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mr C.S. > Anatomy of the Upper Limb and Breast > Flashcards

Anatomy of the Upper Limb and Breast Flashcards

1
Q

Parts of the pectoral girdle

Where they join

A

The clavicle and the scapula

Sternoclavicular joint and the acromioclavicular joint

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2
Q

Scapula

Location

Most palpable areas

What is required for full abduciton of the arm?

A

2nd to 7th rib posteriorly

Spine, acromion, coracoid process

Rotation of the scapula required to abduct the arm

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3
Q

Clavicle: difference between the medial 2/3 and lateral 1/3

A

Medial 2/3: convex anteriorly, cicular

Lateral 1/3: convex posteriorly, flat

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4
Q

Articulations of the clavicle

A

Sternum (sternoclavicular joint): articular disc in joint

Acromion (acromiclavicular joint): incomplete articular disc in joint

Coracoid process; held by strong coracoclavicular ligament

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5
Q

Interesting facts about the clavicle

development (x2)

what can pierce it

purpose (x2)

related to ortho?

A

first bone to ossify, only long bone to develop in membrane

supraclavicular nerves

acts as a strut to hold the arm out, transmits forces from the upper limb to the axial skeleton

most commonly fractured site in the body

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6
Q

Humerus anatomy

Head

Shaft

Posterior

Lower end

A

Head: 1/3 sphere, connects tohe shaft via the anatomical neck, below it are the greater and lesser tubercles between which the bicipital groove where the tendon of the long head of the biceps lies

Upper end and shaft (circular and more flat distally) meet at surgical neck = axillary nerve + circumflex humeral vessels lie

Posterior = radial nerve lies in the spiral groove, between the medial and lateral triceps heads

Lower end has rounded capitulum for articulation with radial head, and trochlear for articulation with trochlear notch of the ulna

Medial and lateral epicondyles are extracapsular: ulnar nerve lies in a groove on the posterior aspect of the medial epicondyle

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7
Q

Scapula anatomy

Anteriorly

Posteriorly

A

Posterior: superior angle, scapular notch, supraspinous foss, spine, infraspinous fossa, lateral border

Anterior: acromion, coracoid process

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8
Q

Radius - parts

Ulna - parts

A

Radius: radial head, radial tuberosity, styloid process, expanded end, dorsal tubercle (posterior)

Ulnar: olecranon, trochlear notch, coronoid proces (with its radial notch), head, styloid process

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9
Q

Carpal bones

A

Proximal row (L to M): scaphoid, lunate, triquetrum (+ pisiform)

Distal row (M to L): hamate, cunate, trapezoid, trapezium

Arched transversly - with the palmar aspect being concave - maintained by the posterior aspect of bone being larger than anterior aspect (except lunate)

AND

flexor retinaculum from scaphoid and trapezium laterally to pisiform and hook of hamate medially

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10
Q

Metacarpals - important articulations

A

First metacarpal mobility is important for opposition of the thumb

Second metacarpal = articulates with trapezium, trapezoid, capitate

Capitate = articulates with 2nd, 3rd, 4th metacarpal

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11
Q

Joints of the upper limb

Articulations

Where the capsule surrounds

A

Ball and socket

Articulations: glenoid fosssa (deepened by labrum glenoidale - cartilaginous ring) with head of humerus

Capsule - lax, around the epihyseal line around glenoid and humeral head, extends down to diaphysis at the medial aspect of humerus

Biecps tendon passes through it - capsule lined by synovial membrane here - synovium communicated with the subcapsular bursa, lying beneath tendon of subscapularis

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12
Q

Muscles that provide stability to the shoulder

A

Rotator cuff

Long head of biceps

Pectoralis major, latissimus dorsi, teres major

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13
Q

Muscles acting on the shoulder joint

Abduction

Adduction

Flexors

Extensors

Medial rotators

Lateral rotators

A

Abduction: deltoid, supraspinatus

Adduction: pectoralis major, latissimus dorsi

Flexors: anterior deltoid, coracobrachialis, pectoralis major

Extensors: posterior deltoid, latissimus dorsi, teres major

Medial rotators: pectoralis major, latissimus dorsi, teres major, anterior deltoid, subscapulairs

