Upper Limb Anatomy

Question 1

Clavicle most commonly fractures at … The bones move …

Answer 1

Lateral 1/3, medial 2/3

Lateral 1/3 moves inferomedially (pulled down by upper limb) and medial 2/3 moves superior (pulled by trapezius)

Question 2

Clavicle fractures endanger

Answer 2

Subclavian artery and veins, brachial plexus devisoin and suprascapular nerves

Question 3

Innervation of rotator cuff

Answer 3

Supraspinatus: suprascapular nerve
Infraspinatus: suprascapular
Teres minor: axillary nerve
Subscapularis: upper and lower subscapula nerves

Question 4

attachments and action of subscapularis

Answer 4

subscapular fossa to lesser tubercule of humerus causing internal rotation of humerus.

Question 5

Testing of rotator cuff muscles

Answer 5

Supraspinatus: empty can test
Infraspinatus: resisted external rotation
Subscapularis: lift off test
Teres minor: resisted internal rotation

Question 6

Axillary lymph nodes drainage

Answer 6

Pectoral Nodes: drain upper outer quadrant of breast
Lateral nodes: drain upper arm
Posterior nodes: posterior chest wall
Central nodes: drain posterior, pectoral and lateral nodes
Apical nodes: drain central and hence all others

Question 7

Passing through axilla

Answer 7

axillary artery and vein, cords and branches of brachial plexus and axillary lymph

Question 8

Quadrilateral space of thorax

Answer 8

superiorly bordered by teres minor, inferiorly by teres major, medially by long head of triceps, laterally by surgical neck of humerus.

Contains axiallary nerve and posterior circimflex artery

Structures endangered in surgical neck of humerus fracture and anteroinferior dislocations of humerus

Question 9

Triangular interval

Answer 9

superior border teres minor, medial border long head biceps, lateral border humerus

Contains radial nerve and deep brachial artery

Question 10

Triangular space

Answer 10

Bordered superiorly by teres minor, inferiorly by teres major and laterally by long head of triceps

Contains circumflex scapular artery and vein

Question 11

Damage to axiallry nerve occurs via surgical neck fractures. What is result?

Answer 11

Deltoid paralysis and inability to abduct past 30 degrees. Loss of sensation on regimental patch. May have bleeding from posterior circumflex humeral artery

Question 12

Midshaft humerus fractures endager

Answer 12

Radial nerve in radial groove and deep brachial artery. May cause wrist drop

Question 13

Medial epichodylar fractures endanger

Answer 13

ulnar nerve resulting in minor ulnar claw (ulnar paradox) and loss of sensation to medial 1.5 digits

Question 14

Medial supracondylar ridge fractures endager

Answer 14

median nerve and brachial artery

Question 15

Biceps brachii attachments and innervation, best action

Answer 15

Short head : coracoid process
Long head: supraglenoid tubercle

Innervation: musculocutaneous

Best action: whilst supinated

Pop-eye sign: biceps tendon not attatched.

Question 16

Anterior arm actions and innervation

Answer 16

Actions: flexion of shoulder and elbow, supination of forearm

Innervation: musculocutaneous nerve. Except brachialis which is partially innervated by radial nerve

Question 17

Pop-eye sign

Answer 17

rupture of biceps tendon

Question 18

Cubital fossa borders and contents

Answer 18

medial border is lateral border of pronator teres, lateral border is medial border of brachioradialis, superior border imaginary line bewteen epichondyles

Contents: median nerve, radial nerve (maybe), median cubital vein

Question 19

Posterior arm and forearm innervation

Answer 19

Radial nerve

Question 20

Colles fracture

Answer 20

transverse fracture causing posterior duisplacement of distal radius

FOOSH fracture

Question 21

Smith fracture

Answer 21

falling on flexed hand

Transverse fracture causing anterior displacement of distal radius

Question 22

Anterior forearm innervation

Answer 22

median nerve except flexor carpi ulnaris and medial 1/2 of flexor digitorum profundus by ulnar nerve

Question 23

Anterior forearm muscle attatchments

Answer 23

medial epichondyle

Question 24

difference between flexor digitorum profundus and superficialis

Answer 24

profundus flexes distal IP joint and superficialis won’t

Question 25

Nursemaids elbow

Answer 25

dislocation of radius from annular ligament

Question 26

Student's elbow

Answer 26

inflammation of olecranon bursa

Question 27

Carpal tunnel

Answer 27

4 flexor digitorum profundus tendons, 4 flexor digitorum superficialis tendon, 1 flexor policis longus tendon and median nerve bound by flexor retinaculum

Question 28

median nerve

Answer 28

lateral 3.5 digits sensation

Question 29

guyons canal

Answer 29

carries ulnar nerve and artery. Compression causes loss to medial 1.5 digits

Question 30

Carpal bones

Answer 30

Scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capatate hamate From radius to ulnar in 2 lines

Question 31

innervation of muscles of hand

Answer 31

All innervated by ulnar except LOAF Lateral 2 lumbricals Opponens pollucis Abductor pollicis brevis and flexor pollicis brevis Including posterior hand muscles

Question 32

Anatomical snuffbox

Answer 32

feel scaphoid (fracture) and trapezium and can feel radial artery. Cephalic vein in here as well

Question 33

Brachial plexus nerves

Answer 33

``` Musculocutaneous Median Axillary Radial Ulnar ```

Question 34

Klumpkes paralysis

Answer 34

abducted arm being pulled C8 and T1 damaged Results in weakness of intrinsic arm muscles (ulnar claw) and horners syndrome (T1)

Question 35

Erb's Duchene palsy

Answer 35

traction of head and neck damaging C5 and C6 Presents as medially rotated arm and extended and pronated forearm (waiters tip)

Question 36

Long thoracic nerve

Answer 36

from C5, C6, C7 and innervates seratus anterior anterior Severing causes winging of scapula (protracted and posterior scapular) C5, 6 7 wings to heaven

Question 37

Axillary nerve

Answer 37

motor to deltoid, sensory to regiumental patch Damaged surgical neck humerus C5, C6

Question 38

musculocutaneous nerve

Answer 38

motor to coracobrachial, biceps and brachialis, sensory to lateral skin of forearm C5, C6, C7

Question 39

Radial nerve

Answer 39

motor to forearm and arm extensors and sensory to dorsal lateral 3.5 digits of hand Damaged midshaft humerus of fracture Roots C5,6,7,8,T1

Question 40

median nerve

Answer 40

motor to anterior forearm (except 2) and LOAF Sensory to palmar lateral 3.5 digits of hand damage in carpal tunnel Loss causes hand of benediction, thenar eminence of wasting , loss of sensation to palmar lateral 3.5 C5, C6, C7, C8, T1

Question 41

ulnar nerve

Answer 41

motor to 2 anterior forearm muscles and all intrinsic hand muscles except LOAF Damage at medial epicondyle of humerus and guyons canal Causes ulnar claw, fromet sign and wasting of hypothenar emminence and loss of sensation to medial 1.5 didgits of hands C7, C8, T1

Question 42

Myotomes

Answer 42

``` Shoulder abduction: C5, 6 Shoulder adduction: C6,7,8 Elbow flexion: C5,6 Elbow extension: C7,8 Wrist flexion: C6,7 Wrist extention: C7,8 Finger flexion: C7,8 Finger extention: C7,8 Finger abduction and adduction: C8, T1 ```