Exam 5 Upper Extremity 52X

Question 1

What test is conducted to assess the patency of the radial and ulnar arteries and the collateral circulation in order to reduce risk of ischemia prior to radial arterial blood sampling or cannulation?

Answer 1

Allen’s Test

Question 2

What are the general steps for conducting the Allen test?

Answer 2

1) Patient places hand palm up
2) Pressure is applied over the Radial and Ulnar arteries
3) Patient makes a fist for about 30 sec.
4) Patient opens hand
5) Ulnar occlusion is released
6) Return of color within 7 seconds indicates patent ulnar artery
7) ABG or cannulation of the Radial artery may now occur

Question 3

Branches of what arteries supply blood to the hand?

Answer 3

Radial Artery

Ulnar Artery

Question 4

Which artery branches near the wrist into superficial and deep branches in which the superficial branch gives rise to the superficial palmar arch?

Answer 4

Ulnar artery

Question 5

Which artery completes the remainder of the superficial palmar arch?

Answer 5

Superficial branch of Radial artery

Question 6

The anatomical snuff box is formed by which tendons of the hand?

Answer 6

Abductor pollicis longus
Extensor pollicis brevis
Extensor pollicis longus

Question 7

What nerve provides cutaneous innervation to the anatomical snuff box and surrounding area?

Answer 7

Superficial branch of radial nerve

Question 8

What are the muscles located between the metacarpals and which are responsible for abduction of the digits and which are responsible for adduction of the digits?

Answer 8

Interossei Muscles

• 4 Dorsal Interosseous Muscles: Abduct digits
• 3 Palmar interosseous Muscles: Adduct digits

Question 9

Which nerve innervates the Interossei muscles?

Answer 9

Ulnar Nerve deep branch

Question 10

All muscles of the posterior compartment are innervated by which nerve?

Answer 10

Radial Nerve

Question 11

The origin of the Long Head of the Triceps Brachii?

Answer 11

Infraglenoid Tubercle of Scapula

Question 12

The origin of the Lateral head of the Triceps Brachii?

Answer 12

Humerus (Posterior, superior to radial groove)

Question 13

The origin of the Medial head of the Triceps Brachii?

Answer 13

Humerus (Posterior, inferior to radial groove)

Question 14

The Triceps Brachii insertion?

Answer 14

Olecranon Process of Ulna (via triceps brachii tendon)

Question 15

What are the actions of the Triceps Brachii?

Answer 15

• Extends forearm at elbow joint

- Extends arm at shoulder joint

Question 16

Which nerve innervates the Triceps brachii?

Answer 16

Radial Nerve

Question 17

What is the major muscle of the posterior compartment?

Answer 17

Triceps Brachii

Question 18

Which head of the Triceps Brachii is the only head with origin above the shoulder joint?

Answer 18

Long Head of the Triceps Brachii

Question 19

Which muscles has its origin at the lateral epicondyle of the posterior Humerus and insertion at the upper posterior surface of the ulnar olecranon?

Answer 19

Anconeus

Question 20

What is the action of the Anconeus muscle?

Answer 20

Extension of forearm

Assists the triceps brachii

Question 21

The Anconeus is innervated by which nerve?

Answer 21

Radial Nerve

Question 22

What is the name of the major artery that supplies the arm and is a continuation of the axillary artery?

Answer 22

Brachial Artery

Question 23

Where does the Brachial Artery extend from and to where?

Answer 23

• From: Lower border of teres major

- To: Inferior part of the cubital fossa

Question 24

What does the Brachial artery terminate as? (Branches into what arteries)

Answer 24

Terminates as Radial and Ulnar Arteries

Question 25

What are the Branches of the Brachial artery prior to termination point and which is the major, deep branch?

Answer 25

- Profunda Brachii Artery: Major and deep | - Ulnar Collaterals

Question 26

What are the Superficial and Deep major veins of the arm?

Answer 26

- Superficial: Cephalic and Basilic Vein | - Deep: Brachial Vein

Question 27

What veins of the arm are located beneath the skin and are superficial to the brachial fascia throughout much of their course?

Answer 27

Cephalic and Basilic Veins

Question 28

What may occur if the if the Median Cubital vein is very large?

Answer 28

Divert most/all blood to Basillic vein. Superior Cephalic may be absent

Question 29

What are the Four main nerves that provide innervation of the upper extremity?

Answer 29

Musculocutaneous Nerve Radial Nerve Median Nerve Ulnar Nerve

Question 30

Of the four main nerves which two have no branches in the arm?

Answer 30

Median Nerve | ulnar Nerve

Question 31

The musculocutaneous Nerve passes through what muscle and continues distally between what two muscles, innervating all three as it passes?

