Millers Anatomy - Upper extremity

Question 1

What is the angle of glenoid retroversion relative to the scapular body?

Answer 1

Approximately 5 degrees

Question 2

What separates the suprascapular artery from the suprascapular nerve?

Answer 2

Superior transverse scapular ligament

Question 3

What mnemonic is used to remember the relationship of the suprascapular artery and nerve?

Answer 3

Army over Navy

Question 4

What is the function of the coracoacromial ligament?

Answer 4

Important anterosuperior restraint

Question 5

When does the clavicle begin to ossify?

Answer 5

At 5 weeks’ gestation

Question 6

When does the clavicle fuse completely?

Answer 6

At 25 years of age (medial epiphysis)

Question 7

What should not be repaired to avoid loss of external rotation?

Answer 7

Anterosuperior glenoid labral variants

Question 8

What is the height of the humeral head above the superior border of the pectoralis major tendon?

Answer 8

Approximately 5.6 cm

Question 9

What are the approximate distances of the trapezoid and conoid ligaments from the AC joint?

Answer 9

• Trapezoid ligament: approximately 25 mm
• Conoid ligament: approximately 45 mm

Question 10

What is the ratio of glenohumeral to scapulothoracic motion during arm elevation?

Answer 10

Approximately 2 : 1

Question 11

What is the primary function of the rotator cuff?

Answer 11

Depresses and stabilizes the humeral head against the glenoid

Question 12

What should the radial head align with at all arm positions?

Answer 12

Capitellum

Question 13

What type of forces are at the medial and lateral elbow?

Answer 13

• Tensile forces at medial elbow
• Compressive forces at lateral elbow

Question 14

What is the primary static stabilizer to valgus stress at the elbow?

Answer 14

Ulnar collateral ligament (especially anterior band)

Question 15

What injury is associated with posterolateral rotatory instability (PLRI) of the elbow?

Answer 15

Lateral ulnar collateral (LUCL) injury

Question 16

What is paramount in the fixation of radial shaft fractures?

Answer 16

Restoration of radial bow

Question 17

What is the Space of Poirier?

Answer 17

A central weak area in the floor of carpal tunnel

Question 18

What does the Guyon canal contain?

Answer 18

• Ulnar nerve
• Ulnar artery

Question 19

What are the borders of the Guyon canal?

Answer 19

• Flexor retinaculum (deep)
• Volar carpal ligament (superficial)
• Pisiform (ulnar/proximal)
• Hook of hamate (radial/distal)

Question 20

Which pulley is the most critical to finger function?

Answer 20

A2 pulley

Question 21

What is the result of long thoracic nerve (C5-C7) injury?

Answer 21

Medial winging due to serratus anterior dysfunction

Question 22

What causes lateral winging of the scapula?

Answer 22

Spinal accessory nerve (cranial nerve XI) injury

Question 23

What are the preclavicular branches of the brachial plexus?

Answer 23

• Dorsal scapular nerve
• Long thoracic nerve
• Suprascapular nerve
• Nerve to subclavius

Question 24

Where does the radial nerve traverse?

Answer 24

Radial groove in the posterior humerus

Question 25

What is the position of the ulnar nerve in relation to the brachial artery?

Answer 25

Posteromedial to brachial artery in upper arm

Question 26

What structures does the ulnar nerve split between as it enters the forearm?

Answer 26

The two heads of the FCU

Question 27

What is the lateral antebrachial cutaneous nerve a continuation of?

Answer 27

Musculocutaneous nerve

Question 28

Where do digital arteries arise from?

Answer 28

Superficial palmar arch

Question 29

What are the potential sites of median nerve compression?

Answer 29

* Ligament of Struthers * Pronator teres * FDS aponeurosis * Bicipital aponeurosis * Accessory head of FPL * Carpal tunnel

Question 31

What is AIN syndrome characterized by?

Answer 31

AIN syndrome is motor only with no sensory symptoms. ## Footnote AIN stands for Anterior Interosseous Nerve, which is a branch of the median nerve.

Question 32

Name the sites of potential compression for the ulnar nerve.

Answer 32

* Arcade of Struthers * Medial intermuscular septum * Cubital tunnel * Medial epicondyle * Two heads of FCU * Anconeus epitrochlearis * Guyon canal ## Footnote FCU stands for Flexor Carpi Ulnaris.

Question 33

What happens to clawing in distal ulnar nerve compression?

Answer 33

More clawing occurs as FDP function to ring and small is maintained. ## Footnote FDP stands for Flexor Digitorum Profundus.

Question 34

Identify the sites of potential compression for the radial nerve.

Answer 34

* Fibrous bands at elbow joint * Recurrent leash of Henry * ECRB * Arcade of Frohse * Supinator ## Footnote ECRB stands for Extensor Carpi Radialis Brevis.

Question 35

What should be done to move the PIN anteriorly and radially during elbow approaches?

Answer 35

Pronate the forearm during lateral approach to elbow/posterior approach to forearm. ## Footnote PIN stands for Posterior Interosseous Nerve.

Question 36

What is the recommended forearm position during the anterior approach to the forearm?

Answer 36

Supinate the forearm to move PIN posteriorly and laterally.