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LOCO2 > Clinical Anatomy and Review of the Upper Limb > Flashcards

Clinical Anatomy and Review of the Upper Limb Flashcards

1
Q

What is the upper limb divided into?

A
  • shoulder = pectoral girdle, between thorax and arm
  • arm = between shoulder and elbow
  • forearm = between elbow and wrist
  • hand = portion distal to wrist
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2
Q

What bones make up the shoulder?

A
  • clavicle
  • scapula
  • humerus
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3
Q

What joints make up the shoulder?

A
  • sternoclavicular
  • acromioclavicular
  • glenohumeral
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4
Q

What is the blood supply to the shoulder?

A
  • subclavian
  • axillary
  • brachial
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5
Q

Where does the subclavian artery become the axillary artery?

A
  • lateral border of 1st rib
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6
Q

Where does the axillary artery become the brachial artery?

A
  • inferior border of teres major
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7
Q

What is the venous drainage of the arm?

A
  • parallel arterial deep veins

- superficial veins

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8
Q

What nerve roots does the brachial plexus consist of?

A

C5-T1

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9
Q

What are the terminal nerves of the anterior cord?

A
  • musculocutaneous
  • median
  • ulnar
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10
Q

What are the terminal nerves of the posterior cord?

A
  • axillary

- radial

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11
Q

What is the biggest nerve of the plexus?

A

Radial

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12
Q

What type of nerves are those in the brachial plexus?

A
  • mixed with both sensory and motor axons
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13
Q

What are the trunks?

A

superior, middle, inferior

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14
Q

What are the cords?

A

lateral, posterior, medial

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15
Q

What are the terminal nerves?

A 
Musculocutaneous
Axillary
Median
Radial
Ulnar
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16
Q

What causes a clavicular fracture?

A
  • direct or indirect force
  • at endpoint of limb
  • takes force when falling
  • sternoclavicular and acromioclavicular joints are very strong so clavicle will break before dislocation
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17
Q

Who are clavicular fractures more common in and why?

A
  • clavicle stays softer and is weaker
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18
Q

How does a clavicle fracture present?

A
  • drooped shoulder

- in some cases clavicle can be raised if fractured bones override each other = reduction in width

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19
Q

How does shoulder dislocation occur?

A
  • at glenohumeral joint as it is weak because of large range
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20
Q

What does shoulder dislocation affect mainly?

A
  • impacts brachial plexus especially axillary nerve
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21
Q

How does a shoulder dislocation present differently to a clavicular fracture?

A
  • fracture = deltoid profile rounded, normal glenohumeral joint
  • dislocation = deltoid more squared off
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22
Q

When may a shoulder dislocation/clavicular fracture be a medical emergency?

A
  • if tingling/reduced peripheral pulses
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23
Q

What can cause deltoid paralysis?

A
  • shoulder fracture/dislocation
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24
Q

How does deltoid paralysis present?

A
  • weakness in abduction of the arm due to axillary nerve damage
  • deltoid atrophy = loss of shoulder roundness
  • numbness over regimental badge
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25
Q

How is deltoid paralysis treated?

A
  • nerve repair

- muscle transfer from pec major

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26
Q

What are the features of the pectoralis major?

A
  • 2 parts
  • clavicular part used to act like a deltoid
  • nerve supply is lateral pectoral and not axillary so function regained
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27
Q

To what extent does supraspinatus carry out abduction?

A
  • first 10-15 degrees

- rest by deltoid

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28
Q

How does the shoulder allow movement?

A
  • shoulder and pectoral girdle = hand placed in all directions
  • movement of scapula = more range (physiological scapulothoracic joint)
  • trapezius and serratus anterior muscles rotate scapula
29
Q

What is the lymphatic drainage of the shoulder?

A

5 groups:

  • humeral lymph nodes
  • central lymph nodes
  • subscapular lymph nodes
  • apical lymph nodes
  • anterior lymph nodes

(mainly nodes in axilla)

30
Q

Where does the upper limb lymph mainly drain into?

A

Humeral and central nodes

31
Q

Where do the lymphatics of the lateral breast drain into?

A

Axillary nodes

- medial breast drains into parasternal nodes

32
Q

When may axillary lymph node clearance be carried out?

A
  • metastatic breast cancer surgery
33
Q

What can axillary lymph node clearance lead to?

A
  • injury to thoracodorsal nerve

- injury to long thoracic nerve = scapular wing as normally kept in place by serratus anterior

34
Q

What does the thoracodorsal nerve supply?

A
  • latissimus dorsi
35
Q

What does the long thoracic nerve supply?

