Snell - Orthopedic Quiz Chapter 3: Upper Limb

Questions and Answers

Which structure does the ulna not articulate with at its distal end?

Head of the radius

Wrist joint (correct)

Capitulum of the humerus

Ulnar notch of the radius

In which fracture does the ulnar shaft bow forward while the radial head dislocates?

Monteggia's fracture (correct)

Galeazzi's fracture

Fractures of the head of the radius

Fracture of the olecranon process

What occurs with the ulna during a typical shaft fracture?

Moves laterally

Angles anteriorly

Angulates posteriorly (correct)

Fractures without displacement

What anatomical relationship must be restored to regain normal forearm movements after a fracture?

Interosseous membrane relationship Signup and view all the answers

Which muscle is primarily responsible for pronation of the distal fragment of the radius?

Pronator quadratus Signup and view all the answers

Which injury primarily occurs due to a fall on an outstretched hand in children?

Fractures of the head of the radius Signup and view all the answers

What is one consequence of an avulsion fracture of the olecranon process?

Displacement by the pull of the triceps muscle Signup and view all the answers

What anatomical feature prevents the distal end of the ulna from participating in the wrist joint?

Articular disc Signup and view all the answers

Which structure is primarily affected by a lesser tuberosity fracture?

Subscapularis tendon Signup and view all the answers

What can be damaged in association with a surgical neck fracture of the humerus?

Axillary nerve Signup and view all the answers

What occurs when a humeral shaft fracture is proximal to the deltoid insertion?

Proximal fragment is adducted by several muscles Signup and view all the answers

Which of the following describes a supracondylar fracture?

Results from falling on an outstretched hand Signup and view all the answers

What defines the location of the radial nerve in relation to a humeral shaft fracture?

In the spiral groove on the posterior surface Signup and view all the answers

Which feature characterizes the ulna's proximal end?

Hook-shaped with olecranon Signup and view all the answers

What anatomical feature does the trochlear notch of the ulna form?

Crescent-shaped notch with olecranon and coronoid process Signup and view all the answers

Which nerve is most likely to be injured with supracondylar fractures in children?

Median nerve Signup and view all the answers

What complication can arise from a fracture at the distal end of the humerus?

Volkmann's ischemic contracture Signup and view all the answers

Which muscle is responsible for the action of extending the forearm at the elbow?

Triceps brachii Signup and view all the answers

What causes the humeral head fracture during shoulder dislocation?

Jam of the glenoid labrum into the defect Signup and view all the answers

Which muscles are associated with greater tuberosity fractures?

Supraspinatus, teres minor, and infraspinatus Signup and view all the answers

What is a potential outcome of a greater tuberosity fracture in conjunction with a shoulder dislocation?

Difficulty in shoulder joint reduction Signup and view all the answers

What is the most common cause of a greater tuberosity fracture?

Direct trauma to the shoulder Signup and view all the answers

What complication can arise from a lesser tuberosity fracture?

Loss of function in the subscapularis tendon Signup and view all the answers

Which condition is often associated with posterior dislocation of the shoulder joint?

Lesser tuberosity fracture occasionally Signup and view all the answers

What surgical procedure may be necessary in cases of greater tuberosity fractures after shoulder dislocation?

Open reduction to reattach the rotator cuff Signup and view all the answers

Which anatomical structure is involved in a greater tuberosity fracture due to muscle contraction?

Supraspinatus tendon Signup and view all the answers

What primarily splints the fragments in scapular fractures?

The muscles on the anterior and posterior surfaces Signup and view all the answers

Which scapular condition is caused by paralysis of the trapezius muscle?

Dropped shoulder Signup and view all the answers

Which structure defines the groove for the radial nerve on the humerus?

Radial groove Signup and view all the answers

What is the consequence of a fracture at the surgical neck of the humerus?

Injury to the axillary nerve Signup and view all the answers

What is the primary articulating surface of the humerus at the shoulder joint?

Glenoid cavity of the scapula Signup and view all the answers

In which part of the humerus is the deltoid tuberosity located?

Body or shaft Signup and view all the answers

Which of the following is true regarding the anatomical neck of the humerus?

It is a common site for fractures in the elderly. Signup and view all the answers

What is the primary function of the serratus anterior muscle related to scapular movement?

