Upper limb
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| 1. Know the markings of each bone in the upper limb. |
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| upper limb consists of | the arm (brachium), forearm (antebrachium), and hand (manus)
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| arm (brachium) |
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| humerus | is the sole bone of the arm
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| humerus | It articulates with the scapula at the shoulder, and the radius and ulna at the elbow
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| humerus | Major markings
Proximal humerus includes the head, anatomical and surgical necks, greater and lesser tubercles, and the intertubercular groove
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| humerus | Distal humerus includes the capitulum, trochlea, medial and lateral epicondyles, and the coronoid and olecranon fossae
Medial portion includes the deltoid process
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| Forearm | The bones of the forearm are the radius and ulna
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| Forearm | They articulate proximally with the humerus and distally with the wrist bones
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| Forearm | They also articulate with each other proximally and distally at small radioulnar joints
Interosseous membrane connects the two bones along their entire length
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| Bones of the Forearm Ulna | The ulna lies medially in the forearm and is slightly longer than the radius
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| Ulna | Forms the major portion of the elbow joint with the humerus
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| Ulna | Its major markings include the olecranon, coronoid process, trochlear notch, radial notch, and the styloid process
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| Radius | The radius lies opposite (lateral to) the ulna
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| Radius | The superior surface of the head articulates with the capitulum of the humerus
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| Radius | Medially, the head articulates with the radial notch of the ulna
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| Radius | Major markings include the radial tuberosity, ulnar notch, and styloid process
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| Hand | Skeleton of the hand contains wrist bones (carpals), bones of the palm (metacarpals), and bones of the fingers (phalanges)
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| Carpus (Wrist) | Consists of eight bones
Scaphoid, lunate, triquetral, and pisiform proximally
Trapezium, trapezoid, capitate, and hamate distally
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| Metacarpus (Palm) | Five numbered (1-5) metacarpal bones radiate from the wrist to form the palm
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| Metacarpus (Palm) | Their bases articulate with the carpals proximally, and with each other medially and laterally
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| Metacarpus (Palm) | Heads articulate with the phalanges
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| Phalanges (Fingers) | Each hand contains 14 miniature long bones called phalanges
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| Phalanges (Fingers) | Fingers (digits) are numbered 1-5, beginning with the thumb (pollex)
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| Phalanges (Fingers) | Each finger (except the thumb) has three phalanges – distal, middle, and proximal
The thumb has no middle phalanx
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| 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
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| 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
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| 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
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| Scapulae (Shoulder Blades) | The scapulae are triangular, flat bones lying on the dorsal surface of the rib cage, between the second and seventh ribs
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| 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
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| 2. Where is the highest point of the shoulder? | acromion
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| What is an extension of the scapular spine? | acromion
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| 3. Name the 8 carpal bones. | Scaphoid, lunate, triquetral, and pisiform proximally
Trapezium, trapezoid, capitate, and hamate distally
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| 4. What is a Colle’s fracture? | fracture of the distal end of the radius
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| Which is the most fractured carpal bone? | scaphoid
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| 5. Study the carpal tunnel and carpal tunnel syndrome. What nerve would be compressed and what symptoms would it cause? |
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| 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.
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| 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.
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| What nerve would be compressed and what symptoms would it cause? | median nerve; cause tingling, numbness
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| 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? |
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| 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.
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| 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
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| Does it have more freedom of the movement than any joint of the body? | YES. p, 285
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| 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
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| What is the dislocated shoulder? | the most commonly dislocated joint; the head of the humerus becomes displaced inferiorly.
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| dislocated shoulder | dislocated shoulder the head of
the humerus becomes displaced inferiorly, where the articular capsule
is least protected.
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| 7. How is the wrist joint formed? | Wrist (Radiocarpal) joint:
a. Formed by: the distal end of the radius & lunate, scaphoid, and triquetrum.
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| 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.
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| 9. Study the origin, insertion, and action of each muscle of the upper limb. |
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| Ant. Thoracic Pectoralis minor | Origin: 2 –5 or 3- 5 ribs
Insertion:Coracoid process
Action:Abducts scapula and rotates it downward
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| 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”
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| 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.
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| Post. Thoracic Levator scapulae | Origin:Transverse processes of C1-4
Insertion:Superior vertebral border of scapula
Action:Elevates scapula
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| 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
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| 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
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| 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)
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| 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
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| 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
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| Move the humerus Subscapularis | Origin:Subscapular fossa
of scapula
Insertion:Lesser tubercle of humerus
Action:Medially rotates arm at shoulder only
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| Move the humerus Supraspinatus | Origin:Supraspinous fossa of scapula
Insertion:Greater tubercle of humerus
Action:Abducts arm at shoulder only
(assists deltoid m.)
