1- Upper limb Flashcards
1
Q
(1-601) A 10 year old boy is admitted to the emergency department following a fall. On examination, there is deformity and swelling of the forearm. The ability to flex the fingers of the affected limb is impaired. However, there is no sensory impairment. Imaging confirms a displaced forearm fracture. Which of the nerves listed below is likely to have been affected?
A
Anterior interosseous nerve
Forearm fractures may be complicated by neurovascular compromise. The anterior interosseous nerve may be affected. It has no sensory supply so the defect is motor alone.
2
Q
(1-601/A) What is the anterior interosseous nerve?
A
A branch of the median nerve that supplies the deep muscles on the front of the forearm, except the ulnar half of the flexor digitorum profundus.
3
Q
(1-601/B) Where does the anterior interosseous nerve travel?
A
It accompanies the anterior interosseous artery along the anterior of the interosseous membrane of the forearm, in the interval between the flexor pollicis longus and flexor digitorum profundus.
4
Q
(1-601/C) What muscles does the anterior interosseous nerve innervate?
A
It innervates the flexor pollicis longus, pronator quadratus, and the radial half of the flexor digitorum profundus (the lateral two out of the four tendons).
5
Q
(1-601/D) Where does the anterior interosseous nerve end?
A
It ends below in the pronator quadratus and the wrist joint.
6
Q
(2 - 601)
Which of the following nerves supplies the skin on the palmar aspect of the thumb?
A
Median
The median nerve supplies cutaneous sensation to this region.
7
Q
(2- 601/ A) How is the median nerve formed?
A
t is formed by the union of a lateral and medial root from the lateral (C5,6,7) and medial (C8 and T1) cords of the brachial plexus.
8
Q
(2- 601/ B) What is the path of the median nerve in the upper arm?
A
It descends lateral to the brachial artery, crosses to its medial side (usually passing anterior to the artery) and passes deep to the bicipital aponeurosis and the median cubital vein at the elbow.
9
Q
(2- 601/ C)What is the path of the median nerve in the forearm?
A
It passes between the two heads of the pronator teres muscle and runs on the deep surface of flexor digitorum superficialis (within its fascial sheath). Near the wrist, it becomes superficial between the tendons of flexor digitorum superficialis and flexor carpi radialis, deep to the palmaris longus tendon. It then passes deep to the flexor retinaculum to enter the palm, but lies anterior to the long flexor tendons within the carpal tunnel.
10
Q
(2- 601/ D) What are the branches of the median nerve in the forearm?
A
The branches in the forearm include pronator teres, pronator quadratus, flexor carpi radialis, palmaris longus, flexor digitorum superficialis, flexor pollicis longus, and the radial half of flexor digitorum profundus.
11
Q
(2- 601/ E ) What is the sensory innervation of the median nerve in the hand?
A
It innervates the palmar aspect of the thumb and lateral 2½ fingers. On the palmar aspect, the innervation projects proximally, and on the dorsal aspect, only the distal regions are innervated with the radial nerve providing the more proximal cutaneous innervation.
12
Q
(2- 601/ F ) What are some patterns of damage to the median nerve?
A
Damage at the wrist, such as carpal tunnel syndrome, can cause paralysis and wasting of the thenar eminence muscles and opponens pollicis (ape hand deformity), as well as sensory loss to the palmar aspect of the lateral (radial) 2½ fingers. Other symptoms may include inability to pronate the forearm, weak wrist flexion, and ulnar deviation of the wrist.
13
Q
(2- 601/ G )What is the anterior interosseous nerve?
A
It is a branch of the median nerve that leaves just below the elbow and results in the loss of pronation of the forearm and weakness of the long flexors of the thumb and index finger.
14
Q
( 7 of 601)
A 63 year old lady is undergoing an axillary sentinel lymph node biopsy as part of her breast cancer treatment. Which of the structures listed below is most likely to be encountered?
A
Intercostobrachial nerve
A particularly careless surgeon could encounter all of these. However, during a routine level 1 axillary exploration which is where the majority of sentinel nodes will be located, the nerves most commonly encountered are the Intercostobrachial nerves.
15
Q
( 7 of 601/A )What are the boundaries of the axilla?
A
Medially: Chest wall and Serratus anterior;.
Laterally: Humeral head.
Floor: Subscapularis.
Anterior aspect: Lateral border of Pectoralis major.
