Anatomy: Upper Limb
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Questions and Answers

Which muscle is responsible for opposition of the thumb?

  • Flexor carpi radialis
  • First palmar interosseous
  • Opponens pollicis (correct)
  • Adductor pollicis

    • What is a common complication of an untreated fracture of the scaphoid bone?

  • Swelling of the forearm
  • Numbness of the thumb
  • Temporary weakness of the wrist
  • Permanent weakness and pain of the wrist (correct)

    • Which of the following muscles is NOT attached to the anterior surface of the bones of the hand?

  • Extensor carpi ulnaris (correct)
  • Flexor digitorum superficialis
  • Flexor carpi radialis
  • Adductor pollicis

    • What is the name of the bone that may dislocate in young adults who fall on an outstretched hand?

    <p>Lunate bone</p> Signup and view all the answers

    Which muscle is responsible for flexion of the wrist?

    <p>Flexor carpi radialis</p> Signup and view all the answers

    What is a common associated injury with fracture of the scaphoid bone?

    <p>Injury to the median nerve</p> Signup and view all the answers

    Which of the following muscles is attached to the posterior surface of the bones of the hand?

    <p>First dorsal interosseous</p> Signup and view all the answers

    What is a common consequence of osteoarthritis in the wrist joint?

    <p>Pain and limited mobility of the wrist</p> Signup and view all the answers

    Which process is located on the ulna?

    <p>Coronoid process</p> Signup and view all the answers

    Which muscle is attached to the medial epicondyle of the humerus?

    <p>Pronator teres</p> Signup and view all the answers

    What is the name of the membrane that separates the flexor and extensor compartments of the forearm?

    <p>Interosseous membrane</p> Signup and view all the answers

    Which muscle is attached to the bicipital tuberosity?

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

    What is the name of the artery that passes through the aperture in the interosseous membrane?

    <p>Anterior interosseous artery</p> Signup and view all the answers

    Which muscle is attached to the dorsal tubercle of the radius?

    <p>Extensor pollicis longus</p> Signup and view all the answers

    What is the name of the ligamentous structure that connects the medial epicondyle of the humerus to the medial aspect of the ulna?

    <p>Oblique cord</p> Signup and view all the answers

    Which muscle is attached to the coronoid process of the ulna?

    <p>Pronator teres</p> Signup and view all the answers

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

    <p>It forms a hinge joint with the humerus</p> Signup and view all the answers

    What is the purpose of the olecranon fossa?

    <p>It holds the apex of the olecranon process of the ulna when the elbow is extended</p> Signup and view all the answers

    What is the significance of the medial epicondyle?

    <p>It is susceptible to injury, especially to the ulnar nerve</p> Signup and view all the answers

    What is the characteristic response to stimulation of the ulnar nerve?

    <p>Tingling sensations in the medial border of the hand and fifth digit</p> Signup and view all the answers

    What is the function of the radial fossa?

    <p>It receives the head of the radius when the elbow is fully flexed</p> Signup and view all the answers

    What is the purpose of the trochlea?

    <p>It is the site of the humeroulnar joint</p> Signup and view all the answers

    What is the significance of the capitulum?

    <p>It articulates with the head of the radius</p> Signup and view all the answers

    What is the relationship between the ulnar nerve and the medial epicondyle?

    <p>The ulnar nerve crosses the posterior surface of the medial epicondyle</p> Signup and view all the answers

    What is the direction of displacement of the bony fragments on the site of the fracture line?

    <p>In the direction of the responsible muscle pull</p> Signup and view all the answers

    Which muscle inserts into the lesser tuberosity fracture site?

    <p>Subscapularis</p> Signup and view all the answers

    What type of fracture can occur when a child falls on the outstretched hand with the elbow partially flexed?

    <p>Supracondylar fracture</p> Signup and view all the answers

    Which nerve can be damaged where it lies in the spiral groove on the posterior surface of the humerus?

    <p>Radial nerve</p> Signup and view all the answers

    What is the location of the surgical neck of the humerus?

    <p>Immediately distal to the lesser tuberosity</p> Signup and view all the answers

    What can be damaged or pressured at the time of a supracondylar fracture?

    <p>Brachial artery</p> Signup and view all the answers

    Which muscles pull the distal fragment proximally in a distal fracture of the humerus?

    <p>Biceps and triceps</p> Signup and view all the answers

    What is the relationship between the axillary nerve and circumflex humeral blood vessels and the surgical neck of the humerus?

    <p>They have a close relationship with the surgical neck</p> Signup and view all the answers

    What is the primary action of the pronator quadratus muscle on the distal fragment of the radius?

    <p>Medially deviates and pronates</p> Signup and view all the answers

    What is the common mechanism of injury for fractures of the head of the radius?

    <p>Falls on the outstretched hand</p> Signup and view all the answers

    What is the effect of the brachioradialis and extensor carpi radialis longus and brevis muscles on the forearm?

    <p>Shortens and angulates the forearm</p> Signup and view all the answers

    In what direction does the ulna angulate in fractures of the ulna?

    <p>Posteriorly</p> Signup and view all the answers

    What is the common association with fractures of one forearm bone?

    <p>Dislocation of the other bone</p> Signup and view all the answers

    What is the effect of the supinator and biceps brachii muscles on the proximal fragment of the radius?

    <p>Supinates the proximal fragment</p> Signup and view all the answers

    What is the characteristic deformity of the forearm in Monteggia's fracture?

    <p>Bowing forward of the ulnar shaft</p> Signup and view all the answers

    What is the ligament that ruptures in Monteggia's fracture?

    <p>Anular ligament</p> Signup and view all the answers

    What is the term for the area where the breasts are situated?

    <p>Pectoral region</p> Signup and view all the answers

    What is the number of lobes present in each breast?

    <p>15 to 20</p> Signup and view all the answers

    What is the structure that surrounds the base of the nipple?

    <p>Areola</p> Signup and view all the answers

    What is the term for the dilated part of the main duct from each lobe just before its termination?

    <p>Ampulla</p> Signup and view all the answers

    What is the nerve that supplies the muscles in the pectoral region?

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

    What is the muscle that is located in the pectoral region and is responsible for movements of the upper limb?

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

    What is the artery that supplies the breast tissue?

