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MRCS Anatomy COPY > Upper Limb > Flashcards

Upper Limb Flashcards

1
Q

Name the key bony landmarks of the bones of the upper limb

A

See diagram

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2
Q

What passes in the radial groove of the humerus?

A

Radial nerve + Profunda brachii artery

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3
Q

How many carpal bones are there? and what are the names?

A

There are 8 - First four proximal row, next four in the distal row

Some lovers try positions that they cant handle

Scaphoid, lunate, triquetrum, pisiform = Proximal row

Trapexium, trapezois, capitate, hamat = Distal row

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4
Q

Anatomy of the key superficial veins of the upper limb

A

Cephalic vein = Lateral

Basilic vein = Medial

Median cubital = Joins these in antecubital fossa

Basilic vein joins the rbachial vein to form the axillary vein

Then cephalic drains into axillary after it pierces between deltoid and pec major

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5
Q

Dermatomes of the upper limb

A

See diagram

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6
Q

Myotomes of the upper limb

A

See table

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7
Q

Name the 4 anterior axio-appendicular muscles, their attachment, innervation and main action

A

See table

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8
Q

Pectoralis major + Minor anatomy

A

See diagram

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9
Q

Innervation of pectoralis major + minor

A

Pec Major = Lateral and medial pectoral nerves

Pec minor + medial pectoral nerve

Both from brachial plexus

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10
Q

Innervation serratus anterior

A

Long thoracic nerve (from brachial plexus)

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11
Q

Name the 4 posterior axio-appendicular muscles including attachments, innervation and main actions

A

See table

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12
Q

Innervation of trapezius

A

Spinal accessory CN 11

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13
Q

Innervation lattisimus dorsi

A

Thoracodorsal nerve (from brachial plexus)

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14
Q

Muscle actions of lattisimus dorsi

A

Remember that this is like the pectoralis muscle but is on back

So it is also a strong ADDUCTOR

Also it is posterior = So it will extend the hip joint

It also medially rotates the humerus

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15
Q

Anatomy of the posterior axio-appendicular msucles

A

Remember that trapezius = Has 3 fibre types, superior, middle and inferior ones that run in different directions.

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16
Q

Name the 6 scapulohumeral muscles

A

These are the muscles that cross over the glenohumeral joint

See table

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17
Q

How to test deltoid function?

A

First 15 degrees abduction is done by supraspinatous, so move arm to 15degrees and then do resisted abduction

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18
Q

How to test teres major, and its main actions

A

Remember this goes from bottom of scapula to intertubercular sulcus of humerus (same site as lattisimus dorsi)

It therefore can ADDUCT the humerus as well as medially rotating (same as lattisimus dorsi)

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19
Q

What are the 4 rotator cuff muscles

A

SITS

Supraspinatous

Infraspinatous

Teres MINOR

Subscapularis

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20
Q

Function of rotator cuff muscles

A

These are all muscles that blend and reinforce the joint cpaulse of shoulder to protect and give further stability.

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21
Q

Actions of all rotator cuff muscles

A

All are rotators of humerus except supraspinatous.

Suprapinatous = Asissts deltoid with first 15 abduction

Infraspinatous = Lateral rotator

Teres minor = Laateral rotator, adduction

Subscapularis = This passes to anterior humerus, and therefore is an external rotator, also adduction.

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22
Q

Cause of winged scapula

A

Brest surgery or other cause of trauma to long thoracic

=Loss of serratus anterior

Causes scapula to wing out when pushing against a wall.

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23
Q

Damage to inferior axillary fossa, what nerve and what injury

A

Thoracodorsal nerve in inferior axillary fossa often in breast surgery

Supplies lattisimus dorsi

=Unable to raise trunk with the upper limbs (as needed in climbing)

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24
Q

Injury to axillary nerve

A

Classically in anterior dislocation of glenohumeral joint or incorrect use of crutches.

Loss of deltoid

But also loss of sensation to regimental patch because of superior lateral cutaneous nerve of the arm = The superior lateral cutaneous branch of the axillary nerve.