Lateral rotators: infraspinatus, teres minor, posterior deltoid

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14
Q

Ligaments of the clavicle attaching to the coracoid process

A

Conoid ligament (front)

Trapezoid ligament (behind)

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15
Q

Joints of the shoulder girdle

A

Sternoclavicular joint: sternum and medial end of clavicle; the costoclavicular ligament attaches to the first costal cartilage: acting as a fulcrum when the shoulders are shrugged to depress the medial end

Acromioclavicular ligament: acormion to lateral boder of clavicle, there are two coracoclavicular ligaments: conoid (in front) and trapezoid (behind) - allows easy reduction of outer end of clavicle, but inclination of surfaces means that this can be hard to stay reduced

Rotator cuff: muscles whose tendons have a sheath surrounding most of the joint (apart from the inferior aspect)

Supraspinatous, infraspinatous, teres minor - inserts into the greater tuberosity; subscapularis inserts into the lesser tuberosity

Supraspinatous - beneath the acromion and coracoacromial ligament - separated from these by the subacromial bursa

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16
Q

Abduction of the shoulder

A

Supraspinatous - 15 degrees

Deltoid - 90 degrees

Rotation of scapula by trapezius and serratus anterior - 180 degrees

Any movement of the shoulder causes reciprocal movement at the sternoclavicular joint

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17
Q

Muscles to protract and retract the scapula

A

Protract: pectoralis minor, serratus anterior

Retract: rhomboids, middle fibres of trapezius

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18
Q

Location of the bones after clavicle fracture

A

Lateral end of clavicle - depressed and moved medial - due to shoulder adductors

Modial end of clavicle - raised due to sternocleidomastoid

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19
Q

Serratus anterior supply

A

Long throacic nerve of bell; C5,6,7

Damage causes winging of the scapula

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20
Q

Joints at the elbow

A

Humeroulnar joint - trachlea of humerus with the trochlea notch of ulna (hinge joint)

Humeroradial joint: capitulum and radial head (ball and socket joint)

Proximal radioulanr joint: head of radius and radial notch of ulna (pivot joint)

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21
Q

Capsule of the elbow joint

A

Lax and thin anterior and posteriorly

Laterallly: thickened to form the lateral and medial collateral ligaments

Lateral ligament is atttached to the annular ligament which holds the head of the radius in place; forms the start of the supinator muscle

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22
Q

Movement of the elbow joint

A

Flexion / extension

pronation and supination at the proximal radioulnar joint

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23
Q

Muscles around the elbow joint

A

Flexors: biceps, brachialis, brachioradialis, forearm flexors

Extensors: triceps, ancones

Pronation: pronator teres, pronator quadratus

Supination: supinator, biceps

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24
Q

Articular surfaces of the wrist

A

Distal radus, and head of the ulnar (which has an articular disc - triangular fibrocartilage)

Proximal articulations with the scaphoid, lunate, triquetrum

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25
Q

Wrist type of joint

A

Condyloid joint: can flex, extend, adduct, abduct and circumduct

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26
Q

Movements of the wrist

D

A

Flexion: all anterior muscles of the aforwarm - at both midcarpal and radiocarpal joint

Extension:all posterior compartment mescles

Adduction: flexor and extensor carpi ulnaris, - mainly at the mid carpal joint

Abduction: flexor carpi radialis, extensor carpi radialis longus, adductor policis longus, extensor policis longus

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27
Q

Joints of the hand

A

Carpo-metacarpal joints - all except thumb have limited gliding movement

thumb is a saddle joint: has flexion/extension (plane of palm), adduction/abduction (right angle of palm), opposition of little finger

Metacarpo-phalangeal joints

Thumb - flexes to 60 degrees, fingers - 90 degrees

Abduction, adduction and circumduction in fingers only, not possible when fully flexed

Deep transverse ligaments stop fingers from spreading out during firm grip

Interphalangeal joints

Hing only- flexion, extension,

collateral ligaments lax in extension, taut in flexion

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28
Q

Muscles controlling the hand

A

Long flexors - FDP; FDS

Long extensors - EDL + EDI / EDM

Extensor expansion - covers proximal phalanx, base of middle phalanx, and two lateral slips into distal phalanx - consists of EDL, interossei, lumbricals