    <p>Subscapular artery</p> Signup and view all the answers

    What is the fascia that surrounds the pectoralis major and minor muscles?

    <p>Clavipectoral fascia</p> Signup and view all the answers

    What is the direction of the milk ridge in the early embryo?

    <p>From the axilla obliquely to the inguinal region</p> Signup and view all the answers

    What happens to the milk ridge in humans?

    <p>It disappears except for a small part in the pectoral region</p> Signup and view all the answers

    How many solid cords grow into the mesenchyme from the depressed ectodermal thickening?

    <p>15 to 20</p> Signup and view all the answers

    What is the result of lack of development of the breast?

    <p>Micromastia</p> Signup and view all the answers

    What is the clinical significance of a retracted nipple?

    <p>It can cause difficulty in breastfeeding</p> Signup and view all the answers

    What is the relationship between the trapezius and latissimus dorsi muscles and the upper limb?

    <p>They are connected to the upper limb and function as part of it</p> Signup and view all the answers

    What is the name of the intermuscular space located immediately below the glenohumeral joint?

    <p>Quadrangular space</p> Signup and view all the answers

    Which muscle forms the anterior border of the quadrangular space?

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

    What is the significance of the quadrangular space in terms of neurovascular structures?

    <p>It allows passage of the axillary nerve and posterior circumflex humeral vessels</p> Signup and view all the answers

    What is the name of the artery that passes through the quadrangular space?

    <p>Posterior circumflex humeral artery</p> Signup and view all the answers

    Which muscle forms the medial border of the quadrangular space?

    <p>Long head of the triceps</p> Signup and view all the answers

    What is the location of the surgical neck of the humerus in relation to the quadrangular space?

    <p>Below the quadrangular space</p> Signup and view all the answers

    Which nerve emerges through the quadrangular space and is closely related to the shoulder joint?

    <p>Axillary nerve</p> Signup and view all the answers

    What is the name of the bony landmark that forms the lateral border of the quadrangular space?

    <p>Surgical neck of the humerus</p> Signup and view all the answers

    What is the primary function of having a sound knowledge of the arrangement of tendons, arteries, and nerves in the wrist region?

    <p>To understand the anatomy of the hand</p> Signup and view all the answers

    What is the significance of the wrist from a clinical standpoint?

    <p>It is a common site for injury</p> Signup and view all the answers

    What is the relationship between the wrist and the forearm?

    <p>The wrist is a complex of the eight small carpal bones that connect the forearm and hand</p> Signup and view all the answers

    What is the purpose of the Flexor and Extensor Retinacula?

    <p>To stabilize the wrist</p> Signup and view all the answers

    What is the significance of the palmaris longus muscle?

    <p>It is a site for palpation of the radial artery</p> Signup and view all the answers

    Which muscle forms the anterior wall of the axilla?

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

    What is the main function of the axillary artery and its branches?

    <p>To supply blood to the upper limb</p> Signup and view all the answers

    What is the base of the axilla formed by?

    <p>The skin stretching between the anterior and posterior walls</p> Signup and view all the answers

    What structures are contained within the axilla?

    <p>Axillary artery and its branches, axillary vein and its tributaries, and lymph vessels and lymph nodes</p> Signup and view all the answers

    What is the shape of the axillary space?

    <p>Pyramid-shaped</p> Signup and view all the answers

    Which of the following muscles does NOT form the walls of the axilla?

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

    What is the region drained by the axillary vein and its tributaries?

    <p>The upper limb, the breast, and the skin of the trunk as far down as the level of the umbilicus</p> Signup and view all the answers

    What is the significance of the axilla?

    <p>It forms an important passage for nerves, blood vessels, and lymph channels</p> Signup and view all the answers

    What is the primary site of flexure creases on the skin?

    <p>At the sites of skin movement</p> Signup and view all the answers

    What is the characteristic progression of the condition that starts near the root of the ring finger?

    <p>It draws the finger into the palm, flexing it at the metacarpophalangeal joint</p> Signup and view all the answers

    What is the significance of the fascial spaces of the palm?

    <p>They are potential spaces that can limit the spread of infection</p> Signup and view all the answers

    What is the result of the pull on the fibrous sheaths of the fingers in long-standing cases?

    <p>Flexion of the proximal interphalangeal joints</p> Signup and view all the answers

    What is the purpose of the deep fascia in the wrist and palm?

    <p>To form the flexor retinaculum</p> Signup and view all the answers

    What is the origin of the fibrous septum that passes backward from the medial border of the triangular palmar aponeurosis?

    <p>The distal border of the flexor retinaculum</p> Signup and view all the answers

    What is the function of the pincer-like action of the thumb?

    <p>To enable us to grasp objects between the tips of the thumb and index finger</p> Signup and view all the answers

    What is the shape of the palmar aponeurosis?

    <p>Triangular</p> Signup and view all the answers

    What is the characteristic of the skin of the palm of the hand?

    <p>It is thick and hairless</p> Signup and view all the answers

    What is the direction of the second fibrous septum from the apex of the palmar aponeurosis?

    <p>Obliquely backward</p> Signup and view all the answers

    What is the consequence of Dupuytren contracture?

    <p>It causes a localized thickening and contracture of the palmar aponeurosis</p> Signup and view all the answers

    What is the treatment for the condition that involves the contraction of fibrous bands?

    <p>Surgical division of the fibrous bands followed by physiotherapy</p> Signup and view all the answers

    What is the significance of the radial artery in the anatomical snuffbox?

    <p>It is a site for palpation of the radial artery</p> Signup and view all the answers

    What is the effect of the pressure of the fingers against the palm on the distal interphalangeal joints?

    <p>Extension</p> Signup and view all the answers

    What is the boundary of the fascial compartment containing the three hypothenar muscles?

    <p>The medial border of the triangular palmar aponeurosis</p> Signup and view all the answers

    What is the orientation of the fingers in the hand?

    <p>The thumb is digit 1, and the other numbers follow sequentially from medial to lateral</p> Signup and view all the answers

    Which muscle is responsible for opposition of the thumb in the deep palmar arch?

    <p>Opponens pollicis</p> Signup and view all the answers

    Which muscle is attached to the medial epicondyle of the humerus in the deep palmar arch?

    <p>Abductor pollicis longus</p> Signup and view all the answers

    Which muscle is responsible for flexion of the wrist in the deep palmar arch?