Fascia: Clavipectoral fascia
16
Q
( 7 of 601/B )What is the function of the long thoracic nerve?
A
It supplies the serratus anterior muscle and its damage can lead to winging of the scapula.
17
Q
( 7 of 601/C )What is the location of the long thoracic nerve?
A
It lies on the medial chest wall and passes behind the brachial plexus to enter the axilla.
18
Q
( 7 of 601/D )What does the thoracodorsal nerve and thoracodorsal trunk innervate?
A
They innervate and vascularize the latissimus dorsi muscle.
19
Q
( 7 of 601/D ) Where is the axillary vein located?
A
It lies at the apex of the axilla and is the continuation of the basilic vein. It becomes the subclavian vein at the outer border of the first rib.
20
Q
( 7 of 601/E ) What is the function of the intercostobrachial nerves?
A
They provide cutaneous sensation to the axillary skin and traverse the axillary lymph nodes.
21
Q
( 7 of 601/F )What is the main site of lymphatic drainage for the breast?
A
The axilla serves as the main site of lymphatic drainage for the breast.
22
Q
(10 of 601)
A 35 year old farm labourer injures the posterior aspect of his hand with a mechanical scythe. He severs some of his extensor tendons in this injury. How many tunnels lie in the extensor retinaculum that transmit the tendons of the extensor muscles?
A
Six
There are six tunnels, each lined by its own synovial sheath.
23
Q
(Question 12 of 601)
Which of the muscles listed below is not innervated by the median nerve?
A
Adductor pollicis
Adductor pollicis is innervated by the ulnar nerve.
Medial two lumbricals innervated by the ulnar nerve
24
Q
( 14 of 601 )
A 23 year old man is involved in a fight outside a nightclub and sustains a laceration to his right arm. On examination, he has lost extension of the fingers in his right hand. Which of the nerves listed below is most likely to have been divided?
A
Radial
The radial nerve supplies the extensor muscle group
25
( 17 of 601 )
An injured axillary artery is ligated between the thyrocervical trunk of the subclavian and subscapular artery. Subsequent collateral circulation is likely to result in reversal of blood flow in which of the vessels listed below?
Transverse cervical artery
It is asking about the branches of the axillary artery and knowledge of the fact that there is an extensive collateral network around the shoulder joint
26
( 17 of 601/A )
What is the circumflex scapular artery a branch of?
It is a branch of the subscapular artery.
27
( 17 of 601/B )
What is the normal function of the circumflex scapular artery?
It normally supplies the muscle on the dorsal aspect of the scapula.
28
( 17 of 601/C )
What happens when flow is reversed in the circumflex scapular and subscapular arteries?
It forms a collateral circulation around the scapula.
29
( 17 of 601/D )
Where does the axillary artery extend from and to?
It extends from the outer border of the first rib to the lower border of teres major, where it becomes the brachial artery.
30
( 17 of 601/E )
How is the axillary artery subdivided?
It is subdivided into three parts: the first part lies above pectoralis minor, the second part is behind the muscle, and the third part lies inferior to it.
31
( 17 of 601/F )
What structures enclose the axillary artery and vein within the cords of the brachial plexus?
They are enclosed within the axillary sheath, which is a prolongation of the prevertebral fascia.
32
( 17 of 601/G )
What structures surround the axillary artery in the first part?
The axillary vein, cords of the brachial plexus, axillary sheath, clavipectoral fascia, serratus anterior, long thoracic nerve, and the medial cord of the brachial plexus.
33
( 17 of 601/H )
What structures surround the axillary artery in the second part?
Pectoralis minor and major, posterior cord of the brachial plexus, and the medial cord of the brachial plexus.
34
( 17 of 601/I )
What nerves are interspersed between the axillary artery and subscapularis muscle?
The axillary and radial nerves are interspersed between the artery and subscapularis.
35
( 17 of 601/J )
What nerves are located laterally to the axillary artery?
The median and musculocutaneous nerves and coracobrachialis are located laterally to the artery.
36
( 17 of 601/H )
What is the axillary vein related to medially?
The axillary vein is related medially to the axillary artery.
37
What structures surround the axillary artery in the third part?
Subscapularis, latissimus dorsi, teres major, axillary and radial nerves, medial root of the median nerve, median and musculocutaneous nerves, and coracobrachialis.