Small muscles of hand - interossei, lumbricals

Muscles of the thumb - FPL, EPL, EPB, APL

Muscles of little finger - ADM, FDM, ODM

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29
Q

Long flexors of the hand

A

Flexor digitorum superficialis - attaches to sides of middle phalanx; flexes middle phalanx

Flexor digitorum profundus - gives off lumbricals; attaches to base of distal phalanx; pierces FDS under the proximal phalanx; flexes distal phalamx

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30
Q

Long extensors of the hand

A

Extensor digitorum longus - inserts into the extensor expansion - on the dorsum of the phlanaxes

Extensor indicis - medial side of EDL to the index finger (extensor expansion) - originates from the posterior surface of ulna and interosseus membrane

Extensor digiti minimi - medial side of EDL to the little finger - originates from lateral epicondyle

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31
Q

Where does the extensor expansion for the fingers sit?

A

Covers the proximal phalanx

Inserts into the base of the middle phalanx

Provides two slips to insert into the base of the distal phalanx

Receives insertion of the interossei and lumbricals

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32
Q

Interossei

Where they arise?

Insert?

Innervation?

Action?

A

From the sides and front of the metacarpals

Into the extensor expansion

Deep branch of the ulnar nerve

Abduct / adduct the fingers + flex the MCP, extend the IPJ

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33
Q

Lumbricals

Originate

Insert

Innervation

Action

A

Arise from FDP tendons

Insert into the extensor expansion

Lateral two - median nerve, medial two- ulnar nerve

Flex the MCP, extend the IPJ

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34
Q

Muscles of the thumb

Long muscles

Thenar muscles

Hypothenar muscles

A

Long muscles

Flexor pollicis longus - into distal phalanx

Extensor pollicis longus - into distal phalanx

Extensor pollicis brevis - into proximal phalanx

Abductor pollicis longus - into the first metacarpal

Thenar muscles

Adductor pollicis - base of proximal phalanx

Flexor pollicis brevis - base of proximal phalanx

Abductor pollicis brevis - base of proximal phalanx

Opponens policis - along the first metacarpal

Hypothenar muscles

Abductor digiti minimi

Flexor digiti minimi

Opponens digiti minimi

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35
Q

Abduction and adduction of the fingers - muscles in addition to the intrinsic hand muscles

A

Entensor digitorum longus - weak abduction

Long flexors (FDP, FDS) - weak adduction

Can be eliminated by placing the hand flat on the table

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36
Q

Collateral ligaments of the wrist

A

Radial collateral ligament: radial styloid to scaphoid, trapezium

U;nar collateral ligament: ulnar styloid to triquetral, pisiform

37
Q

AP ligaments in wrist

A

Strong, part of the capsule - Radiocarpal ligaments - dorsal / palmar

38
Q

Muscles of elbow flexors and extensors

A

Brachialis - anterior surface of humerus to ulnar tuberosity

Biceps brachii - in front of brachilais - two heads - long attaches to supraglenoid tubercle, short head to the coracoid process (merges with the coracobrachialis tendon), inseerts on the radial tuberosity with another branch fanning out to form the bicipital aponeurosis - whicg merges with the deep fascia of the forearm

Brachoradialis - from just below the deltoid tuberosity on the humerus, to the distal radius

Extensor - only triceps - long head (arising from the infraglenoid tubercle); lateral head from the lateral side of posterior humerus; medial from the medial side and more of the posterior humerus; three heads converge to form a tendon attaching to the olecranon

Anconeus - smaller - running from lateral epicondyle to the lateral aspect of proximal ulna

Radial nerve runs inbetween the medial and lateral humerus

39
Q

Rotation of the forearm

Pronation

Supination

A

Pronator teres- originates from medial epicondyle (smaller head from proximal ulna) - inserts into the lateral aspect of radius, about halfway down - median nerve travels in between the two heads

Pronator quadratus- on the distal forearm - originates on the anteromedial aspect of ulna - attaches to anterior aspect of radius

Supinator- arises from lateral epicondyle, annular ligament, supinator crest and inserts into ulnar - just above the insertion of pronator teres

Biceps- onto radial tuberosity

40
Q

Muscles of the wirst - flexion

A

Flexors

Common flexor tendon - gives of flexor carpi ulnaris + flexor carpi radialis from the medial epicondule - together they flex - individually one side deviation

FCU - has another head arising from the ulna - between which the ulnar nerve travels - they form a tendon which inserts into the pisiform - this is transmitted onto the base of the 5th metacarpal through the piso-hamate and piso-metacarpal ligaments.

