ADSL4-ws Back-Upper Limb PDF

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ANAT20006

Principles of Human Structure

Anatomy Directed Self Learning

Worksheet for ADSL #4 – Back and Upper Limb This worksheet should be used alongside the ADSL online pages – go to ADSL Tutorials in LMS.

Learning Objectives Back • Organization of the vertebral column, and normal curvatures • Basic structure of a typical vertebra • Vertebral canal and intervertebral foramen (walls and contents) • Joints of the back, and classification of back muscles Upper Limb • Organization of the upper limb, in relation to embryonic mesoderm and limb buds • Bones and joints of the upper limb • Muscles and fascia of upper limb – from back, from scapula, anterior and posterior compartments • Nerve supply – brachial plexus, and distributions of major upper limb nerves • Basic vascular anatomy of the upper limb After you have worked through this tutorial, check your learning with the fourth ADSL Online Test in the LMS. This Test has 10 MCQs. Copyright Notice - Images in these pages have been provided to you pursuant to section 49 of the Copyright Act 1968 (the Act) for the purposes of research or study. The contents of the material may be subject to copyright protection under the Act. Further dealings by you with this material may be a copyright infringement. To determine whether such a communication would be an infringement, it is necessary to have regard to the criteria set out in Part 3, Division 3 of the Act. Suggested Resources – in addition to Lectures Anatomedia e-learning – Back and Upper Limb modules. Eizenberg, Briggs et al. Online via LMS, with UniMelb login ... or on computers in the Museum.

Drake et al. (3e, 2014) Gray's Anatomy for Students, Elsevier, ISBN 9780702051319. Moore et al. (7e, 2013) Clinically Oriented Anatomy, LWW, ISBN 9781469830063 . Morton et al. (2011) Big Picture: Gross Anatomy, McGraw-Hill. http://accessmedicine.mhmedical.com.ezp.lib.unimelb. edu.au/book.aspx?bookid=381

 Label the vertebral column regions, and identify the curvatures. At what age do the secondary curvatures typically become established? Explain terms used for spinal curvature ... Lordosis : Kyphosis : Scoliosis :

University of Melbourne

Anatomy & Neuroscience

rev. 2014-07

ADSL Worksheet

2

#4 Back & Upper Limb

Label the components of this typical (lumbar) vertebra. Adapted from Netter Atlas of Human Anatomy. ISBN 1416059512

Within the vertebral canal are the spinal cord and cauda equina. Name the layers of the meninges, in order. What spaces are there between adjacent layers of meninges, and what do they contain?

Vertebral canal contents: label ... epidural space dura mater arachnoid mater subarachnoid space extradural veins

Anatomedia CAL– Back > Regions > Vertebral Column

List the structures that encircle an intervertebral foramen.

What are the contents of an intervertebral foramen? Abnormalities in any of the encircling structures may make the foramen narrower, and irritate or compress the contents. What are the likely consequences of this abnormality?

Vertebral Joints Intervertebral Discs – identify these parts of a disc. Describe the composition and the role of each. 1. 2.

How does posture influence the forces on an intervertebral disc?

University of Melbourne

Anatomy & Neuroscience

rev. 2014-07

3

ADSL Worksheet

#4 Back & Upper Limb

What happens to the disc when a heavy load is lifted?

What occurs in an intervertebral disc prolapse? Also called herniation.

What structures does IV disc prolapse endanger?

Synovial Joints – What posterior parts of a vertebra have articular surfaces? What is the name of these vertebral synovial joints ? What is the orientation of facets in most thoracic vertebrae, and thus what movements do they permit?

What is the orientation of facets in most lumbar vertebrae, and what movements do they permit?

An Overview of Back Muscles Extrinsic back muscles are superficial. Intrinsic muscles are deep. Two groups of intrinsic back muscles are erector spinae muscles and transversospinales muscles. When you bend over to pick up an object, which part of this action involves mainly concentric contractions of erector spinae and which requires eccentric contractions?

What is the primary function of the transversospinales?

 Basic Organisation of the Upper Limb Name the principal long bone of the upper limb. What types of joints are immediately proximal and distal to it?

Name the paired long bones of the upper limb. What movements occur between them, and at which joints do the movements take place? rd

Upper Limb Bud Development – revises 3 ADSL Tutorial. Does the limb rotation bring the pre-axial border to the radial or ulnar side? Does the post-axial border contain the more rostral or more caudal dermatomes? How does rotation of the developing limb affect the location of upper limb muscle compartments?

University of Melbourne

Anatomy & Neuroscience

rev. 2014-07

ADSL Worksheet

4

#4 Back & Upper Limb

Upper Limb Skeleton Label these bone landmarks ... Shoulder girdle: 1. Spine of scapula 2. Glenoid fossa 3. Acromion process 4. Acromioclavicular joint 5. Sternal end of clavicle Humerus: 6. Head of humerus 7. Anatomical neck of humerus 8. Surgical neck of humerus 9. Medial epicondyle 10. Trochlea Radius, Ulna, Hand: 11. Olecranon process of ulna 12. Head of radius 13. Radial tuberosity 14. Scaphoid bone 15. 1st metacarpal Anatomedia – U.Limb > Systems > Skeletal

Name two vulnerable sites (bones) where a fracture often occurs with a fall on the outstretched hand.

