UL1 - Neurovasculature of the shoulder, arm & elbow

Question 1

what marks the transition from the subclavian to axillary artery?

Answer 1

lateral border of the 1st rib

Question 2

what marks the transition from axillary to brachial artery?

Answer 2

inferior border of teres major

Question 3

What artery runs with the radial nerve in the radial groove of the humerus?

Answer 3

profunda brachii (deep brachial) artery

Question 4

which part of the axillary artery gives rise to the posterior circumflex humeral artery?

Answer 4

3rd part (distal to pectoralis minor)

Question 5

Which artery is at risk during surgical neck fractures of the humerus?

Answer 5

posterior circumflex artery

Question 6

Which artery lies medial to the biceps tendon at the cubital fossa?

Answer 6

brachial artery

Question 7

What three arteries form the scapular anastomosis? where do they arise from?

Answer 7

• suprascapular (thyrocervical trunk > subclavian)
• dorsal scapular (subclavian)
• subscapular (axillary)

Question 8

the brachial artery bifurcates at the level of the:

Answer 8

neck of the radius

Question 9

The axillary artery lies in relation to which muscle?

Answer 9

pectoralis minor

Question 10

Which artery gives rise to the thoracoacromial trunk?

Answer 10

axillary artery (2nd part)

Question 11

The brachial artery lies __________ to the median nerve in the proximal arm.

Answer 11

medial

Question 12

The brachial artery lies __________ to the median nerve in the distal arm.

Answer 12

lateral

Question 13

The posterior circumflex humeral artery anastomoses with the __________ around the surgical neck of the humerus.

Answer 13

anterior circumflex humeral artery

Question 14

The subclavian artery becomes the axillary artery at the __________

Answer 14

Lateral border of the 1st rib

Question 15

The axillary artery becomes the brachial artery at the __________.

Answer 15

Inferior border of teres major

Question 16

Which artery is least likely to be affected in a surgical neck fracture of the humerus?
A. Anterior circumflex humeral
B. Posterior circumflex humeral
C. Subscapular
D. Axillary

Answer 16

C. Subscapular - more medial & not in close proximity to the surgical neck.

Question 17

Which artery travels with the radial nerve in the posterior compartment?
A. Anterior circumflex humeral
B. Profunda brachii
C. Lateral thoracic
D. Superior thoracic

Answer 17

B. Profunda brachii

Question 18

At the cubital fossa, the brachial artery lies:
A. Lateral to the biceps tendon
B. Lateral to the median nerve
C. Deep to the radial artery
D. Lateral to the ulnar nerve

Answer 18

B. Lateral to the median nerve

Question 19

The transition from subclavian to axillary artery occurs at:
A. The medial border of 1st rib
B. Inferior border of teres major
C. Lateral border of 1st rib
D. Lateral border of clavicle

Answer 19

C. Lateral border of 1st rib

Question 20

The axillary artery gives rise to the subscapular artery from:
A. 1st part
B. 2nd part
C. 3rd part
D. 4th part

Answer 20

C. 3rd part

Question 21

Which artery contributes to the scapular anastomosis?
A. Anterior humeral circumflex
B. Lateral thoracic
C. Dorsal scapular
D. Superior thoracic

Answer 21

C. Dorsal scapular

Question 22

Which is true regarding the profunda brachii artery?
A. Supplies anterior arm muscles
B. Arises from axillary artery
C. Travels in radial groove
D. Terminates at clavicle

Answer 22

C. Travels in radial groove

Question 23

A trauma patient has a fracture of mid-shaft humerus. Which of the following is most likely to be injured?
A. Median nerve & profunda brachii
B. Ulnar nerve & radial artery
C. Radial nerve & profunda brachii
D. Axillary nerve & subscapular artery

Answer 23

C. Radial nerve & profunda brachii

Question 24

The lateral thoracic artery arises from:
A. Subclavian artery
B. Thoracoacromial artery
C. 2nd part of axillary artery
D. 3rd part of axillary artery

