Anatomy - upper limb - block 3 Flashcards
1
Q
arm abduction?
A
supraspinatous (15 suprapsin n deltoid 90 - axilary n trapezium 100 (accessory n serratus anterior 180 - long thoracic
2
Q
What bone varies more than almost any other long bone in shape?
A
clavicle - in manual workers, thicker, more curved
one of most frequently fractured bones
common breaks in children w/ outstretched hands
3
Q
weakest part of clavicle?
A
junction of middle and lateral thirds.
if broken, people support sagging limb w/ other hand - shoulder drops,
coracoclavicular lig usually prevents dislocation of acromioclavicular joint, even when there is a break
will be pulled medially by pecs
4
Q
First bone, last bone, broken bone?
A
first long bone to ossify - last long bone to finish growing - age 18 - 25! last epiphysis to fuse
sometimes two ossif centers don’t fuse - and dr thinks it’a break - but it isn’t - xray both clavicles, because usually will occur in both (vs break only in one)
5
Q
fracture of scapula?
A
huge trauma - no treatment re covered on both sides by muscle. usually see ribs fractured too
6
Q
humerous fractures?
A
common in elderly and young - extending arm.
Location? proximal end of neck
artery and nerve in danger?
elderly w. osteoporosis -holding arm out to catch self - avulsion fracture of great tubercle (avulsed - torn away)
7
Q
transverse fracture to shaft of humerous?
A
direct blow -
outstretched hand can also cause spiral fracture of humeral shaft -
severe fall on elbow - intercondylar fracture (ulna driven into space between two condyles)
8
Q
nerves touching humerus?
A
neck - axillary
radial groove - radial
distal end - median
medial epcondyle - ulnar
nerves may be injured with fracture
9
Q
fractures in radius, ulnar?
A
severe injury - joined together w/ interosseous membrane
often if one breaks, both do. -
or dislocation of joint
usually middle 1/3 of bone,
10
Q
> 50 yo break in forearm?
A
women- most common Colles fracture - distal 2cm of radius
11
Q
carpal bones -
A
so long to pinky, here come the thumb
scaphoid (most common break) lunate (most common dislocation) t ? Piriformis hamate HOOK (ulnar nerve and artery near - may be injured - ) c ate trapezium trapezius? zoid
12
Q
most common carpal break?
A
scaphoid -
often misdiagnosed as sprain -
may necrose re not good blood supply
can also create degenerative joint disease
may need to fuse carpal bones
13
Q
Boxer’s fracture?
A
5th metacarpal broken - unskilled punch - flexion deformity
14
Q
Does the ulna or the radius reach the writs?
A
radius
15
Q
Myotome?
A
A myotome is the group of muscles that a single spinal nerve innervates. Similarly a dermatome is an area of skin that a single nerve innervates. In vertebrate embryonic development, a myotome is the part of a somite that develops into the muscles.
16
Q
video re testing upper limb nerves
A
x
17
Q
radial nerve test?
A
wrist extension when arm fully extended (wrist flicking),
thumb extension
innervates posterior full arm and majority of back of hand (thumb to ring finger - not tips of fingers) or pinky
18
Q
ulnar nerve test?
A
move pinky
dorsal and palmar pinky
19
Q
median nerve?
A
thumb pinch, abduction of thumb,
innervates most of palm and tips of dorsal fingers
so if we can feel tips of fingers - MEDIAN
20
Q
Axillary nerve?
A
deltoid, shoulder ABD - badge of skin
21
Q
musculocutaneous nerve?
A
elbow flexion - biceps -
22
Q
ARM - U
NAMe SOME -
arm nerve problems
A
Axil nerve c5-6 Neck fracture (surgical neck of humorous)
ABDUCT - can’t
23
Q
R - AM
Radial nerve
A
Radial nerve c5 - T1 (mediam too)
Axilla or Midshaft fractures
Saturday night
RUTCH palsy crutch
RIST drop
24
Q
M - S
Median -
A
Median c5 - t1
Supracondylar median fracture
Monkey hand - APE hand
25
U
O/ME
Ulnar
ulnar - c8 - T 1
O - outstretched fall (hook of hamate)
Medial Epichondyle fracture
Ulnar CLAW
26
most common dislocated carpal bone?
Lunate
27
superficial branch of radial nerve? is it cutaneous only?
