Anatomical Spaces of Clinical Importance in the Upper Limb

Question 1

What is an anatomical space and what makes them clinically relevant

Answer 1

• A space framed by bone, ligament and muscle.
• They are clinically relevant because tendons, nerves and vessels pass through them and can become impinged .

Question 2

What is the location of interscalene groove

Answer 2

• Between the scalenus Medius and scalene anterior muscles.

Question 3

The roots and trunks of which plexus emerges in the interscalene groove

Answer 3

• Brachial plexus

Question 4

Where does anaesthesia need to be placed to anesthetize the entire brachial plexus.

Answer 4

• In the interscalene block

Question 5

What is the location of the subacromial space

Answer 5

• Superior to the head of the humerus but inferior to the acromion.

Question 6

What is contained within the subacromial space

Answer 6

• Supraspinatus tendon
• Subacromial bursa

Question 7

What are some injuries that can occur in the subacromial space and what are some examples if these injuries

Answer 7

• Rotator cuff injuries:
  > Rotator cuff tears
  > Shoulder dislocation
  > Tendon ruptures in older people
  > Subacromial bursitis

Question 8

What is the location of the suprascapular notch

Answer 8

• Notch at the top of the scapula

Question 9

What is contents of the suprascapular notch

Answer 9

• Suprascapular nerve (passes through to supply supraspinatus and infraspinatus on the posterior aspect of the scapula)

Question 10

What are the effects of impingement of the suprascapular nerve

Answer 10

• Wasting of the supraspinatus and infraspinatus muscles
• Shoulder pain

Question 11

What is the location of the quadrangular/quadrilateral space

Answer 11

• Just under the shoulder joint

Question 12

What are the boundaries of the quadrangular/ quadrilateral space

Answer 12

• Superiorly - Teres minor
• Inferiorly - Teres major
• Laterally - The shaft of the humerus
• Medially - The long head of the triceps brachii

Question 13

What are the contents of the quadrilateral space

Answer 13

• The axillary nerve and posterior circumflex humeral artery

Question 14

What type of injury puts the contents of the quadrangular/ quadrilateral space at risk

Answer 14

• Axillary nerve is at risk of damage during shoulder dislocation

Question 15

What is the location and the boundaries of the (upper) triangular space

Answer 15

• Location: inferior-medial to quadrilateral space
• Boundaries:
• Laterally (long head of triceps brachii)
• Superiorly (Teres minor)
• Inferiorly (Teres major)

Question 16

What are the contents of the triangular space

Answer 16

• Circumflex scapular artery (passes through)

Question 17

What is the location and the boundaries of the triangular interval (aka lower triangular space)

Answer 17

• Location: Inferior to quadrilateral space
• Boundaries:
• Laterally - The lateral head of the triceps
• Medially - Long head of triceps brachii
• Superiorly - Teres Major

Question 18

What is the location of the axilla

Answer 18

• Space between the upper arm and the side of the thorax

Question 19

What are the boundaries of the axilla

Answer 19

• Apex
• Lateral wall
• Medial wall
• Anterior wall
• Posterior wall

Question 20

What makes up the apex of the axilla (aka axillary inlet)

Answer 20

• Lateral border of 1st rib
• Superior border of scapula
• Posterior border of clavicle

Question 21

What makes up the lateral wall of the axilla

Answer 21

• Intertubercular groove of the humerus

Question 22

What makes up the medial wall of the axilla

Answer 22

• Serratus anterior
• The thoracic wall

Question 23

What makes up the anterior wall of the axilla

Answer 23

• Pectoralis major (and underlying minor)
• Subclavius muscle

Question 24

What makes up the posterior wall of the axilla

Answer 24

• Subscapularis
• Teres major
• Latissimus dorsi

Question 25

What are the vessels that are contained in the axilla

Answer 25

- Axillary artery - Axillary vein - Axillary lymph nodes - Brachial Plexus

Question 26

Where in the axilla does the axillary artery lie

Answer 26

- In the groove between the long head of the triceps and coracobrachialis - Can be palpated in the lateral walls of the axilla, can also be compressed here to prevent access bleeding

Question 27

What is significant about the axillary vein

Answer 27

- The cephalic vein drains into the axillary vein - Often damaged by wounds in the axilla, this is dangerous as it bleeds profusely

Question 28

Infection in which regions cause enlargement of axillary lymph nodes

Answer 28

- Upper limb and tenderness - Pectoral region - Breast - Upper abdominal wall

Question 29

What is removed during breast cancer removal surgery

Answer 29

- Axillary lymph nodes - The long thoracic and thoracodorsal nerves are at risk

Question 30

What might cause brachial plexus injuries

Answer 30

- Disease - Stretching - Compression - Penetrating wounds

Question 31

What is the location of the cubital tunnel

Answer 31

- A space which allows passage of the ulnar nerve and the elbow

Question 32

What are the boundaries of the cubital tunnel

Answer 32

- Medially - Medial epicondyle - Laterally - The olecranon process of the ulna and tendinous arch joining the humeral and ulnar heads of the flexor carpi ulnaris - Superiorly - Formed by a fibrous retinaculum stretching between the olecranon and medial epidcondyle.

Question 33

What causes cubital tunnel syndrome

Answer 33

- Compression of ulnar nerve behind the medial epicondyle of the humerus

Question 34

What are the symptoms of cubital tunnel syndrome

Answer 34

- Numbness in the anterior and posterior surfaces of the medial one and a half fingers and associated palm area. - Weakness in hand and forearm pain

Question 35

What are the boundaries of the cubital fossa

Answer 35

- Laterally - Medial border of the brachioradialis - Medially - Lateral border of the pronator teres muscle - Superiorly - Horizontal line is drawn between the epicondyles of the humerus - Roof - Bicipital aponeurosis, fascia, subcutaneous fat and skin. - Floor - Brachialis and supinator

Question 36

What is contained within the cubital fossa

Answer 36

- Median nerve, brachial artery, biceps tendon, radial nerve, posterior interosseous branch radial nerve

Question 37

Where can the brachial pulse be felt

Answer 37

- Medially to the biceps tendon

Question 38

What is usually used for venipuncture or cannulation

Answer 38

- The median antecubital, superficial to the fossa

Question 39

What are the boundaries of the Guyon's canal

Answer 39

- Medially - Pisiform bone - Laterally - Hook of hamate - Roof - Palmar carpal ligament

Question 40

What happens in the Guyon's canal

Answer 40

- Ulnar nerve and artery pass into the hand here - Ulnar nerve can be impinged here (causes numbness, hand muscle weakness

Question 41

What is the carpal tunnel bound by

Answer 41

- Carpal arch - Flexor retinaculum

Question 42

What does the median nerve pass through the carpal tunnel with

Answer 42

- Flex digitorum superficialis tendon - Flexor digitorum profundus tendon - Flexor policies longus tendon - Flexor carpi radialis tendon

Question 43

What causes sensory loss in the lateral 3.5 digits and weakness in the thenar muscle of the hand

Answer 43

- Any inflammation of the wrist which causes compression of the median nerve

Question 44

What are the boundaries of the anatomical snuffbox

Answer 44

Medially - The extensor policies longus tendon Laterally - Extensor policies brevis and abductor policies longus Proximally - Styloid process of radius proximally Floor - Scaphoid and trapezium

Question 45

What is contained in the anatomical snuffbox

Answer 45

- Radial artery - Superficial branch of radial nerve - Cephalic vein