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MRCS part B > Upper Limb 1 > Flashcards

Upper Limb 1 Flashcards

(59 cards)

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1
Q

What are the dermatitis for the following areas:
Thumb
Middle finger
Ulnar border of forearm
Neck

A

Thumb - C6
Middle finger - C7
Ulnar border of forearm - C8
Neck - C4

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2
Q

What are the reflexes associated with the following c spine levels:
C5
C6
C7

A

C5- biceps
C6- brachialis
C7- triceps

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3
Q

Lymph nodes from which locations drain into:
Axillary
Supraclavicular lymph nodes

A

Axillary- from cephalic
Supraclavicular- from basilic nodes

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4
Q

In the anterior/ clavipectoral approach to open the shoulder, what structure are most likely to be damaged?

A

Thoracoacromial artery
Musculocutaneous nerve

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5
Q

Which veins make up the brachial vein?

A

Radial & ulnar veins

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6
Q

What vein joins the basilic and cephalic veins and at what location?

A

Median cubical vein at the ACF

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7
Q

What veins make up the axillary vein?

A

Basilic and brachial

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8
Q

What veins make up the subclavian vein?

A

Cephalic draining into axillary vein (made of basilic and brachial veins)

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9
Q

Which part of the clavicle is most commonly fractured?

A

Middle 1/3rd of clavicle

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10
Q

In what order are the structures that pass from the neck into the thorax under the clavicle?

A

1- subclavian vein + phrenic nerve
2- anterior scalene
3- subclavian artery
4- brachial plexus
5-middle scalene

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11
Q

What muscle does the phrenic nerve pierce to enter the thorax

A

Anterior scalene

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12
Q

How many ligaments attach to the coracoid process and list them

A

3 ligaments:
-coracoacromial
-coracoclavicular (made of 2 ligaments)
Conoid + trapezoid ligaments

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13
Q

What muscles attach to the coracoid process?

A

3 muscles:
-pec minor
-coracobrachialis
-short head of biceps

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14
Q

Describe the pathology in subclavian steal syndrome

A

Block in proximal subclavian artery
Block is proximal to the start of the vertebral artery
Using the UL causes backflow of blood from the vertebral artery back towards subclavian causing reduced blood flow to the brain

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15
Q

What symptoms can patients with subclavian steal syndrome present with?

A

Syncope
Dizziness
UL claudication

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16
Q

What are some causes of thoracic outlet syndrome?

A

Can be due to:
-abnormal 1st rib
-a cervical rib
-hypertrophy of the scalene muscles
-apical lung tumour/ pancoasts tumour

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17
Q

What symptoms can patients with thoracic outlet syndrome present with?

A

VTOS- DVT, swelling
ATOS- ischaemia limb
NTOS- neuropathic pain, paresthesia along ulnar nerve distribution

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18
Q

What investigations can be done for suspected TOS?

A

MRI brachial plexus
Nerve conduction studies
CT neck
CT angiogram UL
Duplex USS
CXR

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19
Q

What are the landmarks of the beginning and end of the axillary artery?

A

Start- inferior to 1st rib
End- superior border of teres MINOR

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20
Q

Which structure divides the axillary artery into 3 parts?

A

Pec minor

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21
Q

What are the branches of the axillary artery?

A

1st part- superior thoracic

2nd part- thoracoacromial + lateral thoracic

3rd part- anterior + posterior circumflex humeral & subscapular

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22
Q

What are the branches of the thoracoacromial artery?

A

Pectoral
Acromial
Clavicular
Deltoid

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23
Q

Which arteries anatamose and supply the scapula? (Mention their arteries of origin)

A

Suprascapular artery- thyrocervical trunk of subclavian artery

Subscapular - 3rd part of axillary artery

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24
Q

What are the branches of the thyrocervical trunk?

