lOMoARcPSD|23674473
UPPER LIMB REVISON
Tuesday, 31 May 2022
10:42 AM
Upper limb
Anatomical positions and planes
Joint classification
classifying joints (type, axial, category) e.g. ball and socket, multiaxial, synovial
Classification Type
Fibrous
Example
Suture
Syndesmosis
Radioulnar joint
Cartilaginous Primary
(Synchondrosis)
Secondary
(Symphysis)
Synovial
Uniaxial
Biaxial
Multiaxial
Scapulothoracic joint
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Scapulothoracic joint
Elevation
- Levitator scapulae
- Trapezius (upper fibres)
Inward rotation
- Trapezius (middle fibres)
- Rhomboid major
- Rhomboid minor
Abduction/protraction
- Serratus anterior
Adduction/retraction
• Trapezius (middle fibres)
• Rhomboid major
• Rhomboid minor
Outward rotation
- Serratus anterior
- Trapezius (upper fibres)
Depression
- Trapezius (lower fibres)
- Pectoralis minor
Projections and depressions
Projections --> bones that poke out, where something is attaching such as a muscle, ligament
or even a bone
- Trochanter - greater trochanter of the femur --> large rough projection
- Tuberosity - tibial tuberosity --> large rough round projection
- Tubercle - greater tubercle of the humerus --> small round projection
- Head - head of radius --> rounded articular surface on the bone constriction
- Condyle - lateral condyle of tibia --> rounded articular projection
- Epicondyle - medial epicondyle of the humerus --> projection above a condyle
- Ramus - ramus of the mandible --> bridge/curved part of a bone
- Line - linea, aspera of the femur --> less prominent than a crest
- Ridge - lateral supracondylar ridge of the humerus --> elevations, margins or borders
- Spine - spine of scapula --> sharp, slender projection of the bone, useful for attachment
of muscles or ligaments
- Process - olecranon process
Depressions --> a hollow in a bone
- Facet - superior articular facet --> smooth flat surface that forms a joint
- Fovea - fovea centralis --> small pit
- Fossa - olecranon fossa of humerus --> broad and shallow depression
- Groove - radial groove --> furrow in the bone surface
- Sulcus - sulcus of the brain --> furrow usually specific to the brain
- Foramen - supraorbital foramen (above eye socket) --> hole where nerves + blood
vessels pass
- Meatus - internal auditory meatus --> tube like tunnel through bone
- Canal - facial canal --> tube passageway which connects to different regions
- Fissure - superior orbital fissure --> open slit in bone (houses vessels)
- Sinus - paranasal sinus --> cavity within any organ or tissue
Bones of the upper limb
Clavicle
- Acromial end (flattened surface that connects to the scapula)
- Sternal end (chunky side that connects to the sternum)
- Superior surface (top of the clavicle closer to the head)
- Inferior surface (bottom of the clavicle)
Scapula
- Acromion process (attaches to the acromial end of the clavicle)
- Glenoid fossa (the depression of the scapula where the humorous attaches)
Humerus
- Proximal end
○ Head (smooth for articulation as it goes into a joint)
- Distal end
- Capitulum (on the outside of the) Distal end capitulum Distal end
trochlea
- Trochlea (on the inside)
- Coronoid, radial and olecranon fossae
○ Coronoid = medium fossa medium word
○ Radial = small fossa, small word
○ Olecranon fossa = big fossa, biggest word
Radius and ulna
- Proximal end
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Radius and ulna
- Proximal end
○ Olecranon process
○ Coronoid process
- Distal end
○ Styloid process
Radius head
Radial tuberosity
Radius neck
Wrist and hand
- Proximal row SLTP (some lovers try positions)
○ Scaphoid = orange
○ Lunate = blue
○ Triquetrum = light green
○ Pisiform = yellow
- Distal row TTCH (that they can’t handle))
○ Trapezium = peach
