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MRCS Part B > Anatomy - Upper Limb > Flashcards

Anatomy - Upper Limb Flashcards

1
Q

Which structures hold the lateral end of the clavicle to the coracoid process?

A

Coracoclavicular ligament formed from:

Trapezoid ligament - anteriorly
Conoid ligament - posteriorly

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2
Q

What are the terms given to superior and inferior movement of the scapula?

A

Elevation and depression

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3
Q

What are the terms given to anterior and posterior movement of the scapula?

A

Protraction and retraction

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4
Q

Which bony landmark is associated with the tendon of the long head of biceps brachii?

A

Bicipital groove (inter-tubercular groove) of the humerus

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5
Q

Where does the long head of triceps brachii originate?

A

Infraglenoid tubercle of the humerus

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6
Q

Where does the long head of biceps brachii originate?

A

Supraglenoid tubercle of the humerus

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7
Q

Action: Subscapularis

A

Internal rotation

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8
Q

Action: Supraspinatus

A

Initiates abduction

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9
Q

Action: Infraspinatus and Teres Minor

A

External rotation

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10
Q

Attachment: Teres Major

A

Posterior lip of the bicipital (intertubercular) groove)

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11
Q

Action: Teres Major

A

Powerful adductor

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12
Q

Action: Coracobrachialis

A

Shoulder flexion

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13
Q

Attachments: Serratus Anterior

A

Anterior aspect of ribs 1-8 to medial edge of the Scapula

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14
Q

Attachments: Levator Scapulae

A

Transverse processes of V1-3 to superior aspect of Scapula

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15
Q

Action: Rhomboids

A

Elevate and retract scapula

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15
Q

Attachments: Trapezius

A

From - Occiput, Nuchal ligament, Spinous processes of T1-12

Attaches to - spine of Scapula, Acromion process and lateral 1/3 of the Clavicle

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16
Q

Attachments: Pectoralis Major

A

From:
Medial 1/3 Clavicle
Sternocostal heads of Ribs 1-6
Aponeurosis of external oblique muscle

To:
Lateral lip of the intertubecular sulcus of the humerus

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17
Q

Attachments: Lattismus dorsi

A

From - Spinous processes of T7-12, Ribs 10-12, Thoracolumbar fascia, Iliac crests

To - medial aspect of the bicipital (intertubercular) groove)

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18
Q

Attachments: Deltoid

A

From - Spine of Scapula, Acromion, lateral ⅓ of the Clavicle

To - Deltoid tuberosity

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19
Q

How do the subclavian artery and vein run in relation to the anterior scalene?

A

Artery - behind
Vein - in front

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20
Q

Which vessel runs in the deltopectoral groove?

A

Cephalic vein

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21
Q

Subclavian artery branches

A

“VIT C & D”

First part:
-Vertebral
-Internal thoracic
-Thyrocervical trunk

Second part:
-Costocervical trunk

Third part:
-Dorsal scapula

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22
Q

Branches of the axillary artery

A

“Screw the lawyer, save a patient!”

First part (proximal to pec minor)
- S: superior thoracic artery

Second part (posterior to pec minor)
T: thoracoacromial artery
L: lateral thoracic artery

Third part (distal to pec minor)
S: subscapular artery
A: anterior humeral circumflex artery
P: posterior humeral circumflex artery

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23
Q

Parts of the subclavian artery

A

First part: from its origin to the medial border of scalenus anterior

Second part: posterior to scalenus anterior

Third part: from the lateral border of scalenus anterior to the lateral border of the first rib