Upper Limb Joints Indicate above where the sternoclavicular joint would be if the sternum were shown. What movements of the clavicle occur at this joint? What are the features of articular surfaces in the gleno-humeral joint that permit a great range of motion?

ADSL 2 emphasised that synovial joints represent a trade-off between stability and mobility. What structures are responsible for stability at the shoulder joint?

In what direction does the shoulder tend to dislocate? What structure does this endanger?

Elbow joint is a hinge joint. Label the articular surfaces in the elbow; and the epicondyles. Label the superior radioulnar joint. ← Netter Atlas of Human Anatomy. ISBN 1416059512

University of Melbourne

Anatomy & Neuroscience

rev. 2014-07

5

ADSL Worksheet

#4 Back & Upper Limb

What types of ligaments are associated with hinge joints? What are the attachments of these ligaments at the elbow? What is the relationship between the proximal radioulnar joint and the elbow joint?

Joints in the hand ... label the mid-carpal joint. Label a metacarpal bone and 3 phalanges in one finger. Then label the more distal synovial joints.

What movements occur at the interphalangeal joints? The carpometacarpal joint of the thumb is a saddle joint, and this is important for opposition of the thumb. What movements occur at this joint, and how do they differ from movements at the other CMC joints?

Integrated limb movement ... When you grasp a small food item and bring it up to your mouth, what combinations of movements at your upper limb joints enable this?

 Muscles from Thorax and Back Identify muscle 1 in this dissection. Muscle 2 in this image inserts into the humerus. Which muscle is it? Structure 3 is one of a series of segmental structures – what is it? “RhMa” is the rhomboid major muscle which retracts the scapula. Which of these muscles is used to shrug your shoulders?

Anatomedia - Back > Dissection > frame 8 University of Melbourne

Anatomy & Neuroscience

rev. 2014-07

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ADSL Worksheet

#4 Back & Upper Limb

Which muscle extends the shoulder (e.g. pulling on a rope)? What are the actions of pectoralis major (anterior thorax)? List several activities that depend on pec major.

Shoulder and Arm Scapular Muscles – includes deltoid and teres major. List the individual rotator cuff muscles. What is the functional role of the rotator cuff muscles? What is the prime mover action of supraspinatus and deltoid? Arm Muscles – act at the elbow ... opposing flexor and extensor compartments. Name the muscles in the anterior compartment. Name the major muscle of the posterior compartment. Forearm Muscle Compartments A number of anterior compartment muscles share the common flexor origin – where is this attachment? This compartment has 3 layers ... all muscles in the superficial layer originate from the CFO, while none of the deep layer muscles use the CFO. Identify these 3 flexor muscles. What layer are they in?

The posterior compartment has a superficial layer of muscles that arise from the common extensor origin – where is this? The posterior deep muscles do not come from the CEO. Know Your Upper Limb Muscles Do the interactive matching task in the online Tutorial, page 3. List the main action of each of these:

Serratus anterior

Levator scapulae

Supraspinatus

Triceps brachii

Extensor carpi radialis

Extensor pollicis longus

Flexor digitorum superficialis

Some Hand Anatomy What is the flexor retinaculum ? Name 2 structures that pass deep to the flexor retinaculum, and 2 that pass superficial to it. Which structure passing through the carpal tunnel is most susceptible to compression injury?

University of Melbourne

Anatomy & Neuroscience

rev. 2014-07

7

ADSL Worksheet

#4 Back & Upper Limb

Know what the terms thenar eminence and hypothenar eminence refer to. From the anatomical position, finger flexion is an anterior movement of the fingertip. If instead the thumb moves anteriorly, is this flexion or abduction?

 ! Nerves of the Upper Limb Brachial Plexus This is an anterior view of the right brachial plexus. Label the nerve roots (nearer the spinal cord). Label upper, middle and lower trunks. Label the 3 posterior and 3 anterior divisions. Label the lateral, posterior and medial cords. Label the 5 terminal branches. Posterior cord divides into axillary nerve and radial nerve (larger). Musculocutaneous nerve is a continuation of the lateral cord. Ulnar nerve is a continuation of the medial cord. Median nerve comes from both lateral and medial cords. Image from Anatomedia – Upper Limbs > Systems

Nerve Distributions Name the nerve supply for each of these:

Deltoid

Biceps brachii

Flexor carpi radialis

Triceps brachii

Extensor carpi ulnaris Small hand muscles that abduct or adduct fingers

Map the cutaneous distributions of the median, ulnar and radial nerves in the hand. You should understand why these regions are not the same as dermatomes.

Label dermatomes: C4, C5, C6, C7, C8, T1, and T2.

Why do the dermatomes on the anterior thorax “jump” from C4 to T2?

University of Melbourne

Anatomy & Neuroscience

rev. 2014-07

ADSL Worksheet

8

#4 Back & Upper Limb

Vessels of the Upper Limb

Label the major blood vessels in the upper limb.

adapted from McKinnon & Morris (1986) Oxford Textbook of Functional Anatomy. ISBN 019262816X

What are venae comitantes, and what do they typically accompany?

Why is the brachial artery the usual location for blood pressure measurement?

Lymph Vessels and Lymph Nodes What is the ultimate destination of lymph from the upper limb?

It is sometimes necessary to surgically remove the axillary lymph nodes (e.g. when a cancer spreads). What complication may occur in the upper limb following removal of the axillary lymph nodes?

University of Melbourne

Anatomy & Neuroscience

rev. 2014-07...