Upper Limb

Question 1

Name the borders of the axilla

Answer 1

Apex (axillary inlet) - lateral border 1st rib, superior border scapula, posterior border clavicle

Lateral wall - intertubercular groove humerus

Medial wall - serratus anterior and thoracic wall

Anterior wall - pectoralis major, minor, subclavius

Posterior wall - subscapularis, teres major, latissimus dorsi

Question 2

Name the contents of the axillary artery

Answer 2

Axillary artery and branches
Axillary vein and branches
Brachial plexus and branches
Axillary lymph nodes
Biceps brachi (short head), coracobrachialis

Question 3

The quadrangular space is a gap in the posterior wall of the axilla.

Which structures pass through the quadrangular space?

Answer 3

Axillary nerve

Posterior circumflex humeral artery

Question 4

What are the borders of the clavicopectoral triangle?

Answer 4

Clavicle, pectoralis major and deltoid muscle

Question 5

Which structures pass through the clavicopectoral triangle?

Answer 5

Cephalic vein

Medial and lateral pectoral nerves

Question 6

Name the borders of the cubital fossa

Answer 6

Superior - line drawn between the humeral epicondyles
Lateral - brachioradialis (medial border)
Medial - pronator teres (lateral border)
Roof - bicipital aponeurosis, fascia, subcutaneous fat and skin
Floor - brachialis (proximally) supinator (distally)

Question 7

List the contents of the axillary triangle from lateral to medial

Answer 7

Radial nerve - divides into superficial and deep
Biceps tendon - attached onto radial tuberosity
Brachial artery - bifurcates into radial and ulna artery at the apex
Median nerve

Roof contains median cubital vein which connects basilic and cephalic vein

Question 8

The ulna tunnel is a fibro-osseous space located in the poster-medial aspect of the elbow

1. 1. Name it’s border
2. 2. Contents

Answer 8

1.1.

Medial - Medial epicondyle
Lateral - olecranon
Floor - joint capsule, medial collateral ligament
Roof - arcuate ligament of Osborne or cubital tunnel retinaculum (medial epicondyle to olecranon)

1.2. Ulna nerve

Question 9

Define cubital tunnel syndrome and it’s clinical features

Answer 9

Cubital tunnel syndrome refers to the compression of the ulna nerve with the cubital tunnel.

Clinical features:

Pain
Paraesthesia - medial 1 and a half fingers
Weakness and wasting of intrinsic hand muscles

Question 10

What are the borders which make up the carpal tunnel?

Answer 10

The deep carpal arch

Medially - hook of hamate and pisiform
Laterally - scaphoid and trapezium

Flexor retinaculum - roof

Question 11

List the contents of the carpal tunnel

Answer 11

FDS
FDP
FPL
Median nerve - palmer cutaneous branch given off pior to carpal tunnel

Question 12

Name the terminal divisions of the Median nerve

Answer 12

Palmer digital nerve -
Sensory - palmer skin and dorsal nail beds of lateral 3 and a half digits
Recurrent branch - supplies thenar muscle group

Question 13

Name the borders of the anatomical snuffbox

Answer 13

Medial (ulna) border - Extensor Pollicis Longus

Lateral (radial) border - Abductor Pollicis Longus, Extensor Pollicis Brevis

Floor - scaphoid, trapezium

Proximal border - radial styloid process

Roof - skin

Question 14

Contents of the anatomical snuff box

Answer 14

Radial artery
Superficial branch radial nerve
Cephalic vein

Question 15

Thoracic outlet syndrome occurs when the contents passing through the the axillary inlet become compressed between the bones.

1. 1. List common causes
2. 2. Describe the clinical picture

Answer 15

1.1.
Trauma e.g. fractured clavicle
Repetitive movements
Cervical rib

1.2.
Pain in affected limb
Tingling 
Muscle weakness
Discolouration

Question 16

Approximately 75% of lymph from the breast drains into the axilla.

1. 1. Which nerve is susceptible to injury during an axillary clearance?
2. 2. Which muscle is innervated by this nerve?

Answer 16

1. 1. Long thoracic nerve

1. 2. Serratus anterior

Question 17

Which muscles attach onto the greater tuberosity?

Answer 17

Supraspinatus
Infraspinatus
Teres minor

Attach onto the superior, middle and inferior facets respectively

Question 18

Which muscles attach onto the lesser tuberosity?

Answer 18

Subscapularis

Question 19

The intertubercular sulcus separates the greater and lesser tuberosity with it’’s edges are known as the medial and lateral lips.

1. 1. Which structure runs through this groove?
2. 2. Which muscle(s) attaches to the medial and lateral lips

Answer 19

1. 1. Tendon of long head of biceps
2. 2. “A lady between 2 majors”

Medial lip - teres major, latissimus dorsi
Lateral lip - pectoralis major

Question 20

Which neurovascular structures are at risk during a fracture of the surgical neck of humerus?

