Limbs and Back: Week Two Flashcards
1
Q
Give the relations of the three parts of the axillary artery in comparison to the pectoralis minor
A
1 - proximal to the pectoralis minor
2 - posterior to pectoralis minor
3 - distal to pectoralis minor
2
Q
What three muscles insert into the coracoid process?
A
Coracobrachialis, short head of the biceps and pectoralis minor
3
Q
What rib is the inferior angle of the scapula level with?
A
Seventh
4
Q
What are the four rotator cuff muscles?
A
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis
5
Q
What is the origin, insertion, function, innervation and blood supply of the supraspinatus?
A
- Supraspinatus fossa
- Greater tubercle
- Forward elevation and first 15 degrees of elevation
- Suprascapular nerve
- Suprascapular artery
6
Q
What is the origin, insertion, function, innervation and blood supply of the infraspinatus?
A
- Infraspinatus fossa
- Greater tubercle
- External rotation with elbow at side
- Suprascapular nerve
- Suprascapular artery
7
Q
What is the origin, insertion, function, innervation and blood supply of the teres minor?
A
- Lateral border of the scapula
- Greater tubercle
- External rotation with elbow at side
- Axillary nerve
- Circumflex scapular artery and posterior circumflex humeral artery
8
Q
What is the origin, insertion, function, innervation and blood supply of the subscapularis?
A
- Subscapular fossa
- Lesser tubercle
- Internal rotation
- upper and lower subscapular nerve
- Subscapular artery
9
Q
What nerve supplies the Subscapularis?
A
Upper and lower subscapular nerve
10
Q
What is the origin of the teres minor?
A
Lateral border of the scapula
11
Q
How many glenohumeral ligaments are there?
A
Three
12
Q
What is the function of the glenohumeral ligaments?
A
Stabilises the anterior aspect of the joint. It prevents anterior dislocation.
13
Q
Where does the coracohumeral ligaments extend and what is its action?
A
The coracoid process to the greater tubercle. It provides superior support.
14
Q
Where does the Transverse humeral ligament extend and what is its action?
A
Between the two tubercles and holds the long of the biceps in the groove
15
Q
Where does the Coraco-Clavicular ligament extend and what is its action?
A
Clavicle to the coracoid process. This keeps the scapula attached to the clavicle.
16
Q
What two ligaments is the Coraco-Clavicular ligament composed of?
A
Trapezoid and conoid ligaments.
17
Q
What is the origin, insertion, function, innervation and blood supply of the Biceps Brachii?
A
The long head originates in the supraglenoid tubercle and the short head is the coracoid process.
They insert into the radial tuberosity and serve in arm flexion and supination. They are innervates by musculocutaneous nerve and supplied by the brachial artery.
18
Q
What is the origin of the long head of the biceps?
A
The Supraglenoid fossa
19
Q
What is the origin, insertion, function, innervation and blood supply of the Coracobrachialis?
A
- Coracoid process
- Mid humerus
- Arm flexion
- Musculocutaneous nerve
- Brachial artery
20
Q
What is the origin, insertion, function, innervation and blood supply of the Brachialis?
A
- half of the humerus
- Ulna tuberosity
- Flexes the arm
- Musculocutaneous nerve
- brachial artery
21
Q
What is the origin, insertion, function, innervation and blood supply of the Triceps brachii?
A
- The long head is the infraglenoid fossa
- The lateral head is the humerus
- The medial head is the humerus
- The olecranon
- Extends elbow
- Radial nerve
- Brachial artery
22
Q
Where does the Triceps insert?
A
The olecranon
23
Q
What is the origin, insertion, function, innervation and blood supply of the teres major?
A
- Inferior angle of the scapula
- Intertubercular grove of the humerus
- lower subscapular nerve
- adducts and internally rotates arm
- circumflex scapular artery
24
Q
What is the function of the teres major?
A
Adduction and internally rotation of the arm
25
What is the origin and insertion of the teres major?
- Inferior angle of the scapula
| - Intertubercular groove of humerus
26
What is the origin, insertion, function, innervation and blood supply of the Deltoid?
- Clavicle, acromion, spine of scapula
- Deltoid tuberosity
- Flexion, medial rotations, abduction, extension and laterally rotation of arm
- Axillary nerve
- Thoracoacromial artery
27
Which bursa supports the deltoid muslce?
Subacromial
28
Which space does the Axillary nerve pass through?
Quadrangular space
29
What two major veins join to form the axillary vein?
Upper cephalic vein and axillary vein
30
Give four functions of the ECM.