    <p>Flexor carpi radialis</p> Signup and view all the answers

    What is the name of the ligamentous structure that connects the medial epicondyle of the humerus to the medial aspect of the ulna?

    <p>Ulnar collateral ligament</p> Signup and view all the answers

    Which muscle is attached to the coronoid process of the ulna in the deep palmar arch?

    <p>Flexor digitorum profundus</p> Signup and view all the answers

    What is the function of the radial fossa?

    <p>To accommodate the radial head</p> Signup and view all the answers

    What is the primary consequence of a delay in treating forearm compartment syndrome?

    <p>Irreversible damage to the muscles</p> Signup and view all the answers

    Which of the following is a common cause of forearm compartment syndrome?

    <p>Soft tissue injury</p> Signup and view all the answers

    What is the primary purpose of incising the deep fascia in forearm compartment syndrome?

    <p>To decompress the affected compartment</p> Signup and view all the answers

    What is the significance of absent palmaris longus muscle?

    <p>It is a relatively weak muscle</p> Signup and view all the answers

    What is the primary characteristic of tennis elbow?

    <p>It is a condition that affects the elbow joint</p> Signup and view all the answers

    What is the primary mechanism of injury in forearm compartment syndrome?

    <p>Compression of the blood vessels</p> Signup and view all the answers

    What is the significance of the metacarpophalangeal joints and the wrist joint in forearm compartment syndrome?

    <p>They are mended</p> Signup and view all the answers

    What is the primary symptom of forearm compartment syndrome?

    <p>Pain disproportionate to the injury</p> Signup and view all the answers

    What is the consequence of neglecting an infection of the digital sheaths of the little finger and thumb?

    <p>Pus may burst through the proximal ends of the radial and ulnar bursae.</p> Signup and view all the answers

    What is the anatomical relationship between the digital sheath of the index finger and the thenar space?

    <p>The digital sheath of the index finger is related to the thenar space.</p> Signup and view all the answers

    What is the result of the pressure within the sheath rising due to the inflammatory process?

    <p>The blood supply to the tendons is compressed.</p> Signup and view all the answers

    What is the consequence of the distended sheath being stretched?

    <p>Any attempt to extend the finger is accompanied by extreme pain.</p> Signup and view all the answers

    What is the relationship between the digital sheath of the middle finger and the palmar fascial spaces?

    <p>The digital sheath of the middle finger is related to both the thenar and midpalmar spaces.</p> Signup and view all the answers

    What is the consequence of rupture of the digital sheath?

    <p>Rupture or severe scarring of the tendons may follow.</p> Signup and view all the answers

    What is the name of the fascial space in the forearm that is commonly referred to clinally as the space of Parma?

    <p>Tudal space</p> Signup and view all the answers

    What is the common route of infection of a digital sheath?

    <p>Introduction of bacteria through a small penetrating wound.</p> Signup and view all the answers

    What is the primary function of the flaxor carpi ulnaris muscle?

    <p>Flexion of the wrist</p> Signup and view all the answers

    Which nerve is responsible for the cutaneous sensation of the medial half of the hand?

    <p>Ulnar nerve</p> Signup and view all the answers

    What is the main branch of the ulnar artery that supplies the forearm?

    <p>Anterior interosseous artery</p> Signup and view all the answers

    Which muscle is responsible for opposition of the thumb and is innervated by the ulnar nerve?

    <p>Adductor pollicis</p> Signup and view all the answers

    What is the name of the ligament that connects the medial epicondyle of the humerus to the medial aspect of the ulna?

    <p>Ulnar collateral ligament</p> Signup and view all the answers

    Which muscle is responsible for flexion of the wrist and is innervated by the ulnar nerve?

    <p>Flexor carpi ulnaris</p> Signup and view all the answers

    What is the name of the nerve that supplies the muscles in the forearm?

    <p>Ulnar nerve</p> Signup and view all the answers

    Which muscle is responsible for flexion of the proximal phalanges of the fingers?

    <p>Flexor digitorum profundus</p> Signup and view all the answers

    What is the characteristic posture of a person with a brachial plexus injury involving the supraspinatus and deltoid?

    <p>waiter's tip</p> Signup and view all the answers

    What is the location of the roots, trunks, and divisions of the brachial plexus?

    <p>lower part of the posterior triangle of the neck</p> Signup and view all the answers

    The long thoracic nerve arises from the roots of which part of the nervous system?

    <p>Brachial plexus</p> Signup and view all the answers

    What is unusual about the long thoracic nerve's entry into its target muscle?

    <p>It enters the muscle on the superficial side of the belly</p> Signup and view all the answers

    What is the common cause of incomplete brachial plexus injuries?

    <p>traction or pressure</p> Signup and view all the answers

    What is the region affected by sensory loss in a lower brachial plexus injury?

    <p>lower half of the deltoid and down the lateral side of the forearm</p> Signup and view all the answers

    Which of the following dermatomes is situated on the middle finger?

    <p>C7</p> Signup and view all the answers

    What is the relationship between the nerve fibers from a particular segment of the spinal cord and the cutaneous nerves?

    <p>The nerve fibers pass to the skin in two or more cutaneous nerves</p> Signup and view all the answers

    What is the typical mechanism of injury for upper brachial plexus injuries?

    <p>excessive abduction of the arm</p> Signup and view all the answers

    Which of the following is a potential danger to the long thoracic nerve due to its anatomical position?

    <p>Trauma</p> Signup and view all the answers

    What is the muscle responsible for opposition of the radioulnar joint in a tendon reflex?

    <p>sternocostal part of the pectoralis major</p> Signup and view all the answers

    What is the characteristic posture of the forearm in a person with a brachial plexus injury involving the biceps?

    <p>pronation</p> Signup and view all the answers

    What is the location of the axilla in relation to the long thoracic nerve?

    <p>The axilla is located where the long thoracic nerve passes through</p> Signup and view all the answers

    What is the term for the injury involving the lower brachial plexus?

    <p>Klumpke's palsy</p> Signup and view all the answers

    What is the purpose of testing the integrity of the C3 to T1 segments of the spinal cord?

    <p>To diagnose a spinal cord injury</p> Signup and view all the answers

    What is the location of the dermatomes for the upper cervical segments C3 to 6?