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25
Q

Describe the anatomy of the axillary artery

A

Becomes the axillary artery at the lateral border of the 1st rib, and becomes the brachial aat the inferior border of teres major

There are 3 parts to the axillary artery

First part = 1st rib to medial border pec minor = Has only the superior thoracic branch

Second part = Lies posterior to the pec minor = Has 2 branches = Thoracoacromial and lateral thoracic arteries = These pass medial and lateral to pec minor respectively

Third part = From lateral border of pec minor to inferior border teres major = has 3 branches = Subscapular, anterior and posterior circumflex humeral arteries.

REMEMBER 1st 2nd 3rd parts correspond to number of branches

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26
Q

Describe the lymphatic of the axilla

A

Remember it is like a pyramid

There are 3 nodes a the base = Pectoral (anterior), Subscapular (posterior), and humeral (lateral) nodes.

These all then feed up into central nodes

Which further feed up into apical nodes

Then ultimately to subclavian lymphatic trunk

And then joined by other turnks to form the right lymphatic duct

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27
Q

What are the 5 parts of the brachial plexus

A

Spinal cord roots = C5,6,7,8,T1

Trunks

Divisions

Cords

Terminal branches/Peripheral nerves

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28
Q

Describe the form of the brachial plexus

A

There are 5 spinal cords that come together to form 3 trunks first

Superior trunk = C5+C6

Middle turnk = Just C7

Inferior trunk = C8+T1

Each trunk then splits into an anterior and posterior Division

Anterior divisions then supply anterior (flexor) compartments of upper limb, and posterior does extensor/posterior compartments

Anterior of superior + middle trunk = forms lateral cord

Anterior of inferior turnk only = Forms medial cord

All 3 posterior trunks = Forms posterior cord

These then mix to form the 5 peripheral nerves

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29
Q

What are the spinal nerve levels of each of the upper limb peripheral nerves?

A

See table

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30
Q

Upper brachial plexus injuries

A

Mechanism Escess inrease in angle between neck and shoulder = Such as thrown from motorcyle.horse, lands on shoudler in a way that seperates head and shoulder distance. Also in neonates during delivery

This avulses/tears the superior roots from plexus

Results in = Waiters tip position = Limb hangs by side and medial rotation

Name = Erb palsy

Muscles = C5 and C6 so deltoid, biceps and brachialis

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31
Q

Inferior brachial plexus injury

A

Name = Klumpe paralsysis is less common.

Mechanism = When upper limb suddenly pullsed superiorly such as when person grasps something when falling or babys upper limbs being pulled up. Avulses the inferior spinal nerves from cord.

Effect = Affets the short muscles of the hand resulting in claw hand, loss of wrist flexors, horners syndrome.

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32
Q

Acute brachial plexus neuritis

A

Sudden onset pain around shoulder followed by muscle weakness and later atrophy

Inflammation fo brachial plexus normally preceeded by URTI or vacciantion or non specific trauma

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33
Q

Compression of brachial plexus cords

A

From prolonged hyperabduction (arm abovehead) like painting a ceiling.

Cords are impinged between coracoid process of scapula and pectoralis minor tendon.

Symptoms = Pain radiating down arm, numbness, parathesia, erythema.

Can also get compression of axillary vessels causing hyperabduction syndrome.

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34
Q

Describe the msucles of the arm including attachments, innervation and muscle actions

A

See table

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35
Q

Innervation of the three anterior arm muscles

A

Biceps Brachii = Musculocutaneous (C5,C6,C7)

Corachobrachialis = Same as above

Brachialis = Also musculocutaneous, but also radial nerve

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36
Q

Attachment/insertion biceps brachii

A

Long head = Passes the shoulder joint. From coracoid process to radial tuberosity (via bicipital aponeurosis)

Short head = Supraglenoid tubercle on scapula to same place

37
Q

Attachments/insertions of the triceps muscle

A

Long head = infraglenoid tubercle of scapula to olecranon

Lateral head = Posterior humerus superior to radial groove to same place

Medial head = Posterior humerus inferior to radial groove to same place

38
Q

What is the course of the brachial artery

A

Remember axillary to brachial at inferior border of teres major

Travels first medially along humerus in the medial bicipital groove (can palpate here)

Then passes anteriorly over the trochlear of humerus.

It accompanies the median nerve

Then divides into ulnar + radial arteries opposite the neck of the radius

39
Q

What are the main branches of the brachial artery, where?