38
What is the relationship of the axillary vein to the axillary artery?
The axillary vein is related medially to the axillary artery.
39
What are the branches of the axillary artery?
1/Highest thoracic artery
2/Thoraco-acromial artery
3/Lateral thoracic artery
4/Subscapular artery
5/Posterior circumflex humeral artery
6/Anterior circumflex humeral artery
40
(23 of 601)
A 43 year old typist presents with pain at the dorsal aspect of the upper part of her forearm. She also complains of weakness when extending her fingers. On examination triceps and supinator are both functioning normally. There is weakness of most of the extensor muscles. However, there is no sensory deficit. Which of the following nerves has been affected?
Posterior interosseous
41
(23 of 601/ A)
Where can the radial nerve become entrapped?
In the arcade of Frohse
42
(23 of 601/ B)
What is the arcade of Frohse?
It is a superficial part of the supinator muscle that overlies the posterior interosseous nerve.
43
(23 of 601/ C)
What muscles does the radial nerve give branches to?
Extensor carpi radialis brevis and supinator.
44
(23 of 601/ D)
What path does the radial nerve take after passing postero-inferiorly?
It enters the supinator and curves around the lateral and posterior surfaces of the radius.
45
(23 of 601/ E)
Where does the posterior interosseous nerve lie after emerging from the supinator?
Between the superficial extensor muscles and the lowermost fibers of the supinator
46
(23 of 601/ F)
What muscles does the posterior interosseous nerve give branches to?
The extensors.
47
(23 of 601/ G)
Where does the posterior interosseous nerve emerge from?
t emerges from the supinator between the superficial extensor muscles and the lowest fibers of the supinator.
48
(23 of 601/ H)
What muscles does the posterior interosseous nerve innervate through recurrent branches?
Extensor digitorum, extensor digiti minimi, and extensor carpi ulnaris.
49
(23 of 601/ I)
What path does the posterior interosseous nerve take after emerging from the supinator?
It passes superficial to the abductor pollicis longus along with the posterior interosseous artery.
50
(23 of 601/ J)
What muscle does the posterior interosseous nerve supply in this region?
It supplies the abductor pollicis longus.
51
(23 of 601/ K)
What muscles does the posterior interosseous nerve give branches to?
Extensor pollicis longus, extensor pollicis brevis, and extensor indicis.
52
(23 of 601/ L)
Where does the posterior interosseous nerve end?
It ends as a small gangliform enlargement at the back of the carpus.
53
(23 of 601/ M)
What is the function of the gangliform enlargement?
It supplies the intercarpal joints.
54
(29 of 601)
A 23 year old man falls and slips at a nightclub. A shard of glass penetrates the skin at the level of the medial epicondyle, which of the following sequelae is least likely to occur?
Claw like appearance of the hand
55
(29 of 601/A)
What is the typical hand deformity seen in ulnar nerve injuries in the mid to distal forearm?
Claw hand
56
(29 of 601/A)
What does the claw hand consist of?
Flexion of the 4th and 5th interphalangeal joints and extension of the metacarpophalangeal joints.
57
(29 of 601/B)
How does the clawing effect change when the flexor digitorum profundus is not affected?
The clawing is more pronounced.
58
(29 of 601/C)
What is the term for the milder hand deformity seen in more proximal ulnar nerve lesions?
Ulnar paradox
59
(29 of 601/D)
Why is it called the ulnar paradox?
Because, despite the more proximal level of transection, the hand does not have a claw-like appearance seen in distal injuries.
60
(29 of 601/E)
Which muscle is affected in ulnar nerve injuries that are more proximally sited?
The first dorsal interosseous muscle.
61
(29 of 601/F)
What is the origin of the ulnar nerve?
C8, T1
62
(29 of 601/G)
Which muscles does the ulnar nerve supply in the forearm?
Flexor carpi ulnaris, flexor digitorum profundus, flexor digiti minimi, abductor digiti minimi, opponens digiti minimi, adductor pollicis, interossei muscles, third and fourth lumbricals, and palmaris brevis.
no muscle in upper arm
63
(29 of 601/H)
What path does the ulnar nerve take from the upper arm to the palm of the hand?
Posteromedial aspect of the upper arm to the flexor compartment of the forearm, then along the ulnar.
It passes beneath the flexor carpi ulnaris muscle, then superficially through the flexor retinaculum into the palm of the hand.