- Scaffold for tissue development
- Mechanical basis for cell attachment and movement
- Transmits force
- Withstand compression
- Provides cell signals
- Reservoir for growth factors
- Cell migrating
31
Give an example of fibril collagen
I, II, III, V
32
Give an example of Hexagonal collagen
X, VII
33
Give an example of Meshwork collagen
IV
34
Give an example of Facit collagen
IX, XII, XXII
35
Give an example of Bead collagen
VI
36
Which vitamin is essential for collagen synthesis?
Vitamin C
37
Which type of collagen is found in the nucleus fibrosis?
Type II
38
What repeating units is preprocollagen made of?
Glycine - X - Y
| X is commonly proline and Y is commonly lysine.
39
Describe the process of collagen synthesis in the body
The hydroxylation of the proline/lysine. Then glycosylation to form the pro-collagen. There is the creation of hydrogen and disulphide bonds, forming a triple helix.
The collagen is transferred to the Golgi and the tropocollagen is cleaved. Tropocollagen is reinforced with lysine covalent bonds, forming collagen.
40
What cells make collagen?
Fibroblasts
41
What collagen is affected in Osteogenesis imperfecta?
Type one
42
Is Osteogenesis imperfecta dominant or recessive?
Dominant
43
What process has gone wrong in collage synthesis to cause Osteogenesis imperfecta?
Glycosylation
44
Which type of Osteogenesis imperfecta is the most severe?
Type Three
45
What collagen is affected in Ehlers-Danlos syndrome?
Type one and three
46
What collagen is affected in Alports syndrome?
Type four
47
What are the consequences of Alports syndrome?
Kidney affected, deafness and eye abnormalities.
48
What is the function of HSP 47?
Allows collagen to be secreted singly
49
What type of cartilage is found in the Epiglottis?
Elastic
50
What type of cartilage is found in the Nose?
Hyaline
51
What type of cartilage is found in the Meniscus?
Fibrocartilage
52
What type of cartilage is found in the trachea?
Hyaline
53
What are the functions of cartilage?
- articulation with smooth lubricated surfaces
- facilitate load transmission
- lower friction
54
What is the composition of cartilage?
5% = Cells
95% = ECM: - 70% water and mineral
- 30% organic: collagen, proteoglycan, protien
55
Give an example of an NSAID and explain why they shouldn't be used for long term cartilage treatment.
Ibuprofen. Diclofenac.
| They may cause cartilage damage.
56
What is the myotendinous junction?
Where muscle meets collagen. There is thin filaments interdigitating with collagen.
57
Why may there many collagen deposits present in the osteotendinous junction?
There are periosteal fibroblasts present in the osteotendinous junction which are precursors of chondrocytes and tenocytes.
58
What is the difference between sheath tendons and paratenon?
Sheath tendons have a poor blood supply. They are found in wrist flexors and have mesothial cells to give them fluidity.
Paratendons are not as lubricated and have more blood.
59
What are the proprioceptors located in tendon called?
Golgi tendon organs
60
What is the composition of tendons?
20% cellular and 80% ECM.
| The ECM is 70& water and 30% solids (collagen and GAGs and proteoglycans)
61
What functions to the endotendium and peritendon serve?
The endotendium covers the fascicle and the paritenon covers the whole tendon,
62
What is the condition when a tendon pulls away?
Avulsion
63
In tendon healing, how many days does the first process (inflammation) take?
0-7 days
64
In tendon healing, how many days does the second process (repair) take?
3-60 days
65
In tendon healing, how many days does the third phase (remodelling) take?
28-180 days
66
Describe the first stage of tendon healing
INFLAMMATION: erythrocytes, platelets and inflammatory cells migrate from the epitendinous tissues and endotendon. The tissue is filled with granulation tissue, haematoma ad tissue debris, Matrix proteins are laid down for collage synthesis.
67
Describe the second stage of tendon healing.
REPAIR: tenocytes migrate and synthesise collage III. This is made very quickly and laid down randomly. Intrinsic fibroblasts then proliferate and synthesize/ resorb collagen to form a tendon callus. There is a switch to collagen one and this is orientated along the line of force. There is vascualr ingrowth via collagen/fibronectin scaffolding.
68
Describe the third stage of tendon healing.
This is where final stability is obtained and there is cross-linking with fibrils to increases strength. Complete regeneration is never obtained.
69
Which muslce forms the anterior axilla fold?
Pectoralis major
70
Which muslce forms the posterior axilla fold?
latissimus Dorsi
71
What nerve is damaged in winging scapula?
Long thoracic nerve which supplies the serratus anterior.
72
What ribs does the serratus anterior originate from?
Ribs 8-9
73
Where in relation in the acromion would a steroid injection be inserted?
2 cm medially and 2 cm lateral
74
How centimetres is the axillary nerve from the acromion?
5cm
75
What degrees in abduction does the scapula start to move?
