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Flashcards in Final Deck (98)
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1
Q

Which muscle abducts to about 15 degrees and then what muscle takes over when you continue to abduct

A

Supraspinatus (with the help of the deltoid) and then deltoid

2
Q

If the axillary A is cut at a certain region that we talked about, direction of blood flow in the __ artery is reversed which allows blood to flow to the distal portion of the axillary artery and the rest of the arm due to the scapular anastomoses

A

Subscapular

3
Q

Name what is found in each space.

1) Quadrangular space
2) Triangular space
3) Triangular interval

A

1) Axillary nerve and posterior circumflex humerul artery
2) Circumflex scapula artery
3) Radial nerve and deep brachial artery

4
Q

Which imaging technique is best to study rotator cuff and labrum injuries?

A

MRI

5
Q

Which scapulohumeral muscle attaches to the ribs?

A

Serratus Anterior

6
Q

Which ribs are vertebrocostal? (AKA they have their own costal cartilaginous anterior attachments to some part of the sternum)

Which ribs are vertebrochondral (AKA they have a convergence onto the cartilage of rib 7, but not their own)

A

True ribs (1-7)

False ribs (8-10)

7
Q

The breast sits on top of pectoral fascia, which is right above which muscle? Also, between the breast and the pectoral fascia is a loose tissue plane or potential space called the __ space (bursa)

Also, what innervates the breast?

Finally, the breast attaches the mammary glands to the dermis of overlying skin via __ ligaments

A

Pectoralis Major, retromammary

Anterior and lateral branches of Intercostal nerves (4th-6th)

Suspensory (also referred to as Coopers ligaments)

8
Q

What are the two origin arteries for blood supply to the breast?

A

Subclavian and axillary artery

9
Q

What is the major venous drainage system of the breast?

A

Lateral thoracic vein to axillary vein (although internal thoracic vein to subclavian vein does a little as well)

10
Q

What is the main lymph drainage system, especially in the superior lateral quadrant and center of breast?

A

Axillary lymph nodes (pectoral, central, apical) - which get drained by the subclavian lymphatic trunk

11
Q

What do we see in the deltopectoral triangle?

A

The cephalic vein (Which can be seen traveling up from the arm and dumping into the confluence between the subclavian and axillary veins), deltopectoral lymph nodes, deltoid branch of thracoacromial A, and clavipectoral fascia

12
Q

What artery would you expect to find in the shoulder region?

A

Axillary (the subclavian would be above the clavicle more towards the head and the brachial artery is more towards the arm)

13
Q

The axillary artery starts just below the clavicle and ends around the surgical neck of the humerus. It is divided into 3 portions based on which muscle?

What divides the subclavian artery into 3 parts?

A

Pectoralis minor

Anterior scalene muscle

14
Q

All veins in the hands eventually dump into the superficial veins of the arm and forearm and the deep brachial veins also called vena commitantes. For the superficial veins, the __ vein is more lateral in the arm and the __ vein is more medial in the arm. Then, these 3 veins dump into the axillary vein

A

Cephalic vein

Basilic vein

15
Q

Name the fascia in the pectoral region

1) Descends from the clavicle, enclosing the subclavius and then pectoralis minor becoming continuous inferiorly with the axillary fascia (aka between deep cervical superiorly and axillary fascia inferiorly)
2) Surrounds the pectoralis major and continuous inferiorly with the fascia of the anterior abdominal wall
3) The pectroal fascia and clavipectoral fascia form this fascia

Also, the clavipectoral fascia becomes the __ ligament of axilla which merges to form the axillary fascia inferiorly

A

1) Clavipectoral fascia
2) Pectoral fascia
3) Axillary fascia

suspensory

16
Q

Impingement syndrome is associated which what muscle? Also, what activities would you most likely see this in?

A

Supraspinatus (supraspinatus tendon can cause tendonitis and it can also involve the subacromial to cause bursitis)

Repetitive overhead activites (like tennis, pitching, swimming)

17
Q

Subscapularis tears can lead to bicipital instability because of its connection to the ___ over the long tendon of biceps brachii

A

transverse ligament of the humerus

18
Q

Although isolated ___ tears are rare since it’s such a big and strong muscle, it can be a common sports injury in pitchers, causing rotator cuff tendonitis.

A

subscapularis

19
Q

What is the most commonly injured rotator cuff muscle?

A

Supraspinatus

19
Q

The cervico-axillary canal that allows large arteries and nerves into the axilla can be found at what part of the Axilla?

A

Apex

20
Q

What muscles form the anterior axillary fold?

What about the posterior axillary fold?