Answer 31

- Passes through: Coracobrachilis Muscle | - Between: Biceps Brachii and Brachialis Muscles

Question 32

The Musculocutaneous nerve arise from where?

Answer 32

Brachial Plexus

Question 33

What is significant about the level of the elbow for the Musculocutaneous Nerve?

Answer 33

- Above Elbow: Muscular innervation | - Below Elbow: Cutaneous innervation

Question 34

The Musculocutaneous Nerve terminates as what nerve and what is innervated by it?

Answer 34

- Lateral Antebrachial Cutaneous Nerve (AKA Lateral Cutaneous Nerve of the Forearm) - Innervates: Large lateral portion of forearm

Question 35

Which Nerve arises from contribution of medial and lateral cords of the brachial plexus and does not give off any branches in the arm? Where does it branch?

Answer 35

- Median Nerve | - Branches: supply forearm and hand

Question 36

The Trochlear Notch (at elbow) is formed by what?

Answer 36

Coronoid Process and Olecranon

Question 37

What Type and classification does the Elbow Joint have?

Answer 37

- Type: Synovial Joint | - Classified: Hinge Joint

Question 38

What does the elbow permit?

Answer 38

Flexion and Extension of Forearm

Question 39

What reinforces the weak articular capsule (lined by synovial membrane) of the elbow?

Answer 39

Collateral ligaments which limit side to side movement

Question 40

The radial collateral ligament extends from where and goes to where?

Answer 40

Lateral Epicondyle of Humerus to Radial notch of ulna

Question 41

What is the name of the ligament that surrounds the head of the radius?

Answer 41

Anular Ligament

Question 42

The Ulnar collateral ligament extends from where and goes to where?

Answer 42

Medial Epicondyle of Humerus to Coronoid Process and Olecranon of the Ulna

Question 43

What is Subluxation?

Answer 43

Incomplete or partial dislocation of a joint or organ

Question 44

What is the difference between Golfer's Elbow and Tennis Elbow?

Answer 44

Golfer's Elbow: Medial Epicondylitis | Tennis Elbow: Lateral Epicondylitis

Question 45

What is the thin, strong, fibrous membrane that joins the radius and ulna of the forearm an provides attachment for some deep forearm muscles?

Answer 45

Interosseous Membrane

Question 46

The interosseous membrane provides the general plane for dividing the forearm into what compartments?

Answer 46

``` Posterior (Extensor) Compartment -Deep -Superficial Anterior (Flexor) Compartment -Deep -Superficial ```

Question 47

The Anterior Compartment of the forearm contains muscles that complete what actions?

Answer 47

Flexors and Pronators

Question 48

The Posterior Compartment of the forearm contains muscles that complete what actions?

Answer 48

Extensors and Supinator's

Question 49

The muscles of the Superficial Anterior (Flexor) compartment originate where and typically insert where?

Answer 49

Origin: Medial Epicondyle of Humerus Insert: Carpals, Metacarpals, and Phalanges

Question 50

The muscles of the superficial anterior (flexor) compartment have what function?

Answer 50

Flexors (and bellies of muscles form bulk of forearm)

Question 51

What are the names of the muscles of the Superficial anterior (flexor) compartment?

Answer 51

- Pronator teres - Flexor carpi radialis - Palmaris longus - Flexor carpi ulnaris - Flexor digitorum superficialis

Question 52

What are the muscles of the Deep anterior (flexor) compartment, in which insert on the base of the distal phalanges and function as flexors?

Answer 52

- Flexor pollicis longus - Flexor digitorum profundus - Pronator quadratus

Question 53

What are the Muscles of the Superficial posterior (extensor) compartment? name from lateral to medial

Answer 53

- Brachioradialis - Extensor carpi radialis longus - Extensor carpi radialis brevis - Extensor digitorum - Extensor digiti minimi - Extensor carpi ulnaris

Question 54

Which muscles of the superficial posterior (extensor) compartment have their origin more distal portion of the Humerus and are innervated by the radial nerve?

Answer 54

- Brachioradialis | - Extensor carpi radialis longus

Question 55

Which muscles of the superficial posterior (extensor) compartment have their origin on the lateral epicondyle of the Humerus and are innervated by the deep radial nerve?

Answer 55

- Extensor carpi radialis brevis - Extensor digitorum - Extensor digiti minimi - Extensor carpi ulnaris

Question 56

The Brachioradialis reflex (AKA Supinator reflex) is carried by which nerve and mediate where?

Answer 56

Radial Nerve | Mediated at: C5 - C6 spinal nerves

Question 57

What are the muscles of the deep posterior (extensor) compartment?

Answer 57

``` Supinator Abductor pollicis longus Extensor pollicis brevis Extensor pollicis longus extensor indicis ```

Question 58

Pronation is essentially a function of which nerve and Supination is essentially a function of which nerve?