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24
Under which ligament does the supraspinatus muscle commonly get impinged
Coracoacromial ligament
25
What type of joint is the sternoclavicular joint?
Atypical synovial containing a fibrocartilginous disc Structurally - saddle joint (shape of articular surfaces) Functionally - ball and socket (multiaxial movement)
26
What are the boundaries of the axillary artery?
Lateral border of the first rib Inferior border of teres major
27
What passes through the quadrangular space?
Axillary nerve Posterior circumflex humeral artery and vein
28
What structures pass through the triangular interval?
Radial nerve and Profunda brachii artery
29
What structures pass through the triangular space?
Circumflex scapular artery (branch of the subscapular artery) and vein
30
Nerve roots: Musculocutaneous
C5-7
31
Nerve roots: Axillary
C5-6
32
Nerve roots: Median
C5-T1
33
Nerve roots: Radial
C5-T1
34
Nerve roots: Ulnar
C8-T1
35
What nerve damage can be caused by shoulder dystocia at birth?
Klumpke's palsy - abduction traction injury of the lower part of the brachial plexus
36
Nerve roots: Medial cutaneous nerve of the forearm
C8-T1
37
How does an upper brachial plexus injury present?
Erb's palsy - paralysis of shoulder abductors (deltoid & supraspinatus) - paralysis of external rotators (infraspinatus & teres minor) - paralysis of elbow flexors and forearm pronators (biceps brachii & brachioradialis) Resulting in adducted, internally rotated shoulder, with extended elbow and pronated forearm - known as the Waiter's tip posture Loss of sensation on the radial side
38
What type of joint is the Elbow?
Synovial Hinge Joint
39
Which muscle allow elbow extension?
Triceps brachii Anconeus
40
Borders of the antecubital fossa
Medial: Pronator teres Lateral: Brachioradialis Superior: Anatomical line between humeral epicondyles Floor: Supinator and Brachialis
41
Contents of the antecubital fossa (medial to lateral)
Median Nerve Brachial Artery Biceps Tendon Radial Nerve
42
Where do the majority of wrist flexors originate?
Medial epicondyle of the humerus
43
Where do the majority of wrist extensors originate?
Lateral epicondyle of the humerus
44
What is the normal site of venepuncture in the antecubital fossa?
Median cubital vein
45
Which nerve is closely related to the surgical neck of the humerus?
Axillary nerve
46
What is the only thenar muscle affected in an ulnar nerve palsy?
Adductor pollicis
47
Where does the long head of biceps originate?
Supraglenoid tubercle
48
What muscles attach to the intertubercular ridge of the humerus?
Medial - Teres Major Middle - Latissimus dorsi Lateral - Pectoralis Major
49
What muscles are involved in full abduction of the arm?
0-15 Supraspinatus 15-90 Deltoid >90 Scapula rotation
50
What nerve supplies the supraspinatus muscle?
Suprascapular nerve
51
Where do the muscles of the anterior compartment of the arm originate?
Coracobrachialis - Coracoid process Biceps brachii - long head - supraglenoid tubercle - short head - coracoid process Brachialis - anterior distal humerus
52
Which muscles attach to the coracoid process?
Short head biceps brachii Coracobrachialis Pectoralis minor
53
Where does the biceps tendon insert?
Radial tuberosity + bicipital aponeurosis
54
What is the function of biceps brachii?
Elbow flexion Forearm supination
55
What is seen in Erb’s palsy?
Complete or partial paralysis of muscles supplied by C5 and C6. Motor paralysis/atrophy - deltoid biceps and brachialis muscles. Arm - abducted and medially rotated Forearm - extended and pronated Producing the “waiters tip posture” Sensation - loss in C5/6 lateral arm/forearm distribution
56
What is Klumpke’s palsy?
C8/T1 palsy Paralysis of intrinsic hand muscles including Lumbricals (flex MCPJ and extend IPJ) therefore paralysis causes clawing Sensory loss - medial forearm Causes - forced traction on abducted arm or Horner’s Syndrome
57
Which structures pass between the two heads of flexor digitorum superficialis?
Median Nerve Ulnar Artery
58
Boundaries of the carpal tunnel
Floor - carpal bones Radial Proximal - Scaphoid Tubercle Ulna Proximal - Pisiform Radial Distal - Trapezium Ulna Distal - Hook of the Hamate Roof - Flexor Retinaculum
59
Contents of the carpal tunner
Tendons of FDP x4 Tendons of FDS x4 Tendon of FPL Median Nerve