64
(29 of 601/I)
What are the effects of ulnar nerve damage at the wrist?
Wasting and paralysis of intrinsic hand muscles (claw hand), wasting and paralysis of hypothenar muscles, and loss of sensation in the medial 1 and a half fingers.
65
(29 of 601/J)
What is claw hand?
It is a condition characterized by the wasting and paralysis of intrinsic hand muscles, resulting in the flexion of the 4th and 5th digits and extension of the metacarpophalangeal joints.
66
(29 of 601/K)
Which muscles are affected in the hypothenar region?
The hypothenar muscles, which are responsible for controlling the movement of the pinky finger and the muscles at the base of the thumb.
67
(29 of 601/L)
Which fingers experience a loss of sensation in ulnar nerve damage at the wrist?
The medial 1 and a half fingers, which includes the pinky finger and half of the ring finger.
68
(29 of 601/M)
What are the effects of ulnar nerve damage at the elbow?
Radial deviation of the wrist and less prominent clawing in the 4th and 5th digits.
69
(29 of 601/H)
Why is clawing less prominent in the 4th and 5th digits in ulnar nerve damage at the elbow?
Because the ulnar nerve is responsible for the flexion of these digits, and damage at the elbow affects its function to a lesser extent compared to damage at the wrist.
70
(31 of 601)
A 43 year old man is stabbed outside a nightclub. He suffers a transection of his median nerve just as it leaves the brachial plexus. Which of the following features is least likely to ensue?
Complete loss of wrist flexion
71
(31 of 601/A)
How is the median nerve formed?
It is formed by the union of a lateral and medial root respectively from the lateral (C5,6,7) and medial (C8 and T1) cords of the brachial plexus.
72
(31 of 601/B)
What is the path of the median nerve in the upper arm and forearm?
It descends lateral to the brachial artery, crosses to its medial side (usually passing anterior to the artery), passes deep to the bicipital aponeurosis and the median cubital vein at the elbow, and runs on the deep surface of the flexor digitorum superficialis (within its fascial sheath).
73
(31 of 601/C)
What is the location of the median nerve near the wrist?
It becomes superficial between the tendons of flexor digitorum superficialis and flexor carpi radialis, deep to the palmaris longus tendon.
74
(31 of 601/D)
Where does the median nerve enter the palm?
It passes deep to the flexor retinaculum to enter the palm.
75
(31 of 601/E)
What is the position of the median nerve within the carpal tunnel?
it lies anterior to the long flexor tendons within the carpal tunnel.
76
(31 of 601/F)
What is the function of the median nerve?
It innervates the flexor muscles.
77
(31 of 601/G)
Which muscle still functions when the median nerve is lost?
Flexor carpi ulnaris
78
(31 of 601/H)
What movements does flexor carpi ulnaris produce when the median nerve is lost?
Ulnar deviation and some residual wrist flexion.
79
(31 of 601/I)
What happens in high median nerve lesions?
There is a complete loss of flexion at the thumb joint.
80
(31 of 601/I)
How is the median nerve formed?
It is formed by the union of a lateral and medial root from the lateral and medial cords of the brachial plexus.
81
(31 of 601/J)
What path does the median nerve take from the brachial plexus to the palm of the hand?
It descends lateral to the brachial artery, crosses to its medial side, passes deep to the bicipital aponeurosis and the median cubital vein at the elbow, passes between the two heads of the pronator teres muscle, and runs on the deep surface of flexor digitorum superficialis.
82
(31 of 601/I)
Where does the median nerve become superficial near the wrist?
Between the tendons of flexor digitorum superficialis and flexor carpi radialis.
83
(31 of 601/K)
What structures does the median nerve pass deep to before entering the palm?
The flexor retinaculum and the long flexor tendons within the carpal tunnel.
84
(31 of 601/L)
What is an example of damage to the median nerve at the wrist?
Carpal tunnel syndrome
85
(31 of 601/M)
What are the effects of median nerve damage at the wrist?
Paralysis and wasting of thenar eminence muscles and opponens pollicis (ape hand deformity), and sensory loss to the palmar aspect of the lateral 2 and a half fingers.
86
(31 of 601/N)
What does the ape hand deformity refer to?
It is a condition characterized by the paralysis and wasting of the thenar eminence muscles and opponens pollicis, resulting in a flattened appearance of the palm and an inability to oppose the thumb.