FCR - inserts into the base of the 2nd metacarpal - passing through a deep ligamentous tunnel near the carpal bones

Palmaris longus - from medial epicondyle - through the carpal tunnel inserts into the deep palmar fascia fanning out; it is frequent absent

41
Q

Muscles of the wrist - extension

A

extensor carpi radialis longus and brevis - originates from the common extensor tendon; longus - lateral epicondylar ridge; brevis - lateral epicondyle; insert into the 2nd and 3rd metacarpal base

extensor carpi ulnaris - from the medial surface of ulna; insert into the 5th metacarpal base

Pass under the extensor retinaculum

42
Q

Superficial veins of the upper limbs

A

Starts on the dorsal venous network of the hand - then drains into the lateral cephalic and dorsal basilic

Cephalic vein on the anterolateral aspect of the arm - stays superficial; runs in the groove along the lateral border of biceps - near the top its between the deltoid and pectoralis major (deltopectoral triangle); pierces the clavipectoral fascia to then enter the axillary vein

Median cubital vein - joins cephalic to basilic

Basilic vein runs along the posterior aspect - then becomes anteiror at the elbow - runs in the medial groove of the biceps. Brachial vein joins basilic vein (the venae comitantes of the brachial artery)and eventually forms the axillary vein - above it are the median nerve and axillary artery - disappears behind pec minor

43
Q

Deep veins of the upper limb

A

Also known as venae comitantes, they follow the arteries

Ulnar and radial veins - drain to form the brachial vein at the elbow

Brachial joins with the basilic vein = forms the axillary vein - at the inferior border of teres major

Axillary vein terminal part is joined by the cephalic vein = subclavian vein when it crosses the first rib lateral border

44
Q

At the elbow what separates the veins from the arteries?

A

The bicipital aponeurosis

45
Q

Why is cephalic vein good for diaplysis?

A

Fairly constant location and in close proximity to the radial artery for a radiocephalic fistula

46
Q

Axillary artery

Start to finish

Branches and parts

Relations

A

Subclavian into axillary – at the lateral border of first rib

Axillary into brachial at the inferior border of teres major

Branches made by pec major

1st part - 1 branch

Superior thoracic artery

2nd part - 2 branches

acromiothoracic artery

lateral thoracic artery

3rd part - 3 branches

subscapular artery

anterior circumflex humeral artery

posterior circumflex humeral artery

Relations: cords of brachial plexus - lateral, posterior, medial surround it

47
Q

Brachial artery

Start to finish

Where does it lie and what crosses it?

A

Lower border of teres major until the neck of the radius

Lies below the deep fascia (easily accessible) and crossed by median nerve from lateral to medial at the level of mid humerus

Gives off a profunda brachii branch immediately below the border of teres major - travelling to the posterior aspect of the humerus in between the long and lateral heads of the triceps

48
Q

Radial artery

A

Superficial - starts at the level of the radial neck

Overlapped by brachioradialis in its upper half

Can be palpated in between braachioradialis and flexor carpi radialis

Travels deep to APL and EPB to enter the anatomical snuff box

Distal to the wrist - gives branches for superficial palmar arch

Pierces through first dorsal interosseus and adductor policis = deep palmar arch

49
Q

Ulnar artery

A

Travels deeper than radial

lies on FDP - overlapped by FCU

Crossed supreficially by median nerve with pronator teres (deep head) in between

Can be palpated when superficial between FDP and FCU in the distal forearm

Crosses in front of the flexor retinaculum to become the superficial palmar arch (with the radial artery)

Accompanied by the ulnar nerve in the distal two thirds of the forearm and across the flexor retinaculum

50
Q

Brachial Plexus

A

Roman Togas Dont Cover Balls

Roots: C5, C6, C7, C8, T1

Trunks: Superior (C5 + C6), Middle (C7), Inferior (C8 + T1)

