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MRCS A > Upper Limb > Flashcards

Upper Limb Flashcards

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1
Q

Where is the origin of the clavicular head of the pectoralis major?

A

medial half of the anterior surface of the clavicle

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2
Q

Where is the origin of the sternocostal head of the pectoralis major?

A

anterior surface of the sternum
upper 6 costal cartilages
EOA

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3
Q

Where is the insertion of the pectoralis major?

A

Lateral lip of bicipital groove

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4
Q

Nerve supply of pectoralis major

A

medial and lateral pectoral nerves

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5
Q

insertion of pectoralis minor

A

Coracoid process of the scapula

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6
Q

Nerve supply of pectoralis minor

A

medial pectoral nerve

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7
Q

Origin of serratus anterior

A

by 8 digitations from outer surface of upper 8 ribs

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8
Q

Insertion of serratus anterior

A

ventral surface of the medial border of scapula

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9
Q

nerve supply of serratus anterior

A

long thoracic nerve

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10
Q

action of serratus anterior

A

fixing scapula to posterior thoracic wall so its paralysis leads to winging of scapula

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11
Q

What structures piercing through the clavi-pectoral fascia?

A

CLAF
Cephalic vein
Lateral pectoral nerve
Acromiothoracic artery
Fat, LNS

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12
Q

Insertion of latissimus dorsi

A

floor of bicipital groove

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13
Q

Nerve supply of trapezius

A

spinal accessory nerve (CN11)

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14
Q

Nerve supply of latissimus dorsi

A

Nerve to latissimus dorsi (thoraco-dosral nerve)

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15
Q

Action of trapezius

A

Shoulder abduction from 90-180 (along with serratus anterior)
Shrugging of the shoulders

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16
Q

Abduction of the shoulder between 0 to 15 degrees

A

supraspinatus

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17
Q

Abduction of the shoulder between 15 to 90 degrees

A

muscle fibres of the deltoid

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18
Q

Abduction of the shoulder between 90 to 180 degrees

A

coupling action of serratus anterior and trapezius

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19
Q

What three muscles are attached at the bicipital groove?

A
  1. Pectoralis major = lateral lip
  2. Latissimus dorsi = floor
  3. Teres major = medial lip
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20
Q

What three muscles are attached at the greater tuberosity?

A
  1. Supraspinatus
  2. Infraspinatus
  3. Teres minor
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21
Q

Where is the origin of the supraspinatus muscle?

A

supraspinous fossa

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22
Q

Where is the origin of the infraspinatus muscle?

A

infraspinous fossa

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23
Q

Where is the origin of subscapularis muscle?

A

Subscapular fossa

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24
Q

Where is the insertion of the subscapularis?

