Anatomy (Upper Limb) Flashcards
Nerve between tendons of flexor digitorum profundus and flexor pollicis Longus
AIN
Nerve of RADIAL half of FDP
AIN
Nerve to pronator quadratus
AIN
Muscle level supplied by AIN
Deep level of anterior compartment of forearm
With which nerve does median nerve communicate with in upper arm?
Musculocutaneous
Branches of median nerve in upper arm
No branches
Nerve used to pick something up off the ground by pronation and gripping
Median
Mnemonic of a LOAF in hand
Median nerve supply of hand muscles
Ape hand deformity occurs in-and because of
Carpal tunnel syndrome
Because of wasting of thenar eminence and loss of opposition
Number of muscles supplied by AIN.
3
In which level majority of sentinel axillary nodes are located and nerve encountered during dissection procedure
Level 1
Intercostobrachial nerve
Floor of axilla
Subscapularis muscle
Fascia of Axilla
Clavipectoral fascia
Origin of subclavian vein
From the axillary vein at the outer border of first rib
Which nerve traverse the axillary nodes
Intercostobrachial
Attachment of extensor retinaculum
Medially pisiform and triquetral
Laterally end of radius
Structures superficial to extensor retinaculum
Cephalic vein
Basilic vein
Dorsal cuteneous branch of ulnar nerve
Superficial branch of radial nerve
Location of radial artery at wrist
Between lateral collateral ligament
And
Tendons of extensor pollicis Brevis and abductor pollicis longus
Origin level of AIN
Leaves just below the elbow
Course of radial nerve in axilla
Posterior to axillary artery
Lying on muscles—Subscapularis, Latissimus dorsi, teres major
Which nerve enters the arm between brachial artery and long head of triceps
RADIAL nerve
Sure of terminal branching of radial nerve
At the level of anterior of lateral epicondyle between BRACHIALIS and brachioradialis into superficial and deep branches
Origin of PIN
Deep terminal branch of radial nerve crosses the supinator and becomes the PIN
Muscles supplied by radial nerve
BEAT
ECRL-by main radial
ECRB-sometimes by main and sometimes by PIN
Nerve of supinator
PIN
Muscles supplied by PIN
Supinator
Extensor compartments 13456 (rad -uln)
What nerve injury will cause weak elbow flexion in mid prone position
Radial nerve inquiry at the level of forearm
What forms axillary sheath and it’s contents
It is a prolongation of Prevertebral fascia
Contents are
Brachial plexus
axillary artery and
Axillary vein
Which cord lies behind the first part of axillary artery
Medial
Which cord lies behind the second part of axillary artery
Posterior
Where and what cord separates the axillary artery from axillary vein
Medial cord behind pectoralis minor
(Second part of the axillary artery)
Nerve anteriorly to this party of axillary artery
Medial root of median nerve
Laterally and medially of third part of axillary artery
Medially axillary vein
Laterally median nerve
Branches of axillary artery
1st part-superior/highest thoracic artery
2nd-lateral thoracic, THORACOACROMIAL
3rd-Subscapular, anterior and posterior circumflex humeral
Origin of circumflex scapular artery and area of supply
It is a branch of Subscapular artery which is a branch of 3rd part of axillary artery
Supply: dorsal aspect of scapula
Function of radial nerve in action
When we fall on the ground we use our hands as shock absorber
(Extension of fingers, wrist and elbow)
What is arcade frohse and importance
Superficial party of supinator
PIN nerve may become entrapped (pinned) here
Nerve within supinator
PIN
Nerve supply of intercarpal joint at back of carpus
Small ganglion enlargement of PIN
Nerve supply of 4,5,6 extensor compartments of hand
Recurrent branch of PIN of radial nerve
Branches of ulnar nerve in upper arm
None
Function of ulnar nerve in action
Ape like gripping
(Without opposition)
Rock, Paper, Scissors, Ok
Nerves
Cause of dysfunction
Rock: median (finger flexion)
*Supracondylar fx of humerus, radioulnar fx
Paper
Radial nerve (finger extension)
*Humeral shaft fx, supracondylar fx
Scissor
Ulnar nerve (intrinsic hand muscles)
*Supracondylar, radioulnar
Ok
AIN (IP thumb flexion and DIP index flexion)
*Supracondylar, radioulnar
Course of ulnar nerve
Posteriomedial of arm>flexor compartment of forearm>along ulnar>beneath special Carpi ulnaris>within Guyon’s canal>superficial to flexor retinaculum>palm of hand
Origin and supply of PALMAR cuteneous nerve
From ulnar nerve at mid forearm
Supply skin of medial palm
Nerve to flexor pollicis brevis and importance
Superficial head
The recurrent branch of the median nerve innervates the superficial head of the flexor pollicis brevis muscle.