A

Pectoralis major

Latissimus dorsi, and teres major

21
Q

What are the contents of the axilla?

A

Axillary A and V, Axillary lymph nodes, and brachial plexus

22
Q

It the brachial plexus ventral or dorsal rami?

A

Ventral (C5-T1)

23
Q

Which portion of the brachial plexus is supraclavicular? AKA if you have a supraclavicular brachial plexus legion it will affect this part of the plexus

What about the infraclavicular part of the brachial plexus?

A

Roots and trunks

Divisions, cords, and branches

24
Q

Which artery is very closely related to the brachial plexus?

A

Axillary artery

25
Q

The Ulnar nerve innervates primarily what?

The median nerve innervates primarily what?

A

The hand

The thumb

26
Q

Anterior compartment does what function and involves which cords?

Posterior compartment does what function and involves which cords?

A

Flex elbow joint, Lat and medial cords

Extend elbow joint, posterior cord

27
Q

Injuries to superior trunk (also known as Erbs Palsey) occurs in what vertebra?

Also how does this injury mostly occur and what are the clinical presentations?

A

C5 and C6

Excessive increase in the angle between neck and shoulder (Falls onto shoulder or grab head of baby)

“Waiters tip” aka arms adducted, medially rotated, pronation, and extension of elbow

28
Q

What specific nerves are affected for C5 and C6 of a superior trunk injury (Erb’s Palsey)?

A

C5: Axillary, Suprascapular, Musculocutaneous nerves

SAM^

C6: Radial nerve

29
Q

Injuries to inferior trunk (also known as Klumpke’s Palsey) occurs in what vertebra?

Also how does this injury mostly occur and what are the clinical presentations?

Finally, what nerves are affected?

A

C8 and T1

Forceful abduction of the arm (like pulling a baby out by the hand or holding on to a tree branch and the arm stretching) and often associated with Horner’s syndrome (which involves T1 sympathetic stuff)

Wrist is extended, claw hand

Median and ulnar nerves

30
Q

What vertebra are affected in radial nerve injuries?

What is the clinical presentation for a radial nerve injury in the axillary region?

If you injure the humerus at the spiral groove by fracturing it, or compress the radial nerve due to “saturday night palsy” what clinical presentations do you expect to see?

A

C5-T1

Wrist drop due to nerve injury before it supplies the triceps (This can be due to improper crutch use) **Note that if the posterior cord was injured before the radial and axillary nerve split, this could also cause wrist drop

Problems with extension (since you affected the radial nerve) so difficulty extending the wrist or extending the fingers. Also wrist drop is seen

31
Q

If one were to fracture their surgical neck of the humerus, dislocate the glenohumeral joint anteriorly, or have a rotator cuff repair surgery what possible injury could have resulted? Also what vertebra would this come from?

What clinical presentations would this cause?

A

Axillary nerve, C5 and C6

Numbness in posterior deltoid, difficulty abducting arm (due to deltoid fucked), diminished lateral rotation (due to teres minor fucked), etc.

32
Q

A penetrating wound to the axillary region or surgical removal of axillary lymph nodes could cause what injury? Also, what vertebra are affected?

What are clinical presentations?

A

Long thoracic nerve, C5-C7

Can’t raise arms above 90 degrees since serratus anterior is injured. Also, winged scapula is seen

33
Q

Fractures to medial epicondyle of humerus or entrapment of nerve in cubital tunnel can cause what nerve injury? And which vertebra are affected?

What would be the clinical presentations?

*** Note that another injury can cause this problem, which is mentioned in a later flash card

A

Ulnar nerve, C8 and T1 (and sometimes C7)

Numbness in 4th and 5th fingers (since remember, the ulnar nerve supplies the medial portion of the hand), weaking of grip, loss of ab and adduction in fingers

*Damage will involve flexors of wrist, digits, and intrinsic hand muscles

34
Q

Fracture of the humerus above the condyles, entrapment of nerve by pronator teres (IMPORTANT), or carpal tunnel syndrome can result in injuries to which nerve? Also, what vertebra are affected?

What clinical presentation is seen?

A

Median nerve, C6-T1

Pain and tenderness in anterior-proximal forearm and decreased sensation along course of median nerve, along with affecting 1st digit. Also hand of benediction can occur because 2nd and 3rd digits can no longer flex

35
Q

Hand of benediction injury is due to what nerve lesioned? What about a hand claw?

