Practical 2 Worksheet- KEY Upper Extremity BONES 1. Which end of the clavicle is on the lateral side (acromial or sternal)? Acromial 2. Describe the difference in the appearance of the acromial and sternal ends of the clavicle: The acromial end is flattened whereas the sternal end is more rounded/triangular 3. Is the clavicle in your hand a right or left? How can you tell? Compare it to a skeleton! The sternal end is medial, the acromial end is lateral, and there is a distinct bump (conoid tubercle) near the acromial end that projects inferiorly and posteriorly 4. Is the spine of the scapula on its dorsal or ventral surface? Dorsal a. Is the spine closer to the superior or inferior edge of the scapula? Superior 5. Is the glenoid cavity located on the medial or lateral side of the scapula? Lateral a. What bone articulates with the glenoid cavity? Humerus 6. Does the coracoid process face anteriorly or posteriorly? Anteriorly 7. Is the scapula in your hand a right or left? How can you tell? The glenoid cavity faces laterally and the spine projects posteriorly 8. Which of these does not touch the spine of the scapula: Subscapular fossa, infraspinous fossa, supraspinous fossa? a. Just from the names, how can you tell? Supraspinous and infraspinous contain spinous in their names b. Which of the three is largest? Subscapularis c. Which faces ventrally (toward the ribs)? Subscapularis 9. What feature should you look for to tell if you are looking at the lateral or medial border? Look for the glenoid cavity, as it is always faces laterally 10. How is the proximal end of the humerus similar to the proximal end of the femur? It has a spherical head which articulates with a socket, as well as processes for muscle attachment. a. How are they different in terms of naming? The processes for muscle attachment are called tubercles in the humerus and trochanters in the femur 1
b. How are they different in terms of anatomy? In the humerus, the neck is less pronounced and the tubercles are smaller than the trochanters 11. (Looking ahead) What three muscles insert on the intertubercular sulcus? Pectoralis major, latissimus dorsi, teres major a. Why is a good mneumonic for these three muscles: PLT? First letter of each muscle b. What function do these three PLT muscles have in common? Adduction of humerus 12. Would you expect more muscles to insert on the greater tubercle or the lesser tubercle? Why? Greater tubercle: because it is larger and more accessible from multiple directions 13. How can you tell the medial side from the lateral side of the humerus? The spherical head projects medially; also the medial epicondyle is larger than the lateral epicondyle 14. While hard to find, is the deltoid tuberosity located on the lateral or medial sided of the humeral shaft? Lateral 15. Of these distal humeral features: capitulum, trochlea, olecranon fossa, radial fossa, & coronoid fossa a. Which four are visible on the anterior side? Capitulum, trochlea, radial fossa, coronoid fossa b. Which two are visible on the posterior side? Olecranon fossa, trochlea 16. Other than it is found on the medial side, what differentiates the medial epicondyle from the lateral epicondyle? It is larger and more pronounced. a. Can you palpate (feel) each of these epicondyles on your own arm? Yes 17. What feature most clearly distinguishes the ulna? Trochlear notch ( C - shaped scoop) a. Is that feature at the proximal or distal end? Proximal 18. What feature most clearly distinguishes the radius? Round, flattened head a. Is that feature at the proximal or distal end? Proximal 2
19. What two specific features (not the whole bone) does the head of the radius articulate with? Capitulum (on humerus), radial fossa (during flexion), and the radial notch (on proximal end of the ulna) 20. When is the head of the radius in (or closest to) the radial fossa: during elbow extension or elbow flexion? Flexion 21. When is the olecranon process in (or closest to) the olecranon fossa: during elbow extension or elbow flexion? Extension 22. When is the coronoid process in (or closest to) the coronoid fossa: during elbow extension or elbow flexion? Flexion 23. Which portion of the humerus articulates with the trochlear notch? Trochlea 24. Is the radial notch on the proximal or distal end of the ulna? Proximal a. Is the radial notch on the lateral or medial side? Why? Lateral: because that is where the radius is with respect to the ulna 25. What do you think the purpose of the radial tuberosity is? Muscle attachment (biceps brachii) 26. Where is the styloid process of the radius found: proximal or distal end? a. Can you palpate it on your own arm? Yes 27. What bone is the ulnar notch found on? Radius a. Proximal or distal end? b. Medial or lateral side? 28. Is the styloid process of the ulna closer to the thumb or the pinkie? 