    <p>Along the lateral margin of the upper limb</p> Signup and view all the answers

    What is the primary function of the muscle that inserts into the lesser tuberosity fracture site?

    <p>Extension of the elbow</p> Signup and view all the answers

    Which nerve is most likely to be damaged in a supracondylar fracture?

    <p>Median nerve</p> Signup and view all the answers

    What is the characteristic deformity of the forearm in Monteggia's fracture?

    <p>Posteromedial angulation of the ulna</p> Signup and view all the answers

    Which muscle is responsible for opposition of the thumb?

    <p>Adductor pollicis</p> Signup and view all the answers

    What is the term for the area where the breasts are situated?

    <p>Mammary region</p> Signup and view all the answers

    What is the common association with fractures of one forearm bone?

    <p>Fracture of the other forearm bone</p> Signup and view all the answers

    What is the effect of the supinator and biceps brachii muscles on the proximal fragment of the radius?

    <p>Supination of the forearm</p> Signup and view all the answers

    What is the ligament that ruptures in Monteggia's fracture?

    <p>Annular ligament</p> Signup and view all the answers

    Which nerve is unusual in that it is a motor nerve that enters its target muscle on the muscle's superficial side rather than the more typical deep side?

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

    Which dermatome is situated on the middle finger?

    <p>C7</p> Signup and view all the answers

    Which nerve fibers pass to the skin in two or more different cutaneous nerves?

    <p>From a particular segment of the spinal cord</p> Signup and view all the answers

    Which muscle is supplied by the long thoracic nerve?

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

    Where does the long thoracic nerve descend?

    <p>Superficial surface of the serratus anterior muscle</p> Signup and view all the answers

    What is the location of the long thoracic nerve in relation to the axillary vessels and brachial plexus?

    <p>Deep to the axillary vessels and brachial plexus</p> Signup and view all the answers

    Where do the nerve fibers from a particular segment of the spinal cord exit?

    <p>In a spinal nerve</p> Signup and view all the answers

    What is the significance of the long thoracic nerve's position?

    <p>It is in a position of greater potential danger to trauma</p> Signup and view all the answers

    What is the characteristic posture of a person with an upper brachial plexus injury?

    <p>WAITER'S TIP POSTURE</p> Signup and view all the answers

    What is the usual cause of incomplete brachial plexus injuries?

    <p>TRACTION OR PRESSURE</p> Signup and view all the answers

    What is the location of the roots, trunks, and divisions of the brachial plexus?

    <p>LOWER PART OF THE POSTERIOR TRIANGLE OF THE NECK</p> Signup and view all the answers

    What is the term for the lower lesions of the brachial plexus?

    <p>KLUMPKE'S PALSY</p> Signup and view all the answers

    What is the usual mechanism of injury for lower lesions of the brachial plexus?

    <p>FALL FROM A HEIGHT CLUTCHING AT AN OBJECT</p> Signup and view all the answers

    What is the muscle responsible for supination of the radioulnar joints?

    <p>BICEPS</p> Signup and view all the answers

    What is the effect of the loss of supraspinatus and deltoid muscles on the upper limb?

    <p>ADDUCTION OF THE UPPER LIMB</p> Signup and view all the answers

    What is the sensation lost in Klumpke's palsy?

    <p>SENSATION OVER THE LATERAL SIDE OF THE FOREARM</p> Signup and view all the answers

    What is the purpose of asking the patient to place their hand on their hip and push medially during an axillary lymph node examination?

    <p>To contract the pectoralis major muscle maximally</p> Signup and view all the answers

    Which lymph nodes drain into the thoracic duct on the left side?

    <p>Apical nodes</p> Signup and view all the answers

    What is the location of the posterior axillary lymph nodes?

    <p>On the posterior wall of the axilla</p> Signup and view all the answers

    What is the purpose of palpating the axillary lymph nodes?

    <p>To examine the breast as part of a clinical examination</p> Signup and view all the answers

    How are the lateral axillary lymph nodes palpated?

    <p>Against the medial side of the axillary vein</p> Signup and view all the answers

    What is the location of the central axillary lymph nodes?

    <p>In the center of the axilla between the pectoralis major and subscapularis muscles</p> Signup and view all the answers

    What is the purpose of asking the patient to relax their shoulder muscles during an axillary lymph node examination?

    <p>To palpate the apical nodes</p> Signup and view all the answers

    What is the location of the anterior axillary lymph nodes?

    <p>On the anterior surface of the pectoralis major muscle</p> Signup and view all the answers

    What is the main reason for the stability of the elbow joint?

    <p>The shape of the humerus and the olecranon process</p> Signup and view all the answers

    What is a common complication of elbow joint injuries?

    <p>Damage to the ulnar nerve</p> Signup and view all the answers

    What is the typical direction of displacement in posterior elbow dislocations?

    <p>Posteriorly</p> Signup and view all the answers

    What is the significance of the olecranon process in aspiration of joint fluid?

    <p>It provides a bony landmark for joint aspiration</p> Signup and view all the answers

    What is the relationship between the bony points of the elbow joint in extension?

    <p>They form a straight line</p> Signup and view all the answers

    What is the significance of the medial and lateral ligaments in the elbow joint?

    <p>They provide stability to the joint</p> Signup and view all the answers

    What is the characteristic of the elbow joint in flexion?

    <p>The bony points form an equilateral triangle</p> Signup and view all the answers

    What is the significance of the pulley-shaped trochlea of the humerus?

    <p>It contributes to the stability of the elbow joint</p> Signup and view all the answers

    What is the significance of knowing the anatomy of the basilic and cephalic veins?

    <p>To understand the implications of venipuncture and blood transfusion</p> Signup and view all the answers

    What is the direction of the axillary vein in relation to the basilic vein?

    <p>In direct line with the axillary vein</p> Signup and view all the answers

    Why is the abducted position of the shoulder joint important in central venous catheterization?

    <p>To reduce the risk of obstruction in the axillary vein</p> Signup and view all the answers

    What is the typical behavior of the cephalic vein in the deltopectoral triangle?

    <p>It divides into small branches</p> Signup and view all the answers

    What protects the brachial artery from the mistaken introduction of irritating drugs?

