1.3 1.2
1.1 QUESTIONS Upper Limb 1
ٗ ٗ ٗ ٗ ٗ ٗ ٗ ٗ ٗ ٗ ٗ ٗ ٗ ٗ ٗ and ulnaiscorrect? Which ofthefollowingstatementsregardingradius noted thatthe: sentence? Whenconsideringthehumerus,itshouldbe Which statementisthebestendingforfollowing scapula? Which ofthefollowingstatementsbestdescribes
c. b. a. e. d. c. b. a. e. d. c. b. a. e. d. Botharticulatewiththecarpalbonesatwrist Surgicalneckseparatestheheadfromtubercles. Thesuprascapularnotchisfoundonitsspine. Bothhaveastyloidprocessattheproximalend. Capitulumarticulateswiththeulna. Lessertuberclehasthreefacets. Mostfracturesinvolvethebody. Itusuallyoverliesthe2ndto9thribs. Fractureismostcommonly oftheSmith’s type. Botharticulatewiththehumerusatelbowjoint. Bicipitalgrooveseparatesthegreater andlesser Thespinecontinueslaterallyasthecoracoidprocess. Commonextensor origin isthemedialepicondyle. Itprovidesattachmentforbothheadsofbiceps. Direct injuryusuallyproducestransversefractures joint. tubercles. of bothbonesinthedistalthird. 1
UPPER LIMB: QUESTIONS 1.4 Which of these statements best describes the carpus? .a. It is markedly concave from side to side anteriorly ٗ .b. The most commonly fractured bone is the lunate ٗ .c. The scaphoid articulates with the 1st metacarpal ٗ UPPER LIMB: QUESTIONS d. Fracture of the hamate may result in damage to ٗ the median nerve. e. The pisiform is usually the first bone to begin ٗ ossification. 1.5 Which statement most appropriately describes the female breast? .a. It overlies the 3rd to 8th ribs ٗ .b. It consists of 2–3 lobules ٗ -c. It has suspensory ligaments, which tether the der ٗ mis to the fascia of the chest wall. d. The retro-mammary space lies deep to pectoralis ٗ major. .e. The areolar glands are responsible for lactation ٗ 1.6 Which of these statements best describes the pectoral gir- dle and shoulder? .a. The clavicle ossifies in the foetus ٗ -b. The clavicle most commonly fractures at the junc ٗ tion of the medial and middle third. -c. The subscapularis bursa is separate from the cap ٗ sule of the shoulder joint. d. The capsule of the shoulder joint communicates ٗ with the subacromial bursa. e. The short head of biceps lies within the capsule of ٗ the shoulder joint. 1.7 Which of the following is true of the rotator cuff? .a. Teres major is one of its four constituent muscles ٗ b. Infraspinatus is innervated by the suprascapular ٗ nerve. c. Part of its action is to pull the humeral head ٗ superiorly. d. Subscapularis inserts onto the greater tuberosity of ٗ the humerus. .e. It is deficient anteriorly ٗ
2 1.8 When considering the axilla, which of the following statements is accurate? -a. Pectoralis major and minor contribute to the ante ٗ rior wall. .b. The long thoracic nerve runs on the posterior wall ٗ c. Teres minor forms the lower part of the posterior ٗ wall. d. The axillary artery lies anterior to the axillary ٗ sheath. e. The axillary nerve exits through the triangular ٗ space.
1.9 Which of these sentences best describes the elbow joint? ٗ
a. The capitulum articulates with the head of the ulna. UPPER LIMB: QUESTIONS .b. The capsule of the joint attaches to the radius ٗ c. The annular ligament is attached to the ulna, but ٗ not to the radius. .d. The radial nerve is a posterior relation ٗ e. The valgus angle created by the joint is larger in ٗ men than in women.
1.10 Which statement correctly describes the cubital fossa? .a. Its borders are entirely muscular ٗ b. A branch of the musculocutaneous nerve is ٗ found in its floor. .c. The median cubital vein traverses its roof ٗ d. The median nerve lies lateral to the brachial ٗ artery within it. e. The radial nerve lies medial to the tendon of ٗ biceps within it.
