Neurovasculature - Upper Limb

Question 1

Where can you find pulses in the upper limb?

Answer 1

Brachial pulse
Radial pulse (at wrist and anatomical snuff box)
Ulnar pulse

Question 2

When does the subclavian artery become the axillary artery?

Answer 2

Lateral border of the 1st rib

Question 3

What arteries branch off of the axillary artery at the surgical neck of humerus?

Answer 3

Posterior and anterior circumflex arteries

Subscapular artery

Question 4

At what point does the axillary artery become the brachial artery?

Answer 4

Inferior border of teres major

Question 5

What can an axillary artery aneurysm result in?

Answer 5

Pain and loss of sensation in the arm due to brachial plexus pressure

Question 6

Who is likely to get an axillary artery aneurysm?

Answer 6

Patients with Marfan’s syndrome
Patients with high blood pressure
(Baseball pitchers)

Question 7

What branch arises just distal to teres major from the brachial artery and where does it travel?

Answer 7

Profunda brachii

Runs down radial groove with radial nerve

Question 8

Is partial or temporary occlusion of the brachial artery a problem?

Answer 8

No, as the anastomotic supply protects the arm

Question 8

What can happen with total blockage of the brachial artery or it being severed?

Answer 8

Ischaemia of the forearm causing necrosis and paralysis of muscles of forearm
The muscles shorten and cause a flexion deformity called Volkmann’s contracture

Question 9

Which artery supplies the anterior and posterior of the forearm?

Answer 9

Radial artery - posterior forearm

Ulnar artery - anterior forearm

Question 10

The radial and ulnar arteries anastamose in the hand to form what?

Answer 10

Superficial palmar arch

Deep palmar arch

Question 11

What arteries arise from the superficial palmar arch?

Answer 11

Common palmar digital arteries

Question 12

What are the two superficial veins of the upper limb called?

Answer 12

Basilic

Cephalic

Question 13

What does the basilic vein drain into?

Answer 13

Forms the axillary vein by combining with deep brachial veins

Question 14

Where does the cephalic vein drain?

Answer 14

Axillary vein in the axilla

Question 15

What connects the cephalic and basilic veins at the elbow?

Answer 15

Median cubital vein

Question 16

The brachial veins lie either side of the brachial artery and use its pulsations to aid return, what are these types of veins called?

Answer 16

Vena comitantes

Question 17

What veins connect the deep and superficial veins?

Answer 17

Perforating veins

Question 18

Where is the main site for venepuncture at the upper limb?

Answer 18

Median cubital vein anteriorly at the elbow

Question 19

What roots make up the brachial plexus?

Answer 19

C5
C6
C7
C8
T1

Question 20

What roots form the superior trunk?

Answer 20

C5 and C6

Question 21

What roots form the middle trunk?

Answer 21

C7

Question 22

What roots form the inferior trunk?

Answer 22

C8 and T1

Question 23

What roots contribute to the musculocutaneous nerve?

Answer 23

C5
C6
C7

Question 24

What roots contribute to the axillary nerve?

Answer 24

C5 | C6

Question 25

What roots contribute to the median nerve?

Answer 25

C6 C7 C8 T1

Question 26

What roots contribute to the radial nerve?

Answer 26

``` C5 C6 C7 C8 T1 ```

Question 27

What roots contribute to the ulnar nerve?

Answer 27

C8 | T1

Question 28

What is Erb's palsy?

Answer 28

Excessive increase in angle between neck and shoulder damaging roots C5 and C6 Leads to waiter's tip position

Question 29

What is Klumke palsy?

Answer 29

Excessive abduction of the arm leading to damage of the T1 root Leads to paralysis of muscles in the hand - full claw of the hand

Question 30

What motor functions does the axillary nerve have?

Answer 30

Teres minor | Deltoid

Question 31

What sensory functions does the axillary nerve have?

Answer 31

Regimental badge area

Question 32

What injury can cause axillary nerve damage?

Answer 32

Surgical neck of humerus fracture | Dislocation of the humerus

Question 33

What is the motor function of the musculocutaneous?

Answer 33

Anterior compartment of the arm: Brachialis Biceps brachii Coracobrachialis

Question 34

What is the sensory function of the musculocutaneous nerve?

Answer 34

Skin on the lateral surface of the forearm

Question 35

How can the musculocutaneous nerve be damaged?

Answer 35

Stab wound to the axilla

Question 36

What is the motor function of the median nerve?

Answer 36

Anterior flexors of the forearm (except flexor carpi ulnaris and part of flexor digitorum profundus) Thenar muscles in the hand Lateral 2 lumbricals

Question 37

What is the sensory function of the median nerve?

Answer 37

Lateral part of the palm Lateral 3.5 fingers of anterior surface of hand Lateral 3.5 fingertips of posterior surface of hand

Question 38

What is the course of the median nerve at the elbow?

Answer 38

Through the cubital fossa

Question 39

What can cause median nerve damage?

Answer 39

Carpal tunnel syndrome Supracondylar fracture Lacerations at the wrist

Question 40

What is the characteristic sign of median nerve damage?

Answer 40

Hand of benediction

Question 42

What are the motor functions of the radial nerve?

Answer 42

Triceps brachii | Posterior compartment of the forearm

Question 43

What is the sensory function of the radial nerve?

Answer 43

Lower lateral and posterior aspects of upper arm Posterior forearm Dorsal palm and 3.5 digits (apart from fingertips)

Question 44

What is the course of the radial nerve at the elbow?

Answer 44

Anterior to the lateral epicondyle of humerus

Question 45

How does radial nerve damage present?

Answer 45

Wrist drop

Question 47

What is the motor function of the ulnar nerve?

Answer 47

``` Flexor carpi ulnaris, part of flexor digitorum profundus Hypothenar muscles Medial lumbricals Adductor pollicis Interossei muscles ```

Question 48

What is the sensory function of the ulnar nerve?

Answer 48

Medial palm | Medial 1.5 fingers anteriorly and posteriorly

Question 49

What is the course of the ulnar nerve at the elbow?

Answer 49

Posterior to medial epicondyle

Question 50

How can the ulnar nerve be damaged?

Answer 50

Medial epicondyle fracture | Lacerations to wrist

Question 51

How does ulnar nerve damage present?

Answer 51

Ulnar claw

Question 52

What can cause damage to the radial nerve?

Answer 52

Midshaft fracture of humerus Fractures of the radial head Stabbing in the forearm