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MRCS A > ANATOMY - upper limb p3 > Flashcards

ANATOMY - upper limb p3 Flashcards

1
Q

what nn roots forms the brachial plexus?

A

anterior rami C5,6,7,8 + T1

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2
Q

how to remember the parts of the brachial plexus

A

read that damn cadaver book!
Roots
Trunks
Divisions
Cords
Branches

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3
Q

which mm do the brachial plexus roots pass between after forming from anterior rami

A

ant + medial scalene mm

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4
Q

what are the 3 trunks of the brachial plexus

A

superior - C5/6
middle - C7
inferior - C8/T1

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5
Q

into what region of the neck do the trunks of the brachial plexus traverse laterally towards

A

posterior triangle of the neck

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6
Q

where do the trunks of the brachial plexus become division

A

in post triangle of neck - divide into ant + post divisions - then leave into axilla to recombine to become the cords

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7
Q

how are the 3 cords of the brachial plexus named?

A

in relation to the axillary aa

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8
Q

lateral cord brachial plexus consists of

A

anterior division sup trunk
anterior division middle trunk

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9
Q

posterior cord of brachial plexus consists of

A

posterior divisions of sup, mid + inf trunks

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10
Q

medial cord of brachial plexus consists of

A

anterior division of inferior trunk

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11
Q

draw brachial plexus

A

plz

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12
Q

nn roots musculocutaneous nn

A

C5,6,7

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13
Q

motor inn musculocutaneous nn

A

biceps
brachialis
coracobrachialis

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14
Q

sensory inn musculocutaneous nn

A

lateral cutaneous branch to forearm - lateral 1/2 anterior forearm + small portion post forearm

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15
Q

which cord is the musculocutaneous nn the terminal branch of

A

lateral

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16
Q

anatomical course musculocutaneous nerve

A

emerges inferior border pec minor to leave the axilla
pierces coracobrachialis
passes into flexor compartment, superior to brachialis but deep to biceps
pierces deep fascia lateral to biceps –> lateral cutaneous branch

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17
Q

Sx musculocutaneous nn injury

A

weakness in flexion + supination

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18
Q

axillary nn roots

A

C5 + 6

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19
Q

motor inn axillary nn

A

teres minor
deltoid

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20
Q

sensory inn axillary nn

A

sup lateral cutaneous nn –> regimental badge area

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21
Q

which cord is the axillary nn a continuation of?

A

posterior cord

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22
Q

anatomical course axillary nn

A

starts in axilla, post to axillary aa + ant to subscapularis
exits axilla at the inferior border subscapularis via the quadrangular space
passes medially to surgical neck to branch into 3
1) post terminal branch - motor inn post deltoid, teres minor, regimental badge sensory
2) ant terminal branch 0 winds round neck humerus - ant deltoid
3) articular brach to glenohumeral joint

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23
Q

Sx injury axillary nn

A

can’t abduct arm past 15’
regimental badge area sensory loss

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24
Q

Erbs palsy is 2’ to

A

damage to C5/6 nn root
axillary, musculocutaneous, suprascapular + nn to subclavius

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25
Q

Sx Erbs palsy

A

can’t abduct/ext rotate shoulder (axillary nn)
can’t supinate forearm, flex shoulder
–> Waiters tip - medially rotated w/ wrist flexed

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26
Q

median nn roots

A

C6-T1

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27
Q

motor inn median nn

A

flexors forearm
thenar mm
lateral 2 lumbricals
flexion wrist+ digits
pronation forearm
flexion at MCPJ
extension at IPJ

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28
Q

sensory inn median nn

A

palmar cutaneous branch - lateral palm
digital cutaneous branch - lateral 3 1/2 palmar digits

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29
Q

which cords of the brachial plexus does the median nn arise from

A

medial and lateral cords

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30
Q

anatomical course median nn

A

descends initially LATERAL to brachial aa
1/2 way - crosses aa –> MEDIAL to brachial aa
enters ant forearm via AC fossa
travels down forearm betw FDP + FPS (gives off 2 branches - ant interossous - deep ant forearm mm + palmar cutaeneous - lat palmar skin)
enters hand via carpal tunnel to terminate as:
- recurrent branch - thenar mm
palmar digital branch - palmar skin lat 3 1/2 digits + 2 lumbricals

