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MRCS B > Anatomy - Upper limb > Flashcards

Anatomy - Upper limb Flashcards

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1
Q

Branches of the roots of brachial plexus (2)

A

Long thoracic(C5-7)
Dorsal scapular (C5)

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2
Q

Branches of the trunks of brachial plexus (2)

A

From superior trunk:
Suprascapular
Nerve to subclavius

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3
Q

Branches of the lateral cord of brachial plexus (1)

A

Lateral pectoral

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4
Q

Branches of the posterior cord of brachial plexus (3+2)

A

Superior + inferior subscapular
Thoracodorsal

Axillary + radial terminally

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5
Q

Branches of the medial cord of brachial plexus (3)

A

Medial cutaneous nerve of the arm + forearm
Medial pectoral

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6
Q

Where are the roots of the brachial plexus?

A

Arise from IV foramena
Between ant + middle scalene

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7
Q

Where are the trunks of the brachial plexus?

A

Posterior triangle of the neck
Behind 3rd part subclavian artery

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8
Q

Where are the divisions of the brachial plexus?

A

behind middle 1/3 clavicle

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9
Q

What are the cords of the brachial plexus related to?

A

2nd part axillary artery

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10
Q

Nerve supply to rotator cuff muscles

A

Supra + infra spinatus = supra scapular nerve (C5-6, from superior trunk)

Subscapularis = upper + lower sub scapular nerves (C5-6/7, from posterior cord)

Teres minor = axillary (C5-6)

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11
Q

Nerves affected in Erbs palsy + resulting sx

A

C5-6 damage

Affects nerves to rotator cuffs (subscapulars, supra scapular), axillary + musculo cutaneous (deltoid/ BBC)

M: Can’t abduct, externally rotate or flex elbow = waiters tip position
S: Loss of lateral sensation of arm/ forearm

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12
Q

Nerves affected in Erbs palsy + resulting sx

A

C8/T1 nerves

Mainly median + ulnar nerves affected

M: claw hand (IPJ flexion + MCPJ hyperextension) due to paralysis of all intrinsic hand muscles, wrist flexors (except FCR)

S: loss over ulnar border of forearm/hand

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13
Q

Insertion of rotator cuff muscles

A

Supraspinatus, infraspinatus, teres minor - GT of humerus

Subscapularis - LT of humerus

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14
Q

Serratus anterior - nerve supply and function

Attachments

A

Long thoracic nerve

Prevents scapula winging

Ribs 1-9 > scapula

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15
Q

Deltoid attachments + nerve supply

A

Lateral clavicle/ scapula -> deltoid tuberosity (humerus)

Axillary nerve (C5/6)

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16
Q

Trapezius attachments

A

Origin:
Spinous process C7-T12
Occipital protuberance
Ligamentum nuchae

Scapula (spine/ acromion) + clavicle

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17
Q

Traps nerve supply

A

Spinal accessory nerve

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18
Q

Pec major + minor nerve supply

A

Major: Medial (C8-T1) + lateral (C5-7) pectoral nerves
Minor: medial only

(From medial and lateral cords of BP respectively)

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19
Q

Boundaries of the scapular triangular space

A

Sup - teres minor
Inf - teres major
Lat - LH triceps

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20
Q

Boundaries of the scapular triangular interval

A

Lat - humerus
Med- LH triceps
Sup - teres major

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21
Q

Boundaries of the scapular quadrangular space

A

Sup - teres minor
Inf - teres major
Lat - humerus
Med - LH triceps

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22
Q

Contents of the scapular triangular space

A

Circumflex scapular artery

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23
Q

Contents of the scapular triangular interval

A

Radial nerve
Profunda brachii artery

(Run in spiral groove behind humerus)

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24
Q

Contents of the scapular quadrangular space

A

Axillary nerve
Post circumflex humeral artery

(Run around surgical neck humerus)