Yes
28
competitive weight lifter, pain proximal forearm, excacerbated by flexion of elbow and supination against pressure? x ray show chornic microtears to prosimal radias
biceps brachii
29
stabbed in back - in posterior axillary fold - weakness in extension, adduction - which muscle likely cut?
lattisimus dorsi
30
stabbed in quadrangular space AKA LATERAL AXILLIARY HIATUS of shoulder - lots of blood - which neural structure likely damaged?
axilliary nerve, important space, allowing posterior humeral circumflex vessels and axil nerve to pass
FOUR structures - teres major, minor, long head of tricep, surg neck of humerus.
axilliary nerve supplies terres minor and deltoid
31
pectoralis minor muscle - where does axil artery lie?
second part of axillary artery lies deep to muscle - divides into three parts -
32
bringing arm back to throw - what muscles produces this lateral rotation of arm?
teres minor, infraspinatus
33
lateral cord of brachial plexus is named because it lies immediately lateral to what?
axilliary artery - medial nerve is medial to artery, posterior nerve is posterior to artery
34
pronator teres syndrome?
median nerve - all five nerves pass thru diff tunnels where they may become compressed - median tunnel is betw median epicondyle and ulna coronoid process
35
does radial nerve divide? If so, where and how?
cubital fossa - superficial and deep - deep passing into posterior compartment, nerve can become entrapped - supinator syndrome (at this point nerve is called posterior interosseus nerve - has pierced supinator muscle
36
compression of ulnar may occur in what canal?
guyon canal - hypothenar muscles affected - palmar aspect of hand
37
pulse of radial artery - most common location - where vessel passes?
lateral to tendon of flexor carpi radialis
38
elder, hands sore when work with them, pain hand and fingers - testing show insuff blood to deep palmar arch - which artery?
radial - ulnar and radial anastomose - radial is deep, ulnar superficial
39
which arm vein is analagous to great saphenous vein of leg?
cephalic - both associated w/ first digits - different rotations put great toe medially, and thumb lateral
40
fracture of surgical neck of humerus - what artery and nerve are in danger?
posterior humeral circumflex artery and axilliary nerve -
41
slashing superficially in front wrist - what muscle tendons may be severed?
flexor carpi radialis - roof of carpal tunnel
42
young man punches locker - swelling over dorsomedial aspect and in hypothenar area of hand - likely injury?
boxer's fractures - fifth metacarpal fracture - unskilled
43
construction worker pain - freq lifts heavy objects over head - sharp pain 80 to 150 degrees of abduction at glenohumeral join?
supraspinatus tendonitis
44
car accident - rear ended - right arm on steering wheel - forced flexion at elbow - months later pins and needed little finger, or when typing
ulnar nerve in elbox is compressed - cubital tunnel syndrome -
45
stop at lippincott Q 37
almost done
46
rotator cuff SITS
supraspinatus - 0 -15 ABD (pre-deltoid)
most common injury to rotator cuff - thru degen or injury
empty/full can test
n - suprascap
Infrasupinatus - PITCHING injury
n - suprascap - external rotate
Teres minor - axil nerve
ext rotates, adducts
Subscapularis (upper and lower subscap nerve) plugs into lesser tubercle - all others into greater tubercle
internally roates and adduct art
47
arm ABDUction?
supraspinature 1 - 15 / n suprascap
deltoid 15 - 100 / n axil
>90 trapezius / n accessory
>100 serratus anterior SALT - n long thoracic
48
upper extremity nerves A, M, R, M U
axilliary - c5 -6
neck of humorus
anterior dislocatin of humerus
loss of deltoid, shoulder sensation
loss of arm abd 0 -15
49
Musultocutaneous c5 -7
biceps, weakness of forearm flexion, supination
| loss of sensation over lateral forearm
50
Radial c5 T1
cRutches, SatuRday night, Rist drop/flick
compression of Axilla (arm pit)
midshaft humurus fracture
scREWdriver use (finger drop)
all of back of arm, dorsal hand but fingertips and pinky dorsal
51
Median c5 - t1
supracondyle fracture of humerus - proximal lesion of nerve
carapl tunnel syndrome, wrist laceration - distal lesion of nerve
MONKEY ape hand,
POPE's blessing
Thumb opposition
finger tip sensations
52
Ulnar c8 - t1
fractured medial epicondyle of humerus FUNNY BONE
Hamate hook (Hamming it up with funny bone)
fractured hook from fall on outstretched hand
ulnar claw
53
recurrent branch of 5 - t1median nerve c
superficial laceration of palm
| ape hand
54
back of arm - I thought it was all radial nerve
but first aid show axil nerve (badge deltoid0 then radial, musculatcutaneous forearm, radia at thumb, medial forarm mediabrachael cutaneous, under arm medial brachial, cutaneous, to intercosta braceal near under arm
55
map of bracial plexus lesions
```
1 erbs palsy
2 claw hand - kumplex salsy - ulnar
3 Rist drop - radial
4 winged scapula (long thoracic)
5 deltoid paralysis
6 sat night right drop
7difficulty flexing elbow
8decreased tubm function - pope's blessing
9claw hand
```
56
notes from class
x
57
which is stronger bicep or radius?
