Upper limb
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Questions and Answers

Which of the following muscles is NOT innervated by the brachial plexus?

  • Latissimus dorsi
  • Infraspinatus
  • Trapezius (correct)
  • Serratus anterior
  • Which of the brachial plexus cords is responsible for innervating the latissimus dorsi muscle?

  • Lateral cord
  • Medial cord
  • Posterior cord (correct)
  • None of the above
  • Which of the following muscles is NOT a rotator cuff muscle?

  • Infraspinatus
  • Subscapularis
  • Supraspinatus
  • Deltoid (correct)
  • Which of the following branches of the brachial plexus is responsible for innervating the muscles that elevate the scapula?

    <p>Dorsal scapular nerve (B)</p> Signup and view all the answers

    Which of the following muscles is NOT innervated by a branch of the brachial plexus?

    <p>Pectoralis major (A)</p> Signup and view all the answers

    Which of the following muscles is responsible for protraction of the scapula?

    <p>Serratus anterior (B)</p> Signup and view all the answers

    Which of the following muscles is NOT innervated by a branch of the posterior cord of the brachial plexus?

    <p>Subscapularis (A)</p> Signup and view all the answers

    Which of the following muscles is responsible for the abduction of the arm at the shoulder joint?

    <p>Deltoid (C)</p> Signup and view all the answers

    What is the primary action of the trapezius muscle?

    <p>Elevates and depresses the shoulder (C)</p> Signup and view all the answers

    Which of the following is NOT a muscle that originates from the spinous processes of T6 to T12?

    <p>Trapezius (B)</p> Signup and view all the answers

    Which nerve primarily innervates the trapezius muscle?

    <p>Accessory nerve CN XI (B)</p> Signup and view all the answers

    Where does the latissimus dorsi insert?

    <p>Intertubercular groove of the humerus (C)</p> Signup and view all the answers

    What are the primary actions of the latissimus dorsi muscle?

    <p>Extends, adducts, and rotates the shoulder medially (B)</p> Signup and view all the answers

    Which muscle of the arm is responsible for both flexing and supinating the forearm at the elbow joint?

    <p>Biceps brachii (D)</p> Signup and view all the answers

    What is the insertion point of the Coracobrachialis muscle?

    <p>Medial surface of the shaft of the humerus, 1/3 part (A)</p> Signup and view all the answers

    Which of the following muscles is NOT innervated by the musculocutaneous nerve?

    <p>Triceps brachii (B)</p> Signup and view all the answers

    What is the origin of the long head of the Biceps brachii muscle?

    <p>Supraglenoid tubercle (C)</p> Signup and view all the answers

    Which of the following is NOT a common cause of Biceps tendinitis?

    <p>Dislocation of the shoulder joint (D)</p> Signup and view all the answers

    What is the characteristic deformity that occurs after a rupture of the tendon of the long head of the Biceps brachii muscle?

    <p>Popeye deformity (D)</p> Signup and view all the answers

    Which of the following is a potential complication of severe Biceps tendinitis?

    <p>Rupture of the biceps tendon (C)</p> Signup and view all the answers

    What is the origin of the medial head of the Triceps brachii muscle?

    <p>Posterior humerus, inferior part below the radial nerve groove (D)</p> Signup and view all the answers

    Which of the following structures is NOT directly involved in the innervation of the trapezius muscle?

    <p>Brachial Plexus (A)</p> Signup and view all the answers

    The latissimus dorsi muscle shares a common origin with which of the following muscles?

    <p>Rhomboid Major (B)</p> Signup and view all the answers

    Which of the following is a potential artery involved in providing blood supply to the trapezius muscle?

    <p>Transverse Cervical Artery (B)</p> Signup and view all the answers

    Which of the following muscles DOES NOT have an attachment to the scapula?

    <p>Latissimus Dorsi (C)</p> Signup and view all the answers

    The action of rotating the glenoid cavity superiorly, as performed by the trapezius muscle, is primarily involved in which of the following movements?

    <p>Upward Rotation of the Scapula (B)</p> Signup and view all the answers

    Which of the following muscles is primarily responsible for flexing the forearm at the elbow joint?

