Embryology, upper Extremities Flashcards
Protein product of SRY gene that determines gonadal sex
Testes determining factor (TDF)
Indifferent gonad present until how many weeks?
7 weeks
Lining epithelium of the PCT
Simple cuboidal with brush borders
Lining epithelium of DCT
Simple cuboidal without brush border
Permanent kidneys seen at how many weeks?
5th week
Upper brachial plexus injury damages what nerves?
- Axillary n (deltoid and teres minor)
- Musculocutaneous n (anterior arm flexors)
- Suprascapular n - supra and infraspinatus
Waiter’s tip deformity
C5-C6
Lower brachial plexus injury - damage to what roots?
C8-T1
Location of sensory loss in lower brachial plexus injury
Lateral
Location of sensory loss of lower brachial plexus injury
Medial aspect
End nerves affected with damage to lower brachial plexus injury
Ulnar and median nerves
Ape hand
Lower brachial plexus injury
C8-T1
Median
Claw hand
Lower brachial plexus injury
C8-T1
Ulnar
Klumpke’s paralysis
Lower brachial plexus injury
C8-T1
Unable to abduct arm - what nerve/s affected?
Suprascapular n - Supraspinatus
Axillary n - Deltoid
Arm muscles for lateral rotation
Infraspinatus and teres minor
Main forearm flexor
Brachialis
Fracture to midshaft of humerus may damage what nerve
Radial nerve - posterior cord
Injury to the SURGICAL
NECK of the humerus will most likely affect what nerve and muscle
Axillary nerve and posterior circumflex artery
Injury to the MIDSHAFT of the humerus will likely affect what nerve and artery?
Radial nerve and profunda brachial artery
Injury to the SUPRACONDYLAR region of the humerus may injure –?
Median nerve
Injury to the medial epicondyle may also damage –?
Ulnar nerve
Claw hand - what nerve?
Ulnar nerve
Hand of benediction - nerve?
Median nerve - proximal
Ape hand - what nerve?
Median nerve - distal
Anterior shoulder dislocation - what is most likely injured?
Axillary nerve - which supplies the deltoid and teres minor
Forearm supinator
Biceps brachii
Paresthesia in first dorsal interossei muscle between thumb and index finger - what nerve?
Radial nerve
Weakness in hand opposition
Median nerve
Fracture of hook of hamate - what nerve affected?
Ulnar nerve
Lunate dislocation - what nerve affected?
Median nerve
Weakness of flexion at wrist - what nerve supply affected?
Median OR Ulnar
Tenderness in palpation of anatomic snuffbox
Scaphoid fracture - scaphoid bone makes up the floor of the anatomic snuffbox
Vessel associated with the anatomic snuffbox
Radial artery
Most commonly dislocated carpal bone
Lunate
Lateral border of anatomic snuffbox
Extensor pollicis brevis and Abductor pollicis longus
APL + EPB
Nerve to extend the thumb
Radial nerve
Funny bone
Ulnar nerve
Muscles for flexion of MCP joint
Lumbricals - inn by median (lateral) and ulnar (medial)
Hand adduction - muscles and nerve
Palmar interossei
PAD
Ulnar nerve
Hand abduction - muscles and nerve
Dorsal interossei
DAB
Ulnar nerve
Can’t flex proximal IP joint - muscle and nerve
FDS - median nerve
Can’t flex distal IP joint - muscle and nerve?
FDP - medial and ulnar
Contents of the Carpal tunnel
4 FDS
4 FDP
Tendon of FPL
Median nerve
Within the carpal tunnel, what is the position of the median nerve in relation to the FCR tendon
Medial
Thenar muscles innervated by the median nerve
Abductor pollicis brevis
Flexor pollicis brevis
Opponens pollicis
AFO
Hypothenar muscles innervates by ulnar nerve
Abductor digiti minimi
Flexor digiti minimi
Opponens digiti minimi
AFO
Winging of scapula
Nerve? Muscle?