60
Contents of Guyon's canal
Ulnar nerve and artery
61
Boundaries of the anatomical snuffbox
Base - trapezium and scaphoid Proximal - radial styloid Ulna - extensor pollicis longus tendon Radial - extensor pollicis brevis tendon and abductor pollicis longus tendon Roof - skin
62
Contents of the anatomical snuffbox
Radial Artery Radial Nerve Cephalic Vein origin
63
What does finger abduction test?
Dorsal interossei - Ulnar nerve
64
How many interossei muscles are there in each hand?
7 in each hand - 3 palmar -> adduction - 4 dorsal -> abduction
65
Describe the pulley system in each digit
5 annular and 3 cruciate pulleys to prevent bowstringing of the flexor tendons A-2 is the strongest
66
How many compartments are there in the extensor retinaculum of the wrist?
Six 1 - EPB + APL 2 - ECRL/B 3 - EPL 4 - EI + ED 5 - EDM 6 - ECU
67
Where does the brachial plexus emerge in relation to the scalene muscles?
Between anterior and middle scalene muscles alongside the subclavian artery
68
Where does the dorsal scapula nerve arise?
C5 Root
69
What nerves arise from the superior trunk of the brachial plexus?
Suprascapular and nerve to the subclavius
70
What nerves arise from the lateral cord of the brachial plexus?
Lateral pectoral nerve and Musculocutaneous
71
What nerves arise from the medial cord of the brachial plexus?
Medial cutaneous nerves of the forearm and arm Medial pectoral nerve Ulnar nerve
72
What nerves arise from the posterior cord of the brachial plexus?
Subscapular (superior and inferior branches) Thoracodorsal Axillary Radial
73
Which structures pass through the quadrangular space?
Axillary nerve Circumflex humeral artery
74
Which nerve roots contribute to the Axillary nerve?
C5-6
75
Which nerve roots contribute to the Musculocutaneous nerve?
C5-7
76
Which nerve roots contribute to the Median nerve?
C6-T1
77
Which nerve roots contribute to the Radial nerve?
C5-T1
78
Which nerve roots contribute to the Ulnar nerve?
C8-T1
79
Sensory: Musculocutaneous nerve
Lateral cutaneous nerve of the forearm (running close to the cephalic vein)
80
Describe the path of the Median nerve
Descends arm initially lateral to brachial artery Crosses medially proximal to ACF Travels between FDP + FDS in forearm Forearm branches -> Anterior Interosseous + Palmar Cutaenous Travels through Carpal Tunnel Hand branches -> Recurrent + Palmar Digital
81
Why is the palm spared in carpal tunnel?
Palmar cutaneous branch arises proximally in the forearm and travels superficial to the carpal tunnel
82
Describe the path of the Radial nerve
Innervates the Long + Lateral heads of Triceps brachii Descends arm medially to laterally in radial groove, innervates medial head of Triceps brachii Arm branches -> Lower lateral cutaneous arm + Posterior cutaneous nerve arm + Forearm Crosses ACF anteriorly over lateral epicondyle Terminates in cubital fossa Superficial -> sensory to hand Deep -> motor to posterior forearm
83
Why is there no wrist drop in radial head fracture/dislocation injuries to the radial nerve?
Extensor carpi radialis longus and Brachioradialis still innervated ECRL prevents wrist drop
84
Describe the path of the Ulnar nerve
Descends arm between axillary artery and vein Posteriorly over elbow in ulnar tunnel Forearm - pierces flexor carpi ulnaris Forearm branches: 1. Muscular -> ulnar ½ FDP, FCU 2. Palmar cutaneous -> medial palm only 3. Dorsal cutaneous -> medial dorsum + digits At the wrist, medial to ulnar artery + superficial to flexor retinaculum, entering hand via Guyon's canal Hand branches: 1. Superficial -> medial 1.5 digits only, palmaris bravis 2. Deep -> intrinsic hand muscles
85
Boundaries of the cubital fossa
Lateral - brachioradialis Medial - pronator teres Superior - line between epicondyles Floor - brachialis (proximal) and supinator distal)
86
Contents of the cubital fossa from medial to lateral
Median nerve Brachial artery Biceps tendon Radial nerve
87
Describe the Ulnar Paradox
Distal injury causes worse clawing due to unopposed action of FPD, causing clawing as flexors are stronger than extensors Lumbricals and intrinsic hand muscles are paralysed
88
UL myotomes
C5 - elbow flexion C6 - wrist extension C7 - elbow extension C8 - finger flexion T1 - finger abduction

MRCS Part B (7 decks)

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