A

3 main branches = Profunda brachii, superior ulnar collateral, inferior ulnar collateral

40
Q

Describe anatomy of the profunda brachii artery

A

Comes of the brachial artery most superiorly of the 3 branches of brachial

Travels with radial nerve along the spiral/radial groove posteriorly around humerus.

Then terminates by dividing into middle and radial collateral arteries which anastamosis around and supply the elbow

41
Q

Course of musculocutaneous

A

Supplies muscles of anterior arm

Travels between biceps brachii and brachialis in the arm

The nerve then pierces the deep fascia lateral to biceps brachii to emerge lateral to the biceps tendon and brachioradialis.

Here it continues as the lateral cutaneous nerve and provides sensory innervation to the lateral aspect of the forearm

42
Q

Describe course of radial nerve

A

Travels in spiral groove with profunda brachii (remember the branch of radial nerve to triceps comes from this groove)

Supplies posterior arm extensors

Then travels down anterior compartment

Just anterior to lateral epicondyle = Divides into deep and superficial branches

Deep branch of radial (later becomes posterior interosseous) = Entirely muscular

Superficial branch of radial = Entirely sensory to dorsum of hand+fingers = This passes superficial to radial side of the extensor retinaculum, so damage to this can damage this branch

43
Q

Describe course of median nerve

A

Runs together with brachial artery (lateral to brachial artery)

Until it reaches middle of arm then passess anteriorly to lie on the medial side of brachial artery

Then descends into cubital fossa where it is deep to biceps tendon

Later gives of 3 branches

1) Muscular branches = flexor carpi radialis, palmaris longus, and flexor digitorum superficialis
2) Anterior interosseous branch (opp of radial) = flexor pollicis longus and the lateral half of flexor digitorum profundus
3) Palmar cutaneous branch = Innervation to thenar eminence

44
Q

Course of ulnar nerve and branches

A

Also passes with brachial artery until middle of arm

Until passing posterior to the medial epicondyle (funny bone)

In forearm it gives off palmar and dorsal branches = For sensation over hypothenar and webbing between 1st+2nd fingers

In the hand = Enters the hand through the Guyons canal and is on the ulnar side of the ulnar artery

Then branches into:

  • *Deep Ulnar** = abductor digiti minimi, flexor digiti minimi, and opponens digiti minimi, 3rd and 4th lumbricals, all the palmar interossei muscles and dorsal interossei of the hand, and adductor pollicis (MOTOR)
  • *Superficial ulnar** = digital branches to the medial one and a half fingers (SENSATION)
45
Q

Compartments, general function, and general innervation rules in the forearm

A

Anterior comaprtment = Flexors and pronators of the forearm

-These are mainly servied by median nerve, except one and a half rules which are by ulnar nerve

Posterior compartment = Extensors and supinators

-All by radial nerve, either directly or by its deep branch/posterior interosseus

46
Q

How is the volar compartment of forearm further divided and what muscles are in each one

A

Superficial volar group = 4 muscles = Flexor carpi radialis, flexor carpi ulnaris, pronator teres, pamaris longus. These are all attached proximally by the same common flexor tendon to the medial epicondyle of humerus

Intermiediate group = 1 muscle = Flexor digitorum superficialis

Deep group = 3 muscles = Flexor digitorum profundus, flexor pollicis longus, pronatory quadratus

47
Q

Action of the FCR/FCU and FDS/FDP

A

FCR and FCU = These are both flexors of the wrist and will ab/adduct the hand depending on if it is ulnaris/radialis

FDS = This will flex middle and proximal PIP joints

FDP = Flex distal PIP joints

48
Q

Innervation of anterior forearm muscles

A

Pronator teres, palmaris longus = Median

All of FCR = Median nerve

All of FCU = Ulnar nerve

All of FDS = Median nerve

FDP = medial 1/5 digits by ulnar, distal 1.5 by median (anterior interosseus)

FPL + pronator qudratus = Anterior interosseous nerve from median

49
Q

Name the important muscles of the extensor/posterior compartment of forearm

A

Brachioradialis = Weak flexion when forearm mid-pronated

Extensor carpi radialis + ulnaris muscles = Extension of wrist and ab/aduction of hand depending on which muscle