○ Trapezoid = grey
○ Capitate = dark green
○ Hamate = pink
Joints of the upper limb
Shoulder girdle
- Glenoid-humeral joint
○ Classification: synovial, ball and socket, multiaxial
○ Articular surfaces --> head of humerus, glenoid fossa of scapula
○ Glenoid labrum --> fibrocartilaginous structure surrounding glenoid fossa of scapula
○ Joint capsule --> loose fibrous joint capsule
○ Ligaments
▪ Coracohumeral = attaches coracoid process to humerus
▪ Coracoacromial = attaches coracoid process to acromial process
▪ Coracoclavicular = trapezoid and conoid part
□ Trapezoid part --> longer word, longer ligament (laterally)
□ Conoid part --> triangle smaller one, smaller word
- Acromioclavicular joint
○ Classification: synovial, plane, multiaxial
○ Articular surfaces --> acromial end of clavicle, acromion process of scapula
○ Coracoclavicular ligament
▪ Trapezoid part = lateral side, out near acromion
▪ Conoid part = medial side, closer to the sternum
○ Movement --> axial rotation/anteroposterior movement
- Sternoclavicular joint
○ Classification: synovial, plane, multiaxial
○ Articular surfaces --> sternal notch of manubrium
sternal end of clavicle
▪ Costoclavicular ligament --> costo = ribs, clavicular = clavicle
▪ Articular disc of SC joint --> divides SC joint into 2
○ Movement --> elevation/depression, protraction/retraction, rotation
Elbow
Elbow joint
- Classification: synovial, pivot, uniaxial
- Articular surfaces --> capitulum and trochlear of humerus, trochlea notch of ulna and
head of radius
- Ligaments
○ Ulna (medial) collateral --> medial epicondyle to coronoid process and olecranon
of the ulna
○ Radial (lateral) collateral --> lateral epicondyle, blending with the annular ligament
of radius (top to bottom fibres)
○ Annular --> ring surrounding radial head, horizontal fibres
- Movement --> flexion/extension
Radioulnar joint
- Classification: synovial, pivot, uniaxial
- Articular surfaces --> radial notch of ulna, head of radius
- Ligaments
○ Annular --> wraps laterally to medially holding head of radius into the ulna notch
○ Radial collateral --> connects humerus to radius (top to bottom fibres)
- Movement --> flexion/extension
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clavicle
Acromion process
humerus
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Wrist and hand --> flexion/extension, adduction/abduction
Inferior radioulnar joint
- Classification: synovial, pivot uniaxial
- Articular surfaces --> head of ulna, ulna notch on distal end of radius
Radiocarpal (wrist) joint
- Classification: synovial, condyloid, biaxial
- Articular surfaces --> distal end of radius, proximal row of carpal bones (SLTP)
- Ligaments
○ Radial collateral --> radius across to carpal bones
○ Ulnar collateral --> ulna across to carpal bones
Carpometacarpal joints
- Classification: synovial, plane, multiaxial
- Articular surfaces --> distal row of carpal bones (TTCH), bases
of metacarpals (2-5)
- Movements --> small glides across all 3 axes
1st carpometacarpal joint (thumb)
- Classification: synovial, saddle, biaxial
- Articular surfaces --> trapezium, base of 1st metacarpal
- Movements --> flexion/extension, abduction/adduction, opposition
(finger pad of thumb to other finger pads)
Metacarpophalangeal joint (MCP)
- Classification: synovial, condyloid, biaxial
- Articular surfaces --> head of metacarpals, base of proximal phalanges
- Movement --> flexion/extension, abduction/adduction
Interphalangeal joints
- Classification: synovial, hinge, uniaxial
- Articular surfaces --> head of proximal and middle phalanges, bases of middle and
distal phalanges
- Movement --> flexion/extension
Muscles of the upper limbs
Myology
- Skeletal muscle - attaches to and moves the skeleton
○ Voluntary