87
(31 of 601/O)
Which fingers experience sensory loss in median nerve damage at the wrist?
The palmar aspect of the lateral 2 and a half fingers, which includes the thumb, index finger, and half of the middle finger.
88
(31 of 601/P)
What are the additional effects of median nerve damage at the elbow?
Inability to pronate the forearm, weak wrist flexion, and ulnar deviation of the wrist.
89
(31 of 601/Q)
Which direction does the wrist deviate in median nerve damage at the elbow?
It deviates towards the ulnar side.
90
(31 of 601/R)
Where does the anterior interosseous nerve branch off from?
It branches off from the median nerve just below the elbow
91
(31 of 601/S)
What are the effects of damage to the anterior interosseous nerve?
Loss of pronation of the forearm and weakness of the long flexors of the thumb and index finger.
92
(33 of 601)
Which of the structures listed below articulates with the head of the radius superiorly?
Capitulum
The head of the radius articulates with the capitulum of the humerus.
93
(33 of 601/A )
What covers the medial to lateral side of the upper end of the radius?
Articular cartilage
93
(33 of 601/B )
What does the upper end of the radius articulate with?
The radial notch of the ulna, connected by the annular ligament
94
(33 of 601/D)
Which muscles attach to the upper third of the body of the radius?
Supinator, flexor digitorum superficialis, flexor pollicis longus
94
(33 of 601/C )
Which muscle attaches to the upper end of the radius at the tuberosity?
Biceps brachii
95
(33 of 601/E)
Which muscle attaches to the middle third of the body of the radius?
Pronator teres
96
(33 of 601/F)
Which muscle attaches to the lower quarter of the body of the radius?
Pronator quadratus
97
(33 of 601/G)
What is the tendon of the supinator called?
Supinator longus
98
(33 of 601/H)
What shape is the lower end of the radius?
Quadrilateral
98
(33 of 601/I)
What does the anterior surface of the lower end of the radius contribute to in lower end ?
The capsule of the wrist joint
99
(33 of 601/J)
What is found on the medial surface of the lower end of the radius?
The head of the ulna
100
(33 of 601/K)
Where does the lateral surface of the lower end of the radius end?
In the styloid process
101
(33 of 601/L)
What is found on the posterior surface of the lower end of the radius?
Three grooves containing the tendons of extensor carpi radialis longus and brevis, extensor pollicis longus, and extensor indicis
102
39 of 601
At the level of the wrist joint, which of the statements below best describes the relationship of the ulnar artery to the ulnar nerve?
It lies on its radial side
103
39 of 60/ A
Where does the ulnar artery start?
In the middle of the antecubital fossa
104
39 of 60/ B
How does the ulnar artery travel in the forearm?
It passes obliquely downward, reaching the ulnar side of the forearm about midway between the elbow and the wrist. It follows the ulnar border to the wrist, crossing over the flexor retinaculum. It then divides into the superficial and deep volar arches.
105
39 of 60/ C
What structures are deep to the ulnar artery?
Pronator teres, flexor carpi ulnaris, and palmaris longus
106
39 of 60/ D
What structures does the ulnar artery lie on?
Brachialis and flexor digitorum profundus
106
39 of 60/ E
Where is the ulnar artery located in relation to the flexor retinaculum at the wrist?
It is superficial to the flexor retinaculum.
107
39 of 60/ F
What is the relationship between the ulnar artery and the median nerve?
The median nerve is in relation with the medial side of the artery for about 2.5 cm. It then crosses the vessel, being separated from it by the ulnar head of the pronator teres.
108
39 of 60/ G
What is a branch of the ulnar artery?
The anterior interosseous artery
109
40 of 601
Which of the following anatomical structures lies within the spiral groove of the humerus?
Radial nerve
The radial nerve lies in this groove and may be compromised by fractures involving the shaft.
110
40 of 601/ A
What is the length of the humerus?
It extends from the scapula to the elbow joint.
111
40 of 601/ B
Where is the greater tubercle located in humurus ?
On the lateral side of the upper end of the bone.
112
40 of 601/ D
Where is the lesser tubercle located in humurus?
On the front of the upper end of the bone.
112
40 of 601/ C
What tendons are inserted into impressions on the greater tubercle in humurus ?
The tendons of the supraspinatus and infraspinatus.
113
40 of 601/ E
What passes through the intertubercular groove?