29. How are the bones of the hand similar to the bones of the feet? Several short, irregularly- shaped bones in the ankle resembles those in the wrist. Five small long bones in the sole of the foot, resembling those in the palm. Five phalanges in both the foot and hand, composed of the same bone number and structure. a. How are they different (in terms of naming)? Tarsals vs carpals; metatarsals vs metacarpals b. How are they different (in terms of anatomy)? 7 tarsals vs 8 carpals, tarsals of foot are larger (esp. calcaneus & talus) 3
Muscles of the Shoulder 30. Why are the rotator cuff muscles called cuff? They surround and protect the shoulder joint, much like a cuff protects the end of a garment sleeve 31. Identify the four rotator cuff muscles: Supraspinatus, infraspinatus, subscapularis, teres minor a. How do their names help you identify the origin of three of these muscles? Except for teres minor, each muscle name contains part of the name of the bony structure it attach to b. Three of these muscles insert on which bone feature? Greater tubercle c. Where does the other insert? Lesser tubercle 32. What is the insertion of teres major? Intertubercular sulcus a. What other two muscles share this insertion? Pectoralis major & latissimus dorsi b. What is an action of all three of these muscles? Adduction of humerus 33. The rhomboids (major & minor) and serratus anterior all insert where? Medial border of scapula a. What is the action of each muscle? Rhomboids: adduction of scapula Serratus anterior: protraction of scapula b. How do you explain the difference in action if all have the same insertion? They have different origins 34. Why is serratus anterior called serratus? Jagged (serrated) appearance to the muscle as it attaches to the ribs anteriorly 35. Explain why the trapezius can cause so many different movements of the scapula. It has origins along the majority of the vertebral column, including superior and inferior to the scapula. The trapezius action on the scapula depends on the angle of the specific muscle fibers 4
Use the diagrams below to answer the following questions (#36-39) 36. Which of these (A- D) shows flexion of the shoulder? D a. Which muscle is primarily responsible for shoulder flexion? Pectoralis major 37. Which of these (A- D) shows ABduction of the shoulder? B a. Which muscle is primarily responsible for this action? Deltoid 38. Which of these (A- D) shows extension/hyperextension of the shoulder? C 39. What action is shown in A? Adduction of humerus a. What four muscles contribute to this action? Latissimus dorsi, pectoralis major, teres major, coracobrachialis 40. Describe how pectoralis minor is different from pectoralis major in terms of: a. Size: Smaller b. Location: Deeper c. Insertion: On scapula rather than humerus d. Action: Acts on scapula (protraction) rather than humerus Muscles of the Arm 41. The root word brachii is found in many muscles. What do all of these - brachi- muscles have in common? Attach to, cross, and/or move the humerus bone 42. Are the triceps brachii muscles found on the anterior or posterior side of the arm? 5
43. Why is anatomical position important when naming the lateral and medial heads of triceps brachii? Because the muscles are specifically named for their locations in the anatomical position 44. Why is the long head of triceps brachii long? It is the longest muscle of the triceps brachii group, as it passes from the ulna to the scapula a. What muscles does it pass between on its proximal end? Teres major and teres minor 45. All three heads of the triceps brachii insert where? Olecranon process of ulna a. All have what action? Extend elbow 46. Which is more superficial: biceps brachii or brachialis? a. Both muscles have what action? Flex elbow 47. Can you see brachialis even without removing biceps brachii? Yes 48. Knowing its function, which bone(s) would you expect the brachialis to insert on? Radius (although ulna is also logical) a. Would its insertion be more like to be on the anterior or posterior side of the forearm? Why? Anterior, so when it pulls on the radius the elbow flexes 49. Describe how the name of coracobrachialis tells you its specific origin and insertion. Coraco refers to coracoid process (origin) and brachi refers to humerus (insertion) 50. Describe the elbow actions shown in this figure: A: Flexion B: Extension 6
