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Year 2 Loco > 2. Review of the upper limb > Flashcards

2. Review of the upper limb Flashcards

1
Q

What are the bones of the shoulder?

A

Clavicle
Scapula
Humerus

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2
Q

What are the joints of the shoulder?

A

Glenohumeral
Sternoclavular
Acromoclavicular

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3
Q

What is the pectoral girdle?

A

Consists of the clavicle and the scapula

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4
Q

What provides strength to the glenohumeral joint and allows movement?

A

Muscles provide the strength rather than ligaments

These also allow for wide range of movement e.g. rotator cuff muscles

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5
Q

What is the role of the rotator cuff muscles in movement of the glenohumeral joint?

A

Rotator cuff muscles are tonically active to pull the head of the humerus into the glenoid cavity to provide stability upon movement

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6
Q

What is the blood supply of the upper limb?

A

Subclavian artery
Axillary artery
Brachial artery
Profunda brachii artery branch to the posterior compartment of arm and triceps

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7
Q

What are the veins of the upper limb?

A

Deep veins parallel the arteries

Superficial veins are the cephalic, basilic and median cubital veins

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8
Q

Draw out the brachial plexus

A

Draw out the brachial plexus

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9
Q

What are the nerve roots of the musculocutaneous nerve?

A

C5, C6, C7

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10
Q

What are the nerve roots of the median nerve?

A

C5, C6, C7, C8, T1

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11
Q

What are the nerve roots of the radial nerve?

A

C5, C6, C7, C8, T1

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12
Q

What are the nerve roots of the axillary nerve?

A

C5, C6, C7, C8, T1

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13
Q

What are the nerve roots of the ulnar nerve?

A

C8, T1, occasionally C7

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14
Q

What does the musculocutaneous nerve innervate?

A

Innervates the anterior compartment of the arm i.e. the biceps

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15
Q

What does the median nerve innervate?

A

Innervates the anterior compartment of the forearm (passes through the carpal tunnel)
(two exceptions - done by the ulnar)

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16
Q

What does the radial nerve innervate?

A

Posterior compartment of the arm (triceps) and posterior compartment of forearm (extension of digits)

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17
Q

What does the axillary nerve innervate?

A

Deltoids
Teres minor
Axilla

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18
Q

What does the ulnar nerve innervate?

A

Flexor carpi ulnaris and flexor digitorum profundus (the two exceptions from the anterior compartment of the arm)
Also the muscles of the little finger

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19
Q

Are the nerves of the brachial plexus sensory or motor?

A

They are mixed motor and sensory

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20
Q

What are the two main clinical conditions that can occur at the shoulder?

A

Break/fracture of the clavicle

Dislocated shoulder

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21
Q

How does a break/fracture of the clavicle occur?

A

Can occur by direct or indirect force
Direct - something falls onto the shoulder or hits the front of the pectoral girdle
Indirect - person falls forwards and puts their hands out to catch their fall - force travels up the upper limb to the shoulder

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22
Q

What is the clinical significance of a fracture to the clavicle?

A

All of the arteries to the upper limb pass under the clavicle and so a fracture can result in an obstruction of the blood flow

If there is a lack of sensation of the arm or an absence of pulses - the blood supply is being cut off and this is a medical emergency

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23
Q

How will a fracture to the clavicle present?

A

Shoulder droops down
Reduced width of shoulder

The shoulder of the broken clavicle will drop due to gravity pulling down on the limb (generally)
Should notice a reduced width of the shoulder in which the clavicle is fractured

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24
Q

What is the clinical significance of a dislocated shoulder?

A

Dislocation of the glenohumeral joint is the most common

Reoccurence rate from minor trauma is very very high e.g. sleeping funny can dislocate it again

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25
Q

How will a dislocated shoulder present?

A

Lose the rounded profile of the shoulder
Square appearance of the shoulder
The acromion becomes more prominent and visible

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26
Q

What are the two main clinical conditions that can occur at the shoulder?

A

Break/fracture of the clavicle

Dislocated shoulder

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27
Q

How does a break/fracture of the clavicle occur?

A

Can occur by direct or indirect force
Direct - something falls onto the shoulder or hits the front of the pectoral girdle
Indirect - person falls forwards and puts their hands out to catch their fall - force travels up the upper limb to the shoulder

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28
Q

What is the clinical significance of a fracture to the clavicle?

A

All of the arteries to the upper limb pass under the clavicle and so a fracture can result in an obstruction of the blood flow

If there is a lack of sensation of the arm or an absence of pulses - the blood supply is being cut off and this is a medical emergency

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29
Q

How will a fracture to the clavicle present?

A

The shoulder of the broken clavicle will drop due to gravity pulling down on the limb (generally - some may hold their shoulder up)

Should notice a reduced width of the shoulder in which the clavicle is fractured

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30
Q

What is the most common joint to dislocate?

A

Dislocation of the glenohumeral joint is the most common

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31
Q

How will a dislocated shoulder present?

A

Lose the rounded profile of the shoulder

The weight of the arm will pull the humerus, forearm and hand inferiorly - all dragged down

Stretching of the deltoid muscle - square appearance of the shoulder

Acromium becomes more visible - usually hidden by the deltoid

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32
Q

What is important about the reoccurrence rate of a glenohumeral dislocation?

A

Reoccurrence rate from minor trauma is very very high e.g. sleeping funny can dislocate it again

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33
Q

What nerve is at greatest risk of damage from a glenohumeral fracture and why?

A

Axillary nerve

Runs just underneath the GH joint

34
Q

What is the recurrence of a glenohumeral dislocation?

A

50-89%

35
Q

What is the most common direction of a glenohumeral dislocation and why?