A

Median nerve

Ulnar nerve and median n

36
Q

What stabilizes the shoulder joint? (AKA muscles that provide support for the joint)

A

The tendons from the rotator cuff (more-so than the joint capsule itself)

37
Q

What nerves travel through the medial inter-muscular septa? AKA in the anterior compartment

What nerves travel through the lateral intermuscular septa? AKA the posterior comparment

A

Median and ulnar nerve

Radial nerve

38
Q

The lateral antebrachial cutaneous n is a branch from what nerve?

A

Musculocutaneous n

39
Q

If you hit your humerus posterior to the medial epicondyle aka the funny bone, what nerve did you hurt?

In other words, WHAT NERVE RUNS POSTERIOR TO THE MEDIAL EPICONDYLE OF HUMERUS?

A

Ulnar nerve

40
Q

Which arch branches off the ulnar A? What about the radial A?

A

Superficial palmar arch

Deep palmar arch

41
Q

Adduction????? is easier because of the __ of the radius

A

styloid process

42
Q

All of the superficial 1st layer of muscles in the anterior compartment of the forearm attach to __

A

medial epicondyle of humerus

44
Q

If the ulnar nerve becomes compressed by the humeral and ulnar heads of ___ musle in the region of the elbow, tingling and numbness in the medial part of the palm and medial digits can occur

A

Flexor carpi ulnaris

45
Q

What nerve runs posterior to the medial epicondyle?

A

Ulnar N

46
Q

A wrist drop would be due to breaking which part of the humerus and which nerve is affected?

A

Mid-shaft of humerus and radial N

47
Q

Which muscle grouped in with the superficial extensors is a flexor of the elbow joint?

A

Brachioradialis

48
Q

What are the two arteries in the forearm?

A

Ulnar and radial

49
Q

Medial epicondyle of humerus is sometimes called the common __ origin, and the lateral epicondyle is the common __ origin

A

flexor

extensor

50
Q

If the humeral shaft is fractured, what nerve can be injured due to its relationship to the spiral groove?

A

Radial nerve

51
Q

What three muscles make up the anatomical snuff box, and what artery runs with it?

Also what is the floor and roof?

A

APL, EPL, EPB (the three outcropping muscles of the deep layer)

radial artery (scaphoid bone and superficial radial nerve branches are also inside it)

Floor is scaphoid bone, roof is superficial radial nerve branches

52
Q

Give the full name of the joint, what type of joint it is (hinge, pivot, etc.), and what type of axial it is **Also note that all of these joints are synovial and diarthrotic (full movement possible)

1) Acromion process of scapula and clavicle
2) Scapula and humerus
3) Ulna (and radius) with humerus
4) Radius and ulna (give both)
5) Sternum and clavicle

A

1) Acromioclavicular, plane, No axial given
2) Glenohumeral (shoulder), Ball and socket, multiaxial
3) Elbow, hinge, uniaxial
4) Radioulnar proximal or distal, pivot, uniaxial
5) Sternoclavicular, saddle (with articular disc), multiaxial

53
Q

The only “true” boney articulation between the upper limb and thorax is what joint?

A

Sternoclavicular joint

54
Q

What are the four ligaments that reinforce the sternoclavicular joint?

A

Anterior SC lig
Posterior SC lig
Costoclavicular lig
Interclavicular lig

55
Q

What 3 ligaments support the acromioclavicular joint?

A

Acromioclavicular ligament
Trapezoid ligament and Conoid ligament (both are parts of the coracoclavicular ligament that attach the coracoid process to the clavicle )

56
Q

A separated shoulder would result from what joint being separated?

Also, list which grade shoulder separation each is

1) Acromioclavuclar ligament tear
2) Both AC and coracoclavicular ligaments torn
3) AC ligament sprain

A

Acromioclavicular

1) Grade 2
2) Grade 3
3) Grade 1

57
Q

What is a cartilaginous rim that extends the surface area of the glenoid (to make it a little deeper)

A

Glenoid labrum

58
Q

What holds the humeral head and glenoid cavity together? (Muscles and ligaments)

Also, what muscle pierces the capsule and originates on the supraglenoid tubercle located on the scapula?

A

Tendons of the rotator cuff muscle (SITS - mneumonic)

The ligaments are:

glenohumeral ligaments (three of them: superior, middle, and inferior)

Coracohumeral ligament,

transverse humeral ligament

coracoacromial ligament (although this does not really do anything since it attaches from the corocoid process to the acromion)

Biceps Brachii

59
Q

Which 2 bursa are most likely to cause bursitis in the shoulder?

What are two other important bursa we are suppose to know?

A

Subacromial into the subdeltoid bursa

Subscapular bursa and subcoracoid bursa

60
Q

What bursa facilitates movement of the supraspinatus tendon under the coracoacromial arch and of the deltoid over the joint capsule of the glenohumeral joint and the greater tubercle of the humerus?