Study These Flashcards
A

Inferior thyroid
Subscapular
Ascending cervical
Transverse cervical

25
What are the rotator cuff muscles?
Supraspinatus Infraspinatus Teres minor Subscapularis
26
What are the origins and insertions of the rotator cuff muscles?
Supraspinatus- supraspinus fossa, GT Infraspinatus- Infraspinus fossa, GT Teres minor- lateral scapula, GT Subscapularis- subscapular fossa, LT
27
Which shoulder muscles are supplied by the axillary nerve?
Deltoid Teres minor
28
Which rotator cuff muscles are supplied by the suprascapular nerve?
Supraspinatus & infraspinatus
29
What nerve supplies the Subscapularis?
Upper and lower subscapular nerve
30
Which shoulder muscles cause external rotation of the arm?
Infraspinatus and teres minor
31
Which shoulder muscles cause internal rotation of the arm?
Subscapularis
32
Which muscles cause abduction of arm up to: 0-15 90 deg >100
0-15 deg= Supraspinatus >90= deltoid, trapezius >100= serratus anterior
33
What are the nerves originating from the lateral trunk of the brachial plexus?
Lateral pectoral Musculocutaneous Median
34
Which trunk of the brachial plexus do the following nerves originate? Medial Posterior
Medial= ulnar, median Posterior= axillary, radial
35
What are the nerves involved in Erb’s palsy?
ASMR: Axillary Suprascapular Musculocutaneous Radial
36
Describe how the nerves involved in Erb’s palsy affect the muscles
Axillary- teres minor= arm internally rotated Suprascapular- Supraspinatus= adducted Musculocutaneous- biceps= extension Radial- forearm extensors= wrist flexed
37
What are the causes of Erb’s palsy
Damage to the upper trunk of brachial plexus affecting C5-C6. Eg: neck flexed laterally during birth when baby pulled out of birth canal Fall onto laterally flexed neck
38
What are the nerves and corresponding muscles affected in Klumpke’s palsy?
Ulnar + median nerves All intrinsic hand muscles affected
39
Which nerve roots are affected in klumpke’s palsy?
C8-T1
40
What are the boundaries and contents of the quandrangular space?
Boundaries: Sup= teres minor Inf= teres major Lateral= long head triceps Medial= surgical neck humerus Contents= axillary nerve + vessels
41
What are the boundaries and contents of the triangular SPACE?
Circumflex scapular vessels
42
What are the boundaries and contents of the triangular INTERVAL?
Radial nerve Profounda brachial artery
43
What structures are at risk of injury during an anterior shoulder dislocation?
Axillary nerve
44
What nerve pierces the coracobrachialis muscle in the upper arm?
Musculocutaneous nerve
45
What is the location of the median nerve in relation to the brachial artery as it travels from proximal to distal in the upper arm?
Proximal- lateral Crosses Anteriorly Distal- medial to brachial artery In ACF lateral to medial structures: Biceps tendon Brachial artery Median nerve
46
What are the function of the muscles innervated by Musculocutaneous nerve?
Flexion Supination
47
What are the motor and sensory symptoms seen with radial nerve injury at: Above spiral groove At spiral groove Below spiral groove
Above spiral groove- Unable to extend elbow + wrist No sensation in arm + forearm dorsal At spiral groove Unable to extend at wrist No sensation in forearm + hand dorsum Below spiral groove Unable to extend fingers Sensation intact
48
What branch of the radial nerve is injured below the spiral groove?
Posterior interosseous nerve (PIN)
49
Why are patients able to extend AND supinate their wrist with PIN injury?
Brachioradialis and extensor carpi radialis allows weak wrist extension (not supplied by PIN) Deep branch of radial nerve supplies supinator (deep branch becomes PIN after emerging from under supinator)
50
Why are patients able to feel their hannd (dorsum) with PIN injury?
PIN only gives motor supply Superficial radial nerve provides sensory innervation and branches off before PIN
51
What are the muscles supplied by the PIN?
EPL, APL EPB Extensor indicis Extensor carpi ulnaris, extensor digiti minimi, extensor digitorum
52
What thumb movement is not possible when hand is flat on a table?
Abduction
53
What are the borders of the ACF?
Sup- imaginary line b/w condyles Medial- pronation teres Lateral- brachioradialis Roof- aponeurosis
54
What are the contents of the ACF? Lateral to medial
Radial nerve Biceps tendon Brachial artery Median nerve
55
What is the most commonly injured nerve in supracondylar fractures?
Anterior interosseous nerve
56
What is the classification system for supracondylar fractures?
Gartlands: 1- undisplaced 2- displaced but posterior cortex inatact 3- displaced in 2-3 planes 4- complete periosteal disruption (can only assess intra-op)
57
Which type of supracondylar fractures need surgery and what is the surgical mx?
Gartland 2,3,4 Closed K wire fixation
58
What complication can occur with: Conservative mx K-wire fixation Ischaemia In supracondylar fractures
Conservative mx- malunion K-wire fixation-ulnar nerve palsy (medial K-wire) Ischaemia- volkman’s contracture
59

MRCS part B (3 decks)

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