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25
Structures damaged in humeral neck #
Axillary nerve Post circumflex humeral artery
26
Structures damaged in humeral shaft #
Radial nerve Profunda brachii artery (Run in spiral groove behind humerus)
27
What muscle divides axillary artery into 3 parts
Pec minor
28
What muscle divides subclavian artery into 3 parts
Ant scalene
29
Where is the border of the subclavian > axillary artery
Lat border 1st rib
30
Where is the border of the axillary > brachial artery
Lower border teres major
31
what artery is at risk during a 3rd level axillary node dissection
Thoracoacromial (branch of 2nd part axillary)
32
What nerve is at risk during breast surgery/ node clearance
Long thoracic - winging of scapula
33
Subclavian artery branches
1st: Vertebral Internal thoracic/ mammary Thyrocervical (>inf thyroid) Costocervical 3rd: Dorsal scapular
34
Axillary artery branches
1st: Superior thoracic 2nd: Lateral thoracic Thoracoacromial (splits to deltoid, pectoral, clavicular, acromial) 3rd: Circumflex (and + post humeral) Subscapular (> thoracodorsal)
35
Attachments to coracoid process of scapula (3 muscles, 3 ligaments)
Ligaments: Coracoacromial Coracohumeral Coracoclavicular Muscles: Pec minor Coracobrachialis Short head biceps
36
Muscles inserting into bicipital groove
"lady between 2 majors" Teres major (med) Lat dorsi (floor) Pec major (lat)
37
Muscles for shoulder abduction beyond 90 degrees
traps + serratus anterior
38
Factors that make the shoulder joint less stable
Shallow glenoid Laxity, few ligaments Inf aspect not supported due to quadrangular space
39
Define synovial joint
Articular surfaces covered in hyaline cartilage and separated by synovial fluid within a fibrous joint capsule (lined by synovial membrane)
40
UL myotomes
C5 - elbow flexion (biceps) C6 - wrist extension C7 - elbow extension (triceps) C8 - Finger flexors T1 - finger abductors C567 raise arms up to heaven (serrates anterior - long thoracic nerve)
41
What is the supinator / brachioradialis reflex testing
C5/6 / radial nerve
42
Neurovascular injury assoc with supracondylar humeral #
Brachial artery AIO nerve Radial/ ulnar nerves
43
Muscles in flexor compartment of upper arm + nerve innervation
Coracobrachialis Biceps brachii Brachialis Musculocutaneous nerve (brachial also by radial)
44
The transverse humeral ligament encloses which structure
Long head biceps brachii
45
Action of the BBC muscles (individually)
Coracobrachialis - flex + adduct shoulder? (only inserts to humerus above elbow) Biceps brahchii - flexion and supination at elbow Brachialis - elbow flexion (as both insert to radial + ulnar tuberosities respectively)
46
Where does the biceps common tendon insert
Radial tuberosity on anterior proximal radius
47
Where do the radial nerve/ profound brachii artery lie in relation to the triceps?
Between lat + medial heads
48
What is the common flexor and common extensor origins of the forearm muscles?
Flexor origin = medial epicondyle humerus Extensor = lateral epicondyle
49
Superficial forearm flexor compartment muscles + function (4)
Pronator teres Flexor carpi radialis Palmer's longus Flexor carpi ulnaris Flex wrist +FCR/FCU abduct/ adduct PT - pronates
50
Intermediate forearm flexor compartment muscles + function (1)
Flexor digitorum superficialis Flexes wrist/ MCP/PIP
51
Deep forearm flexor compartment muscles (3)
Flexor digitorum profundus Flexor policies longus Pronator quadratus
52
Forearm flexor compartment nerve supply
Superficial + int = median n Deep = Median > AIO n
53
Forearm extensor compartment nerve supply
Superficial - radial n Deep - radial >PIO n
54
Superficial forearm extensor compartment muscles + function (7)
1) Aconeus - elbow ext 2) Brachiradialis - elbow flex 3) ECRL 4) ECRB 5) ECU (all Extend wrist + adduct/ abduct) 6) Ext digitorum 7) ext digiti minimi (DIP ext)
55