#Deep head /medial head
The deep branch of the ulnar nerve, which originates from spinal roots C8 and T1, innervates the deep head of the flexor pollicis brevis muscle. The deep head may also receive some innervation from the recurrent branch of the median nerve.
*Importance
For losing complete function (thumb flexion) both of those nerves have to be damaged
Which nerve passes deep to the bicipital aponeurosis
Median
Nerve between two heads of pronator teres
Median
Nerve deep to flexor digitorum superficialis
Median
Nerve between tendons of flexor digitorum superficialis and flexor Carpi radialis
Median
Nerve deep to tendon of palmaris Longus
Median
Branches of median nerve at upper arm
None
Mnemonic for median nerve function with action
Softly grab (FDS,lat.2FDP & FPoli.L) a piece of LOAF (hand muscles) by its undersurface (already supinated forearm) with keeping the wrist flexed to support them weight (FCR)
and then give it (pronators) to someones middle (median N.) of palm.
Is Carpal tunnel syndrome painful
Yes, carpal tunnel syndrome (CTS) can be painful:
Pain
CTS can cause pain in the hand and fingers, especially in the thumb, index, middle, and ring fingers. Pain can also travel up the forearm to the shoulder.
Other symptoms
CTS can also cause tingling, numbness, burning, weakness, and clumsiness in the hand. Pain can be worse at night, interrupting sleep.
When pain occurs
Pain can occur when gripping objects, twisting a doorknob, lifting something heavy, or holding a phone to your ear.
When symptoms worsen
As CTS worsens, symptoms can occur more often and become worse.
Treatments for CTS
include:
Wearing a splint at night
Physical therapy — extension and flexion stretch -hold for 15 seconds for 5 times in a row
Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, Aleve, Tylenol, Advil, or Motrin
Corticosteroids to reduce inflammation
Ice packs or ice baths
Heat therapy
In severe cases, surgery may be necessary.
Which nerve injury will cause ULNAR deviation of wrist and injury location
Damage of median nerve at elbow
Which nerve injury will cause RADIAL deviation of wrist and injury location
Damage of ulnar nerve at elbow
muscles supplied by anterior interosseous nerve
Flexor pollicis longus: A deep forearm muscle
Flexor digitorum profundus: The lateral half of this muscle, which supplies tendons for the index and middle fingers
Pronator quadratus: A deep forearm muscle
Articular branches of the AIN supply the distal radioulnar and wrist joints.
Muscle attachment of upper end of radius
Biceps at tuberosity
Origin and insertion of supinator and neurovascular supply
Attachments: Originates from the lateral epicondyle of the humerus and the posterior surface of the ulna. Inserts onto the posterior surface of the radius
Innervated by deep radial
Blood by ulnar artery
What is supinator Longus
, there is no supinator longus muscle, but the term “supinator” can refer to any muscle that causes supination. In older texts, the brachioradialis was called the “supinator longus”, and the muscle now known as the supinator was called the “supinator brevis”.