    <p>Brachialis (C)</p> Signup and view all the answers

    What is the insertion point of the long head of the Biceps brachii muscle?

    <p>Radial tuberosity (C)</p> Signup and view all the answers

    Which of the following nerves innervates the Brachialis muscle?

    <p>Musculocutaneous nerve (D)</p> Signup and view all the answers

    Which of the following structures is most likely to be inflamed in a case of Biceps tendinitis?

    <p>The tendon of the long head of the Biceps brachii (B)</p> Signup and view all the answers

    The characteristic "Popeye deformity" after a ruptured tendon of the long head of the Biceps brachii is due to:

    <p>The detached muscle belly forming a ball in the center of the arm (B)</p> Signup and view all the answers

    Which of the following muscles is NOT involved in extending the arm at the elbow joint?

    <p>Brachialis (D)</p> Signup and view all the answers

    Which of the following is NOT a potential cause of Biceps tendinitis?

    <p>A direct blow to the shoulder joint (C)</p> Signup and view all the answers

    Which muscle is NOT innervated by a branch of the posterior cord of the brachial plexus?

    <p>Subscapularis (A)</p> Signup and view all the answers

    Which muscle, innervated by a branch of the brachial plexus, contributes to both flexion and supination of the forearm?

    <p>Biceps brachii (A)</p> Signup and view all the answers

    Which of the following muscles receives direct innervation from a branch of the brachial plexus originating from C5 and C6?

    <p>Supraspinatus (C)</p> Signup and view all the answers

    Which muscle, innervated by the brachial plexus, originates from the lateral border of the scapula?

    <p>Teres Minor (A)</p> Signup and view all the answers

    Which branch of the brachial plexus directly innervates the muscle responsible for protraction of the scapula?

    <p>Long thoracic nerve (A)</p> Signup and view all the answers

    Which muscle, innervated by a branch of the brachial plexus, directly aids in the process of pulling the arm downward and backward?

    <p>Teres major (B)</p> Signup and view all the answers

    Which of the following branches of the brachial plexus is responsible for innervating the muscle that assists in internal rotation of the shoulder?

    <p>Subscapular nerve (A)</p> Signup and view all the answers

    Which of the following muscles originating from the scapula is NOT innervated by a branch of the brachial plexus?

    <p>Trapezius (C)</p> Signup and view all the answers

    Flashcards

    Anterior compartment muscles

    Muscles that primarily flex the shoulder and elbow joints and supinate the forearm.

    Coracobrachialis muscle

    A muscle that flexes and adducts the arm, originating from the coracoid process and inserting on the humerus.

    Biceps brachii muscle

    A muscle with two heads that flexes the elbow and supinates the forearm, innervated by the musculocutaneous nerve.

    Brachialis muscle

    A muscle that flexes the forearm at the elbow, originating from the humerus and inserting into the ulnar tuberosity.

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    Biceps tendinitis

    Inflammation of the biceps tendon due to repetitive strain, often causing tenderness and a popping sensation.

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    Rupture of long head of biceps

    Tear of the biceps tendon from its attachment, leading to a 'Popeye' deformity on the arm.

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    Posterior compartment muscles

    Muscles that primarily extend the arm and forearm, including the triceps.

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    Triceps muscle

    A muscle with three heads that extends the forearm at the elbow, important for pushing movements.

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    Hand Infections

    Infections in the hand usually swell on the back due to strong fascia.

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    Tenosynovitis

    Infection of finger synovial sheaths leading to swelling and pain.

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    Trapezius Muscle

    Muscle that elevates, depresses, and rotates the shoulder.

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    Latissimus Dorsi Muscle

    Muscle extending, adducting, and rotating the arm medially.

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    Accessory Nerve (CN XI)

    Innervates the trapezius muscle to control shoulder movement.

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    Brachial plexus roots

    Anterior rami of spinal nerves from C5 to T1, forming the basis of the brachial plexus.

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    Brachial plexus trunks

    Three main trunks (upper, middle, lower) originating from the roots of the brachial plexus.

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    Brachial plexus divisions

    Each trunk divides into anterior and posterior divisions that serve different functions.