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| Move the humerus Infraspinatus | Origin:Infraspinous fossa of scapula
Insertion:Greater tubercle of humerus
Action:Laterally rotates and adducts arm at shoulder
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| 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
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| Move the humerus Teres minor | Origin:Lateral border of scapula
Insertion:Greater tubercle of humerus
Action:Laterally rotates and adducts arm at shoulder
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| Move the humerus Coracobrachialis | Origin:Coracoid process
of scapula
Insertion:Middle of medial shaft of humerus
Action:Flexes and adducts arm
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| 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
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| Forearm Flexors Brachialis | Origin:Distal, ant. Surface of humerus
Insertion:Ulna tuberosity & coronoid process
Action:Major flexor of forearm
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| 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
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| Forearm Extensors Triceps brachii | Origin:Infraglenoid tubercle of scapula, medial & lateral surfaces of humerus
Insertion:Olecranon process
Action:Extends forearm & arm
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| 10. What muscles (4 of them) insert on the greater tubercle of the humerus? | Pectoralis major
Supraspinatus
Infraspinatus
Teres minor
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| 11. What muscles (3 of them) origin or insert to the coracoid process of the scapula? | Coracobrachialis, origin
Biceps brachii, origin
Brachialis, insertion
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| 12. What muscles attach to or run in the intertubercular sulcus of the humerus? | Pectoralis major, insertion
Latissimus dorsi,insertion
Teres major,insertion
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| 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
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| Name its subdivisions: rami (roots), ___, divisions, ______. | Roots, Trunks, Divisions, Cords
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| 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
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| 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.
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| Five important nerves arise from the brachial plexus: | musculocutaneous & part of median nerves
part of median nerve & ulnar
axillary & radial
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| 15. Study the table on p.78. Know the name of each nerve, its distribution and injury. |
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| 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
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| nerve Musculocutaneous | Origin: C5-C7
Distribution: Flexors: coracobrachialis, biceps brachii, & brachialis
injury:
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| 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
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| nerve Radial | injury:wrist drop, the
inability to extend the wrist and finger
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| nerve Median | Origin:C5-C8, T1
Distribution:Flexors of forearm except flexor carpi ulnaris and ulnar half of flexor digitorum profundus
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| nerve Median | injury:Median nerve palsy: numbness, tingling, pain in palm and fingers; inability to pronate the forearm and flex the proximal interphalangeal joint
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| nerve Ulnar | Origin:C8-T1
Distribution:Flexor carpi ulnaris & part of the flexor digitorum profundus; most of the hand muscles
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| nerve Ulnar | injury:Clawhand: inability to adduct or abduct the four fingers (not the thumb), loss of sensation of the little finger
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| nerve Dorsal scapular | Origin:C5
Distribution:Levator scapula, rhomboid major & minor
injury:
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| nerve Long thoracic | Origin:C5–C7
Distribution:Anterior serratus
injury:Winged scapula: paralysis of the serratus anterior
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| nerve Suprascapular | Origin:C5–C6
Distribution:Supraspinatus & infraspinatus
injury:
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| nerve Thoracodorsal | Origin:C6–C8
Distribution:Latissimus dorsi
injury:
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| nerve Upper subscapular | Origin:C5–C6
Distribution:Subscapularis
injury:
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| nerve Lower subscapular | Origin:C5–C6
Distribution:Subscapularis, teres major
injury:
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| nerve Lateral pectoral | Origin:C5–C7
Distribution:Pectoralis major
injury:
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| nerve Medial pectoral | Origin:C8–T1
Distribution:Pectoralis major, minor
injury:
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| 16. What nerve supplies the deltoid and teres minor muscles? | Axillary
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| 17. What nerve supplies supplies most of hand muscles? | Ulnar
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| 18. What nerve supplies supplies lattisimus dorsi? | Thoracodorsal
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| 19. What nerve supplies supplies supraspinatus and infraspinatus? | Suprascapular
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| 20. What nerve supplies Biceps brachii and brachialis? | Musculocutaneous
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| 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
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| 22. Which nerve injury would lead to wrist drop? | Radial nerve
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| 23. What muscles does the axillary nerve supply? | Deltoid and teres minor muscles; skin over deltoid and superior posterior aspect
of arm
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| What is the consequence with the axillary nerve injury? | axillary nerve palsy
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| 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.
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| What is the consequence with the axillary nerve injury? | Loss of sensation in the skin over a small part of the lateral upper arm.
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| What is the consequence with the axillary nerve injury? |
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