Deep forearm extensor compartment muscles + function (5)
Ext policis longus Ext policis brevis AbDuctor policis longus Supinator
56
Nerve supply of intrinsic hand muscles
All ulnar (deep branch) EXCEPT LOAF = median n (recurrent branch) Lumbricals (lateral 2) + Thenars -Opponense policis -AbDuctor policis brevis -Flexor policis brevis
57
What are the thenar muscles
Opponense policis AbDuctor policis brevis Flexor policis brevis
58
What are the hypothenar muscles
Opponens digiti minimi AbDuctor digiti minimi Flexor digiti minimi brevis
59
Function of hand interossei + nerve supply
Dorsal - finger aBduction Ventral - aDDuction Deep branch ulnar nerve
60
ADDuctor policies nerve supply (intrinsic hand muscle)
Ulnar ABductor policis brevis = medial (thenar) ABductor policis longus = radial (deep ext)
61
Carpal tunnel contents
* superficial: FCR * intermediate: FDS * deep: FDP, FPL * Median nerve aka 4 muscle tendons 1 nerve
62
Carpal tunnel boundaries
Roof - flexor retinaculum Floor - carpal bone arch
63
Cubital fossa boundaries
Sup - line between 2 epicondyles Med - pronator teres Lat - brachioradialis Floor - brachialis
64
Contents of cubital fossa
Lat > Med Really need beer to be at my nicest Radial nerve Biceps tendon Brachial artery Median Nerve + veins - cephalic (lat), MCV, basilic (med)
65
Where do cephalic and basilic veins drain to
Axillary vein (deep)
66
What nerves run alongside the cephalic and basilic veins
Lat + medial cutaneous nerves of the forearm respectively
67
How many deep UL veins are there per artery
2 - run each side of respective artery
68
Median nerve injury at elbow manifestation
Sensory loss: Lat 2/3 palm + 3 1/2 digits (palmar + dorsal finger tips) Motor: thumb hyperextension (FPB paralysis) Adducted thumb (Abd PB paralysis)
69
Cause of the ulnar nerve paradox
Proximal ulnar nerve injuries - paralysis of medial 1/2 FDP, decreasing flexion of IPJs More distal injury= worse claw hand
70
Where do median/ ulnar/ radial nerves pass in relation to elbow
Ulnar - behind median epi Median - ant to median epi Radial - round humerus to ant lateral epi Then all run down anterior forearm Radial passes behind lateral wrist
71
Which arteries form the superficial palmar arch?
Ulnar artery - superficial division* Joined by superficial palmar artery (radial)
72
Blood supply to scaphoid
Radial -> lateral and distal branches Proximal part - retrograde blood flow
73
Flexor retinaculum attachments
Proximal: Lat - scaphoid tubercle Med - pisiform Distal: Lat - trapezium Med - hook hamate
74
How to assess FDS/ FDP
FDS- fix adjacent fingers and ask to flex affected FDP - fix PIP + flex at DIP
75
Where do tendons of FDS + FDP insert on the finger
FDS - splits to both sides of middle phalanx FDP - through split tendon to distal phalanx
76
What tendon is attached to pisiform?
FCU
77
Anatomical snuff box boundaries
Lateral - ext policis brevis + abductor policis longus Medial - ext policis longus Prox - styloid process of radius Floor: scaphoid +trapezium
78
Anatomical snuff box contents
Scaphoid + trapezium bones Radial artery Cephalic vein
79
Insertion of extensor policis longus and brevis
EPL - distal phalanx base EPB - proximal phalanx base
80
Ulnar/ cubital tunnel boundaries (posteromedial elbow)
* Med – medial epicondyle * Lat – olecranon * Floor – elbow joint capsule + MCL * Roof – Arcuate ligament (from med epicondyle to olecranon)
81
Ulnar/ cubital tunnel contents (posteromedial elbow)
Ulnar nerve
82
Axilla boundaries
Apex - lateral 1st rib, posterior clavicle, superior scapula Medial - thoracic cage + serratous anterior Lateral - inter tubercular groove of humerus Anterior - pec major/ minor, subclass muscles Posterior - teres major, lat dorsi, scapula/ subscapularis
83
What is thoracic outlet syndrome? + causes
compression at apex of axilla Causes: cervical rib, trauma, strain)

MRCS B (10 decks)

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