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MRCS Other > Doctors Academy - Upper limb COPY > Flashcards

Doctors Academy - Upper limb COPY Flashcards

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1
Q

Brachial Plexus:
What nerves arise directly from the roots?

A

C5 - Dorsal Scapula Nerve

C5, C6, C7 - Long thoracic Nerve

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2
Q

Brachial Plexus:
What nerves arise directly from the trunks?

A

C5, C6 - Suprascapular nerve

C5, C6 - Nerve to Subclavius

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3
Q

What does the Supra scapular nerve innervate

A

Supra and infra spinatous

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4
Q

Brachial Plexus:
What nerves arise directly from the Lateral Cord

A

3 nerves:

  1. Lateral Branch of median nerve
  2. Musculocutaneous Nerve
  3. Lateral Pectoral Nerve
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5
Q

Brachial Plexus:
What nerves arise directly from the Medial Cord

A
  1. Medial cutaneous nerve of the arm
  2. Medial cutaneous nerve of the forearm
  3. Medial pectoral nerve
  4. Ulnar Nerve
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6
Q

Brachial Plexus:
What nerves arise directly from the Posterior Cord

A

5 Nerves: (ULNAR)

  1. Upper sub scapular
  2. Lower Sub Scapular
  3. nerve to latissimus dorsi / thoracodorsal nerve
  4. Axillary Nerve
  5. Radial Nerve
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7
Q

What does the Musculocutaneous Nerve supply?

A

BBC muscles

  1. Biceps
  2. Brachialis
  3. Coracobrachialis
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8
Q

What is the course of the musculocutaneous nerve in the arm and forearm

A
  • it pierces the coracobrachialis
  • in the lower 1/3 it passes between brachialis and biceps
  • it then continues in to the forearm as the lateral cutaneous nerve of the forearm
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9
Q

Shoulder Movements:
What shoulder muscles causes Flexion

A
  • Anterior fibres of the deltoid
  • choracobrachialis
  • Biceps
  • pec major
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10
Q

Shoulder Movements:
What shoulder muscles causes extension

A
  1. posterior fibres of the deltoid
  2. Teres Major
  3. latissimus dorsi
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11
Q

Shoulder Movements:
What shoulder muscles causes Abduction

A

0-30 degrees - supraspinatus
30-100 degrees - deltoid
>100 degrees - Rotation of the scapula (supported by levator scapulae)

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12
Q

Shoulder Movements:
What shoulder muscles causes adduction

A
  • Latisimus dorsi
  • Teres Major
  • Pectoralis Major
  • Choracobrachialis
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13
Q

Shoulder Movements:
What shoulder muscles causes External Rotation

A
  1. Teres Minor
  2. Infraspinatus
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14
Q

Shoulder Movements:
What shoulder muscles causes Internal Rotation

A
  • Subscapularis
  • Anterior Deltoid
  • Teres Major
  • Lat Dorsi
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15
Q

What are the 4 rotator cuff muscles and what are their nervous innervation

A
  1. Suprapinatus - Suprascapular Nerve
  2. Infraspinatus - Suprascapular Nerve
  3. Teres Minor - Axillary Nerve
  4. Subscapular - Upper and lower sub scapular nerve

NB: S, I & T attach to the greater tubercle of the humerus. Subscapular attaches to the lesser tubercle

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16
Q

What nerve would be at risk in a neck of humerus fracture

A

Axillary nerve

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17
Q

What area of skin does the axillary nerve supply

A

regimental badge region

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18
Q

Describe the relation of the median nerve to the brachial artery arm and forarm

A

Lateral to Anterior to Medial

(Forearm: Runs between heads of pronator Teres)

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19
Q

What are the branches of the median nerve

A

AIN - given off after elbow
Median nerve Proper

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20
Q

What muscles are supplied by the Median Nerve

A

Flexors of the forearm:

  • Pronator Teres
  • Palmaris Longus
  • FCR
  • FDS

LOAF muscles:

  • Lateral 2 lumbricles
  • Oponons Policus
  • Abductor Policus Brevis
  • Flexor Policus Brevis
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21
Q