Divisions: each trunk divides into anterior and posterior

Cords: Posterior (from all the posterior divisions); lateral (anterior division of superior and middle trunks); medial (anterior division of lower trunk)

Branches: Lateral cord - musculocutaneous; posterior cord - radial and axillary (only C5,6); medial cord - ulnar; lateral + medial cord - median

Additional nerves:

Medial cord - 3M’s = medial antebrachial cutaneous, medial brachial cutaeous, medial pectoral

Posterior cord - LMU - lower middle upper subscapular nerve (middle also known as thoracodorsal nerve)

Lateral cord = lateral pectoral

Superior trunk = 3S’s = suprascapular (supplies supraspinatus/infraspinatus), subclavius, dorsal scapular (from C5 only - supplies rhomboids)

C5,6,7 = long throacic nerve of Bell

51
Q

Key facts about axillary nerve

A

C5,C6

Motor - deltoid, teres minor (cant abduct if damaged)

Sensory - skin over deltoid

Wound around the surgical neck of the humerus

52
Q

Key facts about radial nerve

A

Arises behind axillary artery, then acoompanies profuda brachii to the posterior compartment - lies in the spiral groove - between the long and medial head of the triceps

Enters anterior compartment by piercing the intermuscular septum

At lateral epicondyle gives off posterior interosseos branch - this supplies supinator, adductor pollicis longus and all extensor muscles except ECR-L

Continues superficially under brachioradialis, emerges posteriorly and provides sensation to radial 3,5 digits posteriorly

Motor innervation of triceps, anconeus, brachioradialis, ECR-L

53
Q

Key facts about musculocutaneous nerve

A

Arises from C5,6,7

Pierces coracobrachialis - runs between biceps and brachialis

Motor innervation - biceps, brachialis, coracobrachialis

Sensory innervation - lateral aspect of forearm

54
Q

Key facts about the median nerve

A

From C6,7,8,T1

Anterior to the axillary artery, crosses brachial artery to become medial at the midhumerus

Enters forearm between the heads of pronator teres - gives off anterior interosseous branch here

Lies on the deep aspect of FDS

gives off palmar cutaneous branch - supplies palmar skin over thenar eminence - does not travel in the carpal tunnel

Median nerve supplies muscles of the forearm, lateral FDP, lateral lumbricals, OAF of thenar eminence

Sensory to lateral 3.5 on the palmar surface

55
Q

Key facts about the ulnar nerve

A

Formed from C7,8,T1

Medial to axillary and brachial artery until midhumerus

then pierces the intermuscular septum to lie on the anterior surface of the triceps

Passess behind the medial epicondyle

Descends between FCU and FDP - lying to the radial side of the tendon of FCU superficially

Gives of dorsal cutaneous branch - sensation for the dorsal aspect of ulnar 1.5 fingers

Motor to the interosseous muscles, medial lumbricals, FCU, FDP medially, adductor policis, hypothenar muscles

56
Q

Erb’s palsy

A

Upper roots damaged - C5,C6

Nerves to deltoid, supraspinatus, infraspinatus (abduction)

Nerves to biceps, brachialis (supination)

Can be from forced downward traction during birth, falling on side of head and shoulder - pushing the two apart

Leaves arm adducted, pronated and palm facing backwards

57
Q

Klumpke’s paralysis

A

Lower nerve roots damaged

Forced upward traction during breech delivery / fall and holding onto something

Intrinsic hand muscle paralysed - claw hand to due to unopposed long flexors and extensors (long flexors flex the IP joints, long extensors extend the MCP - intrinsic muscles entend the IP)

Loss of sensation on the inner and upper arm and forearm

Wasting of small muscles - channels form; horner’s syndome can occur due to proximity to sympathetic chain

Can also occur in pancoast tumour / cervical rib

58
Q

Axillary nerve

A

Damaged during fracture of surgical neck of the humerus / anterior dislocation of the shoulder joint

Cannot abduct and sensory deficit over the regimental area

59
Q

Radial nerve damage

A

Fracture of the shaft of the humerus

or Saturday night palsy - lying arm over a chair and compression of the nerve between the chair and the humerus

Causes wrist drop if main radial nerve is damaged

If only posterior interossesous nerve is damaged then no wristdrop as EPL supplied by main radial nerve

