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MRCSalah anatomy > Brachial plexus and shoulder > Flashcards

Brachial plexus and shoulder Flashcards

1
Q

What is the origin of the brachial plexus?

A

Ventral rami C5-T1

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2
Q

What are the sections of the brachial plexus?

A

Randy texans drink cold beer

(roots, trunks, divisions, cords, branches)

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3
Q

Where are the roots of the brachial plexus located?

A

Pass between scalenus anterior and medius

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4
Q

Where are the trunks of the brachial plexus located?

A

-upper and middle trunk are superior to subclavian
-Lower trunk runs posterior to subclavian

Edit:
-Run from base of posterior triangle
-Over first rib
-Behind first part of subclavian

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5
Q

Where are the divisions of brachial plexus located?

A

Apex of axilla, lie behind middle 1/3rd of clavicle

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6
Q

Where are the cords of the brachial plexus located?

A

My there names related to axillary artery
–> posterior
–> lateral
–> medial

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7
Q

Draw out the brachial plexus

A

Upper roots:
-Long thoracic: C5-C7-serratus anterior
-Dorsal scapular: C5, rhomboids and levator scapulae

Upper trunk
-Nerve to subclavius: C5-C6, subclavius
-Suprascapular: C5,C6

Lateral cord:
-Lateral pectoral nerve (C5-C7)

Posterior cord
–> upper subscapular (upper part subscapularis)
–> lower subscapular (lower part subscapularis, teres major)
–> Thoracodorsal (LD)

Medial cord
-Medial pectoral nerve (part of pec major), pec minor
-Medial cutaneous nerve of arm
-Medial cutaneous nerve of forearm

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8
Q
A
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9
Q

Describe Erb’s palsy

A

Causes
-During newborn delivery
-Traumatic force downwards on arm and shoulder

-Damage to upper nerve roots C5,C6

Motor
–> Adduction: denervation arm abductors (deltoid, supraspinatus)
–> Internal rotation: denervation arm external rotators (teres minor, infraspinatus)
–> pronationand extension: denervation elbow flexors and supinators (biceps, brachialis, coracobrachialis)

Sensory
–> loss of sensation radial side of arm and forearm

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10
Q

Describe Klumpke’s palsy

A

Injury to lower trunk (C8, T1)

Hyperabduction/birth trauma

Motor (claw hand deformity)
–> Denervation all intrinsic muscles of hand
–> paralysis of wrist flexors (except flexor carpi radialis-innervated by C6+7)
–> hyperextension MCP joints
–> flexion IP joints

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11
Q
A
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12
Q

Label posterior scapula

A
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13
Q

Label lateral scapula

A
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14
Q

label anterior scapula

A
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15
Q
A
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16
Q

left scapula and clavicle articulation from above

A
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17
Q
A
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18
Q

What is the origin and insertion of the pec major?

A

Origin

Clavicular head:
–> Medial half anterior clavicle

Sternocostal head
–> Anterior sternum
—> upper 6 costal cartilages
–> external oblique aponeurosis

Insertion
–> lateral intertrochanteric groove
–> Lateral lip of bicipital groove

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19
Q

Pec major action

A

Whole muscle:
–> adduction and medial rotation of the arm

Clavicular head
–> Flexion of the humerus

Sternocostal head
–> extension of the flexed humerus
–> acts as accessory muscle of respiration by elevating the ribs

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20
Q

What is the innervation of pec major?

A

-Medial (C8-T1) pectoral nerve
-Lateral (C5-C7) pectoral nerve

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21
Q

What is the origin/insertion/innervation/action of trapezius?

A

Origin:
–> Spinous process T6-T12
–> Occipital protuberance
–> ligamentum nuchae

Insertion
–> Spine/acromion of scapula
–> clavicle

Action
–> rotates scapula

Innervation:
–> spinal accessory nerve (12th cranial nerve)

22
Q

What is origin/insertion/action/innervation of serratus anterior?

A

Origin
–> Ribs 1-9

Insertion
–> Scapula (ventral medial)

Action
–> prevents winging

Innervation
–> long thoracic nerve

23
Q

Deltoid origin/insertion

A

Origin:
–> spine of scapula, acromion
–> clavicle

Insertion
–> Humerus (deltoid tuberosity)

24
Q

Deltoid action/innervation

A

Action:

Anterior fibres
–> Flexion and internal rotation

Posterior fibres
–> Extension and external rotation

Middle fibres
–> major abductor of arm (after 15 degrees)

Innervation
–> axillary nerve

25
Q

Origin/insertion/action/innervation subscapularis

A

Origin:
–> Subscapular fossa

Insertion
–> Humerus (LT)