Muscles attached to shaft off radius
Upper third
Supinator
FDS
FPL
Middle third
Pronator teres
Lower third
Pronator quadratus
Brachioradialis
Head of radius and head of ulna
R up
U down
Tendons in 3 grooves on dorsal surface is radial lower end
From radial to ulnar
Extensors of—
Carpi radialis Longus
Brevis
Pollicis Longus
Indices
Which nerve is overlapped by FCU and where
Ulnar
In mid forearm
What is Guyon’s canal and contents
It is a superficial layer from flexor retinaculum containing ULNAR nerve and artery
Relation among FDS, ulnar artery and ulnar nerve in distal 2/3 of forearm
Artery between them
Relation of ulnar artery to muscles of forearm
Lies on brachialis and FDP
Deep to pronator teres and FCU
What is Struthers’ ligament
Attached along medial humeral condyle and median nerve passes through it
Relation of median nerve to pronator teres
The nerve passes between superficial humeral and deep ulnar head of the muscle
Relation of pronator teres and ulnar artery
Ulnar artery passes deep to deep ulnar head of the muscle
What structure separates superficial median nerve from deep ulnar artery and their relation
Deep ulnar head of pronator teres
Relation
Median nerve is medial to ulnar artery for about 2.5 cm then crosses anteriorly to lie on radial side of it
Commonest site of humeral fracture
Surgical neck
Relation between anatomical and Surgical neck of humerus
Superiorly anatomical
Inferiorly surgical
Relation between greater and lesser tubercle of humerus
Greater superolateral
Lesser anterosuperior
Location of coronoid fossa and olecranon fossa
Coronoid anteroinferior
Olecranon posteroinferior
Articulation of scaphoid
scaphoid bone articulates with five bones
“rt palm anticlockwise”around it
Trapezium
Trapezoid
Head of capitate
Lunate
Radius
Radial tubercle
Origin of radial collateral carpal ligament
Radial tubercle,
Narrow strip between radial and trapezial surface
Joint affected by abductor pollicis Brevis
Abducts Carpometacarpal and metacarpophalangeal joints
Muscle responsible for typing movement of thumb
Abductor pollicis
Insertion of FCR
Front of bases of second and third metacarpals
Function of FCR
At wrist—
Flexion
Radial deviation/abduction
Radioulnar joints—
Pronation
Elbow joint —
Flexion
Insertion of FCU
Pisiform and base of fifth metacarpal
Structures passing through quadrangular space of shoulder
Axillary nerve and posterior circumflex humeral artery
Structures passing through triangular space of shoulder
Circumflex scapular artery
Structures passing BENEATH triangular interval/triceps hiatus of shoulder
Radial nerve
Profunda brachii artery
Root of axillary nerve
C5,6
Common form of rotator cuff disease
Damage to supraspinatus muscle
Defects of capsule of shoulder joint
Two
1. Biceps tendon
2. Below Subscapularis tendon
Nerve at risk of anteroinferior dislocation of shoulder joint
Axillary
Because inferior extension of capsule is in close relation with axillary nerve
Importance of inferior extension of joint capsule onto surgical neck of shoulder joint
Proximally sited osteomyelitis may progress into septic arthritis
Function of Latissimus dorsi and teres major
Extension
Adduction
Medial rotation
Function of Subscapularis
Medial rotation
Function of posterior two rotator cuff muscles
Lateral rotation
Subclavian artery
Parts
Branches
The subclavian artery has three parts and several branches:
Parts
The subclavian artery is divided into three parts based on its position relative to the anterior scalene muscle:
First part: Also known as the prescalene part, this part extends from the origin of the vessel to the medial border of the anterior scalene muscle.
Second part: Also known as the scalene part, this part lies behind the anterior scalene muscle.
Third part: Also known as the postscalene part, this part extends from the lateral margin of the anterior scalene muscle to the outer border of the first rib.
Branches
The subclavian artery has several branches, including:
Vertebral artery: The first and largest branch.
Internal thoracic artery: Divides into two terminal branches, the superior epigastric and the muscular phrenic artery.
Thyrocervical trunk: A branch of the subclavian artery.
Costocervical trunk: A branch of the subclavian artery.
Dorsal scapular artery: A branch of the subclavian artery that supplies the rhomboids.
The subclavian arteries supply blood to the upper body, including the head, neck, and arms. There is a subclavian artery on the left and right sides of the chest.