Extensor digitorum = Extending at MCP and IP joints

Extensor digiti minimi

Supinator

Extensor indicis

Abductor pollicis longus = Abduction of thumb + extension at MCP

Extensor pollicis longus + brevis muscles = Extension of thumb MCP + PIP

50
Q

Surface anatomy of medial view of pronated hand

A

EPL on top of anatomical snuffbox

EPB below anatomical snuffbox

APL below EPB

51
Q

Median nerve injury

A

When asked to make fist = Hand of benediction

Unable to flex 2/3 digits as these are median nerve parts

52
Q

Ulnar nerve injury

A

Compression of ulnar nerve at elbow = Cubital tunnel syndrome

Injury causes loss of most intrinic muscles of hand + sensory loss

Closure of fist = Produces claw hand, where you are unable to flex 4/5th digits as these are the ones supplied by ulnar.

53
Q

What are the compartments in the hand and what do they contain?

A

5 compartments

1) Thenar compartment = Abductor policis brevis, flexor pollicis brevis, opponens opllicis
2) Adductor compartment = Adductor pollicis
3) Hypothenar compartment = Abductor digiti minimi, flexor digiti minimi brexis, opponens digiti minimi
4) Central compartment = Short muscles of the hand, the lumbricals
5) Interosseous compartments = The interossei muscles

54
Q

Thumb movements and the muscles responsible

A

Extension = EPL, EPB Abductor pollicis longus

Flexion = FPL and FPB

Abduction = Abductor pollicis longus + brevis

Adduction = Addutor policis and 1st dorsal interossei

Opposition = Opponens policis

55
Q

Action of short muscles of hand

A

1st,2nd,3rd,4th lumbiricals = These all flex MCP and extend IP joints

1st-4th dorsal interossei = Abduct fingers away from axial line

1st to 3rd palmar interossei = Adducts the fingers to axial line

DAB + PAD = Dorsal ABduct and palmar ADduct

56
Q

Innervation of short muscles of the hand

A

1st and 2nd lumbrical = median nerve

3rd and 4th lumbrical = Deep branch of ulnar nerve

1st-4th Dorsal interossei = Deep branch ulnar

1st-3rd palmar interossei = Deep branch ulnar

57
Q

Damage to median nerve in hand and clinical features

A

Causes the simian hand = Where thumb movements limited to flexion and extension of the thumb.

58
Q

Ligaments of elbow joint

A

Radial collateral ligament (lateral) = Extends from lateral epicondyle of humerus and blends with annular ligament of radius

Ulnar collateral ligament (medial) = Triangular in shape

59
Q

Laceration jsut lateral of piriformis bone likely to injure?

A

Ulnar artery or nerve

60
Q

Describe course of subclavian artery vs vein, and what structures travel with them

A

Subclaviana artery + brachial plexus = Passes posterior to scalenus anterior

Subclavian vein + Phrenic = PAsses anterior to scalenus anterior

61
Q

With a supracondylar fracture

Location fo radial nerve at this location

A

Radial nerve will be anterolateral of the humerus

62
Q

Which bone is a sesamoid bone for the FCU muscle

A

Piriformis = Remember this as it is most medial of the first row of carpal bones.

63
Q

What does radial head articulate with?

A

The capitulum of the humerus

Remember ulnar articualtes with the ulnar trochlear

64
Q

Damage to anterior interosseous nerve

A

Means loss of flexor pollicis longus + lateral part of FDP

Means you lose the pincer grip

Remember this is a motor only branch of median nerve = So now sensory losses

65
Q

What does the long thoracic innervate

Damage to this nerve?

A

Serratus anterior

Can be damaged in axillary surgery = Winging of scapula

Cannot push against wall

66
Q

How many sheaths are there in the extensor retinaculum of the hand, and what are the names/contents

A

There are 6 = Going from radial to ulnar side

1) EPB + abductor policis longus (rememebr these form anterior border of snuffbox)
2) ECR longus and brevis
3) EPL
4) Extensor indicis + Extensor digitorum
5) Extensor digiti minimi
6) ECU

67
Q

Loss of thumb adduction, what muscle and what nerve

A

Adductor policis brevis = Intrinsic hand muscle

Innervated by the deep branch of the ulnar nerve

68
Q

What is the gantzer muscle and what pathology can it cause

A

Gantzer muscle = Abberant accessory long head of flexor pollicis longus

Pathology = This can cause compression of the anterior interosseous nerve (Branch of the median)