Answer 58

Pronation: Median Nerve Supination: Musculocutaneous and Radial Nerves

Question 59

Which muscles are responsible for Pronation?

Answer 59

- Pronator teres - Pronator quadratus - Brachioradialis

Question 60

Which muscle pronates the forearm at the radioulnar joint?

Answer 60

Pronator quadratus

Question 61

Which muscles are responsible for supination?

Answer 61

- Supinator muscle - Biceps brachii - Brachioradialis

Question 62

What are the superficial veins of the forearm?

Answer 62

Cephalic Basilic Median Antebrachial

Question 63

The radial pulse is palpated where the radial artery lies between the tendons of what two muscles?

Answer 63

Flexor carpi radialis | Abductor pollicis longus

Question 64

The wrist and hand consist of how many bones and muscles?

Answer 64

28 bones 19 intrinsic muscles 20 extrinsic muscles

Question 65

What is formed by the antebrachial fascia thickening posteriorly over the distal ends of the radius and ulna?

Answer 65

Extensor retinaculum

Question 66

The extensor retinaculum function and prevents what?

Answer 66

Retains extensor tendons in position | Prevents bowstringing

Question 67

The flexor retinaculum extends from where to where?

Answer 67

Across Wrist: Scaphoid and trapezium bones on radial side to hamate and pisiform bone on ulnar side

Question 68

The Flexor retinaculum forms what structure?

Answer 68

Carpal tunnel

Question 69

What lies outside the Flexor retinaculum (Carpal tunnel) but under the palmar carpal ligament?

Answer 69

Tendon of Palmaris longus muscle Ulnar nerve Ulnar artery

Question 70

What encompasses the tendons within the flexor retinaculum?

Answer 70

Synovial sheath

Question 71

What transmit through the flexor retinaculum?

Answer 71

Tendons of: - Flexor pollicis longus - Flexor digitorum superficialis - Flexor digitorum profundus

Question 72

What other significant items lies within the carpal tunnel?

Answer 72

Median nerve

Question 73

What results from any lesion that significantly reduces the size of the carpal tunnel?

Answer 73

Carpal tunnel syndrome

Question 74

Carpal tunnel syndrome affects what portion of the hand for cutaneous sensation and which part for motor function?

Answer 74

Cutaneous (Sensory): Lateral 3 and one-half digits (thumb to lateral aspect of middle finger) Motor: Thenar muscle coordination. unable to oppose the thumb

Question 75

What is Tinel sign often referred to?

Answer 75

Distal tingling on percussion

Question 76

What the name of the extension of the tendon of the palmaris longus muscle, that is most superficial structure of the hand and which fibers attach to overlying skin at the palmer creases, goes deep to fascia, metacarpals, and phalanges?

Answer 76

Palmar aponeurosis

Question 77

What are the intrinsic muscles of the hand?

Answer 77

``` Thenar muscles Hypothenar muscles Adductor muscle Lumbrical muscles Interosseus muscles ```

Question 78

What are the muscles of the thenar compartment and together form the Thenar eminence?

Answer 78

Abductor pollicis brevis Flexor pollicis brevis Opponens pollicis

Question 79

What is the name of the muscle that is fan shaped, adducts the thumb, providing power to the grip?

Answer 79

Adductor pollicis muscle

Question 80

What are the muscles of the Hypothenar compartment that together form the hypothenar eminence?

Answer 80

Abductor digiti minimi Flexor digiti minimi brevis Opponens digiti minimi

Question 81

Which nerve innervates the muscles of the hypothenar compartment?

Answer 81

Ulnar nerve

Question 82

Which nerve innervate the muscles of the Thenar compartment?

Answer 82

Recurrent branch of median nerve (motor branch)

Question 83

What is the name of the muscles that have a wormlike appearance and attach proximally to tnedons of the flexor digitorum porfundus and distally to parts of the extensor digitorum tendon called extensor expansions?

Answer 83

Lumbrical muscles

Question 84

Which Lumbrical muscles are innervated by the median nerve and which by the ulnar nerve?

Answer 84

Median: Lateral two lumbrical muscles Ulnar: Medial two lumbrical muscles

Question 85

What function do the lumbrical muscles serve?

Answer 85

Flex the digits at the metacarpophalangeal Joint (MCP joint) and extend the interphalangeal joints

Question 86

Which lumbricals are unipennate and which are bipennate?

Answer 86

Unipennate: 1st and 2nd Bipennate: 3rd and 4th