Serratus anterior
Long thoracic nerve
Weakness in PROTRACTION of scapula
Aka Winging of scapula
Serratus anterior muscle
Long thoracic nerve
Chief stability of the shoulder joint
Rotator cuff muscles
Position of bone segments with clavicular fracture
Medial segment pulled upward (c/o SCM)
Lateral segment pulled downward (c/o deltoid)
Complications of clavicular fracture
Injury to Lower trunk of brachial plexus
Hemorrhage from subclavian vein
Position of leg in hip dislocation
Lower limb shortened and medially rotated
Strongest support of the hip joint
Iliofemoral ligament
Y-shaped ligament
Hip joint ligament that prevents overextension during standing
Iliofemoral ligament
Function of iliofemoral ligament
Prevents overextension during standing
Muscles for medial rotation of hip/ thigh
Gluteus medius
Gluteus minimus
Tensor fascia lata
Action of gluteus medius and minimus. Innervation?
Hip medial rotation
Superior gluteal nerve
Positive trendelenburg sign
Pelvis falls to unsupported side
Ex. Right side is weak. Patient raises left leg and will fall to the left
Thigh adductors
Adductor magnus, brevis, longus
Pectineus, gracilis
What type of bone is the patella
Sesamoid
Thigh muscle with dual nerve innervation
Adductor Magnus
- adductor portion: obturator nerve
- hamstring portion: sciatic nerve
Muscles of the medial thigh are purely innervated by — except —
Obturator nerve
Except adductor Magnus - with two innervations (obturator and sciatic nerve)
Decreased patellar tendon reflex - what nerve is involved?
Femoral nerve - L4
Action of gluteus Maximus
Extension and lateral rotation of hip
Which muscles of the gluteal region does not attach to the greater trochanter of the femur
Gluteus Maximus
Tensor fascia lata
Quadratus femoris
Nerves that pass through the lesser sciatic Foramen
Pudendal nerve
Nerve to obturator internus
Vessels that pass through the lesser sciatic foramen
Internal pudendal artery and vein
Vastus-es
Innervation? Action?
Femoral nerve
Extension of leg at knee joint
No Action on thigh!!
Only anterior thigh muscle that laterally rotates at hip joint
Sartorius
Innervation of tensor fascia lata
Superior gluteal nerve
Only muscle with action at leg and thigh
Rectus femoris
Inn: femoral nerve
Extension of leg at knee joint
Flexion of thigh at hip joint
Common attachment of the quadriceps muscles
Patellar tendon
Location of femoral sheath
2.5 cm/ 1 in below inguinal ligament
Femoral artery - what compartment of the femoral sheath?
Lateral compartment
Components of the lateral, intermediate and medial compartments of the femoral sheath
Lateral - fem artery
Intermediate - fem vein
Medial - lymphatics, femoral canal
Femoral hernia in relation to the pubic tubercle
Neck of the femoral sac is always below and lateral to the pubic tubercle
(An inguinal hernia lies above and medial to the pubic tubercle)
Main blood supply to hip joint
Medial circumflex femoral artery from profunda femoris
Largest bone of the foot
Calcaneus
Bone that articulates with the tibia and fibula to form the ankle joint
Talus
Attachment of the Achilles’ tendon
Calcaneus - posterior surface
Spinal nerve root of Achilles’ tendon reflex? Patellar tendon reflex?
Achilles - S1
Patella - L4
Spinal nerve roots of tendon reflexes
Biceps brachi - C5 Brachioradialis - C6 Triceps brachii - C7 Patellar tendon - L4 Achilles' tendon - S1
Motor innervation of the anterior leg? Blood supply?
Deep peroneal nerve
Anterior tibial artery
Lateral and medial boundaries of the popliteal fossa
Lateral: biceps femoris (above), gastroc and plantaris (below)
Medial: semimem and semiten (above) and medial gastroc (below)
Muscles of the lateral compartment of the leg
Peroneus longus
Peroneus brevis
Inn: superficial peroneal nerve
Action: plantarflexion, eversion
Can’t tiptoe
Tibial nerve
Steppage gait
Common peroneal nerve or deep peroneal
Dupuytren contracture
Thickening and contracture of palmar aponeurosis
Volkman’s ischemic contracture
Causes contraction of forearm muscles
Assoc with supracondylar fracture - brachial artery goes into spasm