radius - between radius and ulna - radius moves
58
what does annular lig connect?
The annular ligament is attached by both its ends to the anterior and posterior margins of the radial notch of the ulna, together with which it forms the articular surface that surrounds the head and neck of the radius.
59
dermatones which easier to distinguish where problem
if axial line isn't overlapping - c5 vs T2 as opposed to c5, c7
60
during masectomy, common nerve injured?
long thoracic
61
what muscle has two nerve supplies? high YIELD
Teres major is supplied primarily by the lower subscapular nerve and additionally by the thoracodorsal nerve (middle subscapular nerve). ... These three nerves branch off the posterior cord of the brachial plexus. The nerves that innervate teres major consist of fibers from spinal nerves C5-C8.
62
glenohumerol joints?
ball and socket joint between the scapula and the humerus. It is the major joint connecting the upper limb to the trunk. It is one of the most mobile joints in the human body, at the cost of joint stability.
63
What is axilliary sheath formed by? HIGH YIELD
prevertebral fascia -
The axillary sheath is a fibrous sheath that encloses the axillary artery and the three cords of the brachial plexus to form the neurovascular bundle, surrounded by the axillary fat. It is an extension of the prevertebral fascia of the deep cervical fascia.
64
What are the arteries that supply the arm and forearm?
The forearm region is thus supplied by two major vessels, the radial artery and ulnar artery. These arteries originate from the brachial artery at the apex of the cubital fossa, with the radial artery descending through the lateral part of the forearm and the ulnar artery through the medial part.
65
What muscle is most affected during winging of scapula?
Scapular winging is almost always caused by damage to one of three nerves that control muscles in your arms, back, and neck:
the long thoracic nerve, which controls the serratus anterior muscle.
the dorsal scapular nerve, which controls the rhomboid muscles.
the spinal accessory nerve, which controls the trapezius muscle.
66
What muscle causes winging of the scapula?
Scapula winging is caused by severe injury to the muscles that control the scapula or to the nerves that supply these muscles. One common cause is injury to the serratus anterior muscle.
67
axillary artery?
In human anatomy, the axillary artery is a large blood vessel that conveys oxygenated blood to the lateral aspect of the thorax, the axilla (armpit) and the upper limb. Its origin is at the lateral margin of the first rib, before which it is called the subclavian artery.
As it moves downward it becomes the brachial artery.
68
Axillary artery branches (mnemonic) ...
S AL SAP. Screw the lawyer, save a patient!
```
superior thoracic
thraco acromila
lateral thoracic
sucscapular
anterior circumflex
```
posterior circumflex
RUNS w/ axilliary nerve
69
What does the anterior circumflex humeral artery supply?
The anterior circumflex humeral artery provides part of the blood supply to the glenohumeral joint, teres major and minor, and deltoid muscles. The ascending branch provides supply to the head of the humerus
70
anterior and posterior circumflex anastamose?
The anterior humeral circumflex artery is an artery in the arm. It is one of two circumflexing arteries that branch from the axillary artery, the other being the posterior humeral circumflex artery. The anterior humeral circumflex artery is considerably smaller than the posterior ... muscle, and anastomoses with the posterior humeral circumflex artery.
71
posterior circumflex artery? Quadragular space
The posterior humeral circumflex artery (posterior circumflex artery, posterior circumflex humeral artery) arises from the third part of axillary artery at the lower border of the subscapularis, and runs posteriorly with the axillary nerve through the quadrangular space.
72
thoracic outlet syndrome?