A

Lesser tuberosity of the humerous

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25
What nerve supplies the supraspinatus + infraspinatus?
Suprascapular nerve
26
What muscles are supplied by the axillary nerve?
teres minor deltoid
27
Origin of the teres minor
upper 2/3 of lateral border of scapula
28
Origin of the teres major
Lower 1/3 of lateral border of scapula
29
Insertion of the teres major
Medial lip of the bicipital groove
30
What are the rotator cuff muscles
Above = supraspinatus In front = subscapularis Behind = infraspinatus + teres minor Below = not supported -->** common dislocation**
31
Contents of the quadrangular space
Axillary nerve Posterior circumflex humeral artery
32
Contents of the upper triangular space
Circumflex scapular artery
33
Contents of the lower triangular space
Radial nerve Profunda brachii artery
34
What are the important contents of the axilla?
Intercostobrachial nerve = lateral cutaenous branch of 2nd intercostal nerve Long thoracic + thoraco-dorsal nerve (commonly injured in axillary node clearance)
35
Draw the brachial plexus from the roots to the cords
Roots (C5 to T1) Trunks (upper = C5/6, middle = C7, lower = C8/T1) Divisons (each trunk into ant and post) Cords (post = all post divisions, lateral = anterior of upper/middle, medial = anterior of lower)
36
What nerves branch off the lateral cord?
1. Lateral pectoral (C5-7) 2. Lateral root of median nerve (C5-7) 3. Musculocutaenous nerve (C5-7)
37
What nerves branch off the medial cord?
1. Medial pectoral nerve (C8/T1) 2. Medial root of median nerve (C8/T1) 3. Ulnar nerve (C7/C8/T1) 4. Medial cutaenous nerve of arm and forearm (C8/T1)
38
What nerves branch off the posterior cord?
**ULNAR** 1. Upper subscapular (C5/6) 2. Lower subscapular nerve 3. Nerve to latissimus dorsi - thoracodorsal N. (C6/7/8) 4. Axillary nerve (C5/6) 5. Radial nerve (C5/6/7/8/T1)
39
What is the result of an injury to the upper trunk (C5/6)?
Erb's palsy
40
What is the motor impairment from Erb's palsy?
The shoulder is: * adducted (from supraspinatus + deltoid) * internally rotated (from infraspinatus + teres minor) The elbow is: * extended + pronated (from biceps, brachialis, brachioradialis)
41
What is the sensory loss of Erb's palsy?
Loss of sensation on radial side of arm + forearm
42
What are deformities noted in Erb's palsy?
Policeman tip paralysis Waiter's tip deformity
43
What is the result of an injury to the lower trunk (C8/T1)?
Klumpke's paralysis
44
What is the motor impairment from Klumpke's paralysis?
* Paralysis of intrinsic muscles in hand * Hyperextension of MCP and flexion of IP joints * Paralysis of wrist flexors
45
What is the sensory impairment from Klumpke's paralysis?
Loss of sensation over ulnar border of forearm and arm
46
What deformity is seen from Klumpke's paralysis?
Klumpke's paralysis Complete claw hand
47
What are the branches of the axillary nerve?
* Articular branch = to shoulder joint * Muscular branch = to deltoid + teres minor * Cutaenous branch = to skin over upper 1/2 of lateral side of arm
48
Cause of axillary nerve injury
fracture of surgical neck of humerus
49
Sensory loss from axillary nerve?
Loss over skin of upper part of lateral arm
50
Motor effect of axillary nerve
paralysis of deltoid + teres minor = loss of abduction of arm (15-90)
51
Deformity from axillary nerve injury
flat shoulder due to atrophy of deltoid
52
Origin of axillary artery
Outer border of first rib
53
termination of axillary artery
lower border of teres major
54
Course of axillary artery
crossed by pectoralis minor + divided into 3: 1. above muscle 2. behind muscle 3. below muscle
55
Branches of axillary artery at 1st part
Superior throacic artery
56
Branches of axillary artery at 2nd part
1. Acromiothoracic artery 2. Lateral throacic artery
57
Branches of axillary artery at 3rd part
1. Anterior circumflex humeral artery 2. Posterior circumflex humeral artery 3. Subscapular artery
58
What muscles form the anterior group of arm?
1. Coracobrachialis 2. Brachialis 3. Biceps
59
Where is the origin of the coracobrachialis?
Tip of coracoid process in common origin with short head of biceps
60
Where is origin of short head of biceps?
tip of coracoid process
61
Where is origin of long head of biceps?
from supraglenoid tubercle
62
Where is the insertion of the brachialis?
ulnar tuberosity
63
Where is the insertion of the biceps?
By tendon in radial tuberosity
64
What muscles of the arm are supplied by the musculocutaenous nerve?
Coracobrachialis Biceps Medial part of the brachialis
65
What muscles of the arm are supplied by the radial nerve?
Lateral part of the brachialis Triceps
66
What is the action of the biceps?
Flexion of the elbow + shoulder joint Powerful supination of forearm
67
Where is the origin of the long head of the triceps?
From infraglenoid tubercle of scapula
68
Where is the origin of the lateral head of the triceps?
From back of humerus above spiral groove
69
Where is the origin of the medial head of the triceps?
From back of humerus below the spiral groove
70
What is the main action of the triceps?
Extensor of the elbow joint
71
What are the boundaries of the cubital fossa?
Lateral = brachioradialis Medial = pronator teres Floor = brachialis
72
What are the contents of the cubital fossa (from medial to lateral)?
1. Median Nerve 2. Brachial Artery 3. Biceps Tendon 4. Radial Nerve | MBBR
73
Name the five superficial flexors of the forearm
1. Pronator teres 2. Flexor carpi radialis 3. Palmaris longus 4. Flexor carpi ulnaris 5. Flexor digitorum superficialis
74
What superficial flexors of the forearm are supplied by the median nerve?
