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Anatomy (The Upper Limb and Breast) Flashcards

1
Q

Joining of bones of pectoral girdle

A

Acromioclavicular joint
(incomplete articular disc in joint)

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2
Q

Some unique points about clavicle

A

• It has no medullary cavity.
• It is the first bone to ossify in the fetus.
• It is the only long bone to develop in membrane.
• It may be pierced by the supraclavicular nerves.
• It transmits forces from the upper limb to the axial skeleton.
• It acts as a strut to hold the arm free from the trunk.
• It is the most commonly fractured bone in the body, the fracture usually occurring at the junction of the middle and outer thirds.

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3
Q

Anatomical neck vs surgical neck of humerus

A

• The HEAD is separated from the greater and lesser TUBERCLES by the anatomical neck.
• The upper END and SHAFT meet at the surgical neck,around which lies the axillary nerve and circumflex humeral vessels.

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4
Q

Proximal carpal row

A

lateral to medial—scaphoid, lunate, triqu-
etral (plus ATTACHED pisiform).

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5
Q

Attachment of flexor retinaculum

A

From the scaphoid and trapezium laterally to the pisiform and hook of the hamate medially
Carpus Arch is also maintained by the flexor retinaculum, together with shape of individual bones.

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6
Q

Proximal articulation of second metacarpal bone

A

• Second metacarpal articulates with three carpal bones:trapezium,trapezoid,capitate.

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7
Q

Distal articulation of capitate

A

• Capitate articulates with three metacarpals: second,third and fourth.

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8
Q

Origin and insertion of rotator cuff muscles

A

Scapulal dial surface, central surface and lateral border>Humeral greater & lesser tuberosity

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9
Q

What is boxer’s muscle

A

Serratus anterior
because it’s responsible for the protraction of the shoulder blade, which is a movement used when throwing a punch.

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10
Q

How does the serratus anterior abduct the shoulder joint above 90°?

A

By rotation of the scapula upwards by C567

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11
Q

What is Supraspinatus tendinitis

A

• Supraspinatus tendinitis results in a painful arc of shoulder movement between 60° and 120°. It is during this range of movement that the tendon IMPINGES against the overlying acromion and coracoacromial ligament.

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12
Q

Elbow Joint composition

A

Consists of three articulations and ONE synovial cavity.hinge+ball and
socket+pivot

The medial and lateral epicondyles are extracapsular.

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13
Q

What is breastbone)

A

Sternum

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14
Q

Types of synovial joints according to shape of bones and movement

A

*Ball and socket joint
Allows for the GREATEST RANGE of movement, with a ball-shaped structure fitting into a cup-like socket.
*Hinge joint
Allows for flexion and extension in one plane, similar to a DOORS opening and closing
* Pivot joint
Allows for bone ROTATION around another bone, such as the joint between the first and second vertebrae in the neck,
radioulnar joints
*Condyloid joint
This joint is shaped like a condyle that fits into an elliptical cavity. Condyloid joints allow for movement in TWO planes, but without rotation. The knuckles and the joints at the base of the fingers are examples of condyloid joints.
*Saddle joint
This joint is shaped like a saddle, with one bone resting on top of the other like a rider on a horse. Saddle joints allow for movement in ALL directions EXCEPT axial rotation. The joint at the base of the thumb is an example of a saddle joint.
*Gliding joint
Allows for limited movement, such as the wrist joints, where smooth surfaces SLIP over one another

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15
Q

Location of deep transverse ligaments of hand

A

• Metacarpophalangeal joints of fingers (not thumb) are joined by deep transverse ligaments which prevent them spreading during a firm grip.

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16
Q

Function of interossei

A

PAD (1 into ulnar 2,3 into radial side)
DAB (1,2 into radial 3,4 into ulnar side)
Flex the metacarpophalangeal joints.
Extend the interphalangeal joints.