Preventing winging of the scapula Signup and view all the answers

What structure separates the greater and lesser tubercles of the humerus?

Intertubercular (bicipital) groove Signup and view all the answers

What is the primary cause of winged scapula?

Imbalance due to muscular paralysis Signup and view all the answers

Which structure is located on the distal, posterior end of the humerus and is involved in articulation with the ulna?

Olecranon fossa Signup and view all the answers

The intertubercular groove houses the tendon of which muscle?

Biceps brachii Signup and view all the answers

Which muscle is NOT attached to the humerus?

Flexor carpi radialis Signup and view all the answers

What is the primary function of the coronoid process of the ulna?

Fits into the coronoid fossa of the humerus Signup and view all the answers

Which structure is found on the medial side of the distal humerus?

Medial epicondyle Signup and view all the answers

Which muscle is responsible for flexion at the elbow joint?

Brachialis Signup and view all the answers

What type of joint is formed by the trochlear notch of the ulna and the trochlea of the humerus?

Hinge joint Signup and view all the answers

Which depression of the humerus is located on the distal, anterior side?

Coronoid fossa Signup and view all the answers

What is the primary function of the clavicle in relation to the upper limb?

To transmit forces from the upper limb to the trunk Signup and view all the answers

Which structure articulates with the lateral end of the clavicle?

The acromion process of the scapula Signup and view all the answers

Which feature of the scapula is located on the superior border?

Scapular notch Signup and view all the answers

What is the significance of the conoid tubercle on the clavicle?

It is the attachment site for the conoid ligament Signup and view all the answers

What is the most common cause of a clavicle fracture?

Falls on the shoulder or outstretched hand Signup and view all the answers

Which muscle is primarily responsible for tilting the medial end of the clavicle upward after a fracture?

Sternocleidomastoid Signup and view all the answers

Which nerves may be involved in callus formation after a clavicular fracture?

Supraclavicular nerves Signup and view all the answers

What anatomical structure is primarily responsible for deepening the glenoid cavity?

Glenoid labrum Signup and view all the answers

In the context of the suprascapular artery and nerve, what is the significance of the superior transverse scapular ligament?

It prevents nerve compression from the clavicle Signup and view all the answers

Which feature is associated with the lateral angle of the scapula?

Glenoid cavity Signup and view all the answers

Which of the following borders of the scapula is the longest?

Medial (vertebral) border Signup and view all the answers

Where can the inferior angle of the scapula be palpated?

At the level of the seventh rib Signup and view all the answers

What complication can arise from the narrowing of the interval between the clavicle and the first rib?

Compression of the brachial plexus and blood vessels Signup and view all the answers

Which of the following structures connects the supraspinous fossa with the infraspinous fossa?

Spinoglenoid notch Signup and view all the answers

Which area of the scapula is the larger region inferior to the spine?

Infraspinous fossa Signup and view all the answers

What is the primary function of the acromion?

Articulate with the clavicle Signup and view all the answers

Which surface of the scapula lies against the rib cage?

Costal surface Signup and view all the answers

Which part of the scapula is involved in forming the glenoid cavity?

Head of the scapula Signup and view all the answers

What connects to the coracoid process of the scapula?

Biceps muscle Signup and view all the answers

Which muscular attachment is related to the dorsal surface of the scapula?

Infraspinatus Signup and view all the answers

Which of the following bones primarily defines the arm in the upper limb?

Humerus Signup and view all the answers

What is the significance of the opposable action of the thumb?

It enables the thumb to grasp and manipulate objects. Signup and view all the answers

Which structure connects the upper limb to the thorax?

Clavicle Signup and view all the answers

Which part of the upper limb is compartmentalized into working units with distinct nerve and blood supply?

Arm, forearm, and hand Signup and view all the answers

What is the role of the carpal bones in the upper limb?

Form the wrist Signup and view all the answers

Which type of injury is most commonly associated with the upper limb?

Fractures Signup and view all the answers

Which bone articulates with the sternal extremity of the clavicle?

Sternum Signup and view all the answers

What role does the subcutaneous nature of the clavicle play?

It makes the clavicle easily palpable. Signup and view all the answers

Which of the following is NOT a part of the upper limb's bones?

Femur Signup and view all the answers

Which nerve is primarily responsible for innervating the muscles of the posterior compartment of the upper limb?