Thoracic outlet syndrome is a group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) are compressed. This can cause pain in your shoulders and neck and numbness in your fingers.
There are 3 types of thoracic outlet syndrome:
Neurogenic: Affects nerves leading from the spinal cord to the neck to the arm. Most thoracic outlet syndrome cases involve nerves.
Venous: Affects veins.
Arterial: Affects arteries.
73
What passes through the superior thoracic aperture?
The superior thoracic aperture allows connection of the anatomic structures of the thorax and the neck. ... The right and left subclavian arteries and veins pass through the superior thoracic aperture.
74
What is its other name?
The superior thoracic aperture, also known as the thoracic inlet or outlet, connects the root of the neck with the thorax.
VAN compression of structures near 1st rib
75
What is the Interscalene triangle?
The inter-scalene triangle is a region of the neck that holds fundamental structures to upper extremity function. The triangle is composed of two muscles and the first rib. The two neck muscles are the anterior and middle scalenes.
76
What is the Interscalene triangle?
The inter-scalene triangle is a region of the neck that holds fundamental structures to upper extremity function. The triangle is composed of two muscles and the first rib. The two neck muscles are the anterior and middle scalenes.
NO VEIN - vein is in front of anterior scalene muscle
77
costoclavicular syndrome - soldiers!
first described in soldiers with loaded knapsacks, who developed pain, numbness, and fatigueability of the arms as they stood at attention.
78
Hyperabduction syndrome?
is often caused by prolonged or repetitive hyperabduction of the arm, which stretches the nerves and vascular bundles that run between the pectoralis minor tendon and the corocoid process.
common carpenters, construction workers, and plumbers.
79
What is Roos test?
To test for the presence of neural or vascular compromise in the thoracic outlet. Test position: Standing. Performing the Test: Have the patient abduct each shoulder to 90 degrees with the shoulders laterally rotated and the elbows flexed slightly behind the frontal plane.
EAST test - like arrested / surrender- hold 3 minutes
80
axil vein
axillary vein is a large blood vessel that conveys blood from the lateral aspect of the thorax, axilla (armpit) and upper limb toward the heart. There is one axillary vein on each side of the body. Its origin is at the lower margin of the teres major muscle and a continuation of the brachial vein.
81
The cephalic vein?
is a superficial vein of the upper limb and it's one of the two main veins of the arm. Its name derives from 'cephalic' meaning head, as the vein runs up to the shoulder. The superficial venous network is the source of blood for most blood tests, and is the easiest place to access venous blood
82
The basilic vein
is a large superficial vein of the upper limb that helps drain parts of the hand and forearm.
83
breast cancer - lymph nodes
Axillary" means "of the armpit," and the axillary lymph nodes are typically the first place breast cancer spreads to. You have many axillary nodes, and the first ones cancer is likely to move into are called the sentinel lymph nodes
84
Lymph nodes in axillary region?
The body has about 20 to 40 bean-shaped axillary lymph nodes located in the underarm area. ... They are about 1cm in size and are arranged into five groups: subscapular axillary (posterior), apical (medial or subclavicular), pectoral axillary (anterior), brachial (lateral), and central lymph nodes
feed tinto central collectors.
85
brachial plexus anterior vs posterior?
anterior - flex, posterior extend - posterior brachial doesn't give any branches
86
biggest nerve of brachial plexus?
radial
87
boxer's muscle
The serratus anterior is occasionally called the "big swing muscle" or "boxer's muscle" because it is largely responsible for the protraction of the scapula — that is, the pulling of the scapula forward and around the rib cage that occurs when someone throws a punch.
88
two types of scapular winging? - medial more common -
Winging of the scapula is divided into two categories, medial and lateral, according to the direction of winging. Medial winging is more common, being caused by serratus anterior paralysis. This is typically due to damage (i.e. lesions) of the long thoracic nerve.
89
Lateral winging - surgery, accessory nerve
The second category is the lateral winging which is caused by injury of the spinal accessory nerve. Severe atrophy of the trapezius is seen with accidental damage to the spinal accessory nerve during lymph node biopsy of the neck.
90
two types of scapular winging? - medial more common -
Winging of the scapula is divided into two categories, medial and lateral, according to the direction of winging. Medial winging is more common, being caused by serratus anterior paralysis. This is typically due to damage (i.e. lesions) of the long thoracic nerve.