30
76
What is a tear in the Glenoid Labrum called?
Bankart Lesion
77
What artery does the vertebral arteries arise from?
Subclavian
78
What levels of the thoracic spine does the thoracic artery span?
T4-T12
79
Name the main pulses of the body.
- Temporal
- Carotid
- Apical
- Brachial
- Radial
- Ulnar
- Femoral
- Popliteal
- Dorsalis Pedis
- Posterior tibial
80
Where is the brachial plexus formed?
Anterior rami of spinal nerves C5-T1
81
What muscles does the brachial plexus run in-between?
Anterior and medial scalene muscles
82
The trunks of the brachial plexus travel in the posterior triangle. What is the relation to the subclavian artery?
The trunks are behind the subclavian artery.
| The trunks go over the lung apex and first rib before dividing into the divisions.
83
What structure are the cords named in relation to?
The second part of the axillary artery.
84
When do the cords divide into the terminal branches?
The third part of the axillary artery.
85
Name the three trunks of the brachial plexus
Superior, middle and inferior
86
Name the divisions of the brachial plexus
posterior and anterior
87
Name the three cords of the brachial plexus
lateral, posterior and medial
88
Name the five terminal branches of the brachial plexus
Musculocutaneous, axillary, median, radial, ulnar
89
What is Erb Duchenne Palsy?
This is an upper trunk lesion (C5-C6). This is caused by trauma or a traumatic birth.
The clinical findings are the limb hanging by the side, the arm being medially rotated and a pronated forearm.
90
What is a lesion of the upper trunk known as?
Erb Duchenne Palsy
91
What is Klumpke's Palsy?
This is a lower trunk lesion (C8-T1).
This is caused by a pancoast tumour or a traumatic birth. This affects radial, ulnar and median nerves (RUM). There is the loss of all the lumbricals (hence all fingers are clawed) and both the forearm extensors and flexors are lost.
92
What is a lesion of the lower trunk known as
Klumpke's Palsy
93
What nerves does Klumpke's Palsy affect?
RUM: radial, ulnar and median.
94
What muscle does the musculocutaneous nerve pierce?
The Coracobrachialis
95
Which two muscles does the musculocutaneous nerve run between?
Biceps and Brachialis
96
Is the musculocutaneous nerve posterior or anterior in the am?
Anterior
97
Which three Muslces does the musculocutaneous nerve supply?
Biceps brachii, Coracobrachialis and Brachialis
98
What would happen if the musculocutaneous nerve got damaged?
Inability to flex elbow
99
What relation does the axillary nerve have to the surgical neck of the humerus?
The axillary nerve is posterior to the surgical neck of the humerus.
100
The axillary nerve is posterior to which structure?
The surgical neck of the humerus
101
What two muscles does the axillary nerve supply?
Teres minor and Deltoid
102
What fracture would cause damage to the axillary nerve?
Surgical neck fracture
103
What muslce does the median nerve travel between?
The two heads of the pronator teres
104
What Muslces of the wrist does the median nerve supply?
Lateral flexors
105
Which lumbricals does the median nerve supply?
Two lateral
106
Which branch of the median nerve supplies the thenar eminence?
Recurrent branch
107
What is the sensory supply of the median nerve?
lateral three and one-half fingers on the palmer surface and the dorsal finger tips.
108
Name three ways in which the median nerve can be damaged
- Carpal Tunnel syndrome
- Supracondylar fracture of the humerus
- Lunate dislocation
109
What happens to thumb opposition when the median nerve is damaged?
Opposition is lost.
110
What are the clinical signs of distal median claw hand?
There is the loss of the two lateral lumbricals and hence the 2nd and 3rd fingers stay flexed
111
What are the clinical signs of proximal median claw hand?
There is the loss of the two lateral lumbricals and thumb opposition. The lateral lumbricals and thumb stay extended when asked to make a fist.
112
What groove does the radial nerve travel in?
Radial groove of the humerus
113
What wrist muscles does the radial nerve supply?
Wrist extensors
114
What supplies the brachioradialis?
Radial nerve
115
What nerve supplies the Triceps?
Radial nerve
116
What is the sensory supply of the Radial nerve?
- Posterior arm and forearm
| - below fingertips or lateral three and one-half fingers on dorsal side
117
Name two conditions that can cause injury to the Radial nerve
- Fracture of humerus body
| - Saturday Night Palsy
118
What condition results in 'wrist drop'?
Saturday Night Palsy
119
What epicondyle is the Ulnar nerve posterior to ?
Medial
120
What position does the Ulnar nerve have in comparison to the flexor retinaculum?
Superficial
121
What muscles of the wrist does the Ulnar nerve supply?