Radial nerve Signup and view all the answers

What is the primary role of the rotator cuff muscles?

Stabilization of the shoulder joint Signup and view all the answers

Which structure is NOT contained within the carpal tunnel?

Flexor carpi radialis tendon Signup and view all the answers

Which anatomical feature forms the boundaries of the cubital fossa?

Brachioradialis muscle, pronator teres muscle, and the line connecting the medial and lateral epicondyles of the humerus Signup and view all the answers

What is the major function of the axillary artery in the upper limb?

Supplying blood to the arm, axilla, and chest wall Signup and view all the answers

Which muscle group is most responsible for the action of supination of the forearm?

Biceps brachii and supinator muscles Signup and view all the answers

Which part of the brachial plexus gives rise to the musculocutaneous nerve?

Lateral cord Signup and view all the answers

What is the anatomical snuffbox bordered by?

Extensor pollicis brevis and extensor pollicis longus Signup and view all the answers

Which of the following describes a common consequence of lesions to the ulnar nerve?

Claw hand deformity Signup and view all the answers

What is the primary anatomical feature involved in the formation of the palmar arterial arches?

Radial and ulnar arteries Signup and view all the answers

What is most likely the cause of the loss of the shoulder curvature in this patient?

Displacement of the head of the humerus Signup and view all the answers

Which nerve injury is primarily responsible for the sensory deficits observed in the posterior arm and hand?

Radial nerve Signup and view all the answers

Which anatomical process is likely affected by the displacement of the humerus in a subcoracoid dislocation?

Rotational stability of the shoulder joint Signup and view all the answers

What is the result of damage to the axillary nerve in this case?

Loss of sensation over the lateral shoulder Signup and view all the answers

In relation to the axillary nerve, what anatomical feature is crucial for a clinician to understand?

Its position relative to the humeral head Signup and view all the answers

What muscle is primarily responsible for stabilizing the shoulder joint during a dislocation?

Subscapularis Signup and view all the answers

Which symptom is most characteristic of an injury to the radial nerve?

Loss of wrist extension Signup and view all the answers

What type of dislocation is indicated in this patient's diagnosis?

Inferior dislocation Signup and view all the answers

Study Notes

Proximal End of Humerus Fracture

Humeral head fractures can occur with anterior and posterior shoulder dislocations.
The glenoid labrum can jam into fractures, complicating shoulder joint reduction.

Greater Tuberosity Fracture

Caused by direct trauma or dislocation; may be avulsed by supraspinatus muscle contractions.
Key attachments to rotator cuff muscles (supraspinatus, teres minor, infraspinatus).
Severe rotator cuff tearing can cause posterior displacement after shoulder reduction, necessitating surgery.

Lesser Tuberosity Fracture

May occur with posterior shoulder dislocation.
The fractured bone fragment serves as the insertion for the subscapularis tendon.

Surgical Neck Fracture

Located just below the lesser tuberosity; susceptible to direct blows or falls.
Potential damage to the axillary nerve and circumflex humeral vessels.

Shaft of Humerus Fracture

Common fracture site; displacement is influenced by muscle attachments.
Proximal fractures lead to adduction by pectoralis major, latissimus dorsi, and teres major.
Distal fractures result in abduction by the deltoid, while biceps and triceps pull the distal fragment proximally.
Radial nerve injury is possible due to its proximity along the humerus.

Distal End of Humerus Fracture

Supracondylar fractures are frequent in children; injuries usually result from falls.
May damage median, radial, or ulnar nerves, with function typically restored post-reduction.
Risks include brachial artery damage and potential Volkmann's ischemic contracture.

Ulna and Radius

The ulna lies medially in the forearm, articulating with the humerus and radius.
The olecranon serves as the triceps insertion, forming the elbow's "point."
Radius fractures can occur from falls and can be associated with significant displacement.

Ulnar and Radial Fractures

Radius head fractures typically arise from falls on an outstretched hand, causing splintering.
Neck fractures more common in children, similarly from falls.
Shaft fractures may affect radius and ulna together or separately, involving muscle pull dynamics.

Monteggia and Galeazzi Fractures

Monteggia fracture is characterized by ulna shaft fracture with radial dislocation.
Galeazzi fracture features radial neck fracture with distal ulna dislocation.