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31
Q

cause median nn damage at elbow

A

usually 2’ to supracondylar fracture

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32
Q

Sx median nn damage at elbow

A

constant forearm supination
weak wrist flexion
thenar eminence wasting
hand of Benediction

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33
Q

cause median nn damage at wrist

A

2’ laceration flexor retinaculum

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34
Q

Sx median nn damage at wrist

A

thenar + lat 2 lumbricals affected
+ hand benediction

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35
Q

radial nn root s

A

C5-T1

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36
Q

motor inn radial nn

A

triceps brachii
posterior forearm mm

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37
Q

sensory inn radial nn

A

posterior forearm + arm
posterolateral dorsal hand

38
Q

which cord is the radial nn a continuation of

A

posterior cord

39
Q

anatomical course radial nn

A

arises in axilla, posterior the axillary aa
exits via traignular interval to supply lat + long head triceps
descends in radial groove
wraps around humerus laterally - supply med head triceps
3 cutaneous branches - lower lateral (lat arm inf to deltoid insertion), post cutaneous (post arm) - post cutaenous forearm (mid post forearm)

enters forearm anterior to lateral epicondyle @ cubital fossa, then braches to derminate as:
deep branch - post mm forearm
superificial branch - sensation dorsal hand/fingers
after it innervates the supinator, continues as the posterior interosseous nn

40
Q

Sx of radial nn injury in axilla

A

wrist drop
loss of sensation

41
Q

Sx radial nn injury in radial groove

A

triceps weakened
wrist drop
superficial sensory branch affected

42
Q

Sx radial nn injury in forearm

A

superficial branch if 2’ to stabbing - lat 3 1/2 digits + dorsum sensory loss
deep branch (2’ fracture/dislocation) - no wrist drop as ECRL unaffected

43
Q

ulnar nn roots

A

C8, T1

44
Q

motor inn ulnar nn

A

mm hand except thenar + lat 2 lumbricals
FCU + med ½ FDP

45
Q

sensory inn ulnar nn

A

ant + post surface medial 1 ½ fingers

46
Q

anatomical course ulnar nn

A

descends in plane between axillary aa (lat) + axillary vv (med)
down med aspect of arm with brachial aa laterally
mid point of the arm - penetrates the emdial fascial septum –> post arm compartment
passes posterior to elbow –> ulnar tunnel (here articular branch to supply elbow joint)
in forearm - pierces FCU, travels deep to mm alongside ulnar
3 main branches in forearm - mm branch - FCU + med ½ FDP, palmar cutaneous branch - med 1 ½ palm + dorsal cutaneous branch - dorsal surface med 1 ½ fingers
travels superficial to flexor retinaculum + medial to ulnar aa –> hand via ulnar canal
terminates into sup (palmaris brevis) + deep (hypothenar mm, med 2 lumbricals, palmar + dorsal interossei) branches

47
Q

which mm is tested for with Froments

A

adductor pollicis

48
Q

What is the ulnar paradox

A

different manifestation of a high ulnar nerve lesion (at the elbow) and a low ulnar nerve lesion (at the wrist). In a high lesion the clawing is paradoxically more mild than in a low lesion

49
Q

minor branches from brachial plexus roots (2)

A

dorsal scapular nn
long thoracic nn

50
Q

minor branches from the brachial plexus trunks (2)

A

suprascapular nn
nn to subclavius

51
Q

minor branches from lateral cord brachial plexus (1)

A

lateral pectoral nn

52
Q

minor branches from the medial cord brachial plexus (3)

A

medial pectoral nn
medial cutaneous nn of arm
medial cutaneous nn of forearm

53
Q

minor branches from the posterior cord brachial plexus (3)