A

Subacromial bursa (also could be called the deltoid bursa)

61
Q

Shoulder dislocation involves what joint?

Shoulder separation involves which joint?

A

Glenohumeral joint * Don’t confuse this with shoulder seperation which is due to acromioclavicular problems

62
Q

What direction are most shoulder dislocations?

A

Inferior (down) and anterior - this is because the coracoacromial structures and the rotator cuff tend to prevent upward dislocation

63
Q

What nerve can be damaged with shoulder dislocation that wraps around the surgical neck of the humerus?

So what artery running with nerve could also be damaged?

A

Axillary nerve

Posterior circumflex humeral artery

64
Q

If a patient comes in who previously disloacted their glenohumeral joint, between the age of 40-60, limited abduction and compensatory scapular movements; what injury might they have?

A

Adhesive capsulitis of the glenohumeral joint (also called frozen shoulder) - due to fibrosis between the joint capsule, rotator cuff muscles, and synovial bursa

65
Q

Forceful and abrupt overhead motion in a baseball player, tennis player, pushing off with arms (like when an elderly is getting out of a chair), falling on an outstretched arm or hand could lead to what kind of injury

A

rotator cuffs

66
Q

What joint articulation makes up the true elbow joint?

What remaining two joints make up the elbow?

A

Humeroulnar articulation

Humeroradial articulation and the proximal radioulnar articulation

67
Q

What are the 4 ligaments that reinforce the proximal elbow joint?

A

Ulnar (medial) collateral ligaments, radial (lateral) collateral ligaments, Anular ligament (which wraps around the head of the radius), and the quadrate ligament (helps to reinforce the articulation between the radius and the ulna)

68
Q

What are the ligaments that make up the proximal radioulnar joint?

What about the distal joint?

A

Annular and quadrate (even though we mention 4 total on a previous notecard)

Palmar radioulnar ligament and dorsal radioulnar ligament

69
Q

Subluxation (disloaction of radial head) occurs when the head of the radius slips out of which ligament?

A

Anular ligament

** Children being suddenly lifted by their upper limb in a jerking motion are prone to this

70
Q

Lateral epicondylitis, also called tennis elbow, occurs from repetitive use of forearm extensors, in particular the tendon of __ becomes inflamed or torn

A

Extensor carpi radialis brevis

**Remember, the lateral epicondyle is the common extensor origin ** and carpi radialis brevis attaches there

71
Q

BBQ*

What nerve is injured when a winged scapula is present. Furthermore, what muscle is also injured and then what motion can no longer be completed?

A

Long thoracic nerve (C5, C6, C7) and serratus anterior. The upper limb can not be abducted above the horizontal because the serratus anterior lifts the scaupla upwards

72
Q

BBQ*

What is the most common rotator cuff muscle torn?

A

Supraspinatus

73
Q

BBQ*

An injury to the axillary nerve due to incorrect use of crutches, fracture of surgical neck of humerus, or dislocation of glenohumeral joint can cause the __ muscle to atrophy. In addition, loss of sensation can occur over the lateral side of the proximal part of the arm because it is supplied by the __, a branch of the axillary N.

A

Deltoid

Superior lateral cutaneous nerve of arm

74
Q

BBQ*

Since breast cancer normally spreads by means of lymphatic vessels, where is the most common place to find a cancer?

If a cancer has invaded the retromammary space, pectoral fascia of the perctoralis major, or metastasized to the interpectoral nodes, a clincal sign would be breast ___ when the muscles contract

A

Axillary lymph nodes

elevation

75
Q

BBQ*

If a women or man were to develop supernumeray breasts or nipples (more than 2 nips), what is this called?

A

Polymastia or polythelia

76
Q

BBQ*

During subclavian vein puncture, technically the axillary artery is the entry point because the catheter is inserted right below the first rib/clavicle, however once inserted in instantly turns into the subclavian vein. Therefore, it is important that the axillary vein is ___ and inferior (superficial) to the axillary artery and brachial plexus

A

Anterior

77
Q

BBQ*

During axillary lymph node dissection, which 2 nerves could possibly be injured

A

Long thoracic nerve and thoracodorsal nerve

78
Q

BBQ*

When the superior root of the plexus is C4 and the inferior root is C8, what is this called?

What about when the superior root is C6 and the inferior root is T2

A

Prefixed brachial plexus

Postfixed brachial plexus

79
Q

BBQ*

Backpacker’s palsy can result in injury to the superior brachial plexus which results in what nerves being injured?