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    Brachial plexus cords

    Three cords (lateral, medial, and posterior) formed from the divisions of the trunks.

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    Dorsal scapular nerve

    A nerve from C3-C5 supplying muscles like the rhomboids and levator scapulae.

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    Suprascapular nerve

    A nerve from C4-C6 that supplies the supraspinatus and infraspinatus muscles.

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    Long thoracic nerve

    A nerve from C5-C7 supplying the serratus anterior muscle.

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    Thoracodorsal nerve

    A nerve from C6-C8 supplying the latissimus dorsi muscle.

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    Dorsal swelling from infection

    Swelling from hand infections usually occurs on the back due to thick palmar fascia.

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    Digital synovial sheath infection

    Infection that causes swelling and pain in a finger, often from a puncture.

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    Trapezius muscle origins

    Originates from the superior nuchal line and spinous processes of C7 to T12.

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    Latissimus dorsi actions

    Extends, adducts, and rotates the arm medially, capable of pulling the body upward.

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    Accessory nerve function

    Innervates the trapezius muscle, assisting in shoulder movement.

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    Coracobrachialis origins

    Originates from the coracoid process and inserts on the humerus.

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    Biceps brachii origins

    Has two heads; long head from supraglenoid tubercle, short head from coracoid process.

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    Brachialis function

    Primarily flexes the forearm at the elbow.

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    Biceps tendinitis cause

    Inflammation due to repetitive strain, often from throwing.

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    Popeye deformity

    Occurs when the long head of biceps tendon ruptures, forming a ball in the arm.

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    Triceps muscle origins

    Has three heads originating from infraglenoid tubercle and posterior humerus.

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    Anterior compartment muscle functions

    Flex the shoulder and elbow joints, and supinate the forearm.

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    Musculocutaneous nerve role

    Innervates the biceps brachii, brachialis, and coracobrachialis.

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    Brachial plexus

    A network of nerves formed from spinal nerves C5 to T1 that supplies the upper limb.

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    Subclavian nerve

    A nerve from C5-C6 that supplies the subclavius muscle, aiding in shoulder stability.

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    Study Notes

    Upper Limb - Clinical Anatomy

    • The upper limb is created by upper limb girdle muscles.
    • The upper limb girdle is composed of a series of muscles including the deltoid, supraspinatus, infraspinatus, subscapularis, teres minor, and teres major.
    • The deltoid muscle originates from acromion, clavicle acromial end, spine of scapula. It inserts into deltoid tuberosity. Its function includes abduction, lateral and medial rotation, extension, and flexion. The nerve that supplies the deltoid muscle is the axillary nerve.
    • The supraspinatus originates from supraspinatus fossa and inserts into the greater tubercle of the humerus. Its function is abduction of the arm. This muscle is supplied by the suprascapular nerve.
    • The infraspinatus originates from infraspinatus fossa and inserts into greater tubercle (posteriorly). Its function is lateral rotation of the arm. The nerve that supplies it is the suprascapular nerve.
    • The subscapularis originates from subscapular fossa and inserts into lesser tubercle. Its function is adduction and medial rotation of the arm. It is supplied by subscapular nerves.
    • The teres minor originates from lateral border of the scapula and inserts into the inferior facet of the greater tubercle. Its function is lateral rotation of the arm. Its innervation is the axillary nerve.
    • The teres major originates from inferior angle of the scapula and inserts into medial lip of intertubercular groove. Its function is adduction and medial rotation of the arm. Its innervation is from subscapular nerves.
    • Clavicle fractures are most common in the middle third (80%), and less frequent in the lateral or medial thirds. They can be associated with coracoclavicular ligament tears.
    • A secondary ossification center appears at the sternal end of the clavicle and fuses with the shaft between ages 18-31. This is the last of the epiphyses of the long bones to fuse.
    • Glenohumeral dislocation occurs predominantly anteriorly (95% of cases). Common types include subcoracoid (most frequent) and subglenoid dislocations. During dislocation axillary and musculocutaneous nerves can be injured.
    • Shoulder tendinitis and bursitis can result from tendon and bursa inflammation around the joint. The supraspinatus muscle, located in the shoulder, can be vulnerable to impingement or pinching due to its proximity with the greater tubercle and acromion.
    • Rotator cuff muscles (supraspinatus, infraspinatus, subscapularis, and teres minor) are commonly affected when significant damage is involved.
    • The boundaries of the axillary cavity include the axillary inlet; first rib; superior border of the scapula; pectoralis minor and major muscles; clavipectoral fascia; subscapularis, teres major, latissimus dorsi, and long head of triceps; serratus anterior; intercostal muscles; and the humerus