A

superior subscapular nn
thoracodorsal nn
inferior subscapular nn

54
Q

what is Klumpe’s palsy 2’ to

A

injru to lower roots of brachial plexus C8-T1
assoc w/ dificult vaginal delivery

55
Q

which nn are most commonly affected in Klumpe’s palsy (2)

A

ulnar nn
median nn

56
Q

Sx Klumpe’s palsy

A

clawed hand 2’ to lumbricals paralysis

57
Q

what are the 5 main vessels of the UL

A

SCA
Axillary
brachial
Radial
Ulnar

58
Q

where does the SCA originate from on the R vs L

A

R - brachiocephalic trunk
L - arch of aorta

59
Q

which mm divides the SCA into 3 parts

A

anterior scalene

60
Q

1st vs 2nd vs 3rd part SCA location

A

1st part = origin SCA –> med border ant scalene
2nd part = posterior to ant scalene
3rd part = lat border ant scalene to 1st rib

61
Q

what does the SCA become once it enters the axilla ?

A

axillary aa

62
Q

which mm is the axillary aa deep to

A

pec minor

63
Q

what surrounds the axillary aa

A

axillary sheath

64
Q

how is the axillary aa divided in 3?

A

via relation to pec minor
1) proximal to pec minor
2) post to pec minor
3) distal to pec minor

65
Q

branches in 1st part axillary aa

A

PROXIMAL TO PEC MINOR
superior thoracic aa

66
Q

branches in 2nd part axillary aa

A

POST TO PEC MINOR
thoraco-acromial aa
lateral thoracic aa

67
Q

branches in 3rd part axillary aa

A

subscapular aa
ant = post circumflex aa

68
Q

which mm’s lower border does the axillary aa become the brachial aa

A

teres major

69
Q

1st branch brachial aa

A

profunda brachii

70
Q

which nn does the profunda brachii travel with

A

radial nn (hence supplies triceps)

71
Q

where does the profunda brachii terminate

A

at an anastomotic network around the elbow

72
Q

what does the radial aa supply

A

psterolat forearm
elbow joint + carpals via anastomotic network
thumb, index + palmar arches (after goes through snuffbox)

73
Q

where can you palpate the radial aa in the arm

A

lateral to FCR tendon

74
Q

between which mm head does the radial aa travel through the anatomical snuffbox

A

Abductor pollicis brevis

75
Q

what does the ulnar aa supply

A

anteromed foreoarm
anastomoses - elbow joint
then ant + post interosseous aa
superifical and deep palmar arches

76
Q

where does the ulnar aa enter the hand

A

anterior to flexor retinaculum
lateral to ulnar nn

77
Q

where is the superficial palmar aa arch + what does it supply

A

anterior to flexor tendons of the hands
deep to the palmar aponeurosis
becomes digital aa to the 4 fingers

78
Q

where is the deep palmar arch and what does it supply

A

deep to flexor tendons
blood to digits + wrist joint

79
Q

what are the 2 main superficial vv of the upper limb

A

cerphalic vv + basilic vv

80
Q

what drains into the basilic vv

A

dorsal vv network

81
Q

where does the basilic vv ascend on the upper limb

A

medial aspect

82
Q

where does the basilic vv leave the arm

A

border teres major

83
Q

where does the basilic vv drain into

A

+ brachial vv –> axillary vv

84
Q

what drains into the cephalic vv

A

dorsal vv network

85
Q

where does the cephalic vv ascend in the UL

A

anterolateral aspect of the upper limb, anteriorly at elbow

86
Q

between what 2 muscles does the cephalic vv travel before entering the axillary at the clavicopectoral groove

A

deltoid
pec minor

87
Q

where does the cephalic vv drain into

A

axillary vv

88
Q

what vv connects the basilic and cephalic vv at the elbow

A

medial cubital vv

89
Q

where are the deep vv of the UL

A

under the deep fascia

90
Q

which is the largest of the deep vv of the uL

A

brachial vv

91
Q

what is vena comitantes

A

pulsations of the aa (e.g. brachial aa) assist w/ vv return

92
Q

what connects the superficial and deep vv of the UL

A

perforating vv

MRCS A (36 decks)

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