What muscles are supplied by the AIN

A

Flexor Policus Longus
Lateral 2 x FDP
Pronator Quadratus

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22
Q

What muscles are supplied by the Radial Nerve Proper

A

Aconeus
ECRB
ECRL
Brachioradialis

+ Triceps

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23
Q

What muscles are supplied by the PIN nerve (Branch of radial nerve)

A
  • All extensors of the forearm not supplied by radial nerve proper
  • Supinator
  • Abductor Policus Longus
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24
Q

What muscles are supplied by the ulnar nerve

A
  • All intrinsic small muscles of the hand except LOAF muscles
  • FCU
  • Medial 2 x FDP
  • Adductor policus

NB: supplies no muscles in the arm

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25
which structure separates superficial from deep structures in the antecubiltal fossa?
Bicipital tendon (biceps tendon)
26
In Froment's test which muscle function is tested
Adductor Policus
27
What are the symptoms of kulmpkes palsy
- Claw hand - Loss of sensation over medial aspect of forearm and hand - Horner's syndrome - Loss of flexors of the wrist - arm is supernated
28
What nerve is commonly damaged in a medial epicondylar fracture
Ulnar nerve
29
What nerve is commonly damaged in a supracondylar fracture?
Median nerve - specifically the AIN
30
What movement of the fingers do the dorsal and Palmer Interossi produce?
PAD DAB: Palmar Interossi Adduct Dorsal Interossi Abduct
31
What muscles do the superficial and deep branches of the ulnar nerve supply?
**Superficial Branch:** Palmaris Brevis + Skin sensation to ulnar side of the hand **Deep branch:** All other intrinsic muscles of the hand (the three hypothenar muscles, the two medial lumbricals, the seven interrosei, the adductor pollicis and the deep head of the flexor pollicis brevis.) *Essentially, all muscles are supplied by the deep ulnar branch appart from the palmaris brevis. Superficial Branch then supplies sensation to the skin.*
32
In what condition are bouchard and hebredens nodes found? Where are these nodes commonly found within the hand?
These are seen in osteoartheritis Bouchards: PIPJ Hebradens: DIPJ (+ cause deviation of the finger tip)
33
What structures are found in the quadrangular space?
Axillary Nerve and posterior circumflex artery
34
What structures are found in the triangular space?
Radial Nerve and the profunda brachi artery
35
What divides the quadrangular and triangular space
the teres minor
36
What signs would a patient present with in a: 1. High median nerve injury 2. Damage at the elbow 3. Damage at the wrist
High median Nerve Injury: * Child - pointing sign * Adult - hand of benidiction Damage at elbow: * Loss of flexors of the forearm (AIN would remain intact ) (Sensation intact) Damage at wrist: * Unable to lift thumb to ceiling (Flexion normal)
37
What are the signs of ulnar nerve injury?
* Wasting of the hypothenar muscles * waisting of the palmer and dorsal interossi * loss of sensationover medial 2 digits * Claw Hand (higher the paw, lower the claw)
38
What signs would you get a radial nerve injury: 1. Above the spiral Groove 2. Between spiral groove and elbow 3. Below elbow
Above spiral groove: * Triceps and all extensors affected - wrist drop and innability to extend elbow. * Loss of sensation to dorsum of hand Between spiral groove and elbow: * no wrist drop * can lift hand but cannot radially abduct (ERCL lost) Below elbow = PIN injury: * Unable to fully extend fingers * no sensory loss
39
What structures are commonly damaged in a supracondylar injury?
Median Nerve (AIN) + Brachial artery
40
What nerve is commonly damaged in a montegio fracture?
PIN
41
What structures are commonly injured in a galiezi fracture?
Median nerve
42
what structures are commonly damaged in a mid shaft humerus fracture (around spiral groove)
Raidal nerve + profuna brachii artery
43
What muscle does the median nerve travel between
enters the forearm between the two heads of the pronator teres then continues between FDP and FDS
44
What muscle does the ulnar nerve travel through
two heads of FCU
45
What muscles does the musculocutaneous nerve pass between?
biceps brachii
46
What muscles does the radial nerve pass between
the 2 heads of the suppinator
47
