle; extension of the forearm at the elbow |
| The cephalic vein is not an ideal vein for venipuncture because a cutaneous nerve accompanies it. Name that nerve. | Lateral antebrachial cutaneous nerve (lateral cutaneous nerve of the forearm) |
| At what depth are the cephalic vein, median cubital vein and basilic vein in the forearm and cubital fossa? | Superficial fascia |
| What fan of tendon separates them from the depth of the brachial artery? | Bicipital aponeurosis of biceps brachii |
| What nerve goes “right up the middle” of the cubital fossa? | Median nerve |
| What major vessel is lateral to the median nerve? Lateral to that is the biceps brachii tendon. | Brachial Artery |
| Which nerve is the only major nerve that passes posterior to the elbow joint (posterior to an epicondyle of the humerus)? | Ulnar nerve |
| Name the nerve in the arm that ends with a cutaneous branch that passes near the lateral side of the biceps brachii tendon. What is the name of that cutaneous nerve? | Musculocutaneous nerve |
| The fourth nerve is buried a little more lateral than the musculocutaneous nerve. Name it. | Radial nerve |
| What word describes the radial nerves location relative to the lateral epicondyle of the humerus? | Anterior |
| We have discussed three of four "quadrants" of the elbow (a nerve and vessels in the anteromedial quadrant, one nerve in the posteromedial quadrant, two nerves in the anterolateral quadrant). Which of the four quadrants has no major nerve? | Posterolateral quadrant |
| What ligament makes the anterior border of the carpal tunnel? | Flexor retinaculum |
| What group of four tendons is located relatively superficially in the carpal tunnel? | Flexor digitorum superficialis muscle |
| What group of four tendons is located more deeply in the carpal tunnel? What other tendon is with them there? | Flexor digitorum profundus tendon. Flexor pollicis longus tendon |
| What, then, is the tenth structure passing from the forearm to the hand through the carpal tunnel? | Median nerve |
| Is there a major artery or vein in the carpal tunnel? | No. |
| All of the major contents passing through the main compartment of the carpal tunnel reach the digits. What tendon is entirely outside the carpal tunnel on the ulnar side, stopping at the base of the hand? | Flexor carpi ulnaris muscle |
| What tendon is outside the main compartment of the tunnel on the radial side, stopping at the base of the hand? | Flexor carpi radialis muscle |
| How many hand muscles for the radial nerve? | 0 |
| How many hand muscles for the median nerve? | 45 |
| Which two muscles of the thumb are innervated, all or in part, by the ulnar nerve? | Adductor pollicis muscle (all), flexor pollicis brevis muscle (half) |
| Which two “median nerve muscles” of the hand are not thenar muscles? | Lumbrical muscle of second digit, lumbrical muscle of third digit (first and second lumbricals) |
| Which four interosseous muscles are easily identified on the dorsal side of the hand? | Dorsal interosseous muscles (note First dorsal interosseous muscle) |
| Between which two bones is this particular interosseous muscle located? If, on the lab exam, you see a bunch of pins in that one muscle, be specific--include the number. | First metacarpal, second metacarpal. First dorsal interosseous muscle is the most distal muscle the ulnar nerve innervates, therefore tends to be the first muscle to suffer (paresis or atrophy) when there is an ulnar nerve lesion |
| Which of the two major nerves serving the palmar side of the hand does not utilize the carpal tunnel? | Ulnar nerve |
| A prominent feature of the hamate bone is deep to that nerve at the wrist. What part of the hamate bone is this? | Hamulus |
| Which of that patient's fingers will be the primary target of your cutaneous sensory testing? | Fifth digit |
| Will abducting and adducting the fingers test muscle function in the nerve? | Yes, both will work well |
| Which branch of the radial nerve crosses the wrist? The location of this nerve is something to know for the laboratory exam. What two functions does it serve in the hand? | Superficial radial nerve. General sensory, sympathetics |
| What muscle allows you to flex the proximal interphalangeal joints of your fingers while leaving the distal interphalangeal joints relaxed (so your fingertips can wiggle)? | Flexor digitorum superficialis muscle |
| What flexor muscle reaches the distal phalanx, applying flexion force there, too? | Flexor digitorum profundus muscle |
| What extensor muscle on the radial side will you use to prevent your whole hand from flexing? What extensor muscle on the ulnar side? | Extensor carpi radialis muscles. Extensor carpi ulnaris muscle |
| What action do those two muscles exert on the whole hand at the wrist? | Flexion |
| The lumbrical muscle's origin is the flexor digitorum profundus tendon; what is its insertion? | Extensor expansion |
| Does the lumbrical pass anterior or posterior to the metacarpophalangeal joint? | Anterior |
| What anatomical action on the finger at the metacarpophalangeal joint is determined by the attachments and location of the lumbrical muscle? | Flexion |
| What anatomical action on the interphalangeal joints of the finger is determined by the insertion of the lumbrical muscle? | Extension of the middle and distal phalanges at the interphalangeal joints |
| This combination of two opposite actions is very useful for straightening the fingers. What part of a finger with a paralyzed lumbrical muscle is likely to extend excessively if the extensor digitorum muscle is recruited? | proximal phalanx at the metacarpophalangeal joint |