Answer 24

C. 2nd part of axillary artery

Question 25

Which artery lies deep to pectoralis minor and has four terminal branches? A. Thoracoacromial trunk B. Subscapular artery C. Posterior circumflex humeral D. Transverse cervical artery

Answer 25

A. Thoracoacromial trunk (pectoral, clavicular, acromial, deltoid)

Question 26

Which of these arteries lies in the 1st part of the axillary artery? A. Subscapular B. Lateral thoracic C. Superior thoracic D. Anterior humeral circumflex

Answer 26

C. Superior thoracic

Question 27

Which artery anastomoses with dorsal scapular and suprascapular arteries? A. Subscapular B. Axillary C. Anterior circumflex humeral D. Brachial

Answer 27

A. Subscapular

Question 28

Damage to the posterior circumflex humeral artery will most likely occur with: A. Fracture of lateral epicondyle B. Fracture of midshaft humerus C. Dislocation of elbow D. Fracture of surgical neck of humerus

Answer 28

D. Fracture of surgical neck of humerus

Question 29

what are the key upper limb-related branches of the subclavian artery?

Answer 29

thyrocervical trunk - gives off: - transverse cervical artery - suprascapular artery dorsal scapular artery

Question 30

what are the branches of the axillary artery?

Answer 30

1st part - superior thoracic artery 2nd part - thoracoacromial trunk - lateral thoracic artery 3rd part - subscapular artery - anterior circumflex humeral artery - posterior circumflex humeral artery

Question 31

what are the 4 branches of the thoracoacromial trunk of the axillary artery?

Answer 31

clavicular acromial deltoid pectoral

Question 32

what are the two branches of the thyrocervical trunk of the subclavian artery?

Answer 32

transverse cervical artery suprascapular artery

Question 33

Which arteries form the scapular anastomosis?

Answer 33

Suprascapular artery (thyrocervical trunk) Dorsal scapular artery (subclavian) Subscapular artery (axillary)

Question 34

what is the clinical significance of the brachial artery lying medial to the biceps brachii tendon?

Answer 34

brachial artery is a common pulse point

Question 35

Complete the following about the brachial artery course and relations: a) In the proximal half of the arm, the brachial artery lies __________ to the median nerve. b) In the distal half of the arm, it lies __________ to the median nerve. c) At the cubital fossa, it is located __________ to the biceps tendon, deep to the bicipital aponeurosis, and __________ to the median nerve. d) The brachial artery bifurcates into the __________ and __________ arteries at the level of the __________.

Answer 35

a) Medial b) Lateral c) Medial to biceps tendon; lateral to median nerve d) Radial and ulnar; neck of the radius

Question 36

what is the cubital fossa?

Answer 36

triangular-shaped depression over the elbow joint - transition between anatomical arm to forearm

Question 37

contents of the cubital fossa? (lateral > medial)

Answer 37

radial artery > biceps brachii tendon > brachial artery > median nerve

Question 38

at the cubital fossa, the brachial artery lies a)_______ to the biceps tendon and b) _____ to the median nerve

Answer 38

a) medial b) lateral

Question 39

cubital fossa boundaries - superior, medial, lateral, roof & floor?

Answer 39

superior = line between humeral epicondyles medial = pronator teres lateral = brachioradialis roof = bicipital aponeurosis floor = supinator (proximally), brachialis (distally)

Question 40

What spinal nerve roots contribute to the brachial plexus?

Answer 40

C5,6,7,8, T1 (anterior/ventral rami)

Question 41

between what two muscles do the roots of the brachial plexus emerge?

Answer 41

anterior & middle scalene muscles (with the subclavian artery)

Question 42

what nerve roots contribute to the superior, middle & inferior trunks?

Answer 42

C5 & 6 - superior trunk C7 - middle trunk C8 & T1 - inferior trunk

Question 43

what are the 5 terminal branches of the brachial plexus?

Answer 43

musculocutaneous median ulnar radial axillary

Question 44

What is the root & cord origin of the musculocutaneous nerve?