TEST - push against wall
91
iotrogenic injury?
from surgery, medical treatment
92
most common hand/arm injuries
Common Hand and Arm Injuries
Tennis elbow. - radial nerve
Golfer's elbow. -
cubital tunnel syndrome. This condition is caused by a pinched ulnar nerve as it crosses the elbow on its way to the hand
Frozen shoulder.
Frozen shoulder is the common name for adhesive capsulitis, which is a shoulder condition that limits your range of motion. When the tissues in your shoulder joint become thicker and tighter, scar tissue develops over time. As a result, your shoulder joint doesn't have enough space to rotate properly.
Flexor tendinitis.
swelling in the tendons that help control hand movement.
Rotator cuff tear.
93
musculocutaneous nerve.?
It supplies three flexor muscles in the arm, the first of which is a shoulder flexor, coracobrachialis. The musculocutaneous nerve runs right through coracobrachialis, and emerges here, deep to the biceps. It runs down the arm between biceps and brachialis, supplying both muscles.
94
musculocutaneous nerve.?
It supplies three flexor muscles in the arm, the first of which is a shoulder flexor, coracobrachialis. The musculocutaneous nerve runs right through coracobrachialis, and emerges here, deep to the biceps. It runs down the arm between biceps and brachialis, supplying both muscles.
supinates radius, ulna, fexes elbox jt, flexes shoulder jt
95
rule if two joint muscle
first action is closest to insertion (so need to know where the insertion is) - usually the farthest away - distal
96
What is meant by origin and insertion of a muscle?
Origin is the attachment site that DOES NOT MOVE during contraction, while the insertion is the attachment site that does move when the muscle contracts. The insertion is usually distal, or further away, while the origin is proximal, or closer to the body, relative to the insertion.
97
how much can a muscle typically shorten
1/3 of resting -
98
The medial brachial cutaneous nerve ?
provides sensation to the medial cutaneous aspect of the arm. It is the smallest and most medial branch of the brachial plexus, originating from C8 and T1. As it descends down the arm, it courses with basilic vein, terminating at the distal third of the medial arm
99
how do nerve communicate?
run in same sheath
100
important dermatones?
t10 - umbilicus
t4 nipple
L1 groin
s1 sole of foot
Upper extremity
C6 - Thumb
C7 - Middle finger
C8 - Little finger
T1 - Inner forearm
T2 - Upper inner arm
Lower extremity
L3 - Knee
L4 - Medial malleolus
L5 - Dorsum of foot
L5 - Toes 1-3
S1 - Toes 4 and 5; lateral malleolus
Other
C2 and C3 - Posterior head and neck
T4 - Nipple
T10 - Umbilicus
101
Cubital Tunnel Syndrome?
is a condition that involves pressure or stretching of the ulnar nerve (also known as the “funny bone” nerve), which can cause numbness or tingling in the ring and small fingers, pain in the forearm, and/or weakness in the hand.
102
Pronator teres syndrome?
can't make the OK sign -
is a compression neuropathy of the median nerve at the elbow. It is rare compared to compression at the wrist (carpal tunnel syndrome) or isolated injury of the anterior interosseous branch of the median nerve (anterior interosseous syndrome).
103
thoracodorsal nerve?
middle subscapular nerve or the long subscapular nerve. It supplies the latissimus dorsi muscle. It arises from the brachial plexus. It derives its fibers from the sixth, seventh, and eighth cervical nerves.
104
erb's palsy? baby delivery, waiters
Erb's palsy is a paralysis of the arm caused by injury to the upper group of the arm's main nerves, specifically the severing of the upper trunk C5–C6 nerves. These form part of the brachial plexus, comprising the ventral rami of spinal nerves C5–C8 and thoracic nerve T1.
105
erb's palsy vs klumpke's
Erb-Duchenne (Erb's) palsy refers to paralysis of the upper brachial plexus. Dejerine-Klumpke (Klumpke's) palsy refers to paralysis of the lower brachial plexus.
106
Other birth problem?
In Klumpke's palsy, the muscles of the forearm, wrist and hand are most affected. It is caused by a birth injury to the neck and shoulder due to a difficult vaginal delivery, tumor of the lung or shoulder, or trauma to the arm and shoulder. The nerves may be stretched or torn, causing weakness, pain or numbness.