- Cardiac - makes up the wall of the heart
○ Involuntary
- Smooth - of the organs e.g. bladder, uterus, blood vessels etc
○ Involuntary
Skeletal muscle organ
- Belly - contractile cells, this is where the 'work' happens
- Attachment to the skeleton/muscle bunch order
○ Epimysium = OUTSIDE whole
○ Perimysium = surrounds each bunch
○ Endomysium = inside/surrounds each fibre bunch
- Action = movement that results when the muscle contracts and shortens
- Connective tissue component
Muscles joining axial skeleton to humerus
- Pectoralis major --> flexes and rotates shoulder inwards
○ Origin: sternal head - anterior manubrium and body of sternum. Clavicular head
medial half of anterior clavicle
○ Insertion: lateral lip of intertubercular groove of the humerus
- Latissimus dorsi --> moves shoulder backwards
○ Origin: spinous processes of T6-S5 vertebrae, lilac crest, ribs 9-12
○ Insertion: floor of intertubercular groove of humerus
- Trapezius
○ Origin: external occipital protuberance of skull, superior nuchal line of skull,
acromion of scapula, ligamentum nuchae, spinous processes of C7-T12 vertebrae
○ Insertion: lateral 1/3 clavicle medial end of spine of scapula
- Rhomboid major --> pulls shoulder blades together
○ Origin: spinous processes of T2-T5 vertebrae
○ Insertion: medial border of scapula between base of spine and inferior angle
- Rhomboid minor
○ Origin: spinous process of C7-Y1 vertebrae
○ Insertion: medial border of scapula at base of spine
- Levator scapulae (elevator --> lift up)
○ Origin: Transverse processes of C1-C3 vertebrae
○ Insertion: medial border of scapula above base of spine
- Pectoralis minor
○ Origin: anterior surface of ribs 3-5
Insertion: coracoid process of the scapula
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Connective tissue
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○ Origin: Transverse processes of C1-C3 vertebrae
○ Insertion: medial border of scapula above base of spine
Pectoralis minor
○ Origin: anterior surface of ribs 3-5
○ Insertion: coracoid process of the scapula
Serratus anterior -->(think serrated look of outside)
○ Origin: anterior surface of ribs 1-8
○ Insertion: medial border of the scapula
Deltoid --> moves shoulder away from midline
○ Origin: lateral 1/3 clavicle, acromion process of scapula, spine of scapula
○ Insertion: deltoid tuberosity of humerus
Coracobrachialis --> flexes shoulder
○ Origin: coracoid process of the scapula
○ Insertion: medial side mid shaft humerus
Teres major
○ Origin: posterior surface of scapula near inferior angle
○ Insertion: medial lip of intertubercular groove of humerus
Teres minor --> rotates shoulder outwards
○ Origin: lateral border of the scapula
○ Insertion: greater tubercle of humerus
Muscles connecting shoulder girdle to humerus
Rotator cuff muscles (SITS…on the humerus)
○ Supra. Infra. Teres. Sub
○ All rotator cuff muscles originate from the scapula and insert in the humerus
- Supraspinatus --> doesn’t do rotation, allows abduction
○ Origin: supraspinatus fossa of scapula
○ Insertion: greater tubercle of humerus
- Infraspinatus --> external rotation of shoulder girdle
○ Origin: infraspinous fossa of scapula
○ Insertion: greater tubercle of humerus
- Teres minor --> contract and pull our humerus laterally
○ Origin: lateral border of the scapula
○ Insertion: greater tubercle of humerus
- Subscapularis --> sits anteriorly in the subscapular, pulling inwards for medial rotation
○ Origin: infraspinous fossa of scapula
○ Insertion: lesser tubercle of humerus
Muscles connecting shoulder girdle to forearm
These muscles have an action at the forearm but also at the shoulder
- Biceps brachii --> shoulder flexion, elbow flexion, supination of the radioulnar joint
○ Origin:
▪ Short head - coracoid process
▪ Long head - supraglenoid tubercle of scapula
○ Insertion: radial tuberosity
- Triceps brachii --> elbow extension, shoulder extension
○ Origin:
▪ Long head: infraglenoid tubercle of scapula
▪ Lateral head: posterior shaft of humerus lateral to the spiral groove
▪ Medial head: posterior shaft of humerus medial to the spiral groove
○ Insertion: olecranon process of the ulna
Muscles that move elbow and radioulnar joint
- Biceps brachii --> elbow flexion, supination of the radioulnar joint
○ Origin:
▪ Short head - coracoid process
▪ Long head - supraglenoid tubercle of scapula
○ Insertion: radial tuberosity
- Triceps brachii --> no role in pronation or supination of the elbow
○ Origin:
▪ Long head: infraglenoid tubercle of scapula
▪ Lateral head: posterior shaft of humerus lateral to the spiral groove
▪ Medial head: posterior shaft of humerus medial to the spiral groove
○ Insertion: olecranon process of the ulna
- Brachialis --> strongest in out forearm that does elbow flexion (under bicep)
○ Origin: distal 2/3 of anterior shaft of humerus
○ Insertion: ulnar tuberosity
- Anconaeus --> limited in elbow assistance for elbow extension (not a prime mover)
○ Origin: lateral epicondyle of humerus
○ Insertion: proximal 1/4 posterior ulna, lateral surface of olecranon process of ulna
- Pronator teres --> pronation of forearm, elbow flexion (prime mover for pronation of the
elbow) wraps medially to laterally from elbow to radius
○ Origin: medial supracondylar ridge of humerus, medial epicondyle of humerus
○ Insertion: impression for pronator teres on lateral midshaft of radius
- Pronator quadratus --> wraps around the bottom of the wrist
○ Origin: distal 1/4 anterior ulna
Insertion: 1/4 anterior radius
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○ Insertion: 1/4 anterior radius
- Supinator --> supination of forearm
○ Origin: lateral epicondyle of humerus, proximal shaft of lateral radius
○ Insertion: supinator crest and fossa on ulna
- Brachioradialis --> can't have an action in any wrist movement, strong elbow flexor
○ Origin: lateral supracondylar ridge of humerus
○ Insertion: distal radius just proximal to the styloid process
supinator
Brachioradialis
Muscles in forearm
Flexor group
- Pronator teres (superficial)
○ Origin: medial supracondylar ridge of humerus, medial epicondyle of humerus
○ Insertion: impression for pronator teres on lateral midshaft of radius
- Flexor carpi radialis(superficial) --> wrist flexion, wrist abduction/radius deviation
○ Origin: common flexor origin on medial epicondyle of humerus
○ Insertion: bases of metacarpals 2 and 3
- Palmaris longus (superficial) --> flexor of the wrist
○ Origin: common flexor origin on medial epicondyle of humerus
○ Insertion: flexor retinaculum palmar aponeurosis
- Flexor carpi ulnaris(superficial) --> flexion of the wrist, ulna deviation
○ Origin: common flexor origin on medial epicondyle of humerus
Flexor carpi
Palmaris longus
radialis
Pronator teres
○ Insertion: hook of hamate and base of metacarpal 5
- Flexor digitorum superficialias (superficial)
○ Origin: common flexor origin on medial epicondyle of humerus
○ Insertion: bases of middle phalanges of digits 2-5
- Pronator quadratus (deep)
○ Origin: distal 1/4 anterior ulna
○ Insertion: 1/4 anterior radius
- Flexor digitorum profundus (deep)
○ Origin: coronoid process of ulna, proximal 3/4 ulna
○ Insertion: bases of distal phalanges of digits 2-5
- Flexor pollicis longus (pollicis = thumb)
○ Origin: anterior surface of radius
Flexor digitorum Pronator quadratus
Flexor digitorum
profundus
○ Insertion: base of distal phalanx of thumb
Nerves of the arm
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Flexor carpi
ulnaris
Flexor pollicis longus