Muscles of the Forearm & Hand 51. Is the cubital fossa found on the anterior or posterior side of the arm? a. What common medical procedures use the cubital fossa? Withdraw blood, blood pressure measurement b. The tendon of which muscle can be palpated in the cubital fossa? Biceps brachii c. What muscle is found just lateral to the cubital fossa? Brachioradialis d. What muscle is found just medial to the cubital fossa? Pronator teres 52. Is the palm of the hand found on the anterior or posterior side? 53. Almost all the muscles on the palmar side of the forearm have what common function? Flexion (of wrist or digits) 54. Almost all the muscles on the dorsal/posterior side of the forearm have what common function? Extension (of wrist or digits) 55. Which bone acts as a landmark along the medial side of the forearm? Ulna a. Is this bone on the pinky side or thumb side? 56. All muscles with pollicis in their name act on which body part? Thumb 57. All muscles with digitorum or digiti in their name act on which body parts? Fingers 58. All muscles with carpi in their name act on which body part? Wrist a. What bones have a similar name? Carpals 59. Muscles originating from the medial epicondyle have what function in common? Flexion of wrist a. Based on that action, are these muscles found on the anterior or posterior side of the forearm? 60. Muscles originating from the lateral epicondyle have what function in common? Extension of wrist a. Based on that action, are these muscles found on the anterior or posterior side of the forearm? 61. What is the primary difference between extensor carpi radialis longus and extensor carpi radialis brevis? Length: longus originates more proximally on the humerus 62. What two muscles contribute to ulnar deviation? 7
Flexor carpi ulnaris and extensor carpi ulnaris a. Would another name for ulnar deviation be wrist adduction or wrist abduction? 63. Is flexor digitorum superficialis the most superficial muscle of the forearm? No a. Why is called superficialis? It is the more superficial finger flexor (profundus being the deeper one) 64. The only muscle on the anterior side of the forearm that inserts on the thumb is the: Flexor pollicis longus 65. Is the pronator quadratus found at the proximal or distal end of the forearm? 66. What two muscles contribute to supination? Supinator and biceps brachii Use these figures to answer the following questions (#67-74): 67. Which of the above (A- F) shows ulnar deviation? E 68. Which of the above (A- F) shows supination? B 69. Which of the above (A- F) shows wrist flexion? C 70. Which of the above (A- F) shows pronation? A 71. Which of the above (A- F) shows wrist extension? D 72. Which of the above (A- F) shows radial deviation? F 73. Most of the muscles that accomplish action C originate from which bony feature? Medial epicondyle of humerus 74. Most of the muscles that accomplish action D originate from which bony feature? Lateral epicondyle of humerus 75. Briefly describe where the abductor pollicis longus is located compared to extensor digitorum and extensor carpi radialis brevis. It emerges between the two muscles and inserts at the base of the thumb. 76. Put these four muscles in order from lateral to medial: abductor pollicis longus, extensor indicis, extensor pollicis longus, extensor pollicis brevis Abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, extensor indicis 8
a. Which two of these muscles can be seen without removing superficial muscles? Abductor pollicis longus and extensor pollicis brevis 77. The tendon of which muscle passes superficial to the flexor retinaculum? Palmaris longus 78. Why are the thenar group and abductor digiti minimi called intrinsic muscles? They act on and are found within the hand a. What is an example of an extrinsic muscle? Muscles that act on the fingers but are not found in the hand: any muscle in the forearm with pollicis or digitorum in its name 79. In anatomical position, does abductor digiti minimi move the pinky toward the midline of the body or away from it? a. So why is it called abductor digiti minimi? Abducts the pinky with respect to the midline of the hand 9