Gross Anatomy Forum Upper Limb

Upper Limb Forum

1) Define the difference between shoulder separation and shoulder dislocation.

A shoulder separation involves injury to the ligaments holding the upper limb to the axial
skeleton (or the Acromial-clavicular joint)
The ligaments involved are the acromialclavicular ligament and the coracoclavicular ligament
A shoulder dislocation is when the head of the humerus dislocates from the glenoid fossa
The most common shoulder dislocation occurs anterior/inferiorly because this is the weakest part
of the joint (there are not as many muscles or ligaments in this area)
James Lamberg
2) What is the clinical significance of the radial groove?
The radial nerve runs along the radial groove, the clinical significance is that if you break the
shaft of the humerus it can damage the radial nerve causing problems for the forearm and hand

3) List the rotator cuff muscles, their nerve supplies, origins, insertions, and functions.
Supraspinatus
Proximal – supraspinous fossa
Distal – greater tuberosity of the humerus
Action – abducts the arm (first 15 degrees), stabilizes shoulder
Innervation – suprascapular nerve
Infraspinatus
Proximal – infraspinous fossa
Distal – greater tuberosity of the humerus
Action – laterally rotates the arm, stabilizes shoulder
Innervation – suprascapular nerve
Teres Minor
Proximal – Upper 2/3rd lateral border of scapula
Distal – greater tuberosity of the humerus
Action – medially rotates the arm, stabilizes shoulder
Innervation – Axillary nerve (C5, C6)
Subscapularis
Proximal – Subscapular fossa
Distal – lesser tuberosity of the humerus
Action – medially rotates the arm, stabilizes shoulder
Innervation – subscapular nerve

4) What is the segmental innervation of the following muscles, and the cord of the brachial plexus
involved?
a. Supraspinatus – suprascapular nerve, levels C5 and C6, off of the lateral cord (roots)
b. Infraspinatus – suprascapular never, levels C5 and C6, off the lateral cord (roots)
c. Teres minor – Axillary nerve, levels C5 and C6, off of the posterior cord
d. Subscapularis – subscapular nerve, levels C5, C6, C7, off of the posterior cord
e. Deltoid – Axillary nerve, levels C5 and C6, off of the posterior cord
f. Levator scapulae – dorsal scapular nerve, levels C5, off of the lateral cord (trunk)

5) On the figures below, label all muscles that either originate or insert on the scapula.
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1 = Long head of biceps brachii- attaches to the supraglenoid tubercle of the glenoid fossa
2 = Trapezius – superior region of scapular spine
3 = Deltoid – lateral region of scapular spine
4 = Long head of triceps brachii – infragelnoid tubercle of the glenoid fossa
5 = Teres Minor – Superior lateral border of scapula
6 = Teres Major- Inferior lateral border of scapula
7 = Latissimus Dorsi – Inferior angle of the scapula
8 = Rhomboid Major – Inferior medial border of the scapula
9 = Infraspinatous – Infraspinous fossa
10 = Rhomboid Minor – Superior medial border of scapula
11 = Levator Scapulae – Superior angle of scapula
12 = Supraspinatous – supraspinous fossa
13 = Omohyoid
14 = Serratus Anterior – Medial border and inferior angle of the scapula
15 = Subscapularis – subscapular fossa
16 = Pectoralis Minor – Inferior section of coracoid process
17/18) Short head of biceps brachii and coracobrachialis – lateral border of coracoids process

1) Define the muscular walls of the axilla.

Anterior Wall: Pectoralis Major, Subclavius, and Pectoralis Minor
Posterior Wall: Subscapularis, Latissimus Dorsi, Teres Major
Medial Wall: Upper 4/5 ribs, serratus anterior
Lateral Wall: Coracibrachialis and biceps muscles

2) Define the distribution of the clavipectoral fascia.

The clavipectoral fascia extends between the coracoid process, the clavical and the thoracic wall.
It includes the muscle fascia that envelops the subclavius and pectoralis minor, the costocoracoid
membrane formed in the interval between the two muscles, and the suspensory ligament of the
axilla that is continuous downward and blends with the axillary fascia, maintaining the hollow of
the armpit.

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3) Into what large vessel does the cephalic vein drain?

Axillary vein

4) What is the principal function and innervation of the pectoral muscles?

Pectoralis Major
Adduction and medial rotation, Medial and lateral pectoral nerves
Pectoralis Minor
Depressed the shoulder at the point of the coracoids process, medial pectoral nerve

5) What structure occupies the bicipital groove?

Long head of the biceps tendon runs through it to attach to the supraglenoid tubercle (latissimus
dorsi runs along the floor of the bicepital groove of the humerus, and pectoralis major and teres
major run along the outer ridges

6) What happens to the scapula following complete section of the long thoracic n.?
This denervates the entire serratus anterior and therefore this causes winging of the scapula as
the serratus anterior holds the scapula to the thoracic wall

7) Explain the anatomical location of each of the three cords of the brachial plexus.
The cords are posterior, medial, and lateral. They are in the axilla and named by their position in
respect to the axillary artery.
The posterior cord is formed from the three posterior divisions of the trunks (C5-T1)
The lateral cord is the anterior divisions from the upper and middle trunks (C5-C7)
The medial cord is simply a continuation of the lower trunk (C8-T1)

8) Outline the anatomical location of each of the three parts of the axillary artery, and
identify the branches of each.
From the first rib to the upper border of pectoralis minor
Superior Thoracic Artery
Deep to the pectoralis minor
Thoracoacromial artery
Lateral Thoracic artery
Lower border of the pectoralis minor to the lower border of the teres minor
Subscapular artery
Anterior and Posterior circumflex humeral arteries

9) Draw and label a complete brachial plexus

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1) What is the significance of collateral blood supply/circulation?