Branches of thyrocervical trunk
Suprascapular
Transverse cervical
Inferior thyroid
Ascending cervical
Branches of Costocervical trunk of subclavian artery
Highest intercoastal artery
Deep cervical artery
Structures lying superficial to brachial plexus in neck
Platysma
Supraclavicular nerve
Inferior belly of omohyoid
Transverse cervical artery
Clavicle
Suprascapular vessels
Where the basilic vein is Deep
Mid humerus
Origin level of brachial artery
Lower border of teres major
Which muscle is attached to anterior aspect of fibrous capsule of elbow joint
Sone fibers of brachialis
Nerve supply of elbow joint
Musculocutaneous, medial, radial, ulnar
Origin of trapezius
External occipital protuberance
Medial third of superior nuchal line
Ligamentum nuchae
C7 spine
Spines of all thoracic vertebrae with intervening interspinous ligaments
Insertion of trapezius muscle
Clavicle -lateral third
Acromion -Medial third
Scapula -crest of spine
Origin and insertion of lumbricals
From tendon of FDP
Into extensor hood mechanism
Deepest muscular plane of palm
Adductor pollicis
Parts of metacarpal
From proximal to distal
Base - Carpometacarpal
Body
Head - metacarpophalangeal
Entry of radial nerve into arm and forearm
Into arm between brachial artery and long head of triceps
Into forearm between brachial and brachioradialis
Origin point of PIN
Deep branch of radial nerve crosses the supinator and becomes the PIN
Function of dorsal scapular nerve and injury
originates from the C5 spinal root
Function
The DSN supplies the levator scapulae, rhomboid major, and rhomboid minor muscles, which help to elevate and adduct the scapula towards the spine
Injury
ent
Symptoms
Exercises
Pain
Ultrasound
Function
Root value
Injury
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The dorsal scapular nerve (DSN) is a motor nerve that supplies the muscles of the shoulder and upper back:
Origin
The DSN is a branch of the brachial plexus that usually originates from the C5 spinal root
Function
The DSN supplies the levator scapulae, rhomboid major, and rhomboid minor muscles, which help to elevate and adduct the scapula towards the spine
Injury
Injury to the DSN can cause pain in the lower neck, upper and mid back, and shoulder region. Other symptoms include:
Abnormal or reduced shoulder movement
Winging of the shoulder blade
Difficulty drawing the shoulders together or backwards
Difficulty raising the arm fully upwards
What separates brachial artery from median cubital vein at elbow
Bicipital aponeurosis
Closely related vein with brachial artery in cubital fossa
Basilic vain lies medially
Which muscle is inserted into posterior capsule of elbow joint
Triceps
Perfecting the capsule bring entrapped between olecranon process and olecranon fossa during elbow extension
Initiator of extension of elbow joint from full flexion
Long head of triceps
Peculiar function of triceps
Long head can adduct humerus
Location and function of pretectal nucleus
In high midbrain
Resizing pupils
Pupils of opioid poisoning
Miotic
Why midriasis occurs in oculomotor nerve injury
Ok parasympathetic nerve travel with oculomotor nerve
Pupil of optic neuritis (REDUCED light reflex due to reduced afferent input)is called
Marcus Gunn pupil
Sensory input of corneal reflex travels through which nerve
Nasociliary division of V1
Which nerve producers motor response of corneal reflex
Facial nerve by orbicularis oculi
Which nerve is at risk of injury in case of raised ICP, why is that and manifestation
Abducens
Sure to long intracranial course because the nerve exits the brainstem ANTERIORLY at the pontomedullary junction then comes posteriorly.
Damage will result in weakness of abduction
Why otalgia following tonsillectomy
Due to glossopharyngeal nerve
Parasympathetic fibers to parotid
Glossopharyngeal via otic ganglion
Motor to stylopharyngeus
Glossopharyngeal
Which nerve has multiple origin branches
Spinal accessory
Which nerve lies ON the carotid sheath and important
Hypoglossal
Risk of injury during carotid Endarterectomy resulting
Muscles of tongue are supplied by
Hypoglossal except palatoglossal(IX)
Anterior, posterior, inferior relation of shoulder joint
A- brachial plexus, axillary vessels
I- axillary nerve, circumflex humeral vessels
P- suprascapular vessels and nerve
Origin of PALMAR interossei
From Metacarpal on which it acts
(None from and on middle one)
Origin of Dorsal interossei
From Metacarpal on which it acts and from adjacent metacarpal
Insertion of interossei
Base of proximal phalanx and extensor hood
Clinical sign of interossei damage
Claw hand
Nerve for pincher movement of thumb and index
AIN
Attachment of extensor retinaculum
Ulnar - triquetral, pisiform
Radial - end of radius
Superficial structures of extensor retinaculum
Basic vein
Cephalic vein
Dorsal cuteneous branch of ulnar nerve
Superficial branch of radial nerve
Artery between lateral collateral ligament of wrist and tendons of extensor pollicis Brevis and abductor pollicis Longus
Radial nerve
Insertion of pectoralis major
Lateral edge of bicipital groove
Nerve to pectoralis major
Lateral pectoral nerve
Artery may be injured in fracture of lateral third of clavicle
Thoracoacromial artery
(Arising from 2nd part of axillary artery)
Termination of thoracoacromial artery
Deep to pectoralis major after piercing clavipectoral fascia giving off 4 terminal branches
The clavipectoral fascia and the coracoclavicular fascia
The clavipectoral fascia and the coracoclavicular fascia are both tissues in the shoulder region that play different roles in the body:
Clavipectoral fascia
A loose connective tissue sheet that allows the pectoralis major muscle to glide over the pectoralis minor muscle. It also suspends the floor of the axilla and protects the axillary nerves and vessels. The clavipectoral fascia is located between the clavicle and the pectoralis minor muscle.