69
Q

Froment sign = What is this

What nerve

A

Peice of paper between thumba nd finger = Have to flex IP joint to keep paper, because unable to adduct

Adductor policis = Intrinsic hand muscle innervated by deep branch of ulnar

So lesion to deep branch of ulnar = Froment’s sign

70
Q

After breast surgery pain on painting ceiling

A

Injury to thoracodorsal = innervates lattissimus

Thoracodorsal comes of the rbachial plexus

So raising arm above head repeatedly causes pain

71
Q

Course of the axillary artery, espo in relation to other structures

A

Becomes the axillary when crossing first rib

becomes brachial when crossing inf border of teres major

There are 3 parts that are divided by pec minor

First part = medial to pec minor = 1 branch

Sceond part = Under pec minor = 2 branches

Third part = Lateral to pec minor = 3 branches

branches = Screw the lawyer, save the patient = Superior thoracic, thoracoacromia, lateral thoracic, subscapularis, ant + post humeral circumflex

Relations = In axilla it is sorrounded by the brachial plexus

72
Q

Flexor pollicis brevis Vs Flexor pollicis longus

A

Remember that brevis is an intrinsic muscle of hand, while longus is a long muscle in forearm

Longus innervation = Anterior interosseous branch of median nerve

Brevis innervation = Median nerve also

Longus action = Flex IP joint

Brevis action = Flex thumb at MCP

73
Q

What muscles in the hand does the median nerve innervate?

A

The thenar muscles

= flexor pollicis brevis, abductor pollicis brevis, and opponens pollicis

NOTE ADDUCTOR POLICIS + ABDUCTOR POLLICIS LONGUS (ULNAR NERVE)

74
Q

Innervation of rotator cuff muscles

A

Supraspinatous + Infraspinatous = Suprascapular nerve

Teres minor = Axillary nerve

Subscapularis = Subscapular nerve

75
Q

Innervation of pectoralis major + Minor

A

Major = lateral and medial pectoral nerves

Minor = Only medial pectoral nerve

76
Q

Insertion point of all rotator cuff muscles

A

Supraspinatous, infraspinatous, teres minor = All insert onto posterior of humerus on the greater tubercle and therefore do lateral rotation

Except the subscapularis which actually goes anteriorly to lesser tubercle so does internal rotation.

77
Q

Which finger has no attachment for the palmar interossei

A

Remember there are 4 dorsal and palmar interossei

The middle finger is skipped and has no attachement for the palmar interossie

78
Q

fracture at surgical neck of humerus, what nerve is at risk

A

Axillary

79
Q

Describe crutch palsy

A

When crutch is used wrongly

Causes inferior brachial plexus/radial nerve injury = Wrist drop

80
Q

Blood supply to scaphoid

A

Retrograde blood supply from the dorsal carpal branch vessels

81
Q

Sensation to nailbed of first finger

A

Median nerve

82
Q

Anatomy of the antecubital fossa

A

Lateral to medial

Radial nerve, biceps tendon

Brachial artery, brachial vein

Median nerve

83
Q

What passes through quadrangular space

A

Axillary NERVE

posterior circumflex humeral arteries

84
Q

What does median nerve travel through flexor retinaculum between?

A

Between tendons of

Flexor pollicis longus + flexor digitorum superficialis

85
Q

Nerve roots of supraspinatous nerve and what it supplies

A

Supplies the supra and infraspinatous muscles

Root origins = C5 and C6

86
Q

Innervation of flexor pollicis longus

A

Usually would have thought ulnar, but actually depends

Superficial head = median nerve (anterior interosseous, superficial is also anterior)

Deep head = deep branch of ulnar nerve (BOTH DEEP)

87
Q

What passes through suprascapular foramen

A

The suprascapular nerve + Vein

Note suprascapular artery goes superior

Suprascapular nerve = Supraspinatous + infraspinatous muscles

88
Q

Borders of antecubital fossa

A

Lateral = The medial side of brachioradialis

Medial = Pronator teres

Superior = Line between epicondyles

Floor = Supinator + Brachialis

MRCS Anatomy COPY (10 decks)

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