    <p>The aponeurosis</p> Signup and view all the answers

    What is the significance of the small vein that crosses in front of the clavicle?

    <p>It communicates with the external jugular vein</p> Signup and view all the answers

    Why is it important to know the anatomy of the superficial veins in the arm?

    <p>To know where to obtain blood from the arm in an emergency</p> Signup and view all the answers

    What is the significance of the median cubital vein in the cubital fossa?

    <p>It is the vein of choice for central venous catheterization</p> Signup and view all the answers

    What type of joint is the distal radioulnar joint?

    <p>Synovial pivot joint</p> Signup and view all the answers

    What is the shape of the articular disc of the distal radioulnar joint?

    <p>Triangular</p> Signup and view all the answers

    Where is the base of the articular disc attached?

    <p>The lower border of the ulnar notch of the radius</p> Signup and view all the answers

    What is the effect of the movement of pronation on the hand?

    <p>The hand rotates medially, and the palm faces posteriorly</p> Signup and view all the answers

    What is the function of the ulnar movement during supination and pronation?

    <p>To prevent side-to-side movement of the hand during repetitive movements</p> Signup and view all the answers

    What is the result of the distal end of the radius moving around the circumference of the head of the ulna?

    <p>The hand remains in line with the upper limb</p> Signup and view all the answers

    What is the type of joint that forms between the rounded head of the ulna and the ulnar notch on the radius?

    <p>Synovial pivot joint</p> Signup and view all the answers

    What is the shape of the articular disc that separates the distal radioulnar joint from the wrist?

    <p>Triangular</p> Signup and view all the answers

    In which direction does the ulna move when the hand moves bodily forward?

    <p>Laterally</p> Signup and view all the answers

    What is the purpose of the movement of the ulna in the distal radioulnar joint?

    <p>To prevent side-to-side movement of the hand during repetitive movements</p> Signup and view all the answers

    What is the result of the movement of pronation in the distal radioulnar joint?

    <p>The hand rotates medially and the palm faces posteriorly</p> Signup and view all the answers

    What is the significance of the distal radioulnar joint in relation to the upper limb?

    <p>It allows for rotation of the forearm</p> Signup and view all the answers

    When the elbow joint is extended, the medial and lateral epicondyles of the humerus and the olecranon process of the ulna form what shape?

    <p>A straight line</p> Signup and view all the answers

    What is the position of the head of the radius in relation to the lateral epicondyle of the humerus?

    <p>Distal to the lateral epicondyle</p> Signup and view all the answers

    What is the movement that occurs when the head of the radius rotates during pronation and supination of the forearm?

    <p>Rotation</p> Signup and view all the answers

    What is the shape formed by the medial and lateral epicondyles of the humerus and the olecranon process of the ulna when the elbow joint is flexed?

    <p>An equilateral triangle</p> Signup and view all the answers

    What is the location of the inferior angle of the scapula?

    <p>On the posterior surface of the scapula</p> Signup and view all the answers

    What is the name of the structure that can be palpated on the posterolateral aspect of the extended elbow, distal to the lateral epicondyle?

    <p>Head of the radius</p> Signup and view all the answers

    What is the anatomical landmark opposite the second thoracic spine?

    <p>Superior angle of the scapula</p> Signup and view all the answers

    Where does the tendon of the biceps muscle pass downward into?

    <p>Fossa</p> Signup and view all the answers

    What is the sensation felt when the ulnar nerve is compressed?

    <p>Pins and needles sensation</p> Signup and view all the answers

    What is the boundary formed by the brachioradialis muscle?

    <p>Lateral boundary</p> Signup and view all the answers

    What is the location of the scapula relative to the thoracic spine?

    <p>At the level of the third thoracic spine</p> Signup and view all the answers

    What can be felt as it leaves the tendon to join the deep fascia on the medial side of the forearm?

    <p>Bicipital aponeurosis</p> Signup and view all the answers

    What is the location of the inferior angle of the scapula?

    <p>Opposite the seventh thoracic spine</p> Signup and view all the answers

    What can be felt to pulsate as it passes down the arm?

    <p>Brachial artery</p> Signup and view all the answers

    What is the shape of the breast in young women?

    <p>Hemispherical and slightly pendulous</p> Signup and view all the answers

    In which fascia is the greater part of the breast located?

    <p>Superficial fascia</p> Signup and view all the answers

    What is the relationship between the breast and the axillary vessels?

    <p>The breast comes into close relationship with the axillary vessels in the axilla</p> Signup and view all the answers

    What is the characteristic of the breast in the living subject?

    <p>Soft because of the fat contained within it</p> Signup and view all the answers

    What is the consistency of the breast on careful palpation?

    <p>Firm, overall lobulated</p> Signup and view all the answers

    Where can the stylold process of the ulna be palpated?

    <p>On the lateral side of the wrist</p> Signup and view all the answers

    What is the relationship between the head of the ulna and the forearm?

    <p>The head of the ulna is most easily felt with the forearm pronated</p> Signup and view all the answers

    What is the location of the dorsal tubercle of the radius?

    <p>On the posterior surface of the distal end of the radius</p> Signup and view all the answers

    At which intercostal space do the nipples typically lie in males and immature females?

    <p>Fourth intercostal spaces</p> Signup and view all the answers

    What is the function of the areolar glands?

    <p>Production of tiny tubercles on the areola</p> Signup and view all the answers

    What is the name of the bone that can be felt on the medial side of the wrist?

    <p>Hamate bone</p> Signup and view all the answers

    What is the significance of the transverse creases on the wrist?

    <p>Important landmarks for anatomical orientation</p> Signup and view all the answers

    What is the term for the area where the breasts are situated?

    <p>Pectoral region</p> Signup and view all the answers

    What happens to the areola during the 2nd month of the first pregnancy?

    <p>It becomes darker in color</p> Signup and view all the answers

    What is the primary function of the breasts?

    <p>To secrete milk for lactation</p> Signup and view all the answers

    What is the significance of the axillary tail?

    <p>It is a region of the breast that extends into the axilla</p> Signup and view all the answers

    What is the function of the muscles in the anterior compartment of the forearm?

    <p>To contribute to flexion of the wrist and digits</p> Signup and view all the answers

    What is the function of the pectoralis minor muscle in relation to the axilla?

    <p>It divides the axilla into three subregions</p> Signup and view all the answers

    What is the significance of the axilla?

