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Arm Anatomy Flashcards

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1
Q

Where does the brachial plexus run on a person

A

Roots - posterior triangle of neck
Trunks - posterior to the middle third of the clavicle
Divisions - apex of the axilla
Cords - related to the axillary artery

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2
Q

Where are the parts of the brachial plexus found in relation to other structures

A

Origin: Anterior rami C5-T1

Roots: Posterior triangle, between anterior and median scalenes

Trunks related to subclavian artery middle third of the clavicle. upper and middle above and the lower trunk over the 1st rib posterior to subvlacian artery

Divisions: apex of axilla

Cords: axillary artery

Branches: arm

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3
Q

What is Erb’s paralysis

A

damage to the upper nerve roots of the brachail plexus - C5/6

gives rise to what is described as the waiter’s tip deformity

Paralysis of the arm abductors (supraspin and delt) leads to arm adduction
Paralysis of the external rotators (infraspin adn teres minor) leads to internal rotation
Paralysis of the flexors and supinators (bcieps, brachialis and brachioradialis) leads to forearm extension and pronation

sensory changes: c5/6 dermatome

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4
Q

what is klumpke’s paralysis

A

injury to the lower trunk of the brachial plexus
C8 T1

gives rise to what is called the claw hand deformity

paralysis of all intkrinsic muscles in the hand
paralysis of the wrist flexors except FCR
hyperextenstion of the MCPJs and flexion of the IPJs

sensory: ulnar border of forearm and hand

you loose the lumbricals which flex the mcpj and extend the IPJs

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5
Q

tell me about the axillary artery

A

divided by the pec minor into three parts

part 1 - one branch - superior thoracic (runs medial to serratus anterior and pec muscles)

part 2 - two branches - thoracoacromial (branches to deltoid, acromial, pectoralis, clavicular) and lateral thoracic (descends to serratus anterior)

part 3 - three branches - subscapular (largest, thoracodorsal branch and circumflex scapula which travels in the triangular space) anterior circumflex humeral (supplies humeral head: arcuate artery lateral to bicipital groove) and posterior circumflex humeral (in the quadrangular space with the axillary nerve)

mneumonic: screw the lawyer, save a patient

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6
Q

triangular space

A

borders:
superir teres minor
inferior teres major
lateral long hea dof triceps

contains circumflex scapular artery

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7
Q

quadrangular space

A

superior teres minor
inferior teres major
lateral humerus
medial long head of triceps

contains axillary nerve
posterior circumflex humeral artyert

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8
Q

triangular interval

A

superior terest major
lateral humerus
medial long head of triceps

contains profunda brachii and radial nerve

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9
Q

innervation of the rotator cuff

A

subscapularis - upper and lower subscapular nerves

supraspinatus - suprascapular nerve

infra spinatus - suprascapular nerve

teres minor - axillary nerve

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10
Q

surface marking of th coracoid

A

2cm inferior to the junction between the middle and lateral thirds of the clavicle

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11
Q

structures attached to the coracoid

A

ligaments
- coracoclavicular (trapezoid and conoid)
- coracoacromial
- coracohumeral

muscles
- pec minor insertion
- coracobrachailis origin
- short head of biceps origin

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12
Q

muscles inserted in the bicipital groove

A

PLT sandwich - lady between two majors

Pec major - lateral
latissimus dorsi - floor
teres major - medial

tendon of the long head of bicep runs in the groove

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13
Q

muscles responsible for should abduction

A

0-15 - supraspinatus
15-90 middle fibres of deltoid
over 90 - trapezius and serratus anterior as need upward rotation of the scapular and lateral rotation of the huerus

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14
Q

fractors decreasing stability of the shoulder joint

A

shallow glenoid
lax capsule with few ligaments
inferior aspect is not supported due to the quadrangualr space

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15
Q

what is the main stabilizer of the shoulder

A

rotator cuff

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16
Q

static restraints of the shoudler

A

unidirectional limitations to translatiion

labrm
version
conformity
negative intrarticular pressure
capsule
glenohumeral ligametns

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17
Q

dynamic restraints of the shoulder

A

syndrocnised contaction of the rotator cuff causing joint concavity compression. direct attachment fo the cuff to the capsule increases capuslar tensoin

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18
Q

what is a synovial joint

A

freely moving joint with the articulating surfacies covered in hyaline carticalge and seperated by a film of synovial fluid to act as a lubricant

fibrous capsule provides stability

synovial fluid is a trnasport medium and is produced by the synovial membrane

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19
Q

axillary nerve motor supply

A

deltoid
teres minor

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20
Q

axillary nerve sensory supply

A

skin to eh lower half of th edeloitd (badge patch)

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21
Q

INJURY to axillary nerve

A

inability to abduct the shoulder past 15 degrees
loss of sensation over the badgepatch

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22
Q

upper limb reflexes

A

c5/6 biceps
c7 triceps
supinator c6

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23
Q

myotomes upper limb

A

c5 flexion elbow
c6 wrist extensors
c7 elbow extensors
c8 long finger flexion and thumb extension
t1 small finger abductors

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24
Q

muscles flexing the elbow

A

biceps
brachialis
bacioradials
pronanor teres
FCR

FCR and pronator teres cross the elbow joint (common felxor orgin on the medial epicondyle) so weakly support elbow flexion