Olecranon Process Fractures

Result from falls on a flexed elbow or direct trauma.
Fractures can displace due to triceps muscle traction on the bony fragment.

Scapular Fractures

Often linked to severe trauma (e.g., vehicle accidents) and commonly co-occurring with rib fractures.
Scapular fractures often require minimal treatment due to muscle support.

Dropped Shoulder and Winged Scapula

Dropped shoulder results from trapezius paralysis; winged scapula from serratus anterior paralysis.
These conditions can be identified through physical examination.

Important Features of the Humerus

Key anatomical landmarks include the anatomical neck, surgical neck, greater and lesser tubercles.
Each region correlates with specific muscular attachments and articulations.

Clavicle Overview

The clavicle connects the upper limb to the axial skeleton and is prone to fractures due to its exposed position.
Most frequently fractured bone, commonly resulting from falls on the shoulder.

Mechanism of Clavicle Fracture

Fractures typically occur at the junction of the middle and outer thirds, leading to characteristic lateral displacement.
Proximity to supraclavicular nerves might cause post-fracture pain complications.### Clavicular Compression and Upper Limb Anatomy
Clavicular compression occurs between the clavicle and first rib, affecting the brachial plexus, subclavian artery, and subclavian vein.
Understanding upper limb anatomy is essential for diagnosing injuries, pain, motor deficits, and congenital issues.

Learning Objectives in Upper Limb Anatomy

Identify major bones: clavicle, scapula, humerus, radius, ulna, carpal, metacarpal, and phalangeal bones.
Understand anatomical regions: shoulder, arm, forearm, wrist, and hand.
Explore female breast anatomy, lymphatic drainage, and implications of mastectomy.
Define axilla and cubital fossa boundaries and contents.
Explain the development of the upper limb and components of the shoulder complex.
Identify rotator cuff muscles and significant anatomical spaces (quadrangular, triangular).
Understand osseofascial compartments, including muscle innervation and function.
Describe movements of the wrist and hand, carpal tunnel, and synovial sheaths.
Outline the brachial plexus, peripheral nerves, blood flow, and lymphatic drainage patterns.

Overview of Upper Limb

The upper limb functions as a multijointed lever, primarily for hand manipulation.
The hand's unique structure allows it to grasp objects with precision, largely due to thumb opposition.
Organized into defined sections: shoulder region, arm, forearm, wrist, and hand, each with specific muscle compartments.

Osteology

Clavicle: S-shaped, subcutaneous, connects arm to thorax, first bone to ossify.
Scapula: Provides attachment for shoulder muscles, plays a key role in arm movement.
Humerus: Largest bone in the arm, connects forearm bone to shoulder.
Radius and Ulna: Form forearm bones with distinct roles in movement and stability.
Carpal bones: Form the wrist, provide flexibility and support.
Metacarpals and Phalanges: Form the structure of the hand and fingers.

Clinical Case Example

A 64-year-old woman presented with left shoulder pain and sensory deficits after a fall.
Diagnosis: Subcoracoid dislocation of the shoulder, impacting the axillary and radial nerves.
Symptoms: Loss of shoulder curvature due to humeral displacement, resulting in significant skin sensation loss along specific areas.

Anatomical and Physiological Relationships

Shoulder joint anatomy knowledge is crucial for accurate diagnosis of nerve injuries.
The distribution of the axillary and radial nerves is vital for understanding upper limb function.

Chapter Outline Components

Sections include Osteology, Upper Limb Regions, Muscles, Nerves, Vasculature, Lymphatics, and Joints.
Highlights include the specific roles of cranial and spinal nerves and the significance of vascular supply and lymphatic drainage.

Summary of Movements and Functions

Pronation and supination involve coordinated muscle action for effective arm usage.
The carpal tunnel's arrangement is clinically significant, particularly in carpal tunnel syndrome.

Clinical Relevance

Knowledge of anatomical relationships aids in injury management and therapeutic strategies to preserve upper limb function.
Attention to wrist and hand injuries is crucial due to the thumb's role in grasping and fine motor skills.

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Description

Test your knowledge on upper limb fractures, focusing on lesser tuberosity and surgical neck injuries. Understand the implications of these fractures on shoulder joint function and the role of the rotator cuff. Enhance your orthopedic expertise with this quiz!