Brachial and Lumbo-Sacral Plexuses

Question 1

What does the anterior wall of the axilla consist of?

Answer 1

+ Pectoralis major
+ Pectoralis minor/subclavius
+ Clavipectoral fascia (deep)

Question 2

What is pectoralis major palpable as?

Answer 2

The anterior axillary fold

Question 3

What is the movement of the humerus at the GH joint?

Answer 3

+ Adduction
+ Medial rotation
+ Flexion
+ Extension

Question 4

Where does pectoralis minor attach?

Answer 4

+ Ribs 3-5

+ Coracoid process of the scapula

Question 5

What supplies pectoralis minor?

Answer 5

Medial pectoral nerves

Question 6

Where does the subclavius attach?

Answer 6

from superior border of 1st rib to inferior surface of middle 1/3 of clavicle

Question 7

What is the medial wall of the axilla composed of?

Answer 7

+ Ribs and intercostal spaces

+ Serratus anterior

Question 8

Where does serratus anterior attach?

Answer 8

Ribs 1-9 to medial margin of scapula

Question 9

What are the movements and functions of serratus anterior?

Answer 9

+ Superior external rotation of scapula
+ Draws scapula internally and forwards
+ Lowers the arm from a raised position
+ Elevation of ribs

Question 10

What parts of the biceps and coracobrachialis are sometimes included in the contents of the axilla?

Answer 10

The proximal parts

Question 11

What structures form the lateral wall of the axilla?

Answer 11

+ bicipital wall

+ proximal parts of biceps and coracobrachialis

Question 12

What structures from the posterior wall of the axilla?

Answer 12

+ subscapularis
+ latissimus dorsi
+ teres major

+ scapula

Question 13

where does the radial nerve pass?

Answer 13

posteriorly through lower triangular space with profunda brachii artery

Question 14

what does the radial nerve supply?

Answer 14

+ all extensor muscles of arm and forearm

+ posterior skin of arm, forearm and hand

Question 15

what are the roots of the radial nerve?

Answer 15

C5-8, T1

Question 16

what are the roots of the axillary nerve?

Answer 16

C5-6

Question 17

where does the axillary nerve pass?

Answer 17

through quadrilateral space and lies on surgical neck of humerus with posterior circumflex humeral artery

Question 18

what does the axillary nerve supply?

Answer 18

+ deltoid
+ teres minor
+ skin over lower part of deltoid

Question 19

what are the roots of the musculocutaneous nerve?

Answer 19

C5-7

Question 20

where does musculocutaneous lie?

Answer 20

• it pierces coracobrachialis

- travels between brachialis and biceps brachii

Question 21

what does musculocutaneous supply?

Answer 21

flexor compartment of arm (BBC)

- biceps brachii, brachialis, coracobrachialis

Question 22

what does muculocutaneous become in the forearm?

Answer 22

lateral cutaneous nerve

Question 23

what are the roots of the median nerve?

Answer 23

C5-8 (lateral cord)

T1 (medial cord)

Question 24

where does the median nerve lie?

Answer 24

in the cubital fossa - travels with brachial artery

Question 25

what does the median nerve supply?

Answer 25

+ all flexor muscles of forearm (except 1.5) + thumb (thenar) muscles except 1 and lateral 2 lumbricals + skin over lateral palm + latter 3 1/2 digits including nail beds

Question 26

what are the roots of the ulnar nerve?

Answer 26

C8, T1

Question 27

where does the ulnar nerve lie?

Answer 27

passes posterior to the elbow

Question 28

what does the ulnar nerve supply?

Answer 28

``` + 1.5 flexors of forearm + majority of intrinsic muscles in hand (1 thenar muscle, all hypothenar and interosseal muscles and medial 2 luumbricals) + skin over palm + medial 1.5 digits ```

Question 29

what is caused by a traction injury to the upper trunk (C5, C6)?

Answer 29

Erb-Duchenne Palsy/Erb's Paralysis

Question 30

what are symptoms of Erb-Duchenne Palsy?

Answer 30

+ paralysis of muscles in arm and shoulder (deltoid, biceps, brachialis) + loss of sensation to lateral forearm

Question 31

what is the presentation of Erb-Duchenne Palsy?

Answer 31

+ "waiter's tip position" + hanging limb (adducted shoulder, medial rotation of arm, elbow extended)

Question 32

what is caused by a traction injury to the lower trunk (C8, T1)?

Answer 32

Klumpke's Palsy/Paralysis

Question 33

what are the main causes of Erb-Duchenne Palsy?

Answer 33

+ high energy trauma (motorcycle/horse) | + during birth (shoulder dystocia)

Question 34

what are the main causes of klumpke's palsy?

Answer 34

+ during birth if limb pulled excessively | + breaking a fall from height

Question 35

what are the symptoms of klumpke's palsy?

Answer 35

+ paralysis of: - intrinsic hand muscles - flexor muscles of wrist and fingers - forearm pronator + loss of sensation to medial forearm and little finger

Question 36

how does klumpke's palsy present?

Answer 36

claw hand (wrist and fingers flexed, forearm supinated)

Question 37

what are the roots of the lumbar plexus?

Answer 37

L1-4

Question 38

what are the roots of the sacral plexus?

Answer 38

L4-S4

Question 39

where is the lumbar plexus located?

Answer 39

+ within psoas major | + anterior to transverse process of lumbar vertebrae

Question 40

which nerves supply the lower limb in the lumbar plexus?

Answer 40