Answer 44

lateral cord; C5-7

Question 45

What is the root & cord origin of the median nerve?

Answer 45

C6-T1; medial & lateral cords

Question 46

What is the root & cord origin of the ulnar nerve?

Answer 46

C8-T1; medial cord

Question 47

What is the root & cord origin of the radial nerve?

Answer 47

C5-T1; posterior cord

Question 48

What is the root & cord origin of the axillary nerve?

Answer 48

C5-6; posterior cord

Question 49

Which nerve is most likely to be injured in a midshaft humeral fracture? A. Axillary B. Radial C. Median D. Ulnar

Answer 49

B. Radial - runs in the radial groove of the humerus

Question 50

Which terminal branch of the brachial plexus is formed from both lateral and medial cords? A. Ulnar B. Radial C. Median D. Axillary

Answer 50

C. Median

Question 51

The anterior division of the inferior trunk continues as which cord? A. Lateral cord B. Posterior cord C. Medial cord D. None

Answer 51

C. Medial cord

Question 52

A lesion to the posterior cord could impair function of which nerve(s)? A. Axillary & Radial B. Median only C. Ulnar only D. Musculocutaneous & Median

Answer 52

A. Axillary & Radial

Question 53

Which nerve pierces the coracobrachialis muscle?

Answer 53

musculocutaneous nerve

Question 54

The musculocutaneous nerve runs between which two muscles in the arm?

Answer 54

biceps brachii & brachialis

Question 55

After supplying the anterior arm, the musculocutaneous nerve continues as...?

Answer 55

lateral cutaneous nerve of the forearm

Question 56

The median nerve lies lateral to which artery in the arm before crossing medially at the cubital fossa?

Answer 56

brachial artery

Question 57

which muscles (2) is supplied by the ulnar nerve in the forearm?

Answer 57

flexor carpi ulnaris medial half of flexor digitorum profundus

Question 58

name the muscles innervated by the musculocutaneous nerve

Answer 58

coracobrachialis brachialis biceps brachii (anterior arm compartment)

Question 59

The axillary nerve passes through which anatomical space?

Answer 59

quadrangular space

Question 60

the radial nerve travels in the __________ with the profunda brachii artery.

Answer 60

radial groove

Question 61

which nerve provides motor innervation to all posterior compartment muscles of the arm and forearm?

Answer 61

radial nerve

Question 62

The median nerve is formed from the union of the __________ and __________ cords of the brachial plexus.

Answer 62

lateral & medial cords

Question 63

The ulnar nerve passes posterior to the __________ epicondyle of the humerus.

Answer 63

medial epicondyle

Question 64

Which of the following muscles would still function after a lesion of the median nerve at the cubital fossa? A. Flexor carpi radialis B. Pronator teres C. Flexor carpi ulnaris D. Palmaris longus

Answer 64

C. Flexor carpi ulnaris

Question 65

A patient has wrist drop and numbness over the dorsum of the hand. The injury most likely involves which of the following? A. Median nerve in carpal tunnel B. Ulnar nerve at Guyon’s canal C. Radial nerve in radial groove D. Axillary nerve at surgical neck

Answer 65

C. Radial nerve in radial groove

Question 66

Which nerve passes between the two heads of pronator teres as it enters the forearm? A. Ulnar B. Radial C. Axillary D. Median

Answer 66

D. Median

Question 67

Musculocutaneous Nerve – Course and Relations a) The musculocutaneous nerve arises from the __________ cord of the brachial plexus, receiving fibres from __________ nerve roots. b) It pierces the __________ muscle early in its course. c) It then descends between the __________ and __________ muscles. d) After supplying the anterior compartment of the arm, it continues as the __________ nerve. e) This cutaneous branch supplies sensation to the __________ aspect of the forearm.