The tendon of the biceps within its synovial sheath.
113
40 of 601/ F
What is the spiral groove on the posterior surface of the humerus for?
What runs within the spiral groove?
It is for the radial nerve.
The radial nerve and brachial vessels.
113
40 of 601/ D
Where does the intertubercular groove pass?
On the body between the greater and lesser tubercles.
114
40 of 601/ G
What forms the middle third of the distal edge of the humerus?
The trochlea
115
40 of 601/ H
What indentations are found superior to the trochlea in humurus ?
The coronoid fossa anteriorly and olecranon fossa posteriorly.
116
40 of 601/ I
What does the rounded capitulum articulate with?
It articulates with the radius.
117
40 of 601/ J
What is the medial epicondyle in humurus ?
It is a prominent structure on the humerus.
118
40 of 601/ K
What is found on the smooth posterior surface of the medial epicondyle?
A sulcus for the ulnar nerve and collateral vessels.
119
40 of 601/ L
What attaches to the distal margin of the medial epicondyle?
The ulnar collateral ligament.
120
40 of 601/ L
What is found on the anterior surface of the medial epicondyle?
An impression for the common flexor tendon.
121
41 of 601
A 24 year old man falls and sustains a fracture through his scaphoid bone. From which of the following areas does the scaphold derive the majority of its blood supply?
From the distal end
The blood supply to the scaphoid enters from a small non articular surface near its distal end. Transverse fractures through the scaphoid therefore carry a risk of non union
122
41 of 601/A
What is the shape of the articular surface of the scaphoid bone for the head of the capitate?
Concave
123
41 of 601/B
What bone is adjacent to the concave articular surface of the scaphoid bone for the head of the capitate?
Lunate
124
41 of 601/C
What type of articular surface does the scaphoid bone have with the radius?
Wide convex surface
124
41 of 601/D
Which bones are associated with the lateral side of the scaphoid bone?
Trapezium and trapezoid bones
125
41 of 601/E
What ligament arises from the narrow strip between the radial and trapezial surfaces of the scaphoid bone?
Radial collateral carpal ligament
126
41 of 601/F
Which part of the scaphoid bone allows for the entry of blood vessels?
The area around the tubercle
127
41 of 601/G
Where do fractures commonly occur in the scaphoid bone?
In the area around the tubercle
128
41 of 601/G
What can occur as a result of fractures in the scaphoid bone?
Avascular necrosis
129
43 of 601
A patient sustains damage to the median nerve during a carpal tunnel release. Which of the following muscles will be affected?
Abductor pollicis brevis
Of the muscles listed, only the abductor pollicis brevis is innervated by the median. In questions like this one, ensure you don't become confused between adductor and abductor.
130
43 of 601/A
Where does the abductor pollicis brevis muscle originate from?
Fleshy fibres from the flexor retinaculum, scaphoid, and trapezium.
131
43 of 601/B
Where does the abductor pollicis brevis muscle insert?
Via a short tendon into the radial side of the proximal phalanx of the thumb.
132
43 of 601/C
Which nerve innervates the abductor pollicis brevis muscle?
Recurrent branch of the median nerve in the palm.
133
43 of 601/D
What actions does the abductor pollicis brevis muscle perform?
It abducts the thumb at the carpometacarpal and metacarpophalangeal joints. This causes the thumb to move anteriorly at right angles to the plane of the palm and rotate medially. It is involved in activities such as typing.
134
43 of 601/E
What is the angulation between the proximal phalanx and the metacarpal when the thumb is fully abducted?
Around 30 degrees.
135
43 of 601/E
What other muscle is used along with the abductor pollicis brevis in the initial stages of thumb opposition?
Opponens pollicis.
136
52 of 601
Which of the nerves listed below is directly responsible for the innervation of the lateral aspect of flexor digitorum profundus?
Anterior interosseous nerve
The anterior interosseous nerve is a branch of the median nerve and is responsible for innervation of the lateral aspect of the flexor digitorum profundus.
137
55 of 601
Which of the structures listed below are most closely related to the axillary nerve within the quadrangular space?
Posterior circumflex humeral vessels
The posterior circumflex humeral vessels which are branches of the axillary artery are related to the axillary nerve within the quadrangular space
138
55 of 601/A
What is the origin of the axillary nerve?
What are the root values of the axillary nerve?