| What effect does that excessive extension have on the more distal parts of the finger? | It causes slack in the distal part of the extensor digitorum tendon and thereby prevents forceful extension of the interphalangeal joints of the affected finger |
| What nerve innervates the extensor digitorum? What nerve innervates the lumbrical of the fifth digit and, usually, of the fourth digit? | Radial nerve. Ulnar nerve |
| If those two lumbrical muscles lose their innervation by deep laceration, is the extensor digitorum also likely to be paralyzed? If not, what will be the position of the fourth and fifth proximal phalanges as affected by the extensor digitorum muscle? | No. Extended |
| Are the flexor digitorum superficialis and flexor digitorum profundus muscles likely to be paralyzed by that nerve injury? What will be the positions of the fourth and fifth middle and distal phalanges as affected by the flexor digitorum muscles? | No; they are innervated in the forearm. Flexed at the interphalangeal joints |
| This partially paralyzed hand posture is the “claw hand” deformity. Will the doctor or patient be able to straighten the medial fingers passively? Will the patient be able to make a fist? | Yes. Not very well |
| If atrophy is visible in the spaces between the metacarpal bones, what other muscles have lost their innervation? | Interosseous muscles. Dorsal interosseous muscles will be most obvious |
| Is atrophy of all muscles in the thenar muscle group likely? Some or part? If so, what part? | No. Yes. Deep belly of flexor pollicis brevis |
| Would any other thumb muscles be affected? If yes, what muscle is it, and what movement of the thumb would you expect to be very weak in this case? | Yes. Adductor pollicis, adduction of the thumb |
| What movement of the arm at the shoulder occurs to stretch the biceps brachii? | Extension or abduction of the arm at the shoulder, or both together |
| What movement of the forearm at the elbow occurs to stretch the biceps brachii? | Extension of the forearm at the elbow |
| What movement within the forearm occurs to stretch the biceps brachii? | Pronation of the radius relative to the ulna |
| Which two roots of the brachial plexus are involved in upper brachial plexus injury? | C5, C6 |
| Do nerve fibers in those two roots terminate relatively proximal in the upper limb, or relatively distal in the upper limb? | Proximal |
| In a typical upper brachial plexus injury, what is the posture of the arm (abducted or adducted, etc.)? | Adducted, internally rotated |
| What muscles that act on the arm at the shoulder are paralyzed in a brachial plexus injury? | Pectoralis major muscle, biceps brachii, coracobrachialis, deltoid, rotator cuff |
| What muscles that act on the arm at the shoulder are functional to produce the posture adduction and internal rotation? | Latissimus dorsi muscle (it has a lot of C8 in its nerve supply) |
| Are muscles that act on the hand certain to be affected in a case of upper brachial plexus injury? | No |
| Which two nerve roots are involved in lower brachial plexus injury? | C8, T1 |
| Do nerve fibers in those two roots terminate relatively proximal in the upper limb, or relatively distal in the upper limb? | Distally |
| Are muscles that act on the arm at the shoulder certain to be affected in a case of lower brachial plexus injury? | No |
| Are muscles that act on the hand or the digits certain to be affected in a case of lower brachial plexus injury? | Yes |
| If there are motor deficits caused by lower brachial plexus injury, will muscles innervated by the musculocutaneous nerve be affected? | No |
| If there are motor deficits caused by lower brachial plexus injury, will muscles innervated by the median nerve be affected? | Yes |
| If there are motor deficits caused by lower brachial plexus injury, will muscles innervated by the ulnar nerve be affected? | Yes |
| If there are motor deficits caused by lower brachial plexus injury, will muscles innervated by the axillary nerve be affected? | No |
| If there are motor deficits caused by lower brachial plexus injury, will muscles innervated by the radial nerve be affected? | Maybe |
| In parenthesis on the lab study list you will find the cutaneous branch of the axillary nerve. Name it. | Superior lateral brachial cutaneous nerve |
| If there is paresthesia in the field of this nerve, where might you look for a fracture? | Surgical neck of humerus |
| Name another major nerve that will be affected if this is a posterior cord lesion rather than a lesion of the axillary nerve. | Radial nerve; the three subscapular nerves; nerve to deltoid muscle (i.e., all fibers in the axillary nerve) |
| the second and third proximal phalanges cannot flex at the metacarpophalangeal joints. What two intrinsic hand muscles would be paralyzed to produce this effect? What nerve innervates them? | lumbrical muscles of second and third digits. Median nerve |
| Comparing pure and logical cases of pronator teres syndrome and carpal tunnel syndrome, which will have more proximal signs and symptoms? | Pronator teres syndrome |
| Which of pronator teres syndrome and carpal tunnel syndrome would you expect to present with signs and symptoms in the hand only? | Carpal tunnel syndrome |
| Name a muscle with a nerve supply that could be diminished by nerve impingement between the two heads of pronator teres, but that could not be affected directly by nerve impingement within the carpal tunnel. | Flexor digitorum superficialis muscle |
Created by:
cherubicsiren
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