Answer 67

a) lateral; C5-7 roots b) coracobrachialis b) biceps brachii & brachialis d) lateral cutaneous nerve e) lateral aspect

Question 68

Median Nerve – Course and Relations a) The median nerve is formed by the union of lateral and medial cords, receiving contributions from nerve roots __________ to __________. b) In the arm, it initially lies __________ to the brachial artery. c) Midway down the arm, it crosses to lie __________ to the brachial artery. d) In the cubital fossa, the median nerve lies __________ to the brachial artery and __________ to the biceps tendon. e) It enters the forearm by passing between the two heads of the __________ muscle. f) It gives off the anterior interosseous branch, which runs along the __________ membrane. g) It enters the hand by passing deep to the __________ ligament, within the __________ tunnel. h) It innervates the thenar muscles, lateral two lumbricals, and provides sensation to the __________ side of the palm and the palmar surface of the lateral __________ fingers.

Answer 68

a) C6-T1 roots b) **lateral** to the brachial artery c) **medial** to the brachial artery d) **medial** to the brachial artery; **deep & medial** to the biceps tendon e) pronator teres f) interosseus membrane g) **flexor retinaculum**; within the **carpal tunnel** h) ** lateral** side of the palm; palmar surface of lateral **3 and a half** fingers

Question 69

Ulnar Nerve – Course and Relations a) The ulnar nerve arises from the __________ cord of the brachial plexus, carrying fibers from nerve roots __________ and __________. b) It descends along the __________ aspect of the arm, medial to the __________ artery. c) At the elbow, it passes posterior to the ______ epicondyle of the humerus, in the ulnar groove. d) It enters the forearm by passing between the two heads of the __________ muscle. e) In the forearm, it runs alongside the __________ artery. f) At the wrist, it passes superficial to the flexor retinaculum but within a fibrous tunnel called __________ canal. g) It innervates __________ in the forearm and most intrinsic muscles of the hand. h) Sensory distribution includes the __________ 1½ fingers on both the palmar and dorsal aspects.

Answer 69

a) C8-T1 b) **medial** aspect of arm; medial to **brachial artery** c) **medial** epicondyle of humerus d) flexor carpi ulnaris e) ulnar artery f) Guoyan's canal g) flexor carpi ulnaris h) **medial** one and half fingers

Question 70

Radial Nerve – Course and Relations a) The radial nerve arises from the __________ cord of the brachial plexus, with contributions from roots __________ to __________. b) It travels posteriorly with the __________ artery in the __________ groove of the humerus. c) It lies between the __________ and __________ heads of triceps brachii. d) It then passes anterior to the __________ epicondyle and enters the cubital fossa. e) In the cubital fossa, it divides into a deep __________ branch and a superficial __________ branch. f) The deep branch (posterior interosseous nerve) passes through the __________ muscle to enter the posterior compartment. g) The superficial branch continues down the forearm to provide sensation to the __________ aspect of the dorsum of the hand and the dorsal surface of lateral __________ fingers (excluding the fingertips).

Answer 70

a) **posterior** cord; C5-T1 roots b) **profunda brachii/ deep brachial** artery; **radial** groove c) **lateral** and **medial** heads of triceps brachii d) **lateral** epicondyle e) deep **motor** branch; superficial **sensory** f) **supinator** muscle g) **lateral** aspect of the dorsum of the hand; lateral **three and a half** fingers

Question 71

Axillary Nerve – Course and Relations a) The axillary nerve arises from the __________ cord of the brachial plexus and carries fibers from roots __________ and __________. b) It passes through the __________ space, accompanied by the __________ artery. c) It winds around the __________ of the humerus. d) It innervates the __________ and __________ muscles. e) It gives rise to the superior lateral cutaneous nerve of the arm, supplying sensation to the lateral deltoid region (also known as the __________ badge area). f) It is most vulnerable to injury during fractures of the __________ neck of the humerus or dislocation of the __________ shoulder.

Answer 71

a) **posterior** cord; C5-6 roots b) **quadrangular** space; **posterior circumflex humeral** artery c) **surgical neck** of humerus d) deltoid & teres minor e) regimental badge area f) **surgical neck**; **anterior** shoulder