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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
Q

Under which ligament does the supraspinatus muscle commonly get impinged

A

Coracoacromial ligament

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25
Q

What type of joint is the sternoclavicular joint?

A

Atypical synovial containing a fibrocartilginous disc

Structurally - saddle joint (shape of articular surfaces)
Functionally - ball and socket (multiaxial movement)

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26
Q

What are the boundaries of the axillary artery?

A

Lateral border of the first rib
Inferior border of teres major

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27
Q

What passes through the quadrangular space?

A

Axillary nerve
Posterior circumflex humeral artery and vein

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28
Q

What structures pass through the triangular interval?

A

Radial nerve and Profunda brachii artery

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29
Q

What structures pass through the triangular space?

A

Circumflex scapular artery (branch of the subscapular artery) and vein

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30
Q

Nerve roots: Musculocutaneous

A

C5-7

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31
Q

Nerve roots: Axillary

A

C5-6

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32
Q

Nerve roots: Median

A

C5-T1

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33
Q

Nerve roots: Radial

A

C5-T1

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34
Q

Nerve roots: Ulnar

A

C8-T1

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35
Q

What nerve damage can be caused by shoulder dystocia at birth?

A

Klumpke’s palsy - abduction traction injury of the lower part of the brachial plexus

36
Q

Nerve roots: Medial cutaneous nerve of the forearm

A

C8-T1

37
Q

How does an upper brachial plexus injury present?

A

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
Q

What type of joint is the Elbow?

A

Synovial Hinge Joint

39
Q

Which muscle allow elbow extension?

A

Triceps brachii
Anconeus

40
Q

Borders of the antecubital fossa

A

Medial: Pronator teres
Lateral: Brachioradialis
Superior: Anatomical line between humeral epicondyles
Floor: Supinator and Brachialis

41
Q

Contents of the antecubital fossa (medial to lateral)

A

Median Nerve
Brachial Artery
Biceps Tendon
Radial Nerve

42
Q

Where do the majority of wrist flexors originate?

A

Medial epicondyle of the humerus

43
Q

Where do the majority of wrist extensors originate?

A

Lateral epicondyle of the humerus

44
Q

What is the normal site of venepuncture in the antecubital fossa?

A

Median cubital vein

45
Q

Which nerve is closely related to the surgical neck of the humerus?

A

Axillary nerve

46
Q

What is the only thenar muscle affected in an ulnar nerve palsy?

A

Adductor pollicis

47
Q

Where does the long head of biceps originate?

A

Supraglenoid tubercle

48
Q

What muscles attach to the intertubercular ridge of the humerus?

A

Medial - Teres Major
Middle - Latissimus dorsi
Lateral - Pectoralis Major

49
Q

What muscles are involved in full abduction of the arm?

A

0-15 Supraspinatus
15-90 Deltoid
>90 Scapula rotation

50
Q

What nerve supplies the supraspinatus muscle?

A

Suprascapular nerve

51
Q

Where do the muscles of the anterior compartment of the arm originate?

A

Coracobrachialis - Coracoid process

Biceps brachii
- long head - supraglenoid tubercle
- short head - coracoid process

Brachialis - anterior distal humerus

52
Q

Which muscles attach to the coracoid process?

A

Short head biceps brachii
Coracobrachialis
Pectoralis minor

53
Q

Where does the biceps tendon insert?

A

Radial tuberosity + bicipital aponeurosis

54
Q

What is the function of biceps brachii?

A

Elbow flexion
Forearm supination

55
Q

What is seen in Erb’s palsy?

A

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
Q

What is Klumpke’s palsy?

A

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
Q

Which structures pass between the two heads of flexor digitorum superficialis?

A

Median Nerve
Ulnar Artery

58
Q

Boundaries of the carpal tunnel

A

Floor - carpal bones

Radial Proximal - Scaphoid Tubercle

Ulna Proximal - Pisiform

Radial Distal - Trapezium

Ulna Distal - Hook of the Hamate

Roof - Flexor Retinaculum

59
Q

Contents of the carpal tunner

A

Tendons of FDP x4
Tendons of FDS x4
Tendon of FPL
Median Nerve

60
Q

Contents of Guyon’s canal

A

Ulnar nerve and artery

61
Q

Boundaries of the anatomical snuffbox

A

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
Q

Contents of the anatomical snuffbox

A

Radial Artery
Radial Nerve
Cephalic Vein origin

63
Q

What does finger abduction test?

A

Dorsal interossei - Ulnar nerve

64
Q

How many interossei muscles are there in each hand?

A

7 in each hand
- 3 palmar -> adduction
- 4 dorsal -> abduction

65
Q

Describe the pulley system in each digit

A

5 annular and 3 cruciate pulleys to prevent bowstringing of the flexor tendons

A-2 is the strongest

66
Q

How many compartments are there in the extensor retinaculum of the wrist?

A

Six

1 - EPB + APL
2 - ECRL/B
3 - EPL
4 - EI + ED
5 - EDM
6 - ECU

67
Q

Where does the brachial plexus emerge in relation to the scalene muscles?

A

Between anterior and middle scalene muscles alongside the subclavian artery

68
Q

Where does the dorsal scapula nerve arise?

A

C5 Root

69
Q

What nerves arise from the superior trunk of the brachial plexus?

A

Suprascapular and nerve to the subclavius

70
Q

What nerves arise from the lateral cord of the brachial plexus?

A

Lateral pectoral nerve and Musculocutaneous

71
Q

What nerves arise from the medial cord of the brachial plexus?

A

Medial cutaneous nerves of the forearm and arm
Medial pectoral nerve
Ulnar nerve

72
Q

What nerves arise from the posterior cord of the brachial plexus?

A

Subscapular (superior and inferior branches)
Thoracodorsal
Axillary
Radial

73
Q

Which structures pass through the quadrangular space?

A

Axillary nerve
Circumflex humeral artery

74
Q

Which nerve roots contribute to the Axillary nerve?

A

C5-6

75
Q

Which nerve roots contribute to the Musculocutaneous nerve?

A

C5-7

76
Q

Which nerve roots contribute to the Median nerve?

A

C6-T1

77
Q

Which nerve roots contribute to the Radial nerve?

A

C5-T1

78
Q

Which nerve roots contribute to the Ulnar nerve?

A

C8-T1

79
Q

Sensory: Musculocutaneous nerve

A

Lateral cutaneous nerve of the forearm (running close to the cephalic vein)

80
Q

Describe the path of the Median nerve

A

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
Q

Why is the palm spared in carpal tunnel?

A

Palmar cutaneous branch arises proximally in the forearm and travels superficial to the carpal tunnel

82
Q

Describe the path of the Radial nerve

A

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
Q

Why is there no wrist drop in radial head fracture/dislocation injuries to the radial nerve?

A

Extensor carpi radialis longus and Brachioradialis still innervated
ECRL prevents wrist drop

84
Q

Describe the path of the Ulnar nerve

A

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
Q

Boundaries of the cubital fossa

A

Lateral - brachioradialis
Medial - pronator teres
Superior - line between epicondyles
Floor - brachialis (proximal) and supinator distal)

86
Q

Contents of the cubital fossa from medial to lateral

A

Median nerve
Brachial artery
Biceps tendon
Radial nerve

87
Q

Describe the Ulnar Paradox

A

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
Q

UL myotomes

A

C5 - elbow flexion
C6 - wrist extension
C7 - elbow extension
C8 - finger flexion
T1 - finger abduction

MRCS Part B (7 decks)

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