Pronator teres Flexor carpi radialis Palmaris longus Flexor digitorum superficialis
75
What superificial flexors of the forearm are supplied by the ulnar nerve?
Flexor carpi ulnaris
76
What is the insertion of the flexor digitorum superficialis?
Muscle is divided into 4 tendons + inserted into the middle phalanges of the medial 4 fingers
77
Name the three deep flexors of the forearm.
1. Flexor pollicis longus 2. Pronator quadratus 3. Flexor digitorum profundus
78
What nerve supplies the deep flexors of the forearm
anterior interosseous nerve
79
What nerve supplies the ulnar side of the flexor digitorum profundus?
Ulnar nerve
80
What is the insertion of the flexor digitorum profundus?
Base of distal phalanges of medial 4 fingers
81
Name the 7 superficial extensors of the forearm
1. Brachioradialis 2. ECRL 3. ECRB 4. Extensor digitorum 5. Extensor digiti minimi 6. Extensor carpi ulnaris 7. Anconeous
82
Name the 5 deep extensors of the forearm
1. Supinator 2. Abductor policis longus 3. Extensor policis brevis 4. Extensor polices longus 5. Extensor indices
83
What is the nerve supply to the extensors of the forearm?
Posterior interosseous nerve (branch of radial), except for the BEAT muscles, which are supplied by the radial nerve. Brachioradialis ECRL Anconeous Triceps
84
What is the insertion of the extensor digitorum?
Extensor expansion of the medial 4 fingers
85
What is the distance between the ulnar nerve to ulnar artery?
1cm
86
What is the flexor retinaculum?
Thickened band of deep fascia lies in front of the carpal bones, converting the concavity on their anterior surface into a tunnel.
87
What are the lateral attachments of the flexor retinaculum?
to the scaphoid + trapezium
88
What are the medial attachments of the flexor retinaculum?
Pisiform + hook of hamate
89
What structures are superficial to the flexor retinaculum?
- ulnar nerve - ulnar artery - palmar cutaneous branch of ulnar nerve - palmer cutaneous branch of median nerve - palmaris longus tendon
90
What structures are deep to the flexor retinaculum?
Dr PM Digitorum (FDS, FDP) Radialis muscle (FCR) Policis muscle (FPL) Median nerve
91
What are the names of the carpal bones?
made of two rows of 4 bones She Looks Too Pretty, Try To Catch Her Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium, Trapezoid, Capitate, Hamate.
92
What nerve supplies the adductor pollicis?
Ulnar Nerve
93
What muscles are supplied by the median nerve?
LOAF Lateral 2 lumbricals Opponens pollicis Abductor pollicis brevis Flexor pollicis brevis
94
What is the origin of the median nerve?
Lateral root from lateral cord Medial root from medial cord
95
Course of median nerve in axilla + arm?
LAM Lateral to upper 1/2 of brachial artery Anterior to brachial artery Medial to lower 1/2 of brachial artery
96
What does the median nerve supply in the forearm?
PT, FCR, PCL, FDS
97
What does the anterior interosseous nerve supply in the forearm?
FPL, PQ + Lateral 1/2 of FDP
98
What is the sensory innervation by the median nerve?
Lateral 2/3 of palm Palmar surface of lateral 3.5 fingers
99
Motor injury to median nerve
Paralysis of: 1. thenar muscles --> flattening in thenar eminence + loss of thumb opposition 2. lateral 2 lumbricals 3. PT + PQ --> loss of pronation 4. Flexors of forearm (except FCU + medial 1/2 of FDP) --> weak flexion of wrist with ulnar deviation due to unopposed action of FCU
100
Deformity presentation of median nerve
Ape-like hand
101
Cause of injury to anterior interosseous nerve
Supracondylar fracture humerus in children
102
Origin of ulnar nerve?
Medial cord of brachial plexus
103
Ulnar nerve supply to what muscles in forearm?
FCU, medial 1/2 of FDP
104
Ulnar nerve supply to what muscles of hand?
Adductor policis muscle Hypothenar Palmar + dorsal interossei 3rd/4th lumbricals
105
Injury to the ulnar nerve causes...
Paralysis of: 1. adductor policis --> abducted thumb 2. hypothenar --> atrophy + flattening of hypothenar eminence 3. Interossei + lumbricals --> loss of adduction + abduction, loss of extension of IP --> clawing 4. FCU --> lateral deviation of hand
106
What deformity is noted when ulnar nerve injured?
Clawing - Ulnar paradox (higher the lesion the less clawing, lower the lesion the more clawing)
107
What are the boundaries of the snuff box?
Medial = EPL tendon Laterally = tendons of APL, EPB Floor = Scaphoid, Tendons of extensor carpi radialis longus + brevis Roof = skin + fascia
108
What are the contents of anatomical snuff box?
Radial artery Radial nerve Cephalic vein Tendons of ECRL + ECRB
109
What is the blood supply to the scaphoid bone?
from the distal end by the radial artery AVN to proximal part of scaphoid
110
What are the thenar muscles (lateral)?
Abductor policis brevis Flexor policis brevis Opponens policis brevis Adductor policis
111
What is the action of the interossei?
PAD Palmar = ADduction Dorsal = ABduction
112
Origin of radial nerve?
Posterior cord of brachial plexus
113
What is the course of radial nerve?
Passes in the lower triangular space, and into the spiral groove downward + lateral between lat/med head of triceps
114
What is the motor consequence of injury to radial nerve?
Loss of extension in: - fingers = fingers drop - wrist = wrist drop - elbow = paralysis of triceps muscle Loss of supination
115
Cause and consequence of posterior interosseous nerve
during lateral approach to elbow Loss of motor function only --> finger drop No sensory loss
116
What is the drainage of the basilic vein?
Into the axillary vein

MRCS A (3 decks)

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