``` + ilioingual + lateral cutaneous of thigh + genitofemoral + femoral + obturator ```

Question 41

what are the boundaries of the femoral triangle?

Answer 41

BASE: inguinal ligament APEX: sartorius MEDIAL: adductor longus

Question 42

what are the roots of the femoral nerve?

Answer 42

L2-4

Question 43

what does the floor of the femoral triangle consist of?

Answer 43

pectineus and iliopsoas

Question 44

what is enclosed within the femoral sheath?

Answer 44

femoral artery and vein

Question 45

what does the femoral nerve supply?

Answer 45

+ some anterior thigh muscles (hip flexors, knee extensors) | + skin of anteromedial thigh and medial leg and foot

Question 46

what is the terminal branch of the femoral nerve?

Answer 46

saphenous nerve

Question 47

where is the sacral plexus located?

Answer 47

+ surface of posterior pelvic wall | + anterior to piriformis muscle

Question 48

which nerves supply the lower limb in the sacral plexus?

Answer 48

+ superior gluteal + inferior gluteal + sciatic + posterior femoral cutaneous

Question 49

what are the roots of the sciatic nerve?

Answer 49

L4-5, S1-3

Question 50

what muscles does the sciatic nerve supply?

Answer 50

+ biceps femoris, and semitendinosus with semimembranosus

Question 51

where does the sciatic nerve branch?

Answer 51

at the apex of the popliteal fossa, occasionally near piriformis

Question 52

what are the roots of the tibial nerve?

Answer 52

L4-5, S1-3

Question 53

which is the larger of the two branches of the sciactic nerve?

Answer 53

tibial

Question 54

where does the tibial nerve lie?

Answer 54

+ descends in popliteal fossa | + passes posteriorly and inferiorly to medial malleolus

Question 55

what does the sciatic nerve supply?

Answer 55

+ posterior muscles in leg and knee joint: thigh extensors, leg flexors) (hamstring muscles) + skin of posterolateral leg, sole of foot and lateral foot

Question 56

what are the roots of the common fibular/peroneal nerve?

Answer 56

L4-5, S1-2

Question 57

where does the common fibular/peroneal nerve lie?

Answer 57

descends laterally in the popliteal fossa towards lateral compartment of leg

Question 58

what does the common fibular/peroneal nerve supply?

Answer 58

+ short head of biceps + muscles in anterior and lateral leg + skin of upper lateral leg, lower posterolateral leg, anterolateral leg and dorsum

Question 59

what joint movements are used to test C5 myotome?

Answer 59

abduction of shoulder

Question 60

what joint movements are used to test C6 myotome?

Answer 60

flexion of the arm at elbow

Question 61

what joint movements are used to test C7 myotome?

Answer 61

extension at the elbow

Question 62

what joint movements are used to test C8 myotome?

Answer 62

flexion of fingers

Question 63

what joint movements are used to test T1 myotome?

Answer 63

abduction and adduction of fingers

Question 64

what is the function of the axilla?

Answer 64

gateway to upper limb

Question 65

what is a distinguishing feature of medial pectoral nerve?

Answer 65

can be seen piercing pectoralis minor

Question 66

what nerves are branches of the posterior cord?

Answer 66

- radial | - axillary

Question 67

which nerve does not supply anything in the arm?

Answer 67

median nerve

Question 68

which nerve does not supply anything in the arm?

Answer 68

median nerve

Question 69

where does the sciatic nerve enter the gluteal region?

Answer 69

inferior to piriformis (infrapiriform space?greater sciatic foramen)

Question 70

what is the origin of pec major?

Answer 70

- medial half of clavicle - anterior surface of manubrium of sternum - anterior surface of body of sternum - ribs 1-6 costal cartilage - aponeurosis of external abdominal oblique

Question 71

what is the insertion of pec major?

Answer 71

lateral lip of intertubercular sulcus of humerus

Question 72

what nerve supplies pec major?

Answer 72

lateral and medial pectoral nerves