*Middle metacarpal and phalanx have no palmer interossei
*DORSAL interossei have DOUBLE belly

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17
Q

Insertion of thenar muscles

A

All but opponens(metacarpal) into bar of proximal phalanx

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18
Q

WEAK adductor and abductor of metacarpophalangeal joints and when they work

A

• The long flexors have a weak adduction action.
• Extensor digitorum has a weak abduction action.
• The abductor/adductor actions of extensor digitorum and the long flexors are eliminated by placing the hand flat on a table. Abduction/adduction then become the actions of the intrinsic muscles only.
• The above can be tested by gripping a card between the fingers (tests T1 and partly ulnar nerve integrity).

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19
Q

Fascia pierced but cephalosporin vein

A

Pierces the clavipectoral fascia to enter the axillary vein.

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20
Q

Deltopectoral/Clavipectoral triangle with importance

A

The clavipectoral triangle (also known as the deltopectoral triangle) is an anatomical region found in humans and other animals. It is bordered by the following structures:

Clavicle (superiorly)
Lateral border of Pectoralis Major(medially)
Medial border of Deltoid muscle (laterally)

Importance
#It contains the CEPHALIC vein(it is superficial until it reaches the deltopectoral triangle) and deltopectoral FASCIA, which is a layer of deep fascia that invests the three structures that make up the border of the triangle. The deltoid branch of the THORACOACROMIAL artery also passes through this triangle, giving branches to both the deltoid and pectoralis major muscles.
The subclavian VEIN and the subclavian ARTERY may be ACCESSED via this triangle, as they are deep to it.

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21
Q

Formation of axillary vein

A

*Basilic vein joins venae comitantes of brachial artery, eventually forming the axillary vein.
The venae comitantes(accompanying) of the brachial artery are the brachial veins, which are a pair of deep veins that run alongside the brachial artery in the arm

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22
Q

What is Cimino–Brescia fistulae

A

radiocephalic fistulae for dialysis

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23
Q

Some points of axillary artery

A

*lateral border of the first rib
*lower border of teres major
*by pectoralis minor(1st>1,2nd>2,3rd>3)
*cords surround

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24
Q

Relation of brachial artery and median nerve

A

•Artery is crossed superficially from the lateral to medial side by the median nerve at the level of the MIDHUMERUS.
*nerve guards artery