Answer 20

Axillary nerve

Posterior circumflex humeral artery

Question 21

The radial groove is a shallow depression which runs diagonally on the posterior aspect of the humerus.

Which anatomical structure(s) run in this groove?

Answer 21

Radial nerve

Profunda brachi artery

Question 22

Supracondylar fractures can result in injury to which anatomical structure(s)?

Answer 22

Brachial artery
Anterior interosseous nerve (branch of Median nerve)
Ulna nerve
Radial nerve

Question 23

Supracondylar fractures can result in injury to which anatomical structure(s)?

Answer 23

Brachial artery
Anterior interosseous nerve (branch of Median nerve)
Ulna nerve
Radial nerve

Question 24

How does one test the anterior interosseous nerve?

Which muscle is innervated by AIN?

Answer 24

Ask the patient to make the “OK” sign

Tests weakness in the FPL

Question 25

The distal end of the radius articulates with which carpal bones to make up the wrist joint?

Answer 25

Scaphoid | Lunate

Question 26

Radius and ulna are attached by the interosseous membrane 1. 1. Describe a Monteggia fracture 1. 2. Describe a Galeazzi fracture

Answer 26

1. 1. Fracture of the proximal ulna with a proximal radio-ulna joint dislocation 1. 2. Fracture of the distal radius with the ulna head dislocation at the distal radio-ulna joint

Question 27

Describe a Bennett's fracture

Answer 27

Fracture of the base of the 1st metacarpal - extending into the 1st CMC joint leading to instability or subluxation of the joint - - often requires surgical repair

Question 28

Name the muscles of the thenar eminance and the nerve which innervates them

Answer 28

Oponens Pollicis Abductor Pollicis Brevis Flexor Pollicis Brevis Median nerve

Question 29

Name the muscles of the hypothenar eminance and the nerve which innervates them

Answer 29

Opponens Digiti Minimi Abductor Digiti Minimi Flexor Digiti Minimi Brevis Ulna nerve

Question 30

The lumbricals of the hand originate on the tendon of FDP and insert onto the extensor hood of it's corresponding finger. Denervation of the lumbricals are responsible for ulna claw and hand of benediction. 1. 1. What are the actions of the lumbricals 1. 2. Innervation

Answer 30

1.1. Flexion of the MCPs and extension of the IP joints 1.2. Lateral 3.5 - Median nerve Medial 1.5 - Ulna nerve

Question 31

The interossei muscles originate from the medial and lateral surfaces of the metacarpals and insert into the extensor hood of the proximal phalanx 1. 1. Actions of the dorsal and palmer interossei 1. 2. Innervation

Answer 31

1.1. Palmer interossei - adduction Dorsal interossei - abduction 1.2. Ulnar nerve

Question 32

Which muscles share a common origin at the lateral epicondyle?

Answer 32

Extensor carpi radialis brevis Extensor digitorum Extensor carpi ulnaris Extensor Digiti Minimi

Question 33

The extensor compartment of the forearm contains muscles responsible for extension of the wrist and fingers. 1. 1. Name muscles of the superficial posterior compartment of the forearm 1. 2. Name the muscles of the deep posterior compartment of the forearm 1. 3. Innervation

Answer 33

``` 1.1. Superficial group Brachioradialis ECRL and ECRB ED EDM ECU Anconues ``` ``` 1.2. Deep group Supinator Abductor Pollicis Longus EPL and EPB Extensor indicis ``` 1.3. Radial nerve

Question 34

The deep muscles of the posterior compartment of the forearm are innervated by the posterior interosseous nerve (branch of radial nerve) except for _______ ?

Answer 34

Supinator - innervated by deep branch radial nerve

Question 35

Ulnar nerve arise from C8-T1 1. 1. Describe it's anatomical course 1. 2. 3 branches arising in the forearm 1. 3. Name the branch arising in the hand 1. 4. Muscles innervated in the forearm

Answer 35

1.1. Arises from brachial plexus - descends down arm between axillary artery (lateral) and axillary vein (medial) Proceeds down medial aspect medial to brachial artery Mid-point forearm - pierces medial fascia to enter posterior compartment arm then passes through cubital tunnel into forearm Forearm - pierces the 2 head of FCU and gives off 3 branches Enters hand via Guyons canal - superficial to Flexor retinaculum - medial to ulnar artery 1. 2. Muscular branch, palmar and dorsal cutaneous branches 1. 3. Superficial branch 1. 4. Medial half of FDP, FCU

Question 36

What is Froment's sign?

Answer 36

Tests weakness of ulnar nerve - specifically Adductor Pollicis

Question 37

The Median nerve (C6-T1) is terminal branch of the brachial plexus. Name the branches given off in the... 1. 1. Forearm 1. 2. Terminal branches in the hand

Answer 37

1.1. Anterior interosseous nerve Palmer cutaneous nerve 1.2. Recurrent branch - innervates thenar muscles Palmer digital branch - lateral 2 lumbricals, sensation to lateral 3.5 digits and palmer surface and fingertips