107
operating table injury?
radial nerve compression - tourniquet on thin person -
108
if injury to nerve in spinal groove - can elbow still work?
yes, elbow extension spared
109
tennis elbow?
injury to lateral epicondytes
110
figuring out where radial nerve not working?
if elbow work but wrist drop - means ?
if both elbow and wrist not working - means injury is higher up
111
Ulnar paradox :
The higher the lesion of the median and ulnar nerve injury , the less prominent is the deformity and vice versa, because in higher lesions the long finger flexors are also paralysed (which were causing interphalangeal flexion/clawing).
112
Image result for what if patient can't make the OK sign?
Unable to do the O.K. sign means that there is a loss of motor function. There will be aching in the anterior forearm. A patient with a complete anterior interosseous nerve injury or a high medial nerve injury is asked to make a fist.
Injuries to the arm, forearm or wrist area can lead to various nerve disorders. ... If the median nerve is damaged, the ability to abduct and oppose the thumb may be lost due to paralysis of the thenar muscles. Various other symptoms can occur which may be repaired through surgery and tendon transfers.
113
rotator cuff injuries -
weakness two ways - muscle messed up OR nerve not working at muscle. If nerve not working - no pain.
s supraspinatus ABd 0 - 15%, empty can can you push arm down?, or drop art test - lowering arm until 15% then if problem, drops
infraspinatous- external rotation - arm behind back - can they push back?
teres minor (doesn't matter)
s - front of scap -INTERNAL rotation - test - adduct arm to torso, bend elbow -push are out and see if they can push it medially back in
114
shoulder dislocations? two types
elbow adducted in both -
anterior - external rotate COMMON - sports injury, fall from standing
DANGER - putting back in - can damage AXIL nerve
posterior - internal rotation - lots of force LIghtning STRIKE - seizures, etc
115
Elbow - 3 problems
medial epicondyle - where hand flexes - GOLFERS elbow
lateral epicondyle - where hand extends - TENNIS Elbow
test - have person do the extend or flex and push against - see if they can resist
3. Radial head sublacation
ulna and radius connected via annular ligament - ulna yanked out - and when ulna comes back in - KIDS yanking - when arm extended - hurts because ligament is now in the way
116
wrist
carpal tunnel - medial nerve soft - bones hard - compressing - thenar weakness is LATE sign - complain pain - tapping on wrist or having them try to put not the reverse of palms together -
Ulnar nerve compression - CYCLISTS -wrist on handlebar - wear gloves/pad
117
hand fractures?
Torus vs greenstick
Torus - buckle fractures, are incomplete fractures of the shaft of a long bone that is characterized by bulging of the cortex. They result from trabecular compression due to an axial loading force along the long axis of the bone
118
two types of break?
greenstick on one side, force perpendicular to bone -
torous fracture - axial stress -
Boxer's fracture - 5th finger hurt
119
FOOSH - fall on outstretched hand - 3 types
Scaphoid - adult male (vignette) - watershed area - if breaks not good blood supply - necrosis - often misdiagnose - pain at anatomical snuffbox and necrotic bone a week later
Radial head - old ladies - break near wrist - colles fracture - rare is smith fracture (flexed wrist fall)
supracondular humeral - MOST COMMON in kids - pain at elbow - usually at growth plate - weakest spot -
120
humerul fractures?
surgical neck - axil nerve
midshaft - radial n injury
supracondular - media nerve
medial condyle - ulnar n
121
crutches, sat night palsy?
wrist drop - radial nerve
122
medial nerve injury? proximal, distal, carpal tunnel
Pope's blessing - digits 1,2,3 can't flex - remain extended while making fist
proximal - lose more - lose elbow flex
distal
carpal tunnel? - one branch jumps over on the superficial area - likely spared if injuries more proximal
123
Ulnar injury - surgery injury - while people padded in proximal
proximal and distal
proximal - digits 4, 5 can't flex, can't make fist - operating table problem
distal - lose part of fingers = PIP, DIP flexed, MPM - extended
I didn't follow his explanation
124
dermatomes - tested all the time - not really useful except shingles
envision arm pushing at 7, mid finger c7
shoulder - c4
armpit t2
125
4 things to memorize re brachial plexus - because therre is no logic which explains which nerves should be where?
Erb's palsy?