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25
Where the radial artery is palpated at the wrist.
#In the distal forearm it lies between brachioradialis and flexor carpi radialis #Passes deep to tendons of abductor pollicis longus and extensor pollicis brevis to enter the anatomical snuffbox where it is palpable.
26
Termination of radial artery
• Pierces first dorsal interosseous and adductor pollicis to contribute to deep palmar arch.
27
Point of palpation of ulnar artery
• Lies on flexor digitorum profundus, overlapped by flexor carpi ulnaris • Distally in the forearm it becomes superficial between the tendons of the flexor carpi ulnaris and flexor digitorum profundus.
28
Termination of ulnar artery
• Crosses in front of the flexor retinaculum to form the superficial palmar arch with the superficial branch of the radial artery
29
Relation of median nerve with ulnar artery
Ulnar artery if crossed superficially by the median nerve separated from it by the deep head of pronator teres.
30
Which part of brachial plexus is related to scalenus muscle
Roots: between scalenus anterior and scalenus medius
31
What part of the brachial plexus is in posterior triangle
Trunks: in the posterior triangle of the neck.
32
Point of division of trunk of branch plexus
Behind clavicle into anterior and posterior
33
Location of chords of brachial plexus
in the axilla.
34
What part of nerve forms root of brachial plexus
Anterior primary rami of C5, 6, 7, 8, T1.
35
Area of supply of dual scapular nerve C5 of brachial plexus
Levator scapulae Rhomboid minor Rhomboid major
36
Difference among nerves Dorsal scapular Long thoracic Thoracodorsal
C5>Dorsal S.>Levator S.Rhomboid Mj.&Mi. C567>Long T.>Serratus A. Posterior cord>Thoraco D.>Latissimus D.
37
Root value of axillary nerve with muscular branch
C5, 6. Muscular branches to deltoid, teres minor.
38
Root value of radial nerve , accompanied artery in arm . Muscle supplied
•C5, 6, 7, 8, T1 • Accompanied by profunda brachii artery. • Main radial nerve supplies triceps, anconeus, brachioradialis, extensor carpi radialis longus and PART of BRACHIALIS. • Posterior interosseous branch supplies supinator, abductor pollicis longus and all remaining extensor muscle.
39
Root of musculocutaneous nerve, supplied muscles
C5, 6, 7. • Pierces coracobrachialis and runs between biceps and brachialis & SUPPLIES them
40
Root of median nerve, entrance point into forearm , supplied muscles
C6, 7, 8, T1. • Enters the forearm between the heads of pronator teres. • Supplies in its course all muscles of the flexor aspect of the forearm (except flexor carpi ulnaris and the ulnar half of flexor digitorum profundus), the muscles of the thenar eminence and the radial two lumbricals.
41
Root of ulnar nerve, point of palpability, relation with flexor retinaculum
C7, 8, T1. •It is palpable behind the medial epicondyle • Crosses the flexor retinaculum superficially within it's own canal called Guyon's canal #Ulnar tunnel syndrome, also known as Guyon's canal syndrome or Handlebar palsy, is ulnar neuropathy at the wrist where it passes through the ulnar tunnel (Guyon's canal). The most common presentation is a palsy of the deep motor branch of the ulnar nerve causing weakness of the interosseous muscles. Ulnar tunnel syndrome is usually caused by a ganglion cyst pressing on the ulnar nerve, other causes include traumas to the wrist and repetitive movements like long distance bicycle rides are associated with transient alterations in ulnar nerve function.But often the cause is unknown (idiopathic). Sensory loss in the ring and small fingers is usually due to ulnar nerve entrapment at the cubital tunnel near the elbow, which is known as cubital tunnel syndrome, although it can uncommonly be due to compression at the wrist.
42
cubital tunnel syndrome
Chronic compression of the ulnar nerve in the cubital tunnel is known as cubital tunnel syndrome.There are several sites of possible compression, traction or friction of the ulnar nerve as it courses behind the elbow.It may also be caused by repetitive strain from the use of a cell phone for example manifested SENSORY loss in the ring and small fingers. The cubital tunnel is bordered medially by the medial epicondyle of the humerus, laterally by the olecranon process of the ulna and the tendinous arch joining the humeral and ulnar heads of the flexor carpi ulnaris.The roof of the cubital tunnel is elastic and formed by a myofascial trilaminar retinaculum (also known as the epicondyloolecranon ligament or Osborne band)