    Upper Limb Girdle

    • ###Axillary Cavity Openings

      • Triangular Foramen (medial axillary foramen) -Superior boundary: Teres minor -Inferior boundary: Teres major -Lateral boundary: Long head of the triceps -Contents: Circumflex scapular artery and vein
      • Quadrangular Foramen (lateral axillary foramen) -Superior boundary: Teres minor -Inferior boundary: Teres major -Lateral boundary: Surgical neck of the humerus -Medial boundary: Long head of the triceps -Contents: Posterior circumflex humeral artery and vein, axillary nerve
    • ###Axillary Cavity Contents -Axillary artery -Axillary vein -Brachial Plexus -Axillary tail (of Spence) -Coracobrachialis and biceps portions

    • ###Arterial Supply of the Upper Limb Girdle -Subclavian artery branches -Vertebral artery -Internal thoracic artery -Thyrocervical trunk -Inferior thyroid artery -Suprascapular artery -Transverse cervical artery -Costocervical trunk -Deep cervical artery -Supreme intercostal artery

    Arm

    • ###Anterior Compartment Muscles

      • Generally flexors of the shoulder and elbow joints. -Supinators of the forearm (biceps brachii)
    • ###Muscles of the arm -Coracobrachialis muscle -Origin: coracoid process -Insertion: medial surface of the shaft of the humerus one third part -Action: Flexion and adduction of arm. -Innervation: musculocutaneous nerve. -Biceps brachii muscle -Origin: long head – supraglenoid tubercle, short head coracoid process -Insertion: radial tuberosity, aponeurosis connects to the forearm fascia. -Action: flexion and supination of the forearm at the elbow joint, flexion of the arm. -Innervation: musculocutaneous nerve -Brachialis muscle -Origin: distal half of anterior humerus. -Insertion: ulnar tuberosity -Action: flexion of the forearm -Innervation: musculocutaneous nerve

    • ###Biceps Tendinitis -Caused by repetitive microtrauma, especially in throwing sports. -Intertubercular groove irritation -Tenderness and crepitus are symptoms. -Dislocation of the long head of biceps tendon can result from traumatic epiphysis separation in young people, presenting with popping or catching sensations during arm rotation.

    • ###Rupture of the tendon of long head of biceps -Usually torn from the attachment to the supraglenoid tubercle. -Detached muscle belly forms a ball near the center of the distal part of the anterior aspect. -Associated with Popeye deformity in weightlifters or after prolonged tendinitis.

    • ###Posterior Compartment Muscles -Generally extensors of the arm and forearm.

    • ###Triceps Muscle -Long head: infraglenoid tubercle -Lateral head: posterior humerus superior part over the radial groove -Medial head: posterior humerus inferior part below the radial nerve groove. -Insertion: olecranon posterior surface -Action: extension of the arm at the shoulder, extension of the forearm at the elbow joint -Innervation: radial nerve

    • ###Anconeus Muscle -Origin: lateral epicondyle of humerus -Insertion: Posterior surface of ulna and olecranon -Action: extension of the elbow -Innervation: radial nerve

    • ###Arteries and nerves of the arm -Anterior compartment contains flexor muscles (brachial artery, brachial vein, median nerve, medial cutaneous nerve). -Lateral bicipital groove contains musculocutaneous nerve -Posterior compartment contains extensor muscles (radial nerve, deep brachial artery). -Muscles are separated by two intermuscular septums. -Brachial artery branches to form deep brachial artery, middle collateral artery, radial collateral artery, superior ulnar collateral artery, inferior ulnar collateral artery, radial artery and ulnar artery

    • ###To stop bleeding from the brachial artery The best place to compress the brachial artery is medial to the humerus near the middle of the arm

    • thanks to anastomosis around the elbow, the brachial artery can be clamped distal to the origin of the deep brachial artery, which does not cause any significant tissue damage.

