Upper Limb

Question 1

What is the gross anatomy of the scapula?

Answer 1

Glenoid fossa
- for articulation fo the head of the humeus
- supraglenoid tubercle (attachment of biceps)
- infraglenoid tubercle (attachment of triceps)
- lined with glenoid labrum

Spine (posteriorly)
- divides into supraspinous fossa + infraspinous fossa

Acromion (superior)
- articulates with clavicle

Coracoid process
- for coracoclavicular ligament, attachment of trapezoid and conoid
- for giving origin of short head of biceps, coracobrachialis

Question 2

What are the ligaments involved with the scapula?

Answer 2

• acromioclavicular ligament
• coracoacromial ligament
• coracoclavicular ligament (trapezoid and conoid)

Question 3

What are the joints involved with the scapula?

Answer 3

Glenohumeral joint
- synovial joint
- uses glenohumeral ligament, rotator cuff

acromioclavicular joint
- synovial
- incomplete disc between acromion + clavicle

Question 4

What are the core muscles involved with the scapula?

Answer 4

Rotator cuff muscles
Rhomboids
Serratus anterior
levator scapulae

Question 5

What are the relations to the scapula?

Answer 5

Scapula anastomosis

• suprascapular A: 1st part of the subclavian A.
• dorsal scapular A: 2nd part subclavian + anastomoses with the posterior intercostal A
• subscapular A: 3rd part of the axillary A

Question 6

What are the anatomical variants associated with the scapula?

Answer 6

Sprengel deformity (when there is a congenitally raised scapula)

Acromial variation - can have an accessory ossicle: 7 types
flat undersurface
concave undersurface
hooked undersurface
convex undersurface

Question 7

What is the superior thoracic aperture?

Answer 7

Connects the root of the neck to the superior mediastinum

Question 8

What is the gross anatomy of the superior thoracic aperture?

Answer 8

Anterior: manubrium of the sternum

Lateral: first rib, costal cartilage

Posterior: T1 vertebra

Question 9

What are the contents of the superior thoracic aperture?

Answer 9

Viscera
- thymus
- lung apices
- trachea
- oesophagus

Question 10

What are the arteries in the superior thoracic aperture?

Answer 10

Arteries
- subclavian arteries
- common carotid arteries

Question 11

What are the veins in the superior thoracic aperture?

Answer 11

Veins
- subclavian veins
- internal jugular veins

Question 12

What are the nerves in the superior thoracic aperture?

Answer 12

Nerves
- brachial plexus (behind anterior scalene)
- phrenic nerve (anterior to anterior scalene)
- vagus nerve (anterior to anterior scalene)
- recurrent laryngeal nerve (medial to anterior scalene)

Question 13

What are the nerves in the superior thoracic aperture?

Answer 13

brachial plexus - behind anterior scalene
vagus N - anterior to anterior scalene
phrenic N - anterior to anterior scalene
recurrent laryngeal N - medial to anterior scalene

Question 14

What are the lymphatics contained in the superior thoracic aperture?

Answer 14

Thoracic duct
Right lymphatic duct

Question 15

What are the muscles involved with the superior thoracic aperture?

Answer 15

sternocleidomastoid
anterior scalene
sternohyoid
sternothyroid

prevertebral fascia

Question 16

What are the variants associated with the superior thoracic aperture?

Answer 16

cervical rib
c1 fibrous band
bifid c1
hypoplastic c1
c1 pseudoarticulation

Question 17

What is anterior to scalenus anterior?

Answer 17

Phrenic N (under the prevertebral fascia)
Vagus N
Ascending cervical A
Transverse cervical / suprascapular A
Thoracic duct
Carotid sheath
lower belly of omohyoid
deep cervical nodes

Question 18

What is posterior to scalene anterior?

Answer 18

Brachial plexus
2nd part subclavian artery
anterior rami C3 - T1
Costocervical trunk
Superior intercostal and deep cervical arteries
Scalenus medius

Question 19

What is medial to scalene anterior?

Answer 19

longus coli
carotid tubercle
pyramidal space
carotid sheath
stellate ganglion
vertebral artery
middle cervical ganglion
inferior thyroid artery
1st part subclavian artery
ansa subclavia
thyrocervical trunk
vertebral vein

Question 20

What is lateral to scalene anterior?

Answer 20

trunks of brachial plexus
3rd part of subclavian A

Question 21

What is the clavicle?