    <p>It is a space that conveys major blood vessels, nerves, and lymph channels</p> Signup and view all the answers

    What is the function of the muscles in the posterior compartment of the arm?

    <p>To contribute to extension of the shoulder and elbow</p> Signup and view all the answers

    What is the significance of the lymph drainage of the breast?

    <p>It is important for the role in metastasis of cancer</p> Signup and view all the answers

    What is the function of the muscles in the anterior compartment of the arm?

    <p>To contribute to flexion of the shoulder and elbow</p> Signup and view all the answers

    Study Notes

    Osteology of the Upper Limb

    • The capsule of the elbow joint attaches to the coronoid process and the medial and lateral epicondyles of the humerus.
    • The bicipital tuberosity is a bony projection on the proximal end of the radius.
    • The supinator muscle attaches to the lateral epicondyle of the humerus.
    • The flexor pollicis longus muscle attaches to the medial epicondyle of the humerus.
    • The interosseous membrane is a fibrous sheet that connects the radius and ulna bones.

    Muscular Attachments to the Radius and Ulna

    • The flexor carpi radialis muscle attaches to the anterior surface of the radius.
    • The extensor pollicis longus muscle attaches to the posterior surface of the radius.
    • The abductor pollicis longus muscle attaches to the posterior surface of the radius.
    • The pronator teres muscle attaches to the medial epicondyle of the humerus.
    • The flexor pollicis brevis muscle attaches to the anterior surface of the ulna.
    • The adductor pollicis muscle attaches to the medial epicondyle of the humerus.
    • The extensor carpi ulnaris muscle attaches to the posterior surface of the ulna.

    Muscular Attachments to the Hand

    • The thenar muscles (opponens pollicis, abductor pollicis brevis, and flexor pollicis brevis) attach to the anterior surface of the hand.
    • The interosseous muscles attach to the palmar and dorsal surfaces of the hand.
    • The flexor digitorum profundus muscle attaches to the palmar surface of the hand.
    • The extensor digitorum communis muscle attaches to the dorsal surface of the hand.
    • The extensor carpi ulnaris muscle attaches to the posterior surface of the hand.

    Clinical Notes

    • Fractures of the scaphoid bone can occur in young adults who fall on an outstretched hand.
    • Fractures of the lunate bone can occur due to hyperextension of the wrist joint.
    • Fractures of the metacarpal bone can occur as a result of a fall onto the hand.
    • The coronoid process of the ulna is susceptible to injury in fractures of the humerus.
    • The radial nerve can be damaged in fractures of the humerus.
    • The median nerve can be involved in fractures of the lunate bone.
    • Fractures of the distal end of the humerus can occur in children and adults.
    • Supracondylar fractures are common in children and can result in damage to the median, radial, and ulnar nerves.
    • The pronator quadratus muscle pronates and medially deviates the distal fragment of the radius in fractures.
    • The brachioradialis and extensor carpi radialis longus and brevis muscles can shorten and angulate the forearm in fractures.

    Upper Limb

    • The breast consists of 15 to 20 lobes, which radiate out from the nipple.
    • The main duct from each lobe opens separately on the summit of the nipple and possesses a dilated ampulla just before its termination.

    Pectoral Region

    • The pectoral region is the anterior aspect of the shoulder.
    • The breast is situated in the pectoral region, and its blood supply and lymphatic drainage are largely related to the armpit.

    Scapular Region

    • The scapular region is the posterior aspect of the shoulder.
    • The underlying bones of the back are shown in Figure 3.18 and are described in detail in Chapter 2.
    • Several structures in the scapular region (e.g., trapezius and latissimus dorsi muscles) connect with and function as part of the upper limb.

    Breast Development

    • In the early embryo, a linear thickening of ectoderm appears, called the milk ridge, which extends from the axilla obliquely to the inguinal region.
    • The ridge disappears except for a small part in the pectoral region, which thickens, becomes slightly depressed, and sends off 15 to 20 solid cords, which grow into the widely lying mesenchyme.

    Embryology Notes

    • Retracted or inverted nipple is a failure in the development of the nipple during its later stages.
    • Micromastia is an excessively small breast on one side, resulting from a lack of development.
    • Macromastia is an excessively large breast.

    Axilla

    • The axilla is a pyramid-shaped space between the upper part of the arm and the side of the chest.
    • The axilla forms an important passage for nerves, blood vessels, and lymph channels as they travel between the root of the neck to the upper limb.

    Quadrangular Space

    • The quadrangular space is an intermuscular space located immediately below the glenohumeral (shoulder) joint.
    • The axillary nerve and the posterior circumflex humeral vessels emerge through this space to reach their terminal destinations in the shoulder.

    Axillary Walls

    • The four walls of the axilla are constructed as follows:
      • Anterior wall: By the pectoralis major, subclavius, and pectoralis minor muscles.
      • Posterior wall: By the subscapularis and teres minor muscles.
      • Medial wall: By the chest wall.
      • Lateral wall: By the humerus.

    Wrist

    • The wrist (carpus) is a complex of the eight small carpal bones that connect the forearm and hand.
    • The wrist is a common site for Injury.

    Hand Anatomy

    • The hand is located at the distal end of the upper limb and is a very important organ.
    • The palmar surface is the anterior side of the hand, while the dorsal surface is the posterior aspect.

    Palmar Fascial Spaces

    • The fascial spaces of the palm are potential spaces filled with loose connective tissue.
    • Their boundaries are important clinically as they may limit the spread of infection in the palm.

    Palmar Aponeurosis

    • The triangular palmar aponeurosis fans out from the distal border of the flexor retinaculum.
    • A fibrous septum passes backward from its medial border and is attached to the anterior border of the fifth metacarpal bone.

    Hand Skin

    • The skin of the palm of the hand is thick and hairless.
    • It is bound down to the underlying deep fascia by numerous fibrous bands.

    Dupuytren Contracture

    • Dupuytren contracture is a localized thickening and contracture of the palmar aponeurosis, which limits hand function.
    • It commonly starts near the root of the ring finger and draws the finger into the palm, flexing it at the metacarpophalangeal joint.