Action
–> internally rotates arm
–> provides anterior stability

Innervation:
–> upper and lower subscapular nerves (posterior cord of brachial plexus)

26
Q

Origin/insertion/action/innervation of supraspinatus/infraspinatus/teres minor

A

Origin:
-Supraspinatus–> supraspinatus fossa
-Infraspinatus–> infraspinatus fossa
-Teres minor: –> dorsolateral scapula

Insertion
–> GT of humerus

Action
-Supraspinatus –> abducting, providing stability, externally rotating arm
-Infraspinatus + teres minor –> external rotating, providing stability

Innervation:
-Supraspinatus and infraspinatus –> suprascapular nerve
-Teres minor–> axillary nerve

27
Q
A
28
Q
A
29
Q
A
30
Q

What are the borders and contents of the triangular space?

A

Superior: teres minor
Inferior: teres major
Lateral: Long head of triceps

Contents
-Circumflex scapular artery

31
Q

What are the borders and contents of the triangular interval?

A

Borders:
-Medial: long head of triceps
-Lateral: Lateral head of triceps/humerus
-superior: Teres major

Contents
-Profunda brachii artery
-Radial nerve

32
Q

What are the borders and contents of the quadrangular space

A

-Medial: long head of triceps
-Lateral: humerus
-Superior: Teres minor
-Inferior: teres major

Contents
-Axillary nerve
-Posterior circumflex humeral artery

33
Q

What are the branches of the axillary artery?

A

Semen tastes like sweet apple pie

1st part (above pec minor)
–> Superior thoracic artery

2nd part (posterior to pec minor)
–> Thoracoacromial
–> Lateral thoracic

3rd part (inferior to pec minor)
–> Subscapular (largest branch)
–> Anterior circumflex humeral
–> posterior circumflex humeral

34
Q
A
35
Q

What is the surface marking of the coracoid process?

A

2cm inferior to junction between middle and lateral 1/3rd of the clavicle

36
Q

What structures attach to the coracoid process?

A

-Ligaments:
–> Coracoclavicular
–> coracohumeral
–> coracoacromial

Muscles
–> pec minor (insertion)
–> Coracobrachialis (origin)
–> short head of biceps (origin)

37
Q

What muscles are inserted into the bicipital groove?

A

-A lady between two majors

Lateral: Pec major
Medial: teres major
Floor: LD

Tendon of long head of biceps lies within the groove

38
Q

Muscles involved in shoulder abduction

A

Supraspinatus 0-15
Middle fibres deltoid 15-90
>90 trapezius and serratus anterior, which will require upward rotation of the scapula with lateral rotation of the humerus

39
Q

What factors reduce the stability of the shoulder joint?

A

-Shallow glenoid cavity
-Lax capsule with few ligaments
-Inferior aspect not supported due to presence of quadrangular space

40
Q

What factors stabilise the shoulder?

A

Static restraints:
-Glenoid labrum
-Capsule
-Glenohumeral ligaments

Dynamic restraints
-Rotator cuff
—> joint cavity depression produced by synchronised contraction of rotator cuff
—> Increased capsular tension due to attachments of rotator cuff to the capsule

41
Q

What is a synovial joint?

A

-Articulating surfaces covered in hyaline cartilage
-Separated by film of synovial fluid that acts as a lubricant
-Joint stability is provided by fibrous capsule and accessory ligaments
-Synovial fluid is produced by synovial membrane that lines the joint capsule

42
Q

Describe axillary nerve motor and sensory supply, and deficit

A

Motor:
-Deltoid
-Teres minor

Sensory
-Skin to lower half deltoid (regimental badge)

Injury
-Inability to abduct arm beyond 15 degrees
-sensory deficit over regimental badge area

43
Q

1,6,10,11,14

A

1,6,10,11,14

44
Q
A
45
Q
A
46
Q
A
47
Q

What are the upper limb myotomes?

A

C5: elbow flexion
C6: wrist extension
C7: elbow extension
C8: finger flexion
T1: finger abduction

48
Q

What are the reflexes?

A

1,2 buckle my shoe (ankle)
3,4 kick the door (knee)
5,6 pick up sticks (biceps and brachioradialis)
7,8 lay them straight (triceps)

49
Q

Dermatomes

A

C4: lateral neck and shoulder
C5: lateral upper arm and elbow
C6: lateral forearm and thumb
C7: Middle finger
C8: little finger and medial palm
T1: Medial forearm and elbow

50
Q

What are the findings in upper limb nerve root compressions?

A
51
Q

What is the main stabiliser of the shoulder joint?

A

-Rotator cuff muscles

MRCSalah anatomy (15 decks)

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