Coracoclavicular fascia
Also known as the coracoclavicular ligament (CCL), this is a strong ligament that stabilizes the acromioclavicular joint (ACJ) in the shoulder. The CCL also helps transmit the weight of the upper limb to the axial skeleton. The CCL is located under the clavicular portion of the pectoralis major muscle.
Fascia between clavicle and pectoralis MINOR
Clavipectoral
Function of clavipectoral fascia for Axilla
Suspends floor of Axilla and protects axillary vessels and nerves
Which fascia is below clavicular part of pectoralis major
Coracoclavicular fascia also called ligament
What happens after thoracoacromial artery pierces coracoclavicular fascia
Gives off 4 branches
Clavicular-SC joint, subclavius
Pectoral-betw.2 mus. & Supply them
Deltoid-delt.pect. groo.>supply them
Acromial-under deltoid supply it
Formation of axillary sheath
Prolongation of Prevertebral fascia
Fascia anterior to axillary artery
Clavipectoral
Muscles posterior to third part of axillary artery
Subscapularis, Latissimus dorsi, teres major
Superficial structure at risk of injury of extensor retinaculum
Superficial branch of radial nerve
Relation of supraspinatus nerve with trapezius muscle
Deep to the muscle
Muscles under breast
Pectoralis major
Serratus anterior
External oblique
Effect on wrist flexors in Klumpke’s palsy
Loss of functions
Termination of basilic vein
It is joined by medial brachial vein before draining into axillary vein
Drainage of circumflex humeral veins
At the lower border of teres major the anterior and posterior circumflex humeral veins drain into basilic vein
Function of serratus anterior
Causes pushing out of scapula during punch
How does IX nerve injury cause winging of scapula
Loss of function of trapezius muscle
Why injury to Dorsal scapular nerve will cause winging of scapula
Loss of function of
Levator scapulae
Rhomboid major and minor
Breaks in posterior triangle of neck
Subclavian artery
External jugular vein
Branches of cervical plexus and location
Located in posterior triangle of neck
They are
Supraclavicular
Transverse cervical
Great auricular
Lesser occipital
What nerve traverses level 2 axillary node and its function
Thoracodorsal
Supplies Latissimus dorsi
Nerves at risk during axillary nodes clearance
Long thoracic
Thoracodorsal
Intercostobrachial
Weak supination due to
Radial nerve injury
Weak supination along with weak elbow flexion due to
Musculocutaneous nerve injury
Origin of flexor digiti minimi
From hamate
Origin point of right subclavian and right commonly carotid artery
Behind right SC joint
Termination of cephalic vein by piercing which fascia
After piercing clavipectoral fascia it terminated into axillary vein
Vein related to anatomical snuff box
Cephalic vein originating from dorsal venous arch laterally
Groove at shoulder joint for cephalic vein
Deltopectoral
Which is the largest carpal bone
Capitate
Action of accessory nerve on shoulder joint
Shrugging/upward rotation
Nerve responsible for writing
AIN
Nerve lying between FPL & FDP
AIN
Weakness of overhead shoulder movement
Injury to thoracodorsal nerve causing weak Latissimus dorsi
Paralysis in Erb’s palsy
Supraspinatus
Infraspinatus
Deltoid
Biceps
Brachialis
Brachioradialis
Nerve at risk of fracture of surgical neck of humerus
Axillary
Nerve at risk in mid shaft fracture of humerus
Radial
Artery at risk of injury during level 3 axillary nodes clearance
Thoracoacromial artery pierces pectoralis major and gives off branches within this space.