Answer 21

link between the shoulder and the thorax
S shaped bone

Question 22

What is the structure of the clavicle?

Answer 22

S shaped
Medial 2/3 makes one curve
lateral 1/3 makes the other curve

Point between the two curves is where fractures are most likely to occur

Conoid tubercle / trapezoid line

Question 23

What is the ossification / fusion dates of the clavicle?

Answer 23

It is the first bone to ossify at 5-6 weeks
Completely fused at 20 weeks

Question 24

What are the joints involved with the clavicle?

Answer 24

Acromioclavicular - has incomplete disc
Sternoclavicular - has complete disc

both are synovial

Question 25

What are the ligaments involved with the clavicle?

Answer 25

Acromioclavicular ligament Coracoclavicular ligament - trapezoid, conoid Costoclavicular ligament Sternoclavicular ligament **interclavicular ligament

Question 26

What are the important muscles with the clavicle?

Answer 26

Pec major Sternocleidomastoid Trapezius Deltoid Subclavius

Question 27

What are the important relations with the clavicle?

Answer 27

Subclavian artery Subclavian vein (anterior scalene will be between vein + artery)

Question 28

What are common anatomical variants associated with the clavicle?

Answer 28

forked clavicle Supraclavicular foramen coracoclavicular joint (between conoid tubercle of clavicle + coracoid process of scapula)

Question 29

What is the first rib?

Answer 29

It is the most superior rib Anatomical landmark Parietal pleura is in contact with the inner border

Question 30

What is important about the structure of the first rib?

Answer 30

Head - has only one facet which articulates with T1 Neck - crossed by sympathetic trunk Tubercle - articulates with the facet of transverse process Scalene Tubercle - for attachment of scalene anterior Body - groove for subclavian artery (posterior to scalene tubercle) and is inferior to trunks of brachial plexus, groove for subclavian vein (anterior to scalene tubercle)

Question 31

What are the joints involved with the first rib?

Answer 31

Costotransverse Costovertebral Costochondral

Question 32

What are the key relations of the first rib?

Answer 32

Superior - clavicle, anterior scalene, subclavian vein, subclavian artery, brachial plexus Inferior - parietal pleura, neurovascular bundle (intercostal A/V/N) Anterior - sympathetic trunk + superior /supreme intercostal A (from costocervical trunk) Posterior - internal thoracic artery and vein

Question 33

What are the ligaments involved with the first rib?

Answer 33

Radiate Superior / lateral costotransverse Costo clavicular ligament

Question 34

What are the muscles involved with the first rib?

Answer 34

Anterior scalene Middle scalene Subclavius External intercostal Internal intercostal Innermost intercostal

Question 35

What are the arteries / veins/ nerves involved with the first rib?

Answer 35

Intercostal A/V/N Superior / supreme intercostal A

Question 36

What are the anatomical variants associated with the first rib?

Answer 36

bifid rib fibrous articulation / fusion with cervical rib rudimentary/hypoplastic rib

Question 37

What are the different parts of the humerus?

Answer 37

Proximal - Head Greater tubercle (for rotator cuff except subscap) Lesser tubercle (for subscap) Bicipital groove between the 2 Shaft - Radial (spiral) groove Deltoid tuberosity Distal - Olecranon fossa Condyle - medial and lateral Epicondyles - medial and lateral Trochlea and Capitulum

Question 38

What are the joints / ligaments involved with the humeus?

Answer 38

Glenohumeral joints (with tendons of the rotator cuff) Elbow joint (TURC) - with radial collateral ligament + annular ligament - ulnar collateral ligament - both are synovial

Question 39

What are the key relations of the humerus?

Answer 39

At surgical neck - axillary nerve / posterior circumflex humeral artery - At shaft (in radial groove), RADIAL NERVE and profunda brachii - at lateral epicondyle - radial N - at medial epicondyle; Anterior: median N and brachial artery Posterior: ulnar N Medially - median nerve and brachial artery

Question 40

What are the anatomical variants associated with the humerus?

Answer 40

Olecranon foramen (can replace the olecranon fossa) Supracondylar process - Associated with ligament (of struthers) which attaches above epicondyle to create a foramen to transmit median n. and brachial a.

Question 41

What is key about the ossification of the humeus?

Answer 41

Primary centre in mid shaft at 8 weeks Secondary centre is at head of humerus, greater and lesser tuberosities at 1 year