A

Musculocutaneous and radial nerves (the end of SAM R- mnemonic)

80
Q

BBQ*

Biceps tendinitis occurs in which head of the bicep since it is enclosed in a synovial sheath?

Furthermore, if a patient comes in with the “popeye deformity” aka a ball near the center of the distal part of the anterior aspect of the arm, what injury has most likely occurred?

A

Long head

Rupture of tendon of long head in biceps

81
Q

BBQ*

If one were to have a mid-humeral fracture or a supra-epicondylar fracture, and injury the radial nerve, what muscles would NOT be affected?

A

Triceps (even though they are supplied by this nerve, the origin of the nerves to two of its three heads is so high that it probably wouldn’t be affected

82
Q

BBQ*

If one were to be stabbed in the axilla, the musculocutaneous nerve could be injured. What kind of sensation would be lost in the skin?

A

Lateral surface of forearm due to the lateral antebcrachial cutaneous nerve being injured (since it is a direct branch of the musculocutaneous nerve)

83
Q

BBQ*

Patients with tennis elbow have pain that is felt over the __ epicondyle and radiates down the __ surface of the forearm.

This is caused by repeated extension and flexion of the wrist, which injures the common extensor tendon (aka the tendon that which four superficial extensors are attached to?)

A

Lateral, posterior

ECRB, ED, EDM, ECU

84
Q

BBQ*

If one were to break their olecranon process on their ulna, what muscle would pull it away from the bone due to tonic contraction?

A

Triceps, since they attach to the olecranon

85
Q

BBQ*

What nerve is compressed in carpal tunnel syndrome

A

Median

86
Q

BBQ*

If one were to injure the median nerve, which digits could no longer flex at the distal interphalangeal joints?

If you tell someone to make an “OK” sign but they can only make a pinching sign instead, which specific nerve is injured? And which muscles?

A

2nd and 3rd since FDS and the part supplied by the median nerve of FDP is destroyed. However, 4th and 5th could still flex because even though FDS also supplies the 4th and 5th, FDP is innervated by the ulnar nerve for the 4th and 5th digits, so they would not really be affected. This is why hand of benediction occurs (you can flex your thumb, 4th and 5th fingers, but not your 2nd and 3rd)

Anterior interosseous nerve (from the median nerve) due to flexor pollicis longus and FDP

87
Q

BBQ*

What nerve could become entrapped in pronator teres and results in pain in the anterior compartment of the forearm (since that’s where pronator teres exists), and palmar aspects of radial three and half digits with pain (because that’s the area that this nerve supplies)

A

Median nerve

88
Q

BBQ*

If one were to injure the deep branch of the radial N, what kind of sensation would they feel and where?

A

None, because the deep branch is solely musculature. It’s the superficial branch that does cutaneous sensation

89
Q

BBQ*

A good place to draw blood is the median cubital vein. However, it’s not a good place to inject drugs because which artery could possibly be punctured and injected with the drugs instead?

A

Brachial A

90
Q

BBQ*

__ is when the SC joint becomes stiff or fixed and can be called SAPHO syndrome (Synovitis, acne, pustulosis, hyperostosis, and osteitis)

A

Ankylosis

Fixed by removing part of the clavicle

91
Q

BBQ*

SC joint dislocations are extremely rare, however when they do happen in patients less than 25 years old, it occurs at the __

A

Epiphyseal plate

92
Q

BBQ*

A patient comes in complaining of pain in the shoulder and when images are taken it becomes obvious the calcification of the ___ bursa has occurred. This is called calcific scapulohumeral bursitis

A

Subacromial

93
Q

BBQ*

A person is told to hold out their arms and lower them, when they get to about 15 degrees from their body the arms suddenly drop. What is injured?

A

A rotator cuff muscle, specifically supraspinatus

94
Q

BBQ*

Minners elbow also called dart thrower elbow occurs from friction of subcutaneous __ bursitis

A

olecranon

95
Q

BBQ*

SC joint dislocations are extremely rare, however when they do happen in patients less than 25 years old, it occurs at the __

A

Epiphyseal plate

96
Q

BBQ*

A patient comes in complaining of pain in the shoulder and when images are taken it becomes obvious the calcification of the ___ bursa has occurred. This is called calcific scapulohumeral bursitis

A

Subacromial

97
Q

BBQ*

A person is told to hold out their arms and lower them, when they get to about 15 degrees from their body the arms suddenly drop. What is injured?

A

A rotator cuff muscle, specifically supraspinatus

98
Q

BBQ*

Minners elbow also called dart thrower elbow occurs from friction of subcutaneous __ bursitis

A

olecranon