Arm anatomy Flashcards
how many osteofascial compartments is the upper arm divided into?
two (anterior and posterior)
Name the three muscles of the upper arm that make up the anterior osteofacial compartment
Biceps Brachii
Coracobrachialis
Brachialis
name the muscle that is found in the posterior compartment of the upper arm
Triceps brachii
Biceps receive innervation from which nerve
A - musculocutaneous nerve
B-radial nerve
C- ulnar nerve
D- median nerve
A - musculocutaneous nerve (c5-C7)
Triceps Brachii recieves innervation from which nerve
A - musculocutaneous nerve
B-radial nerve
C- ulnar nerve
D- median nerve
B - radial nerve (C5-T1)
what is the name of main arterial supply to the upper arm
Brachial artery
What is the name of the artery when it first branches of the aortic arch before it becomes the brachial artery?
Subclavian artery
what is the name of the subclavian artery once it passes the first rib to enter the axilla
axillary artery
when the axillary artery passes the inferior border of teres major what is the artery now called?
brachial artery
the brachial artery runs above the deep fascia in the upper arm
True or False
false - the brachial artery runs below the deep fascia (it is sub fascia) but takes a superficial course along the medial aspect of the upper arm
What is the name of the two branches that the brachial artery divides into at the level of the radius
ulnar and radial artery
how many branches does the brachial artery have?
1
2
3
4
4
what are the names of the two veins that drain the upper arm
cephalic and basilic vein
the cephalic vein runs above or below the deep fascia in the upper arm?
above the deep fascia for its course in the upper arm
at what point does the bascilic vein thought to lie below the deep fascia
it is thought that the basilic vein pierces into the deep facia around the mid shaft of the humerus and then runs below the deep fascia proximally (so approximately 5-8cm above medial epicondyle the basilic vein will be above the fascia and prone to injury here)
what does the basilic vein drain into?
brachial vein
what is the origin of the axillary nerve in the brachial plexus
C5-C6
which nerve supplies the deltoid, teres major and lateral head of the triceps brachii
A- Axillary nerve
B-Radial Nerve
C- Ulnar nerve
D- Musculocutaneous nerve
axillary nerve
what is the origin of the radial nerve in the brachial plexus
C5-T1
what is the name of the ‘groove’ that the radial nerve runs in on the posterior aspect of the humerus
radial groove
what area of the hand does the radial nerve supply?
dorsal of the hand - lateral 3 and half fingers (thumb, then 2 1/2 fingers)
a patient presents with wrist drop, which nerve is likely to have been injured?
A- Axillary nerve
B-Radial Nerve
C- Ulnar nerve
D- Musculocutaneous nerve
B - radial nerve
what is the origin of the musculoskeletal nerve in the brachial plexus
C5-C7
what is the role of the musculoskeletal nerve in the forearm
supplies the lateral aspect of the forearm
what are the nerve roots of the median nerve at the brachial plexus
C6-T1
what is the sensory nerve supply of the median nerve
supplies the lateral 3 and half fingers of the palmar (anterior) surface of the hand
what are the nerve roots of the ulnar nerve
c8-t1
a patient presents with weak thumb adduction and you notice the hand has a clawed appearance. You suspect damage to which nerve?
A- Axillary nerve
B-Radial Nerve
C- Ulnar nerve
D- Musculocutaneous nerve
c- ulnar nerve
what is another name given to the brachial fascia
deep fascia
what is the maximum dose of lidocaine per kg without adrenaline based on the emu
4.5mg/kg
what is the maximum dose of lidocaine with adrenaline (mg/kg)
7mg/kg
what type of local anaesthetics are lidocaine and mepivircane
amides
local anaesthetics work to block which type of voltage gated ion channels
sodium voltage gated ion channels
where is the binding site located for LA on the sodium voltage gated channels
domain 4, loop S of sodium voltage gated ion channels
local anaesthetic action is dose dependent - true or false
true - with increased LA doses the peak action potential is reduced and firing threshold of the nerve increases, refractory period lengthens
what type of nerve fibres innervate the muscle
myelinated A gamma fibres
what type of nerve fibres transmit nocioception
A-sigma fibres
Sympathetic or parasympathetic nerve fibres most easily blocked by LA
sympathetic nerve fibres
why can we increase the maximum dose of lidocaine when combined with adrenaline
adrenaline is a vasoconstrictor and therefore when LA is combined with adrenaline this allows for less systemic absorption resulting in less toxicity
Name the co-morbidities and medications that we should avoid using LA in combination
patients taking beta blockers
heart block
TCA
MOIs
What is the treatment used in LA toxicity that causes a sustained bradycardia?
atropine 500mcg IV or IM can be repeated every 3-5 minutes with a max dose of 3mg
how many milligrams of lidocaine does 1ml of 3% lidocaine contain
30mg per ml
(% times 10 - therefore 1% = 10mg/ml, 2%= 20mg/ml, 3%=30mg/ml)
what is the maximum dose for kg of mepivircaine
6mg/kg
what nerve is most vulnerable to damage during nexplanon insertion
ulnar nerve
if looking at a coronal view of an arm when a patient is lying with the hand behind their head (in the recommended position) for nexplanon insertion. Starting at the biceps moving down the arm list the structures in order that you would find them within the neuromuscular bundle in the upper arm
biceps muscle
Median nerve
Basilic vein
Brachial artery
Ulnar nerve
triceps muscle
out of the following list of local anaesthetics which are classed as amides
- lidocaine
- xylcocaine
- procaine
- mepivocaine
- cocaine
- prilocaine
- benzocaine
Amides are:
1. lidocaine
2. Xylocaine (this contains lidocaine)
4. mepivocaine
5. prilocaine
out of the following list which anaesthetics are esters
- lidocaine
- xylcocaine
- procaine
- mepivocaine
- cocaine
- prilocaine
- benzocaine
procaine
cocaine
benzocaine
which type of local anaesthetics have a higher rate of causing anaphylaxis?
esters or amide LA
esters
what metabolises esters
A) liver
B) kidneys
C)pseudocholinesterase
D) phosphodiesterase
c - pseudocholinesterase
where are amide LA metabolised
A) liver
B) kidneys
C)pseudocholinesterase
D) phosphodiesterase
A - liver
what types of LA does EMLA cream contain
emla cream contains lidocaine 2.5% and prilocaine 2.5%
how many milligrams of LA in total are contained in EMLA 5%
A) 20%
B) 25%
C) 50%
D) 100%
C - 50%
1% = 10mg per ml
so 5% = 50mg per ml
EMLA cream contains differing quantities of prilocaine and lidocaine
True or false
false - contains equal amounts 2.5% of both
which type of LA has a longer duration of action
A) esters
B) amides
B - amides
Local anaesthetics are structurally related to what recreational drug
cocaine
all LA are synthetic LA structurally related to cocaine