Serves to supply an area where the main blood supply has been cut off

2) The medial, lateral, and posterior cords of the brachial plexus are named due to their position
relative to what structure?
The axillary artery

3) List at least one motor deficit that would follow section of each of these nerves at the indicated
places:
a. median nerve, proximal to the elbow
The pronator muscles of the forearm and the long flexor muscles of the wrist (except for the
flexor carpi ulnarus)
b. ulnar nerve, proximal to the elbow
Loss of function of the flexor carpi ulnaris and medial half of the flexor digitum profundus (ulnar
claw)
c. axillary, at the shoulder
The shoulder will not be able to abduct pass 15 degrees (due to loss of deltoid function) and the
arm would not be able to medially rotate due to loss of function of the teres minor
d. radial, proximal to the origin of the triceps

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The triceps, anconeus and long extensors of the wrist are paralyzed; Unable to extend the elbow
joint the wrist joint and the fingers (wrist drop occurs)
e. lower subscapular, near its origin
Loss of function of teres major and subscapularis, therefore the arm would be unable to medially
rotate
f. musculocutaneous nerve, in the axilla
The biceps and coracobrachialis are paralyzed and the brachialis muscle is weakened

4) Draw upper limb with dermatome level map. C5, C6, C7

5) Describe the boundaries of the cubital fossa.

The cubital fossa is a triangular depression that lies in front of the elbow.
Laterally: Brachioradialis
Medially: Pronator teres
The base of the triangle is formed by an imaginary line drawn between the two epicondyles of
the humerus. The floor is formed by the supinator laterally and the brachialis medially. The roof
is formed by skin and fascia and is reinforced by the bicipital aponeurosis.

6) List in order, the mediolateral relationships of the biceps tendon, median nerve, and brachial
artery in the cubital fossa.
Median Nerve, Brachial artery (bifurcation into ulnar and radial branches), biceps tendon
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7) In the figure below, which is a section through the arm at the humeral mid-shaft, label the
structures indicated.

A) Biceps brachii
B) Brachialis
C) Cephalic vein
D) Musculocutaneous nerve
E) Medial cutaneous nerve of forearm
F) Brachial artery
G) Basilic vein
H) Median nerve
I) Long head of triceps
J) Medial head of triceps
K) Lateral head of triceps
L) Radial nerve
M) Radial collateral artery

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1) List the muscles associated with the common flexor tendon of the forearm.
Flexor carpi ulnarus, flexor carpi radialis, and Palmaris longus

2) Describe the course of the median nerve in relation to the pronator teres and flexor digitorum
superficialis.
The median nerve pierces the pronator teres and runs with the flexor digitorum superficialis

3) In the figure below, which is a cross-section of the wrist through the distal carpal row, identify the
tendons, nerves, arteries, and bones.

A Trapezium K Flexor pollicis longus tendon in

tendon sheath
B Trapezoid L Flexor carpi radialis tendon
C Capitate M Tendon m. extensor carpi
radialis longus
D Hamate N Tendon m. extensor carpi
radialis brevis
E Palmaris Longus Tendon O Tendon m. extensor pollicis
longus
F Ulnar artery P Tendon m. extensor digiti
minimi
G Ulnar nerve Q Not labeled in atlas
H Median Nerve R Not labeled in atlas
I Flexor digitorum superficialis S Radial artery
tendons
J Flexor digitorum profundus T Tendon m. extensor carpi
tendons ulnaris

4) What is carpal tunnel syndrome? What are the physical symptoms of a patient with it?
Produced by compression of the medial nerve within the tunnel (formed by the bones of the hand
and the flexor retinaculum) The median nerve lies within a restricted space and gets compressd
(exact mechanism unknown – thickening of synovial sheath) causing pins and needles feelings
(burning pain) along the distribution of the median nerve, the lateral 3.5 fingers and the thenar
muscles

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5) If a patient suffers a fracture at the medial epicondyle of the humerus, what nerve is most likely to
be injured?
The ulnar nerve

6) What is a Colles' fracture? Besides an x-ray, what is an obvious indication that a patient has a
Colles' fracture?
Fracture of the distal end of the radius usually due to a fall on the hand
The posterior displacement sticks out getting

1) What are the principal digital movements mediated by the: a) palmar interossei; b) dorsal
interossei?
Palmer adduction; Dorsal abduction

2) What is the extensor expansion and what muscles insert into it?
It’s a sheet-like tendon that holds the flexor digitorum to the surface of the fingers

3) Define the boundaries of the "anatomical snuff box" and list its key contents.
Extensor pollicis longus (medially), center = extensor pollicis brevus, abductor pollicis longus
(lateral)

4) What are the osseous attachments of the extensor retinaculum?

The extensor retinaculum extends on the posterior wrist from the lateral margin of the radius to
the styloid process of the ulna, the pisiform, and the triquetrum.

5) In the following diagram identify the cutaneous distribution of the median, ulnar and radial
nerves.

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6) The muscles of the hand receive motor input from the median and ulnar nerves. List the motor
deficits that will result from nerve injury at the indicated locations:
Median nerve, proximal to flexor retinaculum (as in wrist slashing):
Loss of ability to oppose the thumb (loss of ability to lateral 3.5 fingers) an thenar muscles
Ulnar nerve, at the wrist (ulnar nerve entrapment):
Ulnar claw (pinkie and ring finger)

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