Posterior cord of the brachial plexus
C5 and C6
139
55 of 601/B
Where does the axillary nerve descend posteriorly?
Behind the axillary artery
140
55 of 601/C
At what location does the axillary nerve pass through with the posterior circumflex humeral vessels?
Quadrangular space
141
55 of 601/D
What are the branches into which the axillary nerve divides?
Anterior and posterior branches
142
55 of 601/E
Which muscles does the axillary nerve innervate?
Deltoid and lateral head of the triceps
143
55 of 601/E
Which area of the skin does the axillary nerve provide sensory innervation to?
Small patch over the deltoid muscle
144
62 of 601
Which muscle initiates abduction of the shoulder?
Supraspinatus
The intermediate portion of the deltoid muscle is the chief abductor of the humerus. it can only do this after the movement has been initiated by supraspinatus. Damage to the te supraspinatus is a common form of rotator cuff disease.
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Which muscles provide stability to the shoulder joint?
Muscles of the rotator cuff
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What is the glenoid labrum?
Fibrocartilaginous rim attached to the edge of the glenoid cavity
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Where does the tendon of the long head of the biceps arise from?
Supraglenoid tubercle
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What is the attachment point of the long head of the triceps?
Infraglenoid tubercle
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Where does the fibrous capsule attach in shoulder joint ?
To the scapula outside the glenoid labrum and to the labrum itself (postero-superiorly)
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in shoulder Which tendons are in contact with the anterior, superior, and posterior parts of the capsule?
Anterior: Subscapularis tendon, Superior: Supraspinatus tendon, Posterior: Infraspinatus and teres minor tendons
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in shoulder What are the two defects in the fibrous capsule?
Superior for the biceps tendon, Anterior beneath the subscapularis tendon
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in shoulder What nerve is closely related to the inferior extension of the fibrous capsule?
Axillary nerve
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in shoulder What is the risk in anteroinferior dislocations related to the axillary nerve?
Injury to the axillary nerve
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What can proximally sited osteomyelitis progress to?
Septic arthritis
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The first root of the brachial plexus commonly arises at which of the following levels?
C5
It begins at C5 and has 5 roots. It ends with a total of 15 nerves of these 5 are the main nerves to the upper limb (axillary, radial, ulnar, musculocutaneous and median)
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Where does the brachial plexus extend from and to?
From the neck to the axilla
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What nerves form the brachial plexus?
Fifth to eighth cervical nerves and the first thoracic nerve
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Where do the ventral rami of the brachial plexus enter in the neck?
Lower part of the posterior triangle along with the ventral rami of the cervical plexus
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What lies anterior to the lower two rami?
Second part of the subclavian artery
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Where do the upper three rami of the brachial plexus pass towards?
Axilla and subclavian artery
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What surrounds the upper three rami of the brachial plexus?
An extension of the prevertebral fascia
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What structures are deep to the brachial plexus in the neck?
Platysma, supraclavicular nerves, inferior belly of omohyoid, and transverse cervical artery
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Where does the brachial plexus pass beneath?
Clavicle and suprascapular vessels
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Where do the roots of the brachial plexus lie?
Between scalenus medius and anterior
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Which roots unite to form the upper trunk of the brachial plexus?
C5 and C6
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Which roots unite to form the lower trunk of the brachial plexus?
C8 and T1
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What does the C7 root continue as?
Middle trunk
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What do the trunks of the brachial plexus divide into?
Ventral and dorsal divisions
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What do the ventral divisions supply?
Anterior (flexor) parts of the upperlimb
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What do the dorsal divisions supply?
Posterior (extensor) parts of the upper limb
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Where are the cords of the brachial plexus formed?
In the axilla
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What does the dorsal divisions unite to form?
Posterior cord
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What does the ventral divisions of the upper and middle trunks unite to form?
Lateral cord
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What does the ventral divisions of the lower trunk continue as?
Medial cord
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How are the cords named?
Based on their relationship to the axillary artery
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Which cervical ventral rami receive grey rami communicantes from the middle cervical ganglion?
Fifth and sixth
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Which cervical ventral rami receive grey rami communicantes from the inferior cervical ganglion?
Seventh and eighth
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Which ganglion supplies the first thoracic ventral ramus with its grey ramus?
Cervicothoracic ganglion
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What syndrome can complicate an injury to the inferior plexus?
Horner's syndrome
