gross- practice q's (upper limb) Flashcards
the axillary nerve is a direct branch of which cord of the brachial plexus
posterior
Which is the primary blood supply of the latissimus dorsi?
thoracodorsal artery
thoracodorsal nerve → innervates latissimus dorsi
the brachial plexus is formed by the …
C5-T1 ventral rami
(ventral rami = anterior branches of spinal nerves)
lateral thoracic is typically a direct branch of the _________ artery
axillary
Which landmark marks the location where the subclavian artery becomes the axillary artery?
first rib
the pectoralis major & minor are innervated by …
medial & lateral pectoral nerves
what does the subscapularis do?
internally rotates arm
what does the pectoralis major do?
adducts & internally rotates the arm
the biceps brachii is innervated by the …
musculocutaneous nerve
how to differentiate b/w teres major & teres minor?
teres major: originates from inferior angle of scapula & inserts at medial lip of bicipital groove of humerus
teres major: originates from lateral border of scapula & inserts at the greater tubercle of humerus
which nerve supplies (innervates) the teres major muscle?
lower subscapular nerve
what does the biceps brachii do?
flexes elbow joint & supinates the forearm
which nerve becomes the posterior interosseous nerve?
radial nerve
if a muscle has the word “carpi” in its name, it typically inserts on the __________
base of the metacarpal
if your patient couldn’t pronate her forearm, you might suspect damage to which nerve?
median nerve
if your patient couldn’t supinate her forearm, you might suspect damage to which nerve?
radial nerve
which muscle flexes the distal phalanx of the middle finger?
flexor digitorum profundus
which muscle flexes the proximal & middle phalanx of the middle finger?
flexor digitorum superficialis
what does the superficial branch of the radial nerve supply
supplies skin of the dorsal hand (back of the hand)
what are the primary movements that occur at the distal radio-ulnar joint?
pronation & supination
which nerve is damaged if a patient cannot move his thumb, especially can’t do opposition?
recurrent branch of the median nerve
(oppenens pollicis not working)
which digital sheath is continuous with the common flexor sheath?
5th
where does the central band of the extensor digitorum tendon insert?
base of the middle phalanx (?)
the recurrent branch of the median nerve innervates what part of the hand?
the thenar space
(including all the muscles of it- so no flexion or opposition in thumb if this is damaged)
Define supination and mention the joints and muscles at which this movement takes place.
supination: movement that turns palm of hand or forearm upward (opposite of pronation)
joints: proximal & distal radioulnar joint
- radius rotates around the ulna
muscles:
- biceps brachii (most powerful supinator)
- supinator muscle
- brachioradialis (can assist in supination when forearm is in a neutral position)
Give the nerves directly originating from the upper trunk of brachial plexus and name the muscles supplied by them.
upper trunk: C5 & C6 TRUNKS not the roots
suprascapular: supraspinatus, infraspinatus
nerve to subclavius: subclavius
these are the only ones from the trunks, everything else is from the roots/cords
Name the supporting ligaments of the shoulder joint and give their attachments.
-
Glenohumeral ligaments (superior, middle, inferior): Attach the glenoid of the scapula to the humerus
- superior: supraglenoid tubercle os scapula to greater tubercle of humerus
- middle: anterior aspect of glenoid to lesser tubercle of humerus
- inferior: inferior aspect of glenoid to neck of humerus - Coracohumeral ligament: connects coracoid process to greater tubercle of the humerus
- Coracoacromial ligament: connects coracoid process to acromion.
- Transverse humeral ligament: greater tubercle to lesser tubercle of humerus, covering biotic-ital groove, holds long head of biceps tendon in place
- **Acromioclavicular ligament: acromion os scapula to clavicle, stabilizes the acromioclavicular joint
Give boundaries and contents of mid palmer space.
contents:
- 3rd & 4th lumbricals
- ulnar artery & nerve branches
- palmar metacarpal arteries
boundaries:
- anterior: palmar aponeurosis & flexor tendons
- posterior: interosseous muscles (3-5th metacarpals)
- lateral: medial fibrous septum
Enlist contents of axilla that can be damaged.
- Axillary artery & vein
- All cords of brachial plexus lie in axilla: Axillary nerve, Radial Nerve, Ulnar nerve, Medial cutaneous nerves of arm and forearm, muculocutaenous nerve, lateral pectroral nerve
- Axillary lymph nodes
- Muscular structures: pec major & minor, teres major, latissimus dorsi, serratus anterior, subscapularis (on the walls)
Explain an anastomosis around shoulder joint.
anastomosis arteries:
1. Suprascapular artery
2. Dorsal scapular artery
3. Circumflex scapular artery
4. Transverse cervical artery
What will be the site of ligation of axillary artery in order to preserve blood circulation to upper limb through collateral circulation?
collateral circulation: if blockage to axillary artery, scapular anastomosis provides alternate route for blood to reach shoulder & arm
safe site of ligation: b/w first and second part of the axillary artery, before the origin of the subscapular artery
Following an accident, patient has no cutaneous sensation over lower half of deltoid muscle. Give reason for this sensory loss.
Injury to axillary nerve, specifically cutaneous branch
Patient has a painless lump in upper lateral quadrant of left breast. Name the primary lymph nodes that will drain this quadrant and give their location. Give the other areas which are also drained by these lymph nodes.
primary lymph nodes draining upper lateral quadrant of breast: axillary lymph nodes, specifically anterior (pectoral) group of axillary lymph nodes
location: along lower border of pec minor muscle in anterior wall of axilla
drainage areas: upper lateral quadrant of breast, most of skin & parenchyma of breast, anterior thoracic wall, anterior abdominal wall above the level of the umbilicus