43
cubital tunnel syndrome
Chronic compression of the ulnar nerve in the cubital tunnel is known as cubital tunnel syndrome.There are several sites of possible compression, traction or friction of the ulnar nerve as it courses behind the elbow.It may also be caused by repetitive strain from the use of a cell phone for example The cubital tunnel is bordered medially by the medial epicondyle of the humerus, laterally by the olecranon process of the ulna and the tendinous arch joining the humeral and ulnar heads of the flexor carpi ulnaris.The roof of the cubital tunnel is elastic and formed by a myofascial trilaminar retinaculum (also known as the epicondyloolecranon ligament or Osborne band)
44
What is Erb’s (Erb–Duchenne) Paralysis
Root C5, C6 affected. •Forced downward traction on arm during birth.,Fall on side of head and shoulder, forcing the two apart. • Paralysis of deltoid, supraspinatus, infraspinatus, brachialis, biceps. Resulting in WAITER'S tip position
45
What is Klumpke’s paralysis
damage T1 (Wasting) Resulting in Claw hand due to unopposed action of long flexors and long extensors • Associated area of numbness along inner and upper arm and forearm CENTRED on elbow JOINT level. Area of T1 dermatome • Upward traction on arm breech delivery,Pancoast’s tumour,a cervical rib. • Intrinsic muscles of hand paralysed, wasted resulting inClaw hand due to unopposed action of long flexors and long extensors • May be associated with Horner’s syndrome due to traction on sympathetic chain(miosis,anhydrosis,ptosis?
46
Nerve injured in ‘Saturday night palsy’
trapping the RADIAL nerve between the chair and the humerus other than that fractures of midshaft of humerus
47
Which nerve injury will of wrist drop
wrist drop if the main RADIAL nerve is damaged (due to extensor carpi radialis longus, which is supplied by the main radial nerve before the posterior interosseous branch is given off which may be damaged in fractures or dislocations of the radial head or in the surgical approach to the radial head.
48
Area of sensory loss in radial nerve injury
Small area of anaesthesia on the skin on dorsum of first web space.
49
Mode of injury of axillary nerve
Damaged in fracture of surgical neck of humerus or anterior dislocation of the shoulder joint.
50
Pulp Spaces of Fingers with importance
•Pulp space is fat packed between fibrous septa from skin to periosteum. • Blood vessels have to pass through this space, EXCEPT the PROXIMAL branch to the base of the distal phalanx. • Pulp space INFECTION increases the pressure in the space.This may result in arterial thrombosis and necrosis of the DISTAL phalanx with the exception of its base, which is SPARED because of the proximal branch.
51
Spreading of infection of the synovial sheath
• Infection of the synovial sheath to the second, third and fourth digits is confined to the finger, because 234 sheaths close proximally at the metacarpal head. #However, infection of the first and fifth sheaths may spread into the palm or from one bursa to another. •Because synovial sheath of the thumb EXTENDS 2.5 cm proximal to wrist (radial bursa) AND synovial sheath of fifth finger FORMS the ulnar bursa. Ulnar bursa encloses all finger tendons in the palm and extends proximally deep to the flexor retinaculum for 2.5 cm above the wrist.
52
Which fascia is involved in Dupuytren’s contracture
results in thickening and contraction of the PALMAR fascia with flexion of the metacarpophalangeal joints and proximal interphalangeal joints. The distal interphalangeal joint is not involved.
53
Lateral wall of axilla
bicipital groove of the humerus.
54
Content of Antecubital Fossa
brachial artery and medial to it, the median nerve.
55
Effect is carpal tunnel syndrome on sensory function
• The superficial palmar branch of the nerve is given off proximal to the flexor retinaculum, and therefore there is no sensory impairment on the lateral side of the palm if the nerve is compressed in the carpal tunnel.
56
Location of LYMPHATICS OF THE UPPER LIMB
• Superficial and deep lymphatics. Superficial lymphatics accompany the veins and the deep lymphatics accompany the arteries
57
Location of axillary lymph node
five groups •Anterior lying deep to pectoralis major along the lower border of pectoralis minor • posterior: along the subscapular vessels • lateral: along the axillary vein • central: in the axillary fat • apical: immediately behind the clavicle at the apex of the axilla above pectoralis minor, and arranged along the axillary vein (ALL other axillary nodes drain THROUGH this group). • From these nodes the subclavian lymph TRUCK emerges.