what structures are commonly damaged in a medial condylar fractures
ulnar nerve and ulnar colateral artery
48
What are the features of a Montegia Fracutre?
* Ulnar fracture * Proximal Bones affected * Dislocation of radial head
49
What are the features of a Galliezi fracture?
* Radius fracure * Distal bones affected * distal radioulnar joint dislocation
50
Which local anaesethic is contraindicated in a biers block and why
Bupivicaine - it is cardiotoxic
51
What structures are at risk during an axillary node clearence
1. Thoracodorsal nerve 2. Long thoracic nerve 3. Intercostal brachial nerve 4. medial pectoral nerve
52
What structures pierce the clavicopectoral fascia
1. Acromiothoracic trunk (Thoracoacromial artery) 2. lateral pectoral nerves 3. cephalic vein 4. lymphatics
53
What structures lie in the roof of the anticubital fossa?
* Medial cutaneous nerve of the forearm * Lateral cutaneous nerve of the forearm * Cephalic vein * Basilic vein * median cubital vein
54
what strucures are found within the anticubital fossa
* Median nerve * brachial veins * brachial arteries * Biceps tendon * radial nerve
55
what are the borders of the anticubital fossa?
Lateral: brachioradialis Medial: Pronator Teres Superior: Epicondylar line Floor: brachiallis
56
What are the boarders of the antatomical snuff box?
Lateral: Extensor Policus Brevis Medial: Extensor Policus longus Proximal: Styloid process of the radius Floor: Scaphoid and trapezium
57
what is the contents of the anticubital fossa
* Radial artery * superficial branch of radial nerve * cephalic vein
58
What are the contents of the carpel tunnel
1. FDP 2. FDS 3. Median Nerve 4. FPL 5. FCR
59
What is the treatment of surgical and anatomical neck of humerus fractures?
Anatomical neck : Anatomical neck fractures which are displaced by \>1cm carry a risk of avascular necrosis to the humeral head. therefore a hemiarthroplsty may be required Surgical Neck: Impacted fractures of the surgical neck are usually managed with a collar and cuff for 3 weeks followed by physiotherapy. More significant injuries may require an ORIF
60
What nerves accompany the basilic and cephalic veins in the forearm
1. The median cutaneous nerve accompanies the basilic vein 2. The lateral cutaneous nerve accompanies the cephalic vein
61
Where do the rotator cuff muscles insert on the humerus?
All attach to the greater tuberosity apart from the subscabular which inserts in to the lesser tuberosity
62
What muscle does the long thoracic nerve supply
Serratus anterior
63
What is the classification system for supracondylar fractures and what are the fixation methods?
Garlands classification ## Footnote Type 1 (Undisplaced) - K wires Type 2 and 3 (displaced ) - ORIF
64
If you have had a previous Colles fracture what residual defect might you have?
Thumb drop from EPL damage
65
What is the auxiliary sheath a continuation of?
The pre vertebral fascia
66
What does the auxiliary sheath contain?
Auxiliary artery The 3 chords of the brachial plexus
67
How many extensor compartments of the wrist are there and what are their contents?
There are 6 extensor compartments ## Footnote 1. EPB + APL 2. ECRB + ECRL 3. EPL 4. EI and ED 5. EDM 6. ECU
68
What structures are found below the flexor retinaculum
1. FDS 2. FDP 3. FPL 4. FCR 5. Median Nerve
69
In what fractures do you get a cubits Varus deformity
Supracondylar fracture
70
What are the contents of the 6 extensor compartments?
1. EPB + APL 2. ECRB + ECRL 3. EPL 4. EI + EDC 5. EDM 6. ECU
71
What structures articulate with the radius superiorly?
Capitulum ("Capital Radio")
72
What is froments test and what does it test for?
hold a piece of paper between your thumb and index finger it tests the adductor policus and the function of the ulnar nerve
73
What two muscle heads does the radial nerve travel between?
the long and short head of the biceps
74
Which muscle of the upper arm attaches to the ulnar
brachialis muscle - all other muscles of the upper arm attach to the radius
75
what is the relationship of the ulnar artery and ulnar nerve + radial artery and radial nerve in the wrist
Ulner nerve is ulnar to the artery radial nerve is radial to the artery both nerves sit on top of the arteries
76
what nerve is most commonly injured in a surgical neck of humerus frature
axillary nerve

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