A

Anterior dislocation because the posterior aspect is protected by three rotator cuff muscles (supra, infra and teres minor at a common tendon insertion) and the scapula and the acromium

BUT the posterior aspect is only protected by the subscapularis muscle

36
Q

What does the axillary nerve innervate and what is the function?

A

Deltoid muscle

Abduction of the arm

37
Q

What will damage to the axillary nerve result in?

A

Paralysis of the deltoid muscle - weak abduction of the arm

Loss of sensation in a small area of skin covering the central region of the deltoid

38
Q

How can damage to the deltoid be treated?

A

Replace the deltoid with the pectoralis major - has a different nerve supply so can be used instead

39
Q

What nerve is responsible for winging of the scapula?

A

Winging of the scapula indicates damage to the long thoracic nerve

40
Q

What does the long thoracic nerve innervate?

A

The serratus anterior muscle

41
Q

Where does the long thoracic nerve come from?

A

Comes from the brachial nerve

42
Q

What does damage to the long thoracic nerve result in?

A

Loss of serratus anterior movement - do not have the full range of movement of the scapula - only have the trapezius

Winging of the scapula presentation

43
Q

What does the thoracodorsal nerve innervate?

A

Latissimus dorsi

44
Q

Which nerves can be damaged in an axillary node clearance and which of these is the most important?

A

Long thoracic nerve
Thoracodorsal nerve

Most important to not damage the long thoracic nerve

45
Q

What is the trapezius muscle innervated by?

A

Spinal accessory nerve - cranial nerve

46
Q

What does damage to the spinal accessory nerve result in?

How will this present?

A

Spinal accessory innervates the trapezius muscle
Damage leads to drop of shoulder (trap acts to keep the shoulder elevated from gravity)

Presents as a much milder form of winging of the scapula

47
Q

What are the joints at the elbow?

A

Humeroulnar joint
Humeroradial joint
Proximal radioulnar joint

48
Q

What are the compartments of the arm?

A

Anterior and posterior

49
Q

What are the arteries and nerves in the anterior compartment of the arm?

A

Brachial artery

Median, musculocutaneous and ulnar nerves

50
Q

What are the arteries and nerves in the posterior compartment of the arm?

A

Profunda brachiii artery (deep artery of the arm)

Radial nerve

51
Q

What nerve is at risk from a midshaft humeral fracture and how will this present?

A

Radial nerve

Wrist drop

52
Q

Which nerve is at risk from a supracondylar fracture and how will this present?

A

Median nerve

Hand of Bennidiction

53
Q

What is the serratus anterior muscle innervated by?

A

Long thoracic nerve

54
Q

What is the latissimus dorsi muscle innervated by?

A

Thoracodorsal nerves

55
Q

What nerve is at the medial epicondyle?

A

Ulnar nerve

56
Q

What are the different compartments of the forearm?

A

Anterior

Posterior

57
Q

What is found the anterior compartment of the forearm?

A 
Flexors of the hand 
Pronators 
Median nerve - carpal tunnel 
Ulnar nerve 
Radial artery 
Ulnar artery
58
Q

What is found in the posterior compartment of the forearm?

A

Extensors of the hand
Supinators
Radial nerve
Posterior interosseus artery

59
Q

Where does the posterior interosseus artery come from?

A

This is a branch from the ulnar artery

60
Q

What is Colles’ fracture?

A

Fracture of the wrist - fracture of the distal radius within 2cm of the most distal end

61
Q

What is a Colles’ like fracture?

A

If the fracture involves the ulnar too

62
Q

What nerve innervates the thenar muscle group?

A

Median nerve through the carpal tunnel

63
Q

What is the group of muscles that moves the middle finger called?

A

The hypothenar muscles

64
Q

What are the three nerve terminations of the hand?

A

Median nerve
Radial nerve
Ulnar nerve

65
Q

Superficial veins of the arm - which is medial and which is lateral?

A

Cephalic - lateral

Basilic - medial

66
Q

Vein joining the cephalic and basilic veins is?

A

Median cubital vein

67
Q

Square appearance of the shoulder - fracture clavicle or shoulder dislocation?

A

Shoulder dislocation

68
Q

Acromion more visible at the shoulder - fractured clavicle or shoulder dislocation?

A

Shoulder dislocation

69
Q

Which looks visibly more severe - fracture clavicle or shoulder dislocation?

A

Shoulder dislocation

70
Q

Which nerve is at risk of injury from shoulder dislocation?

A

Axillary nerve

71
Q

Fracture of clavicle/shoulder dislocation - which is a medical emergency and why?

A

Fractured clavicle

Loss of all peripheral pulses can occur

72
Q

Damage to the deltoid muscle - the deltoid can be replaced with which muscle?

A

Pectoralis major

73
Q

Anterior or posterior dislocation of shoulder more common?

A

Anterior

74
Q

Damage to the spinal accessory nerve presents as?

A

Loss of function of trapezius - drooping shoulder

75
Q

Dislocation of the elbow can damage which artery and which nerve?

A

Ulnar artery and ulnar nerve

76
Q

Radial head fits into which ligament?

A

Anular ligament

77
Q

Anular ligament also referred to as?

A

Anular ligament of the radial head

78
Q

Colles’ fracture has what presentation?

A

Dinner fork deformity

79
Q

Why is subluxation of the radial head common in children?

A

Radial head is much larger than the anular ligament into which it fits at this age

80
Q

Colles’ fracture will only be visible on what x-ray view?

A

Lateral (rather than AP)

81
Q

‘Dorsal’ displacement means anterior or posterior displacement?

A

Posterior

82
Q

Why might a scaphoid fracture go undiagnosed and why should you wait 7-10 days to x-ray again?

A

The healing of the fracture is what is visible on the x-ray and this will not be apparent until 7-10 days later

Year 2 Loco (31 decks)

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