Medial flexors of the wrist
122
What lumbricals does the Ulnar nerve supply?
Medial
123
What muscles of the hand receive motor supply from the Ulnar nerve?
Interosseous muscles
124
Which eminency is supplied by the Ulnar nerve? The hypothenar or the thenar?
Hypothenar
125
What is the sensory supply of the Ulnar nerve?
Dorsal and palmer aspect of medial 1.5 fingers and medial forearm
126
Which carpal bone fracture would affect the ulnar nerve?
Hook of Hamate
127
What are the clinical side effects of ulnar claw hand?
Inability to extend fourth and fifth fingers
128
Where does the dorsal scapular nerve originate?
C5
129
What does the dorsal scapular nerve supply?
Rhomboid major and minor and levator scapular
130
Which nerve innervates the Rhomboids?
Dorsal Scapular nerve
131
Which roots does the long thoracic nerve originate from?
C5, 6, 7
132
What muscle is supplied by the long thoracic nerve?
Serratus Anterior
133
Name the two nerves that come off the superior trunk
Suprascapular and Nerve to subcalvis
134
What does the Suprascapular nerve supply?
Supraspinatus and infraspinatus
135
What nerve supplies the glenohumeral and AC joint?
Suprascapular nerve
136
What does the Nerve to the Subclavis supply?
Subclavis
137
What is the name of the nerve that comes of the lateral cord?
Lateral pectoral
138
What does the Lateral pectoral nerve supply?
Pectoralis major
139
Name the three nerves that come off the posterior cord
- Superior Subscapular
- Thoracodorsal
- Inferior Subscapular
140
What muscles does both the superior and inferior subscapular nerve supply?
The subscapularis
141
What does the thoracodorsal nerve supply?
Latissimus Dorsi
142
Name the three nerves that originate off the medial cord
- Medial pectoral
- Medial cutaneous to arm
- Medial cutaneous to forearm
143
What does the Medial pectoral supply?
The pectoralis minor and major
144
What is the vasa vasorum?
A small network of blood vessels that supply the larger blood vessels
145
What is the process of widening a blocked artery called?
Angioplasty
146
What is an aneurysm?
A bulge in a blood vessel causes by weakness of the blood vessel wall
147
What is a embolism?
Blood vessel blockage
148
There are three parts to the axillary artery. Name their relations to the Pectoralis Minor.
1 - Proximal
2- Posterior
3 - Distal
149
Name the branch from the first section on the axillary artery
Superior Thoracic
150
Name the branches from the second section on the axillary artery
Thoracoacromial
| Lateral Thoracic
151
Name the branches from the third section on the axillary artery
Subscapular
Anterior circumflex humeral
Posterior circumflex humeral
152
Name the six branches of the Axillary Artery.
SCREW THE LAYER, SAVE THE PATIENT
- Superior thoracic
- Thoracoacromial
- Lateral thoracic
- Subscapular
- Anterior circumflex humeral
- Posterior circumflex humeral
153
What is the anterior and posterior border of the axilla?
Anterior: pectoralis major
Posterior: latissimus dorsi
154
What are the borders of the clavipectoral triangle and what does it contain?
Lateral portion of the pectoralis major and the medial deltoid. It contains the cephalic vein.
155
What direction do the fibres of the pectoralis minor run?
Inferiorly
156
What do the cords of the brachial plexus surround?
Axillary artery
157
What is mutated in Bruton's agammaglobulinea
Bruton's tyrosine kinase gene. This means that B cells can' mature.
158
What is mutated in Hyper IgM?
CD40L receptor on the T cells meaning that there is failure of class switching.
159
What is mutated in X-linked SCID?
The IL-2R gamma receptor gene.
160
What is mutated in Chronis Granulomatous disease?
Phagocyte NADPH oxidase
161
What kind of disease is Wiskott Aldrich syndrome?
Primary immunodeficiency
162
What kind of disease is Digeorge's syndrome?
Primary immunodeficiency
163
What is autoimmunity?
Break down in self tolerance leading to a aberrant immune response against self-tissue
164
What is Addison's?
Organ-specific autoimmune disease
165
Name some DMARDs (most sufferers can get appropriate pain control)
```
M- methotrexate
S - sulphasalazine
C -cyclosporine
G - Gold
A - azathioprine
P - penicillamine
C - hydroxychloroquine
```
166
Name some TNF-alpha inhibitors
Infliximab, Etanercept
167
What nerve lies deep to the palmaris longus?
Median nerve
168
What is another name for Condyliod joints?
Ellipsoid
| oval shape
169
What happens in thumb Z-deformity?
Thumb is hyperextended
170
What is tendon healing under the control of?
Cytokines and other mediators: PDGF, TGF-beta