    Treatment of Dupuytren Contracture

    • Surgical division of the fibrous bands followed by physiotherapy to the hand is the usual form of treatment.
    • An alternative treatment is the injection of the enzyme collagenase into the contracted bands of fibrous tissue.

    Forearm Compartment Syndrome

    • Forearm compartments are tightly packed spaces with little extra room, making them prone to compression of blood vessels and nerves.
    • Soft tissue injury is a common cause, and early diagnosis is crucial.
    • Early signs include:
      • Altered skin sensation (caused by ischemia of sensory nerves)
      • Pain disproportionate to any injury (caused by pressure on nerves within the compartment)
      • Pain on passive stretching of muscles (caused by muscle ischemia)
      • Tenderness of the skin over the compartment (a late sign caused by edema)
      • Absence of capillary refill in the nail beds (caused by pressure on the arteries within the compartment)
    • Delay in diagnosis can cause irreversible damage to the muscles, and surgical incision of the deep fascia is required to decompress the affected compartment.

    Absent Palmaris Longus

    • The palmaris longus muscle may be absent on one or both sides of the forearm in about 10% of people.
    • Its absence produces no disability.

    Tennis Elbow

    • No specific details mentioned in this context.

    Anatomy of the Hand

    • Figure 3.44 shows the anterior view of the palm of the hand, with the long flexor tendons removed, but their method of insertion into the fingers is shown.
    • Figure 3.45 shows the anterior view of the palm of the hand, with the deep palmar arch and the deep terminal branch of the ulnar nerve, as well as the interossei.

    Tenosynovitis of Flexor Tendon Synovial Sheaths

    • Tenosynovitis is an infection of a synovial sheath, commonly resulting from the introduction of bacteria into a sheath through a small penetrating wound.
    • Infection of a digital sheath results in distension of the sheath with pus, causing the finger to be held semiflexed and swollen.
    • Any attempt to extend the finger is accompanied by extreme pain due to the distended sheath being stretched.
    • Compressive pressure within the sheath may cause rupture of the sheath or severe scarring of the tendons.
    • Infection of the digital sheaths of the little finger and thumb can quickly involve the ulnar and radial bursae, and if neglected, pus may burst through the proximal ends of these bursae and enter the fascial space of the forearm.

    Ulnar Nerve

    • Originates from C8 and T1 roots
    • Passes through the brachial plexus
    • No branches in the axilla
    • Divides into flexor carpi ulnaris and flexor digitorum profundus (medial half) in the forearm
    • Gives off the ulnar artery
    • Has a palmar cutaneous branch
    • Has a dorsal cutaneous branch
    • Innervates the medial side of the hand and the medial 1 1/2 fingers
    • Controls the adductor pollicis, third and fourth lumbricals, and interossei muscles

    Brachial Plexus Injuries

    • Can be divided into upper and lower lesions
    • Upper lesions: roots, trunks, and divisions of the brachial plexus are affected
    • Incomplete injuries are common and usually caused by traction or pressure
    • Lower lesions: cords and most of the branches of the plexus are affected
    • Can result in a "waiter's tip" posture due to loss of supination and adduction

    Lower Lesions of Brachial Plexus (Klumpke's Palsy)

    • Usually caused by traction injuries, such as falling from a height
    • Results in loss of sensation over the lower half of the deltoid and lateral side of the forearm

    Dermatomes and Cutaneous Nerves

    • Dermatomes for the upper cervical segments C3 to 6 are located along the lateral margin of the upper limb
    • C7 dermatome is situated on the middle finger
    • Dermatomes for C8, T1, and T2 are along the medial margin of the upper limb
    • Nerve fibers from a particular segment of the spinal cord pass to the skin in two or more different cutaneous nerves

    Long Thoracic Nerve

    • Arises from the roots of the brachial plexus in the neck
    • Passes down over the lateral border of the first rib deep to the axillary vessels and brachial plexus
    • Descends over the superficial surface of the serratus anterior muscle, which it supplies
    • Unusual in that it is a motor nerve that enters its target muscle on the muscle's superficial side rather than the deep side
    • Places the nerve in a position of greater potential danger to trauma

    Ulnar Nerve

    • Originates from C8 and T1 roots
    • Passes through the brachial plexus
    • No branches in the axilla
    • Divides into flexor carpi ulnaris and flexor digitorum profundus (medial half) in the forearm
    • Gives off the ulnar artery
    • Has a palmar cutaneous branch
    • Has a dorsal cutaneous branch
    • Innervates the medial side of the hand and the medial 1 1/2 fingers
    • Controls the adductor pollicis, third and fourth lumbricals, and interossei muscles

    Brachial Plexus Injuries

    • Can be divided into upper and lower lesions
    • Upper lesions: roots, trunks, and divisions of the brachial plexus are affected
    • Incomplete injuries are common and usually caused by traction or pressure
    • Lower lesions: cords and most of the branches of the plexus are affected
    • Can result in a "waiter's tip" posture due to loss of supination and adduction

    Lower Lesions of Brachial Plexus (Klumpke's Palsy)

    • Usually caused by traction injuries, such as falling from a height
    • Results in loss of sensation over the lower half of the deltoid and lateral side of the forearm

    Dermatomes and Cutaneous Nerves

    • Dermatomes for the upper cervical segments C3 to 6 are located along the lateral margin of the upper limb
    • C7 dermatome is situated on the middle finger
    • Dermatomes for C8, T1, and T2 are along the medial margin of the upper limb
    • Nerve fibers from a particular segment of the spinal cord pass to the skin in two or more different cutaneous nerves

    Long Thoracic Nerve

    • Arises from the roots of the brachial plexus in the neck
    • Passes down over the lateral border of the first rib deep to the axillary vessels and brachial plexus
    • Descends over the superficial surface of the serratus anterior muscle, which it supplies
    • Unusual in that it is a motor nerve that enters its target muscle on the muscle's superficial side rather than the deep side
    • Places the nerve in a position of greater potential danger to trauma

    Axillary Lymph Node Examination

    • Axillary lymph nodes are examined as part of the clinical examination of the breast
    • Posterior (subscapular) nodes are palpated by pressing backward against the anterior surface of the subscapularis muscle
    • Lateral nodes are palpated against the medial side of the axillary vein
    • Central nodes are palpated in the center of the axilla between the pectoralis major (anterior wall) and subscapularis (posterior wall)
    • Apical nodes drain into the subclavian lymph trunk, which drains into the thoracic duct on the left side and the right lymph trunk on the right side