Klempke
thoracic outlet syndrom
winged scap
1. erb's palsy - upper trunk - c5 - 6
waiters tip - asking for a tip when injured, baby delivery
stretching out higher nerve rooms - fall with neck stretched out -
126
Klempke's claw
childbirth - breach birth - pulling on arm to get baby out
adults - falling from height - catching self on rail, tree branch - shear lower trunk
loses all - hand power lose lumbricals.
MCPs extended
dip, pip flexed CLAW
127
thoracic outlet syndrome
klempke's + edema - pancoast tumor or cervical rib - call it this
128
winged scap - loss of long thoracic that innervates serratus - ABD
can injure in lymph node dissection.
129
breasts saggy?
cooper's ligaments suspensory
130
lateral lower scap injury?
can't medial rotate or adduct humerous
nerve - lower subscap -
131
court stenographer, weakend carpal tunnel muscles?
thenar and lumbricals I II
132
fracture medial epicondyle, torn ulnar, what muscle injured?
flexor carpi ulnaris (1 and a half muscles) in forearm, and half of digitorum profundis (half)
133
midshaft humerul fracture?
damage radial n and deep brachial artery
134
humerus francture 1 in ch proximal to epicondyles? - what nerve?
median at risk
135
wrist drop ? radial - but here asking for branches
posterior interosseus
The posterior interosseous nerve, also known as the dorsal interosseous nerve, is the continuation of the deep branch of the radial nerve after it penetrates the supinator muscle. It carries fibres from the C7 and C8 spinal nerves, and supplies the majority of the muscles in the posterior compartment of the forearm.
136
breaks in humerous, not much flexion, supination of forearm - loss of lateral surface of forearm?
msuculocutaneous
137
radial bursa in thumb (bitten by dog) - tendon?
flexor pollicus longus
138
which artery at risk at cubital fossa? contents of cubital fossa?
biceps brachii tendon, brachial artery, median nerve
139
lymph from skin near xyphoid drains where?
axillary lymph nodes - skin of anterior chest all
140
graft of long thoracic = what arteries will supply blood to anerior part of upper IC spaces?
posterior intercostal - anastamose with anterior
141
radial pulse palpation lateral to?
flexor carpi radialis tendon - compressed against distal radius
if in snuffbox - radial artery against scaphoid
142
inability to flex distal interphalangeal joints of 4,5 digit? guy walks thru plate glass window
flexor digitorum profundus affected
ulnar nerve superficial
143
wound palm of hand - can't touch thumb to fingers?
recurrent branch of median,
144
child's jerked arm?
anular ligament
145
Erb's syndrome? what part of trunk?
roots of UPPER trunk
146
anatomical snuffbox m?
extensor pollicis brevis, extensor and flexor pollicis longus
147
nerve adducted fingers?
ulnar
148
post shoulder dislocation, following fixing it - can't abduct arm normally - which muscle torn
supraspinatus
149
tennis player - rotator cuff injury, shoulder lig damaged?
coracoacromial lig has over years use of use damaged muscle supraspinatus tendon area
150
three middle digits numb, hard to move, carpenter
atrophy of thenar eminence - compression of median nerve in carpal tunnel
151
accident - unable to extend left wrist, finger, thumb but can extend elbow - no sensation lateral half of dorsal hand?
radial nerve, midhumerus
152
knife fight, weak elbow flexion and supination of left hand - - expect to see what other conditions?
sensory loss over lateral surface of forearm - musculocutaneous nerve damaged (which allow flexion of elbow)
153
lateral thoracic artery arises from what artery?
2nd part of axillary
154
drug addict absess where shoots up - what muscles affected in
brachialis, supinator - all in cubital fossa
155
dr asks patient to make z with hand -
testing deep branch of ulnar
156
skin dimpling orange peel in breast cancer due to what structures?
suspensory ligaments
157
breast cancer - if metastasize - goes to what lymph first?
anterior axilliary lymph level 1
then central level 2, then apical level 3
158
breast cancer - if metastasize - goes to what lymph first? level 1 - 3 based upon nodes nearness to which muscle? pectoralis minor
anterior axilliary lymph level 1
then central level 2, then apical level 3
159
what muscle spreads (abducts) fingers?
dorsal interosseous
160
cyclist nerve compression - involve 4 5 digit
ulnar nerve at wrist - betw pisiform and hook, ulnar canal syndrome, guyon tunnel syndrome
161
carpal tunnel harms which muscles of hand?
thenar - Lumbricals I, II - which are innervated by MEDIAL n.