Level 3 nudes
Nodes lie between pectoralis major and minor
Supply of radial nerve
BEATS
Supply of axillary nerve
Deltoid
Teres minor
Supply of upper Subscapularis
Subscapularis
Supply of lower subscapular nerve
Subscapularis
Teres major
Supply of thoracodorsal nerve
Latissimus dorsi
Muscle used in above head shoulder movement
Latissimus dorsi supplied by thoracodorsal nerve
What attaches periosteum to bone s
Sharpey’s fibrr
Lateral winging of scapula fur which muscle and nerve injury
Trapezius muscle and XI nerve
why wrist flexion of lost on Klumpke’s palsy
Midian nerve root affected
Which structure separates ulnar artery from median nerve
Deep head of pronator teres
& nerve guards the artery (so nerve is below the muscle)
Artery may be injured in fracture of lateral third of clavicle
Thoracoacromial artery
What is coracoid membrane and what pierces it
It is a continuation of clavipectoral fascia and cephalic vein pierces is to terminate in the axillary vein
Relation of cephalic vein to bicepy
Vein is anterolateral to muscle
Why ULNAR paradox with radial deviation
Affected flexor Carpi ulnaris and flexor digitorum profunda (ulnar 2)-
they can’t flexor DIP joint
Nerve to adductor pollicis
DEEP ulnar
Cutting which sympathetic GANGLIA to treat hyperhidrosis of hands and arms
And caution for which one
T2,3
Caution not to injure T1
Its injury may lead to horner’s syndrome
What are separated by bicipital aponeurosis In Antecubital fossa
Brachial artery and cephalic vein
Location of clavipectoral fascia
Situated under the clavicular portion of g pectoralis major
Structures protected by clavipectoral fascia
Axillary neurovasculatures
On which muscle axillary nudes are depended for leveling
Pectoralis minor
How to gain access to level 3 axillary node during Patey mastectomy
Division of pectoralis minor
Supply of Dorsal scapular nerve and sign of injury
Dorsal side of scapula —
Levator scapulae
Rhomboid major
Rhomboid minor
Injury will cause -
shoulder blade may tilt away from the rib cage, or sit in a different resting position on the injured side. It may also be difficult to draw the shoulder blades together or raise the arm fully.
Pain: Pain may be felt in the upper and mid back, lower neck, and shoulder region
neck and spine may be stiff.
Caution during Latissimus dorsi flap reconstruction
Not to injure thoracodorsal TRUNK which is its own blood supply and muscle is superficial to trunk
Relation of thoracodorsal trunk with axilla
The trunk runs through the nodes of Axilla
Which nerve descends between axillary artery and vein
Ulnar
Which nerve is surrounded by the lymph nodes near sternocleidomastoid muscle
XI
Most prone type of must’ve injury during rugby playing and why
Brachial trunk C5,6
They tackle with shoulder and this may cause SUDDEN hyperextension of neck without giving Eno time to the trunks to maintain elasticity.
What to remember with LAM
relation OF median Nerve TO brachial Artery
Mechanism of injury of median nerve in supracondylar fracture of humerus
Angulation and displacement of distal fragment of humerus
Which vessels feed into axillary vein around the neck of humerus
Anterior and posterior circumflex humeral veins
Nerve passing posterior to medial aspect of first rib
Phrenic nerve
To enter into thirax
Nerve lying on anterior surface of scalenus anterior
Phrenic nerve
Which nerve is at more risk of invite during clutch injury
Radial
Transection of Median nerve just below brachial plexus will cause
Complete loss of wrist flexion
First nerve to be encountered/injured in careless axillary dissection
Intercostobrachial
Why is the axillary nerve not at risk during axillary nodes dissection
It leaves axilla superiorly through quadrangular space to go posteriorly
Which vein crosses anatomical snuff box
Cephalic vein
Relation of cephalic vein to fascial plane
It overlies most of the fascial planes
Where does the CEPHALIC vein pierces fascia to join axillary vein and name of fascia
The vein pierces coracoid membrane (continuation of clavipectoral fascia)—deep fascia of Deltopectoral groove