A

Serratus anterior

36
Q

What causes scapular wing?

A
  • dysfunction of the serratus anterior from long thoracic nerve damage
37
Q

What are the causes of long thoracic nerve damage?

A
  • axillary lymph node clearance
  • stab wound
  • thoracic surgery
  • chest tube insertion
38
Q

When may trapezius atrophy occur?

A
  • when damage to spinal accessory nerve

- could be due to tumour around jugular foramen

39
Q

How does trapezius atrophy present?

A
  • weak shoulder abduction but not as prominent as scapula winging
  • shoulder falls
40
Q

What is the bone of the arm?

A

humerus

41
Q

What are the joints of the arm?

A
  • glenohumeral

- elbow

42
Q

What does the elbow joint consist of?

A
  • humeroulnar
  • humeroradial
  • proximal radioulnar
43
Q

What are the arteries and nerves of the arm and where are they?

A
  • Posterior compartment = spiral groove contains radial nerve and deep artery of the arm
  • anterior compartment = median and musculocutaneous nerve, and brachial artery
44
Q

What are the types of humerus fractures? What is the risk of each?

A
  • midshaft = risk of radial nerve injury
  • supracondylar = risk of median nerve injury
  • medial epicondyle = risk of ulnar nerve injury
45
Q

Why may a medial epicondyle fracture damage the ulnar nerve?

A
  • ulnar nerve lies just above elbow and goes behind medial epicondyle to then go back into forearm anterior compartment
46
Q

What type of joint is the elbow?

A
  • hinge and pivot
47
Q

What are the bones of the forearm?

A

Radius and ulna

48
Q

What are the joints of the forearm?

A
  • elbow
  • distal radioulnar joint
  • radiocarpal joint
49
Q

What are the nerves of the anterior forearm compartment?

A
  • median nerve

- ulnar nerve

50
Q

What are the arteries of the anterior forearm compartment?

A
  • radial artery

- ulnar artery

51
Q

What are the properties of the median nerve?

A
  • innervates majority of forearm flexors
  • innervates thenar muscles
  • provides sensation to palm of hand and lateral 3.5 digits
  • goes through carpal tunnel
  • compression = thenar atrophy
52
Q

What is the nerve of the posterior forearm compartment?

A
  • radial nerve
53
Q

What is the artery of the posterior forearm compartment?

A
  • posterior interosseous artery
54
Q

What are the muscles of the posterior forearm compartment?

A
  • extensors

- supinators

55
Q

What is the main blood supply of the forearm?

A
  • ulnar and radial arteries
  • start opposite radius neck in inferior cubital fossa
  • ulnar -> superficial palmar arch
  • radial -> deep palmar arch
56
Q

What are the bones of the hand?

A
  • carpals (scaphoid and lunate)
  • metacarpals
  • phalanges
57
Q

What are the joints of the hand?

A
  • distal radioulnar
  • radiocarpal
  • intercarpals
  • carpometacarpal
  • metacarpophalangeal
  • interphalangeal (distal and proximal)
58
Q

What happens at the wrist?

A
  • ulnar does not articular with carpals

- radius articulates with scaphoid and lunate

59
Q

What are the muscles of the hand?

A
  • APL
  • EPB
  • ECR
  • EPL
  • ED
  • EI
  • EDM
  • ECU
60
Q

What are the most common wrist injuries?

A

Fractures of distal radius and ulna

61
Q

What are the less common wrist injuries?

A
  • carpal injuries

- scaphoid most common to be broken = avascular necrosis

62
Q

What is Colles fracture?

A
  • presents as dinner fork deformity

- occurs in complete fracture of radius

63
Q

What does carpal tunnel syndrome result in?

A
  • atrophy of thenar muscles
64
Q

What are the compartments of the hand and what do they contain?

A
  • superficial = long flexor tendons and their sheaths
  • medial and lateral = hypothenar muscles and thenar muscles
  • deep = intrinsic muscles of the hand
65
Q

What 3 nerves terminate in the hand?

A
  • median
  • ulnar
  • radial
66
Q

What is the function of the median nerve?

A
  • flexors of the wrist except FDU and medial half of FDP

- sensory to skin on lateral 3.5 digits

67
Q

What is the function of the radial nerve?

A
  • all muscles of posterior compartment

- sensory to back of arm and forearm and first dorsal web

68
Q

What is the function of the ulnar nerve?

A
  • intrinsic muscles of hand (FDU and medial half of FDP)

- sensory to skin on medial 1.5 digits

LOCO2 (26 decks)

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