162
1 and a half muscles of Ulnar n?
flexor carpi ulnaris and medial half of flexor digitoris profundis
163
Three compartments of arm?
Arm - musculotaneous - c5-6
Anterior Forearm - median and ulnar (1 1/2)
Posterior Forearm - radial
164
Hand compartments?
MEDIAN N
thenar
Central (Digits 2 -3) flex MP, extend PIP, DIP
Hyperthenar
165
Posterior interosseous nerve?
Radial - also known as the dorsal interosseous nerve, is the continuation of the deep branch of the radial nerve after it penetrates the supinator muscle. It carries fibers from the C7 and C8 spinal nerves, and supplies the majority of the muscles in the posterior compartment of the forearm
166
anterior interosseous nerve
MEDIAN- (volar interosseous nerve) is a branch of the median nerve that supplies the deep muscles on the anterior of the forearm, except the ulnar (medial) half of the flexor digitorum profundus
167
thumb bite - what tendons affected?
flexor pollicus longus / radial bursa
168
cubital fossa - what artery may be harmed during venipuncture?
```
Brachial - contents of c fossa?
TAN -
Tendon - biceps branchai
Artery brachial
N - Median
```
169
if injury where can't move 4,5 finger - likely ULNAR n involved - what muscles in forearm?
flexor digitorum profundis and flexor carpi ulnaris (1 and 1/2 muscles)
170
recurrent branch of median supplies?
thenar eminance
171
holding paper between fingers?
tests ADD - deep branch of ulnar nerves
172
serratus anterior ? actions, innervation, problems?
abducts beyond 90, long thoracic, winging of scapula - holds medial scapula to chest wall
173
Lateral winging? IATROGENIC ~
Posterior cervical triangle
from trapezius paralysis with injury to the spinal accessory nerve, is most likely iatrogenic from procedures involving the posterior cervical triangle.
The omohyoid muscle splits the posterior triangle of the neck into two: The larger, superior part is termed the occipital triangle. The inferior triangle is known as the subclavian triangle and contains the distal portion of the subclavian artery.
174
Erb's palsy - what part of brachial plexus?
upper - c5-6
175
annular ligament?
child's arm being jerked - or childbirth -
176
Pancoast tumor?
thoracic outlet syndrome - lung tumor near 1st rib - scalene triangle
lower trunk compression like Klumpke's
177
two common injuries to axil nerve?
fracture neck of humerus, anterior dislocation of humerus
178
pitching injury? Pitch in the INfield
infraspinatous m - suprrasca n
179
putting dislocated shoulder back in?
be careful re axillary nerve
anterior dislocation common -
posterior very diff to do - electricity, seizure
180
only intrinsic m on dorsum of foot?
extensor digitorum brevis
181
scapula is formed by which type of mesoderm?
somatic lateral plate gives rise to bones, cartialge
muscles - somitic meso
axial mesoderm - notochord
splanchnic lateral plate forms smooth muscle and CT of viscera
muscles -
182
When are muscles most powerful?
when stretched
sarcomeres at optimum tension producing length
183
radial nerve palsy shows what in hands?
inability to extend MP joints
184
What muscle can entrap posterior interosseus (radial) nerve?
supinator
185
what vessel at risk with displaced clavicular fracture?
subclavian vein
186
colles fracture always breaks which bone?
radius, sometimes ulna
187
which bone in wrist is often dislocated?
lunate
188
flexor retinaculum stretches between?
scapoid and trapezium to PISIFORM
189
sesamoid bones near thumb w/ what muscle?
flexor polliscis brevis
190
older women falls?
CERVICAL femoral neck
femoral neck - w compression if can still walk if not - complete displacement
191
flexion of thigh comes from PSOAS - so if gluteal, hip injury?
flexion of thigh will be least affected -
if blood supply cut off from gluteal area - quzds will still get blood
192
hip displacement often puts at risk what nerve?
sciatic
193
anterior compartment of leg, what N?
deep fibular
194
Jones fracture - 5th metatarsal in foot broken, what M?
fibularis peroneus brevis - protator and everter
195
dorsum of foot no sense?
common fibular
all muscle in ANTERIO and LATERAL compatments of LEG - and sensory innervatin to dorsum of foot
196
purse in dodrsalis pedis artery palpated where?
bewteen Extensor HALLUCIS and digitorum
