SHOULDER OSTEOLOGY & ARTHROLOGY

1. Full elevation of the upper limb in the scapular plane requires the coordinated
movement of the clavicle, scapula, and the humerus. List the normal movements of
the clavicle and scapular during scapular plane aBduction.

2. Name the three anatomical joints, in order from most to least, that contribute to full
range of upper limb aBduction.

3. Explain what is meant by “conjunct rotation of the clavicle” during upper limb
elevation in the scapular plane. What is the benefit of this?

4. a. What is the most common mechanism of fracture of the clavicle and the most
common location of the fracture?
b. Describe and explain the resulting deformity.

5. a. What is the most common mechanism of acromioclavicular joint (ACJ) dislocation?

b. Describe and explain the resulting deformity.

6. a. Which structures are the primary stabilisers of the glenohumeral joint (GHJ) in
anatomical position?
b. Which structures are the primary stabilisers of the GHJ through range of
movement?
c. Which structures stabilise the GHJ in a position of aBduction & external
rotation?

7. What is the most common mechanism and most common direction of glenohumeral
joint (GHJ) dislocation?
SHOULDER MUSCLE & NEUROVASCULATURE
1. Full elevation of the upper limb in the scapular plane requires the coordinated
movement of the clavicle, scapula, and the humerus. List the normal movements of
the clavicle and the scapular during scapular plane aBduction. For each movement,
indicate the main structures that produce the movement.

2. What evidence exists that supports the argument that the middle deltoid and the
muscles of the rotator cuff work together throughout the range of full upper limb
aBduction?

3. a. What is the normal acromiohumeral distance on an anterior-posterior x-ray in

standing?
b. Name two (2) structures located in the subacromial space.
c. How is the reduction in this space minimised during upper limb aBduction?

4. Why is it important for the rotator cuff to work with middle deltoid during upper
limb aBduction from anatomical position?

5. a. What is a dermatome? Provide details of one dermatome test in the upper limb.
b. What is a myotome? Provide details of one myotome test in the upper limb.
c. Why are skeletal muscles usually innervated by several spinal levels? Give an
example.

6. The brachial plexus innervates muscles of the pectoral girdle and upper limb.
Describe the location of the specific parts of the brachial plexus relative to other
anatomical structures.

7. The brachial plexus innervates muscles of the pectoral girdle and upper limb.
a. Which spinal levels contribute to the brachial plexus?
b. Describe the general pattern of spinal level innervation to the muscles of the
pectoral girdle and upper limb. Provide four (4) specific examples (muscle name and
spinal level innervation) in your answer.
ARM, ELBOW & FOREARM REGION
1. a. What are the normal ranges of movements for elbow flexion and extension and
forearm pronation and supination?
b. What ranges of flexion – extension and pronation – supination are required to
accomplish most activities of daily living?

2. Describe the passive stability of the elbow hinge joint (humeroulnar and
humeroradial joints).

3. a. Regarding joint stability, what is a primary constraint?

b. Regarding joint stability, what is a secondary constraint?
c. The elbow joint complex is exposed to high valgus forces during activities of daily
living. What is a valgus force?
d. Name the two (2) PRIMARY PASSIVE constraints against elbow valgus.
e. Name one (1) SECONDARY PASSIVE constraint and one (1) SECONDARY ACTIVE
constraint against elbow valgus.

4. a. Which three (3) muscles are the main flexors of the elbow?
b. What makes them the main elbow flexors?
c. What is the optimal position for elbow flexor strength? Explain why.

5. Describe the structure and stability of the distal radioulnar joint (DRUJ).

6. a. Describe the relative distribution of force transmission from the hand to the two
bones of the forearm.
b. Describe how the position of the elbow and forearm affects load transmission
from the forearm to the humerus.

7. a. What are the margins of the cubital fossa?

b. What are the palpable structures in the cubital fossa from lateral to medial?

8. Describe the course of the median nerve through the forearm. Indicate its main
branches and their sensory and/or motor innervation.

9. Cubital tunnel syndrome is the second most common chronic compression

neuropathy in the upper limb.
a. Which anatomical structures form the floor, ceiling, and walls of the cubital
tunnel?
b. What travels through the cubital tunnel and what sensory and motor deficits
would you expect to see resulting from compression of this structure?

10. Describe the pathway of the radial nerve and its main branches through the arm and
forearm. Indicate the structures innervated by each branch.
WRIST & HAND
1. Describe the stability of the radiocarpal joint (RCJ).

2. Describe the typical carpal bone deformity and alteration in loading that occurs
secondary to wrist ligament instability.

3. What is scapholunate dissociation and what are the consequences for wrist
function?

4. a. Describe the structure of the first carpometacarpal (1st CMC) joint.

b. Explain how the first carpometacarpal (1st CMC) joint is stabilised during pinch
grip.

5. Compare the mobility of the carpometacarpal (CMC) joints with the

metacarpophalangeal (MCP) joints.

6. a. What are the boundaries of the carpal tunnel?

b. What are the contents of the carpal tunnel?
c. Describe and explain the likely sensory changes resulting from sustained increased
pressure within the carpal tunnel (as in carpal tunnel syndrome).
d. Describe and explain the likely muscle weakness resulting from sustained
increased pressure within the carpal tunnel (as in carpal tunnel syndrome).

7. Many muscles cross the wrist however there are five dedicated wrist muscles which
act to move and/or stabilise the wrist.
a. Name these five muscles, state their distal attachments.
b. Describe how we use the combined actions of these muscles to perform wrist
movements.

8. a. Describe the proximal attachments, location of muscle bellies, tendon pathway

and insertion of flexor digitorum superficialis and flexor digitorum profundus.
b. Explain the difference in their action at the elbow joint.
c. Explain the difference in their action on the digits.

9. Describe and explain the action of the lumbrical muscles.

10. Describe the differences in the patterns of spinal nerve versus peripheral nerve
sensory innervation of the palmar and dorsal aspect of the hand.