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25
articulations at the elbow
capitulum of humerus and radial head trochlea of humerus and trochlear notch of ulna olecranon of ulna and olecranon fossa of humerus
26
structures in the spiral groove
radial nerve profunda brachi vessels run in triangula interal
27
clinical picture of radial nerve injury at spinal groove
wrist drop finger drop loss of senstion to the first webspace
28
origin of biceps brachii
coracoid short head supraglenoid long head
29
insertion of biceps
radial tubersoty
30
origin of triceps
long head infraglenoid lateral head and medial head posterior humerus
31
structure running between heads of triceps
radial nerve and profunda brachii run between the medial and lateral heads
32
superficial flexors of the forearm
pronator teres FCR palmaris longus FCU FDS
33
innervation of superfical flexors of the forearm
PT, FCR, PL, FDS - median nerve FCU - ulnar
34
what attaches to the pisiform
FCU
35
what hooks around listers tuberle
EPL
36
deep flexors of the forearm
flexor digitorum profundus flexor pollicus longus pronator quadrarus
37
innervation of the deep flexors of the forearm
AIN
38
superficial extensors of the forearm
brachioradialis extensor carpi radialis longus extensor carpi radialis brevis anconeus exteensor digitorum extensor digiti minimi extensor carpi ulnaris
39
Boundaries of the cubital fossa
Lateral: brachioradialis Medial: pronator teres Floor: Brachialis
40
contents of the cubital fossa
median nerve brachial artery biceps tendon
41
veins the ACF medial to lateral
basilic vein median cubital vein cephalic vein
42
Forearm arteries
brachial radial and ulnar deep and superficial palmar arches
43
median nerve relation to pronator teres and FDS
superficial to the deep head of pronator teres and then deep to the radial head of flexor digitorum superficialis
44
median nerve sensory distribution in the hand
lateral 2/3 of the palm of the hand lateral (radial) 3.5 digits dorsum of the tip of the index, middle and thumb
45
median nerve motor distribution in the hand
LOAF lateral 2 lumbricals opponens pollicus abductor pollicus brevis flexor pollicus brevis
46
clinical picture of median nerve injury at the elbow
hyperextended thumb due to paralysis of FPB Adducted thumb (APB paralysis) flat thenal eminence loss of median nerve sensory region
47
clinical picture of ulnar nerve injury at the wrist
complete claw clawing of 4th and 5th digits (median lumbricals and interossei paralysis) loss of sensation inthe ulnar nerve distrubution
48
ulnar paradox
proximal injury = less clawing Only the intrinsic muscles of the hand are affected at the wrist. Lumbricals flex MCPJs and Extend IPJs and interosei have an indirect role of stbilising the mcjs. threrefore with these paralysed the MCPJs are hyperextended and the IPJs are flexed. Flexion fo the DIPJs is by FDP and flexion of PIPJs is by FDS. Loss of FDP and FDS in a higher injury means you lose the flexion of the IPJs, making the claw less pronounced.
49
blood supply to the scaphoid
primarily from palmar and dorsal branches of radial artery proximal portion relies on retrograde flow
50
how to test the ulnar artery
allen's test elevate the hand and make a fist for 30 seconds occlude oth radial and ulnar arteries open the hand whilst still elevated - blanched release the ulnar artery pressure colour should return in 7 seconds
51
attachment of the flexor retinaculum
laterally - scaphoid tubercle ad hook of hamate medially - trapezium and pisiform proximal - pisiform and tubercle of scaphoid distal -hook of hamate and trapezium
52
structures passing through carpal tunnel
4 tendons of FDS 4 tendons of FDP 1 tendon of FPL 1 tendon of FCR (retincaculum wraps aorund it) median nerve
53
Movements of the thumb
MCP/IPJ flexion - FPL and FPB (AIN) MCP/ICJ extension - EPL, EPB (PIN) Flexion - FPB, adductor pollicus (median and ulnar) Extension - Abductor pollicus longus, EPB (PIN) Abduction - abductor pollicus longus and brevis (Radial, median) Adduction - adductor pollicus (ulnar) opposition - opponens pollicus, flexor pollicus brevis, abductor pollicus brevis (median recurrent)H
54
How to test FDP
Fip PIPJ
55
How to test FDS
hold adjacent digits in extension to eliminate the FDP motion in adjacent digits
56
where do FDS and FDP tendons insert
FDS: split tendon on both sides of the middle phalynx FDP passes through the split tendon of FDS to insert into the distal phalynx
57
What tendon is attached to pisiform?
FCU
58
What attaches extensor tendons to phalanges
extensor expansion
59
what is the function of the intertendinous connections?
create space between the extensor tendons redistribute the force between tendons coordinate extension of fingers stabilize MCP
60
what is the insertion of the entensor digitorum
extensor expansion of the phalanges of 2,3,4,5th fingers
61
two extensor tendons inserting into index finger
extensor digitorum (lateral) enxtenosr indices (medial = ulnar side)
62
first dorsal interosseous
origin: 1st metacarpal insertion: lateral side of the extensor expansion of index finger action: abduction of index finger supplied by deep branch of ulnar nerve
63
what is the role of the rdial nerve in power grip?
wrist extension to give a mechanical advantage by synergistic activity causing more efficient flexion of the digits
64
why is hand grip more powerful in extension than flexion
flexor muscles in the extension position are under tension so contraction is more powerful
65
boundaries of anatomical snuffbox
medial: EPL lateral: Abductor pollicus longus, EPB proximal: styloid process distal: apex floor: trapezium and scaphoid content: radial artery
66
Insertion of EPL
dorsum of the base of the terminal phalynx of thumb
67
insertion of EPB
dorsum of the base of the proximal phalynx

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