Sensory loss in the first web space of the dorsum of the hand

60
Q

Median nerve damage

A

Usually at the wrist or a supracondular fracture

At the elbow:

  • loss of pronation
  • weakness of flexion with ulnar deviation (as now depends of FCU and medial FDP only)
  • loss of sensation of radial 3.5 digits

At the wrist

  • paralysis of thenar muscles - except adductor policis
  • paralysis of lumbricals - lateral two
  • loss of sensastion of radial 3.5 digits

Damage at both placesL

  • loss of accurate opposition
  • loss of tactile response / cutaneous sensation = risk of serios injury
61
Q

Ulnar nerve damage

A

Fracture at the medial epicondyle / dislocation of the elbow

Laceration at the wrist

At the wrist:

  • clawing of the hand - less clawing in 2 and 3 due to supply from median nerve
  • sensory loss over medial 1.5 fingers

At the elbow

  • clawing of the hand - less clawing than the wrist at 4 and 5 due to damage to medial FDP

To diagnose - test sensation in medial 1.5 digits + loss of abduction and adduction in digits with hand flat on table

62
Q

Difference between claw hand and hand of benediction

A
63
Q

Pulp space of fingers

What is it?

Result?

A

Fat packed between fibrous septa around the distal phalanx between the skin and the periosteum

The digital artery has branches that go through the pulp space (except for the branch that goes to the base of the distal phalanx)

Important because pulp space infection = increased pressure = arterial thrombosis and necrosis of the distal phalanx but sparing of the base

64
Q

Bursa and sheaths of the hand

A

Flexor tendons travel in fibro-osseous tunnels - flexor sheaths surrounded by synovial membrane (synovial sheaths)

For 2,3,4 fingers - stops at the base of the metacarpal

For little finger - continues onto the the palmar surface forming a sheath that encloses all flexor tendons (except the thumb) - forming the ulnar bursa

The thumb sheath (for FPL) - extends donwards through the flexor retinaculum to 2.5cm below - forming the radial bursa

Ulnar and radial bursa may communicate

Important as infection within 2,3,4 sheaths is confined, whilst elsewhere can spread through the bursa and between each other

65
Q

What is the mid palmar space?

A

Behind the sheath, bursa and flexor tendons, in fornt of 3,4,5 metacarpals

Does not extend to 1,2 metacarpal as the adductor policis tendon arises from the shaft of the 3rd metacarpal

66
Q

What is the thenar space?

A

Space in front of the the 2nd and 3rd metacarpals and adductor policis, away from the mid palmar space by a fibrous partition

Infection in this space - either from direct penetrating injury / neglected tendon sheath infection

Palmar infections = marked dorsal oedema - cant accumulate in palmar aspect as thick skin joined heavily by palmar aponeurosis - on the dorsum skin is loose and fluid can collected easily deep to it

67
Q

Palmar aponeurosis

A

Part of the deep fascia of the hand - blends with the fibrous sheath of the fingers

attached to the sides of the proximal and middle phalanges

Dupuytrens contractures - thickening and contraction of the palmar fascia causing flexion of PIP and MCP

68
Q

Carpal tunnel bones

Flexor retinaculum - other compartments

Extensor retinaculum attachments

A

Hook of the hamate + pisiform

Crest of the trapezium and scaphoid tubercle

Radial side - encompasses FCR

Ulnar side - ulnar artery and nerve

From the ridge on the radius to the ulnar styloid, triquetral, hamate

69
Q

MCP joint - capsule

A

Capsule surrounds the MCP

Lax on the dorsum - to allow flexion

Thickend palmar ligament at the front - moves with flexion

Also attached are the collatera ligaments - run obliquely from the back of the proximal phalanx to the the head of the distal MC - taut when flexed, lax when extended = allow side to side movement when extended but not flexed

Deep transverse metacarpal ligament attached to the top - joining all for MCPs

70
Q

IP Joints - collateral ligaments

A

Equally taut in flexion and extension - so prevent side to side movement

71
Q

Borders and contents of the axilla

A

Base: skin and fascia of the armpit

Medial: rib cage covered by serratus anterior

Lateral: bicipital groove of the humerus

Anterior: pec major and minor

Posterior: latissimus dorsi, teres major, subscapularis

Apex bounded anteriorly by clavicle, first rib medially, acromion and superior border of scapula posteriorly