58
Surgical anatomy of the axillary lymph nodes
• Surgical anatomy of the axillary lymph nodes is important in relation to breast surgery. From this point of view they are classified into three levels: • level 1 nodes: present below and lateral to the inferolateral border of pectoralis minor • level 2 nodes: behind pectoralis minor • level 3 nodes: above the upper border of pectoralis minor.
59
Surgical anatomy of the axillary lymph nodes
• Surgical anatomy of the axillary lymph nodes is important in relation to breast surgery. From this point of view they are classified into three levels: MINOR ^ • level 1 nodes: present below and lateral to the inferolateral border of pectoralis minor • level 2 nodes: behind pectoralis minor • level 3 nodes: above the upper border of pectoralis minor.
60
What type of gland is breast
fibrofattyglandular
61
What is ligaments of Astley Cooper with importance
•Breast lobules are separated by fibrous SEPTA running from the subcutaneous tissues to the fascia of the chest wall • Dimpling of the skin over a carcinoma of the breast is the result of malignant INFILTRATION and CONTRACTION of Astley Cooper’s ligaments.
62
Type of Montgomery gland and function
large modified sebaceous glands. areola is lubricated by the glands
63
What is galactocele?
A blocked lactiferous duct may become dilated during lactation to form a galactocele.
64
What is galactocele?
A blocked lactiferous duct may become dilated during lactation to form a galactocele.
65
Importance of nipple inversion
• The nipple may fail to evert and it is important to know if this has been present since birth or is a recent event, as the latter may indicate carcinoma of duct ectasia.
66
Importance of nipple inversion
• The nipple may fail to evert and it is important to know if this has been present since birth or is a recent event, as the latter may indicate carcinoma of duct ectasia.
67
Attachment of clavicle and coracoid process
By coracoclavicular ligament having 2 parts Medially conoid Laterally trapezoid
68
Which joint is responsible for opposition of the thumb.
carpometacarpal joint
69
Muscles attached anterior to CORONAL section of humerus MEDIAL rotators
pectoralis major, latissimus dorsi, teres major, subscapularis, anterior fibres of deltoid.
70
Muscles attached posterior to CORONAL plane of humerus LATERAL rotators
infraspinatus, teres minor, posterior fibres of deltoid.
71
Protractor of scapula
Serratus anterior and pectoralis minor
72
Retractors off scapula
rhomboids and middle fibres of trapezius
73
Direction of scapular rotation by serratus anterior.
upwards
74
Internet of supraclavicular nerve
Supraspinatus and infraspinatus
75
Nerve to teres minor
Axillary nerve
76
Origin level of PIN
Behind lateral epicondyle
77
Nerve to supinator
PIN
78
Root of musculocutaneous nerve
C567
79
Which nerve lies between brachialis and brachioradialis
Radial
80
Which nerve pierces coracobrachialis and runs between biceps and brachialis.
Musculocutaneous Mnemonic BBC
81
Root of median nerve
C678 T1
82
Relation of median nerve to axillary and brachial artery
Anterior to axillary artery LAM to brachial artery
83
Nerve between two heads of pronator teres
Median nerve
84
Origin point of AIN
At entry of median nerve to firearm between two heads of pronator teres
85
Site of giving off PALMAR cuteneous branch of median nerve
Before entering flexor retinaculum
86
Nerve to thenar skin and thenar muscle
Skin-palmar cuteneous branch of MAIN median nerve superficial to flexor retinaculum Muscles-branches of MAIN median nerve deep to flexor retinaculum
87
Nerve to flexor Carpi ulnaris
Ulnar
88
Root of ulnar nerve
C78 T1
89
Relation of ulnar nerve to axillary and brachial artery in midhumerus and ulnar artery in lower 2/3 of forearm
Medial to them
90
Course of ulnar nerve after piercing medial intermuscular septum of arm
Lies on anterior surface of triceps
91
Which nerve lies on deep aspect of flexor digitorum superficialis
Median
92
Which nerve descends between flexor carpi ulnaris and flexor digitorum profundus and then lies superficial on the radial side of the tendon of flexor carpi ulnaris.
Ulnar
93
Level of dorsal cutaneous branch of ulnar nerve and function
• Gives off a dorsal cutaneous branch 5 cm above the wrist, which is sensory to the dorsal aspect of the ulnar one-and-a-half finge
94
Paralysed muscles in Erb’s (Erb–Duchenne) Paralysis
