Anatomical Spaces of Clinical Importance in the Upper Limb Flashcards

1
Q

What is an anatomical space and what makes them clinically relevant

A
  • A space framed by bone, ligament and muscle.
  • They are clinically relevant because tendons, nerves and vessels pass through them and can become impinged .
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2
Q

What is the location of interscalene groove

A
  • Between the scalenus Medius and scalene anterior muscles.
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3
Q

The roots and trunks of which plexus emerges in the interscalene groove

A
  • Brachial plexus
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4
Q

Where does anaesthesia need to be placed to anesthetize the entire brachial plexus.

A
  • In the interscalene block
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5
Q

What is the location of the subacromial space

A
  • Superior to the head of the humerus but inferior to the acromion.
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6
Q

What is contained within the subacromial space

A
  • Supraspinatus tendon
  • Subacromial bursa
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7
Q

What are some injuries that can occur in the subacromial space and what are some examples if these injuries

A
  • Rotator cuff injuries:
    > Rotator cuff tears
    > Shoulder dislocation
    > Tendon ruptures in older people
    > Subacromial bursitis
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8
Q

What is the location of the suprascapular notch

A
  • Notch at the top of the scapula
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9
Q

What is contents of the suprascapular notch

A
  • Suprascapular nerve (passes through to supply supraspinatus and infraspinatus on the posterior aspect of the scapula)
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10
Q

What are the effects of impingement of the suprascapular nerve

A
  • Wasting of the supraspinatus and infraspinatus muscles
  • Shoulder pain
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11
Q

What is the location of the quadrangular/quadrilateral space

A
  • Just under the shoulder joint
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12
Q

What are the boundaries of the quadrangular/ quadrilateral space

A
  • Superiorly - Teres minor
  • Inferiorly - Teres major
  • Laterally - The shaft of the humerus
  • Medially - The long head of the triceps brachii
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13
Q

What are the contents of the quadrilateral space

A
  • The axillary nerve and posterior circumflex humeral artery
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14
Q

What type of injury puts the contents of the quadrangular/ quadrilateral space at risk

A
  • Axillary nerve is at risk of damage during shoulder dislocation
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15
Q

What is the location and the boundaries of the (upper) triangular space

A
  • Location: inferior-medial to quadrilateral space
  • Boundaries:
  • Laterally (long head of triceps brachii)
  • Superiorly (Teres minor)
  • Inferiorly (Teres major)
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16
Q

What are the contents of the triangular space

A
  • Circumflex scapular artery (passes through)
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17
Q

What is the location and the boundaries of the triangular interval (aka lower triangular space)

A
  • Location: Inferior to quadrilateral space
  • Boundaries:
  • Laterally - The lateral head of the triceps
  • Medially - Long head of triceps brachii
  • Superiorly - Teres Major
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18
Q

What is the location of the axilla

A
  • Space between the upper arm and the side of the thorax
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19
Q

What are the boundaries of the axilla

A
  • Apex
  • Lateral wall
  • Medial wall
  • Anterior wall
  • Posterior wall
20
Q

What makes up the apex of the axilla (aka axillary inlet)

A
  • Lateral border of 1st rib
  • Superior border of scapula
  • Posterior border of clavicle
21
Q

What makes up the lateral wall of the axilla

A
  • Intertubercular groove of the humerus
22
Q

What makes up the medial wall of the axilla

A
  • Serratus anterior
  • The thoracic wall
23
Q

What makes up the anterior wall of the axilla

A
  • Pectoralis major (and underlying minor)
  • Subclavius muscle
24
Q

What makes up the posterior wall of the axilla

A
  • Subscapularis
  • Teres major
  • Latissimus dorsi
25
Q

What are the vessels that are contained in the axilla

A
  • Axillary artery
  • Axillary vein
  • Axillary lymph nodes
  • Brachial Plexus
26
Q

Where in the axilla does the axillary artery lie

A
  • In the groove between the long head of the triceps and coracobrachialis
  • Can be palpated in the lateral walls of the axilla, can also be compressed here to prevent access bleeding
27
Q

What is significant about the axillary vein

A
  • The cephalic vein drains into the axillary vein
  • Often damaged by wounds in the axilla, this is dangerous as it bleeds profusely
28
Q

Infection in which regions cause enlargement of axillary lymph nodes

A
  • Upper limb and tenderness
  • Pectoral region
  • Breast
  • Upper abdominal wall
29
Q

What is removed during breast cancer removal surgery

A
  • Axillary lymph nodes
  • The long thoracic and thoracodorsal nerves are at risk
30
Q

What might cause brachial plexus injuries

A
  • Disease
  • Stretching
  • Compression
  • Penetrating wounds
31
Q

What is the location of the cubital tunnel

A
  • A space which allows passage of the ulnar nerve and the elbow
32
Q

What are the boundaries of the cubital tunnel

A
  • Medially - Medial epicondyle
  • Laterally - The olecranon process of the ulna and tendinous arch joining the humeral and ulnar heads of the flexor carpi ulnaris
  • Superiorly - Formed by a fibrous retinaculum stretching between the olecranon and medial epidcondyle.
33
Q

What causes cubital tunnel syndrome

A
  • Compression of ulnar nerve behind the medial epicondyle of the humerus
34
Q

What are the symptoms of cubital tunnel syndrome

A
  • Numbness in the anterior and posterior surfaces of the medial one and a half fingers and associated palm area.
  • Weakness in hand and forearm pain
35
Q

What are the boundaries of the cubital fossa

A
  • Laterally - Medial border of the brachioradialis
  • Medially - Lateral border of the pronator teres muscle
  • Superiorly - Horizontal line is drawn between the epicondyles of the humerus
  • Roof - Bicipital aponeurosis, fascia, subcutaneous fat and skin.
  • Floor - Brachialis and supinator
36
Q

What is contained within the cubital fossa

A
  • Median nerve, brachial artery, biceps tendon, radial nerve, posterior interosseous branch radial nerve
37
Q

Where can the brachial pulse be felt

A
  • Medially to the biceps tendon
38
Q

What is usually used for venipuncture or cannulation

A
  • The median antecubital, superficial to the fossa
39
Q

What are the boundaries of the Guyon’s canal

A
  • Medially - Pisiform bone
  • Laterally - Hook of hamate
  • Roof - Palmar carpal ligament
40
Q

What happens in the Guyon’s canal

A
  • Ulnar nerve and artery pass into the hand here
  • Ulnar nerve can be impinged here (causes numbness, hand muscle weakness
41
Q

What is the carpal tunnel bound by

A
  • Carpal arch
  • Flexor retinaculum
42
Q

What does the median nerve pass through the carpal tunnel with

A
  • Flex digitorum superficialis tendon
  • Flexor digitorum profundus tendon
  • Flexor policies longus tendon
  • Flexor carpi radialis tendon
43
Q

What causes sensory loss in the lateral 3.5 digits and weakness in the thenar muscle of the hand

A
  • Any inflammation of the wrist which causes compression of the median nerve
44
Q

What are the boundaries of the anatomical snuffbox

A

Medially - The extensor policies longus tendon
Laterally - Extensor policies brevis and abductor policies longus
Proximally - Styloid process of radius proximally
Floor - Scaphoid and trapezium

45
Q

What is contained in the anatomical snuffbox

A
  • Radial artery
  • Superficial branch of radial nerve
  • Cephalic vein