    Elbow Joint Stability

    • The elbow joint is stable due to the wrench-shaped trochlea of the humerus and strong medial and lateral ligaments
    • In extension, the medial and lateral epicondyles and the top of the olecranon process are in a straight line
    • In flexion, the bony points form the boundaries of an equilateral triangle
    • The normal relations of the bony points must be remembered when examining the elbow joint

    Elbow Joint Dislocation

    • Elbow dislocations are common, and most are posterior
    • Posterolateral dislocation usually follows falling on an outstretched hand

    Ulnar Nerve Damage with Elbow Joint Injuries

    • The ulnar nerve is closely related to the medial side of the joint and can become damaged in dislocations or fracture dislocations
    • Nerve lesions can occur at the time of injury or weeks, months, or years later
    • The nerve can become involved in scar tissue formation or become stretched due to lateral deviation of the forearm in a badly reduced supracondylar fracture of the humerus

    Venipuncture and Blood Transfusion

    • Superficial veins are clinically important for venipuncture, transfusion, and cardiac catheterization
    • The median cubital or basilic veins are the veins of choice for central venous catheterization
    • The basilic vein increases in diameter and is in direct line with the axillary vein, making it suitable for catheterization

    Distal Radioulnar Joint

    • Located between the rounded head of the ulna and the ulnar notch on the radius
    • Type: Synovial pivot joint
    • Capsule: Encloses the joint, but is deficient superiorly
    • Ligaments: Weak anterior and posterior ligaments strengthen the capsule

    Articular Disc

    • Triangular in shape and composed of fibrocartilage
    • Attached by its apex to the lateral side of the base of the styloid process of the ulna
    • Attached by its base to the lower border of the ulnar notch of the radius
    • Shuts off the distal radioulnar joint from the wrist

    Joint Movement

    • Pronation: hand rotates medially, palm faces posteriorly, and thumb lies on the medial side
    • Supination: reversal of pronation movement, hand rotates laterally, and palm faces anteriorly

    Distal Radioulnar Joint

    • Located between the rounded head of the ulna and the ulnar notch on the radius
    • Type: Synovial pivot joint
    • Capsule: Encloses the joint, but is deficient superiorly
    • Ligaments: Weak anterior and posterior ligaments strengthen the capsule

    Articular Disc

    • Triangular in shape and composed of fibrocartilage
    • Attached by its apex to the lateral side of the base of the styloid process of the ulna
    • Attached by its base to the lower border of the ulnar notch of the radius
    • Shuts off the distal radioulnar joint from the wrist

    Joint Movement

    • Pronation: hand rotates medially, palm faces posteriorly, and thumb lies on the medial side
    • Supination: reversal of pronation movement, hand rotates laterally, and palm faces anteriorly

    Surface Anatomy

    • The medial and lateral epicondyles of the humerus and the olecranon process of the ulna can be palpated in the elbow region.
    • When the elbow joint is extended, these bony points lie on the same straight line; when the elbow is flexed, these three points form the boundaries of an equilateral triangle.
    • The head of the radius can be palpated in a depression on the posterolateral aspect of the extended elbow, distal to the lateral epicondyle.
    • The head of the radius can be felt to rotate during pronation and supination of the forearm.
    • The cubital fossa is a skin depression in front of the elbow, and the boundaries can be seen and felt.
    • The brachioradialis muscle forms the lateral boundary, and the pronator teres muscle forms the medial boundary.
    • The tendon of the biceps muscle can be palpated as it passes downward into the fossa.
    • The bicipital aponeurosis can be felt as it leaves the tendon to join the deep fascia on the medial side of the forearm.
    • The ulnar nerve can be palpated where it lies behind the medial epicondyle of the humerus.
    • The brachial artery can be felt to pulsate as it passes down the arm, overlapped by the medial border of the biceps muscle.

    Scapula

    • The inferior angle of the scapula can be palpated opposite the seventh thoracic spine.
    • The superior angle of the scapula can be felt through the trapezius muscle and lies opposite the second thoracic spine.

    Breast

    • In children and men, the breast anatomy is rudimentary and the glandular tissue is confined to a small area beneath the pigmented areola.
    • In young women, the breast is usually hemispherical and slightly pendulous, overlapping the second to the sixth ribs and their costal cartilages.
    • The breast lies in the superficial fascia and can be moved freely in all directions.
    • The upper lateral edge of the breast extends around the lower border of the pectoralis major and enters the axilla, where it comes into close relationship with the axillary vessels.
    • The breast is soft because the fat contained within it is fluid.
    • On careful palpation with the open hand, the breast has a firm, overall lobulated consistency, produced by its glandular tissue.

    Wrist and Hand

    • The stylold process of the radius can be palpated at the wrist.
    • The dorsal tubercle of the radius is palpable on the posterior surface of the distal end of the radius.
    • The head of the ulna is most easily felt with the forearm pronated.
    • The pillform bone can be felt on the medial side of the anterior aspect of the wrist between the two transverse creases.
    • The hook of the hamate bone can be felt on deep palpation of the hypothenar eminence, a fingerbreadth distal and lateral to the pisiform bone.
    • The transverse creases seen in front of the wrist are important landmarks.
    • The proximal transverse crease at the level of the wrist joint corresponds to the proximal border of the flexor retinaculum.

    Arm

    • The arm contains two osseofascial compartments, anterior and posterior.
    • The muscles in the anterior compartment contribute to flexion of the shoulder and elbow and to power supination.
    • The muscle in the posterior compartment acts in extension of the shoulder and elbow.

    Forearm

    • The forearm contains three osseofascial compartments, anterior, posterior, and lateral.
    • The muscles in the anterior compartment contribute largely to flexion of the wrist and digits and to pronation.

    Axilla

    • The axilla is a pyramid-shaped space between the arm and side of the chest.
    • It conveys major blood vessels (axillary artery and vein and their branches), nerves (brachial plexus), and lymph channels (axillary nodes).
    • The pectoralis minor muscle divides the axilla into three subregions that are useful in describing the pathways of the arteries and lymph drainage.

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    Description

    Learn about the bones and muscles of the upper limb, including the elbow joint, radius, and ulna bones.

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