    • Ulnar and radial arteries will still receive enough blood due to the anastomosis around the elbow.

    • ###Veins of the Arm -Brachial veins are venae comitantes of the brachial artery, deep veins. -Superficial veins are extensions from veins of the hands. -Basilic vein runs on the medial surface of the arm. -Cephalic vein runs on the lateral surface of the arm.

    • ###Venipuncture in cubital fossa -Common site for sampling and transfusion. -Median cubital vein is commonly selected. -Used for introduction of cardiac catheters, blood sampling of great vessels

    • ###Deep Tendon Reflexes -Muscle stretch reflexes depend on: -Intact efferent (sensory) nerve fibers -Normal functional synapse in spinal cord -Intact efferent (motor) nerve fibers -Normal neuromuscular junctions on tapped muscle -Normal muscle fiber function (contraction) -Reflexes involve several spinal cord segments. If there is a pathology at the tested level, the reflex may be weak or absent. -Reflexes, for the arm, are Biceps brachii reflex (C5 and C6), Triceps brachii reflex (C7 and C8)

    • ###Forearm Muscles -###Anterior Compartment -Pronator teres -Flexor carpi radialis -Palmaris longus -Flexor digitorum superficialis -Flexor carpi ulnaris

      -###Deep Flexors -Flexor digitorum profundus -Flexor pollicis longus -Pronator quadratus

      -###Lateral Compartment -Brachioradialis -Extensor carpi radialis longus -Extensor carpi radialis brevis

      -###Posterior Compartment -Extensor digitorum -Extensor digiti minimi -Extensor carpi ulnaris -Supinator -Abductor pollicis longus -Extensor pollicis brevis -Extensor pollicis longus -Extensor indicis

    • ###Arteries of the forearm -Radial artery branches -Radial recurrent artery, palmar carpal branch, superficial palmar branch, dorsal carpal branch, dorsal metacarpal arteries, dorsal digital arteries, princeps pollicis artery, radialis indicis artery, and deep palmar arch

      -Ulnar artery branches -Ulnar recurrent artery, common interosseus artery, posterior interosseus artery, recurrent interosseus artery, anterior interosseus artery, dorsal carpal branch, superficial palmar arch, common palmar digital arteries, and proper palmar digital arteries

    • ###Arteries of the Hand -###Lacerations of palmar arches -Bleeding is typically profuse when lacerated, it is not sufficient to ligate one only forearm artery. -Better option is to compress brachial artery

    • ###Ischaemia of the digits -Intermittent attacks of cyanosis, often accompanied by paresthesia and pain -Brought on by cold and emotional stimuli -Idiopathic or primary, it's called Raynaud syndrome.

    • ###Venous supply of the upper limb: superficial veins -Dorsal venous network of the hand -Superficial palmer venous arch -Cephalic region -Basilic region -Median cubital veins -Median antebrachial vein -Median cephalic vein -Median basilic vein

    • ###Lymph Vessels of the upper limb -Dorsomedial arm territory, dorsolateral arm territory, middle arm territory, radial bundle territory, ulnar group of lymphatics, radial group of lymphatics, dorsal descending lymphatics, and cubital lymph nodes

    • ###Skin Innervation of the upper limb -Posterior cutaneous nerve of the arm -Posterior cutaneous nerve of the forearm -Lateral cutaneous nerve of the arm -Lateral cutaneous nerve of the forearm -Medial cutaneous nerve of the arm -Medial cutaneous nerve of the forearm -Hand - Dorsal surface

    Hand

    • ###Dupuytren Contracure -Disease of the palmar fascia and aponeurosis. -Fibrous tissue degenerates over time. -Pulls the 4th and 5th fingers in the hand into partial flexion at the metacarpophalangeal and proximal interphalangeal joints. -Occurs primarily in men over 50.