3 a. Explanations of latissimusdorsi. cles, andcontainsthelongheadofbicepsattachment b. 1.2 e. c. b. a. Explanations coracobrachialis. arises fromthecoracoidprocessviaaconjointtendonwith capsule initsownsynovialsheath.Theshortheadofbiceps noid tubercleanditstendonrunswithintheshoulderjoint d. 1.1 ANSWERS Thesuprascapularnotchoccursonthesuperiorborderat The lessertuberclehasonefacet,whichprovidesattach- The scapulaoverliesthe2ndto7thribsonposterola- The bodyisrarelyfracturedbecausethemajorityof Thebicipital,orintertuberculargrooveseparatesthetuber- The spinecontinueslaterallyastheacromionprocess, The longheadofbicepstakesoriginfromthesupragle- tus andteresminor. which aretheattachmentsites ofsupraspinatus,infraspina- ment forsubscapularis.Thegreater tuberclehasthreefacets, taneous, morevulnerable,acromion. high-energy injury, andmostfracturesinvolvethesubcu- Fractures ofthescapulabodyarethereforeassociatedwith bone isprotectedbyitsassociationwiththethoracicwall. scapular surfaceiscoveredbystrongmusclesandthe capular nerverunsbelow. notch; thesuprascapulararteryrunsaboveitandsupras- superior transversescapularligamentrunsacrossthis the junctionbetweenitsmedial2/3andlateral1/3.The inous, andlargerinfraspinous,fossa. ula dividestheposteriorsurfaceintoasmallersuprasp- which articulateswiththeclavicle.Thespineofscap- parallel to,thespinousprocessesofthoracicvertebrae. teral aspectofthethorax.Itsmedialborderrunslateral,and 11
UPPER LIMB: ANSWERS ture and classically occurs when falling on the outstretched ture and classically occurs when falling cm proximal to 2–3 hand. This results in a radial fracture displaces posteriorly, the wrist joint. The distal fragment producing a “dinner radially and proximally (impaction), fracture involves volar displace- A Smith’s fork” deformity. common. ment of the distal fragment and is less does articulate with the triangular cartilage, the distal end does articulate with the triangular cartilage, of which forms part of the wrist joint. level. This would duce transverse fractures at the same bones as this is the mostly occur in the middle third of the weakest point. end. The radial styloid is larger and usually projects 1 cm is larger and usually projects 1 end. The radial styloid distal to the ulnar styloid. capitulum for articulation with the head of the radius and with the head of the radius and capitulum for articulation for articulation with the trochlear medially the trochlea notch of the ulna. of the humerus, and separates this from the tubercles. The this from the tubercles. and separates of the humerus, end tubercles at the proximal lies distal to the surgical neck site for fractures. shaft, a common of the humeral lateral epicondyle. aspect of the of both bones by direct trauma will usually pro- Fracture The site of the common extensor origin is the anterior origin is of the common extensor The site with with the trochlea, and the radius The ulna articulates in 2 rows of 4, form the car- The 8 carpal bones, arranged is the commonest form of forearm frac- A Colles fracture at the distal the radius and ulna have a styloid process Both the has two articular surfaces: laterally The distal humerus The ulna does not articulate with any carpal bone, but the head by a groove around neck is formed The anatomical 1.4 a. and concave anteriorly pus. The carpus is convex posteriorly by the shape of the from side to side. This shape is maintained bones and by the pull of the flexor retinaculum. 12 d. e. c. a. 1.3 b. the capitulum. Explanations d. e. c.
UPPER LIMB: ANSWERS e. d. b. a. Explanations weaken withagethebreastbecomesmorependulous. as thesuspensoryligamentsofCooper. Astheseatrophyand fascia overlyingpectoralismajorbyfibrousstrandsknown c. 1.5 e. d. c. b. Explanations The dermisistetheredtothebreastductsanddeep Thescaphoidis oneofthefourproximalboneswrist TheareolarglandsofMontgomeryaremodifiedsebaceous The baseoftheadultfemalebreastconsistentlyoverlies The pisiformbone isasmall,pea-shaped,sesamoidbone Thebreastconsistsof15–20lobules glandulartissue,all The mostcommonlyfracturedboneisthescaphoid.This The retro-mammary spaceislocatedbetweentheposterior The deepbranchoftheulnarnerveiscloselyrelatedto glands locatedbeneaththe areola andareresponsiblefor implants. This spaceiscommonlyexploited intheplacementof capsule ofthebreastand fasciaoverpectoralismajor. which emptyatthenipplevialactiferoussinus. individually drainedbyacorrespondinglactiferousduct, axilla asthe“axillarytail”. lary line.Theupperouterquadrantextendstowardsthe the 2ndto6thribs,fromsternaledgemidaxil- It isthelastcarpalbonetobeginossification. centre usuallydoesnotappearuntiltheageof9–12years. in thetendonofflexorcarpiulnaris.Itsossification ture. Decreasedgripstrengthusuallyensues. hook ofthehamate,andisthreatenedbyahamatefrac- the carpalbonewhicharticulateswith1stmetacarpal. and articulateswiththeradiusproximally. Thetrapeziumis degenerative change. fragment, leadingtoavascularnecrosisandconsequent may thereforeinterruptthebloodsupplytoproximal supply ofthescaphoidentersfromitsdistalend.Afracture with thehandextendedandabducted.Theprincipalblood occurs mostcommonlyasaresultoffallontothepalm, 13
UPPER LIMB: ANSWERS