• Paralysis of deltoid, supraspinatus, infraspinatus, brachialis, biceps.
95
Mnemonic for Klumpke's paralysis
Claw
96
Area of numbness in Klumpke's palsy
along inner and upper arm and forearm centred on elbow joint level. Area of T1
97
What causes ‘channels’ between metacarpals
Wasting of small muscles of hand in ulnar nerve paralysis
98
Which nerve is at risk of fracture or surgery near radial head
PIN
99
What does wrist drop indicate
Damage of main radial nerve
100
Why damage to posterior interosseous branch allows extension of the wrist
due to extensor carpi radialis longus, which is supplied by the main radial nerve BEFORE the posterior interosseous branch is given off
101
Sensory loss in radial nerve injury
Coin in snuff box/ anaesthesia on the skin on dorsum of first web space.
102
Which nerve may damage in supracondylar fractures of the humerus.
Median
103
Mnemonic of HAND muscle supplied by median nerve
Having a LOAF in MIDDLE of hand L: Lateral two lumbricals O: Opponens pollicis A: Abductor pollicis brevis F: Flexor pollicis brevis (except deep head)
104
Supply of AIN
The anterior interosseous nerve (AIN) supplies the following muscles in the forearm: Flexor pollicis longus Pronator quadratus Radial half of flexor digitorum profundus: "PICKING UP SOMETHING OFF GROUND" The AIN also supplies articular branches to the wrist and distal radioulnar joints.
105
Loss of opposition of thumb indicates which nerve injury
Median
106
Nerve supply of extensor Carpi radialis longus and brevis
Longus—main radial Brevis —PIN
107
To test abduction and adduction of the fingers with the hand flat on a table implies what
excludes trick movements of long flexors and extensors
108
Tunnel for flexor tendons
Flexor tendons traverse a fibro-osseous tunnel for each digit.
109
Origin of adductor pollicis and its relation with thenar space
Shaft off middle metacarpal Thenar Space is superficial to second and third metacarpals and adductor pollicis
110
Relation of synovial sheath with flexor sheath
Fibrous flexor seath encloses flexor seath
111
Surgical level of axillary nodes
1- below pectoralis minor 2-behind 3-above — 1-lateral, anterior and posterior 2-central,some of the apical 3-apical,infraclavicular
112
Which axillary nodes are related to the lateral thoracic artery
anterior
113
Which axillary nodes are ying along the subscapular vessels
Posterior
114
Which axillary nodes are lying along the axillary vein
Lateral
115
Which axillary nodes are lying in the axillary fat
Central
116
Which axillary nodes are lying immediately behind the clavicle superior to pectoralis minor?
Apical
117
Few superficial lymph nodes in the upper limbs like—
chiefly the epitrochlear nodes. • Efferents from epitrochlear nodes pierce the deep fascia and end in the axillary nodes.
118
What structure augment deep fascia of Antecubital Fossa?
bicipital aponeurosis.
119
Which flexor tendon has its own osseofascial compartment
Flexor Carpi radialis
120
Relation of flexor Carpi ulnaris with flexor retinaculum
FCU tendon inserts into pisiform, so it ends before proximal border of flexor retinaculum
121
Sensory impairment in carpal tunnel syndrome
• The superficial palmar branch of the nerve is given off proximal to the flexor retinaculum, and therefore there is no sensory impairment on the lateral side of the palm if the nerve is compressed in the carpal tunnel.
122
Location and function of dorsal branch of the radial artery. And it's importance
In anatomy snuff box Function :The dorsal carpal branch of the radial artery is a small vessel that originates from the radial artery and contributes to the dorsal carpal arch.The dorsal carpal branch crosses the carpus transversely toward the medial border of the hand. Then the dorsal carpal branch anastomoses with the dorsal carpal branch of the ulnar artery to form the dorsal carpal arch. The dorsal carpal arch supplies the dorsal aspect of the wrist joint. Importance: • Dorsal branch of the radial artery lies close to the cephalic vein and therefore this is an appropriate site for creating arteriovenous fistulae for dialysis.
123
Why do palmar infections may result in marked dorsal oedema?
This is caused by the thick palmar skin being firmly bound down to the underlying palmar aponeurosis. In contrast, the skin of the dorsum of the hand is loose and fluid can readily collect deep into it.
124
Supply of subclavian artery
Thyroid Breast Diaphragm Brainstem Upper limb

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