    • ###Hand Infections -Palmar fascia is thick, so swelling is often on the dorsum of the hand where fascia is thinner. -Pus accumulates according to the area of infection.

    • ###Tenosynovitis -Infection in digital synovial sheaths. -Causes digit swelling and restricted movement, typically limited to one digit.

    Back

    • ###Extrinsic Muscles -Trapezius muscle -Origin: superior nuchal line (descending), spinous processes C7-T12 -Insertion: clavicle, acromion, spine of scapula -Action: elevates and depresses the shoulder, rotates the glenoid cavity. -Innervation: Accessory nerve (spinal part), spinal nerves C3, C4 cervical plexus. -Latissimus dorsi muscle -Origin: spinous processes T6-T12, thoracolumbar fascia, iliac crest, ribs 9-12 -Insertion: intertubercular groove of humerus -Action: extends, adducts, rotates medially, raises body toward arms -Innervation: Thoracodorsal nerve (C6-C7, C8) -Serratus posterior superior muscle -Origin: C6, C7, T1, T2 -Insertion: posterior parts of ribs 2-5 -Action: elevates the ribs (inspiration muscle) -Innervation: 2nd to 5th intercostal nerves -Serratus posterior inferior muscle -Origin: T11,T12,L1,L2 -Insertion: posterior parts of ribs 9-12 -Action: depresses the ribs (expiration muscle) -Innervation: 9th to 11th intercostals and subcostal nerve

    • ###Intrinsic Muscles -Splenius muscles -Origin: nuchal ligament and spinous processes C7-T6 -Insertion: mastoid process and superior nuchal line of the occipital bone, and transverse processes of C1-C3, C4 vertebral -Action: flexes neck, rotates head, extends head and neck -Erector Spinae muscles -Iliocostalis, Longissimus, and Spinalis MUSCLES -Origin: posterior part of iliac crest, sacral and lumbar vertebrae, supraspinous ligament -Insertion: angles of ribs above the cranium -Action: extend cervical and head, flex laterally neck -Multifidi, Rotatores, and Levator Costalis, Intertranversarii muscles -Origin: transverse processes C4-T12 -Insertion: spinous processes of superior vertebrae -Action: Extension, rotation, stabilization of the vertebral column

    • ###Suboccipital Muscles -Rectus capitis posterior major -Origin: Posterior tubercle of axis -Insertion: Inferior nuchal line -Rectus capitis posterior minor -Origin: spinous process of atlas (C1) -Insertion: Inferior nuchal line -Obliquus superior -Origin: transverse process of atlas (C1) -Insertion: inferior nuchal line -Obliquus inferior -Origin: spinous process of axis (C2) -Insertion: transverse process of atlas (C1) -Action: Extension of atlantoaxial joint (working together), flexion and rotation of the joint to the same side. Stabilisation of the vertebral column. -Innervation: Posterior branches of spinal nerves. C1= suboccipital nerve, C2 = lesser occipital nerve

    Injuries of the fingers

    • ###Coach's Finger -Dorsal dislocation of the joint -Dislocation or avulsion fracture of the middle phalanx

    • ###Swan Neck Deformity -Dorsal dislocation of the joint and disruption of palmar volar and collateral ligaments

    • ###Mallet Finger -Torn extensor digitorum tendon on the distal phalanx due to direct blow when finger is extended.

    • ###Boxer Fracture -Fracture of the metacarpal shaft at the distal end (often seen in a boxer)

    • ###Game Keeper's Thumb -Rupture of the medial collateral ligament with an avulsion fracture.

    Hand

    • ###Dupuytren's Contracture -Disease of the palmar fascia -Fibrous tissue degenerates over time. -Pulls the 4th and 5th fingers in the hand into partial flexion at the metacarpophalangeal and proximal interphalangeal joints. -Occurs primarily in men over 50.

    • ###Hand Infections -Palmar fascia is thick, so swelling is often on the dorsum of the hand where fascia is thinner. -Pus accumulates according to the area of infection.

    • ###Tenosynovitis -Infection in digital synovial sheaths. -Causes digit swelling and restricted movement, typically limited to one digit.

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    Upper Limb Clinical Anatomy PDF

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