72
Q

Contents of the axilla

A

Brachial plexus

Axillary artery

Axillary vein

lymph nodes

fat

73
Q

Antecubital fossa relations and contents

A

Medially - pronator teres

Laterally - brachioradialis

Inferiorly - brachialis + supinator

Superiorly - skin + superficial fascia + deep fascia of bicipital aponeurosis

Contents: brachial artery and median nerve (medially)

74
Q

Carpal tunnel relations and contents

A

Scaphoid tubercle + crest of the trapezium

Hook of the hamate and pisiform

FDS + FDP + FPL + median nerve

+ FCR (runs in its own osseo-fascial compartment)

Superficial palmar branch of median nerve - innervates the palmar aspect of thenar eminence - not affected in carpal tunnel syndrome

75
Q

Anatomical snuffbox contents and relations

A

Medial border - extensor pollicis longus

Lateral border - extensor pollicis brevis + abductor pollicis longus

Contents - base of thumb metacarpal, trapezium, scaphoid, radial styloid, dorsal branch of the radial artery (close proximity to cephalic vein = good for fistula)

76
Q

Structures around the wrist

A

See image

77
Q

Axillary lymph nodes

A

5 groups

Apical (all drain into here) - immediately behind clavicle at the apex of axilla above pec minor, along axillary vein

“Medial” - deep to pec major along border of pec minor

Lateral - along axillary vein

Central - in the axillary fat

Posterior - along subscapular vessels

From these the subclavian lymph trunk forms

78
Q

Leves of axillary lymph nodes

A

Level 1 - below and lateral to the inferolateral border of pec minor

Level 2 - behind pec minor

Level 3 - above the upper border of pec minor

79
Q

Dermatomes in the arm

A

C5 lateral

C6 index

C7 middle

C8 medial

T1 upper inner aspect of arm

80
Q

Cutaneuous nerve suply of the hand

A

Anterior:

Medial 3.5 fingers

Ulnar 1.5 fingers

Posterior

Radial 1.5 fingers

Ulnar 2.5 fingers

Fingertips of 2.5 fingers + thumb = median

81
Q

Cutaenous nerve of the arm

A

Anterior

Supraclavicular

Upper and lower lateral nerve of the arm

Intercostobrachial nerve

Medial and lateral cutaneous nerve of the forearm

Posterior

Supraclavicular

Posterior cutaenous nerve of the arm

Medial cutaneous nerve of the arm

Posterior cutaneous nerve of the forearm

Medial and lateral cutaneous nerve of the forearm

82
Q

Composition of the female breast

Glands in the areola

A

Fat, fibrous tissue, glandular tissue

15-20 lobules of glandular tissue - separated by fibrous septa (goes from subcutaneous tissue to the fascia of the chest wall - known as ligaments of Astley Cooper)

Each drains into a lactiferous duct - converges at the nipple - lactiferous sinus

Areola - lubricated by glands of montgomery - large modified sebaceous glands

83
Q

Blood supply of the breast

A

Axillary artery via lateral thoracic and acromiothoracic branches

Internal mammary (thoracic) artery via its perforating arteries

Intercostal arteries - via lateral perforators

Venous system corresponds to the arteries

84
Q

Lymphatic drainage of the breast

A

Laterally via the axillary vessels to the axillary lymph nodes

Medially via the internal mammary vessels to the internal mammary chain

85
Q

Male breast

A

Rudimentary

Small primitive ducts may be present, supported by fat and fibrous tissue

At risk of carcinoma

86
Q

Where can breast malignanyc spread via lymphatics?

A

Lymphatic of the contralateral breast

Contralateral axillary lymph nodes

Cervical nodes

Inguinal nodes

87
Q

What is a glactocoele?

A

Blocked lactiferous duct during lactation

88
Q

Montogomery’s tubercles?

A

Dilatation of montogomery’s glands during pregnancy

89
Q

Dimpling of the skin over a breast: cause and pathophysiology

A

Due to contraction of ligaments of Astley-Cooper - due to malignant infiltration by carcinoma

Can also cause nipple inversion

mr C.S. (4 decks)

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